老年开胸病人的围手术期护理

老年病人由于机体的衰老,各种脏器的生理功能减退,免疫功能低下。加之他们常患有多种疾病,使手术危险性及术后并发症明显高于年轻病人,手术死亡率高。如根据老年病人的生理、心理变化特点,加强术前术后护理,则可降低术后并发症。本文旨在分析、讨论60岁以上老年病人开胸手术的护理问题。1　一般资料我院自1994年1月～1997年1月,共为60岁以上高龄病人行开胸术112例,年龄60～78岁,平均年龄669岁,男性75例,女性37例。食道癌72例,贲门癌27例,肺癌13例。全部行手术根治切除或姑息切除。术后并发切口感染裂开2例,食管胃吻合口瘘1例,肺部感染及肺不…     

760例骨科老年患者手术风险因素分析

目的研究与骨科老年患者手术后出现并发症或死亡相关的风险因素。方法对2000年1月~2006年12月在本院骨科住院的760例行中等以上手术的老年患者(≥60岁)进行回顾性分析,以潜在性手术风险因素作为变量,采用SPSS 13.0软件对术后死亡及各种手术后并发症进行统计学分析研究。结果56.7%的骨科老年患者存在不同程度的并发症,术后死亡率为2.1%。23.3%的住院患者术后出现1个或1个以上的并发症。经统计学分析发现,术前心肺功能2级以上、体能状况差、营养不良、神志异常、肾功能不全、手术类型、术中出血量及手术耗时是手术后死亡及出现并发症的主要原因。结论尽管骨科老年患者手术后大部分恢复顺利,但仍有一定程度的并发症(23.3%)和术后死亡率(2.1%),术前应引起高度重视。正确评估患者方面及手术方面存在的风险,并积极调整其生理状态或者改变手术方式,是避免出现术后并发症及死亡的重要措施。     

老年肺癌病人围术期处理(附62例分析)

为提高老年肺癌病人手术切除的成功率,降低围术期死亡率。探讨６２ 例老年肺癌病人手术后肺部、心血管系统并发症的预防及处理。６２ 例病人无１ 例死亡。指出加强围术期的处理,是预防术后并发症、降低死亡率的关键。对６０ 岁以上肺癌病人的手术治疗应持积极态度。     

78例老年心血管疾病的外科治疗体会

目的总结老年心血管疾病的外科治疗特点。方法回顾性分析心胸外科2001年1月-2011年5月期间60岁以上的老年心脏手术病人的临床资料。结果本组老年心脏病患者78例,男性52例,女性26例;年龄60～82岁;体重41～76 kg。均在体外循环下行心脏手术,平均转流时间为（157.11±53.66）m in,平均阻断时间（94.81±35.79）m in,术后呼吸机辅助时间（22.60±10.44）h。术后早期死亡6例,手术早期死亡率7.69%。术后发生严重并发症11例（14.1%）,其中因术后引流量多而行二次开胸探查止血2例（2.56%）,低心排3例（3.85%）,呼吸功能不全2例（2.56%）,术后肾功能不全2例（2.56%）,多脏器功能不全2例（2.56%）。结论年龄并非心脏直视手术的禁忌症,选择适当的手术方式、加强围手术期处理是手术治疗成功的关键。     

乙状结肠扭转的手术治疗

<正> 乙状结肠扭转多见于老年患者,其治疗方法目前仍有争论。本文根据我院1964～1981年间所收治的27例乙状结肠扭转患者,36次手术资料,重点讨论乙状结肠扭转的手术治疗问题。临床资料本组27例中,男20例,女7例。年龄19～78岁,平均53.6岁,50岁以上18例(66.6％)。农村病人20例,占74％。     

207例老年胸部非血管疾病的外科治疗

作者于1978年1月至1988年12月对207例60岁以上老年病人进行了开胸手术。其中男性164例,女性43例,年龄60～80岁。179例为恶性肿瘤,6例为良性肿瘤,胸部结核及包虫病17例,居第二位。97例(46.9％)伴有其他全身疾病,其中大多数为心血管疾病(50.5％)和呼吸系统疾病(43.3％)。术后发生各种并发症17例(8.2％),死亡9例(死亡率为4.3％)。作者对老年人胸部疾病的特点,正确选择手术指征,认真做好术前准备及术中处理,加强术后护理,并发症的预防等作了讨论。     

老年食管癌病人的外科治疗

目的：评价老年食管癌病人外科治疗的价值，方法：回顾分析80例60岁以上食管癌病人的手术治疗，包括术前检查，处理，手术方法及术后并发症的防治。结果：手术切除率87．5％，死亡率3．75％，术后严重并发症的发生率12．5％，结论：对老年食管癌应采用手术治疗的积极态度，围手术期处理的关键为心血管并发症和呼吸功能不全的防治。     

100例骨科老年患者手术风险因素分析

目的探讨骨科老年患者于术后出现相关并发症或者死亡的风险因素。方法选取自2009年1月～2010年12月收入骨科的100例行中等以上手术的老年患者（≥60岁）的临床资料进行回顾性分析,将潜在性的手术风险因素作为参考变量,对术后出现死亡以及其他各种术后并发症进行统计学分析。结果术后患者死亡3例,死亡率为3%,出现1个或1个以上的术后并发症占总数的25%。经统计学分析发现,关节置换术、肺部感染、心肺功能分级、脑梗塞、肾功能不全、体能状况评估及神志状况是手术后死亡及出现并发症的主要原因。结论通过正确评估患者耐受手术风险的能力及手术可能造成的影响,积极调整患者的身体状况或者改变手术方式,能够一定程度上降低术后的并发症以及死亡的发生率。     

70岁以上老年人结直肠癌手术137例分析

目的探讨70岁以上老年人结直肠癌围术期的治疗。方法对2000—2008年间收治的70岁以上的老年结直肠癌手术患者137例病历资料进行回顾性分析,年龄70～99岁,中位年龄79.1岁,其中结肠癌56例,直肠癌81例。结果70岁以上老年人结直肠癌手术患者手术前并存病多达81.8%,术后并发症发生率为21.17%,围术期死亡率5.84%,均较中青年患者为高。结论对70岁以上老年人拟行结直肠癌手术患者应重视术前并发病的治疗和充分准备,术中有效的麻醉管理及严密的心血管系统监测,术后及时精准的并发病处理、周密的护理是降低术后并发症发生率和手术死亡率的关键。     

老年急腹症并多器官功能衰竭治疗体会

老年急症外科术后并发症发生率和死亡率均高于年轻人。多器官功能衰竭（MOF）是老年急腹症危重病人死亡的主要原因。我院自1990~1997年收治60岁以上老年急腹症患者67例，其中出现多器官功能衰竭23例，现总结分析如下。1资料与方法1．1一般资料：本组男38例，女29例，年龄60~90岁，平均年龄71．8岁。1.2老年急腹症与MOF关系：见附表。2治疗及结果在23例MOF病人中，起病至手术时间＜48小时7例。起病至手术时间＞48小时16例。手术治疗根据病因分别处理，术后加强对各脏器功能的监测，根据脏器衰竭情况采用呼吸机机械通气，利尿、透析、护肝…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.