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《广州医药》编辑部
目的 探讨肌少症性肥胖(SO)诊断标准的演进及其在中国老年人群中的本土化综合干预路径。方法 评述ESPEN/EASO最新共识,结合我国老年人代谢特征,系统分析“筛查-诊断-分期”流程及运动营养协同干预的临床效能。结果 SO诊断核心在于识别“隐性肥胖”,建议在AWGS2019标准基础上,叠加中国特异性腰围切点(男≥90 cm,女≥85 cm)或体脂率指标,并应用ALM/BMI校正肌肉质量。研究证实,以渐进式抗阻训练联合高蛋白营养(1.2~1.5 g·kg-1·d-1)为核心的协同模式,通过激活mTOR通路可显著逆转肌肉流失并改善胰岛素抵抗。融入八段锦等传统功法及乳清蛋白补充,能有效重塑中国患者“高碳水、低蛋白”的膳食习惯,提升依从性。结论 构建护士主导、社区依托的多学科管理模式,并借助远程健康工具实现闭环监测,是提升我国SO精准诊疗水平的关键路径。
Objective To explore the evolution of diagnostic criteria for sarcopenic obesity(SO)and its localized comprehensive intervention pathways tailored to the metabolic characteristics of the Chinese elderly population.Methods The latest ESPEN/EASO consensus was reviewed.Combined with the metabolic profile of Chinese older adults,the “screening-diagnosis-staging” workflow and the clinical efficacy of synergistic exercise and nutrition interventions were systematically analyzed.Results The core of SO diagnosis lies in identifying “hidden obesity.”It is recommended to incorporate Chinese-specific waist circumference cut-offs(male≥90 cm,female≥85 cm)or body fat percentage into the AWGS2019 framework,utilizing ALM/BMI for muscle mass calibration.Evidence suggests that a synergistic model,centered on progressive resistance training(PRT)and high-protein nutrition(1.2~1.5 g·kg-1·d-1),can significantly reverse muscle loss and improve insulin resistance by activating the mTOR pathway.Integrating traditional Chinese exercises(e. g. ,Baduanjin)and whey protein supplementation effectively reshapes the “high-carbohydrate,low-protein” dietary habits of Chinese patients,thereby enhancing intervention adherence.Conclusions Establishing a nurse-led,community-based multidisciplinary management model,integrated with digital health tools for closed-loop monitoring,is a pivotal strategy for enhancing the precision of SO diagnosis and treatment in China.
目的 探讨以整合照护理念为基础的综合干预体系对稳定性冠心病患者衰弱的影响。方法 选择2021年8月—2022年6月在驻马店市中医院诊治的老年稳定性冠心病患者78例,根据1∶1随机数字表法分为两组,每组各39例。常规组给予常规护理,整合组在常规组护理的基础上给予以整合照护理念为基础的综合干预体系,记录两组患者的预后情况。结果 两组患者在护理3个月后的平衡测试评分、座椅站立测试评分均低于护理前,整合组护理3个月后的平衡测试评分、座椅站立测试评分与常规组相比也降低(P<0.05)。整合组护理3个月后的躯体、心理、社会、精神等维度的生活质量评分均高于常规组(P<0.05)。整合组随访1年的靶血管重建、心肌梗死、心源性死亡、冠状动脉再狭窄等主要心血管事件不良事件发生率为5.13%,常规组为25.64%,整合组低于常规组(P<0.05)。结论 以整合照护理念为基础的综合干预体系能缓解老年稳定性冠心病患者的衰弱状况,改善患者的生活质量,降低主要心血管事件不良事件发生率。
Objective To explore and analyze the effects of a comprehensive intervention based on integrated care on the frailty of elderly stable coronary heart disease(CHD)patients.Methods From August 2021 to June 2022,78 cases of elderly stable CHD patients who were diagnosed and treated in Zhumadian City Hospital of Traditional Chinese Medicine were selected.According to a 1:1 random number table method,78 patients were divided into the integrated group and the traditional group,with 39 cases of each group.The traditional group was given routine care,while the integrated group was given a comprehensive intervention based on integrated care concepts on the basis of the traditional group's care,and the patients' prognosis was recorded.Results The balance test scores and chair stand test scores of both groups after 3 months of nursing care were lower than those before nursing care.The balance test scores and chair stand test scores of the integrated group after 3 months of nursing care were also significantly lower than those of the traditional group(P<0.05).After 3 months of nursing care,the quality of life scores in physical,psychological,social,and spiritual dimensions in the integrated group were significantly higher than those in the traditional group(P<0.05).The incidence of major cardiovascular adverse events such as cardiac death,myocardial infarction,target vessel reconstruction,and coronary artery restenosis during a one-year follow-up in the integrated group was 5.13%,compared to 25.64% in the traditional group.The integrated group was significantly lower than the traditional group(P<0.05).Conclusions The application of a comprehensive intervention based on integrated care concept in elderly stable CHD patients can alleviate frailty,improve quality of life,and reduce the incidence of major cardiovascular adverse events.
目的 分析社区综合干预对小儿反复呼吸道感染的影响,为社区临床治疗小儿反复呼吸道感染性疾病提供理论依据。方法 采用随机抽签方式,从我社区2012年10月—2014年10月期间收治的小儿反复呼吸道感染患儿中,随机抽取60例纳入本项研究,依据就诊单双顺序,分为研究组30例(社区综合干预方式)和对照组30例(常规性治疗和常规措施进行干预),对两组患儿干预结果进行对比分析。结果 研究组治疗总疗效高于对照组(93.33% vs 76.67%),差异有统计学意义(P<0.05)。对比治疗干预过程中疾病发作次数、就诊次数状况,研究组优于对照组,差异有统计学意义(P<0.05)。干预后研究组小儿呼吸道感染致病因素改善情况(除滥用抗生素外)优于对照组,差异有统计学意义(P<0.05)。结论 针对小儿反复呼吸道感染疾病可采用社区综合干预方式,可显著提升治疗有效率,缓解病情,降低反复感染发生率,效果突出,具有广阔应用前景。