PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Quality of Life and its Influencing Factors in Urban Elderly Patients with Chronic Diseases

Objective: To analyze and discuss the quality of life of elderly patients with chronic diseases and its influencing factors. The aim of this study was to provide a theoretical basis for targeted intervention of influencing factors of chronic diseases and improvement of the quality of life of patients. Methods: A total of 1000 elderly patients with chronic diseases in our health center were randomly selected as the study subject. Questionnaire survey was conducted by self-designed questionnaire. The SF-36 quality of life scale was used to evaluate their quality of life;and linear regression model was used to explore the relevant influencing factors. Result: The SF-36 score showed that there was a correlation between the six dimensions, including overall health, physiological function, somatic pain, vitality, social function and mental health, and the number of chronic diseases in elderly patients. With the increase of chronic diseases, the scores of each dimension showed a downward trend. Linear regression analysis showed that age, anxiety and poor sleep quality were the main factors affecting the quality of life in elderly patients with chronic diseases. Conclusion: The quality of life of elderly patients with chronic diseases in our city is poor. In community work, targeted nursing and intervention should be given according to the types of diseases suffered by the elderly.

Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain.

Health Effect of Forest Bathing Trip on Elderly Patients with Chronic Obstructive Pulmonary Disease

Forest bathing trip is a short, leisurely visit to forest. In this study we determined the health effects of forest bathing trip on elderly patients with chronic obstructive pulmonary disease （COPD）. The patients were randomly divided into two groups. One group was sent to forest, and the other was sent to an urban area as control. Flow cytometry, ELISA, and profile of mood states （POMS） evaluation were performed. In the forest group,

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Exploration of collaborative drug therapy management mode for elderly patients with chronic diseases

As China is accelerating into an aging society,the coexistence of multiple diseases,multiple drugs,and the decline of body function are serious problems faced by elderly patients.Therefore,it is imperative to carry out the comprehensive prevention and control of chronic diseases,strengthen the health guidance and comprehensive intervention of common and chronic diseases of the elderly,and strengthen the health management of elderly patients.Collaborative drug therapy management(CDTM)is a drug treatment management mode that emerged in pharmaceutical services under the situation of new medical reform,aiming to expand the role of pharmacists in the medical team and improve the quality of hospital medical service.Although CDTM has shown some favorable effects in managing chronic diseases in the elderly population,the popularization of CDTM in China is limited by the differences in supporting facilities,management mode,and pharmacist’s abilities in hospitals.By exploring the CDTM mode for elderly patients with chronic diseases,we provided a reference for further promoting the CDTM services and laid a good foundation for displaying pharmacist value and the realization of real pharmaceutical care.

Study on the changes in pulmonary artery pressure in elderly Chronic kindney disease patients without end-stage renal disease

Objective To prospectively investigate the characteristics and correlative influential factors for the changes in pulmonary artery hypertension(PAH)in chronic kidney disease(CKD)patients without end-stage renal disease.Methods Complete clinical and laboratory data of133 outpatients without ESRD(CKD stage 2,3 and 4)

The relationship between the expression of transient receptor potential vanilloid 1 and the airway remodeling in elderly patients with chronic obstructive pulmonary disease

Objective To investigate the relationship between the expression of trannsient receptor potential vanilloid(TRPV1)and the severity of airway remodeling in elderly patients with chronic obstructive pulmonary disease(COPD).Methods According to airflow obstruction severity,totally 100 cases of elderly patients with

HDSMP结合CDSMP模式对老年高血压患者疾病应对和自我管理能力的影响

目的 探讨本土化的高血压、糖尿病自我管理教程(hypertension&diabetes self-management program, HDSMP)结合美国斯坦福大学首创的普适性慢性病自我管理项目(chronic disease self-management program, CDSMP)对老年高血压患者疾病应对和自我管理能力的影响。方法 选取2021年6-12月在郑州大学第一附属医院内科门诊就诊的符合纳入和排除标准的300例老年高血压患者作为研究对象,采用随机数字表法分为对照组150例和干预组150例。对照组患者接受以健康讲座和宣教手册为主的健康教育,干预组患者接受HDSMP结合CDSMP模式的慢性病自我管理,以自我管理小组的形式进行。两组患者的干预时间均为8周。评价并比较两组患者干预前后的疾病认知情况、生活质量、疾病应对能力、自我管理能力、血压控制效果。结果 干预组干预后对高血压知识(包括疾病诊断标准、高危因素、高血压危害、治疗方法)知晓率相比较干预前和对照组干预后均明显升高,差异有统计学意义(P<0.05)。干预组干预后健康调查简表(SF-36)各维度评分相比较干预前和对照组干预后均明显升高,差异有统计学意义(P<0.05)。干预组干预后医学应对方式问卷(medical coping modes questionnaire, MCMQ)中的面对得分相比较对照组干预后明显升高[(22.70±2.28)分vs.(20.95±2.62)分],屈服、回避得分相比较对照组干预后明显降低[(5.13±1.36)分vs.(5.96±1.65)分,(13.72±1.45)分vs.(15.10±1.49)分],差异有统计学意义(P<0.05)。干预组干预后自我管理各维度评分和总评分均显著高于对照组干预后(P<0.05)。两组患者干预后的舒张压和收缩压相比较干预前均显著降低,其中干预组相比较对照组降低更明显(P<0.05),干预后干预组的血压控制达标率相比较对照组明显升高(收缩压:88.67%vs. 76.00%,舒张压:93.33%vs. 78.67%,P<0.05)。结论 HDSMP结合CDSMP模式对提高和改善老年高血压患者的疾病应对能力、自我效能和自我管理能力的效果更佳,从而能进一步提高和改善患者的血压控制达标率及生活质量水平。

Effect of warming needle moxibustion on pulmonary function of elderly patients with stable chronic obstructive pulmonary disease

Objective To observe the therapeutic effects of warming needle moxibustion on pulmonary function of elderly patients with stable chronic obstructive pulmonary disease. Method Eighty elderly patients with stable chronic obstructive pulmonary disease were divided randomly into an acupuncture group and a drug group, with forty cases in each group. The patients in the acupuncture group were treated with warming needle moxibustion on specific acupoints. Main acupoints include Zusanli （足三里 ST 36）, Feishu （肺俞 BL 13） and Dingchuan （定喘 EX-B 1）. Matching acupoints include Gaohuang （膏肓 BL 43）, Xinshu （心俞 BL 15）, Dazhui （大椎 GV 14） and Fangmen （风门 BE 12）. The acupoints were punctured with even reinforcing and reducing method. Meanwhile, two moxa stick of warming needle moxibustion were applied separately at the acupoints at back and ST 36. The needles were retained for approximately 0.5 h each time. The treatment was given every other day, 3 times a week and the course of treatment was 8 weeks. Patients in the drug group were treated by seretide inhalation （50 μg salmeterol and 250 μg fluticasone propionate）, twice a day for 8 weeks. The improvement in pulmonary function and the symptom of chills and fever were compared between the two groups. Results After treatment, pulmonary function indices [forced expiratory volume in one second （FEV1）, forced expiratory volume in one second to forced vital capacity （FEVl/FVC）, forced expiratory volume in one second to predicted value ratio （FEV1%） and peak expiratory flow （PEF）] of the patients in both groups were improved significantly compared with that before treatment （P〈0.05）. There was no statistically significant difference between the two groups （all P〉0.05）. Improvement in comprehensive scores of the symptom of chill and fever in the acupuncture group was significantly superior to that in the drug group after 4 and 8 weeks of the treatment, respectively （P〈0.05）. Conclusion Warming needle moxibustion was obviously effective on the improvement in pulmonary function of elderly patients with stable chronic obstructive pulmonary disease.

多量表评估对老年慢性疾病患者生命质量、营养状态及睡眠质量的影响

目的 观察多量表评估应用于老年慢性疾病患者的机体功能效果。方法 选择2018年1月至2021年1月南京鼓楼医院老年科收治的100例老年慢性疾病患者作为研究对象,采取随机数字表法将其分为研究组和对照组,各50例。对照组单纯在生命质量测定量表(QLQ-C30)评估下给予患者护理,而研究组在对照组基础上采用营养风险量表(NRS2002)、匹兹堡睡眠质量指数(PSQI)众多量表对患者进行测评并给予相应护理措施。于入院时和入院1个月时,采取QLQ-C30量表、营养状态、免疫功能对患者进行测评。结果 干预后,研究组躯体功能、角色功能、社会功能、认知功能、情绪功能、整体生活质量评分高于干预前,且高于对照组;倦怠、恶心呕吐、疼痛、呼吸困难、失眠、食欲丧失、便秘、腹泻评分低于干预前,且低于对照组,差异有统计学意义(P<0.05)。干预后,研究组体重指数、白蛋白、总蛋白水平高于干预前,且高于对照组,差异有统计学意义(P<0.05)。干预后,两组免疫球蛋白(Ig)G、Ig M、Ig A水平高于干预前,且研究组高于对照组,差异有统计学意义(P<0.05)。结论 多量表评估的护理干预可增强老年病科的慢性疾病患者的免疫功能和营养状态,在晚年生活中保持良好的生命质量。

老年慢病共存患者自我感知老化对主观幸福感的影响研究

目的:了解老年慢病共存患者自我感知老化的现状及影响因素,并探讨其与主观幸福的相关性,为提高老年慢病共存患者的心理健康水平提供参考依据。方法:便利抽取373名老年慢病共存患者,采用一般资料调查表、简版自我感知老化量表及纽芬兰纪念大学幸福度量表进行调查。结果:老年慢病共存患者自我感知老化总均分为(52.28±10.39)分,纽芬兰纪念大学幸福度总均分为(25.27±4.84)分。相关性分析显示,自我感知老化总得分与主观幸福感总得分呈负相关(r=-0.624,P<0.01);年龄、婚姻状况及生活是否能够自理是老年慢病共存患者自我感知老化的影响因素(均P<0.05),共解释总变异度的25.6%;年龄、居住方式是老年慢病共存患者主观幸福感的影响因素(均P<0.001),共解释总变异度的14.0%;自我感知老化能够独立解释主观幸福感的44.3%。结论:老年慢病共存患者自我感知老化处于中等偏上水平,主观幸福感水平偏低,且自我感知老化对其主观幸福感有较大影响。因此,医务工作者需采取有效措施帮助老年慢病共存患者树立正确的老化观念,以进一步提高其主观幸福感水平。

基于血肌酐和胱抑素C的肾小球滤过率计算方程对老年慢性肾脏病肾功能评估的价值和意义

目的探讨现有4种基于血肌酐的肾小球滤过率计算方程在评估老年慢性肾脏病患者的肾小球滤过率的价值,并开发基于胱抑素C的计算肾小球滤过率的方程。方法测定267例2008年1月至2009年4月在该科住院的老年患者(年龄>50岁,男性114例,女性153例,)血清胱抑素C水平,同时应用放射性核素标记物99mTc-DTPA测定肾小球滤过率(tGFR),以Gates法准确确定受试者GFR。血清胱抑素C(CysC)采用颗粒增强透射免疫比浊法,通过多元回归推算出基于血清胱抑素C计算肾小球滤过率的方程(eGFR),并与Cockcroft-Gault公式、MDRD公式、改良MDRD公式和基于我国人口学资料改良的简化MDRD公式计算的eGFR比较,(依次以eGFR1、eGFR2、eGFR3、eGFR4表示),评估现有4种的肾小球滤过率计算方程及基于血清胱抑素C计算肾小球滤过率的方程对老年慢性肾脏病患者的价值。结果eGFR1、eGFR2、eGFR3、eGFR4、eGFR均与tGFR呈正相关,相关系数为0.74、0.74、0.47、0.75、0.68,组内相关系数为0.80、0.74、0.30、0.79、0.65(P<0.001),基于血清胱抑素C计算肾小球滤过率的直线回归方程为eGFR=76.75-1.03×血清胱抑素-0.59×年龄+0.23×血清清蛋白(血清胱抑素:mg/L,年龄:岁,血清清蛋白:g/L),Bland-Altman回归分析显示eGFR1、eGFR4的偏差度和准确度及准确率均较eGFR2、eGFR3和eGFR良好。eGFR4落在tGFR±15%、±30%和±50%范围内的患者百分数反映了eGFR4与tGFR符合程度(准确)性,分别为29.4.8%、39.43%和64.4%。结论现有四种的肾小球滤过率计算方程中,基于我国人口学资料改良的简化MDRD公式对老年慢性肾脏病患者肾小球滤过率评估较准确,偏差度小,准确度及准确率高。基于血清胱抑素C的计算方程能用于老年慢性肾脏病患者肾小球滤过率,以基于我国人口学资料改良的MDRD公式比较无明显优势。

全麻复合硬膜外阻滞用于老年慢性阻塞性肺疾病患者手术

目的:探讨全麻复合硬膜外阻滞(GEA)用于COPD老年患者手术的可行性和安全性。方法:32例择期行上腹部和胸腔手术的老年患者随机均分为GEA组和单纯全麻(GA)组,术后分别采用硬膜外和静脉镇痛,记录手术时间、术后苏醒和拔除气管导管时间、术后镇痛效果(VRS评分)和术后呼吸系统事件,测定手术次日晨FVC、FEV_1/FC%、FEF_(25%～75%)。结果:术后苏醒和拔除气管导管时间GEA组较GA组明显缩短(P<0.05),术后镇痛GEA组明显优于GA组(P<0.05),呼吸系统事件的发生率GA组高于GEA组,手术次日晨测定FVC、FEV_1/FC%、FEF_(25%～75%)值GEA组与GA组存在明显差异(P<0.05),GEA组肺功能的恢复明显好于GA组。结论:全麻复合硬膜外阻滞可缩短苏醒时间和提高苏醒质量,术后镇痛完善,利于术后恢复,用于合并有COPD老年患者的手术是一种安全、有效、切实可行的麻醉方法。

降低老年慢性病患者出院后非医源性不良事件发生率

针对老年慢性病患者出院后非医源性不良事件发生率较高的现状,从用药失误、压疮、跌倒三个症结寻找问题真因,从医院层面、社区层面、家庭层面、社会支持层面4方面采取针对性改善措施,取得了较满意效果,但社区医疗机构服务能力、信息化建设仍有较大改进空间。

内科慢性疾病在眼科专科医院中的管理

目的:探索眼科专科医院内科慢性疾病管理的重点和方向。方法:回顾性选取2015年1-12月本院60岁及以上入院手术患者7306例,按年龄分为3组:A组(60～69岁)、B组(70～79岁)、C组(≥80岁),统计其合并内科慢性疾病情况及会诊原因。结果:老年眼科患者合并内科慢性疾病比例55.32%,主要为高血压病(41.53%)、糖尿病(18.78%)、冠心病(10.46%)。内科会诊比例8.51%,血压高(61.09%)、血糖高(33.44%)是会诊主要原因。合并内科慢性疾病比例B组与C组接近,但高于A组,三组比较差异有统计学意义(P=0.000),其中A组分别与B和C组比较差异均有统计学意义(P<0.05)。内科会诊比例C组最高10.19%,其次为A组8.63%,B组最小为7.80%,三组比较差异有统计学意义(P<0.05),其中B组与C组比较差异有统计学意义(P=0.007)。血压高及血糖高导致会诊统计,三组整体及组内比较差异均有统计学意义(P<0.05),其中因血压高导致会诊C组最高74.29%,因血糖导致会诊A组最高45.54%。结论:老年眼科患者合并内科疾病的比例高,C组患者的患病率及会诊率高,是重点关注的对象;高血压病、糖尿病、冠心病是老年眼科患者合并的主要内科疾病;血压高血糖高是会诊的主要原因,C组和A组分别是监测血压和血糖的重点人群。

老年COPD患者气道重塑的HRCT临床分析

目的 观察高分辨率 CT(HRCT)扫描对老年 COPD患者气道重塑检测的敏感度及临床意义。方法 对 32例临床确诊的老年 COPD患者胸部行 HRCT扫描 ,观察、测定直径 >2 mm的细支气管内 /外径比以及与其相伴行的肺小血管直径比 ,并与其临床 COPD分级相对照 ,探讨 HRCT对 COPD气道重塑检测的敏感性。结果 小气道异常改变以双肺下叶多见 (5 6 .97% ) ,其分布以肺周实质为主 (72 .48% ) ,特别是呼气状态下小气道内 /外径比及血管内径 /外径比与对照组有明显差异 (P<0 .0 1) ,其改变与COPD分级呈正比。结论 HRCT扫描可显示 COPD气道重塑的形态学改变 ,与 COPD严重程度有较好的相关性 ,可评估临床COPD病变的严重程度。

纳洛酮联合无创呼吸机治疗老年慢性阻塞性肺疾病并发呼吸衰竭125例

目的探讨纳洛酮联合无创呼吸机在老年慢性阻塞性肺疾病(COPD)并发呼吸衰竭临床治疗中的效果。方法将120例COPD并发呼吸衰竭患者随机分为两组,对照组在常规治疗基础上采用无创呼吸机正压通气,观察组在常规治疗基础上采用纳洛酮联合无创呼吸机治疗,对比两组临床疗效及血气指标变化。结果两组治疗后血气指标均比治疗前有明显改善,且观察组优于对照组;观察组治疗总有效率明显高于对照组。结论纳洛酮联合无创呼吸机治疗老年慢性阻塞性肺病并发呼吸衰竭效果显著。

血清PCT水平和中性粒细胞比例预测感染性COPD急性加重期老年患者治疗后再次加重的价值

目的探究感染性慢性阻塞性肺疾病(COPD)急性加重期(AECOPD)老年患者经静脉抗生素治疗后血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)及中性粒细胞(NG)比例等的变化。方法选取2016年7月至2018年2月扬州友好医院内科收治的122例老年AECOPD患者,根据治疗后1年内是否至少出现1次急性加重分为再次加重组(82例)和未加重组(40例)。分析比较末次静脉抗生素治疗后患者PCT、CRP、WBC及NG比例,并利用感受性曲线(ROC)曲线分析其预测COPD患者预后的价值。结果再次加重组患者血清PCT及NG比例均明显高于未加重组(P<0.05),而CRP、WBC比较差异无统计学意义(P>0.05);ROC曲线分析结果显示PCT及NG比例均可高效预测感染性AECOPD治疗后再次加重,曲线下面积(AUC)分别为0.939、0.901,最佳临界值分别取0.109μg/L、58.5%,此时敏感性为81.7%和85.4%,特异性为92.5%和85.0%。结论血清PCT、NG比例能预测和评估感染性AECOPD老年患者经静脉抗生素治疗后未来再次加重的风险,可靠性较高。

住院患者老年综合征发生情况及评估分析

目的 分析住院患者老年综合征的发生情况及特征,探讨老年综合征评估的方法及价值,为老年患者健康干预提供支持。方法 123例60岁以上老年住院患者作为研究对象,根据年龄将患者分为60~74岁组(53例)、75~84岁组(51例)、≥85岁组(19例)。对老年综合征发生情况以及共患慢性疾病情况进行回顾性分析和评估,同时对不同年龄组患者的老年综合征发生率进行对比分析。结果 123例患者中,合并1种慢性疾病者26例(21.1%),合并2种慢性疾病者57例(46.3%),合并3种慢性疾病者22例(17.9%),合并3种以上慢性疾病者18例(14.6%)。在慢性疾病类型方面,高血压、糖尿病及其并发症、高脂血症、冠心病的占比较高。三组患者的冠心病占比比较,差异有统计学意义(P<0.05),其中≥85岁组患者的占比最高,为63.2%。三组患者的高血压、高脂血症、脑梗死、糖尿病及其并发症、慢性阻塞性肺疾病、慢性肾功能不全占比比较,差异无统计学意义(P>0.05)。在老年综合征发生类型中,衰弱、谵妄、焦虑抑郁、认知功能障碍的发生率相对较高,均>30%。三组患者的日常生活能力受限、衰弱、跌倒、视力障碍、听力障碍、认知功能障碍发生率比较,差异有统计学意义(P<0.05),随着年龄的增长,相关老年综合征的发生率也会随之增加。三组患者的尿失禁、慢性疼痛、营养不良、谵妄、焦虑抑郁发生率比较,差异无统计学意义(P>0.05)。结论 多数老年住院患者合并有慢性疾病,老年综合征的发生率较高,且类型较多,通过对老年综合征进行科学评估具有重要意义,可指导临床采取有效的干预措施,改善患者的健康状态及生活质量。