老年慢性创面的特点及救治的现状分析

随着我国进入老龄化社会,压力性溃疡、糖尿病溃疡、静脉性溃疡等老年慢性创面日趋增多,病因复杂,治疗难度大,给临床医师带来了巨大的挑战。本文从老年慢性创面形成的特点、原因、预防以及治疗等几个方面阐明慢性创面的防治理念。老年慢性创面重在预防,积极治疗原发疾病的同时,采用个体化、多学科合作的综合治疗方案,从而降低老年慢性创面患者的发病率和死亡率,提高治愈率。     

老年高血压病的特点及心理护理

老年高血压在发病机制、临床表现、治疗与预后等方面具有某些特殊性.老年高血压的防治日益受到重视.因此,对老年高血压病人护理不仅要从疾病观察、症状治疗护理、针对老年高血压患者的不同心理特点实施不同的护理方式已成为防治老年高血压工作中一个重要环节.现将护理体会报道如下:     

老年人嵌顿性和绞窄性腹股沟疝的围手术期处理

老年人嵌顿性或绞窄性腹股沟疝是老年外科急腹症的常见病因。老年患者因其自身并存慢性疾病多,机体重要脏器代偿功能差,对疾病反应能力减弱,因此,老年人嵌顿性和绞窄性腹股沟疝患者易发生术后并发症,致使病情危重,甚至死亡。所以,对老年人嵌顿性或绞窄性腹股沟疝强调及时诊断,早期手术,同时应重视术前准备,术中监测及术后支持治疗等围手术期处理,以保证患者顺利康复。     

中国老年烧伤患者流行病学研究现状分析

现代医疗技术的不断发展,使得烧伤患者的病死率逐渐降低,但老年烧伤患者救治难度依然较大,病死率相对较高。流行病学研究对烧伤防治有重要意义,本文从老年烧伤患者年龄构成、性别分布、受伤场所、受伤季节、烧伤原因、烧伤严重程度、合并吸入性损伤情况、伤前基础疾病情况、院前急救情况、病死率及其影响因素等方面就目前我国老年烧伤患者流行病学研究文献进行综述,旨在了解老年烧伤患者的流行病学特点,为制定有效的老年烧伤防治策略,进而降低老年烧伤的发病率和病死率提供理论依据。     

老年冠心病人脑循环动力学的改变

目的：心脑血管疾病在当今疾病死亡率中占第一位,如何早期防治,减少死亡率,对其相应研究内容非常之多。本文侧重研究心功能基本正常的老年冠心病患者,其脑循环动力学的改变。方法：６０例老年冠心病患者及６８例正常对照组间的心功能参数及脑循环动力参数的比较。结果：本组冠心病患者心功能８个指标中,唯有主动脉内径减小有显著性差异外,余项均在正常范围内。但脑循环动力参数已有显著性改变。主要表现在颈内动脉最大血流速、最小血流速均减小、颈内动脉直径减小、搏动指数、阻力指数均增高。脑血管阻力、特性阻抗增高。脑血管功能已受到明显损害。提示早期防治脑血管疾病的重要性。结论：虽然老年冠心病人没有任何脑部症状和体征,但他们的脑血管功能早已发生变化。因此,对冠心病人早期防治脑血管疾患,减少脑血管疾病对病人带来的危害是十分重要的。     

老年人嵌顿性和绞窄性腹股淘疝的围手术期处理

老年人嵌顿性或绞窄性腹股沟疝是老年外科急腹症的常见病因。老年患者因其自身并存慢性疾病多，机体重要脏器代偿功能差，对疾病反应能力减弱．因此，老年人嵌顿性和绞窄性腹股沟疝患者易发生求后并发症，致使病情危重，甚至死亡。所以，对老年人嵌顿性或绞窄性腹股沟疝强调及时诊断，早期手术，同时应重视求前准备，求中监测及求后支持治疗等围手术期处理，以保证患者顺利康复。     

腹部外科老年患者常见合并症的围手术期处理

随着中国人口的老龄化的进程,腹部外科手术患者中高龄化现象十分明显。对老年患者而言,年龄已不再是腹部外科手术的障碍,但手术治疗的风险依然较大。除了老年患者耐受力较差以外,合并症多是重要影响因素。本文将结合近年相关领域研究及实际临床工作经验对合并高血压、冠状动脉粥样硬化性心脏病、慢性阻塞性肺疾病及糖尿病的老年腹部外科患者的围手术期处理进行综述。     

脑梗死患者院内获得性压力性损伤的影响因素及预防措施分析

目的探讨脑梗死患者院内获得性压力性损伤的影响因素及预防措施。方法回顾性分析2016年7月至2019年12月我院就诊的242例脑梗死患者临床资料,分析脑梗死患者院内获得性压力性损伤相关影响因素。结果 242例脑梗死患者中出现院内获得性压力性损伤21例(8.68%);住院时间≥10d、发热、瘫痪、贫血、大小便失禁、空腹血糖6.1mmol/L是脑梗死患者出现院内获得性压力性损伤的独立危险因素(P0.05且OR≥1);营养支持、使用预防性敷料是脑梗死患者出现院内获得性压力性损伤的保护因素(P0.05且OR≥1)。结论脑梗死患者发生院内获得性压力性损伤是多种因素共同作用结果,临床需针对各种危险因素加强预防措施,尽可能的减少压力性损伤发生。     

探讨老年患者浸渍性皮肤损伤的原因及全面性护理

目的：探讨NCU老年患者浸渍性皮肤损伤的全面性护理。方法总结分析92例老年患者发生浸渍性皮肤损伤的原因并采取相应的护理对策。结果92例患者浸渍性皮肤损伤者治愈60例，好转32例。结论做好入院评估，有预见性的护理，早期发现，采取相应的护理对策，是浸渍性皮肤损伤患者全面性护理的主要环节。     

住院老年冠心病患者健康教育及其效果评价

目的分析健康讲座对于老年冠心病（CHD）患者掌握CHD防治知识、提高治疗依从性的效果。方法入选127例老年CHD患者，在规范化药物治疗的基础上开展健康讲座。进行健康讲座前评估及出院前评估患者对CHD防治知识的掌握程度，评价健康讲座效果。数据资料应用Excel软件建立数据库，SPSS11．5软件进行数据分析。结果通过健康讲座，使94．5％的老年cHD患者掌握了cHD的规范用药，93．7％的患者掌握了cHD发病时自我救护的知识和方法。92．1％的患者认识到CHD患者定期复查的重要性，85％以上的患者掌握了CHD的原因、危险因素、主要症状、治疗方法、H日常保健知识及随诊复查的指标。出院1个月后随诊，92．9％的患者进行了门诊复诊，95．3％的患者规律服药。结论针对老年CHD患者的健康讲座，能够提高患者在CHD防治过程中的主观能动性，达到预防疾病、促进健康的作用，减少疾病的复发率和再住院率。     

Antihypertensive treatment with cerebral hemodynamics monitoring by ultrasonography in elderly hypertensives without a history of stroke may prevent or slow down cognitive decline. A pending issue

The role of the antihypertensive therapy in preventing cognitive disorders in elderly persons without a history of stroke is still a matter of debate. This article focuses on the pathogenesis of vascular cognitive disorders in hypertension and on the impact of antihypertensive treatment in their prevention. Cerebral white matter lesions, caused by small vessel disease and cerebral hypoperfusion, have been found in the majority of elderly hypertensives. They correlate with cognitive disorders, particularly impairments of attention and executive functions. Excessive blood pressure lowering in elderly patients with long-standing hypertension below a certain critical level, may increase the risk of further cerebral hypoperfusion because of disrupted cerebral blood flow autoregulation. As a result, worsening of the cognitive functions could occur, especially in cases with additional vascular risk factors. Five randomized, placebo-controlled trials have focused on the efficacy of antihypertensive treatments in preventing cognitive impairments in elderly patients without a prior cerebrovascular disease. Four of them have not found positive effects. We suggest that repeated neuropsychological assessments and ultrasonography for evaluation of carotid atherosclerosis, as well as cerebral hemodynamics monitoring could adjust the antihypertensive therapy with the aim to decrease the risk of cerebral hypoperfusion and prevent or slow down cognitive decline in elderly hypertensives. Prospective studies are needed to confirm such a treatment strategy.     

National consensus on geriatric immunization 2011

As the growth of elderly population increases, the number of geriatric patients who may demand health care services is also increasing since the elderly are more vulnerable to various conditions of acute illnesses. Upper respiratory tract infections are the leading cause of death and the most significant cause that impairs quality of life in the elderly. Upper respiratory tract infections and influenza are common in the elderly and may develop into pneumonia. Considering the high morbidity and mortality rates related to pneumonia in the elderly, it is important to have prevention strategies. A delay in diagnosis due to non-specific signs and symptoms of pneumonia in the elderly has demanded greater concern on the importance of pneumonia prevention strategies. Influenza and pneumonia impair quality of life in the elderly, resulted in decreased functional status (ADL scores) during infection and recovery period. With increasing antibiotic resistance, the management may be complicated as it may lead to conditions that reduce quality of life and cause high mortality rate. Therefore, immunization is very important as the prevention strategy against influenza and or pneumonia, reducing the incidence as well as the complication. The consensus has been made in order to provide immunization against influenza and pneumonia for elderly population in Indonesia. It is expected that by 2025, about 60% of the elderly in Indonesia would have immunization against influenza and 50% of them would have immunization against pneumonia annually.     

老年压疮研究的新进展

随着我国人口老龄化的不断发展,60岁以上的老年人口已经超过2.3亿,老年压疮逐渐成为社会上不可忽视的问题。老年压疮治疗不仅花费高,周期长,而且往往合并多种慢性疾病,不正规及欠缺的治疗往往导致伤口进一步恶化、伤口不愈合等严重的后果。如何预防及治疗压疮是现如今医务工作者及相关护理人员高度关注及亟待解决的问题。本文就近年来关于老年压疮的病因、形成机制、易发部位、预防及治疗方案进行研究,将相关研究的新进展作一综述。     

Evaluation of antidecubitus mattresses

Pressure sores are a current problem in hospitals and care of the elderly, leading to protracted hospital stays and a high care burden. The trauma for the patients is severe, and the cost of pressure sore prevention and treatment, is considerable. Antidecubitus mattresses are used for prevention and in treatment, but they also contribute to the cost of treating pressure sores. The problem highlighted in the review is that the mattresses' effectiveness in preventing and treating pressure sores has not been sufficiently evaluated. When antidecubitus mattresses are evaluated, it is often only with regard to aspects of the interface pressure and the mattresses' ability to redistribute the pressure. The review points out the important observation that, to be able to evaluate the efficacy of the antidecubitus mattress, the mattress's effect on tissue viability needs to be studied. The parameters that ought to be considered when evaluating a support surface are: interface pressure, pressure and blood flow distribution, temperature and humidity in the skin-support surface interface. The authors propose that the effect on tissue viability of external loading can be assessed by simultaneous measurement of the interface pressure and tissue perfusion.     

Oral mucositis in patients with leukaemia following high-dose chemotherapy and autologous haematopoietic stem cells transplantation

Historically, oral mucositis (OM) has been identified as a symptom developing in patients undergoing irradiation due to head and neck cancers, those undergoing therapy in preparation for a stem cell transplant, or receiving special therapeutic protocols due to acute myeloid leukaemia. It results from direct toxic injury to the mucosal epithelial cells by the immunosuppressive regimen. In this article we want to describe pathogenesis, diagnostic and actual possibility of treatment of OM. The literature reports several rating scale for OM that have been used for patients undergoing cancer therapy. The most useful of them are Oral Toxicity Scale and Oral Mucositis Assessment Scale. In the prevention and treatment of OM associated with standard chemotherapy various drugs and agents acting locally and systemically are used. Many of them are still remaining in the course of research.     

Spinal and supraspinal adaptations associated with balance training and their functional relevance

Traditionally, balance training has been used to rehabilitate ankle injuries and postural deficits. Prospective studies have shown preventive effects with respect to ankle and knee joint injuries. Presently, balance training is not only applied for rehabilitation and prevention but also for improving motor performance, especially muscle power. The recent application of noninvasive electrophysiological and brain imaging techniques revealed insights into the central control of posture and the adaptations induced by balance training. This information is important for our understanding of the basic control and adaptation mechanisms and to conceptualize appropriate training programmes for athletes, elderly people and patients. The present review presents neurophysiological adaptations induced by balance training and their influence on motor behaviour. It emphasizes the plasticity of the sensorimotor system, particularly the spinal and supraspinal structures. The relevance of balance training is highlighted with respect to athletic performance, postural control within elderly people as well as injury prevention and rehabilitation.     

Allogeneic hematopoietic cell transplantation as treatment for hematological malignancies: a review

Allogeneic hematopoietic cell transplantation (HCT) was originally developed as a form of rescue from high-dose chemoradiotherapy, which is given both to eradicate malignancy and provide sufficient immunosuppression for allogeneic engraftment. The first attempts of allogeneic HCT in humans met with little success. However, a better understanding of the complexities of the human leukocyte antigen (HLA) system has allowed selecting compatible sibling donors, and the development of postgrafting immunosuppressive regimens has helped prevent serious graft-versus-host disease, thereby changing the role of allogeneic HCT from a desperate therapeutic maneuver to a curative treatment modality for many patients with malignant hematological diseases. In addition, the establishment of large registries of HLA-typed volunteers has permitted finding suitable unrelated donors for many patients without family donors. Further advances in the immunogenetics of HLA, especially typing by molecular techniques, have improved results after unrelated HCT, which have begun resembling those obtained with HLA-identical sibling grafts, at least in young patients. Important advances have also been made in the prevention and treatment of infectious complications and in other areas of supportive care. Since the late seventies, it has been recognized that allogeneic immunocompetent cells transplanted with the stem cells, or arising from them, mediated therapeutic anti-tumor effects independent of the action of the high-dose therapy, termed graft-versus-tumor (GVT) effects. This has prompted the recent development of non-myeloablative conditioning regimens for allogeneic HCT that have opened the way to include elderly patients and those with comorbid conditions. Remaining challenges include further advances in the prevention and treatment of both severe graft-versus-host disease and infections. Also, progress in adoptive transfer of T cells with relative tumor specificity and disease-targeted therapy with agents such as Imatinib, Rituximab or radiolabeled monoclonal antibodies would make allogeneic HCT even more effective.     

Blood pressure in the elderly

The distribution of blood pressure levels in elderly patients is described and the evidence that higher levels are associated with morbidity at this age is reviewed. In the absence of definitive evidence about the results of treating hypertension in the elderly, the physiological factors that have to be taken into account are surveyed with particular reference to aggravating cerebral ischaemia.

More potent hypotensive agents should be avoided in older patients and in practice the decision on whether to treat may depend more on the clinical context than on the level of the blood pressure itself.

     

2005年至2016年上海交通大学医学院附属瑞金医院老年严重烧伤特点分析

目的通过对老年严重烧伤患者特点回顾性研究,探讨老年严重烧伤流行病学特征,为未来烧伤学科在老年严重烧伤治疗领域提供较为详实的依据。 方法回顾性分析2005年1月1日至2016年12月31日入住上海交通大学医学院附属瑞金医院灼伤整形科的年龄≥60岁、烧伤总面积大于30%总体表面积(TBSA)的老年严重烧伤患者住院病史信息,收录信息包括患者入院日期、年龄、性别、烧伤面积和Ⅲ度烧伤面积、烧伤原因、受伤场所、合并伤前疾病、烧伤后并发症、合并吸入性损伤、生存患者重症加强护理病房(ICU)留治时间及治疗结果。对数据行重复测量方差分析、单因素方差分析、独立样本t检验、秩和检验、χ²检验、Fisher确切概率检验、二项分布检验,生存患者和病死患者对比有差异的因素(年龄、烧伤面积、Ⅲ度烧伤面积、吸入性损伤、存在伤后并发症)行单因素及多因素Cox回归分析。 结果本研究共收录老年严重烧伤患者73例,老年严重烧伤患者发病率从2005年2.7%上升到2017年17.8%,呈显著上升趋势,差异有统计学意义(χ²＝45.18,P<0.05)。男性患者(65.8%)多于女性患者(34.2%),差异有统计学意义(P＝0.01)。患者年龄分布为61～86岁,年龄中位数为66岁,男、女性患者年龄差异无统计学意义(Z＝－0.22,P＝0.83)。患者平均烧伤面积为(53.9±20.9)%TBSA,Ⅲ度烧伤面积中位数0。不同烧伤严重程度患者性别、年龄、烧伤原因比较,差异均无统计学意义(P值均大于0.05);特重度烧伤患者合并吸入性损伤例数、生存患者ICU留治时间、病死例数均多于重度烧伤患者,差异均有统计学意义(P值均小于0.05)。特重度烧伤患者中工作场所烧伤占比高。患者烧伤原因以火焰烧伤为主(79.5%),受伤场所以家庭为主(57.5%),其次为工作场所(31.5%)。患者伤前明确诊断疾病主要有心血管疾病32例(43.8%)、神经系统疾病7例(9.6%)、糖尿病5例(6.8%)、呼吸系统疾病5例(6.8%)。患者烧伤后并发症主要为创面感染31例(42.5%)、多器官功能障碍综合征8例(11.0%)、肺部感染8例(11.0%)。合并吸入性损伤11例(15.1%),生存患者ICU留治时间中位数为12 d。患者病死率为32.9%,烧伤总面积、Ⅲ度烧伤面积是影响老年严重烧伤患者病死的危险因素,Ⅲ度烧伤面积是影响老年严重烧伤患者病死的独立危险因素(HR为1.024, 95%CI为1.006～1.041,P＝0.008)。 结论随着社会老龄化,老年严重烧伤发病率显著增高,老年患者家庭烧伤占比高,应积极制定老年烧伤特别是家庭预防策略,切实降低发病率及减小烧伤面积、提高治愈率,建立有效烧伤康复体系改善患者愈后生存质量。