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,

Analysis on influencing factors of patients experience in community health centers of Shenzhen,China

Objective To investigate the patients experience in community health centers( CHCs) and explore its associated factors. Methods A cross-sectional study was conducted among 330 patients who visited CHCs in Shenzhen,China from January to March 2018. Dependent variable was patient experience. Key descriptive variables were age,gender,marital status,working status groups,visits frequency for the past 6 months,whether patients had signed a family doctor,whether trusted in family doctor,whether had chronic diseases. Results Questionnaires for 300 patients were assessed. In the univariate analysis,patients experience total score was significantly associated with marital status( P < 0. 1),working status groups( P < 0. 1),frequency of visit for the past 6 months( P < 0. 05),whether had signed a family doctor( P < 0. 05),whether trusted in family doctor( P < 0. 05),whether had chronic diseases( P < 0. 05). The multivariate analysis showed that unmarried patients( P = 0. 011,OR = 2. 96,95% CI: 1. 24-5. 43) and had signed a family doctor( P = 0. 023,OR = 0. 44,95% CI: 0. 22-0. 85) were more likely to get a higher score. Conclusions Findings of this study showed a medium-level score of patients experience in the community. Patients had a quite good experience and more interventions should be focused upon the influence factors to improve patients experience.

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

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.

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。

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。

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。

1例慢性阻塞性肺疾病急性加重期老年患者的用药分析与药学监护

目的:了解慢性阻塞性肺疾病急性加重期(COPD-AE)患者治疗用药的有效性、安全性和药学监护情况,探讨临床药师如何在临床实践中发挥作用。方法:药师参与吴忠市人民医院1例COPD-AE患者临床诊疗过程,特别是治疗中各种药物的实施和调整,与医生共同观察治疗效果,并对患者进行用药指导,提高患者对药物治疗的依从性。结果:该例COPD-AE患者临床症状均明显改善,治疗药物安全、有效。结论:临床药师对临床治疗进行用药分析与药学监护,在临床合理用药方面起着重要作用。

沙库巴曲缬沙坦对高龄老年冠心病合并慢性心力衰竭患者心功能的影响

目的观察沙库巴曲缬沙坦钠片对高龄老年冠状动脉粥样硬化性心脏病(冠心病)合并慢性心力衰竭患者心功能的影响。方法选取2018年1月至2021年6月于解放军总医院第七医学中心老年医学科心血管病区住院及门诊就诊的高龄老年冠心病合并慢性心力衰竭患者125例,其中使用沙库巴曲缬沙坦钠片治疗患者65例为研究组,其余60例为对照组,观察两组在治疗前、治疗12周后患者6分钟步行距离(6MWD)、N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)的变化及不良反应发生情况。结果研究组治疗12周后患者心功能明显改善、生活质量明显提高,与治疗前相比,患者6MWD高于治疗前[(289.6±44.9)vs.(117.1±36.1),P<0.05]。NT-proBNP显著低于治疗前[(2190.1±531.8)vs.(9718.4±1380.1)pg/ml,P<0.05];LVEF高于治疗前[(54.7±2.2)vs.(42.0±2.1),P<0.05]。治疗后研究组的6MWD高于对照组[(289.6±44.9)vs.(159.1±40.1),P<0.05],NT-proBNP低于对照组[(2190.1±531.8)vs.(4191.2±491.2)pg/ml,P<0.05];LVEF高于对照组[(54.7±2.2)vs.(49.7±1.7),P<0.05]。结论沙库巴曲缬沙坦钠片对高龄老年冠心病合并慢性心力衰竭患者可显著增加6MWD,减低NT-proBNP水平,提高LVEF水平,改善心功能,不良反应少,具有较好的安全性。为高龄老年冠心病合并慢性心力衰竭患者提高生活质量提供了新的治疗方法。

抗菌药物降阶梯治疗对老年COPD合并肺部感染患者气道炎症和肺功能与TLR4及NF-κB水平的影响

目的抗菌药物降阶梯对老年慢性阻塞性肺疾病(COPD)合并肺部感染患者气道炎症、肺功能与Toll样受体4(TLR4)、核因子κB(NF-κB)的影响。方法纳入2017年8月-2019年8月南阳医学高等专科学校第一附属医院收治的COPD合并肺部感染患者108例,随机分为常规组和研究组,各54例;常规组采用抗菌药物常规治疗方案,研究组采用抗菌药物降阶梯治疗方案,观察两组患者临床疗效和安全性评价,对比治疗前后肺功能相关指标[用力肺活量(FVC)、一秒用力呼气容积(FEV_(1))和最大呼气峰值流速(PEF)]、气道炎症反应指标[C-反应蛋白(CRP)、降钙素原(PCT)、脑钠肽(BNP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],收集两组患者外周血,分离外周血单个核细胞,采用实时荧光聚合酶链式反应检测细胞中TLR4、NF-κB的mRNA表达水平,分析TLR4/NF-κB通路与气道炎症指标的相关性。结果治疗前,两组患者肺功能指标FVC、FEV_(1)、PEF差异无统计学意义,治疗后,两组患者上述指标皆有明显改善,且研究组上述指标改善幅度优于常规组(P<0.05);研究组疗效优于常规组(P=0.028);研究组不良反应总发生率为3.70%低于常规组(P=0.046);治疗前两组患者气道炎症反应指标CRP、PCT、BNP、IL-6和TNF-α差异无统计学意义,治疗后,两组患者气道炎症反应指标CRP、PCT、BNP、IL-6和TNF-α皆降低,且研究组上述指标降低幅度高于常规组(P<0.05);治疗前两组TLR4 mRNA、NF-κB mRNA差异无统计学意义,治疗后,两组患者TLR4 mRNA、NF-κB mRNA皆降低,且研究组上述指标降低幅度高于常规组(P<0.05)。结论抗菌药物降阶梯治疗可提高COPD合并肺部感染患者的临床疗效及肺功能,降低TLR4、NF-κB水平,减轻气道炎症反应,该方案临床效果较好,安全可靠。

院外健康护理指导对老年慢性病患者生活质量及心理的影响

目的探讨院外健康护理指导对老年慢性病患者生活及心理的影响。方法选取某院住院的年龄〉60岁的老年慢性疾病患者300例，采用随机数字表法分为干预组和对照组，每组150例。出院后，对照组患者回家后正常自然生活；干预组由护理人员每半月与受试者及其家属进行沟通，予以护理指导。并分别在出院后第3个月和第6个月应用简明健康调查量表（SF．36）和SCL-90症状自评量表分别对两组患者的生活质量和心理健康状况进行评估。结果出院前，两组患者的sF一36量表各维度评分差异无统计学意义（P〉0．05）；出院后3个月，干预组患者的sF-36量表中，机体功能、总体健康、活力、社会功能、情感职能、精神健康维度评分分别为（76．8±9．81），（63．4±8．6），（65．2±9．2），（59．1±14．3），（59．1±8．21），（64．2±11．3）分，均高于对照组的（60．4±9．6），（53．3±11．8），（54．8±15．3），（54．3±11．3），（44．4±9．8），（55．3±15．9）分，差异有统计学意义（t值分别为14．63，8．47，7．13，3．23，14．08，5．59；P〈0．01）；出院后6个月，干预组患者的sF-36量表中，机体功能、总体健康、活力、社会功能、情感职能、精神健康维度评分分别为（73．5±11．4），（63．8±10．9），（64．1±17．3），（60．1±11．7），（58．3±8．7），（64．3±15．1）分，均高于对照组的（63．3±11．1），（56．7±14．7），（54．2±14．4），（59．1±10．2），（45．9±10．5），（57．1±18．7）分，差异有统计学意义（t值分别为7．85，4．75，5．39，3．79，11．10，3．67；P〈0．01）。出院前，两组患者的SCL-90症状自评量表各因子得分差异无统计学意义（P〉0．05）；出院后3个月干预组患者的躯体化和抑郁2个因子得分分别为（1．79±0．32），（1．78±0．34）分，优于对照组的（1．89±0．34），（1．89±0．41）分，差异有统计学意义（t值分别为2．62，2．53；P〈0．01）；出院后6个月干预组患者的躯体化和抑郁2个因子得分分别为（1．73±0．52），（1．76±0．44）分，优于对照组的（2．02±0．51），（1．98±0．32）分，差异有统计学意义（t值分别为4．88，4．95；P〈0．01）。出院后3个月和6个月干预组患者再次就诊次数分别为（0．20±0．04）和（0．33±0．11）次，均低于对照组的（0．37±0．07），（0．42±0．10）次，差异有统计学意义（t值分别为25．82，7．41；P〈0．01）。出院后3个月和6个月干预组患者出院后医疗费用分别为（450．00±125．14）和（1000．00±300．11）元，均低于对照的（600．78±120．67）和（1500．00±205．56）元，差异有统计学意义（t值分别为10．62，16．83；P〈0．01）。出院后两组患者的死亡人数差异无统计学意义（P〉0．05）。结论出院患者进行院外护理干预支持可以改善患者的生存质量及部分心理状态，从整体而言可以减少患者的医疗花费和社会负担，节省社会医疗资源。

联合应用复方左旋多巴制剂致睡眠异常1例

1例慢性肾脏病(CKD)87岁男性患者因帕金森病服用卡左双多巴控释片(每片含卡比多巴50 mg、左旋多巴200 mg)半片、tid,治疗超过2年。1周前因精神症状加重,加用多巴丝肼(每片含左旋多巴200 mg、苄丝胼50 mg)半片、qid,治疗12 d后出现嗜睡、呼之不醒。停用卡左双多巴控释片后患者自行清醒,且未再发生睡眠发作。

血清骨桥蛋白在慢性阻塞性肺疾病患者中的表达及临床意义

目的探讨血清骨桥蛋白(osteopontin,OPN)水平与慢性阻塞性肺疾病(COPD)的关系。方法 COPD急性加重期患者26例作为A组,平均年龄(62.32±4.11)岁;COPD缓解期患者23例作为B组,平均年龄(61.38±4.32)岁;C组18例,为年龄、性别匹配的吸烟者对照组;D组18例,为年龄、性别匹配的不吸烟者对照组,检测各组血清骨桥蛋白水平并比较分析。结果 A组患者血清OPN水平最高,较其他三组比较,差异具有统计学意义(P<0.01);B组患者血清OPN水平次之,较C,D组比较,差异有统计学意义(P<0.01);D组血清OPN水平最低,较C组比较,差异有统计学意义(P<0.05)。结论血清OPN水平可能是反应COPD病情变化的早期指标,并且与病情的严重程度有关。