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 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 assess the methodological quality of systematic reviews of Tai Chi for preventing falls in the elderly and the quality of evidence for outcome indicators.MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, CBM and VIP databases were electronically retrieved. According to the inclusion criteria and exclusion criteria, the final articles were selected and the relevant literature information was extracted by reading the abstract and the full text. The methodological quality of the included systematic reviews was evaluated using AMSTAR 2 tool, and the quality of the outcome indicators of the included systematic reviews was further graded according to the GRADE system.ResultsA total of 11 systematic reviews/meta-analyses were included. The AMSTAR 2 evaluation showed that 10 studies were in critically-low methodological quality, and 1 study was in low methodological quality. The GRADE evaluation results showed that among the 36 outcome indicators included, there were 10 intermediate quality indicators, 20 low-level quality indicators and 6 extremely low-level quality indicators. Among the indicators of intermediate quality, single-leg stand test (MD = 5.33, 95%CI 3.35 to 7.32, P< 0.01; WMD = 1.76, 95%CI −7.00 to 10.52, P< 0.01), time up and go test (MD = 1.04, 95%CI 0.67 to 1.41, P< 0.01), the berg balance scale (MD = 2.18, 95%CI 0.93 to 3.43, P< 0.01), number of falls (RR = 0.82, 95%CI 0.73 to 0.92), P< 0.01), the incidence of 2-falls (OR = 0.69, 95%CI 0.49 to 0.97, P< 0.01) and the incidence of 3-falls (OR = 0.39, 95%CI 0.21 to 0.73, P< 0.01). The results of the above indicators were statistically significant, indicating that Tai Chi was better than control group.ConclusionsAt present, the methodological quality of relevant systematic reviews of Tai Chi for preventing falls in the elderly was relatively low and the quality of the evidence was not good, so it can’t be proved that Tai Chi can effectively prevent falls in the elderly, which needs to be further studied at a high level.
ObjectiveTo analyze the risk factors for postoperative mortality of elder patients with intertrochanteric fractures.MethodsPatients with intertrochanteric fractures who underwent proximal femoral interlocking intramedullary nail fixation between January 2014 and December 2015 were enrolled in the study. Among them, 135 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin, albumin, and total lymphocyte count (TLC), and nutritional status. Univariate analysis and Cox proportional hazards regression model were used to screen the risk factors for postoperative mortality.ResultsTwenty-seven patients (20.0%) died within 2 years after surgery, and 16 (11.9%) died within 1 year after surgery. Univariate analysis showed that age, coronary atherosclerotic heart disease, number of comorbidities, preoperative hemoglobin and albumin levels were the influencing factors of postoperative mortality in elder patients with intertrochanteric fractures treated with proximal femoral interlocking intramedullary nail fixation (P<0.05). Multivariate analysis showed that age (≥80 years), combined more than 2 medical diseases, and preoperative albumin (<35 g/L) were the independent risk factors for postoperative mortality (P<0.05).ConclusionTo improve the clinical outcomes, perioperative risk should be comprehensively evaluated and perioperative management strengthened in the elder patients with intertrochanteric fractures, especially those with advanced age, more combined diseases, and low albumin, for the high postoperative mortality.
ObjectiveTo analyze the predictive value of thrombelastogram (TEG) on venous thromboembolism in elderly patients undergoing cardiac surgery.MethodsA total of 64 patients with venous thromboembolism after cardiac surgery in our hospital from March 2014 to March 2018 were selected as a pathogenesis group, including 38 males and 26 females, aged 61-73 (67.3±5.8) years. And 158 patients without venous thromboembolism who underwent cardiac surgery during the same period were selected as a control group, including 82 males and 76 females, aged 59-75 (65.9±7.1) years. Routine coagulation parameters such as plasma prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), platelet count (PLT) and various indicators of TEG were measured in two groups. The correlation analysis was performed on the obtained results, and the specificity and sensitivity of conventional coagulation indicators and TEG indicators for venous thromboembolism were analyzed and compared.ResultsThere were significant differences between the two groups in routine coagulation parameters and TEG (P<0.05). The area under the receiver operating characteristic (ROC) curve for each indicator was >0.5, which was of diagnostic significance. When the sensitivity>90%, the highest specificity value was also selected. The sensitivity and specificity of each indicator of TEG were greater than those of conventional coagulation indicators. The reaction time (R) was positively correlated with APTT in all indicators of TEG, and coagulation speed (K) was negatively correlated with Fib and PLT. Maximum thrombus intensity (MA) and Angle were positively correlated with Fib and PLT (all P<0.05). There was no correlation between TEG indicators and D-D.ConclusionThe TEG has higher predictive value for postoperative venous thromboembolism in elderly patients undergoing cardiac surgery than conventional coagulation tests. However, D-D level tests have unique diagnostic value in the diagnosis of venous thromboembolism.
ObjectiveTo investigate the effect of the screw blade position on the effectiveness of proximal femoral nail anti-rotation (PFNA) internal fixation for unstable intertrochanteric fractures in the elderly.MethodsA clinical data of 131 elderly patients with unstable intertrochanteric fractures who were treated with PFNA internal fixation between January 2010 and January 2017 was retrospectively analyzed. According to the anteroposterior X-ray films, the screw blades were placed in the middle of the femoral neck in 72 patients (group A) and at one-third of the femoral neck in 59 patients (group B). There was no significant difference between the two groups (P>0.05) in the gender, age, bone density, classification of fractures, other medical diseases, and the time between injury and operation. Multiple treatment indexes were analyzed, including complications, hip Harris score, the healing status of fracture, tip-apex distance (TAD), and the height of the tail nail.ResultsAll patients were followed up 11-14 months, with an average of 12.1 months. All incisions healed by first intention with no complications. All fractures healed and no significant difference in bone healing time between the two groups (Z=−0.190, P=0.849). At 6 months after operation, TAD was (2.23±0.07) cm in group A and (2.85±0.12) cm in group B, showing significant difference (t=−47.643, P=0.000); and the height of the tail nail was (1.72±0.14) cm in group A and (0.53±0.26) cm in group B, showing significant difference (t=31.031, P=0.000). According to the Harris score, the hip functions were rated as excellent in 48 cases, good in 15 cases, and poor in 9 cases in group A, while as excellent in 38 cases, good in 16 cases, and poor in 5 cases in group B, with no significant difference between the two groups (Z=−0.075, P=0.941).ConclusionFor the unstable intertrochanteric fracture in the elderly, the PFNA internal fixation with appropriated TAD and the screw blades placed in the middle or at one-third of the femoral neck can obtain good effectiveness.
ObjectiveTo investigate the effect and safety of tranexamic acid sequential rivaroxaban on perioperative blood loss and preventing thrombosis for elderly patients during lumbar interbody fusion (LIF) with a prospective randomized controlled study.MethodsBetween April and October 2019, the elderly patients with lumbar degenerative diseases requiring LIF were included in the study, among which were 80 patients met the selection criteria. According to the antifibrinolysis and anticoagulation protocols, they were randomly divided into a tranexamic acid sequential rivaroxaban group (trial group) and a simple rivaroxaban group (control group) on average. Finally, 69 patients (35 in the trial group and 34 in the control group) were included for comparison. There was no significant difference in general data (P>0.05) such as gender, age, body mass index, disease duration, diseased segment, type of disease, and preoperative hemoglobin between the two groups. The operation time, intraoperative blood loss, drainage within 3 days after operation, perioperative total blood loss, and proportion of blood transfusion patients were compared between the two groups, as well as postoperative venous thrombosis of lower extremities, pulmonary embolism, and bleeding-related complications.ResultsThe operations of the two groups completed successfully, and there was no significant difference in the operation time (P>0.05); the intraoperative blood loss, drainage within 3 days after operation, and perioperative total blood loss in the trial group were significantly lower than those in the control group (P<0.05). The proportion of blood transfusion patients in the trial group was 25.71% (9/35), which was significantly lower than that in the control group [52.94% (18/34)] (χ2=5.368, P=0.021). Postoperative incision bleeding occurred in 4 cases of the trial group and 3 cases of the control group, and there was no significant difference in bleeding-related complications between the two groups (P=1.000). There was 1 case of venous thrombosis of the lower extremities in each group after operation, and there was no significant difference in the incidence between the two groups (P=1.000). Besides, no pulmonary embolism occurred in the two groups.ConclusionPerioperative use of tranexamic acid sequential rivaroxaban in elderly LIF patients can effectively reduce the amount of blood loss and the proportion of blood transfusion patients without increasing the risk of postoperative thrombosis.
ObjectiveTo analyze the risk factors for postoperative mortality of the elderly patients with femoral neck fracture undergoing hemiarthroplasty.MethodsPatients who underwent hemiarthroplasty for femoral neck fractures between January 2011 and December 2015 were enrolled as object. One hundred and nine patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin level and nutritional status. Univariate analysis and Cox proportional hazard regression model were used to screen the risk factors for postoperative mortality.ResultsThe 1-year and 2-year mortalities were 6.4% (7/109) and 17.4% (19/109), respectively. Univariate analysis showed that the age, preoperative hemoglobin level and nutritional status were the influencing factors of postoperative mortality in the elderly patients with femoral neck fractures treated with hemiarthroplasty (P<0.05). Multivariate analysis showed that the age≥80 years and malnutrition were the independent risk factors for postoperative mortality (P<0.05).ConclusionTo improve the clinical outcomes, perioperative risk should be comprehensively evaluated by multidisciplinary and perioperative management should be strengthened in the elderly patients with femoral neck fracture, especially those with advanced age and malnutrition, for the high postoperative mortality.