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Ngai-Yin Chan Chi-Chung Choy Ho-Chuen Yuen Hoi-Fan Chow Ho-Fai Fong 《The Canadian journal of cardiology》2019,35(4):396-404
Background
Persistent iatrogenic atrial septal defect (iASD) is a common but poorly characterized complication after cryoballoon (CB) pulmonary vein isolation (PVI) procedures. We therefore investigate its prevalence, evolution, risk factors, and clinical outcomes in a prospective longitudinal study.Methods
A total of 108 patients (41 women, mean age 57 ± 11.3) underwent CB PVI for AF. Serial transesophageal echocardiography (TEE) was performed 9 months and then annually until 6 years after the procedure to study the characteristics of persistent iASD.Results
Persistent iASD occurred in 33 (30.6%) patients 9 months after CB PVI. Spontaneous closure of iASD was found in 6 (22.2%) and 3 (15.8%) patients 2 and 3 years after the procedures, respectively. No spontaneous closure was observed on 4, 5, and 6-year TEE follow-up. The projected long-term persistence rate of iASD after CB PVI was therefore 20% (30.6% × 0.778 × 0.842). Using multivariate logistic regression, a higher number of cryoapplications (≥ 2 minutes) was the only independent predictor of persistent iASD 9 months after CB PVI (odds ratio [OR] 1.207; 95% confidence interval [CI], 1.033-1.411, P = 0.018). Two (1.9%) patients with significantly larger iASD size than the others (long diameter 12.6 ± 0.8 vs 3.7 ± 1.5 mm, P < 0.001; short diameter 10.9 ± 0.2 vs 3 ± 1.1 mm, P < 0.001) required percutaneous closure because of exertional dyspnea and right ventricular enlargement. Over 129.7 patient-years follow-up, during which iASD persisted, there was no occurrence of neurologic events.Conclusions
Approximately one fifth of patients undergoing CB PVI will have permanently persistent iASD. Patients with defect sizes of greater than 10 mm may need percutaneous closure due to significant left-to-right shunting. 相似文献3.
目的观察老年患者腹部手术后S100ββ蛋白的变化以及术后认知功能障碍(POCD)的发生情况,并探讨二者的关系。方法26例65岁以上的老年患者ASAⅡ~Ⅲ级,行腹部手术。监测术前、术毕、术后6、24、48、72h血清S100ββ的变化,并评定术前及术后1周内的认知功能。结果老年患者血清S100ββ蛋白在术毕最高(P<0·01),术后6h和24h逐渐下降,但术后48h再次上升(P<0·01),术后72h回复至术前水平。26例老年患者腹部手术后1周内有7例发生POCD。POCD组与非POCD组相比,术毕及术后6h血清S100ββ蛋白水平明显增高(P<0·05)。结论老年患者腹部手术后POCD的发生与血清S100ββ蛋白的变化有密切关系。血清S100ββ蛋白可作为评估老年患者术后发生POCD的重要指标。 相似文献
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预期无残疾寿命(ELWD)在国外公共卫生及老年医学研究中已得到普遍重视,但ELWD的计算中却存在着若干错误,直接影响着ELWD的正确使用。文章简述了ELWD的概念及原理,推导了正确的计算公式,并以实例说明了计算步骤及方法,对ELWD在医学研究中的应用进行了讨论。 相似文献
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Ronald B. Stewart Ronald G. Marks Phillip D. Padgett William E. Hale 《Pharmacoepidemiology and drug safety》1994,3(1):23-29
The objective of the work was to identify changes in antidepressant drug use and determine if the prevalence of antidepressant use has changed over 14 years. A longitudinal analysis comparing antidepressant drug use at 14 yearly intervals from 1978–79 to 1991–92 was undertaken using the longitudinal health screening program of ambulatory elderly participants (Florida Geriatric Research Program). Participants included all subjects screened in the Florida Geriatric Research Program from 1 August 1978 to 31 July 1992. The outcome measures were self-reported antidepressant drug use. Approximately 3.0 per cent (range of 2.3 to 3.2 per cent over 14 yearly intervals) of participants in this program reported the use of an antidepressant drug. There was no statistically significant change in antidepressant use between 1978–79 and 1991–92 (p > 0.6630). Across all study intervals women reported more frequent use of antidepressant drugs than men. In 1991–92, amitriptyline and imipramine represented over 50 per cent of all antidepressant drug use in this elderly population. Less than 6 per cent of all antidepressant drug use was for fluoxetine, the newest selective serotonin uptake inhibitor. The majority of elderly patients are receiving older tertiary amine tricyclic antidepressants such as amitriptyline, imipramine and doxepin that are not the preferred drugs for the elderly. Educational programs are needed to improve antidepressant prescribing for geriatric patients. 相似文献
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老年人生理适应与防卫能力进行性下降,对有害因子易伤性增加,导致多种老年病的发生。因此,免疫系统功能与衰老的关系问题,已是现代老年病学和免疫学进行多方深入研究的重要内容。我们近两年多来对老年人免疫功能变化做了临床观察检测与统计分析。现报告如下。 1.临床资料 相似文献
9.
2002年某院老年内科死亡病例情况分析 总被引:2,自引:0,他引:2
[目的 ] 通过老年人内科疾病死亡情况的分析 ,为临床及时诊断、治疗和预防相关疾病提供证据。 [方法 ] 应用回顾性调查的方法 ,对 2 0 0 2年 1~ 12月在我院因内科疾病而死亡的 60周岁以上的病例进行分析。 [结果 ] 13 5例死亡病人中 ,13 3例 ( 98.5 % )患有基础疾病 ,其中 97例 ( 71.9% )为心脏疾病 ,64例 ( 4 7.4% )为高血压 ,49例 ( 3 6.3 % )为慢性阻塞性肺病。肺部感染为死亡的主要诱因 ,占 83 .7% ( 113 / 13 5 ) ;发生多器官衰竭 (MOFG)者占 44 % ( 60 / 13 5 ) ;发生衰竭的器官共 14 2例次 ,其中呼吸衰竭 89-4 5 6+1居首位 ,占 3 8.7% ( 5 5 / 14 2 )。 [结论 ] 我国老年人多患有慢性基础疾病 ,肺部感染是诱发病情加重导致死亡的最常见的因素 ,增强抵抗力 ,预防呼吸道感染是提高生活质量、延年益寿的关键 相似文献
10.
Sung-Ae Cho Sieun Yoon Seok-Jin Lee Young-Seok Jee Choon-Kyu Cho Tae-Yun Sung 《International journal of medical sciences》2022,19(10):1548
Background: Short-term prewarming effectively reduces intraoperative hypothermia in adult patients. However, few data exist regarding its efficacy in elderly patients. Elderly people have a reduced ability to regulate their body temperature, which affects the efficacy of prewarming. This study aimed to compare the clinical efficacy of short-term pre-warming in elderly patients with that in adult patients.Methods: We enrolled 25 adult (20-50 years) and 25 elderly (> 65 years) patients scheduled for ureteroscopic stone surgery under general anaesthesia. All patients received preanaesthetic forced-air warming for 20 min. The core temperature was measured using an infrared tympanic thermometer during awakening and nasopharyngeal thermistors during anaesthesia. Incidence and severity of intraoperative hypothermia (< 36°C) was compared. Postoperative shivering and number of patients requiring active warming in the post-anaesthesia care unit were also assessed.Results: Intraoperative hypothermia was more frequent in elderly than in adult patients (58.3% vs. 12.0%; relative risk 2.6; 95% confidence interval 1.5 to 4.6; effect size h = 1.010; p = 0.001). The severity of intraoperative hypothermia showed a significant intergroup difference (p = 0.002). Postoperative shivering was more frequent in elderly than in adult patients (33.3% vs. 8.0%, p = 0.037). A greater number of elderly patients in the post-anaesthesia care unit required active warming (33.3% vs. 8.0%, p = 0.037).Conclusions: The effects of short-term prewarming on the prevention of hypothermia and maintenance of perioperative normothermia are not the same in the elderly and adult patients. 相似文献