健康老年人及老年冠心病患者心率变异的短期重复性研究

目的:观察健康老年人及病情稳定的老年冠心病患者在相隔4～8周的心率变异性(HRV)参数的重复性,评价其临床使用的可靠性。方法:21例健康老年人和37例病情稳定的老年冠心病患者分别相隔4～8周进行二次动态心电图检查,微机自动分析出HRV的时域指标。结果:两组受试者自身前后两次HRV参数比较均无统计学意义(P>0.05),其中SDNN、SDANNin和SDNNin的相关系数r在0.85～0.91之间,呈高度显著相关,rMSSD和PNN50的r为0.62～0.80,相关程度稍差。两次HRV的各项参数的变异系数(CV)值的差异也无统计学意义。结论:健康老年人和病情稳定的老年冠心病患者短期内HRV参数有较好的重复性,可做为临床评价疗效和预后的方法之一。     

Healthy Eating: How Do We Define It and Measure It? What's the Evidence?

A healthy diet can be defined in many ways, including defining one’s food intake by a dietary pattern. As described in the Dietary Guidelines for Americans Committee report, there are several defined dietary patterns associated with lower rates of chronic diseases. These include the Healthy Eating Index, Dietary Approach to Stop Hypertension, and those based on the Mediterranean diet. This review will focus on guiding health care professionals, including nurse practitioners, how a healthy diet pattern is defined, how it is measured, and a summary of recent evidence supporting the healthfulness of these dietary patterns.     

老年人食管癌贲门癌合并心肺疾患的围手术期处理

目的：为了提高老年人食管癌、贲门癌合并心肺疾患的手术疗效，探讨老年人食管癌、贲门癌合并心肺疾患的围手术期处理。方法：回顾分析87例老年人食管癌、贲门癌合并心肺疾患的病例。结果：本组术后15例发生严重心肺并发症，6例死亡。结论：正确评估心肺功能．严格掌握手术适应证，认真做好围手术期的处理对老年患者的预后有重要意义。     

心脏急诊病种变化及护理对策

目的 通过对比1992和2001年的急诊就诊患者情况，了解心脏急诊患者就诊特点与规律的变化，指导我们的护理工作。方法 病例选自1992和2001年2年急诊心内科就诊的全部患者。以描述法着重分析人口学资料，就诊人数和时间的关系以及主要疾病的构成比，并进行对比。结果 2年比较就诊人数明显增加，高发年龄，2年均为60～69岁年龄组。冠心病、高血压、心律失常均为2年患者的主要就诊人群。风湿性心脏病的构成比明显下降。就诊高峰为9：00～11：00，19：00～21：00。结论 对心脏急诊患者就诊分析不但可以为医疗工作提供有价值的资料和可靠的依据，也可为护理工作提供很好的指导，进行有针对性的管理，对提高护理质量，制定与时俱进的护理对策有重要的指导意义。     

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings

ContextThe Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest.ObjectivesTo crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer.MethodsA cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested.ResultsThe CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74–0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33–0.36, respectively).ConclusionThe study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.     

Hospice and Heart Disease: Missed Opportunities

ABSTRACT

A relatively low percentage of eligible heart disease patients receive hospice care in the United States. In 2005, the most recent year with complete reporting, only 18.36% of patients who were dying of heart failure and were hospice eligible actually received hospice care. Reasons for this include the lack of reliable prognostic indicators, the lack of a consensus on when to stop life prolonging therapies, and the relatively high cost of life-prolonging (versus life-enhancing) pharmacotherapy such as dobutamine. In addition, most studies and case reports that address symptom management in hospice care focus on cancer patients, not those with nononcologic diagnoses. This lack of evidence may discourage practitioners who care for cardiac patients from referral to hospice programs, and may keep some hospice practitioners from aggressively targeting this population. Strategies to increase hospice program utilization by heart disease patients are discussed.     

老年心血管患者拔牙中血压、心率及血氧饱和度监测的意义

目的：评价老年心血管病患者在拔牙中监测血压、心率、血氧饱和度临床意义。方法：对205例老年拨牙患者分成心血管病组和非心血管病组，拨牙中分别进行心电监护，观测术前、术中及术后心率、血压、血氧饱和度的变化，并比较两组的差别。结果：所有患者的血压、心率、血氧饱和度3项指标在围拔牙期均发生变化，拔牙术中血压升高，心率加快，血氧饱和度下降；心血管病组患者的变化更明显，与非心血管组患者相比较，有显著差别（P＜0．05）。结论：老年心血管病患者在拔牙过程中监测血压、心率、血氧饱和度的变化有利于提高拔牙手术的安全性。     

Heart valve disease: investigation by cardiovascular magnetic resonance

Cardiovascular magnetic resonance (CMR) has become a valuable investigative tool in many areas of cardiac medicine. Its value in heart valve disease is less well appreciated however, particularly as echocardiography is a powerful and widely available technique in valve disease. This review highlights the added value that CMR can bring in valve disease, complementing echocardiography in many areas, but it has also become the first-line investigation in some, such as pulmonary valve disease and assessing the right ventricle. CMR has many advantages, including the ability to image in any plane, which allows full visualisation of valves and their inflow/outflow tracts, direct measurement of valve area (particularly for stenotic valves), and characterisation of the associated great vessel anatomy (e.g. the aortic root and arch in aortic valve disease). A particular strength is the ability to quantify flow, which allows accurate measurement of regurgitation, cardiac shunt volumes/ratios and differential flow volumes (e.g. left and right pulmonary arteries). Quantification of ventricular volumes and mass is vital for determining the impact of valve disease on the heart, and CMR is the 'Gold standard' for this. Limitations of the technique include partial volume effects due to image slice thickness, and a low ability to identify small, highly mobile objects (such as vegetations) due to the need to acquire images over several cardiac cycles. The review examines the advantages and disadvantages of each imaging aspect in detail, and considers how CMR can be used optimally for each valve lesion.