Objective To explore the clinical character of senile pneumonia of mental symptoms as the main performance in order to diagnose and treat early. Methods The clinical data of mental symptoms as the main performance of 52 cases with se-nile pneumoniafrom January 2013 to October 2015were collected and analyzed using descriptive statistical analysis. ResultsA clear history of catching cold inonly 4 cases(7. 7%),cough in 34 cases(65. 4%),expectoration in 28 cases(53. 8%),fever in 11 cases (21. 2%),shortage of liberties in 2 cases(3. 8%),chest pain in 1 case(1. 9%),breathing faster( >25 times/min) in 12 cases (23. 1%),increasing heart rate( >100 times/min)in 15 cases(8. 8%),dry or wet raleson lung in 24 cases(46. 2%),total number of leucocytes increasing( >10 ×109)in 17 cases(32. 7%),neutrophil percentage increasing( >75%)in 36 cases(69. 2%),chest DR or lung CT examination showing small patchy infiltrates shadow and lesions involving singlelobein 30 cases(57. 7%),involving double lobesin 12 cases(23. 1%),interstitial pneumonia performance in 10 cases(19. 2%),pleural effusion in 2 cases(3. 8%),pos-itive sputum culture in only 5 cases(16. 7%)of 30 cases(57. 7%). Outcome:39 cases(75%)were cured,11 cases(21. 2%)changed the departmentor hospital,2 cases(3. 8%)among of auto-discharge these cases there were 5 critical(9. 6%),and no death. Comorbid-ity:schizophrenia in 19 cases(36. 5%),mania in 2 cases(3. 8%),organic psychosis in 22 cases(42. 3%),vascular dementia in 3 patients(5. 8%),mental disorders caused by alcohol poisoning in 3 patients(5. 8%),Alzheimer's disease in 1 case(1. 9%),hyper-tension in 8 cases(15. 4%),type 2 diabetes in 9 cases(17. 3%),chronic obstructive pulmonary disease in 3 patients(5. 8%),coro-nary heart disease(CHD)in 3 patients(5. 8%),prostate hyperplasia in 4 cases(7. 7%),Parkinson's disease in 1 case(1. 92%),and with no basic disease in 3 cases(5. 7%). Conclusion Senile pneumonia of mental symptoms as the main performance is generally more hidden of onset,more atypical of symptoms,and more likely to be ignored because of the covering of mental symptoms. The keys to detect and treat this type of senile pneumonia early are paying attention to the subtle signs and symptoms of small,detailed physical examination,more comprehensive medical knowledge and wary clinical thinking when mental symptoms develops as the first symptom in elderly.%目的 探讨以精神异常为主要表现的老年肺炎临床特点,以便早期诊断、早期治疗.方法 收集2013年1月至2015年10月以精神症状就诊的52例老年肺炎的临床资料进行描述性统计分析.结果 有明确受凉史者仅4例(7.7%),咳嗽34例(65.4%),咳痰28例(53.8%),伴发热11例(21.2%),气紧2例(3.8%),胸痛1例(1.9%),呼吸增快(>25次/min)12例(23.1%),心率增快(>100次/min)15例(8.8%),肺部闻及干、湿啰音24例(46.2%),白细胞总数升高(>10×109)仅17例(32.7%),中性白细胞百分比升高(>75%)36例(69.2%),胸部DR或CT检查肺部多呈小的斑片状浸润影改变,累及单叶病变30例(57.7%),双叶病变12例(23.1%),间质性肺炎表现10例(19.2%),伴胸腔积液2例(3.8%),痰培养30例(57.7%)仅5例阳性(16.7%).转归:治愈好转出院39例(75%),转科、转院11例(21.2%),自动出院2例(3.8%),其中病危5例(9.6%),无死亡病例.共病:精神分裂症19例(36.5%),躁狂症2例(3.8%),器质性精神病22例(42.3%),血管性痴呆3例(5.8%),酒精中毒所致精神障碍3例(5.8%),阿尔茨海默病1例(1.9%);高血压病8例(15.4%),2型糖尿病9例(17.3%),慢性阻塞性肺疾病3例(5.8%),冠心病3例(5.8%),前列腺增生症4例(7.7%),帕金森氏病1例(1.92%),其中有3例(5.7%)无任何基础疾病.结论 在精神症状掩盖下,以精神症状为主要表现的老年肺炎较一般老年肺炎起病更加隐匿,症状更加不典型,临床上更易被忽略.老年期首发精神症状、关注细微的症状和体征、详尽的体格检查、更全面的医学知识与警惕的临床思维是这类老年肺炎早发现、早治疗的关键.
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