老年自发性气胸临床特点分析

目的探讨老年自发性气胸的临床表现特点。方法选择我院近15年收治的60岁以上老年自发性气胸51例,观察其临床表现、病因、诱因、气胸类型与部位及肺压缩面积、合并症、误诊情况及其治疗,并与79例青壮年自发性气胸作对照,探讨老年自发性气胸发生的临床特点。结果老年组气胸的病因、诱因、临床表现、气胸类型与部位及肺压缩面积、合并症、误诊情况及其治疗与对照组有明显不同。结论老年自发性气胸具有自身的特点,及时诊断和治疗,防止误诊,具有重要临床意义。     

老年人和青年人自发性气胸的对照性研究

目的总结老年人自发性气胸的临床特点,提高认识。方法对老年人自发性气胸45例和青年人自发性气胸43例临床资料进行分析对照。结果老年组继发性气胸的发生率、紫绀、大汗淋漓、休息时呼吸困难的临床症状及张力性气胸的类型明显高于青年组且误诊率和死亡率高于青年组,而特发性气胸的发生率、胸痛症状以及闭合性气胸的类型,明显低于青年组,两组的差异均有显著性P〈0．05;在气胸发生部位、肺萎缩的面积两组未显示统计学意义。结论老年人具有病因明确,临床表现不典型,病情凶险,误诊率高,预后差等特点。     

老年自发性气胸的临床特征（附40例分析）

1993年 1月～ 1999年 12月共收治 2 2 4例自发性气胸 ,其中老年自发性气胸 (以下简称老年组 ) 40例 ,为了探讨老年自发性气胸的临床特征 ,随机抽出青壮年自发性气胸 (以下简称青壮年组 ) 40例进行对比分析。1　临床资料1.1　一般资料　老年组 :男 35例 ,女 5例 ,年龄 60～92岁 ,平均年龄 68岁。右侧气胸 2 0例 ,左侧气胸 2 0例 ,其中双侧气胸 5例 ,局限性气胸 18例。青壮年组 :男 39例 ,女 1例 ,年龄 14～ 4 5岁 ,平均年龄 30岁 ,右侧气胸 18例 ,左侧气胸 2 2例 ,局限性气胸 1例 ,无一例双侧气胸。1.2　基础疾病和诱因　老年组 :慢性阻塞性…     

老年人自发性气胸48例临床分析

目的探讨老年人自发性气胸的临床特点。方法对我院2001年1月至2008年11月收治的老年人自发性气胸48例临床资料进行回顾性分析，并和同期住院的青壮年气胸40例进行对照分析。结果（1）病因：老年组中慢性阻塞性肺病34例（70．8％）、肺结核9例（18．8％）、特发性气胸5例（10．4％），而对照组分别为10例（25％）、11例（27．5％）、17例（42．5％），老年组继发性气胸占89．6％（43／48），明显高于对照组，差异有显著性。（2）临床表现：老年组表现为胸闷气急45例（93．7％）、胸痛25例（52％），而对照组分别为27例（67．5％）、35例（87．5％），两组相比差异有显著性。（3）气胸类型及治疗：老年组交通性、张力性气胸多见、治疗常需胸腔闭式引流，而对照组以闭合性气胸多见，老年组平均肺复张时间为16．2天，远高于对照组的10．4天，差异有显著性。结论老年人以继发性气胸多见，临床表现不典型，误诊率高，须认真检查，及时进行有效的治疗。     

老年性肺结核并发自发性气胸90例临床分析

目的总结老年性肺结核并发自发性气胸的资料,提高对老年性肺结核并发自发性气胸的诊治。方法总结我所2000年～2009年老年性肺结核并发自发性气胸的一般资料、诊断及治疗情况。结果本组90例首诊误诊48例,误诊率达53．3％;死亡12例,病死率13．3％。结论老年性肺结核并发自发性气胸临床症状多不典型,体征多不明显,合并症多,且易误诊、漏诊,病情重,预后差,应引起l临床重视。     

老年自发性气胸52例临床分析

目的探讨老年自发性气胸的临床特点。方法对老年自发性气胸52例与非老年自发性气胸58例的临床资料进行对比分析。结果老年自发性气胸多为继发性,伴有基础疾病,其中以慢性阻塞性肺疾病(COPD)为多见。诱因多为呼吸道感染。老年组咳嗽,气促症状较早出现,且症状均重,而体征不典型。自发性气胸3种类型两组间比较无显著性差异。结论由于老年自发性气胸患者常有慢性肺部基础疾病,一旦发生气胸,易发生呼吸衰竭,死亡率高。且老年组临床症状常为基础疾病所掩盖,易导致临床漏诊和误诊。老年自发性气胸并发症多,易造成心肺功能衰竭等,及早诊断治疗非常重要。了解老年自发性气胸的临床特点对于全科医生进行社区医疗有着非常重要的指导意义。     

COPD合并自发性气胸28例临床分析

目的 提高对COPD合并自发性气胸的诊断水平。方法 对2001—2006年中确诊为COPD合并自发性气胸28例进行回顾性分析。结果 误诊率达39％。结论 COPD合并自发性气胸是临床的常见疾病,误诊较高,应提高诊断水平,减少误诊。     

老年人与青年人自发性气胸临床对比分析

目的 通过对比分析两种不同年龄组患者气胸的临床特点,提高对老年人气胸的认识.方法 对≥60岁老年人气胸58例(老年组)和≤40岁青年人气胸121例(青年组)的病因、诱因、临床表现、气胸类型、治疗方法、并发症、误诊率、病死率进行对比分析.结果 病因构成:老年组继发性气胸占100%,高于青年组29.8%,P＜0.01.诱因:老年组有诱因者(19.0%)低于青年组(42.1%),P＜0.01.临床表现:胸痛症状老年组(41.4%)低于青年组(72.7%)(P＜0.01).气急症状老年组(91.4%)高于青年组(20.7%)(P＜0.01).咳嗽症状老年组(96.6%)与青年组(81.8%)相比差异无统计学意义(P＞0.01).但老年组的咳嗽同时有咯痰,而青年组的咳嗽症状则以刺激性干咳为主.气胸类型与治疗:老年组张力型气胸(21例)高于青年组(0例)(P＜0.01).老年组需给予胸腔闭式引流术治疗的病例(81.0%)高于青年组(43.0%)(P＜0.01).并发症:老年组(44.8%)高于青年组(9.1%)(P＜0.01).误诊率:老年组(25.9%)高于青年组(2.5%),P＜0.01.病死率:老年组(6例)高于青年组(0例),P＜0.01.结论 老年人气胸具有原发病多为慢性阻塞性肺疾病、胸痛症状较少、呼吸困难明显、并发症多、易误诊、病死率较高的临床特点.     

基层医院COPD并发自发性气胸误诊防范的探讨

目的探讨基层医院减少COPD合并气胸误诊率的有效途径。方法对2001年12月～2007年12月期间确诊为COPD合并气胸的106例患者进行回顾性分析。结果误诊率达33％。结论COPD并发自发性气胸是临床的常见病,误诊率较高,应提高诊断水平,减少误诊     

160例气胸临床分析

目的提高临床对气胸的诊治水平。方法对2003年6月-2008年6月本院诊治的自发性气胸160例临床资料分析。结果经治疗108例自发性气胸全部治愈（100％）;继发性气胸52例,治愈50例（96．2％）,死亡2例（3．8％）。结论特发性气胸以青壮年为主,症状轻,治疗效果好;继发性气胸以中老年居多,合并症多,诊断复杂,易漏诊与误诊。     

卡托普利早期和长期治疗对老年急性心肌梗死患者生存率的影响

目的　比较早期和长期卡托普利治疗对≥65岁和＜65岁急性心肌梗死(心梗)患者生存率的影响。　方法　根据是否早期及长期卡托普利治疗,将822例首次心梗72h内入院患者分为＜65岁卡托普利组209例、≥65岁卡托普利组269例,＜65岁对照组131例、≥65岁对照组213例。　　结果　住院期(1～42d)＜65岁卡托普利组死亡8例(3.83%),＜65岁对照组死亡10例(7.63%),差异无显著性(P＞0.05);≥65岁卡托普利组死亡25例（9.29%）,≥65岁对照组死亡52例（24.41%）,差异有显著性(P＜0.0001)。卡托普利治疗患者住院期心原性死亡与年龄相关(P=0.0002),随访1.3～54.0个月表明,心原性死亡与年龄关系不密切;＜65岁卡托普利组158例中猝死3例(1.9%),＜65岁对照组97例猝死11例(11.4%,P＜0.01);≥65岁卡托普利终访192例中猝死7例(3.6%),≥65岁对照组终访128例中猝死25例(19.5%,P＜0.01)。≥65岁和＜65岁卡托普利组心源性事件发生也低于相应对照组(P＜0.01)。　结论　卡托普利治疗急性心梗作用住院期有年龄差异,而长期应用改善预后作用无年龄差异。     

直接PCI治疗高龄急性ST段抬高性心肌梗死

目的评价高龄急性ST段抬高性心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者行直接经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗的安全性和有效性。方法对比分析46例高龄STEMI患者（高龄组）和64例年轻STEMI患者（年轻组）冠状动脉造影特征、直接PCI治疗的情况．即刻手术成功率、住院及随访期间主要心血管事件的发生情况。结果高龄组与年轻组比较,冠状动脉病变多为多支病变（73．9％比28．1％,P〈0．01）;2组手术即刻成功率无明显差异;2组术后达到心肌梗塞溶栓（thrombolysis inmyoxardial infarction,TIMI）3级血流患者比率无明显差异;高龄组手术操作时间较年轻组长[（64．4±25．4）min比（49．7±21．8）min,P〈0．05];高龄组住院期间、随访期间累计总的主要心血管事件发生率明显高于年轻组。随访期间,高龄组1例术后4个月猝死,死亡原因不明,1例术后1年死于脑出血：年轻组无死亡病例。结论对高龄STEMI患者行直接PCI治疗是比较安全而有效的再灌注手段。     

家属参与糖尿病教育管理临床分析

目的 在医生、家属、患者、护士参与（MUST）的糖尿病教育模式研究基础上,观察不同家属与患者组合对糖尿病患者长期治疗依从性的影响.方法 选择2010年3至5月在山东省滨州市人民医院门诊就诊的居住于本市的2型糖尿病患者,按就诊顺序确定入选患者及其家属300对.按照不同的家属与患者关系分为妻管夫型、夫管妻型、晚辈管长辈型以及长辈管晚辈型4组.采用改良的Deborah糖尿病自我管理评价表进行24个月的患者依从性测定,分析依从性的影响因素.两组间均数比较采用独立样本t检验,多组均数比较采用方差分析.结果 家属中女性明显多于男性（60％比40％,x2=24.00,P＜0.05）,主要来源于妻管夫型组（31.0％）.各分组家属和患者年龄、家属主动联系次数和自愿参加糖尿病教育次数差异均有统计学意义（x2=61.18、107.77、35.45、44.79,均P ＜0.05）,其中最高的主动联系次数比例出现在妻管夫型（12.3％）,而主动联系医护人员的夫管妻型中的丈夫只有1.0％.家属主动参加糖尿病教育次数总体偏少,大部分为两年只参加了不到3次.24个月的观察期间,夫管妻型完全从医率呈持续上升趋势,各观察时期与观察前（33.9％）比较差异均有统计学意义（第6、12、18、24个月分别为60.3％、67.9％、70.9％、74.1％,x2=6.762、9.626、12.131、11.707,均P＜0.05）.晚辈管长辈型和妻管夫型完全从医率呈现上升并维持高平台趋势.长辈管晚辈患者完全从医率呈“∧”形分布.观察结束时,完全从医率以夫管妻型患者最高（74.1％）,其次为晚辈管长辈型（60.8％）、妻管夫型（48.3％）和长辈管晚辈型（29.0％）.所有患者的完全从医率为52.3％.以观察结束时完全从医为因变量分析影响因素显示,与患者完全从医相关的家属因素为性别、年龄、主动联系次数和分组（OR=3.593、0.251、2.734、0.692,均P＜0.05）.与患者自身相关的完全从医影响因素为性别、文化程度和分组（OR=0.497、2.558、0.443,均P＜0.05）.结论 夫管妻型长期完全从医率最佳.同等辈分中女性作为监管者比男性效果好,不同辈分中晚辈监管长辈效果好,这种良好的效果与家属联系医护人员的主动性有关.     

肺功能检查在老年支气管哮喘诊断中的意义

目的探讨肺功能检查在老年支气管哮喘诊断中的意义。方法调查我院286例老年支气管哮喘确诊患者,其中观察组144例,经肺功能检查确诊,对照组142例患者经身体特征确诊,分析两组患者的误诊率。结果经跟踪调查发现观察组中有10例患者不是支气管哮喘,误诊率6.9%;而在对照组中有21例患者不是支气管哮喘,误诊率为14.7%。两者差异有统计学意义(P<0.05)。结论肺功能检查诊断支气管哮喘的误诊率低,对临床指导治疗支气管哮喘有着十分重要的意义。     

The management of bleeding peptic ulcer in the elderly with heater probe thermocoagulation

BACKGROUND/AIMS: The aim of this study was to compare the clinical characteristics of bleeding peptic ulcers in the elderly with those in younger patients, retrospectively. METHODOLOGY: Between 1986 and 1994, 274 patients with bleeding peptic ulcers were treated with heater probe endoscopically. They were divided into 2 groups: 48 in the elder group (70 years of age or older) and 226 in the younger group (<70). We evaluated the rate of concomitant disease, rebleeding rate, incidence of emergency surgery, mortality and blood transfusion requirement between the 2 groups. RESULTS: The incidence of concomitant disease was significantly higher in the elderly group (83.3%) than in the younger group (33.3%) (p<0.01). The rate of rebleeding (younger group 23.5% vs. elderly group 31.3%), the incidence of emergency surgery (5.8% vs. 6.3%, respectively) and the rate of mortality due to hemorrhage (2.2% vs. 4.2%, respectively) were similar in the 2 groups. There was no significant difference in the mean volume of blood transfused. CONCLUSIONS: It was revealed that aggressive endoscopic hemostasis improved the mortality rate and the incidence of emergency surgery in elderly patients as well as in younger patients, provided that their general condition was monitored carefully.     

老年女性急性心肌梗死患者近期死亡的影响因素分析

目的探讨老年女性急性心肌梗死患者发病情况及近期死亡的影响因素。方法选择初发急性ST段抬高心肌梗死后收治入院的女性患者共336例,根据年龄分为2组:老年组298例,非老年组38例。回顾性分析比较2组患者一般临床资料、发病特点和发病后30d内死亡情况,采用多元logistic回归分析年龄对女性急性心肌梗死患者近期死亡的影响。结果老年组患者年龄、血肌酐明显高于非老年组患者,而左心室射血分数明显低于非老年组患者,差异有统计学意义(P0.05,P0.01);老年组患者近期病死率明显高于非老年组患者(25.8% vs5.3%,P0.01)。年龄≥60岁的女性是急性心肌梗死后30d死亡的独立危险因素,其死亡危险较非老年组患者高6.6倍(OR=6.553,95% CI:1.183～36.294,P0.01)。结论老年女性急性心肌梗死患者具有更高的近期病死率。年龄≥60岁、发病至入院时间、空腹血糖、严重心律失常和急性左心功能不全是预测女性急性心肌梗死患者近期死亡的独立预测因素。     

莫西沙星序贯治疗老年人社区获得性肺炎的临床研究

目的探讨莫西沙星序贯治疗老年社区获得性肺炎的临床疗效，安全性和治疗费用。方法70例老年社区获得性肺炎患者先给予莫西沙星注射液400mg／250ml静脉滴注，每天1次，治疗5～7d。临床症状改善后，随机分成序贯组和对照组。序贯组35例换予莫西沙星片剂400mg口服，每天1次。对照组35例继续使用莫西沙星注射液400mg／250ml静脉滴注，每天1次。两组总疗程14d。观察治疗效果，药物的不良反应和治疗费用。结果两组的治愈率无明显差异（P〉0．05），分别为91．43％和94．29％。序贯组的治疗费用、不良反应均明显低于对照组（P〈0．01或P〈0．05）。结论莫西沙星序贯治疗老年社区获得性肺炎疗效确切，不良反应少，并可节省医疗费用。     

Gastric adenocarcinoma in young adults: A comparative study with elderly patients

"Background: Gastric adenocarcinoma (GA) has been considered a disease of elderly age and has been rarely reported in patients younger than 35 years of age. The aim of this demographic, clinicopathological and prognosis of gastric cancer in young patients and to compare their features with the behavior in elder adults. Methods: Between 1993 and 2008, 1536 patients with GA were enrolled in a retrospective database. Clinical and pathologic features of thirty patients aged 35 years or less (young group) were compared with those of 458 aged 75 years or more (elder group). Results: Mean patient age was 31 and 80-years old in the young and elder groups, respectively, with a predominance of females in the last group (61%). Lauren diffuse type carcinoma was more frequent in people younger than 35 years (70%) than in older patients (17.4%). Main symptoms were dyspepsia (40%) and hemorrhage (20%). The most common T stage in young and elder patients was T3 (52.9% and 56.7% respectively). Surgical resection was performed in 68% of cases and the rest received only systemic chemotherapy. Conclusion: Gastric adenocarcinoma is rare in young patients and most cases presented at advanced clinical stage similar to elderly patients, so the prognosis in both age groups is poor. For this reason is important to be aware of alarm symptoms and risk factors in order to perform an early endoscopic diagnosis and a treatment with curative intent."     

Characteristics of 109 index cases in TB outbreak

OBJECTIVES: To elucidate characteristics of index cases in TB outbreak. SUBJECTS AND METHODS: The subjects of this retrospective study were 109 index cases in TB outbreak observed in Japan between 2003 and 2005, and reported to the Ministry of Health, Labour and Welfare. An index case rate (ICR) for a category of patients was defined as following; ICR=NI/NA, where NA: Number of TB patients in a category A, and NI: Number of index cases in category A. RESULTS: Of the 109 patients, 20 were female and 89 were male. Smear-positive pulmonary TB patients were 102 in number, and separated to 87 patients with cavitary lesion on a chest X-ray and 15 without cavitary lesion, and the remaining 7 patients were smear-negative and culture-positive pulmonary TB patients. The index case rates were 0.46% for smear-positive cavitary patients, 0.10% for smear-positive non-cavitary patients, and 0.04% for smear-negative culture-positive patients. The differences were highly significant between smear-positive cavitary patients and smear-positive non-cavitary patients, as well as between smear-positive cavitary patients and smear-negative culture-positive patients (p<0.001). In 57 male patients with smear-positive cavitary lesion, the index case rates were significantly different between the thirties and the forties (1.84% vs 0.61%, p<0.01). All patients were grouped by age to a younger group with 10 to 39 years of age, a middle aged group with 40 to 69 years, and an elder group with 70 years or higher. The index case rates in smear-positive cavitary patients were 2.32% for the male younger group, 0.37% for the male middle group, 0.06% for male elder group, 0.41% for the female younger group, 0.37% for the female middle group, and 0% for female elder group. The differences were highly significant between the male younger group and the male middle group, as well as between the male younger group and the female younger group (p<0.001). The index case rates for smear-positive cavitary patients were significantly higher than non-cavitary patients in two categories; 1.58% versus 0.21% for the younger group (p<0.001), and 0.37% versus 0.11% for the middle aged group (p<0.05). CONCLUSION: These findings suggest that TB outbreak risk is the highest in those patients categorized to be smear-positive, cavitary, younger group, and male.     

安徽地区老年肺结核的临床特点分析

目的进一步了解老年肺结核的临床特点。方法对我院1999年1月-2003年12月期间门诊和住院的75例老年肺结核,52例青壮年肺结核的临床资料进行回顾分析。结果与青壮年相比老年肺结核临床症状不典型,并发症多,病程长,复治病例多,治疗效果差。结论近年来老年肺结核疫情严重,临床症状不典型,误诊率高,应及早诊断与治疗。