目的:探讨老老年患者颈动脉中层厚度(IMT)及其相关危险因素的关系,为老老年患者心脑血管疾病的预防及治疗提供临床参考。方法:根据年龄将139例老老年患者纳入分析,有血糖、血压、血脂代谢紊乱的123例作为观察组,无血糖、血压、血脂代谢紊乱的16例作为对照组,分别进行颈动脉超声检查、动态血压监测、糖化血红蛋白及血脂等生化指标检查,并结合临床资料进行分析。结果: 老老年患者均无一例外地存在着IMT增厚,在相同的年龄情况下,吸烟史、血脂紊乱、糖调节异常、血管炎症反应与IMT的增厚呈正相关,各组未显示出统计学差异,IMT的发生发展与年龄、性别、吸烟史、血糖、血压控制水平及血脂紊乱等因素在两组对照中均未显示出统计学差异,多因素Logistic回归分析,显示年龄、吸烟史及病程为危险因素(OR为0500～1196)。结论:老老年患者均不同程度地存在着IMT增厚,其中增龄是其最主要的危险因素,但是对合并有血糖、血压、血脂代谢紊乱的老老年患者也应该积极重视对各种危险因素的筛选和干预,特别在疾病发生发展的早期可能对延缓病变的进展和减少心脑血管事件有一定意义,可是其用药的安全性在该类患者就显得尤为重要。
【摘要】 目的 探讨人工双极股骨头置换术治疗老老年（gt;80岁）股骨颈骨折的临床疗效。 方法 2006年1月－2009年12月采用人工双极股骨头置换术治疗23例老老年股骨颈骨折患者，其中男8例，女15例；年龄81~100岁，平均88岁。左侧10例，右侧13例。致伤原因：走路摔伤20例，交通事故伤3例。骨折按Garden分型：Ⅲ型14例，Ⅳ型9例。均为新鲜骨折，受伤至手术时间3~12 d。术前均合并慢性内科疾病。 结果 术后切口均I期愈合，3例发生肺部感染，1例发生深静脉血栓形成，无切口感染及假体脱位。2例患者分别于术后5个月死于急性心肌梗死及术后1年死于高血压性脑溢血。余21例均获随访，随访时间12~48个月，平均26个月。X线片示假体位置良好。根据Harris髋关节评分标准：优12例，良6例，可2例，差1例，优良率为85.7%。 结论 人工双极股骨头置换术治疗老老年股骨颈骨折手术时间短，可早期髋关节活动，减少了卧床并发症，提高了生存率，改善了患者生活质量，是一种较理想的治疗手段。【Abstract】 Objective To discuss the clinical effects of bipolar hemiarthroplasty for treatment of femoral neck fracture in super-aged patients who were over 80 years old. Methods From January 2006 to December 2009, 23 cases of femoral neck fracture were operated by bipolar hemiarthroplasty. Among the patients, there were 8 males and 15 females, with their age ranged from 81 to 100 years old averaging at 87.5 years. Ten patients had left femoral neck fracture, and 13 had right femoral neck fracture. Twenty patients had the injury because of falling on the ground while walking, and 3 due to car accident. Based on Garden classification, there were 14 cases of type Ⅲ and 9 of type Ⅳ fractures. All fractures were fresh. The interval between the injury and operation was 3 to 12 days. Before operation, all patients had concomitant chronic diseases. Results All incisions healed in the first stage with 3 cases of lung infection and 1 case of deep venous thrombus, and without incision infection or prosthesis dislocation. One patient died of acute myocardial infarction 5 months after operation and the other one died of hypertensive cerebral hemorrhage 1 year after operation. All the remaining 21 patients were followed up for 12 to 48 months averaging at 26 months. X-ray result showed a good location of the prosthesis. According to the Harris scoring system, the results were very good in 12 cases, good in 6 cases, fair in 2 cases and poor in 1 cases, with a total effective rate of 85.7％. Conclusions Bipolar hemiarthroplasty is an ideal method to treat femoral neck fracture in super-aged patients. It can shorten operation time, facilitate early movements of the hip joint, decrease complication rate due to lying in bed, and improve survival rate and quality of life.
【摘要】 目的 探讨老老年患者留置尿管内壁细菌生物被膜形成情况及其对导管相关感染(CRI)的影响。〖HTH〗方法〖HTSS〗 分析2007年2月—2009年10月住院的175例留置尿管患者,均为男性,年龄75~96岁,平均86岁。不同留置时间(7~15 d 53例、16~30 d 49例、31~45 d 44例、gt;45 d 29例)的尿管,于拔出尿管后运用超声震荡使尿管内表面生物被膜完全脱落,梯度稀释后进行生物被膜活菌计数,细菌的培养分类及构成比分析；采用扫描电镜观察尿管内壁细菌生物被膜形成的情况；观察尿管留置时间与生物被膜CRI的关系。结果 随着尿管留置时间的延长,尿管内表面生物被膜活菌计数呈指数趋势增长,CRI发生率有升高趋势,各置管时段组间尿管内表面生物被膜活菌计数及CRI发生率比较差异均有统计学意义(Plt;0.05)。扫描电镜见生物被膜的形成随时间的延长而明显增多。结论 细菌生物被膜形成是老老年患者留置尿管相关性尿路感染的重要致病因素,尿管留置时间越长,尿管生物被膜感染的危险性及几率越高。更换尿管或缩短留置时间仍是防止尿管生物被膜感染的主要方法。