舌骨下肌皮瓣在老年口腔癌术后缺损修复中的应用

目的：探讨舌骨下肌皮瓣在老年口腔癌切除术后缺损修复中的应用价值。方法：回顾分析2005年12月—2010年11月间收治的口腔癌患者19例。男11例,女8例;年龄65～89岁,平均72.8岁。舌癌10例,口底癌6例,颊癌2例,下颌牙龈癌1例。均采用舌骨下肌皮瓣修复术后所致软组织缺损。结果：术后切口均一期愈合,19例舌骨下肌皮瓣全部成活,无1例发生全部或部分皮瓣坏死。患者获得满意的外观和功能。经过6个月～5a的随访,无一例肿瘤复发或远处转移。结论：舌骨下肌皮瓣制备较简单,效果可靠,且成活率高,是老年患者口腔癌修复重建的适用方法。     

七氟醚不同诱导方式对老年患者血流动力学的影响

目的 比较七氟醚逐渐增加吸入浓度诱导与高浓度快速吸入诱导两种诱导方式对老年患者血流动力学的影响.方法 全麻下择期手术的65岁以上老年患者40例,随机均分为逐渐增加吸入浓度诱导组(IS组)和高浓度快速吸入诱导组(RS组).IS组七氟醚初始吸入浓度为2%,每3次呼吸递增1%直至4%～5%;RS组吸入5%七氟醚.记录两组睫毛反射消失时间、脑电双频指数(BIS)降至60的时间及无意识肢动、呛咳、喉痉挛、屏气发生情况.分别于诱导前(T1)、吸入即刻(T2)、吸入后1 min(T3)、2 min(T4)、5 min(T5)、插管即刻(T6)和插管后1 min(T7)、5 min(T8)记录HR、SBP、DBP、MAP、SpO2及BIS等指标.结果 RS组2例发生呛咳、体动,IS组1例发生呛咳.RS组睫毛反射消失时间为(64.2±33.7)s,明显快于IS组的(138.0±82.7)s(P＜0.05).RS组BIS降至60的时间为(189.1±28.7)s,明显快于IS组的(232.2±36.8)s(P＜0.05).与T1时比较,RS组从T3后BIS开始下降,而IS组则从T5后才开始下降(P＜0.05).RS组T2～T4时BIS明显低于IS组(P＜0.05).结论 七氟醚吸入诱导对老年患者血流动力学无明显影响.逐渐增加吸入七氟醚浓度诱导时间略长于高浓度快速吸入诱导,吸入1 min后BIS明显下降.     

老年人脑血管病的临床及脑电图分析

目的探讨脑电图与老年人脑血管病的临床关系。方法对确诊的95例老年人脑血管病的临床及脑电图总结。结果脑电图正常24例（25．3％）,异常71例（74．7％）,其中轻度异常28例,占异常的39．4％;中度异常以上7例（9．9％）,局限性异常者36例,占异常脑电图的50．7％。结论脑血管病的脑电图虽无特异性改变,但脑电图的动态观察对于诊断、鉴别诊断及预后有一定的指导价值,脑电图复查好转或正常,一般预后较好。而脑电图异常,临床症状好转或正常,说明受损脑部不具有重要性,但要定期复查。     

Domestic violence against elderly with disability

Abuse against elders with disabilities is a growing problem as the world population ages. Though they require mandatory reporting, these cases are most frequently not detected or not reported by health professionals for a variety of reasons, including the difficulty of making an accurate diagnosis. By performing a retrospective analysis of alleged domestic violence cases against elders with moderate or severe disability, presented to medical forensic examination at the North Branch of the National Institute of Legal Medicine and Forensic Sciences of Portugal, in Porto, between 2005 and 2013 (n = 70), we aimed to improve our knowledge of some demographic and forensic characteristics of these cases as well as improve their detection and prevention. The most frequently reported type of abuse was physical (86%), allegedly perpetrated by male abusers (63%) living with their victims (90%), who were most commonly their children (47%) or partners (49%; when victims are married). The victims were most frequently female (63%) who had motor disabilities (49%) and presented a history of previous episodes of abuse in 74% of cases; however, only 28% were previously reported. The physical consequences were most frequently minor injuries (95%) with permanent consequences (scars) in only 6.8% of the cases. The injuries were multiple in the majority of the cases (64%), and the preferred locations were the head and neck (75%). Elderly females with motor disabilities appear to have a greatest risk of domestic violence, which translates, most frequently, into multiple injuries that are mainly in the head and neck.     

老年高血压患者颈动脉粥样硬化与心血管危险因素关系初探

目的对颈动脉粥样硬化与心血管危险因素的相关性进行回顾性研究。方法选择老年原发性高血压患者共149例,行颈动脉超声检查,分析颈动脉粥样硬化和心血管危险因素间的关系及与脑梗死发生的相关性。结果CAS的发生与合并糖尿病、高血压病程、最高SBP和PP、血UA均呈正相关(P<0.01),与HDL-C水平有统计学意义(P<0.05),与脑梗死发生率有统计学意义(P<0.05)。结论颈动脉粥样硬化与上述心血管危险因素均有密切关系,有效控制以上危险因素可减少颈动脉粥样硬化发生发展,降低脑梗死的发生。     

高龄初产妇妊娠与分娩状况研究

目的探讨高龄初产妇发生的原因，妊娠合并症、并发症的发生率及其处理对策。方法对2000年1月-2005年1月武汉市4家三甲综合医院妇产科就诊115例高龄初产妇（高龄组）与同期115例年轻初产妇（对照组）的临床资料进行性病例对照分析。结果高龄组与对照组职业、流产史差异性显著（P值〈0．001）；高龄组妊娠期合并子宫肌瘤、并发妊高症、前置胎盘、产褥病、剖宫产率及分娩期并发症发生率均明显高于对照组（P值〈0．05）。结论高龄初产妇与职业、流产史有关；高龄初产妇妊娠合并症和并发症发生率明显高于年轻初产妇。     

阿立哌唑与利培酮治疗老年期精神分裂症对照研究

目的比较阿立哌唑与利培酮治疗老年期精神分裂症的疗效及不良反应。方法将对病程<4年的160例老年期精神分裂症的住院患者,按入院顺序随机分为服用阿立哌唑组(A组)与服用利培酮组(B组),每组80例。阿立哌唑剂量为10￣30mg/d,利培酮剂量为2￣6mg/d。疗程8周,采用阳性与阴性症状量表(PANSS)评定疗效,采用副反应量表(TESS)评定不良反应。结果A组退出2例,B组退出3例。两药对老年期精神分裂症的疗效相当,两组无显著性差异。阿立哌唑的不良反应较利培酮轻微,其中震颤、静坐不能、肌强直等发生率少于利培酮组。结论阿立哌唑与利培酮治疗老年期精神分裂症的疗效相当,不良反应较利培酮少。     

Elder mistreatment in women

Elder mistreatment is a serious syndrome that affects more than 1.5 million older Americans every year. Actions such as abuse, neglect, exploitation, and abandonment by caregivers, relatives, friends, or acquaintances can have devastating sequelae for the elderly. Such actions may be intentional or unintentional, but the detrimental outcomes for older individuals can destroy the elder's quality of life and health. A lack of empirical research addresses gender differences in elder mistreatment. There is also confusion and debate over what constitutes elder mistreatment in older women versus what is domestic violence that has continued into later life. Professional nurses need to include both types of screening for their older female patients in order to address both types of family violence.     

高龄初产妇阴道分娩观察与护理

通过分析73例高龄初产妇与73例非高龄初产妇临床资料及阴道分娩情况结果,发现两组的流产史、第二产程及阴道手术率均有差异,而新生儿窒息无差别。提示：应重视高龄初产妇产前监护及健康教育,分娩时给予有效的指导及合理干预等。在无明显产科剖宫产手术指征的情况下,通过阴道试产,一般能够经阴道顺利分娩,并且得到良好的结果。     

高龄老人四肢骨折治疗措施对短期生存率的影响

目的:探讨高龄老人四肢骨折后不同治疗措施对短期生存率的影响。方法:收集我院2005年1月～2010年8月住院治疗的75岁以上老年人四肢骨折患者658例,分别采取手术、无创外固定治疗、止痛制动3种治疗措施,对3组病例伤后第12个月的生存率分为上、下肢骨折分别进行统计。结果:随访骨折后12个月时仍存活635例。在上肢骨折组内的生存数和生存率分别是:手术组139例(97.8%),无创外固定组7例(77.8%),止痛制动组9例(100.0%),组间无统计学差异(P>0.05)。在下肢骨折组内的生存数和生存率分别是:手术组435例(97.1%),无创外固定组34例(89.5%),止痛制动组11例(91.7%),组间有统计学差异(P<0.05)。结论:上肢骨折的治疗措施可能会对肢体功能造成影响,但对伤后1年时的生存率无影响;下肢骨折手术治疗可以提高伤后1年时的生存率,对于不能手术的高龄老人仅止痛制动治疗生存率高于长期卧床行牵引或石膏固定治疗者。