老年人血脂异常的治疗策略

随着我国经济水平发展和居民生活水平的提高，血脂异常的发生率增高。但既往学者认为，老年人接受调脂治疗发生不良反应机会大，效价比低，因此，重视不够。随着更多临床试验及荟萃分析结果的问世，人们逐渐认识到，积极治疗血脂异常是老年人心血管疾病预防的重要组成部分。     

老年人血脂异常的心血管危险及治疗策略

<正> 随着全球老龄化进程加速,许多国家已经进入老龄化社会。老龄化带来的诸多问题中,心血管病的高发病率、高致死率和高致残率,已经成为社会关注的重大问题,其中,血脂异常在心血管病发病、进展、恶化和不良转归中的作用也越来越受到重视。     

老年人血脂异常治疗受益的证据

<正> 虽然各种调脂药物都能使患者受益,但对于老年人而言,3-羟基-3-甲基戊二酰辅酶A(3-hydroxy-3-methylglutaryl-coenzymeA,HMG-CoA)还原酶抑制剂——他汀类药物在心血管事件一级、二级预防中的价值更为显著。 1 他汀类药物与老年人冠心病二级预防他汀类药物预防老年人心血管事件的作用,最早来自大型多中心、随机、双盲试验的亚组分析。多个研究一致表明,老年人接受调脂治疗可以显著获益,他汀类药物在老年人心血管疾病二级预防中,降     

老年人血脂异常调脂治疗的新动向

现今临床研究已表明调脂治疗可降低老年人的心血管意外及总死亡率。本文对此综述的结果为：调脂治疗对老年人冠心病一级和二级预防均有益;他汀类药物可使冠状动脉意外明显减少;急性冠脉综合征早期应用普伐他汀可改善血管内皮功能;在对老年人混合性高脂血症的治疗上,联合用药的调脂疗效明显优于单用药者。     

老年人混合型血脂异常的药物治疗

混合型血脂异常是以三酰甘油（TG）升高、高密度脂蛋白胆固醇（HDL-C）降低伴总胆固醇（TC）或小而密的低密度脂蛋白胆固醇（sdLDL—C）升高为特点的一种临床常见的血脂异常类型。     

老年人血脂异常的治疗

随着"老龄化"社会的到来和人们饮食结构的改变,老年人的血脂异常成为了一个社会及医生面临的重要问题.血脂代谢异常是引发动脉粥样硬化性心脑血管疾病的主要危险因素之一.由于老年人生理上进入衰退阶段,脂代谢状况有不同于一般人群的特点,但老年人群的血脂异常同样对心脑血管疾病产生十分不利的影响.因此,重视对老年人的血脂异常的治疗是心脑血管疾病防治的重要组成部分.     

老年高血压伴血脂异常的治疗策略

近年来,老年高血压的研究已引起了人们极大的兴趣,不仅是因为老年患者的比例正在不断增长,也因为随着年龄增长,高血压发病率也增高。美国评估与治疗高血压全国委员会第七次报告（JNC7）指出：老年人高血压的患病率较高,≥65岁老年人中三分之二患有高血压,而且治疗效果差,控制率在全人群中最低;     

老年人血脂异常的治疗进展

<正>随着年龄增长,心脑血管病的发病率和病死率增加。血脂异常是老年人心血管病重要的独立危险因素,调脂治疗是防治动脉粥样硬化和心脑血管事件的重要措施。生活方式的调整、使用调脂药物治疗并根据个体特点选择治疗策略,对于老年血脂异常患者的综合管理尤为重要。本综述就2013年ACC/AHA胆固醇治疗降低成人动脉粥样硬化性心血管疾病(ASCVD)风险指南(ACC/AHA指南)和国际动脉粥样硬化学会(international atherosclerosis society,IAS)全     

灯盏花素片治疗老年血脂异常的临床效果

血脂异常的调脂治疗是冠心病一、二级防治极其重要的组成部分,中成药可在这方面发挥一定作用.本研究选择老年血脂异常患者,观察灯盏花素片的调脂作用,以临床上广泛应用的血脂康胶囊作为对照药物,比较两者的调脂效果.     

血脂异常的药物治疗新进展

血脂异常（dyslipdemia)一般是指血中总胆固醇（TC）、低密度脂蛋白-胆固醇（LDL-C）、甘油三酯（TG）超过正常范围及（或）高密度脂蛋白-胆固醇（HDL-C）低下,血脂异常也演唱凸透镜为高脂血症（hyperlipidemia),主要是指TC或（和）LDL-C或（和）TG增高,血脂异常在动脉粥样硬化（atherosclerosis,AS)的发生发展及其引起的心血管事件（cardiovascular events,CVE）中起非常重要的作用。是近年来AS和冠心病（CHD）防治中飞速发展的领域之一。本拟对血脂异常药物治疗的几个主要问题作简单介绍。     

老年血脂异常患者调脂治疗的现状分析

目的分析老年血脂异常患者调脂治疗情况及影响血脂LDL-C达标率的可能因素。方法应用统一的调查表,调查2007年8月～2008年8月在我院住院的607例患者调脂治疗情况,按年龄分老年组(≥60岁,403例)和非老年组(60岁,204例)。对患者进行血脂异常危险分层,以LDL-C为判断标准,计算血脂控制达标率。结果与非老年组LDL-C达标率(36.8%)比较,老年组LDL-C达标率为42.4%,差异无统计学意义(P0.05)。老年组患者中低危、中危、高危和极高危LDL-C达标率分别为100%、77.4%、45.7%和21.5%,差异有统计学意义(P0.01)。血脂异常危险分层、医疗付费方式、有无合并疾病与血脂控制达标率显著相关。结论老年血脂异常患者调脂治疗与2007年新指南标准仍有差距,危险分层越高,达标率相对越低。     

老年人心力衰竭的治疗原则

老年心力衰竭患者的治疗应遵循下列基本原则：综合治疗,即对所有心力衰竭的病因、诱因、临床症状、血流动力学异常、内环境改变和各种临床合并症的全面治疗;个体化治疗,即要根据每名患者的具体病情特点,采取个体化的治疗方案;同时重视用药指导和日常生活管理。     

老年高血压的治疗策略

高血压是老年人群中的常见疾病,目前老年高血压已成为重要的公共卫生问题。老年高血压的治疗策略主要为：在改善生活方式等非药物治疗措施的基础上,选择合适的降压药物治疗使血压达标。常用的五类降压药物,噻嗪类利尿剂、钙通道拮抗剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂均可作为一线降压药物用于老年高血压的起始和维持治疗、单药或优化联合治疗。老年人降压治疗应遵循个体化原则,宜平稳、缓慢,降压药物起始剂量要小,逐渐增加剂量。治疗过程中须注意监测药物不良反应和其他心血管危险因素及合并疾病的治疗,并长期坚持治疗。     

Treatment of aggressive Non-Hodgkin's lymphoma in the elderly

A nonanthracycline-containing chemotherapeutic combination for the treatment of intermediate and high-grade non-Hodgkin's lymphoma was evaluated. Thirty-four consecutive and previously untreated patients, with a median age of 75 (range 54-86) years, with aggressive lymphoma, received daily etoposide (60 mg/m² intravenous infusion [IVI]), cytosine arabinoside (50 mg/m² subcutaneously), and methylprednisolone (60 mg/m² IVI) on each of 5 consecutive days. Individuals with limited disease (stages I and II) (n = 9) received six, 3-day cycles of the same therapy and involved field radiation (36 Gy in 20 fractions) between the third and fourth courses. Patients with disseminated lymphoma (n = 25) received 10 cycles over 8 months of the same combination, with the addition of methotrexate (200 mg/m² on days 8 and 15), followed by leucovorin rescue (10 mg/m² orally every 6 hr for 8 doses). Of the 34 patients, 44% entered complete remission (CR), and 7 died before completing the first cycle of chemotherapy. Fifty-six percent of the patients with limited disease and 40% with disseminated lymphoma (P > 0.05) achieved CR. For all patients, median survival was 14 months (range 3 days->54 months), this being 12 and 15 months, respectively. For the entire population of responding patients, median survival has not been reached at a median follow-up of 39 months, while the median CR duration is 21 months. Ten of the 15 responders are alive in unmaintained CR at a median of 41 (range 30-54) months. Myelotoxicity was the major side effect, leading to adjustments in dose and schedule in two-thirds of the patients, although treatment changes did not affect outcome. Of the 15 deaths that occurred in this trial, in 53.3% it was unrelated to lymphoma or its therapy. Four patients that had achieved CR died of cardiovascular events (n = 2) or of progressive second malignancies (n = 2). It is concluded that cytosine arabinoside in combination regimens is effective in selected patients; this is particularly relevant in the elderly. © 1995 Wiley-Liss, Inc.     

Hyperkalemia in the elderly

Objective

To review the pathophysiology underlying the predisposition to hyperkalemia in the elderly; the medications that disrupt potassium balance and promote the development of hyperkalemia in the elderly; the prevention of hyperkalemia in elderly patients treated with potassium-altering medications; and the appropriate management of hyperkalemia when it develops.

Methods and main results

A MEDLINE search of the literature (1966–1996) using the terms hyperkalemia, drugs, elderly, and treatment was conducted and pertinent review articles, textbooks, and personal files were consulted. Elderly subjects appear to be predisposed to the development of hyperkalemia on the basis of both innate disturbances in potassium homeostasis and comorbid disease processes that impair potassium handling. Hyperkalemia in the elderly is most often precipitated by medications that impair cellular uptake or renal disposal of potassium. This electrolyte disorder is best prevented by recognition of at-risk physiology in the aged, avoidance of therapy with certain high-risk medications, and monitoring of plasma potassium concentration and renal function at intervals appropriate for the medication prescribed. Management of hyperkalemia entails identification of the clinical manifestations of severe hyperkalemia, stabilization of cardiac tissue, promotion of cellular potassium uptake, and ultimately removal of potassium from the body.

Conclusions

Geriatric patients should be considered at risk of developing hyperkalemia, especially when they are prescribed certain medications. Potassium levels should be monitored at appropriate intervals when these patients are treated with potassium-altering medications. Appropriate management of hyperkalemia in the elderly can avoid life-threatening neuromuscular and cardiac complications.     

Management of coronary heart disease in the elderly

The prevalence of coronary heart disease (CHD) increases rapidly with advancing age and remains the major cause of death among elderly Americans. The number of elderly has doubled in the last 30 years and is projected to continue growing at more than twice the rate of the general population. The resources required in managing CHD in this population will reach astronomical levels during the next few decades and will severely tax our ability to provide adequate medical care to all citizens, unless cost effective diagnostic and therapeutic strategies are developed which do not severely compromise health care. Risk factors for CHD should be identified and modified as early in life as possible. Modification of risk factors begun at advanced age appears to confer benefit, however. Anti-ischemic drug therapy is the treatment of choice for patients with mild or moderate stable angina. Select elderly may be willing to accept the increased risks of coronary revascularization to achieve relief from debilitating angina or prolongation of life. Physicians must use care in planning diagnostic and therapeutic strategies. Quality of life and independence are often more important considerations than longevity in this age group.     

非融合技术在老年退变性腰椎疾病中的应用

腰椎非融合外科技术因不固定脊柱节段,也许较融合术具有更多的优势。本文讨论了对于适合的老年患者,腰椎非融合术的主要类型、进展、适应证及禁忌证、存在的优势与不足。并对非融合技术在老年退变性腰椎疾病中的应用前景进行了展望。我们认为,各主要非融合技术在延缓治疗节段椎间盘退变的速度、保留该节段的运动功能、预防相邻节段的退变、减轻临床症状及改善生活质量等方面都显示出较融合术所具有的更多优势和更少的负面影响。     

老年胃癌患者外科治疗的临床研究

目的探讨老年胃癌患者的临床特点及其外科治疗方法的选择及预后。方法回顾性分析1993年1月至2003年1月收治的443例≥65岁老年人胃癌的临床资料和生存资料。结果本组围手术期病死率为2.5%,手术并发症发生率为20.1%。根治性胃切除组术后1、3、5年生存率分别为90%、65.8%和42.1%,姑息性胃切除组分别为73.6%、13.6%和0,未切除组平均生存10月。各组术后生存率比较差异有统计学意义(P<0.05)。结论老年人胃癌术后并发症较多,围手术期处理至关重要。手术方式应视患者全身情况、癌肿所在部位、大小及侵犯范围而定,对早中期患者力争行根治性胃切除术。术后生存率和手术方式密切相关。     

老年人慢性便秘的药物治疗进展

慢性便秘是老年人最常见的消化道症状之一,不仅影响老年人的生活质量,也存在诱发或加重其他疾病的危险性。老年人慢性便秘的病因复杂,治愈难度大,目前主要是根据便秘的病因、分类及其严重程度进行综合治疗,常见的治疗方法包括调整生活方式、药物治疗、精神心理治疗、手术治疗及生物反馈等。本文针对近年来国内外老年人慢性便秘药物治疗进展,尤其是5-羟色胺受体激动剂、鸟苷酸环化酶c受体激动剂、氯离子通道激活剂、阿片μ受体拮抗剂等新型药物的疗效及安全性进行综述。     

老年睡眠呼吸暂停低通气综合征

在老年患者中,睡眠呼吸暂停低通气综合征（SAHS）并不少见。老年睡眠呼吸暂停低通气综合征的患病率往往较高,其发病机制、临床表现均有老年人独特的特点,诊断标准也与中青年患者不同,其并发症往往更加严重,治疗方法的选择上考虑老年人自身特点主要采用持续正压通气。本文将从老年SAHS与中青年SAHS的患病率、发病机制、临床表现、诊断标准、并发症及结局、治疗方案各个不同方面进行综述。