目的 探究老年食管鳞癌患者单纯放疗、同步放化疗临床治疗效果。方法 选我院2018年1月—2020年12月期间90例老年食管鳞癌患者为研究对象,依据不同治疗方式将其分为对照组、观察组,各45例,分别接受单纯放疗、同步放化疗治疗,比较2组治疗效果及治疗安全性。结果 观察组治疗总有效率为75.56%,与对照组60.00%相近(P＞0.05);观察组疾病控制率为97.78%,较对照组84.44%高(P＜0.05);观察组放射性肺炎、骨髓抑制发生率为24.44%、77.78%,较对照组6.67%、48.89%高;且观察组放射性肺炎、骨髓抑制、放射性食管炎2级占比分别为17.78%、35.56%、57.78%,均较对照组2.22%、8.89%、24.44%高(P＜0.05)。结论 在老年食管鳞癌患者治疗中,与单纯放疗相比,同步放化疗可提升疾病控制能力,但会增加治疗不良反应,增加不良反应严重程度,因此在临床治疗中,需慎重选择。

Objective To explore the clinical effect of radiotherapy only and concurrent chemoradiotherapy in elderly patients with esophageal squamous cell carcinoma. Methods Ninety cases of elderly patients with esophageal squamous cell carcinoma in our hospital from January 2018 to December 2020 were selected as research objects.According to different treatment methods, they were divided into control group and observation group, 45 cases in each group.They were treated with radiotherapy and concurrent chemoradiotherapy respectively.The treatment effect and safety of the two groups were compared. Results The total effective rate of the observation group was 75.56%, which was close to the control group (60.00%, P>0.05). The disease control rate of the observation group was 97.78%, which was higher than control group (84.44%, P<0.05). The incidence of radiation pneumonia and bone marrow suppression of the observation group were 24.44% and 77.78%, which were higher than that of the control group (6.67%, 48.89%). The proportion of radiation pneumonia, bone marrow suppression, radiation esophagitis grade 2 of the observation group were 17.78%, 35.78% and 57.78% respectively, higher than that of the control group (2.22%, 8.89%, 24.44% respectively, P<0.05). Conclusion Compared with radiotherapy only, concurrent chemoradiotherapy improved the ability of disease control in elderly patients with esophageal squamous cell carcinoma, but it increased the adverse reactions and aggravated the severity of adverse reactions.Therefore, it is necessary to make a careful choice in clinical treatment.

目的 探讨老年吸入性肺炎的危险因素,建立风险预测模型,以期降低老年吸入性肺炎的发病率。方法 选取2017年8月28日—2020年 10月30日广州市第一人民医院老年病科住院治疗的老年肺炎患者205例,按照是否发生吸入性肺炎分为吸入性肺炎组和非吸入性肺炎组,对比2组患者的各项指标,分析老年吸入性肺炎的危险因素,建立风险预测模型,采用ROC曲线对模型进行预测效果检验。结果 多因素Logistic回归分析结果显示,脑梗塞、帕金森、留置胃管、长期卧床为老年吸入性肺炎的危险因素(P<0.05)。模型公式为Logit(P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀。该模型ROC曲线下面积为0.894。结论 本研究中的模型预测效果良好,可为医护人员预测老年患者发生吸入性肺炎的概率,及时采取相应的预见性护理及干预性治疗。

Objective To explore the risk factors of aspiration pneumonia in the elderly and establish the risk prediction model, in order to reduce the incidence of aspiration pneumonia in the elderly. Methods A total of 205 elderly patients with pneumonia who were hospitalized in the department of geriatrics, Guangzhou First People's Hospital from August 28, 2017 to October 30, 2020, were divided into aspiration pneumonia group and non-aspiration pneumonia group according to whether aspiration pneumonia occurred. The indicators of the two groups of patients were compared, the risk factors of aspiration pneumonia in the elderly were analyzed, the risk prediction model was established, and the prediction effect of the model was tested by receiver operating characteristic curve. Results Multivariate Logistic regression analysis showed that cerebral infarction, Parkinson's disease, indwelling nasogastric tube, and being bedridden were risk factors for aspiration pneumonia in elderly patients (P<0.05). The model formula was Logit (P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀. The area under receiver operating characteristic curve of this model was 0.894. Conclusion The prediction effect of the model in this study was good, which could predict the probability of aspiration pneumonia in elderly patients for medical staff, and to timely take the corresponding predictive care and interventional treatment.

目的 观察中等强度有氧运动联合力量训练对老年高尿酸血症(HUA)尿酸、身体机能及生活质量影响分析。方法 2019年1月—2019年12月在我社区收治的老年HUA患者60例纳入研究,随机数字表法进行分组,选取其中的30例患者实施常规饮食、运动指导为对照组,另30例患者配合中等强度有氧运动联合力量训练为研究组。比较2组患者对干预的依从性,干预前、后的血尿酸水平,身体机能及生活质量评分(WHOQOL-100评分)。结果 2组患者均在干预期内完成训练,依从性优良率比较,差异无统计学意义(P＞0.05)。干预前2组患者的血尿酸水平、身体机能比较,差异无统计学意义(P＞0.05)。干预后2组患者的血尿酸水平、安静心率较干预前降低,研究组低于对照组,而肺活量则较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。干预前2组患者的WHOQOL-100评分比较,差异无统计学意义(P＞0.05),干预后2组WHOQOL-100各项评分较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。结论 在老年HUA患者的相关指导中,运用中等强度有氧运动联合力量训练的运动干预,可较为明显的降低血清血尿酸水平,降低并平稳安静心率,提升肺活量,提升生活质量,效果理想。

Objective To observe the effect of moderate intensity aerobic exercise combined with strength training on uric acid level, physical function and quality of life in elderly patients with hyperuricemia (HUA). Methods Sixty elderly patients with HUA were treated in our center from January 2019 to December 2019. They were randomly divided into two groups, 30 cases in each group. Among them, 30 cases given routine diet and exercise guidance were included in control group, and the other 30 cases given moderate intensity aerobic exercise combined with strength training on the basis of the control group were included in study group. The compliance, blood uric acid level, physical function and quality of life (WHOQOL-100 scores) before and after the intervention were compared between the two groups. Results Two groups of patients completed the training within the expected time, and there was no significant difference in compliance (P＞0.05). Before the intervention, there were no significant differences in blood uric acid level and physical function between the two groups (P＞0.05). After the intervention, the serum uric acid level and resting heart rate of the two groups were lower than those before the intervention, and those of the research group were even lower than the control group, while the vital capacity was higher than that before the intervention, and the research group was higher than the control group, those differences were significant (P＜0.05). Before the intervention, there was no significant difference in WHOQOL-100 score between the two groups (P＞0.05). After the intervention, the scores of WHOQOL-100 in the two groups were higher than those before the intervention, and that in the study group was higher than the control group (P＜0.05). Conclusions In the relevant guidance of elderly patients with hyperuricemia (HUA), the application of moderate intensity aerobic exercise combined with strength training can significantly lower the serum uric acid level, reduce and stabilize the resting heart rate, improve the vital capacity and quality of life, with ideal effect.

目的 探究不同麻醉方式对患有冠心病的老年患者外科介入不良心血管事件作用的对比。方法 选取2020年1月—2021年1月,我院确诊的冠心病患者,且无心脏外科干预手术80 例,随机分为研究干预组(n=40)和空白对照组(n=40),研究组采用2%的七氟醚,对照组用丙泊酚联合瑞芬太尼,维持麻醉血浆靶浓度在3.0～6.0 mg/L 之间,方式为静脉泵注;分析2组病人外科术后负性心脏情况控制影响; 结果 研究组和对照组患者的肌酸激酶存在差异,同时心脏肌钙蛋白T的高低也存在差异(P均<0.05);研究组在术后的负性心血管情况发病率均低于空白对照组,其中研究组的心源性猝死、心律紊乱不齐和心脏源性的休克等的病变率要远低于对照组,统计学差异存在意义(P均＜0.05);而其中研究组的心力衰竭与对照组相比,差异不具有统计学意义(P＞0.05)。结论 相比于静脉麻醉,吸入式麻醉能够趋好性降低非心脏手术术后负性心脏相关风险的发生率,该研究对于临床实践有一定的参考意义和实践可操作性,可以考虑普及推广。

目的 探讨应用56孔冷盐水(STSF)压力导管高功率消融模式治疗老年阵发性房颤患者的有效性和围手术期安全性。方法 回顾性分析广州市第一人民医院2019年1月—2021年6月使用STSF导管高功率消融模式行射频治疗的老年阵发性房颤患者68例(STSF组),匹配同期年龄、性别、左房直径、左室射血分数无差异且使用6孔冷盐水 (ST)压力导管常规功率消融的老年房颤患者71例(ST组),比较2组患者之间的即刻环肺静脉隔离成功率、单圈隔离成功率、手术时间、X线透视时间、消融时间、术中盐水灌注量,以及并发症发生率。结果 2组患者都成功完成环肺静脉电隔离,STSF组单圈隔离成功率与ST组无差异(左侧肺静脉92.6% vs 90.1%,P>0.05;右侧肺静脉83.8% vs 87.3%,P>0.05),与ST组比较,STSF组手术及消融时间缩短[(70.9±10.0)min vs (79.1±14.2)min,P<0.001;(25.4±4.5)min vs(30.5±6.3)min,P<0.001],灌注量更低[(406.5±46.3)mL vs (729.2±106.1)mL;P<0.001],X线透视时间相近[(6.5±2.5)min vs(7.3±2.6)min;P=0.056]。2组围手术期并发症率均较低(2.9% vs 3.9%;P=0.39),STSF组2例术中发生气体爆破,但未引起心包填塞,ST组有2例术后出现心衰,利尿后好转,1例出现持续性胸痛,胃镜提示食道糜烂,予流质饮食及质子泵抑制剂治疗后恢复。结论 应用STSF导管高功率消融模式在老年阵发性房颤患者行肺静脉大环隔离可提高消融效率,减少术中液体负荷,且不增加围手术期风险。

Objective To investigate the effectiveness and perioperative safety of ThermoCool SmartTouch SurroundFlow (STSF) catheter high-power ablation mode in the treatment of elderly patients with paroxysmal atrial fibrillation. Methods A total of 68 elderly patients with paroxysmal atrial fibrillation who used STSF catheter high-power ablation mode (STSF group) in Guangzhou First People's Hospital from January 2019 to June 2021 were analyzed retrospectively. There were 71 elderly patients with atrial fibrillation who had no significant difference in age, sex, left atrial diameter and left ventricular ejection fraction, used ThermoCool SmartTouch (ST) catheters for conventional power ablation (ST group) at the same time. The success rate of immediate circumferential pulmonary vein isolation, single lap isolation, operation time, X-ray fluoroscopy time, ablation time, intraoperative saline perfusion volume and the incidence of complications were compared between the two groups. Results Both groups of patients successfully completed circular pulmonary vein electrical isolation. There was no significant difference in the success rate of single-circle isolation between STSF group and ST group (left pulmonary vein 92.6% vs 90.1%, P>0.05; right pulmonary vein 83.8% vs 87.3%, P>0.05). Compared with ST group, STSF group had shorter operation and ablation time [(70.9±10.0) min vs (79.1±14.2) min, P<0.001; (25.4±4.5) min vs (30.5±6.3) min, P<0.001], lower perfusion volume [(406.5±46.3)mL vs (729.2±106.1)mL, P<0.001], similar X-ray fluoroscopy time [(6.5±2.5)min vs (7.3±2.6)min, P=0.056 ]. The perioperative complication rate of the two groups was low (2.9% vs 3.9%, P=0.39). Two cases of STSF group had steam pops during operation but did not cause pericardial tamponade, and 2 cases of ST group had postoperative heart failure occurred and improved after diuresis. One case developed persistent chest pain, which gastroscope indicated esophageal erosion, and recovered after liquid diet and PPI treatment. Conclusions Using STSF catheter high-power ablation mode to perform pulmonary vein isolation in elderly patients with paroxysmal atrial fibrillation could improve ablation efficiency, reduce intraoperative fluid load, and without increasing perioperative risk.

术后谵妄(POD)指术后严重的注意力及神经认知障碍,其发病率高,且可致多种术后并发症的发生率增加,老年患者为其高危人群之一。相关研究显示:心率变异性(HRV)作为反映自主神经系统(ANS)功能的生物电指标,与老年患者POD的发生相关。本文综述了近年HRV指数与老年患者POD关系的研究,描述了老年患者POD的流行病学规律、ANS功能异常引发POD的可能机制以及HRV与神经认知功能及POD的可能联系,以期为POD的防治提供新的思路。

Postoperative delirium (POD) is a syndrome of severe postoperative attention and neurocognitive impairment, which has a high incidence and can lead to an increased incidence of various postoperative complications. Elderly patients are one of the high-risk groups for POD. Relevant studies have shown that heart rate variability (HRV), as a bioelectrical indicator reflecting the function of the autonomic nervous system (ANS), is associated with the occurrence of POD in elderly patients. This paper reviewed the recent studies on the relationship between HRV index and POD in elderly patients, described the epidemiological regularity of POD in elderly patients, the possible mechanism of POD caused by abnormal ANS function, and the possible connection between HRV and neurocognitive function or POD, in order to provide new evidence for the prevention and treatment of POD.

目的 探究支气管镜下肺泡灌洗并局部使用阿米卡星治疗老年支气管扩张合并感染患者的疗效及对血清炎性因子水平的影响。方法 选取我院2018年3月—2019年5月确诊支气管扩张症、合并感染的符合纳入标准的患者共64例,按照1:1比例抽签分为2组,32例纳入观察组,应用支气管镜下肺泡灌洗阿米卡星治疗;32例纳入对照组,以单纯的支气管镜下肺泡灌洗治疗。观察并比较2组患者的治疗效果、血清炎性因子水平、肺功能情况等。结果 疗效比较显示观察组的96.9%总有效率高于对照组的75.0%(P＜0.05);血清炎性因子水平在患者用药前检测无差异(P＞0.05),经过治疗后,观察组水平均优于对照组P＜0.05;经治疗后,观察组静态肺活量、补呼气量、补吸气量、用力肺活量均优于对照组,差异具有统计学意义(P＜0.05)。结论 对老年支气管扩张合并感染患者应用支气管镜下肺泡灌洗阿米卡星治疗,促进临床效果改善,患者的症状、炎症及肺功能等指标均得到明显改善,值得推广。

Objective To investigate the efficacy of bronchoscopic alveolar lavage and local application of amikacin in the treatment of elderly patients with bronchiectasis complicated with infection and its effect on the level of serum inflammatory factors.Methods A total of 64 patients with bronchiectasis complicated with infection diagnosed in our hospital from March 2018 to May 2019 were selected.They were divided into two groups evenly by proportional drawing. Thirty-two cases were included in the observation group that were treated with bronchoscopic alveolar lavage with amikacin.The other 32 cases were included in the control group that were treated with the bronchoscopic alveolar lavage only.The therapeutic effect,serum inflammatory factor level and pulmonary function of the two groups were observed and compared.Results The total effective rate of 96.9% in observation group was higher than 75.0% in control group (P<0.05).There was no difference in the levels of serum inflammatory factors before treatment (P>0.05).After treatment,the levels of the observation group were better than those of the control group (P<0.05).After treatment,the slow vital capacity,expiratory reserve volume,inspiratory reserve volume and forced vital capacity of the patients in the observation group were better than those in the control group (P<0.05).Conclusions Bronchoscopic alveolar lavage of amikacin in elderly patients with bronchiectasis complicated with infection could improve the clinical effect.The symptoms of the patients,the serum inflammatory factors and lung function of the patients were significantly improved.The treatment is worthy of promotion.

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.