PFNA与DHS治疗高龄不稳定股骨转子间骨折的疗效比较

目的：比较股骨近端防旋髓内钉（proximal femoral nail anti-rotation，PFNA）与动力髋螺钉（dynamic hip screw，DHS）治疗高龄不稳定股骨转子间骨折的临床疗效。方法：2012年1月至2015年12月收治的83例高龄不稳定股骨转子间骨折患者分为采取PFNA治疗的45例与采取DHS治疗的38例。PFNA组中男24例，女21例；年龄82～94（88.35±6.12）岁；病程1.5～10（4.33±1.07） h；交通事故33例，高空坠落10例，跌倒伤2例；Evans-Jensen分型：ⅢA型21例，ⅢB型18例，Ⅳ型6例。DHS组中男20例，女18例；年龄83～95（88.77±5.52）岁；病程1～10（4.37±1.05） h；交通事故27例，高空坠落10例，跌倒伤1例；Evans-Jensen分型：ⅢA型18例，ⅢB型15例，Ⅳ型5例。观察比较两组手术时间、术中出血量、出院时并发症。利用健康调查简表（the Mos 36-item Short Form Health Survey，SF-36）测定术前及术后12个月生活质量。采用Harris评分评价术后12个月髋关节功能。结果：PFNA组手术时间、术中出血量、并发症发生率均明显低于DHS组（P<0.05）；两组患者均获得12个月随访，期间无脱落，两组术后12个月Harris评分、SF-36评分均高于术前（P<0.05），PFNA组均明显高于DHS组（P<0.05）；PFNA组优良率高于DHS组（P<0.05）。结论：与DHS相比，PFNA治疗高龄不稳定股骨转子间骨折操作更为简便、创伤更小、并发症更少、短期优良率与患者生活质量更高，可作为治疗高龄不稳定股骨转子间骨折的优选治疗方法。     

经皮椎间孔镜技术治疗老年腰椎侧隐窝狭窄症

目的:探讨经皮椎间孔镜技术治疗老年腰椎侧隐窝狭窄的临床疗效及安全性。方法:对2018年3月至2019年8月采取经皮椎间孔镜技术减压治疗的31例老年腰椎侧隐窝狭窄患者进行回顾性分析,其中男16例,女15例,年龄65~81(71.13±5.20)岁,病程3个月~7年,平均(14.36±6.52)个月。采用视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI)评估术前及术后1,6,12个月临床症状及功能状态;末次随访采用改良Macnab标准评估临床疗效。结果:手术均顺利完成,手术时间75~120(97.84±11.22)min。31例患者均获得随访,时间12~28(17.29±5.56)个月。术后1、6、12个月腰腿痛VAS及ODI较术前均得到明显改善(P<0.01)。末次随访采用改良Macnab标准评定疗效,结果优23例,良5例,可3例。1例患者神经根与周围组织粘连严重,术后出现下肢感觉异常,给予中药加营养神经药物等保守治疗,术后2周恢复。无神经根损伤、感染等并发症出现。结论:椎间孔镜技术在局麻下进行,操作时间短,在保证充分减压的同时又可减少并发症发生,是治疗老年腰椎侧隐窝狭窄症的一个安全、有效的的手术方法。     

Factors associated with voice disorders among the elderly: a systematic review

Introduction

During the aging process, natural modifications occur in the larynx and the structures involved in phonation which explain the specific characteristics found in the voices of elderly persons. When, at any moment, a voice fails and there is interference with communication, a voice disorder has occurred. This can generate disadvantages in communicative efficiency and have a negative impact on quality of life, compromising mechanisms of socialization, the maintenance of autonomy, and the sense of well-being. Nevertheless, there appears to be little clarity about which factors are associated with voice disorders in this population, especially from an epidemiological perspective.

绵阳市60岁及以上老年人帕金森综合征现况及相关影响因素分析

目的 了解绵阳市60岁及以上老年人帕金森综合征的流行现况,探讨其影响因素。方法 采用多阶段随机抽样,抽取4 000名绵阳市60岁以上城乡居民,采用χ2检验,非条件logistic回归模型计算OR值和95%CI。结果 最终调查3 996名老年人,平均年龄为(69.66±6.51)岁,其中男性1 824人(45.65%),女性2 172人(54.35%)。检出帕金森综合征303例,检出率为7.58%。女性(OR = 0.586),文化程度越高(小学OR = 0.464,初中及以上OR = 0.252),经常打牌或玩麻将(OR = 0.399),每天体育锻炼(OR = 0.592)是老年人帕金森综合征的保护因素。年龄大于80岁,居住在农村,职业为农民,患高血压,患脑卒中,存在睡眠问题,嗅觉有变化,有便秘均是老年人帕金森综合征的危险因素(OR值均1)。结论 帕金森综合征在老年人中很常见,患有高血压。脑卒中等疾病,存在嗅觉变化。经常便秘。睡眠障碍的农村老年人群应引起重点关注,建议老年人积极参加体育锻炼和社会活动。     

A Randomized Trial of Alerting to Low Glycated Hemoglobin Level in Older Adults: Results of the Low Indexes of Metabolism Intervention Trial B (LIMIT-B)

ObjectivesThe benefit of alerting clinical staff to low plasma glycated hemoglobin (HbA1c) in patients aged 75 years and older who receive antidiabetic drugs remains uncertain.Design, Setting, and ParticipantsIn a randomized controlled trial, 1684 patients with HbA1c ≤ 6.5% who received antidiabetic drugs were assigned to have an e-mail alert sent to their physician, and 1643 were assigned to have no such alert (control group). The primary outcome of the trial was annual death. Secondary outcomes included antidiabetic drug dose reduction and HbA1c change.ResultsIn the first quarter, antidiabetic drug-defined daily doses were reduced on average by 10.4 ± 35.8 (16% ± 55%) in the intervention group and by 6.4 ± 36.1 (10% ± 56%) in the control group (difference −4.1 ± 1.2, 95% confidence interval [CI] −6.5 to −1.6; P = .001). Measured HbA1c levels were raised by a mean (± standard deviation) of 0.28 ± 0.77 in the intervention group and by 0.18 ± 0.57 in the control group (difference 0.10 ± 0.02, 95% CI –0.15 to −0.059, P < .001). One year after the alerts, 121 patients (7.2%) died in the intervention group and 107 patients (6.5%) died in the control group (relative risk 1.1, 95% CI 0.86-1.42; P = .44).Conclusions and ImplicationsIn this trial, alerting clinical staff to low HbA1c in patients aged 75 years and older treated with antidiabetic medicines was associated with mildly reduced antidiabetic doses and increased HbA1c but was not associated with a significant difference in survival rate compared with usual clinical care.     

低每搏量变异度指导的液体治疗对老年患者肺叶切除术后恢复质量的影响

目的 探究低每搏量变异度（SVV）指导的液体治疗对老年患者肺叶切除术后恢复的影响。

方法 选择2022年2月至2023年1月择期胸腔镜下肺叶切除术的老年患者100例,男50例,女50例,年龄65～75岁,BMI 18～24 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数表法将患者分为两组：低SVV阈值目标导向液体治疗（GDFT）组（G组）和对照组（C组）,每组50例。G组8%＜SVV≤10%,C组10%＜SVV≤13%。记录麻醉时间、手术时间、单肺通气（OLV）时间,记录入手术室即刻（T₀）、插管即刻（T₁）、OLV开始即刻（T₂）、手术开始即刻（T₃）、OLV结束即刻（T₄）和术毕（T₅）时的HR和MAP。记录术中液体出入量以及各种血管活性药使用情况。记录术前24 h和术后24、48 h血浆胃动素（MTL）、胃泌素（GAS）、肠型脂肪酸结合蛋白（IFABP）浓度。记录术后2、6、12、24、48 h静息时VAS疼痛评分以及术后48 h内PCIA有效按压次数、PCIA总按压次数以及补救镇痛例数。记录术后首次肛门排气时间、首次排便时间、首次下床活动时间、术后住院时间、胃肠道并发症（恶心呕吐、腹胀）发生情况。

结果 与C组比较,G组T₁—T₅时MAP、术后24、48 h血浆MTL和GAS浓度均明显升高（P<0.05）,术后24、48 h血浆IFABP浓度、术中胶体输注量和总液输注量均明显降低（P<0.05）,术后首次肛门排气时间、首次排便时间、首次下床活动时间和术后住院时间均明显缩短（P<0.05）。两组尿量、出血量、术后2、6、12、24、48 h静息时VAS疼痛评分、术后48 h内PCIA有效按压次数、PCIA总按压次数、补救镇痛率差异均无统计学意义。

结论 低SVV阈值（8%＜SVV≤10%）GDFT能很好地促进胃液分泌和肠黏膜屏障功能恢复,对老年患者肺叶切除术后胃肠功能的恢复有积极作用。     

0.375%罗哌卡因用于老年患者股骨颈骨折髋关节囊周围神经阻滞的半数有效容量

目的 采用序贯法测定0375%罗哌卡因用于老年患者股骨颈骨折超声引导下髋关节囊周围神经（PENG）阻滞麻醉前镇痛的半数有效容量（EV₅₀）。

方法 选择2022年1—8月拟行髋关节置换手术的股骨颈骨折老年患者23例,男9例,女14例,年龄≥65岁,BMI 18～24 kg/m²,ASAⅠ—Ⅲ级。在超声引导下行PENG阻滞,定位成功后,于腰肌肌腱后方和耻骨支之间的肌筋膜平面单次注入0375%罗哌卡因。采用序贯法测定0.375%罗哌卡因EV₅₀,初始给药容量为12.5 ml,相邻容量梯度为1.5 ml。注药后20 min评估镇痛效果,若患肢活动时VAS疼痛评分＜4分,视为镇痛有效,则下一例患者容量降低一个梯度;反之,则升高一个梯度,至出现7个镇痛有效-镇痛无效交叉点时结束研究。采用Probit概率回归法计算0.375%罗哌卡因用于老年患者股骨颈骨折超声引导下PENG阻滞的EV₅₀、95%有效容量（EV₉₅）及其95%可信区间（CI）。

结果 0.375%罗哌卡因EV₅₀为8.84 ml（95%CI 7.50～9.85 ml）,EV₉₅为11.12 ml（95%CI 9.78～17.09 ml）。

结论 0.375%罗哌卡因用于老年患者股骨颈骨折超声引导下单侧PENG阻滞进行麻醉前镇痛的EV₅₀为8.84 ml（95%CI 7.50～9.85 ml）。     

经腋窝入路免充气腔镜甲状腺手术在中老年患者中的应用价值

背景与目的：近年来随着微创技术的不断更新以及人们对生活质量要求的不断提高,腔镜甲状腺手术逐渐普及应用,尤其受到年轻女性患者的青睐。对于中老年患者,临床上仍以开放手术为主,较多患者术后会出现皮瓣下垂,吞咽联动,异物感等情况,严重影响患者的生活。经腋窝入路免充气腔镜手术利用颈部肌肉的自然间隙建腔,在颈前带状肌深面显露甲状腺并进行手术操作,对颈部功能影响较小,而且不需要CO2,对心肺影响较小。本研究探讨经腋窝入路免充气腔镜甲状腺手术在中老年患者中的疗效及安全性,为其在中老年患者中的应用提供参考。方法：回顾性分析2021年1月—2022年6月江苏省宿迁市第一人民医院甲乳外科收治的56例中老年甲状腺癌患者的临床资料。其中,26例接受经腋窝入路免充气腔镜下甲状腺手术（观察组）,30例接受传统开放手术（对照组）。比较两组患者手术指标、疼痛状况、颈部损伤指数、吞咽障碍指数、并发症及预后。结果：56例患者均顺利完成手术。观察组手术时间长于对照组,术后引流量多于对照组（均P<0.05）。两组患者术中出血、呼吸困难、声音嘶哑、手足麻木、饮水呛咳、皮下血肿等并发症,中央区清扫淋巴结数,住院时间差异均无统...     

Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas

ObjectiveTo evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community.DesignRandomised clinical trial.SettingFamily health centre, primary care.ParticipantsIndependent elderly people living in the community.InterventionFor intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre.Main measurementsPerception of risk of falls, number of risk factors and number of falls in the study period.ResultsIn both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004).ConclusionsThe multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.