Sasaki H, Sekizawa K, Yanai M, Arai H, Yamaya M, Ohrui T
Department of Geriatric Medicine, Tohoku University School of Medicine, Sendai.
Intern Med. 1997 Dec;36(12):851-5. doi: 10.2169/internalmedicine.36.851.
Aspiration pneumonia is associated with decreases in both swallowing and cough reflexes and is the most common cause of death in the elderly. Basal ganglia strokes might predispose these patients to develop pneumonia owing to reductions of both reflexes, resulting in frequent aspiration during sleep. An impairment of dopamine metabolism in the basal ganglia is observed in these patients and levodopa administration improves the impaired swallowing reflex. Both swallowing and cough reflexes are mediated by endogenous substance P (SP) released from vagal sensory nerves in the pharynx and upper airways. The addition of a low dose of capsaicin to liquid or food, which stimulates the release of SP, may help prevent aspiration pneumonia. Angiotensin-converting enzyme inhibitor decreases SP catabolism resulting in improvements in both reflexes. Oral care and the sitting position after meals may decrease aspiration pneumonia in the elderly.
吸入性肺炎与吞咽和咳嗽反射减弱有关，是老年人最常见的死亡原因。基底节区中风可能使这些患者因两种反射减弱而易于发生肺炎，导致睡眠期间频繁误吸。在这些患者中观察到基底节区多巴胺代谢受损，给予左旋多巴可改善受损的吞咽反射。吞咽和咳嗽反射均由咽部和上呼吸道迷走感觉神经释放的内源性P物质（SP）介导。在液体或食物中添加低剂量辣椒素可刺激SP释放，可能有助于预防吸入性肺炎。血管紧张素转换酶抑制剂可减少SP分解代谢，从而改善两种反射。口腔护理和餐后坐姿可能会降低老年人吸入性肺炎的发生率。
