目的 研究氯吡格雷联合低分子肝素对老年急性心肌梗死(acute myocardial infarction, AMI)患者血清中血脂及炎性因子的影响,为临床AMI的治疗提供参考依据。方法 选取新乡医学院第一附属医院于2016年10月—2019年11月期间收治的老年AMI患者112例,按照随机分配的原则分成两组,即对照组和观察组,每组病例各56例,治疗方式为对照组单给予口服氯吡格雷进行治疗,观察组给予口服氯吡格雷与皮下注射低分子肝素联合治疗,比较治疗前后两组患者血清中甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)及低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDH-C),炎性因子的水平变化及心功能的改变情况。结果 与治疗前相比较,治疗后对照组和观察组患者血清TG、TC及LDH-C水平均降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平均降低,患者的左心室后壁厚度、左心室舒张末期内径均有降低,射血分数升高;而与对照组治疗后相比较,治疗后观察组患者血清TG、TC及LDH-C水平进一步降低,炎性因子TNF-α,IL-1β,CRP,IL-6的水平进一步降低,患者的左心室后壁厚度、左心室舒张末期内径均降低,而射血分数升高,差异有统计学意义。结论 氯吡格雷联合低分子量肝素可通过降低血清中血脂的水平,抑制AMI过程中的炎症反应,减少炎性因子的释放,提高患者的心功能,改善患者的病情。

Objective To explore the effects of clopidogrel combined with low molecular weight heparin on serum lipids and inflammatory factors in elderly patients with acute myocardial infarction, and provide reference for clinical treatment of AMI. Methods 112 elderly patients with AMI admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2016 to November 2019 were randomly divided into control group and observation group,56 cases in each group.The control group was treated with clopidogrel alone, and the observation group was treated with clopidogrel combined with low molecular weight heparin. The levels of serum TG, TC and LDH-C, inflammatory factors and cardiac function were compared between the two groups before and after treatment. Results Compared with before treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased in the observation group and the control group after treatment. The left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased in the observation group and control group after treatment. Compared with control group after treatment, the levels of serum TG, TC and LDH-C decreased, and the levels of inflammatory factors TNF-α, IL-1β, CRP and IL-6 decreased, the left ventricular posterior wall thickness and LVEDD decreased, but LVEF increased further in observation group after treatment. Conclusion Clopidogrel combined with low molecular weight heparin may improve the patient's cardiac function, then improve the patient's condition through reducing the level of serum lipids, inhibit the inflammatory reaction in AMI, reduce the release of inflammatory factors.

目的 探讨老年急性缺血性脑卒中并发肺部感染患者的临床特征和相关危险因素。方法 采用回顾性研究方法,选择2017年7月— 2019年10月深圳市第二人民医院神经内科收治的1 113例老年急性缺血性脑卒中患者,其中卒中并发肺部感染患者(108 例)纳入感染组,未并发肺部感染患者(1 005例)纳入对照组。以单因素对比分析两组患者的临床资料,采用 Logistic多因素回归分析方法分析合并肺部感染的高危因素。结果 单因素分析提示两组年龄(尤其是高龄患者)、住院天数、房颤、脑梗死史、慢性肺疾病、吞咽困难、言语不清、意识障碍差异有统计学意义(P <0.05)。多因素 Logistics 回归分析显示,高龄(≥80岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍与老年急性缺血性脑卒中并发肺部感染密切相关。结论 老年急性缺血性脑卒中并发肺部感染的独立危险因素主要是高龄(≥80 岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍,临床应高度重视。

Objective Objective To investigate the clinical characteristics and risk factors of elderly patients with acute ischemic stroke complicated with pulmonary infection. Methods A retrospective study was conducted on 1 113 elderly patients with acute ischemic stroke admitted to the department of neurology, Shenzhen Second People's Hospital from July 2017 to October 2019. Among them, 108 patients with stroke complicated with pulmonary infection were included in the infection group and 1 005 patients without concurrent pulmonary infection were included in the control group. The clinical data of the two groups were analyzed by single factor comparison, and the risk factors for pulmonary infection were analyzed by logistic multiple factor regression analysis. Results Single factor analysis showed there were statistically significant differences between the two groups in age (especially elderly patients), length of stay in hospital, atrial fibrillation, history of cerebral infarction, chronic pulmonary disease, dysphagia, slurred speech, and disturbance of consciousness (P <0.05). Multi-factor logistic regression analysis showed that old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech, and disturbance of consciousness were closely related to pulmonary infection in elderly patients with acute ischemic stroke. Conclusion The independent risk factors of acute ischemic stroke complicated with pulmonary infection in the elderly mainly include old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech and disturbance of consciousness, which should be paid more attention to clinically.

目的 探讨老年中度急性胆囊炎患者采用经皮经肝胆囊穿刺引流术与腔镜胆囊切除术联合治疗的效果。方法 本文将2019年2月—2020年2月收治的60例老年中度急性胆囊炎患者作为研究对象,按照随机数字表法分组,对照组30例患者仅采用择期腔镜胆囊切除术治疗,观察组30例患者在对照组的基础上应用经皮经肝胆囊穿刺引流术治疗。统计分析体液免疫指标、细胞免疫指标、手术前后ALP、TBIL、IBLL水平、AMY水平、白细胞计数、VAS评分及并发症发生情况。结果 两组之间ALP、TBIL、IBLL水平、AMY水平、白细胞计数、VAS评分及并发症发生情况相比,观察组低于对照组;体液免疫指标、细胞免疫指标相比,观察组高于对照组,P＜0.05。结论 在采用择期腔镜胆囊切除术治疗老年中度急性胆囊炎的基础上联合经皮经肝胆囊穿刺引流术可提升疗效,降低择期腔镜胆囊切除术的风险,有助于患者术后尽快恢复,还可减轻患者的免疫功能损伤情况,改善体液免疫指标,减轻疼痛程度,降低并发症发生率,具有较高的应用价值。

Objective To investigate the effect of combined treatment of percutaneous transhepatic cholecystectomy and endoscopic cholecystectomy in elderly patients with moderate acute cholecystitis. Methods The research objects were 60 elderly patients with moderate acute cholecystitis, grouping according to random number table method, the control group of 30 cases were treated with selective endoscopic cholecystectomy, the observation group of 30 patients were treated with the percutaneous liver gallbladder puncture drainage on the basis of selective endoscopic cholecystectomy. Statistical analysis of humoral immunity, cellular immunity, ALP, TBIL, IBLL levels before and after operation, AMY, white blood cell count, VAS score and complications were conducted. Results The levels of ALP, TBIL, IBLL, AMY, WBC count, VAS score and complications in the observation group were lower than those in the control group. The indexes of humoral immunity and cellular immunity in the observation group were higher than those in the control group (P<0.05). Conclusion Endoscopic cholecystectomy used in the treatment of elderly moderate acute cholecystitis combined on the basis of percutaneous transhepatic gallbladder puncture drainage can improve curative effect, reduce the risk of selective endoscopic cholecystectomy, help patients with postoperative recovery, also can reduce the patient's immune function damage, improve the humoral immunity indexes, relieve pain, reduce the incidence of complications, which has high application value.

目的 分析高龄呼吸道感染患者病原菌检测结果及耐药性情况,总结高龄呼吸道感染患者抗菌药物的合理用药经验。方法 对我院2018年1月—2020年12月收治的784例高龄呼吸道感染患者痰液标本进行病原菌培养及药敏试验,统计分析检测结果。结果 701株病原菌中,革兰阴性(G-)菌、革兰阳性(G+)菌和真菌分别检出497株、136株和68株,分别占70.90%、19.40%和9.70%。G-菌以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌和奇异变形杆菌为主,分别占21.97%(154株)、18.97%(133株)、14.98%(105株)和7.13%(50株),G+菌以金黄色葡萄球菌为主,占11.27%(79株)。G-菌耐药性前五位依次为氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶,耐药率依次为95.96%、85.11%、79.88%、77.06%和52.92%。G+菌耐药性前五位依次为青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑,耐药率依次为95.59%、89.71%、84.56%、80.15%和75.00%。结论 高龄呼吸道感染患者病原菌构成以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、奇异变形杆菌和金黄色葡萄球菌为主,G-菌对氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶耐药最强,G+菌对青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑最强,且呈多重耐药特征,加强临床耐药性监测有助于指导合理用药。

Objective To analyze the test results and drug resistance of pathogenic bacteria in elderly patients with respiratory tract infections, and summarize the rational use of antibiotics in elderly patients with respiratory tract infections. Methods The sputum samples of 784 elderly patients with respiratory tract infections admitted to our hospital from January 2018 to December 2020 were collected for pathogen culture and drug sensitivity test, and the test results were statistically analyzed. Results Among 701 strains of pathogenic bacteria, 497 strains were Gram-negative (G-) bacteria (70.90%), 136 strains were Gram-positive (G+) bacteria (19.40%) and 68 strains were fungi (9.70%). G-bacteria were mainly Klebsiellapneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus mirabilis, accounting for 21.97% (154 strains), 18.97% (133 strains), 14.98% (105 strains) and 7.13% (50 strains). G+bacteria were mainly Staphylococcus aureus, accounting for 11.27% (79 strains). The top five antibiotics which G-bacteria resisted were ampicillin, piperacillin, compound sulfamethoxazole, cefazolin and ceftazidime.The resistance rates were 95.96%, 85.11%, 79.88%, 77.06% and 52.92%,respectively. The top five antibiotics which G+bacteria resisted were penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and the drug resistance rates were 95.59%, 89.71%, 84.56%, 80.15% and 75.00%, respectively. Conclusions The pathogenic bacteria in elderly patients with respiratory tract infections were mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Staphylococcus aureus. G-bacteria resisted ampicillin, piperacillin,compound sulfamethoxazole, cefazolin and ceftazidime the most. G+bacteria were most resistant to penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and were characterized by multi-drug resistance.Enhancing bacterial resistance monitoring helps guiding the rational use of drugs.

目的 探讨广州地区老年住院患者营养状态与日常生活能力(ADL)的相关性。方法 选取2018年7月—2019年6月在广州市第一人民医院住院年龄≥60岁的老年人共275例,收集其一般资料信息,各项临床营养指标(BMI、血清白蛋白、血红蛋白、总胆固醇、甘油三酯)、并运用营养风险筛查2002(NRS2002)评估营养风险、采用Barthel指数评定量表评估日常生活能力;分析老年住院患者营养状态与ADL之间的相关性。结果 在本组研究中,根据NRS2002评分(营养风险:NRS2002≥3;无营养风险NRS2002＜3),营养风险发生率58.9%(162/275);无营养风险发生率41.1%(113/275)。老年住院患者的NRS2002评分与ADL评分呈负相关关系(r=-0.393,P＜0.05);ADL评分与BMI、血清白蛋白、总胆固醇、血红蛋白水平呈正相关关系(P＜0.05)。结论 广州地区老年住院患者NRS2002为日常生活能力的影响因素,通过降低NRS2002评分来减少营养风险可改善老年人的日常生活能力;老年人的营养风险发生率高,应当尽早进行营养干预。

Objective To investigate relationship between nutritional status and activities of daily living(ADL) in elderly inpatients in Guangzhou. Methods Total of 275 people older than 60 were included in this study from Guangzhou First People's Hospital from July 2018 to June 2019. Their nutritional markers(including BMI, plasma albumin, hemoglobin, total cholesterol, triglyceride),the activities of daily living(ADL) were evaluated with Barthel index and the nutrition risk screening 2002(NRS2002)used to assess the nutritional risk status were collected to analyze the relationship between nutrition and ADL. Results In these subjects, based on the NRS2002 scores(nutritional risk that the NRS2002 scores were equal or greater than 3, and the non-nutritional risk that the NRS2002 scores were less than 3),58.9%(162/275) patients were having nutritional risk and 41.1%(113/275) were having non-nutritional risk. In elderly inpatients,NSR2002 were negatively associated with ADL(r=-0.393,P＜0.05). ADL was positively associated with BMI, plasma albumin and hemoglobin level(P<0.05). Conclusion In the old, the NRS2002 is an influencing marker of activities of daily living in Guangzhou. Reducing the nutritional risk by lowering the NRS2002 scores can improve ADL in the elderly. The incidence of nutritional risk is highly prevalent in elderly and early nutritional treatment will be needed.

目的 探究高龄患者植入静脉输液港并发感染相关影响因素分析。方法 随机抽取我院2015年5月—2018年8月期间收入高龄患者总计72例,对并发感染患者数量进行统计,采取Logistic回归方程进行计算,分析高龄患者植入静脉输液港并发感染相关因素。结果 共计纳入植入静脉输液港并发感染患者总计72例,其中并发感染患者为23例,占比31.94%,对比两组一般资料,发现两组患者在穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量上存在差异,数据对比差异有统计学意义(P＜0.05),将上述有差异资料带入Logistic回归方程计算,发现穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量均为导致高龄患者植入静脉输液港并发感染影响因素。结论 对高龄患者而言,植入静脉输液港并发感染各项因素中,包括穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量,患者需加强关注,可控制输液港相关感染。

Objective To explore the influencing factors of infection in elderly patients with intravenous infusion port. Methods 72 elderly patients from May 2015 to August 2018 were randomly selected in our hospital. After counting the number of patients with complicated infection,the relative factors of infection in elderly patients were analyzed by using the Logistic regression equation. Results A total of 72 patients were included in the intravenous infusion port with concurrent infection,of which 23 were accompanied with infection,accounting for 31.94%.By comparing the general data,two groups in puncture sites,types of diseases,application times and frequencies,histories of diabetes and body masses had statistically difference(P<0.05). It was found all the above factors were the concomitant factors leading to the implantation of intravenous infusion port in elderly patients by putting the difference data into the Logistic regression equation. Conclusion To control infusion port related infection,the elderly patients should focus more on the infection factors of the implantation in intravenous infusion port which included puncture sites,types of diseases,application times and frequencies,histories of diabetes and body masses.

目的 探讨孕中后期中低等强度有氧运动对高龄孕妇产前生活质量和母婴结局的影响。方法 选2017年8月—2018年12月我院接收的560名高龄孕妇作为研究对象,随机分成数量相等的两组。对照组采取常规孕期保健服务和健康教育,观察组则在此基础上增加孕中后期中低等有氧运动的干预,问卷法调查两组孕妇的抑郁情况、睡眠质量、产前生活质量,并比较两组孕妇的母婴结局。结果 χ²检验结果显示,研究组对象平均每周运动次数≥3次及平均每次运动时间≥30 min的比例高于对照组(P=0.001)。研究组对象的EPDS抑郁分值和SRSS睡眠质量分值均低于对照(P=0.006)。研究组对象产前GQOLI-74生活质量问卷中生活质量总得分高于对照组(P=0.000 1)。研究组对象的妊娠糖尿病、妊娠高血压、难产率、巨大儿发生率均低于对照组(P=0.039),但自然分娩率高于对照组(P=0.004)。结论 以瑜伽、慢走或散步为主的中低强度的有氧运动可能有助于提供高龄孕妇的产前生活质量,预防妊娠疾病和不良母婴结局,在临床上具有一定的推广意义。

Objective To study the influences of medium or low strength aerobics during 2^nd and 3^rd trimester on life quality and pregnant outcome of elderly pregnant women. Methods To select 560 elderly pregnant women in our hospital during August 2017 to December 2018 as the objects of this study. Objects were divided into control group which was given routine pregnant health services and study group which was given medium or low strength aerobicsduring 2^nd and 3^rd trimester excluding in addition. Questionnaires were used for collecting messages of depression, sleeping, life quality of objects. Pregnant outcome were compared of two groups by Chi-square test in this study. Results The ratio of average aerobics more than 3 times per week and average time more than 30min each time of study group were higher than control group(P=0.001). The scores of EPDS and SRSS of study group were lower than control group(P=0.006). The scores of GQOLI-74 of study group were higher than control group(P=0.000 1). The ratio of pregnant diabetes mellitus, pregnant hypertension, dystocia, fetal macrosomia of study group were lower than control group(P=0.039) but the ratio of eutocia was higher than control group(P=0.004). Conclusion The medium or low strength aerobics such as Yoga, taking a walk may improve pregnant life quality of elderly pregnant women and prevent pregnancy disease and abnormal pregnant outcome that deserved to promote in clinic.

目的 分析融合功能训练在大龄人群行斜视矫正术后建立双眼三级视功能及巩固术后效果的可能性。方法 回顾性研究2008年10月—2016年12月在广州爱尔眼科医院被诊断为共同性斜视并进行手术矫正的患者174例,术后进行融合功能训练。根据术前诊断斜视的类型分成共同性内斜视组、共同性外斜视组、间歇性外斜视组,根据两眼最佳矫正视力差别分为＞2行、≤2行组,训练时对单眼抑制及交叉抑制者先采用脱抑制训练再扩大融合功能训练,具有较小融合范围的矫正术后的患者直接从扩大融合功能开始训练,对比观察斜视手术矫正前和矫正后进行融合训练后融合功能及双眼视情况。结果 斜视矫正术后128例建立了正常的融合范围,随访1年斜视无复发,无视疲劳症状发生。其中共同性外斜视组、共同性内斜视组、间歇性外斜视组进行训练后治疗的有效率分别为32.35%、28.57%、100%,两眼最佳矫正视力相差＞2行和≤2行的有效率分别为11.54%、100%。结论 大龄斜视患者尤其是间歇性外斜视或双眼最佳矫正视力相差在2行以内的患者,经过融合训练均获得良好的双眼视,视疲劳得到改善,斜视手术效果得到巩固。

Objective To analyze the possibility of fusion function training to establish binocular tertiary vision function and consolidate the effect of postoperative strabismus correction in elderly people. Methods Conduct a retrospective study about 174 patients who were diagnosed with common strabismus and had corrective surgery at Guangzhou Aier Eye Hospital from October 2008 to December 2016, and those patients was performed after the fusion function training. According to the type of preoperative diagnosis of strabismus, they were divided into common esotropia group, common exotropia group, intermittent exotropia group. According to the difference of the best corrected visual acuity between the two eyes, they were divided into>2 lines group and ≤2 lines group. Monocular-suppression and cross-suppression patients firstly used de-inhibition training and then expand the fusion-range training. Patients with a smaller fusion range started training directly by expanding the fusion function. We compared and observed the fusion function and binocular condition between before and after strabismus surgery. Results The normal fusion range was established in 128 cases after strabismus correction, and there was no recurrence of strabismus and visual fatigue symptoms after 1 year of follow-up. Among them, the effective treatment rates of the common exotropia group, the common esotropia group, and the intermittent exotropia group after training are 32.35%, 28.57%, and 100%, respectively. The two groups which are divided into>2 lines group and ≤2 lines group are 11.54% and 100%, respectively. Conclusion Elderly patients with strabismus, especially those with intermittent exotropia or within two lines of best corrected visual acuity, have achieved good binocular vision after fusion training, have been improved visual fatigue, and the effect of strabismus surgery is consolidated.

目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

目的 应用NRS2002、MNA-SF两种营养筛查方法评估住院老年冠心病患者营养风险,观察营养风险与营养指标及心功能的关系。方法 选取2017年8月-2018年6月在我院全科医学科住院的老年冠心病患者129例,使用两种方法分别进行营养筛查,分成存在营养风险组和不存在营养风险组,完善血常规、生化、心功能检查,统计两组各项指标之间的关系,及两种营养筛查方法与各项指标的相关性。结果 NRS2002筛查出营养风险发生率为38.76%,MNA-SF筛查出营养风险发生率75.97%。与不存在营养风险组比较,存在营养风险组的BMI、HB、ALB下降,且NRS-2002评分中存在营养风险组pro-BNP较不存在营养风险组明显升高。两种营养筛查方法与HB、PA、ALB、pro-BNP均有相关性。结论 运用两种营养筛查方法,结合各项指标能更好对老年冠心病患者进行营养风险评估。

Objective To analyze the preoperative nutritional screening results of the nutritional risk screening 2002（NRS2002） and the Mini Nutritional Assessment Short Form（MNA-SF） in 129 elderly patients with coronary heart disease and their relationships with some nutritional indicators and heart function. Methods NRS2002 and MNA-SF were used to evaluate the nutritional risk of 129 elderly patients with coronary heart disease. We divided the patients into nutritional risk group and non- nutritional risk group. The relationships between two groups with the nutritional indicators and the heart function were analyzed,and the value of the two nutritional screening tools was compared. Results The incidence rate of malnutrition by using NRS2002 was 38.76% and that of MNA-SF was 75.97% among 129 CHD patients. The nutritional risk group had lower BMI,HB and ALB. Nutritional risk group that was screened by NRS2002 had higher pro-BNP. And the two nutritional risk texts were related to HB,PA,ALB and pro-BNP. Conclusion It would be better to use two methods and some indicators to analyze the nutritional risk in elderly CHD patients in the hospital.