高龄老年人血压管理中国专家共识

<正>我国已进入老龄化社会,根据2013年的统计,80或80岁以上高龄人口超过2 300万,并以每年5%的速度递增,预计2020年将达到3 067万,2040年将增加到7 400多万人。随着年龄的增长,高血压的患病率显著增加[1]。80或80岁以上人群中,70%~90%患有高血压[2-3]。高血压是心血管病最重要的危险因素之一,也是危害老年人健康的重大公共卫生问题。我国每年有200万人死于高血压,脑卒中导致的死亡71%与高血压相关,冠状动脉粥样硬化性心脏病(冠心病)导致的死亡53%与高血压相     

高龄老年人卒中一级预防中的血压管理

高龄老年人口增长迅速,其预期寿命也明显延长.年龄是卒中的独立危险因素,高龄老年人卒中风险极高.高血压是高龄老年人最常见的可干预卒中危险因素.近20年来,抗高血压在卒中一级预防中的作用的相关研究结果逐一公布,其中一些大型随机对照研究具有里程碑式的意义,为高龄老年人的血压管理提供了切实的证据.     

健康高龄老年人甲状腺激素水平变化趋势分析

目的 探讨80岁以上高龄老年人甲状腺激素水平变化趋势.方法 将602例健康志愿者按年龄分为中青年组(20～59岁)226例、老年组(60～79岁)195例和高龄组(80～102岁)181例,采用化学发光法及放射免疫法测定志愿者血清三碘甲状腺原氨酸(TT3)、甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、反T3(rT3)水平,并以SPSS 13.0进行统计分析.结果 老年组与中青年组比较,血清FT3和TT3降低,差异有统计学意义(t值分别为2.793和3.627,均为P＜0.01);高龄组与中青年组比较,TT3、TT4、FT3、TSH、rT3浓度差异有统计学意义(t值分别为10.930、6.065、15.398、-2.933、-5.643,均为P＜0.01);老年组与高龄组比较,TT3、TT4、FT3、TSH、rT3浓度差异有统计学意义(t值分别为8.382、4.298、11.573、-3.383、-5.148,均为P＜0.01).FT3、TT3、TT4浓度与年龄呈负相关(r值分别为-0.51、-0.39、-0.25,P＜0.01),rT3、TSH浓度与年龄呈正相关(r值分别为0.32、0.12,P＜0.01),FT4与年龄无相关.高龄组高于或低于临床正常参考值范围的阳性发生率,在TT3、TT4、FT3、FT4、TSH、rT3中分别为0、0、13.8%、0、6.6%、21%.结论 随着年龄增长,老年人血清甲状腺激素水平及促甲状腺激素均有改变,特别是80岁及以上高龄老年人,血清FT3、rT3、TSH变化更为明显,建议临床设立老年人不同年龄段的血清甲状腺激素正常参考值范围,以减少假阳性的发生率.

Abstract：

Objective To explore the variation tendency of serum thyroid hormone level in the elderly aged over 80 years.Methods The 602 healthy volunteers were divided into 3 groups by age:young group (20-59 years of age,n= 226),elderly group (60-79 years of age,n= 195),and advanced age group (80-102 years of age,n=181).Fasting blood of all persons was harvested,then the levels of serum total triiodothyroxine (TT3),total thyroxine (TT4),free tri-iodothyronine (FT3),free thyroxine (FT4),thyroid-stimulating hormone (TSH) and reverse tri-iodothyronine (rT3) were determined by chemistry luminescence technique and radioimmunoassay.Statistical analysis was made by the software SPSS 13.0.Results The levels of serum FT3 and TT3 were lower in elderly group than in young group (t=2.793,3.627,P=0.005,0.000).There were significant differences in the levels of serum TT3,TT4,FT3,TSH and rT3 between young group and advanced-age group (t =10.930,6.065,15.398,- 2.933,- 5.643,all P = 0.000),also between elderly group and advanced-age group (t= 8.382,4.298,11.573,-3.383,-5.148,all P＜0.001).The levels of serum FT3,TT3 and TT4 were negatively correlated with age (r=- 0.51,-0.39 and -0.25,respectively,all P＜0.01).And the levels of serum rT3 and TSH showed positive relationships with age (r=0.32,0.12,all P＜0.01).There were no relationships between the level of serum FT4 and age.The positive rate of serum TT3,TT4,FT3,FT4,TSH and rT3 concentration beyond the reference value was 0,0,13.8%,0,6.6% and 21% in advanced-age group,respectively.Conclusions The levels of serum thyroid hormone and thyroid-stimulating hormone change with age.The levels of FT3,rT3 and TSH change obviously in the elderly aged over 80 years.It could reduce the false positive rate in clinical practice if normal reference range for serum thyroid hormone levels in different aged elderly is established.     

高龄高血压患者健康管理的效果评估

高龄高血压患者由于衰老、疾病等因素,血压变化有其特殊性,使防治工作极为复杂。我们对72例高龄高血压患者进行了为期3年的健康管理,旨在发现健康管理对高龄高血压患者的效果。     

健康高龄老年人甲状腺激素水平变化趋势分析

Objective To explore the variation tendency of serum thyroid hormone level in the elderly aged over 80 years.Methods The 602 healthy volunteers were divided into 3 groups by age:young group (20-59 years of age,n= 226),elderly group (60-79 years of age,n= 195),and advanced age group (80-102 years of age,n=181).Fasting blood of all persons was harvested,then the levels of serum total triiodothyroxine (TT3),total thyroxine (TT4),free tri-iodothyronine (FT3),free thyroxine (FT4),thyroid-stimulating hormone (TSH) and reverse tri-iodothyronine (rT3) were determined by chemistry luminescence technique and radioimmunoassay.Statistical analysis was made by the software SPSS 13.0.Results The levels of serum FT3 and TT3 were lower in elderly group than in young group (t=2.793,3.627,P=0.005,0.000).There were significant differences in the levels of serum TT3,TT4,FT3,TSH and rT3 between young group and advanced-age group (t =10.930,6.065,15.398,- 2.933,- 5.643,all P = 0.000),also between elderly group and advanced-age group (t= 8.382,4.298,11.573,-3.383,-5.148,all P＜0.001).The levels of serum FT3,TT3 and TT4 were negatively correlated with age (r=- 0.51,-0.39 and -0.25,respectively,all P＜0.01).And the levels of serum rT3 and TSH showed positive relationships with age (r=0.32,0.12,all P＜0.01).There were no relationships between the level of serum FT4 and age.The positive rate of serum TT3,TT4,FT3,FT4,TSH and rT3 concentration beyond the reference value was 0,0,13.8%,0,6.6% and 21% in advanced-age group,respectively.Conclusions The levels of serum thyroid hormone and thyroid-stimulating hormone change with age.The levels of FT3,rT3 and TSH change obviously in the elderly aged over 80 years.It could reduce the false positive rate in clinical practice if normal reference range for serum thyroid hormone levels in different aged elderly is established.     

健康高龄老年人甲状腺激素水平变化趋势分析

Objective To explore the variation tendency of serum thyroid hormone level in the elderly aged over 80 years.Methods The 602 healthy volunteers were divided into 3 groups by age:young group (20-59 years of age,n= 226),elderly group (60-79 years of age,n= 195),and advanced age group (80-102 years of age,n=181).Fasting blood of all persons was harvested,then the levels of serum total triiodothyroxine (TT3),total thyroxine (TT4),free tri-iodothyronine (FT3),free thyroxine (FT4),thyroid-stimulating hormone (TSH) and reverse tri-iodothyronine (rT3) were determined by chemistry luminescence technique and radioimmunoassay.Statistical analysis was made by the software SPSS 13.0.Results The levels of serum FT3 and TT3 were lower in elderly group than in young group (t=2.793,3.627,P=0.005,0.000).There were significant differences in the levels of serum TT3,TT4,FT3,TSH and rT3 between young group and advanced-age group (t =10.930,6.065,15.398,- 2.933,- 5.643,all P = 0.000),also between elderly group and advanced-age group (t= 8.382,4.298,11.573,-3.383,-5.148,all P＜0.001).The levels of serum FT3,TT3 and TT4 were negatively correlated with age (r=- 0.51,-0.39 and -0.25,respectively,all P＜0.01).And the levels of serum rT3 and TSH showed positive relationships with age (r=0.32,0.12,all P＜0.01).There were no relationships between the level of serum FT4 and age.The positive rate of serum TT3,TT4,FT3,FT4,TSH and rT3 concentration beyond the reference value was 0,0,13.8%,0,6.6% and 21% in advanced-age group,respectively.Conclusions The levels of serum thyroid hormone and thyroid-stimulating hormone change with age.The levels of FT3,rT3 and TSH change obviously in the elderly aged over 80 years.It could reduce the false positive rate in clinical practice if normal reference range for serum thyroid hormone levels in different aged elderly is established.     

高龄老年人血压管理中国专家共识

<正>我国已进入老龄化社会,根据2013年的统计,≥80岁高龄人口超过2300万,并以每年5%的速度递增,预计2020年将达到3067万,2040年将增加到7400多万人。随着年龄的增长,高血压的患病率显著增加[1]。≥80岁人群中,70%~90%患有高血压[2-3]。高血压是心脑血管病最重要的危险因素之一,也是危害老年人健康的重大公共卫生问题。我国每年有     

高龄危重患者手术麻醉方法和管理

目的探讨合并多个脏器功能异常、年龄逾90岁患者手术麻醉方法和管理的特点。方法总结近3年年龄超过90岁手术患者16例次，其中开腹手术6例次，人工髋关节置换术10例次，术前依据病史有针对性检查各重要脏器的功能，并作相应的积极准备，依手术种类和病情特点选择麻醉方法，应用Hemosonic TM100食道超声多普勒监测血流动力学、A-Line自动回归指数（AAL）监测麻醉深度以及4个成串刺激（TOF）指导追加肌肉松弛剂。结果全组患者术前均伴有2～4个脏器功能异常，且以循环、呼吸和内分泌系统改变较为常见；控制血压、营养心肌、抗心律失常、降血糖和抗感染是术前准备常用且有效的方法；开腹手术以全麻为主，追加维库溴铵间隔时间（87±16）min；人工髋关节置换术全部选择硬膜外阻滞，首次剂量1％利多卡因（7．6±0．9）ml，追加间隔时间（63±17）min。用6％羟乙基淀粉按10ml／kg静输后15min，患者每搏输出量、心输出量、心脏指数和主动脉内血流量（ABF）均分别较扩容前平均增加17％、11％、14％和15％，外周血管阻力和心率分别下降16％和9．6％。术中维持AAI 50～60，术毕出现咳嗽（吞咽）和清醒应答时AAI分别为73±9．4和81±7．3，随访术后无知晓。结论重视术前准备和术中监测；硬膜外阻滞应选用低浓度、小容量局麻药，6％羟乙基淀粉适合用于人工髋关节置换术；分次、小剂量应用静脉麻醉药，间隔更长时间再加肌松剂和维持相对较高AAI，是开腹手术实施全麻应遵循的原则。     

高龄老年人心率状况及变异性特点

目的 了解高龄老年人的心率状况及心率变异性特点.方法 调查149例年龄≥80岁的高龄老年人的动态心电图(Holter)数据,包括24 h平均心率、最快心率、最慢心率及心率变异性指标正常R-R间期的标准差(SDNN)和每5 min正常R-R间期平均值的标准差(SDANN),与同期行Holter检查的188例年龄60 ～ 79岁的老年人的相应指标进行比较.结果 高龄老年人与60 ～ 79岁老年人相比较,24 h平均心率降低[(68.9±8.4)次/min比(71.7±8.3)次/min,P＜0.05],最快心率降低[(103.2±18.8)次/min比(114.7±17.7)次/min,P＜0.05],最慢心率差异无统计学意义[(52.2±7.0)次/min比(52.1±6.2)次/min,P＞0.05],两组SDNN[(116.7±36.8)ms比(131.3±40.7)ms]和SDANN[(36.7±10.2) ms比(42.5±13.1)ms]比较,差异均有统计学意义(均为P＜0.05).结论 高龄老年人的平均心率、最快心率较60～79岁老年人轻度下降,心率变异性降低.     

高龄患者结肠息肉的内镜特点

目的 探讨年龄≥80岁高龄老年人大肠息肉的内镜表现及病理特点.方法 回顾性分析2006年1月至2010年12月150例高龄老年人大肠息肉的检出率、大小、部位、形态、病理学特点及内镜治疗情况,并与同期832例中青年患者(＜60岁) 及635例老年患者(60~79岁)的临床资料进行对比.结果 高龄组息肉检出率62.0%,明显高于中青年组30.2%及老年组48.7%(χ2值分别为56.58、8.64,均P＜0.001);高龄组息肉恶变率5.4%,明显高于中青年组1.2%(χ2=4.90,P＜0.05),但与老年组(3.9%)比较差异无统计学意义(χ2=0.36,P＞0.05);高龄组升结肠息肉癌变率有升高趋势,但与其他年龄组比较,癌变率、息肉直径、形态及腺瘤性息肉的比例等均差异无统计学意义,直径≥2 cm的腺瘤性息肉恶变率有上升趋势.结论 高龄老年人结肠息肉的检出率明显高于老年及中青年人群,并且癌变率也有所增加,对于高龄老年人结肠镜检查的指征应该适当放宽,尽早、定期进行全肠镜检查,及时在内镜下行息肉摘除术,以利于结肠癌的早期防治.

Abstract：

Objective To retrospectively investigate the endoscopic characteristics and pathological features of colorectal polyps in over-aged patients (≥80 years). Methods The 1617 colonoscopies performed between January 2006 and December 2010 were enrolled in our retrospective analysis. The detection rate, size, location, form and pathological feature of polyps in 150 over-aged patients were investigated, and they were compared with those in 832 young patients (＜60 years) and 635 old patients (60-79 years) with colorectal polyps. Results The detection rate of polyps was 62.0% in over-aged group, and was significantly higher than in young group and old group (30.2% and 48.7%, respectively, χ2=56.58 and 8.64,both P＜0.001). The malignant transformation rate of ascending colon polyp was 5.4% in over-aged group, and was significantly higher than in young group (1.2%, χ2=4.90, P＜0.05), but there was no significant difference between over-aged group and old group (3.9%, χ2=0.36, P＞0.05). There were no statistical differences in canceration rate, polyp diameter, morphology and adenomatous polyp rate among the three groups. The malignant transformation rate was significantly increased in adenomatous polyps with diameter over 2 cm, but didn't reach statistical significance. Conclusions The polyp detection rate is noticeably higher in the over-aged than in the old and the middle-aged, and the malignant transformation probability is also increased. The colonoscopy indications in the high risk age groups should appropriately be broadened, they should receive regular intervals follow-up, and undergo polypectomy in time if necessary.     

≥75岁老年患者血脂异常管理的专家共识

<正>心血管疾病的发病率随增龄显著升高。在心血管疾病中,高脂血症是重要危险因素,积极控制血脂可显著降低心血管病发病率和死亡率早已为临床共识。相对于65岁以下人群,65岁以上患者血脂管理的循证医学证据较少,高龄(≥75岁)老年人群的血脂管理证据尤为不足。且老年人常合并多系统疾病、同服多种药物,因此用药还需考虑治疗成本、药物特性和相互作用、患者体能、虚弱程度以及余寿等。尤其是≥75岁高龄老年患者,个体差异极大,而且不同的危险因素对高龄老年人的影响     

高龄老年人血压变异性与踝臂指数关系探讨

目的评价高龄老年人群血压变异性(BPV)与踝臂指数(ABI)的关系。方法入选年龄≥80岁高龄老人111例,按照ABI分为异常ABI组(ABI≤0.9或ABI>1.3)56例和正常ABI组(ABI>0.9)55例,比较2组24h动态血压参数和BPV参数;另根据血压将患者分为高血压组48例和非高血压组63例,观察2组BPV及ABI差异。logistic回归分析ABI独立危险因素。结果异常ABI组较正常ABI组24h舒张压、昼间舒张压和夜间舒张压明显降低(P<0.05),24h收缩压变异性[(12.80±2.66)mm Hg(1mm Hg=0.133kPa)vs(14.14±3.64)mm Hg]明显降低、夜间收缩压变异性[(11.99±4.19)mm Hg vs(9.97±4.05)mm Hg]明显增高(P<0.05)。高血压组24h收缩压变异性[(14.87±3.91)mm Hg vs(13.20±3.41)mm Hg]、夜间收缩压变异性[(12.27±5.50)mm Hg vs(10.33±3.93)mm Hg]明显增高,ABI[(0.98±0.21)vs(1.07±0.20)]明显降低(P<0.05)。logistic回归分析提示,夜间舒张压和夜间收缩压变异性为ABI的独立危险因素(P<0.05)。结论高龄老年人群24h舒张压、昼间及夜间舒张压、24h收缩压变异性、夜间收缩压变异性可能是异常ABI的危险因素。     

80岁以上老年人视力状况调查及影响因素分析

为了解≥80岁老年人的视觉状况,我们对≥80岁老年人的视力状况及影响因素进行调查,现报道如下。1对象及方法1.1对象2004年2月至11月,对在我院干部门诊例行年度体检和长期接受医疗诊治的≥80岁老年人458例进行眼部及全身系统检查。男420例,女38例,年龄80～103岁,平均(88.62±5.7     

阿尔茨海默病康复管理中国专家共识(2019)

随着社会老龄化,阿尔茨海默病(AD)发病率逐渐增高。康复作为一种非药物治疗方法,旨在改善认知和运动功能障碍,减轻痴呆患者的行为和心理症状,提高患者的生活质量。为此,我们组织相关专家编写本共识,以积极推进AD的规范化康复治疗。     

中老年人夜尿增多流行病学调查

目的 了解郑州市40岁及以上人群夜尿增多的患病率及其相关因素. 方法 2010年6月至2011年2月采用多级分层随机抽样、横断面现场调查的方法抽取101 60例郑州市40岁以上常住居民(居住年限≥5年)进行夜尿增多问卷调查.对夜尿增多相关因素包括年龄、性别、糖尿病等进行统计分析,同时对夜尿次数增多进行国际前列腺症状评分(IPSS)比较. 结果 40岁及以上的受访者9880例纳入统计分析,夜尿≥2次者占31.5％;随着年龄增大夜尿增多患病率增加(OR=1.05,95％CI:1.04～1.05,P＜0.01),70岁以上老年人患病率高达(48.9％);糖尿病组夜尿增多患病率高于非糖尿病组(43.1％比29.7％,OR=1.51,95％CI:1.34～1.71,P＜0.01).夜尿增多组前列腺症状评分高于无夜尿增多组(5.1±5.3比1.7±2.7,t=－23.562,P＜o.01). 结论 40岁及以上人群夜尿增多患病率与年龄、糖尿病和前列腺疾病相关.为减少夜尿增多对40岁及以上人群生活质量的影响,应加强夜尿增多的评估和治疗.     

老年人异常血压波动临床诊疗中国专家共识

<正>血压波动(blood pressure fluctuation)是指一定时间内血压的变化程度,是人类血压最基本的生理特征之一~([1]),又叫作血压变异(blood pressure variability,BPV)~([2])。年龄是影响血压的重要因素,老年人不仅血压水平较中青年人高~([3]),而且容易发生血压波动幅度和频率的非生理性变化,称为异常血压波动,临床上可表现为昼夜节律异常、体位性低血压、晨峰血压增高、餐后低血压、白大衣性高血压和隐蔽性高血压、随访间和季节间的血压波动等。     

80岁及以上高血压患者血压与心脑事件和季节性变化研究

目的 观察80岁及以上老年高血压患者血压和心脑血管事件的季节性变化. 方法监测67例年龄80～92岁的高血压患者2年间的家庭自测血压、诊室测血压和每季度1次的24 h时动态血压,记录期间发生的心脑血管事件. 结果高血压患者夏季的收缩压、舒张压最低(P＜0.01).冬季的收缩压最高(P＜0.01),冬季舒张压高于夏季(P＜0.01).春季和秋季的收缩压、舒张压差异无统计学意义.心脑血管事件的发病率在夏季和冬季明显高于春季和秋季(P＜0.05).发生心血管事件的相关因素为:季节(OR=1.525,P=0.001)、体质指数(OR=1.145,P=0.018)、心功能(OR=2.037,P=0.01),发生缺血性脑血管事件的相关因素为季节(OR=1. 604,P=0.001)、脑血管病史(OR=1.598,P=0.034)、诊室测收缩压(OR=0.960,P=0.013)、动态血压的舒张压(OR=0.936,P=0.008). 结论 80岁及以上老人通过3种方式测得的血压结果显示,夏季的收缩压、舒张压为全年最低;冬季的收缩压全年最高,舒张压高于夏季;春季和秋季的血压水平无明显差异.心脑血管事件的发生率在冬季和夏季明显高于春季和秋季.

Abstract：

Objective To investigate the effect of seasonal variation of blood pressure (BP) on the incidence of cardiovascular and cerebrovascular events in the elderly aged 80 years and over.Methods The 67 patients (aged 80-86 years) with essential hypertension were enrolled, the BP were measured at home, in consulting room, and by 24-h ambulatory BP monitor in every season for 2 years. The incidences of cardiovascular and cerebrovascular events were recorded in the meantime.Results Both systolic BP (SBP) and diastolic BP (DBP) were lower in summer than in any other season (P＜0. 01 ). SBP was higher in winter than in any other season. (P＜0.01), DBP was higher in winter than in summer(P＜0. 01). There were no significant differences in SBP and DBP between spring and autumn. The incidence of cardiovascular and cerebrovascular events were higher in winter and summer than in spring and autumn (P＜0.05). The season (OR= 1. 525, P=0. 001), BMI (OR =1.145, P=0.018) and heart function (OR= 2. 037, P=0.01) were related to the incidence of cardiovascular events. And the season (OR = 1. 604, P= 0. 001 ), history of cerebrovascular disease (OR= 1. 598, P=0. 034), office-measured SBP (OR=0.960, P=0.013) and ambulatory DBP (OR =0. 936, P = 0. 008) were related to the incidence of cerebrovascular events.Conclusions The blood pressure measured by three methods in the elderly aged 80 and over shows that both SBP and DBP are at the lowest in summer; SBP is at the highest in winter, DBP is higher in winter than in summer. There are no significant differences in BP between spring and autumn. The incidences of cardiovascular and cerebrovascular events are significantly higher in winter and summer than in spring and autumn.     

75岁以上老年抗栓治疗专家共识

<正>75岁以上(≥75岁)老年人是心血管疾病的高发人群,且随着年龄增长,发病率呈显著增加趋势。约1/3罹患心肌梗死和2/3因心肌梗死死亡的患者超过75岁。制订《75岁以上老年抗栓治疗专家共识》,旨在通过总结临床研究结果并引入新的出血风险评分系统,提出适合我国75岁以上高龄患者的评价体系和抗栓建议。     

Esophagectomy in patients aged over 80 years with esophageal cancer

BACKGROUND/AIMS: Esophagectomy for esophageal cancer is one of the most invasive surgical procedures. However, with the recent aging of the population, clinicians are increasingly encountering patients with advanced age (over 80 years) who require treatment for esophageal cancer. Patients in this age group tend to be regarded as at high risk in terms of surgical treatment. In the present study, the authors examined perioperative complications and clinical outcome in esophagectomy in patients aged over 80 years compared with those aged 70-79 and discuss the risk and appropriateness of esophagectomy in the older group. METHODOLOGY: Of patients with esophageal cancer at our institute, 25 were aged over 80 years, while 95 were aged 70-79 years. We statistically compared those who underwent esophagectomy; 8 in the older group and 62 in the younger group. The oldest patient was an 84-year-old man. Among the 8 older patients, 7 were male and 1 was female. All cases were histologically confirmed as squamous cell carcinoma and this series included 1 case in Stage 0, 3 in Stage I and 4 in Stage III. Total thoracic esophagectomy was performed in 5 patients, transhiatal blunt dissection in 2 and lower thoracic esophagectomy in 1. RESULTS: Rate of surgical treatment was significantly lower in the older group than in the younger group (32.0% vs. 65.3%, p < 0.001). No significant difference was observed in postoperative complications or mortality. Regarding clinical postoperative outcome in the older group, there were 5 deaths: 1 related to surgery, 2 to other causes (at 5 and 12 months), 2 to cancer (4 and 11 months). The remaining patients were alive at 31, 60, and 88 months. No significant difference was observed in overall or disease specific survival after surgery between the 2 groups. CONCLUSION: No statistically significant differences were apparent in morbidity, mortality or clinical outcome in the 2 groups. Since surgery seems to confer similar symptomatic improvements and survival in patients aged over 80 to those expected for patients aged 70-79, we believe that surgeons should not withhold esophagectomy in patients aged over 80 years because of advanced age alone.