Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit （ICU） patients. Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrosp...Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit （ICU） patients. Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients＇ clinical data through medical record review. The basic demographics, primary cause for admission, the condition of respiratory and circulatory support, as well as prognosis were recorded. Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations, laboratory variables, echocardiography, and lung ultrasound results. Results The mean age of the included patients was 95 years with a male predominance （8 to 4, 66.7%）. Regarding the reasons for admission, 6 （50.0%） patients had respiratory failure, 1 （8.3%） patient had shock, while 5 （41.7%） patients had both respiratory failure and shock. Of the 6 patients who suffered from shock, only 1 was diagnosed with distributive shock, 5 with cardiogenic shock. Of the 5 cardiogenic shock patients, 1 was diagnosed with acute coronary syndrome. The rest 4 cardiogenic shock patients were diagnosed with Takotsubo cardiomyopathy. The patient with ST-segment elevation myocardial infarction died within 24 hours. Of the 4 Takotsubo patients, 1 died on day-6 and the other 3 patients were transferred to ward after heart function recovered in 1 to 2 weeks. Of the 10 pneumonia patients, 3 were diagnosed as community acquired pneumonia, and 7 as hospital acquired pneumonia. Only 3 patients were successfully weaned from ventilator. The others required long-term ventilation complicated with heart failure, mostly with diastolic heart failure. Lung ultrasound of 6 during spontaneous breathing trial. patients with diastolic dysfunction showed bilateral B-lines Conclusions Elderly patients in shock tend to develop Takotsubo cardiomyopathy. Diastolic heartdysfunction might be a major contributor to difficult weaning from ventilator in elderly patients. Bedside lung ultrasonography and echocardiography could help decide the actual cause of respiratory failure and shock more accurately and effectively.展开更多
A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, therefore, derive more benefit fi＇om revascularization and have a greater need for it. The elder...A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, therefore, derive more benefit fi＇om revascularization and have a greater need for it. The elderly is a heterogeneous group, but compared to the younger cohort, the choice of the optimal revascularization method is much more complicated among them. In recent decades, results has improved dramatically both in surgery and percutaneous coronary intervention （PCI）, even in very old persons. Despite the lack of evidence in elderly, it is obvious, that coronary artery bypass surgery （CABG） has a more pronounced effect on long-term survival in price of more strokes, while PCI is certainly less invasive. Age itself is not a criterion for the selection of treatment strategy, but the elderly are often more interested in quality of life and personal independence instead of longevity. This article discusses the factors that influence the choice of the revascularization method in the elderly with stable angina and presents a complex algorithm for making an individual risk-benefit profile. As a consequence the features of CABG and PCI in elderly patients are exposed. Emphasis is centered on the frailty and non-medical factors, including psychosocial, as essential components in making the decision of what strategy to choose. Good communication with the patients and giving them unbiased information is encouraged.展开更多
The shortage of organ donors is a problem worldwide, with approximately 15% of adult patients with lifethreatening liver diseases dying while on the waiting list. The use of cell transplantation for liver disease is a...The shortage of organ donors is a problem worldwide, with approximately 15% of adult patients with lifethreatening liver diseases dying while on the waiting list. The use of cell transplantation for liver disease is an attempt to correct metabolic defects, or to support liver function as a bridge to liver transplantation and, as such, has raised a number of expectations. Most of the available studies briefly reported here focus on adult hepatocyte transplantation (HT), and the results are neither reproducible nor comparable, because the means of infusion, amount of injected cells and clinical variability differ among the studies. To better understand the specif ic role of HT in the management of end-stage liver disease, it is important that controlled studies, designed on the principles of evidence-based medicine, be done in order to guarantee the reproducibility of results.展开更多
Objective： To study epidemiological characteristics and influential factors of in-hospital patients struck by the Wenchuan earthquake disaster. Methods： The clinical data of 196 cases were collected from 2 hospital...Objective： To study epidemiological characteristics and influential factors of in-hospital patients struck by the Wenchuan earthquake disaster. Methods： The clinical data of 196 cases were collected from 2 hospitals of Chongqing city, including age, sex, occupation, injury site, dwelling and injury severity score. Results： In this series, 31.63% victims＇ age was over 60 years, and 54.08% were farmers. Multiple trauma accounted for 35.71%, and lower limb injury for 33.67%. There was no significant difference on injury severity score between city dwellers and rural ones （P〉0.05）. Conclusion： The earthquake injury is influenced by many factors. More attention should be paid to the treatment at first 5 days after injury and high risk population.展开更多
文摘Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit （ICU） patients. Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients＇ clinical data through medical record review. The basic demographics, primary cause for admission, the condition of respiratory and circulatory support, as well as prognosis were recorded. Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations, laboratory variables, echocardiography, and lung ultrasound results. Results The mean age of the included patients was 95 years with a male predominance （8 to 4, 66.7%）. Regarding the reasons for admission, 6 （50.0%） patients had respiratory failure, 1 （8.3%） patient had shock, while 5 （41.7%） patients had both respiratory failure and shock. Of the 6 patients who suffered from shock, only 1 was diagnosed with distributive shock, 5 with cardiogenic shock. Of the 5 cardiogenic shock patients, 1 was diagnosed with acute coronary syndrome. The rest 4 cardiogenic shock patients were diagnosed with Takotsubo cardiomyopathy. The patient with ST-segment elevation myocardial infarction died within 24 hours. Of the 4 Takotsubo patients, 1 died on day-6 and the other 3 patients were transferred to ward after heart function recovered in 1 to 2 weeks. Of the 10 pneumonia patients, 3 were diagnosed as community acquired pneumonia, and 7 as hospital acquired pneumonia. Only 3 patients were successfully weaned from ventilator. The others required long-term ventilation complicated with heart failure, mostly with diastolic heart failure. Lung ultrasound of 6 during spontaneous breathing trial. patients with diastolic dysfunction showed bilateral B-lines Conclusions Elderly patients in shock tend to develop Takotsubo cardiomyopathy. Diastolic heartdysfunction might be a major contributor to difficult weaning from ventilator in elderly patients. Bedside lung ultrasonography and echocardiography could help decide the actual cause of respiratory failure and shock more accurately and effectively.
文摘A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, therefore, derive more benefit fi＇om revascularization and have a greater need for it. The elderly is a heterogeneous group, but compared to the younger cohort, the choice of the optimal revascularization method is much more complicated among them. In recent decades, results has improved dramatically both in surgery and percutaneous coronary intervention （PCI）, even in very old persons. Despite the lack of evidence in elderly, it is obvious, that coronary artery bypass surgery （CABG） has a more pronounced effect on long-term survival in price of more strokes, while PCI is certainly less invasive. Age itself is not a criterion for the selection of treatment strategy, but the elderly are often more interested in quality of life and personal independence instead of longevity. This article discusses the factors that influence the choice of the revascularization method in the elderly with stable angina and presents a complex algorithm for making an individual risk-benefit profile. As a consequence the features of CABG and PCI in elderly patients are exposed. Emphasis is centered on the frailty and non-medical factors, including psychosocial, as essential components in making the decision of what strategy to choose. Good communication with the patients and giving them unbiased information is encouraged.
文摘The shortage of organ donors is a problem worldwide, with approximately 15% of adult patients with lifethreatening liver diseases dying while on the waiting list. The use of cell transplantation for liver disease is an attempt to correct metabolic defects, or to support liver function as a bridge to liver transplantation and, as such, has raised a number of expectations. Most of the available studies briefly reported here focus on adult hepatocyte transplantation (HT), and the results are neither reproducible nor comparable, because the means of infusion, amount of injected cells and clinical variability differ among the studies. To better understand the specif ic role of HT in the management of end-stage liver disease, it is important that controlled studies, designed on the principles of evidence-based medicine, be done in order to guarantee the reproducibility of results.
文摘Objective： To study epidemiological characteristics and influential factors of in-hospital patients struck by the Wenchuan earthquake disaster. Methods： The clinical data of 196 cases were collected from 2 hospitals of Chongqing city, including age, sex, occupation, injury site, dwelling and injury severity score. Results： In this series, 31.63% victims＇ age was over 60 years, and 54.08% were farmers. Multiple trauma accounted for 35.71%, and lower limb injury for 33.67%. There was no significant difference on injury severity score between city dwellers and rural ones （P〉0.05）. Conclusion： The earthquake injury is influenced by many factors. More attention should be paid to the treatment at first 5 days after injury and high risk population.
