老年肺结核诊疗与防护的探讨

http://www.100md.com 2011年3月1日 冯颂华 王志君 姚源

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     (哈医大一院大桥分院 150076)

    【摘要】目的：探讨老年人肺结核的早期诊断与合理治疗及有效预防。方法：通过影像学的动态监测、痰菌培养(结核菌敏感与耐药试验)，分析26例老年肺结核病的临床诊治情况，针对其发病特点，找出对策。结果：本组65例病人，特点为老年人发病多，复发或再感染者居多，病情重且复杂者居多。结论：老年肺结核多为继发性，老年人对结核菌的抵抗力下降而发病高是因全身免疫功能下降，肺部免疫力也下降，肺组织弹性减弱，呼吸道分泌功能降低，使肺清除痰液的抵抗疾病能力下降，结核菌侵入发病，症状不典型，发病隐匿且病程长。老年人耐药病例多、重症病例多，已成为主要慢性传染源。老年人尽可能避免与肺结核病人接触以防被传染。

    【关键词】肺结核;耐药;防治

    The old tuberculosis diagnosis and protection are discussed

    Feng Songhua Wang Zhijun Yao Yuan

    【Abstract】to explore the diagnosis and early elderly tuberculosis and prevent reasonable therapy. Methods: through the dynamic monitoring, phlegm imaging were cultured (with drug-resistant TB sensitive experiment), analysis of 26 patients aged tuberculosis treatment in its prevalence and countermeasures. Results: the 65 patients; Characteristics of for the elderly, recurrence or again the majority, the illness weight and infected majority. The complex Conclusion: how old tuberculosis of n/med tuberculosis bacterium, old people are secondary to the resistance of high because of decline and body immune function decline, lung immunity decline, lung tissue abate, respiratory tract secretion elasticity decreased, the lungs clear sputum, n/med tuberculosis bacterium reduced ability to resist disease pathogenesis, symptoms are not typical intrusive, come on hidden and the course of a long. Old people, drug resistance in severe cases, has become a major cases of chronic infection. Elderly people with tuberculosis patients as possible to avoid contact in case to be infected.

    【Keywords】tuberculosis;resistance;control

    【中图分类号】R521【文献标识码】A【文章编号】1008-6455(2011)06-0066-02

    我国是全球结核病高流行、高耐药国家，近年来我国结核病有明显增多的趋势，多为继发或复发结核，缺乏特异性，临床病情呈进行性变化^[1]。尤其是患肺结核的老年人逐渐增多，占所治病人总数的10%以上。老年肺结核症状不典型，发病隐匿，且病程长、复发病例多。老年人由于全身免疫功能下降、肺部免疫力也下降，肺组织弹性减弱，呼吸道分泌功能降低，使肺清除痰液的抵抗疾病能力下降，结核菌乘虚而入而发病。

    肺结核没有终身免疫，有些老年人在年轻时患过肺结核且已痊愈，但到老年时身体抵抗力下降，易使原先潜伏的结核病灶“死灰复燃”或原先结核病灶一直未愈，拖延至老年期^[2]。

    1 资料与方法

    1.1 资料:我院自2006年12月至2008年11月，就诊疑是肺结核病人65例；其中50岁以上老年人26例，占40﹪；其中70岁以上者11例；分别为：95、83、81、79、77、74各1例、71岁2例、70岁3例 ......

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