60岁以上患者心脏瓣膜置换术98例临床分析

目的 总结98例老年心脏瓣膜置换术患者的早期临床结果及特点.方法 选择我院2001年1月至2010年12月60岁以上行瓣膜置换术者98例,其中单瓣置换87例(二尖瓣置换58例,主动脉瓣置换29例)、双瓣置换11例,及同期行冠状动脉旁路移植术41例,左室室壁瘤手术2例.对其临床资料进行总结,分析近年老年瓣膜置换的特点.结果 本组共置换心脏瓣膜109枚,其中机械瓣39枚,生物瓣70枚.主动脉内球囊反搏置入5例.院内死亡4例(4.08％),左室破裂1例,室颤1例,出血二次开胸后继发多器官功能衰竭2例.2例(2.04％)病重自动出院,其余痊愈出院.术后早期16例(16.33％)发生并发症,包括精神神经系统并发症2例、二次开胸止血6例、低心排7例、二次插管1例、气管切开2例、严重心律失常1例、切口感染延迟愈合2例、肾功能不全6例及心包大量积液1例.结论 60岁以上瓣膜病患者多合并其他疾病,且术后并发症较多,生物瓣应用逐渐增多,同期行冠状动脉旁路移植术较多,完善的术前检查、充分准备可获得良好的疗效.     

两种消毒方法对医务人员移动电话机表面的消毒效果

目的观察两种消毒方法对医务人员移动电话机的消毒效果。方法通过现场采样和细菌检测方法,对某医院医务人员移动电话机进行细菌污染调查和消毒效果评价。结果该医院医务人员移动电话机细菌污染率达到94%。采用75%乙醇消毒液擦拭消毒后,其消毒效果合格率为98%;用含乙醇的复方皮肤消毒液擦拭消毒后,消毒效果合格率达到100%。结论医护人员使用中的移动电话机污染严重,用75%乙醇及其复方皮肤消毒液擦拭消毒可取得满意消毒效果。     

Predictors of Functional Recovery in Patients Admitted to Geriatric Postacute Rehabilitation

Objective

To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation.

Design

Observational study.

Setting

Postacute rehabilitation facility.

Participants

Patients (N=2754) aged ≥65 years admitted over a 4-year period.

Interventions

Not applicable.

Main Outcome Measure

Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement.

Results

Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16–1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01–1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31–1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15–1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19–23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13–2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67–2.93; P<.001, respectively).

Conclusions

Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.     

Complexities during transitions to adulthood for youth with disabilities: person–environment interactions

Abstract

Purpose: The purpose of this qualitative study was to explore the experiences of youth with different disabilities from across Canada during their transitions from adolescence to adulthood. Methods: Qualitative methods, using a phenomenological tradition, explored the meaning of the lived experiences of youth with disabilities in transition to adulthood. Purposeful sampling was used to select people with a range of experiences, background, location and demographic characteristics. Individual interviews with key informants and a focus group with an “expert panel” of participants were the methods of data collection. Data analysis was iterative and followed established practices of phenomenology. Results: Over 50 people, including youth with different disabilities, parents/caregivers and service providers from different organizations and systems across Canada participated in individual and/or focus group interviews. An overarching theme of “complexities” emerged from the data analysis. Complexities were related to the interactions between person and environment during transition experiences. Six subthemes about complexities were explored in depth to describe the primary person–environment interactions that were identified by study participants. Conclusions: The complexities involved in the interactions between person and environment during transitions to adulthood appear to be similar for youth with different types of disabilities. Recommendations are provided to address these complexities using holistic and collaborative approaches in service delivery and future research.

• Implications for Rehabilitation

• The complexities involved in transitions to adulthood appear to be similar for youth with different types of disabilities.

• Rehabilitation service providers can address these complexities using holistic, strengths-based and collaborative approaches.

• Service providers and researchers in rehabilitation need to acknowledge the interactions between person and environment rather than addressing each component separately.

• Future research should include youth, families and community members on research teams to ensure that complexities are adequately addressed.

     

Qualities of life design measures with chronic illness or disability

Purpose: Rehabilitation assessment data influence decisions for the design of preferred lifestyles with a chronic illness or disability (CID). As a result, careful consideration of the source, type and scope of these data is needed in selecting appropriate procedures for their collection and use. This article proposes three essential qualities of data to assess in life design counselling with CID.

Method: A narrative analytical review approach is applied to synthesize findings from the research on person-oriented approaches to rehabilitation assessments. In addition, illustrative life design data on preferred community living solutions with CID for rehabilitation clients (n = 68) are presented. The concept of life design foregrounds the narrative analytical review on essential qualities of rehabilitation assessments to support life choices with disability.

Results: The evidence from a narrative synthesis of the person-oriented assessment literature and community living study suggests that effective life design with CID is enhanced with person-centric, resource enabling and participation focused data. Data that prioritizes personal values for participation enable persons with a disability jurisdiction in their life design choices.

Conclusion: Life design is a robust concept to understand the purposes for which rehabilitation assessment data are gathered, and the essential qualities for those data. When life design measures have person-centric qualities, people with CID are empowered to construct their own lives.

Implications for Rehabilitation

• Life design is an important process and outcome for gathering rehabilitation assessment data.

• Rehabilitation assessment measures for life design are person-oriented, resource enabling and participation focused.

• People with chronic illness and disability consider their personal values important to rehabilitation assessments for community living with chronic illness or disability.

     

老年单纯收缩期高血压40例临床分析

目的探讨对患有单纯收缩期高血压病(ISH)病人的治疗与护理。方法配合非药物治疗,对40例单纯收缩期高血压病人应用钙通道拮抗剂(CCB)和血管紧张素转换酶抑制剂(ACEI)治疗单纯收缩期高血压。结果显效30例,有效8例。总有效率95%。结论及时确诊,重视非药物治疗,针对发病机制合理用药,是治疗单纯收缩期高血压病的关键。     

老年人的心律失常——42名老年人24小时动态心电图分析

本文报告22名健康老年人和20例老年心脏病患者24小时动态心电图监护记录结果。22名健康人中21名(占95.45%)有心律失常发生,其中以窦性心动过缓、室性早搏和房性早搏最多见(发生率分別为72.7%、63.6%和54.5%)。20例患者均有心律失常发生。健康组严重室性心律失常的发生率显著低于病人组。本文支持正常或无症状老年人心律失常相当常见的观点。     

帕歌斯在老年退行性关节病治疗中的临床研究

目的 :观察帕歌斯与双氯芬酸钠在老年退行性关节病治疗中疗效及副作用的比较。方法 :对 2 0 2例临床确诊为老年退行性关节病患者随机分两组 ,用双盲法作治疗 ,用药 4周后观察两组的临床疗效及副作用。结果 :帕歌斯与双氯芬酸钠的显效率和总有效率差异无显著性意义 (P >0 .0 5 )。但帕歌斯组的副作用明显少于双氯芬酸钠组 ,两组副作用差异有极显著性意义 (P <0 .0 1)。结论 :在老年退行性关节病的治疗中 ,帕歌斯是一种临床疗效好且无副作用的理想药物。     

The effects of prefrontal intracortical microinjections of an alpha-2 agonist, alpha-2 antagonist and lidocaine on the delayed alternation performance of aged rats

A selective alpha-2 agonist medetomidine, a selective alpha-2 antagonist atipamezole and lidocaine were injected into the prefrontal cortex of aged rats that had been trained to perform a delayed alternation (DA) task in a T maze. Medetomidine at the dose of 0.01 μg/μl improved the memory task performance in four of five rats. The fifth rat improved its performance at the dose of 1.0 μg/μl. Atipamezole did not have any effect on the task performance. The effect of a systemic dose of medetomidine (3 μg/kg), which was previously shown to improve the task performance in old rats, was reversed by an intracortical injection of atipamezole. Lidocaine impaired the DA performance significantly. The results suggest that the beneficial effects of medetomidine on the working memory of old rats are mediated at least partly through the prefrontal cortex.     

奥氮平和氯氮平治疗精神分裂症老年患者的对照研究

目的：对比奥氮平与氯氮平治疗精神分裂症老年患者的疗效和安全性。方法：对64例精神分裂症老年患者分别给予奥氮平、氯氮平治疗，其中奥氮平组30例，氯氮平组34例，疗程8周。以阳性症状和阴性症状量表(PANSS)、临床疗效总评量表(CGI)、简明精神病评定量表(BPRS)评定临床疗效。以副反应量表(TESS)和实验室监测评价安全性。结果：治疗结束时，两组PANSS和BPRS总分较治疗前显著降低，组间差异无显著性。两组间从治疗第1周起各时点PANSS减分率差异有显著性。临床有效率：奥氮平组76．7％，氯氮平组64．7％，两组相仿。奥氮平组不良反应较氯氮平组少，常见不良反应为胆碱能作用、嗜睡、体重增加和一过性肝酶升高等。结论：奥氮平治疗精神分裂症的疗效与氯氮平相似，某些不良反应较氯氮平轻而少；是一种安全有效、服用方便的新型抗精神病药。