超声引导下经皮经肝胆囊穿刺引流术在急性胆囊炎老年高危患者中的应用

目的通过分组对比的方式,观察经皮经肝胆囊穿刺引流术(percutaneous transhepatic gallbladder drainage,PTGD)的治疗效果,及其对择期手术的影响,分析并评价PTGD在急性胆囊炎老年高危患者中的应用价值。 方法回顾性分析扬州大学附属医院普外科2016年3月至2018年3月收治的急性胆囊炎患者189例,选取符合本次试验病例纳入标准的患者78例。其中根据急性期治疗方式不同,将其分为2组,一组接受PTGD治疗,另外一组接受常规抗感染等保守治疗。每组随机选取30例,分别为试验组和对照组。分别对比2组患者首次入院时,从接受治疗开始,腹痛持续时间,体温恢复正常所用时间,抗生素的使用时间。入院治疗48～72 h抽血检测的血液中白细胞计数、转氨酶、总胆红素指标。并对择期腹腔镜胆囊切除术的手术时间,术中出血量,2次治疗总费用,术后并发症发生率进行比较。 结果试验组患者腹痛持续时间(21.10±3.99)h明显低于对照组患者(32.50±6.52)h,试验组患者体温恢复至正常(36.5≤T≤37.2 ℃)所用时间(13.37±3.78)h较对照组患者(28.70±9.27)h明显缩短。入院后48h白细胞计数试验组(8.34±1.80)×10⁹/L低于对照组(11.78±2.09)×10⁹/L,试验组谷丙转氨酶(87.50±30.72)U/L、谷草转氨酶指标(90.57±30.84)U/L低于对照组(110.33±25.81、119.93±29.67)U/L,总胆红素指标试验组(15.24±4.43)mmol/L低于对照组(19.45±5.17)mmol/L。试验组患者抗生素使用时间(3.82±0.83)d少于对照组患者(6.88±1.24)d。差异均具有统计学意义(P<0.05)。患者出院1～3个月至我院行腹腔镜胆囊切除术,试验组手术时间(58.17±10.92)min、术中出血量(25.67±6.02)ml与对照组(58.00±11.73)min、(24.67±5.62)ml相比,差异无统计学意义。治疗总费方面无明显差异。 结论对急性胆囊炎老年高危患者,采取PTGD治疗可以迅速降低胆囊内压力,控制炎症发展,有效地缓解腹痛、发热等感染所带来的临床症状,降低胆囊穿孔和感染性休克等严重并发症发生的风险,加快转氨酶下降速度,保护肝功能,为择期手术创造一定的条件。     

Elder abuse and its impact on quality of life in nursing homes in China

There are limited available data on elder abuse and its impact on quality of life (QOL) in China. This study investigated the prevalence of elder abuse in nursing homes and its associated demographic, clinical factors and QOL in Macau and Guangzhou, China. A total of 681 subjects (244 in Macau and 437 in Guangzhou) were consecutively recruited. The prevalence of elder abuse was 11.48% and 8.24% in Macau and Guangzhou, respectively. Multivariate analyses revealed that having a religion and depressive symptoms were independently and positively associated with elder abuse. No significant association between elder abuse and any QOL domain was found. Elder abuse is common in nursing homes in both Macau and Guangzhou. Appropriate strategies and educational programs should be developed for health professionals to reduce the risk of elder abuse.     

老年抑郁症临床特征对照分析

目的:探讨老年抑郁症的临床特征及与发病有关的因素.方法:采用自制调查表,对74例老年抑郁症(老年组)与78例早发性抑郁症(对照组)的临床特征进行对比分析.结果:老年抑郁症有精神因素和躯体因素诱发者均明显高于对照组(P＜0.05),抑郁症发作时的严重程度明显高于对照组(P＜0.01).结论:老年抑郁症与早发性抑郁症可能是不同的疾病实体.     

61例老年结肠癌患者误诊病例分析

目的了解老年结肠癌患者误诊情况。方法回顾性分析2005年1月-2010年12月医院老年结肠癌患者误诊病例61例的临床资料。结果 61例误诊的老年结肠癌患者以65-69岁最多,为19例,占31.15%;DukesD期27例,占44.26%;中级、高级分化共43例,占70.49%;误诊分为3种：无任何症状,仅在体检时发现20例,占32.79%;有轻微症状,仅作对症处理12例,占19.67%;症状明显,但被诊治错误29例,占47.54%。另外,手术误诊5例。结论对老年患者,医生应把直肠指诊、大便潜血纳入常规检查项目,及时进行结肠镜、B超、CT、MRT扫描检查,必要时作肿瘤标志物抗原检测,注重手术探查,力争降低结肠癌的误诊率。     

109例老年死亡病例分析

目的：分析我科老年患者死亡的主要疾病种类并探讨防治方法.方法：应用ICD-10国际疾病分类法,对住院死亡患者的资料进行总结.结果：我科老年患者死亡的主要疾病为：脑血管疾病、心血管疾病,呼吸系统感染,肿瘤.结论：预防为主,尽早就诊,降低死亡率.     

Types of abuse

The four most common types of abuse are physical, sexual, emotional, and economic. Abuse is often further categorized into child abuse, intimate partner violence, and elder abuse. This article describes the important role that nurses and health care providers play in detecting, assessing, and reporting abuse. Armed with increased knowledge about signs and symptoms of abuse, nurses can guide patients to the appropriate resources.     

European map of prevalence rates of elder abuse and its impact for future research

This article aims to map existing prevalence research on abuse and neglect of older people and to provide a critical overview of existing methodologies, which have been adopted to survey the prevalence rates of abuse against elders. This article is part of the prevalence study of Abuse and Violence against Older Women (AVOW) study, which was conducted in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal). The article provides an overview of the state of the art of prevalence data, survey designs and methods, instruments and results in Europe. Therefore, this draws on an extensive literature search and qualitative content analysis, which was conducted as an early part of the AVOW study. Results indicate that some EU countries have a rich history of prevalence research, whereas other countries have just begun to tackle this aspect of research on of elder abuse. One of the lacunae concerns reliable numbers on the prevalence rates of elder abuse. Research about where, when and how often elder abuse occurs, is inadequate and inconsistent. Data in some cases are based on professionals’ reports rather than on information from older people themselves. Surveying elders about such a sensitive topic, however, implies the need for an adequate research instrument (questionnaire) and research design, and an adapted data collection method. In conclusion, substantial attention is paid to outlining possible guidelines for future research.     

老年患者医院下呼吸道感染碳青霉烯耐药鲍曼不动杆菌流行特征及耐药性分析

目的了解医院下呼吸道感染碳青霉烯耐药鲍曼不动杆菌（CRAB）的分布及耐药状况。方法回顾性分析2008年1月至2009年12月我院下呼吸道感染CRAB的流行特征。测定菌株对抗菌药物的敏感性。结果分离的CRAB大部分来自下呼吸道（82.6%）,科室送检标本ICU最多（59%）。连续2年资料显示,月检出率表现为5～9月份较高。药敏结果显示,12种抗菌药物中耐药率较低的前2位依次为阿米卡星（AMK）和米诺环素（MH）,分别为30.12%和43.48%。结论 CRAB以下呼吸道感染为主,集中分布于ICU,炎热时节检出率高,细菌耐药严重,宜根据药敏试验结果合理选用抗生素。     

抑制控制对老年人心理理论能力使用的影响

目的 考察老年人使用心理理论的能力,并探讨抑制控制对老年人心理理论使用的影响.方法 选择30名65～74岁老人、30名75岁及以上老人、30名青年人为被试,分别采用指示性交流任务和Hayling Test测评被试使用心理理论的能力和抑制控制能力,并采用相关分析和回归分析,探讨二者的关系.结果 75岁及以上老人在指示性交流任务中的正确率(0.43±0.32)显著低于青年人(0.77±0.25,P＜0.01)及65～74岁老人(0.69±0.24,P＜0.01).偏相关分析显示,Hayling Test-B错误数与指示性交流任务的正确率呈负相关(r=-0.442,P＜0.01);分层回归显示,在控制年龄变量后,Hayling Test-B错误数能独立解释心理理论能力使用的16.8%(β=-0.451,P＜0.01,△R2=0.168,△F=19.359,P＜0.01).结论 年龄较长的老年人使用心理理论的能力出现下降,抑制控制能力下降是老年人心理理论使用能力下降的部分原因.     

老年人髋部骨折术后认知障碍临床分析

目的研究高龄患者术后认知功能障碍的临床特点及治疗方法。方法凹顾性分析笔者所在医院2004年6月至2009年6月12例高龄患者髋部骨折术后出现认知障碍的原因,临床表现及其治疗方法。所有病例术后随访3—12个月。结果所有患者住院期间无死亡,经对症处理及上述治疗后,10例患者术后1周内好转,1例术后2周内好转,1例术后随访半年仍有认知功能障碍,但较住院期间明显好转。结论老年患者髋部骨折术后认知功能障碍发病率高,危害大,应早期诊治,加强围手术期处理,纠正各种生理紊乱,加强护理,提高老年患者的生活质量。