老年慢性阻塞性肺疾病合并肺结核的早期诊断及治疗探讨

目的分析住院老年人慢性阻塞性肺疾病（COPD）合并肺结核的临床特点,探讨其早期诊断及治疗措施。方法对48例住院老年COPD合并肺结核患者的临床资料进行回顾性分析。结论老年COPD合并肺结核的临床症状、体征、影像学及辅助检查均不典型,且合并症、并发症多,漏诊、误诊率高。应引起临床医师的高度重视,以早期诊断,及时治疗。     

老年结核性胸膜炎87例临床特点分析

目的总结老年结核性胸膜炎临床特点。方法对87例老年结核性胸膜炎患者的临床资料进行回顾性分析,与非老年人组比较。结果结核性胸膜炎的患病年龄段仍以40岁以下年龄为主;老年结核性胸膜炎症状不典型;诊断过程需要完善的相应检查,有助于鉴别诊断;合并营养不良患者较非老年人组多;合并肺内结核与非老年人组无差异。     

464例老年上消化道出血的临床分析

目的 探讨老年人上消化道出血的临床特点.方法 对464例老年人上消化道出血患者的病因、临床表现、并发症、转归进行回顾性分析.结果 老年人上消化道出血的主要病因依次为十二指肠球部溃疡、急性胃黏膜病变、胃溃疡;老年人上消化道出血以无症状黑便为首发症状较多见;大多数患者预后良好.结论 老年人上消化道出血是老年疾病的急重症,病因以酸相关疾病为主,积极的内科治疗和内镜下止血治疗,能控制大多数患者的出血.     

老年甲状腺功能减退症的治疗

老年甲状腺功能减退（简称甲减）是常见的内分泌疾病,尤其常见于老年女性。由于其起病隐匿,甲减症状与机体老化表现相似,临床易于漏诊。甲减最常见病因是自身免疫性甲状腺炎。老年患者伴随疾病多、合并用药多,因此老年甲减的诊断和治疗具有一定的特殊性。老年甲减的首选药物是左甲状腺素钠（L-T4）,服用时要从小剂量起始,而后缓慢增加剂量,调整用药期间应密切监测甲状腺功能,剂量稳定后定期监测甲状腺功能。对于老年亚临床甲减患者是否需要治疗尚存争议。     

老年入急性腹膜炎的诊断和治疗

本文分析169例老年急性腹膜炎,原发病以常见多发病为最多,62.1％的病人伴有各种不同的合并症。临床上多以可忍受的腹痛为首发症状,其他症状和体征多不典型。对急腹症应及早采取手术治疗,将疾病控制在并发症出现前有较好的效果;诊断时应注意老年人的特点,详细询问病史及体格检查,与必要的辅助检查结果综合分析,腹腔穿刺对诊断有重要意义;治疗应以时间短、损伤少、抢救生命为主的手术方式为宜,原发病是否需一次解决,要根据病人的全身情况而定。     

老年重症急性胰腺炎25例临床分析

目的总结老年人重症急性胰腺炎（severe acute pancreatitis,SAP）的临床诊治特点,以提高对老年人重症急性胰腺炎的认识。方法回顾性分析近5年来收治25例老年（60～84岁）SAP患者的例临床资料,并与同期30例非老年人（22—59岁）对照组SAP患者资料进行对比研究。结果老年SAP患者以胆石症为主要病因,多伴其他慢性疾病,老年患者各种临床症状发生率均低于对照组（P〈0．05）;老年组APACHEⅡ（24、48h）和Ranson评分高于对照组（P〈0．05）;老年患者的局部并发症和多器官功能障碍（衰竭）发生率明显高于对照组（P〈0．05）;病死率和死亡原因与对照组无明显差异。结论我国老年SAP病因以胆源性为主,临床症状无特异性,伴发疾病多,并发症和多器官功能障碍（衰竭）发生率较高。老年人急性胰腺炎仍以内科非手术综合治疗为主。     

232例老年人重症肌无力的临床分析

目的:分析老年人重症肌无力(MG)的有关临床特点。方法:回顾性分析26年间诊治的232例老年MG患者的临床资料。结果:老年人MG占总MG病例数(3010例)的比例为7．7％。男性多于女性，男：女=1．3：1。老年人MG多在60～70岁间发病，在其常见首发症状中，眼症状184例(79．3％)、咽喉肌无力30例(12．9％)、肢体肌肉无力17例(7．3％)。老年人MG中，全身型的构成比多于眼型(62．9％对37．1％)，较少并存自身免疫性疾病和发生危象，常合并胸腺瘤(33例)及内外科其他疾病(87例)。结论:老年人MG具有独特的临床特点，了解这些特点将有利于指导临床诊断和治疗。     

老年人心力衰竭和运动研究进展

<正>心力衰竭(HF)的易感因素主要是老年人群体和传统的心血管风险较高的疾病,如高血压、高血脂和老年2型糖尿病等~〔1,2〕。据统计,全球人口HF发病率约为0.3%~2%,而老年人(65岁)约高达10%;每年HF发病率大概是0.1%~0.5%,45岁后相关疾病发病率每年加倍出现~〔3〕。在老年人群中很难把HF的症状和体征与人类自然衰老过程区分开来。为     

老年消化性溃疡112例病因和临床特点分析

目的 探讨老年消化性溃疡的发病病因、临床表现及内镜特点.方法 收集我院2012年1月～2013年12月住院的消化性溃疡患者273例,将其分为老年组和中青年组,对两组患者的病因、临床表现、内镜特征进行比较.结果 幽门螺杆菌（HP）感染并非老年消化性溃疡的主要病因,老年患者非甾体抗炎药（NSAID）溃疡发病率明显增加,是老年患者的重要病因.老年消化性溃疡多以呕血、黑便为临床首发症状,并发幽门梗阻、癌变的机率高于中青年组.老年组胃溃疡发病率高于中青年组,且巨大溃疡发生率较中青年组多见.结论 老年消化性溃疡临床症状不典型,因同时合并多种基础疾病而增加了复发率及病死率.应了解老年消化性溃疡的发病特点、临床特征及内镜表现,并进行针对性的治疗.     

老年人肺炎46例诊治分析

目的分析老年X（60岁以上）肺炎的临床特点。方法回顾性分析我院2002年10月-2009年2月收住的46例老年人肺炎患者的临床资料。结果老年人肺炎特点是冬春季好发,临床症状不典型,合并症多,病程长,死亡率高,且常发生在多种慢性疾病的基础上。治疗上除抗生素外,必须加强全身综合治疗。结论老年人肺炎疗的关键在于早期诊断和合理的治疗。     

Diagnosis of elderly patients with heart failure

The prevalence and mortality of heart failure (HF) increase with age. As a result, the early diagnosis of HF in this population is useful to reduce cardiovascular morbidity and probably mortality. However, the diagnosis of HF in the elderly is a challenge. These challenges arise from the under-representation of elderly patients in diagnostic studies and clinical trials, the increasing prevalence of HF with relatively normal ejection fraction, the difficulty in accurate diagnosis, the underuse of diagnostic tests, and the presence of co-morbidities. Particularly in the elderly, symptoms and signs of HF may be atypical and can be simulated or disguised by co-morbidities such as respiratory disease, obesity, and venous insufficiency. This review aims to provide a practical clinical approach for the diagnosis of older patients with HF based on the scarce available evidence and our clinical experience. Therefore, it should be interpreted in many aspects as an opinion paper with practical implications. The most useful clinical symptoms are orthopnoea and paroxysmal nocturnal dyspnoea. However, confirmation of the diagnosis always requires further tests. Although natriuretic peptides accurately exclude cardiac dysfunction as a cause of symptoms, the optimal cut-off level for ruling out HF in elderly patients with other co-morbidities is still not clear. In our opinion, echocardiography should be performed in all elderly patients to confirm the diagnosis of HF, except in those cases with low clinical probability and a concentration of brain natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) lower than 100 or 400 pg/mL, respectively.     

老年人心力衰竭

心力衰竭（心衰）是老年人常见和主要的疾病。老年人心血管系统及其他脏器结构与功能均呈老龄性变化。心脏储备能力下降,易患高血压、冠心病等多种心血管疾病;同时常又合并多器官疾病。在感染、心肌缺血等多种诱发因素作用下,极易发生心力衰竭。但临床症状较为复杂、多变,且有时又不典型,因此极易误诊或漏诊,故必须及时做出准确的诊断与治疗。老年人心衰必须采用综合治疗措施,并遵循个体化的治疗原则;加强对治疗的指导与管理,缓解症状、提高生活质量、改善预后。     

Heart failure with preserved ejection fraction

Progressive aging of the population and prolongation of life expectancy have led to the rising prevalence of heart failure (HF). Despite the improvements in medical therapy, the mortality rate of this condition has remained unacceptably high, becoming the primary cause of death in the elderly population. Almost half of patients with signs and symptoms of HF are found to have a nearly normal ejection fraction, which delineates a distinct clinical syndrome, known as HF with preserved ejection fraction (HF-PEF). While early research focused on the importance of diastolic dysfunction, more recent studies reported the pathophysiological complexity of the disease with multiple cardiovascular abnormalities contributing to its development and progression. HF-PEF is a challenging major health problem with yet no solution as there is no evidence-based treatment which improves clinical outcomes. This review summarizes the state of current knowledge on diagnosis, prognosis and treatment of HF-PEF, with particular insights on the pathological characteristics in the elderly population.     

Heart failure in the elderly

Heart failure (HF) is a major disease of the elderly. Since their symptoms of HF are generally light, on admission of the hospitals HF is sometimes in an advanced stage. Therefore, preventive medicine for those with the risk factors of HF is needed as a future strategy of cardiac gerontology. The routine assessment of the HF severity may be performed noninvasively by Nohria's profiles rather than other invasive methods. HF is worsened by the interaction with the co-morbidity factors, such as renal dysfunction and anemia. The interaction between HF and kidney disease (and anemia) is called 'cardiorenal (anemia) syndrome.' Recurrent hospitalization due to HF is common, and the period of hospitalization tends to be long in this syndrome. One of the hopeful therapeutic agents is carperitide, a recombinant human atrial natriuretic peptide. In cardiorenal syndrome, much lower initial doses of carperitide, such as 0.0125 microg/kg/min is recommended for treatment of HF in order to avoid possible worsening of renal dysfunction. In cardiorenal anemia syndrome, supplement of iron, careful blood transfusion in severe cases, administration of recombinant human erythropoietin, should be performed if indicated. However, the possibility of anemia unrelated to HF, such as due to gastrointestinal carcinoma, is also considered in the elderly. In such cases, finding a decrease of serum ferritin preceding that of hemoglobin may contribute to a differential diagnosis of anemia in elderly HF patients. Thus, the therapies considering several features of HF in elderly will contribute to improving quality of life and outcome.     

Frequent non-cardiac comorbidities in patients with chronic heart failure

Heart failure (HF) in elderly patients is associated with more diffuse symptoms and signs due to the presence of other noncardiac comorbidities. This can cause difficulties in assessing the correct diagnosis and initiating appropriate therapy. The four most frequently occurring noncardiac comorbidities and therapies used to treat them are discussed in the present paper. Hypertension is an important precursor of HF, and is still the most common risk factor for HF in the general population. About 50% of patients with untreated hypertension will develop HF. Pressure overload leads to the development of left ventricular hypertrophy (LVH) and diastolic dysfunction. Diabetes, which occurs in about 20-30% of patients with HF, is an important comorbidity resulting in morphological and metabolic disturbances affecting myocardial blood flow and hormonal regulation leading to a poor outcome and necessitating aggressive conventional treatment. Chronic obstructive pulmonary disease (COPD), occurs in approximately 20-30% of heart failure patients, and may complicate HF treatment, it is therefore important to recognize and treat it effectively. Finally, the early detection of anemia, which occurs in 20-30% of HF patients, is important since it is associated with functional impairment and increased mortality and morbidity. Combined treatment with erythropoietin and intravenous iron has shown beneficial effects on clinical symptoms and morbidity. In conclusion early detection of concomitant diseases in patients with HF is important and should be considered carefully when initiating therapy.     

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假性高血压和假性高血压现象是指袖带间接法测定的血压低于血管内直接的定值的临床上的疾病和现象。及时发现和确诊是关键。老年人、糖尿病病史较长、慢性肾脏病及动脉硬化严重等患者中易发生假高血压。正确的血压测定对确诊至关重要。一些辅助检查可以帮助诊断,如:直接血压测定、血管影像学检查等,而传统的Olser法可能对诊断的意义有限。假性高血压在降压治疗时应避免过度降压。     

Prediction of sudden death in elderly patients with heart failure

Most heart failure (HF) related mortality is due to sudden cardiac death (SCD) and worsening HF, particularly in the case of reduced ejection fraction. Predicting and preventing SCD is an important goal but most works include no or few patients with advanced age, and the prevention of SCD in elderly patients with HF is still controversial. A recent reduction in the annual rate of SCD has been recently described but it is not clear if this is also true in advanced age patients. Age is associated with SCD, although physicians frequently have the perception that elderly patients with HF die mainly of pump failure, underestimating the importance of SCD. Other clinical variables that have been associated to SCD are symptoms, New York Heart Association functional class, ischemic cause, and comorbidities (chronic obstructive pulmonary disease, renal dysfunction and diabetes). Some test results that should also be considered are left ventricular ejection fraction and diameters, natriuretic peptides, non-sustained ventricular tachycardias and autonomic abnormalities. The combination of all these markers is probably the best option to predict SCD. Different risk scores have been described and, although there are no specific ones for elderly populations, most include age as a risk predictor and some were developed in populations with mean age > 65 years. Finally, it is important to stress that these scores should be able to predict any type of SCD as, although most are due to tachyarrhythmias, bradyarrhythmias also play a role, particularly in the case of the elderly.     

Diastolic heart failure: The forgotten manifestation of hypertensive heart disease

Heart failure (HF) is a progressively debilitating disorder characterized by frequent hospital admissions and high annual mortality rates. Coronary artery disease (CAD), hypertension, and aging are major risk factors for the development/ progression of HF. For years, most of the attention has been focused on HF caused by reduced left ventricular (LV) systolic function, largely attributable to CAD. It is now generally accepted that nearly 50% of elderly patients with HF might have normal or preserved LV systolic function. This condition is commonly referred to as a distinct type of HF caused by LV diastolic dysfunction, and it often accompanies hypertensive heart disease. Isolated diastolic HF is increasingly recognized as the dominant cause of symptoms and hospitalizations from HF in a large proportion of individuals aged 65 and older. However, the clinicians caring for patients with diastolic HF do not fully understand its cause, how it progresses, or how it could be appropriately diagnosed and treated. Because varying degrees of systolic and diastolic dysfunction might coexist in any individual patient, and given the limitation of current diagnostic tools, the overall impact of isolated diastolic HF continues to evolve. Ongoing clinical trials are testing new strategies for treatment of diastolic HF.     

老年人涂阳肺结核临床特征

目的探讨老年人涂阳肺结核的临床特征。方法对108老年人涂阳肺结核病例进行分析。结果老年人以咳嗽、咳痰、气急、消瘦为主,病程迁延,合并症多,临床症状不典型。结论早期诊断和治疗是改善预后的关键,老年组治疗效果欠佳。对因呼吸道症状就诊的老年人,积极查痰及胸部X线检查,以便及早发现,及早治疗。在治疗时辅以营养和免疫支持治疗,可提高其临床治愈率。     

老年支气管哮喘临床和超敏反应的特征

目的　探讨老年支气管哮喘临床和超敏反应的特征　方法　３０ 例老年组与４５ 例青年组支气管哮喘患者相比较，其临床特征和超敏反应测试指标。　结果　老年组支气管哮喘起病年龄多在４０ 岁以后、病程大于１５ 年，冬季发病，全年发作，吸烟史、呼吸道感染和油烟诱因、脓痰、肺部呼吸音强度降低、呼气相延长和干湿性啰音体征、肺功能ＦＥＶ１ ％ 显著降低较多见。患者常伴有慢性支气管炎、肺气肿、肺心病、肺部感染、高血压、冠心病和糖尿病等疾病。而春秋季发作、吸入诱因、家族过敏史、Ｐｈａｒｍａｃｉａ 变应原阳性者和ＥＣＰ 值升高较少见，与青年组相比有显著差异（ Ｐ＜ ０－０５） 。感冒、本人过敏史、过敏性鼻炎和ＩｇＥ 值升高，２ 组之间无显著差异。　结论　虽老年支气管哮喘有其特有的临床表现和超敏反应特征，但超敏反应是重要而又不是唯一的发病机制；然而超敏反应病的体外诊断仍有其临床意义，但主要依靠病史、症状和体征综合诊断；因并发慢性阻塞性肺部疾病和肺部感染，易漏诊和误诊及治疗不当，故必须进一步提高诊断率和疗效