Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Objective To explore the effect of antihypertensive treatment on target-organ damage in very elderly patients (gt;80 years). Methods One hundred and sixty-seven very elderly hypertensive patients were randomized into two groups, i.e. anti-hypertension treatment group and placebo-control group. All the patients received echocardiographic examination of left ventricular mass index, laboratory tests of urinary creatinine and urinary albumin and 24-hour ambulatory blood pressure monitoring 2 months after placebo washout period and at the end of the one year treatment, respectively. Results After treatment, the improvement in all the dynamic blood pressure parameters except daytime diastolic blood pressure and heart rate(24 h, daytime and night time), were significantly better than that of placebo-control group(Plt;0.05).The improvement in left ventricular and renal functional parameters were significantly better than that of placebo-control group(Plt;0.05). Conclusion Anti-hypertension treatment may significantly improve left ventricular pachynsis and renal function damage in very elderly hypertensive patients.
摘要:发现:66.7%的老人有慢性脑供血不足临床表现,其中95.5%的老年人对脑卒中及老年痴呆症有认识。但是85.6%表示对慢性脑供血不足的危害全然不知,只有14.4%已经有脑血管疾病的老人知道脑供血不足的危害。慢性脑供血不足如果任其发展,最终会造成脑卒中或者老年痴呆症。早期的慢性脑供血不足是可逆的,需要在饮食、生活习惯、药物治疗等受到重视,因此,让老年人正确认识慢性脑供血不足的危害,及时及早预防治疗极为迫切。Abstract: To sample in Baiyun, Yuexiu, Dongshan, Tianhe, Liwan and Haizhu District of Guangzhou elderly venues, 896 pairs of elderly people (aged over 50 years) files: survey 66.7% of the elderly with chronic cerebral insufficiency clinical performance，95.5% said recognizing Alzheimer’s disease. However, 85.6% said the chronic cerebral insufficiency completely unaware of the hazard, only 14.4% have cerebrovascular disease of the elderly know cerebral insufficiency hazards. Chronic cerebral insufficiency if they development and will ultimately have the stroke or dementia. Early chronic cerebral insufficiency is reversible, the need to diet, living habits, drug treatment to be heard, therefore, a correct understanding of the elderly chronic cerebral insufficiency hazards, early preventive treatment in a timely manner is extremely urgent.
摘要:目的:探讨老年人股骨粗隆间骨折不同手术方式的选择。方法:我院2004年1月至2007年12月间应用不同术式治疗老年股骨粗隆间骨折110例,其中动力髋螺钉(DHS)25例, 股骨近端髓内钉(PFN)41例,人工股骨头置换44例。术后所有患者均获随访,平均12.6个月。对术后并发症和按照Kuderna 改良 Merli D’Aubigne标准得到的髋关节功能恢复优良数(率)进行评价。结果:术后出现并发症3例,其中PFN术式2例;人工股骨头置换术式1例。围手术期内无伤口感染,无死亡病例。三种术式总体优良数(率)为:107(97.3%)。结论:三种手术方式各有其优缺点,没有一种术式能普遍适用于各种类型粗隆间骨折,临床上,为了最大限度降低手术风险,我们没有必要专注或偏好于某一种手术方式,要根据患者的个体差异及每种术式的优缺点,灵活地为每例股骨粗隆间骨折患者制定出其最适宜的手术方式,大都能取得满意的疗效。Abstract: Objective: To investigate the chosen of 3 different surgical methods in the treatment of intertrochanteric femoral fractures in the elderly. Methods:From January, 2004 to December, 2007, 110 cases with the femoral intertrochanteric fractures in the elderly were treated with the followed 3 kinds of operations respectively:dynamic hip screw (25 cases), proximal femoral nail (41 cases), hip hemiarthroplasty (44 cases). After surgery all patients were followed up; Followedup period range from 6 months to 18 months(average 12.6 months). The good and excellent number (rate) of 3 surgical methods with Merli D’Aubigne evaluation criteria were evaluated, and compared in the postoperative complications. Results: 3 complications occurred postoperatively ( 2 with PFN,1 with hip hemiarthroplasty), none wound infection or died in Perioperatie. The total good successful number (rate) was 107(97.3%). Conclusion:Each has its advantages and its disadvantages. None of three kinds of surgical methods can be used generally all kinds of the femoral intertrochanter fracture. In clinical work, we don not need to focus on or prefer to the only one of them in order to minimize the risk. The good response to treatment will be get if we can choose the appropriate method according to the individual differences of the advantages and disadvantages of each method.
ObjectiveTo explore the prevalence of anxiety symptoms and its related factors among the family caregivers of the disabled elderly. MethodsA cross-sectional survey based on convenience sampling was conducted among family caregivers between November and December, 2013 in Dongcheng district in Beijing. The Self-rating Anxiety Scale (SAS) and the Social Support Rating Scale (SSRS) were used to evaluate caregivers' anxious symptoms and social support status respectively. The degree of functional impairment of the elderly was measured by Barthel index. ResultsA total of 243 family caregivers took part in the study including 88 males and 155 females. The average age of the family caregivers was (60±1.7) years old, ranging from 25 to 85. The prevalence rate of anxiety was 29.2% reported by family caregivers. The average score of SAS was 35.6±8.6. The risk factors of caregivers' anxiety included Barthel index score ≤20 (OR=1.51), SSRS score ≤33 (OR=4.56), no time to relax (OR=1.57) and poor health status caregivers feeling (OR=3.48). ConclusionA relative high level of anxiety exists in family caregivers for the disabled elderly. Caregiver anxiety is a complex process, influenced by diverse care receiver and caregiver characteristics.
ObjectiveTo evaluate the effects of combined bisoprolol and candesartan therapy on left ventricular hypertrophy and left heart function in in elderly patients with hypertension. MethodsFrom July 2011 to August 2012, 117 elderly inpatients or outpatients with hypertension in our hospital were randomly divided into trial group and control group. Patients in the control group received levamlodipine besylate and bisoprolol, and patients in the trial group received candesartan and bisoprolol. ResultsThere was no statistical difference between the two groups at baseline. Three months later, there was no obvious difference of the blood pressure levels between the two groups (P>0.05). The parameters of left ventricular hypertrophy and left heart function were improved at the end of follow-up in both the two groups, but the parameters of the trial group improved better than the control group (P<0.05). ConclusionIn the elderly patients with hypertension, the combined bisoprolol and candesartan or levamlodipine besylate and bisoprolol therapy can improve left ventricular hypertrophy and left heart function, and the results are better for the combination of bisoprolol and candesartan.
To observe the effects of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and postoperative cognitive dysfunction (POCD) of elderly patients, we collected 80 elderly patients undergoing selective coronary artery bypass graft under cardiopulmonary bypass. The Mini Mental State Examination (MMSE) was applied to test the cognitive function. The SjvO2, Da-jvO2 and CEO2 were used for the analysis of the cerebral oxygen metabolism. We found that POCD was related to disequilibrium of cerebral oxygen metabolism. Ultrasound-guided SGB before surgery reduced the incidence of POCD because of the improvement of cerebral oxygen metabolism.
ObjectiveTo evaluate the conditions of activity of daily living (ADL) and influence factors of ADL of hospitalized elderly (≥60 years old) patients. MethodsA cross-sectional study was conducted to investigate the health and ADL conditions of hospitalized elderly patients in the geriatric department of a tertiary hospital in Chongqing by ADL scale. The influence factors of ADL were analysed by using logistic regression analysis. ResultsA total of 375 hospitalized elderly patients were included. The ADL impairment rate of female was 59.60% (93/156), the one of male was 75.90% (166/219), and there was significant difference between different sex (χ2=11.169, P=0.001). The impairment rate by age were 95.40% at 60 to 69 years old, 91.40% at 70 to 79 years old, 87.20% at 80 to 89 years old, and 98.55% at above 90 years old, respectively; there was significant difference among different age groups (χ2=8.575, P=0.036). The result of logistic regression analysis showed that age was the individual risk factor of ADL (OR=0.188, 95%CI 0.085 to 0.416, P=0.000). The difficulty of walking up and down stairs occupied the highest proportion (68.80%) in 10 items of ADL scale. ConclusionHospitalized elderly patients should be equipped with specialized paramedics to minimize the difficulties of ADL, in order to improve their quality of life.
ObjectiveTo provide the best evidence for an old diabetic patient who combined with frailty syndrome with the goal of glycemic control, treatment strategy and their prognosis. MethodsPubMed, MEDLINE (Ovid), EMbase, The Cochrane Library (Issue 11, 2015) and CNKI were searched from their inception to Nov. 2015, to collect evidence about the management of glycemic control. Evidences were analyzed by the way of evidenced-based criterions. ResultsOne clinical guideline, one meta-analysis, three RCTs, seven cohort studies and four case-control studies were included. Evidence showed that compared with patient uncombined with frailty, old diabetic patients with frailty had a higher prevalence of dementia, cardiovascular diseases and death; Aggressive glycemic control could not reduce the prevalence of cardiovascular events and the risk of death, while it could increase the risk of falling. Glycemic control was more comprehensive which would be taken frailty into consideration. Diet rich in protein (especially leucine), resistance exercise and reasonable medications based on comprehensive geriatric assessment were proved benefit for the old diabetic patient. ConclusionThe incidence of cardiovascular events, hypoglycemia and mortality are increased in this old diabetic patient who combined with frailty. Maintaining HbA1c around 7.5% is reasonable and diet with enough calorie and rich in protein (especially leucine), resistance exercises should be recommended for the person.
Objective To investigate the alternatives of different endoscopic drainages for acute cholangitis of severe type (ACST) in elderly patients with chronic respiratory disease. Methods The clinical data of 74 cases of ACST in elderly patients with chronic respiratory disease undergoing 3 kinds of drainages, endoscopic retrograde double biliary stent drainage (D-ERBD), endoscopic retrograde single biliary stent drainage (S-ERBD), or endoscopic nasobiliary drainage (ENBD) in the First Hospital of Lanzhou University from October 2005 to October 2015 were collected to analyze prospectively. Results Compared with preoperative, the white blood cell (WBC), direct bilirubin (DBIL), temperature, and abdominal pain NRS evaluation in 48 h after operation in 3 groups all decreased, the difference was statistically significant (P＜0.05). Compared among 3 groups, there were no significant difference among the incidences of postoperative hyperamylasemia, pancreatitis and gastrointestinal hemorrhage (P＞0.05). The group of ENBD was more likely to develop pulmonary infection and achieve a secondary treatment than other 2 groups (P＜0.05). Totally 5 patients died in 3 groups, with a mortality of 6.76%, but the mortality rates were similar among the 3 groups (P＞0.05). The deaths were predominantly caused by multiple organ failure (MOF), 4 cases of which were caused by respiratory failure related to respiratory infection. Conclusion The alternative of endoscopic retrograde double biliary stent drainage (D-ERBD) can not only alleviate cholangitis rapidly, but it can reduce the incidence of aspiration pneumonia.