高龄食管癌患者围手术期的护理

1998年3月至2002年12月共收治70岁以上老年食管癌开胸手术患者58例,经过精心护理,疗效满意,现报告如下。 1 临床资料 58例中男51例,女7例,最大83岁;中段食管癌经左胸、左颈二切口食管癌切除加食管、胃颈部吻合15例;经右胸、左颈、上腹正中三切口上段食管癌切除加食管、胃颈部吻合10例;下段食管癌行主动脉弓下吻合33例。本组患者癌     

高龄白内障患者围手术期的舒适护理

目的舒适护理在高龄白内障患者手术中的正确应用。方法对高龄白内障手术患者围手术期进行舒适护理的要点进行分析总结，以明确护士在该类手术患者护理工作中的重点和程序。结果舒适护理在高龄白内障患者围手术期的正确应用有利于提高手术室整体护理工作质量和专科护理技术的质量。结论舒适护理在高龄白内障手术患者围手术期的应用，保证了手术安全，降低了各种并发症的发生，使以病人为中心的服务得到落实，提高了手术室的护理质量。     

高龄患者开腹手术的围术期护理

目的如何提高高龄患者开腹手术围手术期的护理质量。方法分析近年来115例年龄大于80岁开腹手术患者的临床资料。结果115例中109例痊愈出院,治愈率为94.8%,6例延期出院。结论高龄患者,通过加强围手术期护理,可有效地预防术后并发症。     

高龄患者腹腔镜胆囊手术的围手术期护理体会

目的：分析高龄患者腹腔镜胆囊手术的围手术期护理应用价值。方法：选取院内行腹腔镜胆囊手术高龄患者60例行对比调查,随机分为两组,对照组行常规护理,观察组实施围术期护理,对比不同组别患者干预效果。结果：经统计患者手术操作所用时间与术后恢复所用时间均以观察组相对较短。观察组患者术后1 d疼痛评分（4.15±1.05）分,与对照组的（4.36±1.24）分无差异性,术后3 d与术后5 d疼痛评分均小于对照组患者,对比有差异性。术后少数患者发生切口感染与切口出血及胆漏,观察组发生率小于对照组,对比有差异性。不同组别患者干预前评估焦虑抑郁程度未见显著差异,护理后程度缓解效果显著,但观察组焦虑（27.62±2.04）分,抑郁评分（25.34±2.08）分,均低于对照组的（29.52±2.54）分、（28.45±2.38）分。不同护理方案干预后评估生活质量情况,不同方向指标的评分均以观察组相对较高。经满意度的评估,不同护理方案所获得患者认可程度差异显著,以观察组相对较高。结论：高龄患者行腹腔镜胆囊手术治疗期间,给予围术期护理干预有助于缩短术后恢复时间,并降低术后并发症风险。     

高龄口腔颌面部手术患者的围手术期护理

将70岁以上138例高龄口腔颌面部手术患者的围手术期护理进行总结分析，结果表明：严密检测、观察是降低并发症发生率的关键，有效改善全身的营养状况不可忽视，同时做好术前评估、心理护理、安全护理。并制定完善的护理计划，有效的实施护理措施，是高龄患者顺利渡过围手术期的有力保障。     

高龄胆囊炎患者围手术期护理效果分析

目的：探讨高龄胆囊炎患者围手术期护理干预效果.方法：选择笔者所在医院2008年5月-2011年5月胆囊炎高龄患者共60 例,其中合并有高血压、冠心病等心脏方面疾病患者共16 例,脑血管疾病患者1 例,慢性支气管炎、肺气肿、肺心病等患者共6 例,糖尿病患者17 例.18 例患者实施保守治疗,其余42 例患者实施胆囊切除术.本组60 例患者均给予围手术期护理干预.结果：术后并发症有高血压、心律失常、肺病感染、切口感染等,经相关治疗和有效围手术期护理,患者均痊愈出院.结论：对高龄胆囊炎患者实施围手术期护理干预,能够降低患者术后并发症发生,提高手术治疗效果,护理效果显著.     

高龄患者急诊PCI的围手术期护理体会

目的对高龄患者急诊PCI的围术期护理进行探讨。方法回顾分析2011年3月—2012年5月在我院接受术前护理,术中配合及术后康复指导的50例高龄患者。结果 50例患者中47例康复出院,3例治疗无效病死。结论细致的术前教育,术中配合和正确的康复指导,有助于提升高龄患者的治愈率与舒适感,减少病患疼痛及术后并发症的发生。     

高龄骨折患者的围手术期护理

目的:探讨高龄骨折患者围术期护理要点及护理效果.方法:随机选取我院骨科骨折围术期高龄患者共60例,依照随机分组法平均分为观察组与对照组.观察组给予围术期全面优质护理,对照组给予常规护理,对比两组患者护理效果.结果:观察组患者手术顺利27例、住院时间(17.1±2.8)d、术后感染及并发症发生0例,对照组患者手术顺利19例、住院时间(24.7±3.1)d、术后感染及并发症发生4例,观察组患者手术操作效果及感染、并发症预防效果均明显优于对照组,平均住院时间也明显短于对照组患者(P＜0.05).结论:全面的心理辅导、术前准备、术中配合及术后护理工作能有效缩短高龄骨折患者住院时间、提高手术治疗效果、有效预防及控制术后感染与并发症,综合效果显著.     

高龄患者围术期的心理护理

社会人口进入老龄化，需外科手术治疗的高龄患者相对增多。由于高龄患者脏器功能逐渐衰退，常合并慢性疾病，手术对于高龄患者来说是迫不得已的选择，患者态度消极，对手术表现的心理反应较复杂，不良心理反应的存在不仅影响手术效果，增添了手术的风险性，甚至关系患者安危。     

妇科高龄患者的围手术期护理对策以及效果分析

目的：对妇科高龄患者的围手术期护理对策以及效果进行研究分析。方法：从我院妇科高龄患者中选取34例进行研究分析,分析妇科高龄患者的围手术期护理对策以及效果。结果：本次研究选取的34例妇科高龄患者实施相应手术治疗后,均没有出现显著并发症状。其中,2例患者因术后出现剧烈咳嗽使切口裂开,通过二次缝合后痊愈出院,另外32例患者其腹部切口均在Ⅰ期愈合,定时出院。结论：科学合理的护理措施为妇科高龄患者成功完成手术的关键,促使患者早日康复。     

Cardiovascular mortality predictors in the oldest old

This article investigates the association between cardiovascular risk factors and cardiovascular morbidity and mortality in the oldest old. In 1996, 91% of the population > or = 80 years of age from Veranópolis, Rio Grande do Sul State, Brazil, were evaluated to detect cardiovascular risk factors and morbidity. The sample was followed up for three years, with the assessment of deaths. The analysis was done using univariate statistics and multivariate logistic regression analysis. There were 41 deaths (21%): 20 men and 21 women. Deaths were distributed by year as follow: 03 (7.3%) in the first year, 08 (19.5%) in the second, and 30 (73.2%) in the third. There was a significant and independent association between death and the following variables: diastolic blood pressure (DBP), total cholesterol (TC), LDL-C, ApoA-I, prior stroke (CVA), right bundle branch block (RBBB), and left ventricular hypertrophy (LVH) by ECG. Survivors presented higher levels of DBP, TC, LDL-C, ApoA-I, CVA, RBBB and LVH. According to the multivariate analysis, the variables were independent risk factors for mortality. Cardiovascular risk factors appear to have a distinct impact on the oldest old.     

高龄老年重症急性心力衰竭的救治

目的总结高龄老年重症急性心力衰竭的治疗经验。方法19例平均年龄85.46±5.14岁的高龄老年重症急性左心衰患者,应用利尿剂,血管扩张剂、吗啡、气管插管人工机械辅助呼吸、主动脉内球囊反搏(IABP)及双心室起搏等治疗措施。结果2例高血压、2例慢性肾衰尿毒症、1例肺部感染、2例陈旧性心肌梗死、2例急性心肌梗死、1例扩张性心肌病患者,经上述药物治疗后重症急性左心衰完全缓解;8例患者因1型呼衰而行气管插管,人工机械辅助呼吸;1例急性心肌梗死因低血压难以纠正行IABP,1例扩张性心肌病因反复心力衰竭行双心室起搏治疗。1例手术后重症急性心力衰竭治疗无效死亡。该19例中,18例存活,1例死亡。结论本组以利尿剂,血管扩张剂、吗啡为主治疗高龄老年重症急性心力衰竭的疗效较好。     

高龄老年重症急性心力衰竭的救治

目的 总结高龄老年重症急性心力衰竭的治疗经验.方法 19例平均年龄85.46±5.14岁的高龄老年重症急性左心衰患者,应用利尿剂,血管扩张剂、吗啡、气管插管人工机械辅助呼吸、主动脉内球囊反搏(IABP)及双心室起搏等治疗措施.结果 2例高血压、2例慢性肾衰尿毒症、1例肺部感染、2例陈旧性心肌梗死、2例急性心肌梗死、1例扩张性心肌病患者,经上述药物治疗后重症急性左心衰完全缓解;8例患者因1型呼衰而行气管插管,人工机械辅助呼吸;1例急性心肌梗死因低血压难以纠正行IABP.1例扩张性心肌病因反复心力衰竭行双心室起搏治疗.1例手术后重症急性心力衰竭治疗无效死亡.该19例中,18例存活,1例死亡.结论 本组以利尿剂,血管扩张剂、吗啡为主治疗高龄老年重症急性心力衰竭的疗效较好.     

Doing everyday life--experiences of the oldest old

The purpose of this article is to explore how a group of elderly people, living and managing on their own, describe and experience their everyday doings. Interviews and observations were conducted with 18 community-living people aged 85 and above. The experiences of 'Doing everyday life' are described in five overarching themes: 'Experiencing being old', 'Doings in everyday life', 'Patterns of the day', 'Altered doings', and 'The importance of time'. What is done during an ordinary day does not differ much from earlier in life, but how the doings are performed has changed. Being occupied and staying healthy and sound in mind was stressed as important in old age and even if reduced energy and functional constraints limited the doings, a strong volition to manage independently was expressed. The participants perceived society as regarding the elderly as useless and worthless. Knowledge emanating from the very old themselves is vital to diversify the image of elderly people and to offer interventions and support adapted to their needs and desires.     

Alcohol use and health outcomes in the oldest old

Given the increased use of marital- and family-based treatments as part of treatment for alcoholism and other drug disorders, providers are increasingly faced with the challenge of addressing intimate partner violence among their patients and their intimate partners. Yet, effective options for clinicians who confront this issue are extremely limited. While the typical response of providers is to refer these cases to some form of batterers' treatment, three fundamental concerns make this strategy problematic: (1) most of the agencies that provide batterers' treatment only accept individuals who are legally mandated to complete their programs; (2) among programs that do accept nonmandated patients, most substance-abusing patients do not accept such referrals or drop out early in the treatment process; and (3) available evidence suggests these programs may not be effective in reducing intimate partner violence. Given these very significant concerns with the current referral approach, coupled with the high incidence of IPV among individuals entering substance abuse treatment, providers need to develop strategies for addressing IPV that can be incorporated and integrated into their base intervention packages.     

Alcohol use and health outcomes in the oldest old

Background  

As the United States population ages, an unprecedented proportion of the population will be aged 70 and older. Knowledge of alcohol use and its consequences in this age group is not well known. In light of the disparate findings pointing to negative outcomes with excessive drinking yet also benefits of moderate drinking, the true risk of alcohol use in late life needs more investigation.     

Chronic conditions and mortality among the oldest old

Objectives. We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.Methods. Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.Results. As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50–59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90–99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).Conclusions. The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.Numerous studies have shown that both chronic conditions and functional limitations are powerful independent predictors of mortality.1^–4 However, a growing body of research suggests that some risk factors behave differently in people at different ages.5^–10 Some researchers have found that well-established mortality risk factors among younger persons, such as hypertension,7^,8^,11 hypercholesterolemia,7^,8^,12 increased body mass index,7^,9^,13^,14 heart disease,5^,8^,9 and cancer,5^,9 may not continue to pose a risk to the oldest old, suggesting that the association between chronic conditions and mortality may be weaker in the elderly. Autopsy series have also supported this notion, showing that a definitive cause of death attributable to a single disease process is often not found among older people.15 These observations have spurred a growing recognition within the geriatrics community that our methods of measuring and accounting for the burden of disease may be inappropriate for our oldest patients.16^–18Despite these concerns, chronic disease diagnoses remain at the center of clinical care and risk adjustment for older patients.17 However, if the association between chronic conditions and mortality is weaker in the elderly, risk adjustment tools that rely solely on chronic disease diagnoses (such as the Charlson Comorbidity Index19 and the Elixhauser method20) may be suboptimal for our oldest old. Therefore, the use of these methods to compare risk-adjusted outcomes as a proxy for the quality of care21^,22 may lead to erroneous conclusions. Improved risk-adjustment methods may lead to improvements in targeting health care quality interventions, ultimately resulting in better population health outcomes.To address these issues, we examined the ability of specific types of risk factors—chronic conditions, functional limitations, and demographic variables—to differentiate between people at high and low risk of death across a range of age groups. Based on previous research, we hypothesized that chronic conditions would be less predictive of death among older people. Because functional limitations often represent a final common pathway of decline regardless of underlying etiology,23^–25 we further hypothesized that functional limitations would be a stronger predictor of mortality than chronic conditions among our oldest participants.     

高龄严重感染患者应用利奈唑胺的疗效及其对血小板的影响

目的 评价利奈唑胺治疗高龄住院感染患者的疗效和对血小板的影响.方法 回顾性分析53例高龄感染患者应用利奈唑胺治疗的临床资料.结果 利奈唑胺与其他抗革兰阴性杆菌抗生素联用,临床总有效率为94.3%,细菌总清除率为82.8%,血小板减少发生率为67.9%,其中血小板减少50.0%以上者占39.6%,血小板计数最低值≤50×109/L者占17.0%,血小板减少患者中25.0%出现出血并发症,36.1%给予静脉输注血小板治疗.结论 利奈唑胺联用方案治疗80岁以上感染患者的疗效肯定,但要高度警惕血小板减少的可能.