ACE inhibitors and prevention of aspiration pneumonia in elderly hypertensives
ACE inhibitors and prevention of aspiration pneumonia in elderly hypertensives
复制标题
ACE抑制剂与老年高血压患者吸入性肺炎的预防
DOI：
10.1016/s0140-6736(05)76506-5
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Y. Ouchi
中科院分区：
文献类型：
--
作者：
S. Teramoto;Y. Ouchi
Sir-Tadashi Arai 及其同事 (D ec 12, p 1937) 1 报告称，接受 ACE 抑制剂治疗的老年高血压患者的肺炎发生率明显低于接受钙通道阻滞剂治疗的患者。虽然误吸和吞咽障碍使中风患者发生吸入性肺炎的风险很高，但2误吸在老年高血压肺炎发病机制中的作用尚未得到研究。我们调查了门诊高血压患者的肺炎发生率和不同降压药物的治疗情况。从1995年到1998年，对708名服用抗高血压药物的门诊患者的肺炎发生率进行了检查。在年龄小于65岁的成年人中，112名单独服用ACE抑制剂的患者中，有1人(1%)被诊断出新肺炎，132名单独服用钙通道阻滞剂的患者中有2人(2%)被诊断出新肺炎，106名接受两种药物治疗的患者中有1人(1%)被诊断出新肺炎。在 65 岁以上的患者中，122 名单独服用 ACE 抑制剂的患者中，有 2 名 (2%) 被诊断出新冠肺炎；132 名单独服用钙通道阻滞剂的患者中，有 1 名 (1%) 被诊断出新冠肺炎；104 名同时接受两种药物的患者中，有 2 名 (2%) 被诊断出新冠肺炎。我们的结论是，在预防成人和老年高血压患者的肺炎方面，ACE 抑制剂比钙通道阻滞剂没有优势。 Sekizawa 及其同事 3 报道称，ACE 抑制剂可减少有中风病史的患者患肺炎的情况。成人中肺炎的发病率为每 10004 人 4·7 例至每 1 0 0 0 11·6 例。 5 然而，Arai1 和 Sekizawa 3 及其同事报告的肺炎发生率分别为 3·3–8·9% 和 7–18%。这些研究中的人群极易患肺炎，表明老年人的免疫功能受损。尽管老年患者可能存在免疫功能受损，但与年龄相关的上呼吸道反射下降仍有待阐明。已知患有吸入性肺炎的老年患者的吞咽反射会受损，但健康人的吞咽反射不会随着年龄的增长而减弱。因此，年龄本身并不能解释吸入性肺炎患者吞咽反射受损的原因。此外，咳嗽反射比吞咽反射或粘液纤毛清除对于预防误吸更重要
Sir—Tadashi Arai and colleagues (D ec 12, p 1937) 1 report that the rate of pneumonia was significantly lower in elderly hypertensive patients given ACE inhibitors than in those treated with calcium channel blockers. Although aspiration and swallowing disorders put patients with stroke at high risk of aspiration pneumonia, 2 the role of aspiration in the pathogenesis of pneumonia in elderly hypertensives has not been examined.We investigated the rate of pneumonia and treatment with different antihypertensive drugs in outpatients with hypertension. The rate of pneumonia in 708 outpatients on antihypertensives was examined from 1995 to 1998. In adults aged less than 65 years, new pneumonia was diagnosed in one (1%) of the 112 given ACEinhibitors alone, in two (2%) of 132 given calcium channel blockers alone, and in one (1%) of the 106 patients receiving both agents. In patients aged over 65 years new pneumonia was diagnosed in two (2%) of the 122 given ACE inhibitors alone, in one (1%) of 132 on calcium channel blockers alone, and in two (2%) of the 104 receiving both. We conclude that ACE inhibitors have no advantage over calcium channel blockers in prevention of pneumonia in adult and elderly hypertensives. Sekizawa and coworkers 3 reported that ACE inhibitors reduced pneumonia in patients with a history of stroke. The incidence of pneumonia in the adult population is between 4· 7 per 10004 and 11· 6 per 1 0 0 0. 5 However, the frequencies of pneumonia reported by Arai1 and S ekizawa 3 and their co-workers were 3· 3–8· 9% and 7–18%, respectively. The populations in these studies were highly susceptible to pneumonia, suggesting that immune function is impaired in elderly people. Although elderly patients are likely to be immunologically compromised, agerelated decline in upper airway reflexes remains to be elucidated. Swallowing reflex is known to be impaired in elderly patients with aspiration pneumonia, but does not decrease with age in healthy individuals. Thus age alone does not account for impaired swallowing reflex in patients with aspiration pneumonia. Furthermore, cough reflexes rather than swallowing reflex or mucociliary clearance are important in prevention of aspiration