有氧运动对心血管病高危因素新兵高强度军事训练后机体循环功能与应激反应的影响

目的：观察有氧运动对存在心血管病高危因素新兵高强度军事训练后机体循环功能与应激反应的影响。方法选取某部存在心血管病高危因素的新入伍战士40名,在常规体能锻炼基础上增加有氧运动,为期2个月,于有氧锻炼开始前和结束后行10 km 跑步运动应激测试,记录受试者运动应激前30 min 及后10 min 心率、收缩压、心率血压乘积的变化,以及血超敏 C 反应蛋白(hs-CRP)、心肌型肌酸激酶同工酶(CK-MB)和氨基末端脑钠肽前体(NT-proBNP)浓度的变化。结果受试者两次运动应激后心率、收缩压、心率血压乘积及血 hs-CRP、NT-proBNP 浓度均升高(P <0．01);第2次运动应激后心率、心率血压乘积及血 hs-CRP、NT-proBNP 浓度升高幅度低于首次运动应激后(P <0．05或 P <0．01)。结论高强度军事训练可增加心血管病高危人群的应激反应并影响其循环功能,合理的体能锻炼联合有氧运动有助于减少急性心血管病事件甚至心源性猝死的发生。     

替罗非班治疗老年急性冠脉综合征时出血危险因素分析

[目的]探讨老年急性冠脉综合征(ACS)患者应用替罗非班治疗时出血的危险因素.[方法]观察本院84例应用替罗非班静脉滴注治疗的老年ACS患者出血情况,应用多因素Logistic回归分析其出血相关危险因素.[结果]11例(13.10％)ACS患者发生出血,其中2例严重出血,9例轻度出血.多因素回归分析表明:高龄(≥65岁)、吸烟史≥5.2年、急诊经皮冠状动脉介入术(PCI)、肌酐清除率≤70 mL/min、肾小球滤过率(GFR)≤60 mL/(min,1.73 m2)是替罗非班治疗ACS发生出血并发症的独立危险因素.而性别、高血压、糖尿病、高脂血症、体重与出血并发症均无显著相关(P＞0.05).[结论]替罗非班临床应用较为安全,高龄、吸烟、急诊PCI、肌酐清除率降低、肾功能不全为老年ACS患者应用替罗非班治疗时出血的主要危险因素.     

弹力带柔性抗阻运动对中老年女性骨密度和跌倒风险指数的影响

【目的】探讨弹力带柔性抗阻运动用于中老年女性对其骨密度和跌倒风险指数的影响。【方法】随机选取社区内60例中老年女性作为研究对象,指导其进行弹性带柔性抗阻运动,采用双能X线骨密度仪和平衡训练测试系统对训练前后骨密度和跌倒风险指数进行评估。【结果】中老年妇女经过三个月的弹性带柔性抗阻运动,训练后骨密度（59．84±2．25）g／cm2明显高于训练前骨密度（55．53±1．84）g／cm2,训练后跌倒风险指数（1．24±0．45）明显低于训练前指数（2．53±0．47）,差异均有统计学意义（P ＜0．05）。【结论】中老年女性连续进行弹性带柔性抗阻运动能有效提高骨密度,降低跌倒风险指数。     

Dementia: Psychosocial/Mental Health Risk Factors

Dementia currently is a major health concern plaguing the globe that will only become more prevalent as people age. Although medications are available to slow the progression of the disease or improve symptoms, or both, dementia is currently incurable, irreversible, and a major cause of disability for the world’s older population. Identifying risk factors early and applying these risk factors to nurse practitioner practice can help ward off the disease. Although risk factors related to dementia is a large topic, this review will focus specifically on psychosocial/mental health risk factors related to dementia and applications to nurse practitioner practice.     

我国老年人跌倒影响因素研究的可视化分析

目的分析我国近年老年人跌倒影响因素的相关研究,探讨其研究现状及发展趋势,为老年人跌倒预防提供参考依据。方法检索CNKI、万方数据库、VIP和CBM数据库中发表的有关老年人跌倒影响因素的相关文献,检索时间自数据库建库至2018年9月,使用Bicomb 2.0、Ucinet 6.0、Netdraw、gCluto软件进行可视化分析。结果共纳入相关研究432篇,通过影响因素聚类分析得出老年人跌倒的影响因素有生理机能退化、药物相关不良反应以及高龄有跌倒史的女性。通过关键词聚类分析认为该领域的研究热点有以下4类:城市老年人因居家环境、骨质疏松、糖尿病所致的骨折损伤;卒中后老人害怕跌倒、锻炼与其跌倒效能及平衡功能的关系;住院患者跌倒的预防、护理对策及健康教育;对社区、养老机构老年人跌倒的流行病学研究等。结论我国有关老年人跌倒影响因素的相关研究较多,但目前仍缺乏深入的定量分析。有关老年人跌倒影响因素的研究还有待高质量、大数据文献的进一步支持。     

青年冠心病患者的危险因素及冠状动脉病变特点

目的 :探讨青年冠心病患者的心血管危险因素 ,冠状动脉病变特点及与老年冠心病患者的不同。方法 :对青年 (≤ 4 5岁 )冠心病 36例和老年 (≥ 6 5岁 )冠心病 5 8例的临床资料 (包括冠状动脉造影结果 )进行回顾性分析和比较。结果 :青年冠心病组吸烟、大量饮酒、肥胖、心血管病家族史明显多于老年组 (P<0 .0 0 1或 P<0 .0 1) ,男性患者多 (P=0 .0 0 6 ) ,甘油三酯高 (P=0 .0 0 1)。老年冠心病组高血压病、糖尿病多 ,心血管并发症多。青年组冠状动脉单支病变多 (P<0 .0 0 1) ,老年组冠状动脉多支病变多 (P<0 .0 0 1) ,侧支循环多见于老年组。结论 :吸烟、大量饮酒、肥胖、心血管病家族史是青年冠心病患者突出的危险因素 ,不良的生活饮食习惯和遗传因素促使冠心病提早发生。寻求新的无创检查方法筛选青年冠心病的高危人群 ,做好预防工作 ,有利于避免或延迟冠心病的发生     

高龄卒中后高血压患者的临床特征与危险因素分析

目的 探讨高龄卒中后高血压患者的临床特征和危险因素。方法 回顾性分析300例高龄脑卒中住院患者的临床资料，比较不同性别、年龄、病变患者的血压变化，分析高龄卒中患者的临床特点与血压变化规律，探讨其影响因素。结果 高龄组患者的肢体瘫痪、意识障碍发生率高，头痛、呕吐发生率低；卒中后高血压以中、重度为主，收缩压升高明显；危险因素中高血压、糖尿病、吸烟、酗酒比例降低，冠心病比例增高，肺部感染比例明显增高。结论 高龄卒中患者的危险因素与非高龄患者不同，有其独特的卒中后血压变化规律与临床特征。     

运动心电图试验ST/HR滞后(Hysteresis)与冠心病之间关系的研究

目的　探讨平板心电图运动试验ST/HR滞后与冠心病之间的关系及临床意义。方法　对可疑冠心病的136例患者在1周之内分别进行了平板运动试验和冠状动脉造影检查,并计算出心电图运动试验ST/HR滞后最大值。结果　136例患者,传统的ST段压低标准,阳性者86例,可疑阳性21例,其中真阳性78例;ST/HR滞后标准,阳性者83例,真阳性75例。传统的ST段压低标准与ST/HR滞后标准诊断冠心病的敏感性、特异性、准确性分别为714%、862%、758%和903%、868%、890%。结论　平板心电图运动试验ST/HR滞后标准能明显的改进心电图运动试验对冠心病的诊断作用,是检测心肌缺血有价值的指标。     

老年慢性心衰并发心肾综合征的相关危险因素研究

[目的]研究老年慢性心力衰竭(CHF)患者并发心肾综合征(CRS)的相关危险因素,为CRS的预防提供临床参考.[方法]对确诊的138例CHF患者的临床资料进行回顾性研究,采用Logistic回归分析法研究CRS发生的相关危险因素.[结果]138例CHF患者中并发CRS共22例,发生率为15.94％.经logistic回归分析(Wald前进法)筛选出并发CRS的危险因素为糖尿病史、贫血、年龄(均P＜0.05).[结论]高龄(≥80岁)、有糖尿病史和贫血的CHF患者并发CRS的风险性大,对以上三个危险因素加以重点评估和合理控制,可能降低CRS的发生.     

川崎病并发冠状动脉损害的危险因素探讨

目的探讨川崎病并发冠状动脉损害的危险因素。方法对2005年1月～2007年12月临床诊断为川崎病的198例患儿进行回顾性分析,分析性别、年龄、丙利,球蛋白开始治疗的时间、C-反应蛋白（CRP）、血沉（ESR）等因素与冠状动脉损害的关系。结果198例患者中冠状动脉病变41例,其中冠状动脉瘤9例,2例巨瘤形成。实验室检查（血小板、CRP、ESR）冠状动脉扩张组和未扩张组有显著差异;性别、年龄、丙种球蛋白开始治疗的时间、CRP、ESR与冠状动脉病变发生率有密切关系。年龄≤1岁和≥6岁KD患儿较1-6岁患儿更容易并发冠状动脉损害。结论男性患儿,年龄小于1岁,CRP、ESR明显增高、IVIG治疗开始时间大于7d与KD并发冠状动脉扩张密切相关。而≥6岁KD患儿与≤1岁患儿一样更容易引起冠状动脉扩张,应引起临床重视。     

Reducing Risk of Falling in Older People Discharged From Hospital: A Randomized Controlled Trial Comparing Seated Exercises, Weight-Bearing Exercises, and Social Visits

Vogler CM, Sherrington C, Ogle SJ, Lord SR. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits.

Objective

To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.

Design

Twelve-week randomized, controlled trial.

Setting

Home-based exercises.

Participants

Subjects (N=180) aged 65 and older, recently discharged from hospital.

Interventions

Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).

Main Outcome Measures

Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.

Results

Subjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.

Conclusions

In older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.     

Elevated Vancomycin Trough Levels in a Tertiary Health System: Frequency,Risk Factors,and Prognosis

Objective

To investigate the frequency of, risk factors for, and outcomes after elevated levels of vancomycin.

Impact of Exercise Frequency on Hand Strength of the Elderly

ABSTRACT

Purpose: To determine if an every other day exercise program achieves comparable results to an everyday program, and to compare participants’ adherence to each program. Study Design: Randomized controlled trial. Methods: Thirty-six independent living individuals age 55 and older were randomly assigned to one of two groups. Group A performed grip and pinch therapy putty exercises daily. Group B performed the same exercises every other day. Participants were also assessed for program adherence. Results: There was no significant difference (p = 0.05) in grip strength change scores between the low- and high-frequency groups over the 8-week training period. Six out of eight pinch strength change scores indicated no significant difference between groups. Adherence data were better for the low-frequency group. Conclusion: For the most part, results indicated no significant difference between the hand-strengthening protocols when measuring hand strength over an 8-week period. Level of Evidence: 1b.     

冠心病危险因素与睡眠呼吸暂停相关性分析

目的 :为探讨冠心病病人中发生睡眠呼吸暂停(sleepapnea ,SA)危险因素。方法 :对 178例经冠状动脉造影证实的男性冠心病病人及 5 2例非冠心病男性病人进行夜间多导睡眠监测。结果 :冠心病病人中SA的发生率较高 ,平均呼吸暂停 /低通气指数 (AHI)显著高于对照组 (P <0 .0 5 ) ;冠心病合并SA的病人体重指数(BMI)显著高于单纯冠心病病人 (P <0 .0 1) ;高脂血症及AHI≥ 2 0的SA与心肌梗死相关。结论 :应警惕冠心病病人发生SA。     

冠心病患者等长收缩运动与心肌缺血的关系

目的　探讨冠心病患者等长收缩运动与心肌缺血的关系。方法　采用超声多普勒技术 ,比较 2 0例冠心病患者和 10例正常人极量短暂等长收缩运动 (briefisometricexercise ,BIE)、极量持续等长收缩运动(sustainedisometricexercise ,SIE)与动力性运动 (dynamicexercise ,DE)时的血流动力学反应和心功能表现。 结果　有心肌缺血的冠心病患者在DE运动终点时有心肌缺血表现 ,但BIE和SIE时无相应表现。心血管反应总体趋势为 :DE时心率和两项乘积运动增量均明显高于BIE和SIE ,各组间差异不显著。正常组DE时血流动力学多数指标的运动增量均高于BIE和SIE ,但有无心肌缺血的冠心病患者之间无明显差异。结论　在同等主观用力的前提下 ,冠心病患者等长收缩运动时心肌缺血发生率低于动力性运动。等长收缩运动时较高的舒张压和较长的灌注时间对心肌缺血有一定的保护作用。等长收缩运动在冠心病康复中的应用有合理的生理学基础。     

冠状动脉慢血流现象的临床分析

目的:探讨冠状动脉造影术中冠状动脉慢血流现象相关的危险因素.方法:回顾分析2008年1月-2009年12月295例因胸痛、胸闷、心悸等在复旦大学附属中山医院行冠状动脉造影显示冠状动脉无明显病变患者的临床资料,根据判定标准分为慢血流组(n=196)及血流正常组(n=99).应用t检验和卡方检验比较2组间各项临床指标的差异,并采用多元Logistic回归分析对导致慢血流的各因素进行分析.结果:2组患者的年龄、高血压痛所占比例、白细胞计数、血小板计数、空腹血糖、甘油三酯、低密度脂蛋白、超敏C反应蛋白水平等差异均无统计学意义(P＞0.05),而慢血流组男性(73.5％比42.4％,P＜0.01)、吸烟者所占比例(36.2％比24.2％,P=0.038)显著高于血流正常组,高密度脂蛋白水平(1.12±0.25比1.21±0.36,P=0.014)显著低于血流正常组,血尿酸水平(370.34±107.9比326.90±92.4,P＜0.01)显著高于血流正常组.多元logistic逐步回归分析表明,男性、高密度脂蛋白胆固醇下降、尿酸升高是影响慢血流发生的危险因素.结论:吸烟、高密度脂蛋白胆固醇降低、尿酸升高可能参与冠脉慢血流发生的病理生理过程.     

骨密度水平对老年脊柱骨折患者骨痛的影响及危险因素分析

[目的]探讨骨密度水平对老年脊柱骨折患者骨痛和手术预后的影响.[方法]收集2017年7~12月在本院骨科接受手术治疗的老年(>60岁)脊柱骨折患者,采用双能X线测定骨密度,根据骨密度水平分为低水平骨密度组(T值<1.0)和高水平骨密度组(T值≥-1.0).两组均采用模拟疼痛评估量表(VAS)评估疼痛程度,随访记录患者的术后相关指标评估其预后状况.[结果]低水平骨密度组在术后12 h、24 h VAS量表评分均显著高于高水平骨密度组(P<0.05),而术后48 h两组VAS量表评分比较差异无统计学意义(P>0.05);两组术后至出院的天数、总住院天数、术后并发感染及低钾血症构成比比较差异有统计学意义(P<0.05);术后12 h VAS评分与患者骨密度水平呈显著负相关(P<0.05),而术后24 h、48 h VAS评分与患者骨密度水平无显著相关性(P>0.05).骨密度水平减低是术后骨痛程度增加的危险因素(P<0.05);此外,术后并发感染、骨折段数和椎体压缩程度也均为骨痛程度增高的危险因素(P<0.05).[结论]低骨密度水平可能是影响老年脊柱骨折患者骨痛水平的一个危险因素,同时低骨密度水平也可影响患者术后的预后状况.     

The Relationship of Transversus Abdominis and Lumbar Multifidus Activation and Prognostic Factors for Clinical Success With a Stabilization Exercise Program: A Cross-Sectional Study

Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study.

Objective

To examine the relationship between prognostic factors for clinical success with a stabilization exercise program and lumbar multifidus (LM) and transversus abdominis (TrA) muscle activation assessed using rehabilitative ultrasound imaging (RUSI).

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Volunteers with current low back pain (N=40).

Intervention

Not applicable.

Main Outcome Measures

We examined the relationship between prognostic factors associated with clinical success with a stabilization exercise program (positive prone instability test, age <40y, aberrant movements, straight leg raise >91°, presence of lumbar hypermobility) and degree of TrA and LM muscle activation assessed by RUSI.

Results

Significant univariate relationships were identified between LM muscle activation and the number of prognostic factors present (Pearson correlation coefficient [r] =−.558, P=.001), as well as the individual factors of a positive prone instability test (point biserial correlation coefficient [r_pbis]=.376, P=.018) and segmental hypermobility (r_pbis=.358, P=.025). The multivariate analyses indicated that after controlling for other variables, the addition of the variable “number of prognostic factors present” resulted in a significant increase in R² (P=.006). No significant univariate or multivariate relationships were observed between the prognostic factors and TrA muscle activation.

Conclusions

Decreased LM muscle activation, but not TrA muscle activation, is associated with the presence of factors predictive of clinical success with a stabilization exercise program. Our findings provide researchers and clinicians with evidence regarding the construct validity of the prognostic factors examined in this study, as well as the potential clinical importance of the LM muscle as a target for stabilization exercises.     

急性冠脉综合征住院患者跌倒风险评估及影响因素分析

目的 评估急性冠脉综合征（acute coronary syndrome,ACS）住院患者的跌倒风险并分析其影响因素。方法 基于一项单中心、前瞻性队列研究,选取2015年6月—2020年1月在北京市某三级甲等综合医院的住院ACS患者。由经过培训的主管护师对入组患者采用Morse跌倒评估量表进行评分,依据评分标准将患者分为低危风险组（总分<25分）和中高危风险组（总分≥25分）。采用多元逐步Logistic回归分析其影响因素。结果 共纳入1 732例ACS患者,其中低危风险组患者156例（9.0%）,中高危风险组1 576例（91.0%）。与低危风险组患者比较,中高危风险组使用降糖、心血管疾病相关药物（抗血小板、降压、降脂）的比例更高（P<0.05）;两组的夜间平均血氧饱和度比较,差异具有统计学意义（P=0.019）;低危风险组较中高危风险组,患者接受单次经皮冠状动脉介入治疗、术中旋磨、接受分次经皮冠状动脉介入治疗的比例更高（P<0.05）。多元Logistic回归分析显示,夜间平均血氧饱和度（RR=1.035,95%CI为1.020~1.048,P=0.043）、年龄（RR=1.040,95%CI为1.021~1.059,P<0.001）、高血压病史（RR=3.177,95%CI为2.215~4.557,P<0.001）、心肌梗死病史（RR=1.751,95%CI为1.009~3.037,P=0.046）、糖尿病病史（RR=1.633,95%CI为1.073~2.579,P=0.046）、体重指数（RR=1.064,95%CI为1.011~1.120,P=0.018）均是跌倒中高风险的独立影响因素。结论 在ACS住院患者中,存在跌倒中高风险的患者占比高达91.0%;年龄越大、体重指数越高、既往合并高血压、糖尿病、心肌梗死病史以及夜间平均血氧饱和度越低的患者跌倒风险越高。