80岁及以上危重病肥胖患者气管切开术的临床观察

目的 回顾分析80岁及以上危重病肥胖患者气管切开术的临床特点和应对措施.方法 我院2006年7月到2011年8月60例危重病肥胖患者,年龄80～99岁,同期60例年龄60～79岁危重病患者作为对照,在气管插管成功,病情稳定后,根据高危肥胖老人特点择期顺利完成了气管切开手术.收集患者的临床资料,比较两组患者手术时机、术前准备、手术技巧及术后并发症情况.结果 80～99岁组与60～79岁组手术后并发症比较,脱管分别为1例(1.7％)与0例、气囊漏气3例(5.0％)与4例(6.7％)、伤口渗血4例(6.7％)与3例(5.0％)、皮下气肿5例(8.3％)与7例(11.4％)；手术后并发症发生率分别为13例(21.7％)和14例(23.3％)(x2=1.00,P＞0.05). 结论 80岁及以上危重病肥胖患者的气管切开手术有其自身特点,但时机选择恰当,采用个性化手术方案,手术安全可行,手术后并发症发生率较低.     

高龄心肌梗死患者临床特点和住院期转归

目的评价高龄心肌梗死患者临床特点、住院期间不良事件和病死率。方法收集初发急性ST段抬高心肌梗死患者974例临床资料,按照患者年龄分为高龄组（≥75岁,n=161）和对照组（〈75岁,n=813）,对两组临床特点（包括性别、年龄、吸烟、化验指标、并存疾患）、治疗方案、住院并发症和病死率进行比较。结果与对照组相比,高龄组女性以非典型症状为首发表现者更多,从症状发作到医院就诊所需时间更长,心、肾功能更差,存在较多的并患疾病。对照组患者血脂异常、吸烟的比例更高。高龄组服用B受体阻滞剂的比例明显低于对照组。高龄患者住院期间经历了更多的不良事件,包括心律失常、心源性休克、心力衰竭。高龄组住院病死率为18．4％,显著高于对照组患者（P〈0．001）。结论高龄心肌梗死患者一般状态较差,多合并其他系统疾患,接受再灌注治疗的比例较低,住院期间不良事件发生率和住院病死率高。     

80岁以上高龄患者心脏永久起搏器植入术的临床分析

目的探讨80岁以上患者心脏永久起搏器植入术的可行性和安全性。方法选取1997年1月至2007年12月沈阳军区总医院收治的80岁以上心脏首次永久起搏器植入患者125例(高龄组)。与同期首次植入心脏永久起搏器570例65～79岁的患者(老年组)进行对比分析,观察两组的临床资料、手术成功率、围术期并发症发生率等指标。结果高龄组患者多种心脏疾病(除手术适应证疾病外)并存及合并心脏外疾病较老年组均明显增多。两组手术成功率均为100%。高龄组125例患者共植入单腔起搏器69台、双腔起搏器50台、三腔起搏器4台、双腔ICD2台。高龄组患者手术耐受性差,与老年组比较围术期并发症发生率明显增加。因手术操作引起的围术期并发症两组无明显差异。经及时发现并采取相应措施后,并发症均好转。所有患者均存活出院。结论充分考虑80岁以上老年患者心脏疾病的特点,并加强围术期管理,可避免和减少并发症的发生,其行心脏永久起搏器植入术是可行和安全的。     

华法林对超高龄患者抗凝治疗价值研究

目的分析华法林抗凝治疗在80岁以上患者中临床应用的现状,评价其临床适应证、疗效及风险,探讨在超高龄患者中华法林的合理应用方法。方法回顾性分析2006年1月至2010年12月于北京大学第一医院心内科31例华法林抗凝治疗的80岁以上患者的临床资料,总结华法林的起始及维持剂量、国际标准比值(INR)监测及栓塞和出血事件的发生。结果 93.55%患者均属于被动抗栓治疗。70.97%的患者INR达2.0～3.0,70.97%的患者达标剂量<3 mg/d,41.94%的患者维持1.5 mg起始剂量。发生缺血性卒中2例,INR<2.0;出血事件2例,INR>2.5。结论 80岁以上超高龄患者的华法林抗凝治疗,1.5 mg/d的起始剂量安全有效;INR维持在2.0～2.5较为适宜。     

80岁以上老年人多病因心力衰竭诊治中的几个问题

目的 对老年人多病因心力衰竭中的出血、贫血、退行性心脏瓣膜病、慢性肾功能不全等问题的诊治做探讨。方法 本文收集1998—2004年住广州军区广州总医院80岁以上老年人多病因心衰病例145例，就其资料完整的127例的病因构成与组合进行回顾。结果老年心力衰竭患者往往因为有多种病因存在，增加了临床上诊断和处理的难度。结论 对老年人多病因心衰进行治疗时，须多学科协作，调控各系统间的相互影响，抓住主要矛盾，重点治疗其原发病及去除诱因。根据老年特点，格外注意选择药物及调控药物，做到细致和稳妥，注意个体不同耐受性，避免发生副作用。     

Outcomes of lumbar spinal fusion in super-elderly patients aged 80 years and over: Comparison with patients aged 65 years and over,and under 80 years

Despite the increasing prevalence of spinal surgery in super-elderly (SE) patients, the outcomes and complication rates have not been fully elucidated. The purpose of this study was to compare the outcomes and complications of lumbar spinal fusion for degenerative lumbar spinal stenosis (DLSS) in SE patients aged 80 years and over with those in patients aged 65 years and over, and under 80 years.This study analyzed 160 patients who underwent spinal fusion for DLSS between January 2011 and November 2019. Thirty patients in the SE group (group SE, ≥80 years) and 130 patients in the elderly group (group E, ≥65 years and <80 years) were enrolled. The performance status was evaluated by preoperative American society of anesthesiologists (ASA) score. Visual analog scales for back pain (VAS-BP) and leg pain (VAS-LP), and Korean Oswestry disability index (K-ODI) were used to assess clinical outcomes preoperatively and 1 year postoperatively. Percent changes of VAS-BP, VAS-LP and K-ODI were also analyzed. Fusion rates were evaluated by computed tomography 6 months and 1 year postoperatively. Furthermore, bone mineral density, operative time, estimated blood loss, blood transfusion, hospital days, hospitalization in intensive care unit and postoperative complications were compared.The average age of group SE was 82.0 years and that of group E was 71.6 years. There were no differences in preoperative ASA score, preoperative or postoperative VAS BP and VAS-LP, bone mineral density, operative time, estimated blood loss, blood transfusion, hospital days, hospitalization in intensive care unit and fusion rates between the groups. Preoperative and postoperative K-ODI were higher in group SE than group E (all P < .05). However, percent changes of VAS-BP, VAS-LP and K-ODI showed no significant differences. Overall early and late complications were not significantly different between the groups; however postoperative delirium was more common in group SE than group E (P = .027). SE status was the only risk factor for postoperative delirium with odds ratio of 3.4 (P = .018).Spinal fusion surgery is considerable treatment to improve the quality of life of SE patients with DLSS, however careful perioperative management is needed to prevent postoperative delirium.     

80岁以上冠心病患者临床特点和冠状动脉造影结果分析

目的分析80岁以上冠心病患者的临床特点、危险因素及冠状动脉造影的特点。方法收集150例80岁以上患者的资料,分析患者的并存疾病、冠心病类型、临床症状、冠状动脉病变情况、危险因素及其与病变支数和部位的关系。结果高血压是最主要的并存症（109例,72．7%）,不稳定性心绞痛是冠心病主要类型（90例,60．0%）,冠心病临床症状不典型患者比例为62例（41．3%）。冠状动脉以多支病变为主（87例,66．9%）,前降支病变最多（114例,87．7%）,病变血管平均3．1支/例。冠状动脉重度以上狭窄76例（58．1%）。糖尿病、心肌梗死史、脑梗死在不同病变支数分组中差异有统计学意义（P＜0．05）。单支病变、多支病变、左主干病变、前降支病变、右冠状动脉病变的比例与危险因素的数量有关（P＜0．05）。结论80岁以上冠心病患者冠状动脉病变支数多,狭窄程度严重。糖尿病、心肌梗死史、脑梗死是病变严重程度的危险因素。     

Esophagectomy in patients aged over 80 years with esophageal cancer

BACKGROUND/AIMS: Esophagectomy for esophageal cancer is one of the most invasive surgical procedures. However, with the recent aging of the population, clinicians are increasingly encountering patients with advanced age (over 80 years) who require treatment for esophageal cancer. Patients in this age group tend to be regarded as at high risk in terms of surgical treatment. In the present study, the authors examined perioperative complications and clinical outcome in esophagectomy in patients aged over 80 years compared with those aged 70-79 and discuss the risk and appropriateness of esophagectomy in the older group. METHODOLOGY: Of patients with esophageal cancer at our institute, 25 were aged over 80 years, while 95 were aged 70-79 years. We statistically compared those who underwent esophagectomy; 8 in the older group and 62 in the younger group. The oldest patient was an 84-year-old man. Among the 8 older patients, 7 were male and 1 was female. All cases were histologically confirmed as squamous cell carcinoma and this series included 1 case in Stage 0, 3 in Stage I and 4 in Stage III. Total thoracic esophagectomy was performed in 5 patients, transhiatal blunt dissection in 2 and lower thoracic esophagectomy in 1. RESULTS: Rate of surgical treatment was significantly lower in the older group than in the younger group (32.0% vs. 65.3%, p < 0.001). No significant difference was observed in postoperative complications or mortality. Regarding clinical postoperative outcome in the older group, there were 5 deaths: 1 related to surgery, 2 to other causes (at 5 and 12 months), 2 to cancer (4 and 11 months). The remaining patients were alive at 31, 60, and 88 months. No significant difference was observed in overall or disease specific survival after surgery between the 2 groups. CONCLUSION: No statistically significant differences were apparent in morbidity, mortality or clinical outcome in the 2 groups. Since surgery seems to confer similar symptomatic improvements and survival in patients aged over 80 to those expected for patients aged 70-79, we believe that surgeons should not withhold esophagectomy in patients aged over 80 years because of advanced age alone.     

80岁以上患者腹腔镜胆囊切除围手术期处理

目的探讨高龄（≥80岁）患者腹腔镜胆囊切除术（LC）围手术期处理原则。方法2001年6月至2006年6月解放军第451医院共行LC术13776例,对其中≥80岁的结石性胆囊炎病例共34份进行回顾性分析,对术前评估、降低并发症影响因素并减少其发生提出可行性依据。结果本组平均年龄82.1岁,26例有明确的术前合并症,占76.5%,合并有两种以上疾病者15例,占44.1%,胆囊炎急性发作17例,病理诊断为急性化脓性胆囊炎6例,急性发作患者起病48h内急诊手术7例,内科抗感染并治疗合并症后手术10例,住院时间（13.3±5.3）d,手术时间（28.4±8.6）min,全部病例均完成手术,术后第3天发生快速房颤并急性心衰1例,合并糖尿病切口延迟愈合1例,合并肝硬化急诊手术后出现肺部感染、肝功损害加重1例,其余患者均顺利治愈出院,无手术死亡。结论在高龄患者LC围术期,注意术前评估,慎重确定手术时机,充分术前准备,术中仔细处理,是保证高龄老人顺利度过LC围手术期的必要条件,从而降低高龄患者手术风险。     

Pathological characteristics of coronary artery disease in elderly patients aged 80 years and over

<正>Objective To define the pathological changes of coronary artery and compare the clinical diagnosis and pathological diagnosis differences in elderly patients aged 80and over.Methods A total of 909 autopsy cases aged60-100 years in our hospital from April 1 1969 to October31 2013 were analyzed.The prevalence and pathological     

Conservative treatment for patients over 80 years with acute myelogenous leukemia

In order to evaluate the best treatment of very elderly patients with AML, we have retrospectively analyzed 60 cases of patients aged more than 80 years, with a diagnosis of AML and observed from January 1988 to December 1998. Six of these patients were subsequently referred to other centers; of the remaining 54 patients, 20 (37%) received only supportive care, whereas 34 (63%) required palliative chemotherapy to control leukocytosis, after a median time from diagnosis of 9 days (range 0-253). Median overall survival was 13 weeks (range 1-105): 21 (39%) and 6 (11%) patients survived more than 6 and 12 months, respectively. Twenty-eight patients (51.8%) died from progressive disease, 19 (35.1%) died from AML-related or unrelated causes in the phase of stable disease, while in 7 patients the cause of death was unknown. In univariate analysis, PS > 2 and WBC > 50 x 10(9)/L had an adverse prognostic significance on survival. Our results, as compared with those reported in the literature for patients over 80 years treated with intensive chemotherapy, support the idea that intensive chemotherapy is usually not indicated in very elderly patients with AML, and that conservative treatment and the primary strategy of "watch-and-wait" presently seems to be the best choice.     

80岁以上高龄患者76例冠状动脉介入治疗的临床疗效

随着人口老龄化趋势明显加速,老龄人口已大幅增加,高龄冠心病（coronary artery disease,CAD）的比例也随之增加,并严重影响到患者的生存率与生存质量,成为老年人最主要的死亡原因之一。由于80岁以上高龄冠心病患者生理、病理上的特殊性,其介入诊疗的安全性与疗效国内外报道的研究不多。本文旨在探讨80岁以上高龄CAD患者进行介入治疗的安全性与近期临床疗效。1对象与方法     

Clinical characteristics and in-hospital outcomes in patients aged 80 years or over with cardiac troponin-positive acute myocardial infarction -J-MINUET study-

BackgroundThe prevalence of acute myocardial infarction (AMI) in elderly people is increasing worldwide. However, their characteristics and prognosis have been rarely investigated. This study aimed to investigate the characteristics and prognosis in elderly patients with cardiac troponin-positive AMI.MethodsConsecutive patients with AMI from the J-MINUET study were divided into the following 3 groups: patients aged less than 65 years, those aged between 65 and 79 years, and those aged 80 years or over. Their characteristics and in-hospital outcomes were compared.ResultsPatients with AMI aged 80 years or over had the highest incidence of female gender, and the highest incidence of hypertension, chronic kidney disease, and cardiovascular disease, such as peripheral artery disease, atrial fibrillation, and stroke, whereas they had the lowest body mass index, and the lowest incidence of current smoker, diabetes mellitus, and dyslipidemia. Patients with AMI aged 80 years or over had significantly longer onset to door time and longer door to device time, and lower peak creatine kinase (CK). The incidence of ST-segment elevation myocardial infarction (STEMI) was the lowest in the AMI patients aged 80 years or over, but the patients had a higher incidence of in-hospital death and cardiac failure than the other two groups. In addition, the presentation with STEMI and non-ST-segment elevation myocardial infarction with CK elevation among patients aged 80 years or over showed the highest incidence of in-hospital death and cardiac failure.ConclusionsJ-MINUET showed different clinical characteristics between the aged and younger populations. The incidence of in-hospital death and cardiac failure in patients aged 80 years or over with AMI was poorer than their younger counterparts.     

肠内营养支持在80岁以上反复肺部感染患者中的应用

目的 探讨肠内营养支持在≥80岁反复肺部感染患者中的临床应用效果. 方法 对34例≥80岁反复肺部感染患者肠内营养支持情况进行分析.采用经皮内镜下胃造瘘术(PEG/J)治疗组18例,采用鼻胃管治疗组16例,摄入同等热量和同等氮量,营养支持时间＞2月. 结果 经肠内营养支持后,全部患者的营养状况得到改善,2组各指标差异无显著性.PEG/J治疗组反流、误吸、吸入性肺炎的发生次数均明显少于鼻胃管组,对比差异均有统计学意义(P＜0.05). 结论 在≥80岁反复肺部感染患者中选择合适的肠内营养支持方式,不仅可以改善病人的营养状况,还可以减少肺部感染的发生,提高机体免疫功能,促进病人的康复.