老年肺炎患者胃食管反流病和咽喉反流性疾病25例

doi:10.6040/j.issn.1673-3770.0.2024.062

摘要/Abstract

摘要： 目的探讨老年肺炎患者中胃食管反流病(gastroesophageal reflux disease, GERD)及咽喉反流性疾病(laryngopharyngeal reflux disease, LPRD)的临床特点。方法选取2022年1月至2023年12月在中国人民解放军总医院第九医学中心呼吸内科住院的老年肺炎患者。具有完整住院资料且完成了24 h Dx-pH监测的患者被纳入本研究。分析胃食管反流及咽喉反流的临床特征。结果在行咽部24 h pH监测的23例患者中,Ryan指数卧位>6.79有10例,Ryan指数立位>9.41有1例,W指数大于0的患者有16例。在行食管24 h Dx-pH监测的20例患者中,DeMeester积分≥14.72有3例,酸暴露时间百分比(acid exposure time, AET)≥4.0%有4例。咽喉反流组7例(63.6%)患者右肺上叶可见肺炎,无咽喉反流组只有4例(33.3%)患者出现右肺上叶肺炎。咽喉反流患者的CURB-65评分为2.45±0.82,无咽喉反流患者的CURB-65评分为2.08±0.79。咽喉反流患者28 d死亡4例(36.4%),无咽喉反流患者28d死亡1例(8.3%)。结论老年肺炎患者容易出现GERD及LPRD,咽喉反流患者右肺上叶及左肺下叶炎症占比高,咽喉反流组患者死亡明显增加。

关键词: 老年肺炎, 咽喉反流病, 胃食管反流病, 24小时pH监测

Abstract: Objective To investigate the clinical characteristics of gastroesophageal reflux disease(GERD)and laryngopharyngeal reflux disease(LPRD)in elderly patients with pneumonia. Methods The study was conducted on elderly patients with pneumonia hospitalized in the respiratory department at the Ninth Medical Center of Chinese PLA General Hospital from January 2022 to December 2023. These patients completed 24-hour Dx-pH monitoring and had complete hospital records. The study involved analyzing the clinical characteristics in patients with gastroesophageal and laryngopharyngeal reflux were analyzed. Results Of the 23 patients who underwent pharyngeal pH monitoring, 10 had a Ryan index score >6.79 in the supine position, one patient had a Ryan index score >9.41 in the upright position, and 16 had a W index greater than 0. Among the 20 patients who underwent 24-hour esophageal Dx-pH monitoring, 3 had a DeMeester score ≥14.72, and 4 had an acid exposure time(AET)≥4.0%. In the laryngopharyngeal reflux group, pneumonia was observed in the right upper lobe in 7 patients(63.6%), compared to 4 patients(33.3%)in the non- laryngopharyngeal reflux group. CURB-65 scores were 2.45±0.82 for patients with laryngopharyngeal reflux and 2.08±0.79 for those without laryngopharyngeal reflux. Among patients with laryngopharyngeal reflex, 4(36.4%)died within 28 days, while only one(8.3%)patient without laryngopharyngeal reflux died during the same period. Conclusions Elderly patients with pneumonia are susceptible to GERD and LPRD. Among patients with laryngopharyngeal reflux, inflammation in the upper lobe of the right lung and the lower lobe of the left lung is high, and the mortality rate in this group is significantly increased.

Key words: Pneumonia in the elderly, laryngopharyngeal reflux disease, gastroesophageal reflux disease, 24-hour pH monitoring

中图分类号:

R766.5

李逢将,魏婕,刘红丹,张丽,赵伟超,武娜娜,王磊,吴玮,王瑞娟. 老年肺炎患者胃食管反流病和咽喉反流性疾病25例[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 103-107.

LI Fengjiang, WEI Jie, LIU Hongdan, ZHANG Li, ZHAO Weichao, WU Nana, WANG Lei, WU Wei, WANG Ruijuan. Gastroesophageal reflux disease and laryngopharyngeal reflux disease in 25 elderly patients with pneumonia[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(6): 103-107.

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