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nosocomial-acquired pneumonia examination for the elderly, diagnosis of hospital-acquired pneumonia in the elderly

nosocomial-acquired pneumonia examination for the elderly, diagnosis of hospital-acquired pneumonia in the elderly

Common examinations for hospital-acquired pneumonia in the elderly

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Hospital-acquired pneumonia examination for the elderly

1. Laboratory examination of pathogens

(1) Sputum etiological examination is of great significance in the diagnosis of senile hospital-acquired pneumonia

However, it is easy to be contaminated by microorganisms in the oropharynx after ordinary sputum culture, and the reliability is low. But at present, most hospitals in China, especially primary hospitals, due to limited conditions, this method is the main method of collecting specimens. Therefore, before leaving the sputum specimens, gargle with saline or hydrogen peroxide and pay attention to coughing deep sputum as much as possible, which can significantly reduce oral pathogenic bacteria contamination and improve the reliability of detection. In bronchoscopy, it is more convenient to perform endotracheal suction through bronchoscopy for patients who have already had a tracheal intubation. Because the bronchoscopy must pass through the oropharyngeal or tracheal intubation site where the bacterial colonization rate reaches 90%, the aspirate is easily contaminated. In order to avoid pollution, two technologies are available. One of the techniques is a protective brush. This method needs to effectively obtain uncontaminated lower respiratory tract specimens under X-ray orientation, with a sensitivity of 75%. Another method is protective alveolar lavage, collecting lavage fluid for bacteriological examination, the sensitivity can reach 86%. The specimen must be submitted for inspection immediately after using a sterile container. First, perform a microscopic examination to observe the shape, type and number of cells, whether the columnar epithelium and its cilia are damaged, and the type, distribution and number of bacteria between or within cells, and whether there is any damage. Capsule and flagella, with sterile silk and spores. If the specimen is taken from the lower respiratory tract, microscopic examination is still of great significance for quickly determining the general classification of bacteria, obtaining preliminary diagnosis and guiding clinical treatment. In addition to microscopic examination of sputum specimens, bacterial culture should be carried out as soon as possible. After culturing, identification is performed based on the characteristics of the bacterial colony, the pigments produced, and the biochemical and sports test characteristics. Clinically, a large number of bacteria may be found in smears during bacterial examinations, but they grow aseptically during normal culture. This suggests that we have two possibilities: one is that the pathogen is anaerobic; the other is that the patient has used antibiotics. , Inhibit the growth and reproduction of bacteria. Clinically, if the patient is considered to have anaerobic pulmonary infection, conventional sputum examination methods are difficult to work. If necessary, percutaneous lung puncture can be used to collect specimens or blood for culture to confirm the diagnosis.

(2) Blood culture occupies an important position in hospital-acquired pneumonia

A considerable number of patients have bacteremia. Therefore, clinically, blood samples are collected for culture before antibiotics are used or the patients are in the early stages of chills and fever, which can increase the positive rate.

(3) Serological testing

It is mainly used for virus diagnosis. Different viruses can use different methods. Influenza virus can be diagnosed by hemagglutination inhibition test, complement fixation test and ELISA method. During cytomegalovirus infection, respiratory secretions or tissue specimens are taken and inoculated in human embryo fibroblast culture medium. Cytomegalovirus can be isolated, and the diagnosis can also be confirmed by examining cytomegalovirus. Measles

The ELISA method can detect the specific IgM antibody in the serum as an early diagnosis. The serum complement fixation test is also helpful for the diagnosis when the titer of the double serum rises more than 4 times; the respiratory syncytial virus is positive by the ELISA method The rate can reach 85% to 90%, and it can also be detected by monoclonal bridge membrane enzyme labeling method.

2. General inspection

In some patients, the total number of white blood cells increased by more than 10*109/L and the number of neutrophils increased, but most elderly patients did not increase the total number of white blood cells, and the types of neutrophils were normal or decreased. The changes had no obvious specificity, and the erythrocyte sedimentation rate was mostly increased. .

3. X-ray chest radiograph

The diagnosis of hospital-acquired pneumonia in the elderly is extremely important. Chest X-ray film showed that the lesions mostly occurred in the inner and middle zone of the middle and lower fields of both lungs, and inflammation of the bronchial and surrounding interstitials. It is manifested as increased lung texture, thickening and blurring, lobular exudation and consolidation, manifested as fuzzy patch shadows distributed along the lung texture, uneven density, dense lesions can be merged into larger flakes, or involved Multiple lung lobes. However, in the early stage of the patient's onset, especially when the patient is dehydrated or leukopenia, the chest X-ray may be normal. Usually 24 hours after the dehydration is corrected, new infiltrating lesions can be seen on the chest X-ray.

4. Lung CT

CT examination occupies an important position in the diagnosis of hospital-acquired lung infections, especially in patients with bone marrow, organ transplantation, and the elderly. CT can often detect lesions early. CT images of bacterial lung infections mainly show multifocal inflammatory lesions in the basal segment of the two lower lungs. The lesions are mostly patchy, nodular, massive and irregular. Some of the lesions can merge with each other. There are small holes or honeycomb changes, and images of bronchiectasis can also be seen. When fungal pneumonia occurs, CT images mainly show single or multiple villous inflammatory masses, nodules, and halo signs. The surrounding area is a low-density area. The CT value is lower than that of the center of the lesion, but higher than that of the normal lung. CT value.

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