70岁以上老年肺炎患者临床特征探索

目的：分析第三军医大学西南医院近3年老年肺炎的发病特征和并发症,为指导老年肺炎的临床合理综合治疗提供依据。方法分析2007年1月至2009年12月在第三军医大学西南医院老年科病房住院、年龄＞70岁112例老年肺炎患者的临床特征及并发症,了解社区获得性肺炎和医院获得性肺炎的症状、体征、影像学特点,以及常见的并发症、肺部感染诱发因素。结果＞70岁老年肺炎患者中,医院获得性肺炎比例有增加趋势,共占54.6%,症状体征多不典型,病情明显较社区获得性肺炎重,死亡率高,并发症多,影像学特点多变。最常见的前5位并发症分别为多器官功能衰竭、心力衰竭、呼吸衰竭、混合性电解质紊乱、营养性贫血。常见的前5位诱因依次为误吸、反流、脑梗死、心力衰竭、外科手术。结论3年来第三军医大学西南医院老年肺炎有逐年增加的趋势,尤以医院获得性肺炎发病率更高,症状体征多不典型,易合并严重并发症,及时防治诱因和合理综合治疗非常重要。     

老年人常用抗高血压药物的适应证与禁忌证以及合理联用与不合理联用

高血压病是老年人最常见的疾病之一，必须及时用抗高血压药物进行长期或终生治疗。但老年高血压病患者常同时伴发多种疾病，抗高血压药物如应用正确就能达到预期的治疗目的．如应用不当不仅达不到治疗目的，还会引起多种副作用和／或不良反应。所以老年高血压患者用抗高血压药物进行治疗时必须严格掌握适应证和禁忌证，做到合理联用，避免不合理联用。现分别简述如下：适应证：利尿剂有高血压、痴呆、骨质疏松和抑郁症；β阻滞剂有高血压、偏头痛、特发性震颤、青光眼和痛风；钙拮抗剂有高血压、脑卒中、动脉粥样硬化、糖尿病、肥胖症和痛风：血管紧张素转化酶抑制剂(ACEI)有高血压、周围动脉疾病、糖尿病、高脂血症、抑郁症、尿失禁和性功能障碍等。禁忌证：利尿剂有尿失禁，谵妄和体位性低血压；β阻滞剂有周围血管疾病，抑郁症，尿失禁和性功能障碍：钙拮抗剂有心功能不全，肝功能不全，肾功能不全，与p阻滞剂合用，严重便秘，尿失禁，头痛和小腿水肿；ACEI有两侧肾动脉狭窄和肾功能不全。合理联用：抗高血压药物合理联用能显著提高降压效果。主要(或常用)的联用有利尿剂 β阻滞剂，利尿剂 ACEI，β阻滞剂 α1阻滞剂，β阻滞剂 直接血管扩张剂，钙拮抗剂 ACEI，血管紧张素受体阻滞剂 利尿剂。不合理联用：主要有钙拮抗剂 利尿剂，β阻滞剂 异搏定或硫氮革酮，β阻滞剂 ACEI，β阻滞剂 中枢性α2激动剂，钙拮抗剂 αl阻滞剂，钙拮抗剂 直接血管扩张剂，α1阻滞剂 中枢性α2激动剂，αl阻滞剂 直接血管扩张剂，异搏定或硫氮槊酮 二氢吡啶类钙拮抗剂。在应用抗高血压药物对老年人高血压病进行治疗时必须注意避免上述的不合理联用。     

高血压病降压药物不良反应调查及其在健康教育中的意义

高血压病患者进行有效地药物降压治疗 ,可以降低心脑血管并发症的发生率 ,预防脑卒中、冠心病和心力衰竭等并发症的发生发展。老年高血压病患者常同时患有几种老年慢性疾病 ,需要同时服用多种药物 ,增加了药物间相互作用的可能性 ,药物不良反应的出现致使部分患者未经医生同意自行停药 ,从而影响降压效果。本研究对常用几种降压药物不良反应的发生情况进行调查 ,旨在为高血压治疗过程中的健康教育提供理论依据 ,以减少因药物不良反应而影响治疗效果的发生。1　资料与方法选取 2 0 0 2年 5月～ 9月间来我院干部门诊就诊的正在进行抗高血压药…     

常用降压药物的不良反应

降压药的选择不仅要考虑其疗效,还应充分考虑可能出现的不良反应。高血压患者需终身服用降压药,因而降压药物的不良反应更应受到足够的重视。本综述收集了临床试验有关常用降压药不良反应的定量参数,以建立数量概念,帮助临床上权衡效益/风险,合理地针对患者具体临床情况选择应用降压药。1利尿剂常用于治疗高血压的利尿剂有氢氯噻嗪、氯噻酮和吲达帕胺。常见的不良反应有以下4点。1.1低血钠低血钠是排钾利尿剂治疗中最严重的并发症,老年女性多见,有90%的患者年龄超过65岁;65岁以上老人发生低钠血症的危险是65岁以下人的10倍(OR:9.87,95%CI:…     

老年糖尿病的临床特点与合理用药策略分析

目的探讨老年糖尿病的临床特点与合理用药策略。方法选取该院自2010年12月—2014年12月收治的200例老年糖尿病患者为研究对象。回顾性分析所有患者的临床诊断治疗资料,总结老年糖尿病的临床特点及合理用药策略。结果老年糖尿病具有发病率高、症状不典型、容易误诊以及并发症多等特点,其常见并发症有冠心病、感染、高血压,发病率分别为49.5%、38.5%、34.0%。结论与青壮年糖尿病相比,老年人糖尿病的临床特点并不典型,且常伴发有高血压、冠心病等并发症,因此临床药物治疗老年糖尿病患者时需谨慎用药。     

640例老年高血压患者特点分析及降压药物选择

目的探讨老年高血压患者特点及降压药物的选择。方法回顾性分析680例老年高血压患者的临床资料。结果老年高血压临床特点：部分患者对血压升高有一定的耐受且无症状；以2、3级，高危、极高危为主，病情相对较重；并发症和合并症比例高；以收缩压增高为主，脉压大；血压波动较大；心率比较慢；服药依从性差。结论老年高血压具有其特征，应依其临床特点合理选用药物。     

城镇老年高血压患者药物治疗依从性及影响因素

目的探讨城镇老年高血压患者药物治疗依从性现状及其影响因素。方法应用MAQ服药依从性问卷对160例城镇高血压老年人进行调查,分析药物依从性的影响因素。结果城镇老年高血压患者用药依从性有待提高,其中文化程度、有无并发症、病程、药物不良反应为影响患者药物依从性的因素。结论城镇老年高血压患者用药依从性是多项因素共同作用的结果,有待于通过制定个体化方案、进行健康教育来降低血压,减少并发症的发生,提高患者的生活质量。     

非洛地平缓释片治疗老年高血压的疗效研究

目的探讨非洛地平缓释片对老年高血压的临床治疗效果。方法选择140例老年高血压患者,首剂非洛地平缓释片5mg/d早餐前服药,2周后根据血压情况调整为2.5～10.0mg,疗程3个月,治疗期间不加用其他钙拮抗剂、血管紧张素转换酶抑制剂等,比较患者治疗前后血压变化及不良反应情况。结果治疗3月后,140例患者收缩压与舒张压比较均显著下降（P〈0.05）。其中显效率80.7%,有效率19.3%,总有效率100%。2例出现头痛、1例踝部水肿、3例面部潮红,均能耐受,2周后症状消失均不影响治疗。140例患者用药前后肝肾功能、血脂、血糖均无明显变化。结论非洛地平缓释片治疗高血压疗效显著,不良反应轻,可作为治疗老年高血压的首选药物之一。     

抗高血压药物临床应用分析及不良反应预防策略

目的探讨和分析抗高血压药物临床应用效果及不良反应的预防策略。方法选取我院收治的高血压患者120例,回顾性分析抗高血压药物的临床应用情况及患者出现不良反应的情况。结果四组患者疗效对比分析可知,应用利尿剂治疗的总有效率为90.0%,β受体阻滞剂治疗的总有效率为90.0%,钙拮抗剂治疗的总有效率为87.0%,血管紧张素转换酶抑制剂治疗的总有效率为93.3%,四组患者临床治疗效果均比较显著,组间对比无差异统计学意义(P0.05)。结论提高对抗高血压药物不良反应的认识,加强抗高血压药物临床应用的规范性和合理性以及标准性,减少用药不良反应的发生率,以此指导患者合理用药,对提高患者生命质量具有极其重要的意义。     

马来酸依那普利与缬沙坦治疗原发性高血压的疗效比较

有学者认为,高血压与高同型半胱氨酸血症(Hcy)均为老年患者发生心脑血管疾病的独立危险因素[1,2],因而选择降压作用持久有效、不良反应少,且能够降低血浆Hcy水平的降压药物显得十分必要.本文选择较为常用的一线药物,马来酸依那普利与缬沙坦治疗老年原发性高血压,对比分析其疗效. 1对象与方法 1.1 对象资料随机选取本院2011年2月至2012年4月收治入院的80例老年原发性高血压患者(均符合1999年WHO制定的高血压标准),且均排除糖尿病、冠心病、心力衰竭及严重的肝肾系统损害等重大疾病.     

Heart failure in the elderly

Heart failure is common in the elderly population. Approximately 6 to 10 percent of the population 65 years or older have heart failure. Heart failure is the most common reason for hospitalization in elderly patients. Etiology of heart failure is often multifactorial in the elderly. The common causes of heart failure include ischemic heart disease, valvular heart disease, hypertensive heart disease, and cardiomyopathy. Exacerbation of heart failure in the elderly is often accompanied by precipitating factors which include arrhythmia, renal failure, anemia, infection, adverse effect of drugs and non-compliance with medication and/or diet. Diagnosis of heart failure may be difficult in the elderly because symptoms of heart failure are often atypical or even absent. Heart failure with preserved systolic function is common in the elderly because aging has a greater impact on diastolic function. It is important to recognize that very old patients with heart failure are underrepresented in clinical trials.     

Geriatric hypertension: antihypertensive therapy in coronary artery disease

Systemic hypertension is a common clinical problem in the elderly. There is emerging evidence to suggest that with careful utilization of antihypertensive drugs, blood pressure can be lowered in the elderly population. Whether isolated systolic hypertension should be treated aggressively remains an unanswered question despite the evidence that systolic hypertension can cause certain cardiovascular complications. An elderly patient with hypertension and concomitant coronary artery disease merits proper blood pressure control with appropriate drugs to prevent progression of coronary disease. The therapeutic objective is not only to lower the blood pressure but to accomplish this goal with drugs which are likely to have a favorable effect on coronary artery disease. Changing trends in the drug therapy of hypertension indicate that calcium antagonists and beta-blocking drugs offer a therapeutic advantage in elderly hypertensive patients with coronary artery diseases.     

Clinical value of calcium antagonists in treatment of cardiovascular disorders

All calcium antagonists have the ability to decrease the symptoms and signs in some patients with ischemic heart disease and help lower the blood pressure in hypertensive persons, but in clinical doses nifedipine does not exhibit antiarrhythmic properties, although these are an important part of the action of verapamil, diltiazem and some substances with a similar chemical structure. In certain disorders beta-adrenergic blocking drugs are useful adjuncts, and under some circumstances, particularly variant angina and supraventricular arrhythmias, specific calcium antagonists are the drugs of choice. More data are needed to define the role of calcium antagonists during cardiopulmonary bypass, in the protection of the ischemic myocardium, in the management of hypertrophic cardiomyopathy and in specific cases of primary pulmonary hypertension. When used with an appropriate sense of perspective and careful observation, calcium antagonists provide useful additional means of helping selected patients suffering from particular cardiovascular diseases.     

Calcium antagonists and cardiovascular disorders

All calcium antagonists have the ability to decrease the symptoms and signs in some patients with ischemic heart disease and help lower the blood pressure in hypertensive persons, but in clinical doses nifedipine does not exhibit antiarrhythmic properties, although these are an important part of the action of verapamil, diltiazem and some substances with a similar chemical structure. In certain disorders beta-adrenergic blocking drugs are useful adjuncts, and under some circumstances, particularly variant angina and supraventricular arrhythmias, specific calcium antagonists are the drugs of choice. More data are needed to define the role of calcium antagonists during cardiopulmonary bypass, in the protection of the ischemic myocardium, in the management of hypertrophic cardiomyopathy and in specific cases of primary pulmonary hypertension. When used with an appropriate sense of perspective and careful observation, calcium antagonists provide useful additional means of helping selected patients suffering from particular cardiovascular diseases.     

Nifedipine in severely hypertensive patients with congestive heart failure and preserved ventricular systolic function

Nifedipine was used successfully in nine patients with refractory hypertension and left ventricular hypertrophy who had symptoms of congestive heart failure despite preserved left ventricular systolic function. The administration of 10 or 20 mg of nifedipine resulted in an acute decline in BP, from 211 +/- 8/105 +/- 6 mm Hg to 153 +/- 9/78 +/- 5 mm Hg. Six patients received nifedipine and one patient received long-term verapamil therapy (mean follow-up, 16 +/- 4 weeks). In addition to sustained BP control, signs and symptoms of congestive heart failure were greatly improved in all patients treated long term with calcium channel antagonists. No adverse reactions were reported, but a short duration of action limited their usefulness in some patients. Nifedipine seems to be particularly beneficial in this subgroup of severe hypertensive patients with heart failure presumably due to diastolic stiffness of the left ventricle.     

Differential therapeutic topics in antihypertensive therapy. What can angiotensin-converting enzyme inhibitors accomplish?

The results of large epidemiological studies dealing with the prognosis and unfavourable outcome of essential hypertension, clearly show that the pharmacological reduction of the elevated blood pressure of hypertensive patients significantly reduces the risk of at least some major cardiovascular complications. Satisfactory antihypertensive efficacy reflects, nevertheless, merely a minimal requirement for a modern antihypertensive drug. Additional pharmacological properties, which counteract the typical concomitant diseases like CHD, heart failure and other cardiovascular complications would be desirable. In this respect, the oral CE-inhibitors captopril and enalapril offer an exciting new approach to the treatment of arterial hypertension. As the most predictive international studies on prevention of hypertension were conducted before CE-inhibitors were available, the present review evaluates the pharmacological profile of this new class of antihypertensive compounds in the light of previously available baseline drugs, including the calcium channel antagonists. Until now, captopril and enalapril have been the best investigated and documented representatives. Besides new experimental results concerning the molecular mechanism of these drugs, clinical and experimental approaches to verify protective effects on the cardiovascular and the renal system are addressed. These offer a rational basis for the preferential treatment of hypertensive patients with reduced renal function, diabetes and chronic heart failure. In addition, some distinct advantages of enalapril over captopril, resulting mainly from the long-term reduction of high blood pressure, are discussed.     

Diuretics for cardiovascular prevention in the elderly

High blood pressure (BP) is a major risk factor for cardiovascular and cerebrovascular diseases in elderly subjects. Antihypertensive drugs have shown clinical benefit both in primary and secondary prevention of cardiovascular events. If BP lowering represents the major determinant of the effects conferred by the antihypertensive treatment for prevention, recent studies have suggested some differences between classes of antihypertensive drugs according to age. Based on the available clinical data, the recent medical guidelines have recommended thiazide-type diuretics as the preferred drug for the treatment of elderly hypertensive patients, followed by long-acting calcium antagonists. Indeed, diuretics constitute one of the most valuable classes of antihypertensive drugs, and in the elderly, diuretic-based treatment studies have been clearly shown to prevent major cardiovascular events, including stroke, heart failure and coronary heart disease.     

Recent clinical trial highlights in hypertension

Clinical trials continue to guide patient management. However, the hypotheses generally come from observational studies. Studies on women continue to be too little and too few, particularly in light of the fact that most elderly hypertensive patients are likely to be women. Attention has been drawn to the possibility that hypertension per se may engender symptoms such as headache for example, in addition to harder endpoints such as death. The MICROHOPE study, which was not a blood pressure-lowering study, showed that angiotensin converting enzyme inhibition with ramipril in diabetic patients provided the same beneficial effects previously published for the HOPE study. The doxazosin arm of the ALLHAT study was terminated by the data monitoring and safety board because the doxazosin-treated patients developed congestive heart failure at a greater rate than diuretic-treated patients. Two extensive studies testing two different classes of calcium antagonists against primarily diuretic-based treatment showed that the calcium antagonists were no less effective in terms of preventing hard endpoints. A small, but impressive cross-over study testing the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, pravastatin, against placebo showed that statin treatment lowers blood pressure in hypercholesterolemic patients with hypertension. Meta- analyses emphasized the value of blood pressure reduction in the elderly and added to the controversy and confusion about the role of calcium antagonists in the first-line treatment of hypertension. The point may be moot since with the current recommendations few hypertensive patients will be adequately treated with a single agent.     

Arterial hypertension and cognitive deficit

Cognitive impairment and dementia are more and more common in the elderly. The first begins, it advances silently and it leads to dementia in few years. Arterial hypertension represents the most important cerebrovascular risk factor after age. In numerous studies an inverse relationship between blood pressure values and cognitive performance emerges: it is possible that arterial hypertension plays a role in the pathogenesis of cognitive decline. Even in asymptomatic subjects the magnetic resonance signs of cerebral damage accompany cognitive impairment development. Antihypertensive therapy influence on cognitive function represents a subject of actual interest. The most studied drugs are calcium antagonists and ACE-inhibitors; they seem to have a protective effect on cognitive impairment, with regard to diuretics and beta-blockers. It would be important to study hypertensive patients, above all young asymptomatic hypertensives, even about cognitive functions, to prevent and consider cognitive decline and effective organ damage.     

Adverse effects of antihypertensive drug therapy on glucose intolerance

Several antihypertensive drugs have an adverse effect on glucose tolerance that may partially or completely negate the beneficial effects of reducing blood pressure as it relates to the incidence of coronary heart disease and its complications. Diuretics (particularly high doses) and beta-blockers without intrinsic sympathomimetic activity have the greatest adverse effect on glucose intolerance. Central alpha-agonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, and alpha-blockers do not adversely affect glucose and are preferred in diabetic hypertensive patients, selected hypertensive patients at risk for developing glucose intolerance, and probably most other patients with mild essential hypertension as initial and/or monotherapy compared with diuretics and beta-blockers.