床旁饮水试验和支气管镜检查对预防和诊断老年吸入性肺炎的临床研究

发布时间：2018-04-12 15:53

  本文选题：吸入性肺炎 + 床旁饮水试验　； 参考：《辽宁医学院》2012年硕士论文

【摘要】：目的 随着我国老龄化进程的加快，老年吸入性肺炎的发生和发展正逐渐受到重视，但对吸入性肺炎的诊断仍局限于临床症状及体征的观察，尚缺乏统一的“金标准”。床旁饮水试验操作简单、方便，患者耐受性好，为此本文探讨床旁饮水试验的操作方法和观察指标，同时结合纤维支气管镜检查对吸入性肺炎患者的预防和诊断的正确性进行评估。 方法 明确诊断吸入性肺炎（AP）患者46例，社区获得性肺炎（CAP）患者30例，慢性阻塞性肺疾病（COPD）患者21例入选本次研究。3组患者在病情稳定后、意识清醒的状态下，由同一名医生分别进行饮水试验，记录所用时间、观察吞咽过程以及饮水时出现的不正常的现象，，并进行数据统计。在吸入性肺炎组患者知情同意的情况下，在禁食2小时以后行纤维支气管镜检查，做FEES评分，观察呕吐反射和声门闭合情况。 结果 3组患者年龄分布无统计学差异（p=0.17）、CURB-65评分结果无统计学差异（p=0.42）。3组患者饮水相同体积时所用时间显著不同，并具有统计学意义（p＜0.01）。并且，吸入性肺炎组患者出现中断或者哽噎、不正常吞咽现象的频率也明显增高。吸入性肺炎组患者同意行纤维支气管镜检查者共42例，FEES评分平均值为5.50±1.35，有6例（14.29%）评分≤4分，36例＞4分。以AP患者喝完10ml温水所用时间＞5s为标准，纤维支气管镜检查和床旁饮水试验两种方法诊断吸入性肺炎的结果相同（p＞0.1）。 床旁饮水试验不仅可以用于辅助诊断吸入性肺炎患者，还可以指导吸入性肺炎的分级预防和治疗，有较好的临床应用价值。辅助纤维支气管镜检查可增加其诊断的可靠性。
[Abstract]:PurposeWith the acceleration of aging process in China, the occurrence and development of inhaled pneumonia in the elderly is being paid more and more attention. However, the diagnosis of aspiration pneumonia is still limited to the observation of clinical symptoms and signs, and there is still a lack of unified "gold standard".The operation of bedside drinking water test is simple, convenient and patient tolerance is good. Therefore, this paper discusses the operation method and observation index of bedside drinking water test.At the same time, the prevention and diagnosis of aspiration pneumonia were evaluated by fiberoptic bronchoscopy.MethodForty-six patients with inhaled pneumonia (APP), 30 patients with community-acquired pneumonia (CAP) and 21 patients with chronic obstructive pulmonary disease (COPD) were included in this study group.The drinking test was conducted by the same doctor to record the time used to observe the abnormal phenomena in the process of swallowing and drinking water and to carry out statistics.With the informed consent of the patients with aspiration pneumonia, fiberoptic bronchoscopy, FEES score, vomiting reflex and glottic closure were performed 2 hours after fasting.ResultThere was no statistical difference in age distribution among the three groups. There was no statistical difference in the score of CURB-65. There was no significant difference in the time used for drinking water of the same volume in the p0. 42. 3 group, and the difference was statistically significant (P < 0. 01).The frequency of abnormal swallowing was also significantly increased in patients with aspiration pneumonia.The average FEES score of 42 patients with aspiration pneumonia was 5.50 卤1.35, with 6 patients with 14. 29) scores 鈮

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