老年人心律失常的诊断和治疗

老年人心律失常发生率高于一般成年人,其原因与老年性疾病、心脏老化以及对药物的耐量降低有关。在治疗上除药用量稍低于一般成人外其它与一般成人相同。     

老年人心律失常

老年期心律失常发生率颇高且与龄俱增。普通EKG25岁以下正常人最高为2.1％,65及80岁以上正常人各为17.7及50.6％。动态监测(HolterENG)可达无症状老人100％。以早搏、传导阻滞最多,室早(VPS)少于室上性(SVS),余各型失常皆可见。患病老人发生率更高,一组千例病死老人连续尸检中,生前普通EKG34.2％有房     

老年人心律失常

老年人异常心电图出现率颇高,据Mihalick等收集文献资料,70岁以上老年人2482例中出现异常心电图者占52％,这些异常心电图表现,电轴左偏占51％,ST-T变化占16％,房性早搏占10％,Ⅰ°房室传导阻滞占9％,心房纤颤8％。     

老年人的心律失常

传导障碍、心房颤动和早搏等心律失常在老年人中很常见,且被认为可能是老年人跌倒、骨折、卒中和意识丧失的重要原因.本文报告20例无症状和20例有症状的老年人动态心电图检测所得的各种心律失常的发生率,并通过随访,评价症状与心律失常的关系以及无症状老年人心律失常的临床意义.方法:无症状组为20例健康者,男性7例,女性13例,年龄为65～98岁,平均84.2岁.所有受试者的常规心电图均示窦性心律,血压均低于170/95毫米汞柱.症状组为20例,有跌倒、虚脱、眩晕和旋转感等症状的住院病人,病史或体检均未发现     

老年人的心律失常

传导阻滞、心房颤动和期外收缩是老年人中相当常见的心律失常,有作者认为是老人摔跤、骨折,中风和昏厥的重要原因。心脏24小时动态心电图监护应用后,在正常的健康人中发现各种心律失常,以房性和室性异位搏动最为多见。本文旨在运用磁带心电监护仪在有症状和无症状的老人中发现各种心律失常的发病率以及通过随访明确其临床意义。随机取20名“正常”者,年龄65～98岁,平均82.4岁,体检时心脏窦性节律,血压低于170/90毫米汞柱,为无症状组;另征集曾发生摔倒、“虚脱”、     

老年人的心律失常

老年人心律失常多见,主要原因是冲动发放功能低下和传导系统的障碍,高龄者其传导系统本身可有器质性改变,这些皆为老年人发生心律失常的基本原因。本文对老年人的病态窦房结综合征、心房颤动及房室传导阻滞三种心律失常,就有关的几个问题进行讨论。一、病态窦房结综合征:病态窦房结综合征在老年人较常见,据报告,60岁以上的病例约占半数以上,其基本原因是随着年龄增长到高龄,窦房结发生器质性的变性改变,P细胞逐渐减少,到75岁以上减少至正常时的10％以下,同时有进行性纤维化。当有慢性窦房传导阻滞时,提示窦房结有广泛性病变,同时房室结也有变性。以往认为上述改变     

丹参治疗老年人心律失常疗效观察

心律失常是老年人一种常见疾病 ,多数通过抗心律失常药物治疗可消失或好转。但部分患者单纯用抗心律失常药物却难以奏效 ,有的心律失常反而加重。为此作者于 1999- 0 6～2 0 0 2 - 0 6进行了用丹参加镇静剂治疗心律失常的观察。1　对象和方法1.1　对象　住院患者 6 9(男 6 6 ,女 3)例 ,年龄 6 0～ 87(73±8)岁。基础疾病为 :冠心病 2 2例 ,高血压病 2 1例 ,慢性支气管炎 6例 ,脑梗死 7例 ,糖尿病 5例 ,其他疾病 3例 ,单纯心律失常 5例。在用丹参之前均用了抗心律失常药。1.2　方法　所有心律失常患者均先用心律平 15 0 mg,1次 /d口服治疗 ,…     

稳心颗粒治疗老年人心律失常观察

目的观察稳心颗粒治疗老年人心律失常的疗效和安全性。方法治疗组34例，给予稳心颗粒，每次9g。对照组25例，给予普罗帕酮（心律平），每次100mg，两组均为每日3次口服，4周为1个疗程。结果临床症状缓解总有效率治疗组达94．12％，对照组达73．07％（P〈0．05）。Holter显示早搏控制总有效率治疗组与对照组无统计学意义（P〉0.05）。治疗组未发现明显不良反应．实验室检测指标无异常改变。结论稳心颗粒治疗老年人心律失常疗效确切，安全性好。     

老年人快速室上性心律失常的治疗体会

老龄化社会的到来,老年心律失常日趋多见。老年人生理和病理变化特点及抗心律失常药物的复杂性,使老年心律失常的治疗带来一定困难,特别是快速室上性心律失常(SVT)发作突然,多数病情危重,如何选择药物有时相当棘手。根据临床实践结合有关文献,就老年人SVT的治疗体会总结如下。     

老年人心律失常的临床特点及治疗

我院自1988～1990年共收治60岁以上心律失常患者103例,现就老年人心律失常临床特点及治疗试作讨论。一、临床资料男84例,女29例,年龄60～80岁,平均70岁。类型:室上性心律失常61例,其中心房纤颤37例;室性心律失常32例,其中室性早搏29例;房室传导阻滞6例;其他类型心律失常4例。病因:冠心病     

The significance of cardiac arrhythmias in the aged

Twenty-four-hour ambulatory electrocardiography was performed in 25 young and 29 active elderly subjects. Sinus bradycardia and sinus arrhythmia were common in the young but uncommon in the elderly. Ventricular and supraventricular premature beats and brief runs of supraventricular tachycardia were common in the elderly but uncommon in the young. Complex ventricular arrhythmias only occurred in the elderly but brief episodes of nocturnal Wenckebach AV block were quite common in young and old alike. No significant difference in arrhythmia frequency was found between elderly subjects with heart disease and those without heart disease or between elderly subjects without symptoms and those with non-episodic symptoms such as dizziness. None of the arrhythmias in the young or elderly subjects was associated with symptoms. In follow-up at 30 months, only one elderly subject was deceased (from pneumonia) and none had suffered a stroke or heart attack. It is concluded that transient cardiac arrhythmias are commoner in the elderly than in the young. However, their long-term significance remains unknown, but it is likely that they are relatively benign.     

The treatment of extensive onychomycosis in aged patients

The aim of the study was to present the own observations concerning treatment of patients above 50 years of age suffering the toe nail dermatophyte onychomycosis with intensified subungual keratosis and considerable nail plates destruction. Three different treatment methods were administered: 40 patients were treated only with itraconazole pulse method for 3 month, 35 patients besides itraconazole were given also pentoxifylline. In case of 20 individuals besides 3-month itraconazole pulse method treatment, the amorolfine varnish application onto changed nails once a week for 6 month was administered. In the group of patients treated only with itraconazole, in 22 cases (55,0%) the cure was obtained, while in the group of individuals given the combined therapy with pentoxifylline, the cures made 71,4% (25 individuals). From among patients treated with itraconazole and external amorolfine application the cures made 75,0% (15 individuals).     

室性心律失常对老年心力衰竭患者预后的影响

目的　探讨室性心律失常对心力衰竭老年患者预后的影响。方法　 180例心力衰竭老年患者行 2 4h动态心电图检查 ,随访 3个月。观察猝死与各种室性心律失常的关系。结果　 16 9例(93 9% )患者有室性心律失常。 2 4h >10 0 0个室性早搏 (PVCs)者 6 9例 (38 3% ) ,多形PVCs 34例(18 9% ) ,成对PVCs 6 6例 (36 7% )。非持续性室性心动过速 81例 (45 0 % ) ,随访 3个月 7例发生猝死 ,无心动过速的患者猝死 1例。结论　非持续性室性心动过速是心力衰竭老年患者猝死的危险因素     

老年人大面积急性心肌梗死心律失常防治

目的 探讨老年人大面积急性心肌梗死（ＡＭＩ）并发心律失常的防治措施。方法 将７６例老年大面积ＡＭＩ患者随机分为３组，Ａ组（３０例）及Ｂ组（２５例）每天静脉点滴２５％硫酸镁１０－１５ｍｌ和极化液，１２－１４天，Ａ组同时利多卡因７２小时（首剂５０－１００ｍｇ静脉注射后按２－３ｍｉｎ静脉点滴）；Ｃ组（２１例）静脉 点滴极化液１２－１４天，并发室性心律失常患者加用利多卡因（用法同Ａ组）。结果 心律失常发生     

老年自发性气胸的外科治疗

目的 总结老年自发性气胸的外科治疗体会。方法 回顾性分析121例老年自发性气胸患者的诊治资料。结果 左倒气胸63例（52．1％），右侧气胸58例（47．9％）；气胸伴大疱型肺气肿表现者34例（28．1％），伴单纯肺气肿而无明显肺大疱者42例（34．7％），轻度肺气肿伴孤立肺大疱者21例（17．4％），轻度肺气肿伴多个肺大疱者9例（7．4％），无明显肺气肿伴肺大疱者15例（12．4％）；术后13例患者延迟拔除气管插管，余者顺利拔管；108例（89．3％）患者无漏气，10例（8．3％）曾出现Ⅰ度漏气，3例（2．5％）出现Ⅱ度漏气，经保守治疗后治愈。术后所有患者胸闷、气促症状较术前均明显改善，活动耐力增强。术后随访患者未见手术倒气胸复发。结论 老年自发性气胸的治疗应采取综合治疗方案，有手术条件者尽量选择手术治疗，术中要联合采用防止肺创面漏气以及促进胸膜腔粘连，预防气胸复发的措施，术后要重视病人的管理，采取各种措施促使肺复张。     

老年自发性气胸的治疗体会

目的探讨老年自发性气胸的发病特点及治疗方法。方法对2003年至2007年4年间我科收治的老年自发性气胸84例进行回顾性分析并总结。结果老年自发性气胸多合并肺部基础疾病,起病急、憋喘重、需紧急处理,且带管时间长,大多需注入高渗糖等粘连剂愈合。结论老年自发性气胸临床表现不典型,易误诊,运用胸腔闭式引流加注入高渗糖,治愈率高,不良反应少,复发率低。     

Significance of cardiac arrhythmias in the aged and their treatment with propafenone controlled by plasma level

Every form of cardiac arrhythmia can complicate the existing cardiovascular and cerebrovascular changes in elderly people. A controlled clinical study was performed on 37 geriatric patients, aged 45-93 years (average 77.3 years), with supraventricular and ventricular premature beats (SVPB, VPB). The effect of propafenon on premature beats was tested in a 24-hour ECG monitoring: propafenon has a significant reducing influence on SVPB and VPB in elderly patients. More than 50% of all patients had these results with a daily dosage of 2 X 150 mg. In 40% the dosage had to be increased to 2 X 300 mg. There was a negative correlation between plasma levels and number of arrhythmias, i.e. high plasma levels were connected with lower arrhythmias. No laboratory findings were changed, no side effects were observed. Contrary to much higher doses in other studies the good results of our small doses can be explained by the different pharmacokinetics of old age. Bearing this fact in mind, propafenon can be valuable in the treatment of arrhythmias even in older patients.     

高龄原发性肝癌射频治疗疗效分析

目的观察高龄原发性肝细胞癌(HCC)患者射频消融治疗(RFA)疗效及RFA对肝功能及生命质量的影响.方法超声引导RFA治疗的225例HCC患者为本文研究对象;非老年组(年龄≤60岁)109例;老年组(年龄＞60岁)116例中,年龄≥70岁者50例,52.6%(61人)合并其他疾病.治疗前两组病灶大小,肝功能分级均无显著差异.比较两组RFA疗效、生存期、生存率、生命质量变化及对肝功能的影响.结果两组消融成功率,局部肿瘤进展率均无明显差异.平均生存期非老年组为(43.31±3.16)个月,老年组为(41.07±2.50)个月,两组无统计学差异.老年组RFA治疗前后生命质量得分无显著差异;治疗后,老年组社会功能领域得分高于非老年组,两组生命质量总得分及其他领域得分均无显著差异.两组患者治疗前与治疗后1个月的谷丙转氨酶、谷草转氨酶、总胆红素水平均无明显差异.结论RFA对不适合手术治疗的高龄HCC患者,可获得良好疗效,并保持患者较高的生命质量;对高龄患者可作为首选治疗方法之一.