异丙酚和咪唑安定用于老年肿瘤病人全麻诱导的临床观察

目的　观察异丙酚和咪唑安定这二种药物用于老年肿瘤病人全麻诱导时的血液动力学的变化。方法　 40例ASAⅠ～Ⅱ级老年患者随机分成异丙酚组 (Ⅰ组 )和咪唑安定组 (Ⅱ组 ) ,分别静注异丙酚 2mg kg和咪唑安定 0 2mg kg ,入睡后静注芬太尼 0 2mg、氯化琥珀胆碱 10 0mg后气管插管并静注维库溴铵 0 1mg kg ,记录诱导前后的SBP、DBP、MAP、HR等参数。结果　插管后 5min时Ⅰ组HR较诱导前明显减慢 ,Ⅱ组病人无明显变化。诱导后Ⅰ组MAP降幅达 2 7 6% ,Ⅱ组MAP降幅为 11 1% ,两组间有显著差异。结论　与异丙酚相比 ,咪唑安定具有不良反应小、对血流动力学影响轻微等特点 ,更适合于年老体弱、心功能不全或合并传导功能障碍病人的全麻诱导。     

食管癌切除异丙酚全麻诱导的临床观察

对异丙酚全麻诱导前后术中的BP、HR、SpO2 的变化和术毕自主呼吸恢复及拨管时间进行观察分析。选择食管癌切除 5 0例 ,其中A组 30例为对照组 ,B组 2 0例为实验组。A组用硫喷妥钠4mg/kg ,琥珀胆硷 2mg/kg ,B组用异丙酚 2mg/kg ,琥珀胆硷 2mg/kg ,快速诱导插管进行对照观察。术毕自主呼吸恢复及拔管时间B组较A组快 (P <0 0 5 )。异丙酚用于全麻诱导镇静确切、速效 ,速醒作用明显且有短暂血压下降作用 ,所以插管操作一般不引起血压波动     

食管癌切除异丙酚全麻诱导的临床观察

对异丙酚全麻诱导前后术中的BP、HR、SpO2的变化和术毕自主呼吸恢复及拨管时间进行观察分析，选择食管癌切除50例，其中A组30例为对照组，B组20例为实验组。A组用硫喷妥钠4mg/kg,琥碧胆脸2mg/kg,B组用异丙酚2mg/kg，琥珀胆硷2mg/kg，快速诱导插管进行对照观察。术毕自主呼吸恢复及拔管时间B组较A组快（P＜0．05）。异丙酚用于全麻诱导镇静确切、速效、速醒作用明显且有短暂血压下降作用，所以插管操作一般不引起血压波动。     

异丙酚和咪唑安定用于老年肿瘤病人全麻诱导的临床观察

目的 观察异丙酚和咪唑安定这二种药物用于老年肿瘤病人全麻诱导时的血液动力学的变化。方法 40例ASAⅠ-Ⅱ级老年患者随机分成异丙酚组（Ⅰ组）和咪唑安定组（Ⅱ组），分别静注异丙酚2mg/kg和咪唑安定0.2mg/kg，入睡后静注芬太尼0.2mg，氯化琥珀胆碱100mg后气管插管并静注维库溴铵0.1mg/kg，记录诱导前后的SBP，DBP，MAP，HR等参数。结果 插管后5min时Ⅰ组HR较诱导前明显减慢，Ⅱ组病人无明显变化，诱导后Ⅰ组MAP降幅达27.6,Ⅱ组MAP降幅为11.1%，两组间有显著差异。结论 与异丙酚相比，咪唑安定具有不良反应小，对血流动力学影响轻微等特点，更适合于年老体弱，心功能不全或合并传导功能障碍病人的全麻诱导。     

异丙酚、咪唑安定用于全麻诱导时对血流动力学影响比较

目的　比较异丙酚及咪唑安定用于全麻诱导时对血流动力学的影响。方法　 48例病人随机分成 2组 (Ⅰ组 2 3例 ,Ⅱ组 2 5例 ) ,麻醉诱导药物分别为 :2mg/kg异丙酚 (I组 )和 0 2mg/kg咪唑安定 (Ⅱ组 )。肌松完全后行气管插管。分别记录诱导前、诱导后、插管即刻及插管后 1min、3min、5min、10min时收缩压、舒张压及心率。结果　诱导后两组患者SBP及DBP均显著降低 ,气管插管后即刻以及 1min时Ⅱ组SBP和DBP升高 ,其中插管后即刻尚伴HR的升高 ,插管后 5min、10min时两组HR均降低 ,10min时Ⅰ组DBP升高 ,Ⅱ组SBP则仍明显下降。结论　咪唑安定诱导对循环功能抑制较平稳且持久 ,但对气管插管应激反应抑制作用较弱 ,异丙酚诱导对插管应激反应抑制较佳 ,但由于其进一步损害循环功能 ,对循环功能不全者应慎用或不用     

异丙酚、咪唑安定用于全麻诱导时对血流动力学影响比较

目的 比较异丙酚及咪唑安定用于全麻诱导时对血流动力学的影响。方法 48例病人随机分成2组（I组23例，Ⅱ组25例），麻醉诱导药物分别为:2mg/kg异丙酚（I组）和0.2mg/kg咪唑安定（Ⅱ组），肌松完全后行气管插管。分别记录诱导前、诱导后、插管即刻及插管后1min、3min、5min、10min时收缩压、舒张压及心率。结果 诱导后两组患者SBP及DBP均显著降低，气管插管后即刻以及1min时Ⅱ级SBP和DBP升高，其中插管后即刻尚伴HR的升高，插管后5min、10min时两组HR均降低，10min时I组DBP升高，Ⅱ组SBP则仍明显下降。结论 咪啶安定诱导对循环功能抑制较平稳且持久，但对气管插管应激反应抑制作用较弱，异丙酚诱导对插管应激反应抑制较佳，但由于其进一步损害循环功能，对循环功能不全者应慎用或不用。     

咪唑安定用于老年肿瘤病人全麻诱导的临床观察

目的 探讨咪唑安定用于老年肿瘤病人在全麻诱导对循环功能的影响。方法 选择普胸手术４０例，按年龄分为老年组（１组）２０例，中青年组（２组）２０例。麻醉诱导时静注咪唑安定０．２ｍｇ／ｋｇ，观察诱导期间收缩压（ＳＢＰ）、舒张压（ＤＢＰ）、平均动脉压（ＭＡＰ）、心率（ＨＲ）的变化。结果 诱导后两组病人的ＳＢＰ、ＤＢＰ、ＭＡＰ降低，１组更明显（Ｐ〈０．０５）。插管后两组ＳＢＰ均回升（Ｐ〈０．０５），２组的ＤＢＰ、ＭＡＰ有更明显的升高（Ｐ〈０．０１）。整个诱导期间两组病例的ＨＲ变化不大。结论 咪唑安定麻醉效果强，起效快，适宜于全麻诱导，在老年病人诱导插管中能有效地抑制心血管反应，对老年病人可以安全地使用。     

阈下氯胺酮伍合异丙酚在肿瘤病人全麻诱导期对心血管系统的影响

目的：评估预注氯胺酮预防异丙酚在肿瘤病人全麻诱导插管期所致血压下降的作用。方法;２６例肿瘤择期手术全麻病人,随机分为Ｐ组和Ｋ＋Ｐ组各１３例,分别用工分太尼３μｇ／ｋｇ、异丙酚２ｍｇ／ｋｇ及氯胺酮０．８ｍｇ／ｋｇ,芬太尼３μｇ／ｋｇ,划丙酚２ｍｇ／ｋｇ,异丙酚２ｍｇ／ｋｇ行全麻诱导。比较两组病例在诱导前后及气管插管后收缩压（ＳＢＰ）、平均动脉压（ＭＡＰ）、舒张压（ＤＢＰ）和心率（ＨＲ）的变化。结果：     

力月西、惜 内酚和依托咪酯用于全麻诱导的临床观察

目的探讨力月西、异丙酚和依托咪酯全麻诱导与气管插管对血流动力学的影响.方法60例择期上腹部肿瘤手术患者随意分三组.A组全麻诱导;力月西0.2mg·kg-1.B组全麻诱导异丙酚2mg·kg-1.C组全麻诱导依托咪酯0.3mg·kg-1.连续观察监测麻醉前、麻醉诱导给药前,插管后1min、插管后5min时MAP和HR变化,并记录麻醉诱导起效时间和并发症.结果A组全麻诱导对血流动力学影响平稳,起效慢于B、C组.B组全麻诱导对循环有一过性抑制,苏醒时间快.C组全麻诱导平稳但可引起注射部位疼痛和肌颤.结论力月西全麻诱导对血流动力学影响很少,比较适合于心脏功能储备差的患者全麻诱导气管插管.     

Cognitive dysfunctions in elderly cancer patients: A new challenge for oncologists

While chemotherapy is more commonly proposed to the elderly population with cancer, little is known about the impact of therapy on cognitive functions and the way of managing such dysfunctions in clinical practice among this population. Aging by itself is associated with cognitive modifications, comorbidities and functional decline, which may have a significant impact on the autonomy. In elderly patients with cancer, several factors like the biologic processes underlying the disease and therapies will contribute to favor the cognitive decline. The chemobrain phenomenon, referring to the chemotherapy-induced impairment of memory, executive function or information processing speed has been extensively described in patients with breast cancer, and the few studies available in older patients suggest that the impact could be more pronounced in patients with pre-existing troubles.     

GC方案作为诱导方案治疗老年局部晚期非小细胞肺癌的临床观察

目的:评价吉西他滨联合卡铂在老年不可手术的局部晚期非小细胞肺癌(non-small cell lung canc-er,NSCLC)作为诱导方案的疗效和安全性。方法:对于有明确的病理或细胞学诊断,年龄在65-75岁的晚期不可手术的NSCLC患者78例,应用GEM联合CBP化疗,GEM1000mg/m2静脉滴入第1、8天,CBP AUC为4,在第1天给药。21d为1个周期,共2个周期。并按RECIST标准评价疗效和WHO不良反应分级标准记录不良反应。结果:可评价的78例患者,共完成156个周期化疗,CR 0例,PR 32例,NC 37例,PD 9例,总有效率为41.0%。主要不良反应为骨髓抑制和消化道反应。结论:GEM联合CBP作为老年不可手术的晚期NSCLC诱导治疗是安全有效的,不良反应可以接受。     

GC方案作为诱导方案治疗老年局部晚期非小细胞肺癌的临床观察

目的：评价吉西他滨联合卡铂在老年不可手术的局部晚期非小细胞肺癌（non-small cell lung canc-er,NSCLC）作为诱导方案的疗效和安全性。方法：对于有明确的病理或细胞学诊断,年龄在65-75岁的晚期不可手术的NSCLC患者78例,应用GEM联合CBP化疗,GEM1000mg/m2静脉滴入第1、8天,CBP AUC为4,在第1天给药。21d为1个周期,共2个周期。并按RECIST标准评价疗效和WHO不良反应分级标准记录不良反应。结果：可评价的78例患者,共完成156个周期化疗,CR 0例,PR 32例,NC 37例,PD 9例,总有效率为41.0%。主要不良反应为骨髓抑制和消化道反应。结论：GEM联合CBP作为老年不可手术的晚期NSCLC诱导治疗是安全有效的,不良反应可以接受。     

Physical activity interventions in the elderly: cancer and comorbidity

The relationships among age, comorbidity, and physical activity have been relatively understudied among breast, colorectal, and prostate cancer populations despite their known impact on morbidity and mortality. In this article, we review evidence supporting the efficacy of physical activity interventions in improving cardiovascular risk groups, the elderly and cancer patients. Preliminary studies conducted with older patients suggest that physical activity interventions can reduce fatigue, elevate mood, improve physical functioning, reduce physical role limitations, decrease falls, attenuate losses in bone density, promote weight loss, and modify CHD risk factors. Although relatively few randomized clinical trials have assessed the efficacy of physical activity interventions in cancer patients, the research suggests that these interventions can have both physical and mental health benefits. The implications and limitations of these findings are discussed. Further studies that use larger sample sizes and examine possible moderating variables, such as age, on the efficacy of such interventions are needed.     

Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery

BACKGROUND: Cancer is a disease that particularly affects the elderly and, although surgery is the first treatment choice, many elderly cancer patients do not receive standard surgery because they are considered unfit for treatment due to an inaccurate estimation of operative risk. Pre-operative Assessment of Cancer in the Elderly (PACE) was developed in order to address the need to provide detailed information about the functional reserve of the elderly cancer patient to aid individualised management. METHODS: PACE incorporates a battery of validated instruments including the Comprehensive Geriatric Assessment (CGA), Brief Fatigue Inventory (BFI), Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and American Society Anesthesiologists (ASA) grade. An international prospective study was conducted with 460 consecutive elderly cancer patients (216 breast, 146 GIT, 71 GUT, 27 other) receiving PACE prior to receiving elective surgery. RESULTS: Three hundred and eighty four patients (83.4%) were observed to have at least one co-morbidity; the most common being hypertension (n=246, 53.5%). More than two thirds of the patients had good functional and mental status according to PACE. After adjusting for age, sex and type of cancer, six of the seven items of PACE were found to be significantly associated with co-morbidities (according to the Satariano's Index of Co-morbidities (SIC)). A multivariate analysis identified IADL, BFI and ASA to be the most important instruments in explaining SIC. DISCUSSION: PACE has been effectively used to describe the functional capacity and health status in an international cohort of elderly cancer patients. The majority of PACE instruments have been found to be significantly associated with co-morbidities (SIC) and can distinguish between type and severity of cancer. PACE represents a useful tool in evaluating onco-geriatric fitness for surgery.     

丙泊酚与依托咪酯联合应用对卵巢癌化疗患者麻醉诱导时血流动力学的影响

目的观察丙泊酚与依托咪酯联合应用对卵巢癌化疗患者诱导插管期间血流动力学的影响。方法 30例接受术前化疗的卵巢癌患者随机分为3组每组10例患者：丙泊酚组（P组）、依托咪酯组（E组）、丙泊酚＋依托咪酯组（PE组）,观察诱导前（T0）、插管前1 min（T1）、插管后即刻（T2）、插管后1 min（T3）、2 min（T4）、5 min（T5）不同时点的血流动力学变化。结果与T0比较,P组T1～5MAP、HR明显降低（均P〈0.05）;E组T2～4MAP、HP明显增快（均P〈0.05）;PE组T1～5MAP、HR差别无统计学意义;3组患者T1～5时BIS值均显著降低（均P〈0.01）。结论麻醉诱导时,联合应用丙泊酚与依托咪酯可更好地维持卵巢癌术前化疗患者的血流动力学稳定。     

外科治疗70岁以上老年肺癌患者的预后因素分析

背景与目的随着手术和麻醉技术的提高,越来越多的老年肺癌患者接受手术治疗。本研究的目的是探讨70岁以上老年肺癌患者术后生存情况及其影响因素,为老年肺癌的治疗提供依据。方法回顾性分析192例手术治疗的70岁以上老年肺癌患者的术后生存情况,采用单因素和多因素方法分析各种预后因素的影响度。结果全组总的5年生存率为33.5%。手术方式、手术性质、病理类型及分期均可显著影响患者的预后,其中后三者为独立预后因素。结论老年肺癌患者术前应全面检查,尽量避免单纯探查手术和姑息手术。手术以肺叶切除为标准术式,某些特殊情况下,也可行部分肺叶切除术。     

Insight into the treatment of cancer in older patients: developments in the last decade

In the last decades there has been an increased interest in the treatment of elderly cancer patients and a change in attitude of both clinicians and their patients has occurred. Drugs are now available that might be considered "elderly-friendly" and the enormous advances in surgical procedures and supportive treatments over the recent years have enabled adverse effects to be minimized. A Geriatric Assessment is increasingly used as a tool to define those patients who are more suitable for aggressive chemotherapy or, on the contrary, palliative treatment. For almost all cancers, older patients are better treated today than they were in the past, even though we are still far from optimal management. Despite the perceived barriers to including elderly patients in clinical trials, there are few data to support excluding them. We must not permit increased age in cancer patients to continue to be an important and independent risk factor for receiving inadequate care.     

Treatment of elderly cancer patients with chemotherapy

Persons over the age of 65 are the fastest growing segment of the United States population. In the next 30 years, they will comprise over 20 percent of the population. Fifty percent of all cancers occur in this age group and, therefore, there will be an expected rise in the total cancer burden. Data is becoming available that will better guide the use of chemotherapy in the older patient population. Information regarding age-related physiologic changes are presented with their relationship to pharmacology, functional status, and hematopoiesis. Treatments are reviewed in regard to the adjuvant treatment of breast and colon cancer as well as primary therapy of aggressive non-Hodgkin's lymphoma. The treatment of more advanced breast, ovary and non-small cell lung cancer also are discussed.     

老年肺癌病人的临床分析

目的　探讨老年肺癌病人的临床特点。方法　回顾性分析 113例老年肺癌病人 (6 5岁以上 )的临床特点 ,并分析不同年龄组发病时的首发症状 ,中位生存期及不同分期接受不同治疗后的生存期比较。结果　鳞癌占 5 0 .4 % ,腺癌占 36 .3% ,其他非小细胞癌占 7.1% ,小细胞癌占 6 .2 %。 4 7.8%患者在健康普查时发现。因咳嗽、咳痰就诊占 2 3% ,以咯血为首发症状占15 .9%。高龄老年肺癌组 (80～ 90岁 )中 5 3.9%的患者采用免疫治疗或未治 ,显著高于非高龄老年肺癌组 (P <0 .0 1)。仅12 .8%的患者手术 ,也明显低于非高龄老年组 (P <0 .0 1)。 6 4 %的患者生存期在 1年或 1年以内 ,平均生存 11月。 5年生存率仅 6 .9%～ 18.8%。高龄老年组 5年生存率仅 12 .8%。各组之间同期肺癌中位生存期比较均无显著差异 (P >0 .0 5 )。高龄老年肺癌组Ⅲ～Ⅳ期治疗与否 ,生存期并无显著改善 (P >0 .0 5 )。结论　老年肺癌主要为男性病人 ,且半数为鳞癌。首发症状不典型 ,早期诊断较困难。晚期老年肺癌患者不宜采取积极的治疗 ,以支持治疗为主 ,尽量减少患者的痛苦 ,提高生活质量。