Aspiration and Infection in the Elderly
Aspiration and Infection in the Elderly
复制标题
老年人的误吸和感染
作者：
M. Kikawada;T. Iwamoto;M. Takasaki
老年人吸入口咽或胃内容物经常导致下呼吸道感染，如吸入性肺炎或肺炎。老年患者存在吞咽困难和误吸是发生吸入性肺炎的重要因素，但在没有其他危险因素的情况下，不足以引起吸入性肺炎。唾液的流动和吞咽可以消除健康人口咽部的革兰氏阴性杆菌。然而，老年人可能由于药物和口腔/牙科疾病而减少唾液的产生，导致口腔卫生不良和口咽部定植病原体。当吞咽困难的患者在吞咽食物或液体时吸入致病菌时，他们也必须降低防御能力，例如免疫力或肺清除能力受损，以发展为吸入性肺炎。老年脑血管疾病患者通常有吞咽困难，导致误吸的发生率增加。以前有报道称，无症状性脑梗死累及基底节的患者更可能发生亚临床误吸，肺炎发生率增加。基底神经节梗死导致多巴胺代谢受损，从而导致舌咽神经和感觉迷走神经中P物质的减少。因此，部分老年脑血管病患者多巴胺代谢障碍可能导致吞咽困难和咳嗽反射减弱，提示调节多巴胺代谢的药剂可能能够改善基底节梗塞患者的吞咽和咳嗽反射。控制误吸和误吸的主要策略-预防老年人相关肺部感染的方法是防止病原菌沿着吸入口咽或胃内容物。由于老年人吸入性肺炎与某些危险因素有关，包括吞咽困难和吸入，有效的预防措施涉及各种方法，如药物治疗，吞咽训练，饮食管理，口腔卫生和定位。
Aspiration of the oropharyngeal or gastric contents by elderly persons often leads to lower respiratory tract infections, such as aspiration pneumonia or pneumonitis. The existence of dysphagia and aspiration in elderly patients are important factors in the occurrence of aspiration pneumonia, but are not sufficient to cause aspiration pneumonia in the absence of other risk factors. Salivary flow and swallowing can eliminate Gram-negative bacilli from the oropharynx in healthy persons. However, elderly persons may have diminished production of saliva as a result of medications and oral/dental disease, leading to poor oral hygiene and oropharyngeal colonisation with pathogenic organisms. When dysphagic patients aspirate pathogenic bacteria while swallowing food or liquids, they must also have decreased defences, such as impaired immunity or pulmonary clearance, in order to develop aspiration pneumonia.Elderly patients with cerebrovascular disease often have dysphagia that leads to an increased incidence of aspiration. It was previously reported that patients with silent cerebral infarction affecting the basal ganglia were more likely to experience subclinical aspiration and an increased incidence of pneumonia. Basal ganglia infarction leads to the impairment of dopamine metabolism and, as a consequence, a decrease of substance P in the glossopharyngeal nerve and sensory vagal nerves. Therefore, dysphagia and a decreased cough reflex may be induced by the impairment of dopamine metabolism in some elderly patients with cerebrovascular disease, suggesting that pharmaceutical agents which modulate dopamine metabolism may be able to improve swallowing and the cough reflex in patients with basal ganglia infarction.The main strategy for controlling aspiration and aspiration-related pulmonary infection in the elderly is to prevent aspiration of pathogenic bacteria along with the oropharyngeal or gastric contents. Because aspiration pneumonia in the elderly is related to certain risk factors, including dysphagia and aspiration, effective preventive measures involve various approaches, such as pharmacological therapy, swallowing training, dietary management, oral hygiene and positioning.
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头部旋转对咽食管吞咽困难的好处。
影响因子：
4.3
作者：
Logemann,JA;Kahrilas,PJ;Kobara,M;Vakil,NB
通讯作者：
Vakil,NB
DOI：
10.1164/ajrccm/137.2.331
发表时间：
1988
期刊：
The American review of respiratory disease
影响因子：
--
作者：
Shore,SA;Stimler-Gerard,NP;Coats,SR;Drazen,JM
通讯作者：
Drazen,JM
影响因子：
--
作者：
SHAKER, R;REN, JL;HINTZ, J
通讯作者：
HINTZ, J
影响因子：
29.4
作者：
ROBBINS, J;HAMILTON, JW;KEMPSTER, GB
通讯作者：
KEMPSTER, GB
影响因子：
--
作者：
COOK, IJ;DODDS, WJ;HOGAN, WJ
通讯作者：
HOGAN, WJ