Health-related quality of life in patients over sixty years old with benign paroxysmal positional vertigo

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness within the geriatric population causing disability. The diagnosis is established by the position-induced rotatory nystagmus, related to the involved ear, demonstrated by the Dix-Hallpike test (DHT). Although the Epley's modified manoeuvre, or particle respositioning manoeuvre (PRM), is an effective treatment for this disorder, its impact on health outcome in patients over 60 years old is unknown. OBJECTIVE: To assess BPPV health-related quality of life in elderly individuals using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Dizziness Handicap Inventory Short Form (DHI-S). METHODS: A prospective study including new cases of BPPV in patients older than 60 years was carried out. The diagnosis was based on the history of recurrent sudden crises of vertigo and a typical positional-induced nystagmus during the DHT. All patients were treated by a single PRM and relapses were investigated a the 30th post-treatment day. RESULTS: DHT was found negative in 82% (23/28) individuals at 30 days. The eight scales of the SF-36 have a good internal consistency reliability in patients with BPPV (Cronbach's alpha > 0.7). The average standardized score for each SF-36 scale was compared with the reference population normative data, showing differences with norms for role physical, body pain, social function, role emotional and mental health. After PRM, patients restored scores to norms, showing a significant increase in role physical (p < 0.05), body pain (p < 0.04), vitality (p < 0.02), social function (p < 0.003) and mental health scores (p < 0.005). DHI-S total score significantly decreased from 17.19 +/- 9.06 (mean +/- SD) at the first day to 9.70 +/- 10.13 at 30 days (p < 0.001). CONCLUSIONS: BPPV has a significant impact on health-related quality of life in elderly patients on their emotional and physical states compared to those unaffected. The PRM can restore health-related quality of life in elderly patients with BPPV.     

60岁以上老年原发性高血压的动态血压监测

目的　探讨 60岁以上老年原发性高血压的特点。方法使用无锡市中健科仪有限公司的 CB-2 30 0型动态心电血压分析系统监测仪 ,对 60例老年原发性高血压患者及 30例健康老年对照组进行 2 4h动态血压监测 ,日间血压每 30 min、夜间血压每 60 m in记录 1次 ,对各种参数进行对比分析。结果　 2 4h、日间、夜间的收缩压、舒张压和血压负荷值等参数 ,老年高血压组明显高于老年对照组、高血压组与对照组间比较收缩压和血压负荷值有较大差异。夜间血压下降率均≥ 10 %。结论　 2 4h、日间、夜间的收缩压、舒张压及血压负荷值等参数是诊断高血压较重要的指标。老年高血压患者与健康人一样具有血压昼夜节律变化     

Bladder cancer in patients over 80 years old

We studied 86 patients with bladder cancer who were 80 years old and over. All were studied at the time of their first presentation for treatment in our hospital. About 40% of then were somewhat limited in performing usual daily activities before the first treatment, and they could not come to the hospital by themselves. Tumors in patients were larger, of higher grade and more invasive than those in younger patients. Transurethral resection of the bladder tumor (TUR-Bt) was done in 94% of patients with a superficial tumor and in 56% of those an invasive tumor. The recurrence rates after TUR-Bt for superficial tumor were 48%, 64% and 89% in 1 year, 3 years and 5 years, respectively. Recurrence rates were significantly different in younger patients. Overall cancer related survival rates were 86%, 60%, and 56% in 1 year, 3 years and 5 years, respectively. The outcome were significantly worse in patients over 80 years old than in those under 79 years old. To improve the outcome of treatment for bladder cancer in patients over 80 years old, cooperation among doctors, patients and families was important.     

75岁以上老年冠心病患者的介入治疗及疗效观察

目的探讨老年冠心病介入治疗特点和近、远期疗效。方法回顾性分析2001年4月至2004年4月间519例行经皮冠状动脉(冠脉)介入治疗的患者,统计老年组(≥75岁)和年轻组(≤60岁)的临床及冠脉病变特点,即刻手术成功率和近、远期主要不良心脏事件。结果老年组(81例)合并高血压病、心功能、肺功能、肾功能减退及脑血管病的比例高于年轻组(196例)。老年组多见冠脉多支病变(46.9%比15.3%,P<0.01)和复杂病变(67.3%比44.6%,P<0.01)。老年组即刻治疗成功率92.5%(99/107)。年轻组即刻治疗成功率95.2%(239/251)。住院期间及远期随访严重不良心脏事件老年组均高于年轻组(分别为9.9%比3.6%,P<0.05;34.7%比17.8%,P<0.01)。结论老年冠心病患者常合并多种疾病,冠脉病变严重而复杂,虽然介入治疗即刻成功率与年轻者相仿,但近期及远期主要不良心脏事件发生率高。     

70岁以上患者的冠状动脉旁路移植术

目的分析高龄(＞70岁)患者冠状动脉旁路移植术(CABG)的特点及手术疗效.方法349例高龄CABG患者,男性300例,女性49例.年龄70～83(72.7±2.6)岁.左主干病变66例,多支病变335例,加拿大心绞痛分级(CCS Class)1～3(2.2±0.3)级,NYHA心功能分级为1～4(2.3±0.4)级.脑血管意外和慢性阻塞性肺疾病所占比例与同期＜70岁CABG患者对比有显著性差异.体外循环下CABG手术255例,常温非体外循环下CABG(OPCAB)手术94例,占26.9%.所有患者共移植旁路1170支,升主动脉病变为粥样硬化及明显钙化明显高于＜70岁患者(P＜0.05).随访率88%.随访时间为(3.5±1.9)年.结果早期死亡7例,死亡率为2.01%.死亡原因主要为脑并发症和室颤.死亡率明显高于＜70岁组(0.69%).超声心动图复查,左心室射血分数,左心室舒张末径,CCS Class及NYHA心功能分级与术前相比有统计学显著性差异.NYHA心功能3～4级为独立相关危险因素.3年生存率为96.3%,3年免除心绞痛症状95.5%.结论高龄患者CABG总体效果令人满意,死亡率在可接受的范围,故是一种安全、有效的治疗冠心病的手段;减少和预防脑并发症和对心功能不全的高龄患者必要的术前准备是减少手术死亡的重要措施.     

The prognosis of dysphagia patients over 100 years old

Several reports have recently been published regarding dysphagia in very elderly patients, and centenarian dysphagia patients have become more common in Japan. The aim of this study was to assess the prognosis of dysphagia in very elderly patients. Participants were 24 centenarian dysphagia patients. For each patient, we collected information on age, care level, past medical history, and changes in oral intake according to the Functional Oral Intake Scale (FOIS). Patients were divided into two groups based on the mode of food intake at the time of transfer or discharge: the per oral-only group (the PO-only group, i.e., oral intake alone) and the tube feeding-dependent group (the TF-dependent group, i.e., combination of oral intake and tube feeding, or tube feeding alone). In both groups, the FOIS score decreased significantly from pre-hospitalization to the time of transfer or discharge (p = 0.006 for both). The FOIS score at initial assessment was higher in the PO-only group with the TF-dependent group (p = 0.0004). Furthermore, the frequency of a FOIS score of 4 at initial assessment was significantly higher in the PO-only group, and the frequency of a FOIS score of 1 was significantly higher in the TF-dependent group (p = 0.0006). These findings collectively suggest that oral intake can be recovered if the FOIS score is ≥4 at initial assessment, is difficult if the score is 1, and may be possible with a FOIS score of 2.     

75岁及以上老年患者冠脉三支病变的危险因素及临床特点

目的分析老年冠脉三支病变患者的危险因素及临床特点。方法连续入选择期冠脉造影的75岁及以上患者192例,根据造影结果分为非冠脉病变组、一支或两支冠脉病变组和三支冠脉病变组。对3组患者基线特征、危险因素以及心功能情况进行比较。结果3组的年龄、尿酸、空腹血糖、甘油三酯、体质指数（BMI）无差异,而性别、低密度脂蛋白胆固醇（LDL—C）、血清肌酐水平及糖尿病患者比例在3组间有差异,男性患者、高LDL—C者、肌酐高者及糖尿病患者冠脉病变趋于严重（趋势检验P值分别为0．003、0．038、0．020、0．024）。随着冠脉病变的加重,患者左室射血分数（LVEF）逐渐降低、氨基末端脑钠素前体（NT—proBNP）和红细胞体积分布宽度（RDW）依次升高（趋势检验P值分别为0．040、0．045、0．045）。同时RDW与LVEF有正相关趋势（r=0．201,P=0．065）;LVEFI〉55％患者的RDW低于LVEF〈55％患者【（13．05±1．29）VS（13．51±1．39）,P=0．044）】,RDW与Log（NT—proBNP）也存在相关性（r=0．340,P=0．020）。结论男性、肾功能不全、糖尿病、高LDL—C等是老年患者三支病变的危险因素。随着冠脉病变数的增加,患者心功能下降、RDW水平升高。     

65岁以上老年患者心脏瓣膜病手术治疗的临床分析

目的 探讨65岁以上老年心脏瓣膜病患者临床手术治疗的方式及经验。资料和方法 我们总结了2017.3-2018.11 89例65岁以上的行瓣膜手术治疗的患者,85例患者在全麻、低温、体外循环下正中切口行手术治疗,3名单纯主动脉病变患者通过胸骨上正中小切口手术治疗。1例患者在DSA下行TAVI术。结果 全组体外循环时间134.48±43.08min,阻断时间817.9±34.70min,术后呼吸机辅助时间17.26±7.28min,术后监护时间54.12±2=19.96min,术后住院10.2±4.8天。围手术期死亡1例（1.1%）。结论 随着我国人口年龄结构的改变,高龄瓣膜病患者逐渐成为我国瓣膜病治疗的主体,也是未来的发展方向,我们通过加强手术技术及脏器保护,能减少高龄患者术后的并发症及促进恢复。同时,我们应该注意发展微创技术,通过新的技术,能更好的处理高龄瓣膜病患者的病变,减少并发症及死亡率。 关键词：高龄 瓣膜病 TAVI 小切口     

80岁以上患者外科急腹症的诊治特点

目的分析≥80岁外科急腹症住院患者的诊治特点。方法将2002年1月1日至2009年12月31日外科急腹症入院治疗的5426例患者按年龄分为≥80岁组和〈80岁组。观察≥80岁急腹症患者人数、所占比例、病种分布、伴发疾病等特点;统计分析手术比率、治疗效果、病死率、住院时间和住院花费。结果我院8年来纳入患者5426例,≥80岁患者420例,数量和所占百分比总体呈逐年增加趋势。患者从症状发作到就诊时间差2h至21d不等。常伴发多种疾病,以呼吸和心血管系统疾病居多。≥80岁组与〈80岁组比较,急诊手术率下降（48．09％比64．19％,P〈0．01）,病死率增加（3．33％比1．38％,P〈0．01）,住院时间延长[（16．76±11．49）d比（14．50±16．08）d,P〈0．01）],人均住院花费增加[（23733．11±30571．75）元比（18530．83±29637．46）元,P〈0．01）]。结论根据t〉80岁患者的发病特点制定个体化诊治方案;在制定卫生经济学政策和医疗保险制度时,注意考虑年龄对住院患者病死率、住院时间和治疗费用的影响。     

Management of colorectal cancer in elderly patients over 80 years old

AIM: The incidence of colorectal cancer is increasing. Surgery and chemotherapy for elderly patients are also increasing. We evaluated the characteristics of elderly colorectal cancer to clarify issues related to surgical therapy for elderly patients. METHOD: We studied 67 patients (38 men, 29 women) over 80 years old on whom we operated for colorectal cancer from 1990 to 2004. We compared them with 130 patients aged from 70 to 74 who were operated on in the same period, examining clinicopathological factors, operative methods, preoperative morbidity, postoperative complications, chemotherapy and postoperative survival ratio. RESULTS: In the elderly patients aged over 80, the rate of Dukes' B was high, whereas the rate of Dukes' A was high in patients aged from 70 to 74. No significant differences were observed in operative methods for colon cancer but Hartmann's operation and transanal local excision were frequent for rectal cancer in patients aged over 80. The rate of lymph node dissection was low in patients aged over 80 with rectal cancer. A significant difference was observed in lymph node dissection of rectal cancer between patients aged over 80 and those aged from 70 to 74, but there was no significant difference in curative ratio. Preoperative morbidity were recognized in 76% of patients aged over 80. Postoperative complications occurred in 51% of patients aged over 80. There were many cases showing delirium, but no differences in other complications between patients aged over 80 and those aged from 70 to 74. There was no operative mortality in patients aged over 80. CONCLUSION: Even elderly patients can anticipate safe operations without postoperative complications or decreased quality of life, if the appropriate operative procedure is selected with regard to their general condition.     

75岁以上尿毒症患者血液透析的临床研究

本文回顾性地研究了１９００例血液透析患者的临床资料，其中≥７５岁的高龄患者２００例，占同期血液透析（ＨＤ）患者的１０．５３％。资料完整者１４６例，平均年龄８０．５岁。ＨＤ１年存活率为３４．２５％，３年存活率为１４．３８％，与同期５０岁以下组比较差异显著（Ｐ〈０．０１）。死亡原因以心衰为首位，坏死性肠炎及脑出血亦不少见。预后与年龄增加、原发病及透析开始的时机有关。随着透析技术的不断完善，长期存活率不     

低氮低热量营养支持方案在90岁以上患者中的应用

目的 探讨低氮低热量营养支持方案在〉90岁患者中应用的可行性。方法 6例患者,年龄91～99岁,中位年龄94岁,接受非蛋白热卡16kcal／（kg·d）,氮0．12（0．11～0．14）g／（kg·d）的营养支持方案。每周复查营养学及生化指标,同时观察不良事件的发生率。结果 6例患者经过营养支持治疗1月后,营养学指标及肝肾功能与治疗初始比较差异均无统计学意义（P〉O．05）。无明显不良事件发生。结论 低氮低热量营养支持方案在〉90岁患者中应用安全可行。