摘要目的 探讨老年人吸入性肺炎患者的临床表现及病理特征.方法 回顾性分析卫生部北京医院1973-2002年经尸体解剖确诊的30例老年吸入性肺炎患者,其中男28例,女2例;年龄63 ～103岁,平均(83±9)岁.结果 30例均患有冠心病、脑血管病后遗症、高血压、慢性阻塞性肺疾病及2型糖尿病等多种基础疾病中的3种及以上疾病,17例长期接受鼻胃管进食,11例长期卧床.仅15例生前临床考虑为吸入性肺炎,并给予相应治疗.临床及X线胸片表现无特异性,痰培养显示以混合感染为主,多数病例有2种及以上病原菌感染,主要为绿脓杆菌、白色念珠菌、嗜麦芽窄食单胞菌及大肠埃希菌.尸体解剖结果显示30例中14例有多发性散在小脓肿形成,主要分布在细支气管及周围肺组织,以多叶分布为主.单侧或双侧胸腔积液20例.30例病理检查均可见到异物巨细胞.影像学表现与病理所见一致性较差,13例肺部病变影像学表现与病理所见相符,15例影像学诊断是否合并胸腔积液与尸体解剖结果相符.结论 老年吸入性肺炎患者合并多种基础疾病及误吸相关危险因素,且多为混合感染,病理常见多发性小脓肿形成,确诊困难,肺外表现多见.老年人隐性误吸的吸入量小,易反复发生.误吸相关危险因素的评估对老年吸入性肺炎的临床诊断起重要作用.

abstractsObjective To explore the clinicopathological characteristics of aspiration pneumonia in the elderly.Methods The clinical data of 30 cases of autopsy-proven aspiration pneumonia in Beijing Hospital from 1973 to 2002 were reviewed.The patients consisted of 28 males and 2 females,aged from 63 to 103 [mean(83 ± 9)] years.Results Only 15 cases were clinically diagnosed as aspiration pneumonia before death.Concomitant diseases were severe and complex,mostly coronary disease,cerebrovascular disease,hypertension,COPD,and diabetes mellitus.All the patients suffered from at least 3 concomitant diseases.Long-term bedridden and nasogastric feeding was seen in 11 and 17 patients respectively.The clinical presentation and chest X-ray of aspiration pneumonia in the elderly were nonspecific and variable.Mixed infections were common.The main bacteria isolated were Gram-negative bacilli,in particular Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Escherichia coli and Candida albicans.By pathology,macrophages with foreign bodies were found in all the 30 cases and multiple small abscesses were found in 14 cases.The lesions were adjacent to the bronchioles and in the lung tissue around the bronchioles,mostly multi-lobar and bilateral.Unilateral or bilateral pleural effusion developed in 20 patients.The accordance between radiological and pathological diagnosis of aspiration pneumonia was very poor.The foci of infection detected by X-ray were proven by autopsy in 13 patients,while pleural effusions in X-ray were proven by autopsy in 15 patients.Conclusions Multi-concomitant diseases,mixed infection and extra-pulmonary presentations were common in elderly patients with aspiration pneumonia.Multiple small abscesses were the pathological characteristics of aspiration pneumonia in the aged.A definite clinical diagnosis of aspiration pneumonia was difficult.Recurrent silent microaspiration was a feature of aspiration in the elderly.The assessment of risk factor of aspiration played an important role in the clinical diagnosis of aspiration pneumonia.