添加1,6-二磷酸果糖的肠外营养在老年腹部手术病人中的应用

目的:探讨添加1,6-二磷酸果糖(FDP)的肠外营养在老年腹部手术病人中的应用价值.方法:将32例病人随机分成研究组和对照组,每组各16例.所有病人术后第1～6 d接受等热量83.6 kJ/(kg·d)和等氮0.2 g/(kg·d)的肠外营养.研究组不用甘油磷酸钠,手术当天开始每天用FDP 10 g.于术前和术后第1、7 d检测血浆清蛋白、前清蛋白、血磷,并做心电图.术后第1、3、5、7 d测尿3-甲基组氨酸(3-MH),并计算氮平衡.结果:两组病人手术前、后血磷平均值正常,术后血清清蛋白和前清蛋白值较术前均降低,对照组前清蛋白水平下降明显(P＜0.05).研究组术后尿3-MH排出较对照组明显减少(P＜0.05),术后累积氮平衡优于对照组(P＜0.05).结论:FDP具有补磷、肠外营养增效及维护心功能的作用,适合老年腹部手术病人.     

Enclose无阻断近端吻合系统在老年患者OPCAB术中的应用

目的 应用主动脉近端吻合器（Enclose）对比冠状动脉旁路移植术（OPCAB）后脑保护的效果.方法 前瞻性选取我院2006年1月至2010年6月心脏外科单一手术组行OPCAB手术应用Enclose主动脉近端吻合器的150例65岁以上老年患者作为试验组;同期相同手术应用侧壁钳钳夹主动脉侧壁手术的200例65岁以上老年患者作为对照组,比较脑保护的效果.结果 试验组患者脑梗塞发生率、一过性脑缺血发作（TIA）发生率、死亡率和呼吸机使用时间均优于对照组.结论 Enclose无阻断近端吻合系统为升主动脉存在钙化和斑块者提供了一个相对安全的手术机会.使用中收到了良好的效果,近期随访较满意,远期疗效还有待进一步观察.     

Prevalence and prognostic importance of malnutrition,as assessed by four different scoring systems,in elder patients with heart failure

Background and aimsThe lack of standard diagnostic criteria in elder patients with heart failure (HF) makes it challenging to diagnose and manage malnutrition. We aimed to explore the prevalence of malnutrition, its associations and prognostic significance among elder patients with HF using four different nutritional scoring systems.Methods and resultsConsecutively presenting patients aged ⩾65 years, diagnosed with HF, and admitted to HF care unit of Fuwai Hospital CAMS&PUMC (Beijing, China) were assessed for nutritional indices. In total, 1371 patients were enrolled (59.4% men; mean age 72 years; median NT-proBNP 2343 ng/L). Using scores for the prognostic nutritional index (PNI) ≤38, controlling nutritional status (CONUT) score >4, geriatric nutritional risk index (GNRI) ≤91, and triglycerides, total cholesterol, and body weight index (TCBI) ≤1109, 10.4%, 18.3%, 9.2%, and 50.0% of patients had moderate or severe malnutrition, respectively. There was a strong association between worse scores and lower body mass index, more severe symptoms, atrial fibrillation, and anemia. The mortality over a median follow-up of 962 days (interquartile range (IQR): 903–1029 days) was 28.3% (n = 388). For those with moderate or severe condition, 1-year mortality was 35.2% for PNI, 28.3% for CONUT, 28.0% for GNRI, and 19.1% for TCBI. Malnutrition, defined by any of the included indices, showed added prognostic value when incorporated into a model and included preexisting prognostic factors (C-statistic: 0.711). However, defining malnutrition by the CONUT score yielded the most significant improvement in the prognostic predictive value (C-statistic: 0.721; p < 0.001).ConclusionMalnutrition is prevalent among elder patients with HF and confers increased mortality risk. Among the nutritional scores studied, the CONUT score was most effective in predicting the mortality risk.Clinical trial registrationURL: ClinicalTrials.gov; Unique Identifier: NCT02664818.     

自拟健骨强筋汤熏蒸治疗老年人踝关节骨折临床疗效

目的：观察自拟健骨强筋汤熏蒸对踝关节骨折老年患者骨代谢与关节功能的影响。方法：回顾性分析在开封市中心医院2021年1月至2022年1月期间治疗的踝关节骨折老年患者资料，从中选取常规术后治疗的49例患者纳入对照组，另选取49例在常规术后治疗基础上应用自拟健骨强筋汤熏蒸治疗的患者纳入观察组。比较两组患者康复进程，观察治疗前、后患者关节功能、活动度、肌力及血清骨代谢指标的变化。结果：观察组患者关节活动功能复常时间、恢复生活行走时间、完全负重时间均短于对照组，差异具有统计学意义（P <0.05）。治疗后两组患者Olderud–Molander、美国足踝外科协会（AOFAS）、Tinetti、Baird–Jackson评分均较治疗前提高，且治疗后观察组患者Olderud–Molander、AOFAS、Tinetti、Baird–Jackson评分均高于对照组，差异具有统计学意义（P <0.05）。治疗后两组患者肌力与关节活动度均较治疗前增大，且治疗后观察组患者肌力与关节活动度均大于对照组，差异具有统计学意义（P <0.05）。治疗后两组患者骨钙素（BGP）、前胶原羧基端肽（PI...     

小剂量阿糖胞苷和全反式维甲酸治疗老年人高危骨髓增生异常综合征15例

目的 观察小剂量阿糖胞苷（LD－Ara-C）和全反式维甲酸（ATRA）治疗老年高危骨髓增生异常综合征（MDS）的疗效。方法 老年高危MDS患者15例。应用LD－Ata-C10－15mg/m^2／次，每12小时皮下注射1次，14－21天为1疗程；间隔14－21天重复；ATRA30－60mg／天，分次口服。结果 完全缓解4例（26.7%），部分缓解3例（20％）,无效8例，总有效率46.7%；5例（33.3%），在治疗中或达CR／PR后转为急性白血病，化疗相关病死率6.7%。结论 LD－Aar－C和ATRA治疗老年高危MDS有明显疗效且耐受性好。