Aspiration pneumonia in the aged.
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概要
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In order to elucidate the characteristics of aspiration pneumonia in the aged, 27 subjects with aspiration pneumonia were studied. The patients were hospitalized to Tokyo Metropolitan Police Hospital between 1980 and 1986. We then categorized the patients into two groups according to their age. The aged group consisted of 18 subjects (16 males and 2 females) who were 65 years old or above and the younger group consisted of 9 subjects (6 males and 3 females). Concerning to aspiration contents, aspiration of the vomited material was more frequent (9 subjects) in the aged, while food aspiration was found more commonly in the younger group. Survey of the underlying disease revealed that neurological disorders were the most frequent. This was especially notable in the aged group with 11 subjects of cerebrovascular disease. Some of the characteristic clinical manifestations in the aged were high fever defined by the presense of body temperature over 38°C (14 subjects) and leucocytosis with leucocytes in excess of 10, 000/mm3 (12 subjects). Thus, in contrast to the previous reports suggestive of less prominent signs of inflammation, our present study indicated severe inflammatory responses with aspiration pneumonia of the elderly. Bacteriological study revealed high prevalence of a Gram negative infection. Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterococcus were commonly found species which were responsible for aspiration pneumonia in this population. The mortality rate was high with 55.6% in the both groups. Those who aspirated gastric contents showed mortality of 75.0% and the patients with PaO2 less than 60Torr showed high mortality (84.6%). The greater size of pneumonic infiltrate on a chest roentgenogram was indicative of poor prognosis. Immediate steroid administration was tried in 6 subjects, only to fail in 5 patients, casting some doubts on the benefits of this treatment. Through these observations, we conclude as follows. (1) Both aging and underlying neurologic pathology should be regarded as important risk factors for the development of aspiration pneumonia. (2) The aspiration of gastric contents, hypoxemia below 60Torr, and larger area of consolidation on a chest film were all predictive of poor prognosis.
- 社団法人 日本老年医学会の論文