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老年人易患肺炎,而且死亡率很高。其原因是随着年龄增长呼吸机能低下,防御机能减退,免疫功能不全,又多存在基础疾病及身体各器官机能的减退,抵抗力下降等。因此对老年人肺炎的诊断、治疗及其预防非常重要。一、诊断老年人肺炎多半不出现发热、咳嗽、咯痰等,不少人在发病初即出现意识障碍、脱水及其他全身症状,要注意鉴别诊断。脉搏、呼吸加快有助于诊断,有时在胸部可听到湿罗音。化验检查:多不出现白细胞增高,大部分出现核左移、CKP 阳性、血沉增快。血气PaO_2降低、PaCO_2低下。胸部检查多呈大叶性肺炎及支气管肺炎型。查痰可确定致病菌。难以取痰时,用气管穿刺法。如果痰恶臭可做厌氧菌培养,进行血液、尿等培养。
Older people are more susceptible to pneumonia and have a higher mortality rate. The reason is that with age, low respiratory function, defensive dysfunction, immune dysfunction, there are many underlying diseases and the decline of body functions, decreased resistance and so on. Therefore, the diagnosis of elderly pneumonia, treatment and prevention is very important. First, the diagnosis of pneumonia in the elderly most do not appear fever, cough, expectoration, many people early in the onset of consciousness, dehydration and other systemic symptoms, pay attention to differential diagnosis. Pulse, faster breathing helps diagnose, sometimes wet rales can be heard in the chest. Laboratory tests: more white blood cells do not appear to increase, most of the left nuclear shift, CKP positive, ESR faster. Blood PaO2 decreased, PaCO2 low. Chest examination mostly lobular pneumonia and bronchial pneumonia type. Check phlegm to identify pathogens. Difficult to take sputum, tracheal puncture method. If the phlegm can do anaerobic culture, blood, urine and other culture.