门诊老年患者用药情况分析

目的:了解老年患者的用药特点。方法:对我院2000~2006年门诊老年患者的用药品种、患病状况、用药史及药品不良反应等进行回顾性分析。结果:心血管系统药不良反应发生率最高,神经系统药及皮肤系统药次之;8种及以上药物联用占11.74%,并随年龄的增长、疾病的增多而增多。结论:应重视老年患者安全、合理、有效用药。     

老年高血压病患者动态血压与颈动脉粥样硬化的关系

目的:研究老年原发性高血压(EH)患者24h动态血压(ABPM)与颈动脉粥样硬化(CAS)的关系。方法:采用袖带式动态血压仪监测100例老年EH患者的ABPM,彩色超声测量颈动脉内-中膜厚度,有CAS者为研究组,无CAS者为对照组,研究ABPM参数与CAS之间的关系。结果:老年EH患者血压控制达标后,血压曲线异常呈非杓型者明显增多,占66.0%;两组24h平均收缩压和舒张压之间无明显差异,但研究组的动态脉压,日间脉压和夜间脉压[分别是(53.5 6.8,53.7 7.5和53.6 8.3)mmHg]均较对照组[分别是(48.9 8.1,48.1 10.8和48.5 9.8)mmHg]增大,有显著性差异(P=0.005)。CAS的总发生率是64.0%,而杓型组中CAS的发生率是53.0%,非杓型组是68.0%,两组间无显著性差异(P>0.05)。结论:老年EH患者血压控制达标后,脉压(PP)增大与CAS的发生密切相关;血压昼夜节律异常呈非杓型者明显增多。     

老年外伤性颅内血肿的观察与护理

目的：探讨老年外伤性颅内血肿的观察和护理特点。方法：选择本科老年外伤性颅内血肿65例,针对该病种特点,制定详细的观察和护理方案,包括加强生命体征观察,注意防止并发症发生等。结果：经采用针对该病种的特殊护理,减少了并发症的发生,降低了死亡率,促进了患者的康复。结论：针对老年外伤性颅内血肿的特点,采用相应的观察和护理程序,有利于预防并发症的发生,促进康复。     

老年糖尿病

随着人口老龄化速度的加快,老年糖尿病的绝对数和相对数越来越多,其发病是遗传、行为和生活方式等多因素相互作用的结果.防治措施包括开展三级预防、综合治疗、提高防治依从性和提倡健康老龄化.本文从流行病学特征、危险因素、临床特点和诊治等方面综述了老年糖尿病的研究进展.     

连续性静脉-静脉血液滤过在老年多器官功能障碍中的应用

目的:观察连续性静脉-静脉血液滤过(CVVH)在一组老年多器官功能障碍(MODS)患者中应用的效果及安全性。方法:50例老年MODS患者患者分为A组和B组,A组27例接受CVVH治疗,B组23例接受普通透析,患者在治疗前后进行APACHE评分,并检测血钠、钾、氯、尿酸、碳酸氢盐、氧分压、二氧化碳分压和脑钠肽。结果:①治疗后,血电解质紊乱和酸碱失衡得到纠正,毒素明显下降,两组患者间无显著性差异。②与B组患者相比,A组患者治疗后,脑钠肽和二氧化碳分压明显下降,氧分压上升,APACHE评分明显降低。结论:与普通透析相比,CVVH除了能清除毒素和纠正电解质酸碱失衡以外,还能提高患者PO2、减轻CO2潴留,明显改善心肺功能效果,因此应用于老年MODS患者是安全有效的。     

老年急性胆源性胰腺炎38例诊断治疗分析

目的探讨老年急性胆源性胰腺炎临床表现,诊断及治疗方法。方法回顾性分析1996年1月至2005年12月38例老年急性胆源性胰腺炎患者临床资料。结果8例保守治疗痊愈;30例行手术治疗,其中2例合并多器官功能衰竭死亡。治愈率94.74%。结论老年急性胆源性胰腺炎病情凶险,正确的手术方法,术后合理的处理可降低病死率。     

综合医院ICU老年败血症危险因素和耐药菌谱分析

目的探讨ICU老年败血症的危险因素,致病菌的分布和耐药分析。方法回顾性分析2000年1月～2005年12月间经血培养和临床资料证实的21例老年败血症。结果有严重基础病与高危因素占95.84%(20/21)。高危因素包括介入性诊治、滥用抗药菌物、呼吸机的使用等;21例中G-菌9例(42.86%);G 菌9例(42.86%);真菌6例(28.57%)。细菌对常用抗菌药耐药严重。结论老年败血症病情危重,病死率高;G-菌有下降的趋势,但仍是老年败血症感染的主要病原菌,条件致病菌和真菌感染率明显增多;防治ICU老年败血症的关键在于及早治疗基础疾病,预防高危因素,减少耐药菌株的发生显得尤为重要。     

Immunohistochemical study of distribution of apolipoproteins E and D in human cerebral beta amyloid deposits

Several molecules are known to be closely associated with amyloid deposits in human brain. Among these, apolipoproteins such as apolipoproteins E (apo E) and J (apo J) have been found in two neuropathological hallmarks of Alzheimer's disease (AD) and cerebral amyloid angiopathy (CAA): senile plaques (SPs) and cerebrovascular amyloid. These apolipoproteins may be implicated in amyloid fibrillogenesis. Apo D is a multiligand-multifunctional glycoprotein present in SPs, as we previously reported. The aim of this work is to study the link between immunolocalization of apo E and apo D in AD and CAA brains. Both apolipoproteins were found in all types of SPs, but apo E was observed more often than apo D in mature plaques. Whereas apo E is always located overlapping the amyloid core, apo D seems to situate preferably around and near the amyloid. Immunohistochemistry revealed that these apolipoproteins behave differently in cerebral vessels. Apo E labeling in vessels appears mainly linked to amyloid deposits, whereas apo D shows a distribution almost opposite to that of apo E. This could be an indication of the different roles that each apolipoprotein plays in the pathogenesis of amyloid deposition.     

Determination of cadmium and zinc in Alzheimer's brain tissue using inductively coupled plasma mass spectrometry

In this work, brain tissue was taken from Alzheimer's Disease (AD) subjects (n=11), 'normal' subjects (n=10) and from subjects with senile involutive cortical changes (SICC) (n=6). Concentrations of Cd and Zn were determined in all samples, using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The brain tissue was selected and obtained from the Netherlands Brain Bank. Samples were taken in each case, from both hemispheres of the superior frontal gyrus, the superior parietal gyrus, the medial temporal gyrus, the hippocampus and the thalamus of the same brain.Cd which is known to have no essential role in the brain was found to follow, as expected, a lognormal distribution of concentrations in 'normal' subjects (Shapiro-Wilk's test (0.98) (p<0.18)). For the Alzheimer's Disease subjects and SICC subjects, the data tends to follow a lognormal distribution, rather than a normal distribution, but is still significantly different from it (Shapiro-Wilk's test (0.97) (p<0.03); (0.93) (p<0.0067), respectively)).In the case of Zn concentrations, the data tends to follow a normal distribution for the 'normal' subject group, even though the data is significantly different from it (Shapiro-Wilk's test (0.95) (p<0.001)). Whereas in the Alzheimer's Disease and SICC subject groups, the data follows a normal distribution (Shapiro-Wilk's test (0.98) (p<0.21); (0.97) (p<0.2002), respectively)).When comparing age-matched groups, for all regions and both hemispheres, no significant differences (p>0.1) for Cd were found between 'normals' and Alzheimer's Disease subjects and Alzheimer's Disease subjects and SICC but at a low level of significance, lower concentrations of Cd were found in the SICC group compared to the 'normals'. For all regions and both hemispheres, Zn was found to be significantly decreased in the Alzheimer's Disease group, compared to the 'normal' and SICC groups. Zn concentrations were also found to be significantly decreased in the 'normals' compared to the SICC group.It is also of interest that Cd negatively correlates with the scale of tangles in both 'normals' (p<0.001) and Alzheimer's Disease subjects (p<0.01). In the SICC subjects Cd correlates negatively with the tangles but not significantly so (p>0.1).     

69例老年胸腔积液诊治的临床分析

目的观察老年胸腔积液的病因及良、恶性胸腔积液的比较,从临床角度了解老年良、恶性胸腔积液的特点。方法对69例老年胸腔积液的临床资料进行回顾性分析。结果69例老年胸腔积液中,良性积液患者22例(31.9%),其前三位病因是结核性胸膜炎、心功能不全及脓胸。恶性积液患者47例(68.1%),病因前三位是肺癌、乳腺癌及肝癌。良性积液治疗有效率81.8%,明显高于恶性的68.1%(P<0.05),前组的临床表现及辅助检查的阳性率明显低于后组(P<0.05~0.01)。结论良、恶性胸腔积液的比较在临床表现及辅助检查方面均有一定差异。