目的 研究右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用的有效性及安全性。方法 选择择期行阴式子宫切除术患者40例(ASA Ⅰ～Ⅱ级),随机分成两组,选择硬腰联合麻醉下手术,麻醉平面固定后以超声引导给予患者双侧腹横肌膜神经阻滞,Ⅰ组患者选用0.5 μg/kg右旋美托咪啶+0.2%罗哌卡因,每侧20 mL,Ⅱ组以相同方法给予同量生理盐水。记录麻醉前(T₀)、麻醉平面确定后(T₁)、手术开始(T₂)、牵拉子宫(T₃)、术毕(T₄)患者的HR、MAP、SpO₂及NTI评分;评价并记录牵拉反应、术后认知功能障碍及谵妄的发生及患者舒适度及满意度。结果 两组患者一般情况无显著性差异(P>0.05);与I组相比,Ⅱ组HR在T₃时刻有显著性降低,差异有统计学意义(P<0.05),牵拉反应评价Ⅰ组评为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05);Ⅰ组舒适度及满意度评定为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05)。结论 右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用是安全有效的。

Objective To observe the effectiveness and safety of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine in elder vaginal hysterectomy. Methods Forty scheduled for vaginal hysterectomy (ASAⅠ～Ⅱ)were randomly assigned to 2 groups. All patients received spinal anesthesia, and ultrasound-guided subcostal transverses abdominis plane block then, Group Ⅰ: 0.5 μg/kg dexmedetomidine and 0.2% ropivacaine 20 mL for each side, and saline was used for Group Ⅱ. HR、MAP SpO₂ and NTI scale were recorded at the time points of pre-anesthesia(T₀), confirmation of anesthesia plane (T₁), beginning of surgery (T₂), pulling uterus (T₃), surgery end(T₄). Effect of dragging reaction, POCD and delirious and degree of comfort and degree of satisfaction of patients were valuated. Results The general condition did not differ between the two groups(P>0.05). Compared to Group Ⅰ, HR of Group Ⅱ at the time point of T3 was significant lower(P<0.05), number of patients with excellent dragging reaction of Group Ⅰ was significant higher (P<0.05)and patients of Group Ⅰ were more comfortable and satisfied than patinents of Group Ⅱ(P<0.05). Conclusion Ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine is effective and safe for vaginal hysterectomy in elderly female.

目的 探讨临床常用非侵袭性检查指标诊断膀胱出口梗阻(BOO)的准确性及可靠性。方法 回顾性研究2003年11月—2015年11月在广州市第一人民医院就诊并接受压力—流率测定(PFS)的男性LUTS/BPH患者,以侵袭性的PFS为诊断BOO的“金标准”,以前列腺体积(PV)、移行带体积(TZV)、移行带指数(TZI)、前列腺特异性抗原(PSA)、最大尿流率(Qmax)、剩余尿量(PVR)、剩余分数(RF)等非侵袭性检查指标为诊断指标进行诊断试验评价。结果 筛选1319例患者纳入统计分析。以ICS列线图为诊断标准,PV、TZV、TZI、PSA、Qmax、RF、PVR诊断BOO的ROC曲线下面积(AUC)分别为0.803、0.807、0.698、0.775、0.740、0.679、0.641;以Schaefer列线图为诊断标准,PV、TZV、TZI、PSA、Qmax、RF、PVR诊断BOO的AUC分别为0.806、0.814、0.713、0.773、0.721、0.684、0.642。结论 PV、TZV、TZI、PSA、Qmax、RF、PVR等非侵袭性指标对筛查及诊断中老年男性BOO有一定的参考价值及临床意义,其中TZV、PV、PSA、Qmax的诊断准确性较高。

Objective To evaluate and assess the efficacy and validity of the most common and noninvasive parameters in daily clinical practice for detecting bladder outlet obstruction (BOO) in elderly male compared with the golden standard pressure-flow study (PFS). Methods Retrospectively analyze the outpatients and inpatients of male LUTS/BPH from November 2003 to November 2015 in Guangzhou First People's Hospital. Collect the PFS parameters and other noninvasive parameters including PV, TZV, TZI, PSA, Qmax, RF, and PVR. Receiver operating characteristic (ROC) curve was used to evaluate the efficiency of each parameter for detecting BOO. Statistic analyses were performed using SPSS (Version 21). Results The data from 1319 patients were analyzed. According to the ICS-nomogram. The areas under the ROC curve (AUCs) of PV, TZV, TZI, PSA, Qmax, RF, and PVR for detecting BOO were 0.803, 0.807, 0.698, 0.775, 0.740, 0.679, and 0.641, respectively. According to the Schaefer's nomogram, the AUCs of PV, TZV, TZI, PSA, Qmax, RF, and PVR for detecting BOO were 0.806, 0.814, 0.713, 0.773, 0.721, 0.684, and 0.642, respectively. Conclusion PV, TZV, TZI, PSA, Qmax, RF, and PVR would help predicting BOO in elderly male noninvasively, and providing valuable reference and guidance in clinical decision. TZV, PV, PSA and Qmax supply preferable accuracy for detecting BOO, with better sensitivity and specificity.

目的 调查分析注射剂药品说明书中有关老年人用药描述,为完善和修订注射剂药品说明书提供参考依据。方法 收集某医药公司经营300个品种注射剂的药品说明书,按药理作用、国内外生产厂家和所含成份等统计药品说明书中老年人用药内容的标注情况。结果 在所调查的注射剂药品说明书中,284份(95%)注射剂说明书标注有老年用药项,其中48份(17%) 标注老年人具体用量;236份(83%)标注模糊,标注有“老年人药代动力学”仅39份(占13%);国内外厂家的注射剂在老年人用药标注情况有差异(P<0.01)。结论 注射剂药品说明书在老年人用药方面描述不足,需引起政府和各方面的关注,相关部门应加强对注射剂药品说明书的安全监管,完善说明书的内容,以保证药品说明书的科学性、合理性和有效性。

目的 探讨血浆脑利钠肽前体(proBNP)和心肌损伤标志物(CK-MB和cTnI)联合检测对老年脓毒症患者心肌损伤及预后评估的临床意义。方法 选择60例老年脓毒症患者按病情严重程度分为一般脓毒症组和严重脓毒症组,另选取同期在我院行健康体检的同龄人30例作为对照组。比较三组和不同预后患者血浆proBNP、cTNI、CK-MB水平及急性生理和慢性健康状态评分Ⅱ(APACHE Ⅱ) ,并对各指标进行相关性分析。结果 脓毒症患者血浆proBNP、cTnI水平高于对照组,且严重脓毒症组APACHEⅡ评分高于一般脓毒症组(均P＜0. 05);死亡组患者其血浆中的proBNP,cTNI和CK-MB水平及APACHE Ⅱ评分均高于存活组患者(均P＜0.05),差异有统计学意义;严重脓毒症组患者血浆proBNP 水平与cTnI及CK-MB水平呈正相关性(P＜0.05); 血浆proBNP水平、cTnI水平、CK-MB水平分别与APACHEⅡ评分呈正相关性(P＜0.05)。结论 血浆proBNP 及cTnⅠ水平可有效反映老年脓毒症患者心肌受损程度,早期血浆proBNP、cTnI、CK-MB水平联合检测对老年脓毒症患者预后判断可能有重要临床意义。

Objective To study the clinical significance of cardiac injury biomarkers(CK-MB and cTnI) and pro-brain natriuretic peptide(proBNP) joint detection for prognosis value in Elderly sepsis. Methods Sixty elderly patients with sepsis were selected. According to the severity of disease divided into general and severe sepsis group.Meanwhile, 30 healthy volunteers as a control group. Comparative study of plasma proBNP, cTnI, CK-MB levels and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) in three groups;and the correlation analysis of the indicators. Results Compared with control group, the plasma levels of proBNP and cTnI were significantly higher in patients with sepsis; And the APACHEⅡ score in the severe sepsis group was significantly higher than the general sepsis group (P<0. 05). The plasma proBNP, cTnI, CK-MB level and APACHE Ⅱ scores in death group were significantly higher than the survival group (P<0. 05). The proBNP plasma levels, cTnⅠ and CK-MB levels in severe sepsis patients were positively correlated (P<0. 05); They were positively correlated between ProBNP level, cTnⅠ level and the APACHEⅡ score(P<0. 05). Conclusions ProBNP plasma levels and cTnⅠ can effectively reflect the extent of the cardiac damage in elderly sepsis; Early plasma proBNP level, cTnI and CK-MB combined detection of elderly sepsis may have important clinical significance.

目的 研究老年慢性阻塞性肺病(COPD)患者血清IL-33水平与其病程分期的相关性。方法 选择60例老年COPD患者作为观察组,按病程分期分为稳定期组和急性加重组,另选择15例非COPD老年患者作为对照组;分别检测血清IL-33水平。结果 各组组间比较结果显示,AECOPD组和COPD稳定期组的血清IL-33水平均高于对照组(P<0.05),其中,AECOPD组的比COPD稳定期组的更高(P<0.05)。结论 血清IL-33水平在老年COPD患者中增高,急性加重期更明显,提示IL-33在老年人COPD发生、发展中可能起重要作用。

Objective To have relevant research between serum IL-33 level and the stage of disease in elderly patients with chronic obstructive pulmonary disease(COPD). Methods 60 elderly patients with COPD were selected as the observation group, who were divided into stable COPD group and AECOPD group. The other 15 patients with non-COPD were selected as the control group. The serum IL-33 levels were detected respectively. Results The comparison results between the groups showed that the serum IL-33 levels in the AECOPD group and the stable COPD group were higher than those in the control group(P<0.05), which was higher in the AECOPD group than in the COPD group(P<0.05). Conclusion Serum IL-33 levels were increased in elderly patients with COPD, the increase in acute exacerbation was more obvious, suggesting that IL-33 may play an important role in the occurrence and development of COPD in the elderly.

目的 探察老年冠心病无痛性心肌缺血的临床护理效果。方法 选取我院冠心病患者68例,按照护理方式的不同分为观察组与对照组,每组34例;对照组患者给予常规护理,观察组在对照组的基础上给予患者优质的临床护理;观察两组患者的临床护理效果。结果 临床护理后,两组患者的症状均有缓解,但观察组患者心肌缺血的发作次数、发作时间、ST段压低减少的次数及下移减少量显著优于对照组,结果差异有统计学意义(P＜0.05)。结论 对老年冠心病无痛性心肌缺血患者采用针对性合适的临床护理,缓解了患者的临床症状,减少了心肌缺血的发作次数,改善了患者的并发症,效果显著,值得推广。

目的 了解老年患者医院感染的发生情况及相关因素,为有效降低医院感染提供临床依据。方法 对我院2010年6月—2014年6月452例60岁以上的老年患者医院感染情况进行回顾性分析,调查并分析其年龄、住院天数、医院感染部位及相关因素。结果 老年患者医院感染的发生与年龄增长、住院天数延长、感染部位、基础病及抗生素不合理应用等因素密切相关。结论 根据医院感染的相关因素,对老年人加强病房管理及基础护理,不仅改善治疗操作中易感染的环节,减少感染途径,还可以降低医院感染发生率。

目的 探讨群组管理对老年前列腺术后患者下肢活动依从性的效果。方法 将60例患者分为干预组和对照组,对照组按常规护理,干预组实施1周的群组管理活动。结果 干预后干预组患者对预防DVT发生的知晓度、进行下肢主动活动的依从性高于对照组,双下肢皮肤温度、颜色、胀痛等改变显著小于对照组,比较差异均有统计学意义(P＜ 0. 01)。结论 群组管理是一种有效的管理模式,可增强患者的自我效能,提高患者下肢活动的依从性,达到预防DVT发生的作用。

Objective To explore the influence of group management on compliance of lower extremities of elderly patients who underwent prostatectomy. Methods 60 patients were divided into the intervention group and the control group. While the control group was accepted normal nursing, the intervention group was accepted one-week group management. Results The intervention group performed better than the control group in awareness on the prevention of DVT and compliance of activities of lower extremities, and experienced less changes than the control group in skin temperatures, colors and ache of both lower extremities. These changes had statistical significant (P＜0.01). Conclusion Group management is an effective management mode, and improves parents' self-efficacy and compliance of lower extremities, is helping prevent DVT.

目的 探讨社区老年高血压病人直立性低血压的药物影响。方法 通过对辖区内897例社区老年高血压病人开展体检,将年轻老年和老老年高血压两组分为直立性低血压组和非直立性低血压组两组。分析降压药物对社区老年高血压病人直立性低血压的影响。结果 OH组的降压药物使用率稍高于非OH组的降压药物使用率,经统计分析P>0.05。OH组联合两种以上及联合三种以上降压药物使用率略高于非OH的药物使用率, P>0.05。利尿剂OH发生率稍高于其他组的OH发生率,P>0.05。结论 社区老年高血压OH的发病可能与目前常用的5大类降压药物无关。

目的 探讨老年人血尿酸(serum uric acid,SUA)水平与阿尔茨海默病(Alzheimer's disease,AD)的相关性。方法 选择227例我院老年病科住院患者为研究对象,其中阿尔茨海默病67例,其余160例为非AD组。收集病史、吸烟史、服药史,并检测血尿酸、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBS)、血肌酐(Cr)水平。比较各SUA四分位数水平AD的发生率,并进行相关性分析。结果 AD组血尿酸水平低于非AD组,差异有统计学意义(P＜0.01);多因素分析筛选出年龄、性别、缺血性脑卒中是危险因素(P＜0.05),而服用他汀、SUA、HDL-C是保护因素(P＜0.05)。对AD和SUA的四个分组做Spearman等级相关分析(rs=-0.285,P<0.001),结果呈等级负相关。结论 血尿酸水平与老年人AD相关,血尿酸可能是AD发病的保护性因素。

Objective To explore the correlation between serum uric acid(SUA) level and Alzheimer's disease(AD) in elderly patients. Methods 67 cases of the elders with Alzheimer's disease and 160 elders matching with age and gender were enrolled from Jan 2013 to Dec 2014 in the study,the blood levels of biochemical factors such as SUA,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting blood sugar(FBS) and creatinine(Cr) were measured by automatic biochemistry analyzer in the two groups. The related factors such as history of disease,smoking and medication history were collected. The correlation between the level of SUA and AD was analyzed. Results The serum uric acid levels in AD group were significantly lower than those in control group(P＜0.01). Multivariate logistic regression analysis showed that age, gender, ischemic stroke were risk factors, and taking statin, SUA, and HDL-C were protective factors(P＜0.05). Spearman correlation tests indicated that there was an inverse correlation between SUA levels and AD(rs=-0.285,P<0.001). Conclusion Serum uric acid level is significantly related to AD in the elderly.SUA may be a protective factor of the occurrence of AD.