Age And Common Clinical Characteristics Of Senile Pneumonia And Understanding Of Traditional Chinese Medicine

This thesis consists of two parts:literature review and clinical research. First, the literature reviewPneumonia in the elderly is a common disease. The incidence rate of pneumonia in the elderly over65years is1.6%, whi le those over75is11.6%, taking account of50%-60%of elderly patients with infectious diseases. The rate of elderly patients with HAP is5-15/1000in hospital patients, and the mortality rate is about30%-70%. Depending on mechanical ventilation increase6-20times lung infection incidence. Early detection, diagnosis, appropriate treatment and prevention prognosis of elderly pneumonia patients is important. Immune senescence is common in all elderly. Typical high susceptibility and clinical manifestations of pneumonia in the elderly is characterized by immune dysfunction, the result of the interaction of the infection history and genetic background. Pneumonia in the elderly has their own unique clinical features, increase the difficulty of the diagnosis, treatment and management of patients with varying degrees of organ aging and underlying diseases. Long-term hospitalization of elderly patients often has a variety of diseases and poor physical condition, for the immune system degradation with aging. Often lack the typical respiratory symptoms and signs of infection, elderly pneumonia patients have altered mental status and other atypical performance. The elderly pneumonia, in terms of Traditional Chinese Medicine, is discussed from pathogenesis, syndrome types and treatment.Second, the clinical researchObjective To inquire the age-related alterations in the clinical characteristics of HAP in the very old subjects and elderly. Methods Consecutive in-patients with HAP, from September2006to April2013, were retrospectively studied. Patients were classified as very old subjects (age over80years) and elderly (age60-80years), and there is52cases in the very old subjects and60cases in the elderly. Clinical data from cl inical symptoms, s igns, laboratory results, imaging results, underlying diseases, complications, incentives, onset and treatment methods and results were compared across these two age categories. Results Analysis involved52(46.4%) very old patients and60(53.6%) elderly patients. The very old group have less respiratory symptoms (cough and sputum) and more gastrointestinal symptoms (nausea and vomiting) and altered consciousness (irritability, lethargy, apathy), and there is a significant difference between the two groups (P<0.05). Very old group have less fever, more respi ratory rate and oxygen saturat ion decreased, the two groups had significant difference (P<0.01); pulmonary rales and heart rate were no significant difference (P>0.05).In very old group, arterial oxygen pressure less than60mmHg has significant difference (P<0.01); the total number of white blood cells, arterial carbon dioxide partial pressure greater than50mmHg have no difference (P>0.05). Sputum culture resul ts, more fungal infect ions are found in very old group (P<0.01), other pathogens have no significant difference (P>0.05). Very old patients have small pieces, blotchy shadows, pleural effusion, and there are significant differences (P<0.01); elderly group having leaf segments patchy shadows is more common (P<0.01).Very old age group have chronic heart failure, hypertension, coronary heart disease (P<0.05), and more under lying diseases (P<0.01); chronic obstructive pulmonary disease, diabetes, cerebrovascular disease were not significantly different (P>0.05). The very old group has more respiratory fai lure, heart failure, renal insufficiency, and electrolyte acid-base balance disorders complications (P<0.01), gastrointestinal bleeding was not significant ly different (P>0.05). HAP in very old group often caused by aspiration, while elderly patients usually catch cold and upper respiratory tract infection before pulmonary infection (P<0.01). The onset of pneumonia in very old patients are occult (P<0.05),and in elderly patients are acute (P<0.05). Very old patients need two antibiotics, ventilator and nutritional support treatment (P<0.05); elderly group need a single antibiotic (P<0.01). The elderly are healed more, and senior citizens group has more valid (P<0.05); markedly progress were no differences (P>0.05).Conclusion Clinical symptoms and X-ray, more common small-scale exudation, are atypical in the very old subjects. And they have a higher burden of comorbidities, fungi infection, insidious onset and incidence of HAP-related complications. The two groups have a reduced white blood cell count and roughly the same pathogens. The aspiration is the common causes of the very old subjects, while the elderly are often caused by the cold and upper respiratory tract infection. The very old subjects need two antibiotics treatment, nutritional support, and ventilator-assisted treatment and have poor prognosis.