ObjectiveTo investigate the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice of elderly patients. MethodsTotally 338 patients with obstructive jaundice underwent ERCP were divided into elderly group (age ≥60 years old) and nonelderly group (age lt;60 years old) based on age. The levels of serum amylase (AMY), ALT, and TBIL in 6, 24, and 48 h after ERCP were detected. The success rate of cholangiopancreatography, accuracy rate of diagnosis, and incidence of complications after ERCP in two groups were analyzed. ResultsThe difference of serum AMY, ALT, and TBIL levels of patients in 6, 24, and 48 h after ERCP were not significant between two groups (Pgt;0.05). The success rate of cholangiopancreatography in nonelderly group was 96.3% (130/135) and in elderly group was 96.1% (195/203), and no difference was found (Pgt;0.05). However, the accuracy rate of diagnosis of ERCP in nonelderly group (84.6%, 110/130) was significantly lower than that in elderly group (98.5%, 192/195), Plt;0.05. The difference of the incidence of complications was not significant between two groups 〔14.8% (20/135) vs. 17.2% (35/203)〕, Pgt;0.05. There was no mortality in two groups patients. ConclusionERCP is a safe, effective, and accurate method, which is of importance to the diagnosis of obstructive jaundice in elderly patients.
目的 比較腹腔鏡膽囊切除術（LC）與小切口膽囊切除術（MC）在老年患者中的臨床效果，以指導臨床選擇應用。 方法 回顧性分析筆者所在醫院2010年7月至2013年7月期間行LC（LC組，n=109）及MC（MC組，n=111）的老年患者的臨床資料，比較2組術中和術后相關指標的差異。 結果 LC組和MC組患者的手術時間〔（45.72±6.14）min比（40.67±6.02）min〕、術中出血量〔（10.18±3.31）mL比（11.13±2.93）mL〕、住院時間〔（9±5）d比（10±5）d〕及總并發癥發生率〔28.4%（31/109）比31.5%（35/111）〕比較差異均無統計學意義（P＞0.05）；但LC組患者的術后疼痛程度輕、胃腸道功能恢復時間短〔（46.3±10.5）h比（71.4±9.8）h〕、住院費用較高〔（8 010±450）元比（4 800±680）元〕、切口感染發生率較低〔0（0）比15.3%（17/111）〕、肺部感染發生率較高〔17.4%（19/109）比9.9%（11/111）〕，P＜0.05。 結論 LC對老年膽囊結石或膽囊炎患者具有更好的臨床效果；但對心肺功能異常者，尤其是不能耐受全麻和氣腹的患者選擇MC更為合適，所以臨床上應視患者具體情況加以選擇。
Frailty is a syndrome characterized by vulnerability to stressors due to loss of physiological reserve. In recent years, many researches have confirmed that frailty is a risk factor for postoperative complications of cardiac surgery, such as readmission, adverse cardiovascular events, and death in elderly patients. This paper reviews the concept of frailty, the relationship between frailty and cardiac surgery, the frailty assessment and intervention strategy in perioperative period, aimed at providing decision making basis for the risk stratification and perioperative management of cardiac surgery in elderly patients.
ObjectiveTo summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. MethodsWe retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. ResultsMean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. ConclusionMIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.
ObjectiveTo investigate the epidemiological situation of pre-hospital emergency elderly and non-elderly patients in Chengdu and explore the characteristics of pre-hospital care in the city.MethodAll pre-hospital care records in the Chengdu 120 Emergency System Database in 2017 were retrospectively collected. According to the age of the patients, they were divided into the elderly group (≥60 years old) and the non-elderly group (<60 years old). The disease spectrum, the trends of the number of emergency help calls, the changes in different diseases over time, as well as the disease composition of the patients who died in the two groups were compared.ResultsA total of 179 387 pre-hospital emergency patients were enrolled, including 59 980 elderly patients and 119 407 non-elderly patients. Most of them were male patients in both groups. Patients in the elderly group were mainly between 60 to 89 years old, and the ones in the non-elderly group were mainly between 18 to 59 years old. The pre-hospital emergency patients in the elderly group presented with trauma, nervous system, symptoms and signs, and cardiovascular system diseases mainly, accounting for 29.19%, 14.64%, 13.82%, and 12.86%, respectively. In the non-elderly group, trauma, acute poisoning, and symptoms and signs were predominant, accounting for 50.89%, 10.98%, and 10.08%, respectively. Among the pre-hospital deaths, the number in the elderly group was the larger, accounting for 69.61% (7 043 cases); the mortality rate was 11.74%, with sudden death (28.70%), cardiovascular diseases (25.95%), and respiratory diseases (16.07%) being the major causes. The pre-hospital mortality rate of non-elderly patients was 2.58%, mainly including traumatic diseases (35.41%), sudden death (unknown cause of death) (25.33%), and cardiovascular diseases (17.56%). The number of emergency help calls in the elderly group began to increase gradually from September, reaching a peak in December and hitting the trough in February. While in the non-elderly group, the peak of the emergency help calls appeared in July, and it also fell to the lowest in February. The proportion of the number of emergency help calls in the elderly group was higher in January to February and October to December; while the peak in non-elderly group was in July. The number of emergency help calls in the elderly group were mainly concentrated in the daytime (08:00 to 20:00). In the non-elderly group, the changes in the number of emergency help calls were similar to that of the elderly, however, with another peak (20:00 to 24:00). The proportion of the number of emergency help calls in the elderly group was 06:00 to 09:59, and the peak time of the non-elderly group was in the early morning (00:00 to 04:59) and night (20:00 to 23:59).ConclusionsThe number of pre-hospital care for elderly and non-elderly patients has its own characteristics in terms of the time and the distribution of disease spectrum. Trauma and cardiovascular diseases are the most common causes of pre-hospital care and death in Chengdu. And the pre-hospital mortality in the elderly group is much larger than that in non-elderly group. Relevant departments can allocate emergency resources rationally, and focus on improving the on-site rescue capacity towards related diseases.
ObjectiveTo understand the levels of and influencing factors for knowledge of earthquake in the elderly population. MethodPeople who were older than 60 years in the earthquake area of Sichuan Province were surveyed by self-designed earthquake knowledge scale composed of 6 items with a point of 1-5 for each item between October and November 2013. The total score ranged from 6 to 30 points. ResultsUp to 1 509 elderly people participated the survey. The total score of earthquake knowledge was 13.33±4.85. The main resource for acquiring those knowledge was TV (76.87%). Occupation, education level, residency, marital status, residence, self-injury, health status, access to earthquake knowledge, and worrying about earthquake were related factors for their knowledge on earthquake (P<0.05). Regression analysis showed that the higher degree of education, having a spouse, living in city, more access to earthquake knowledge, worrying about earthquake were the promotion factors for earthquake knowledge preparedness. Self-injury, poor health were the factors that hindered the acquiring of earthquake knowledge preparedness. ConclusionsIt is necessary to train knowledge of earthquake for elderly people individually because they lack enough resources and tend to be affected by many factors.
PURPOSE:To approach the changes of visual function by using the dense matrix mapping in macula(DMMM)in patients with age-related macular degenerationl(AMD). METHODS:The DMMM was designed using Humphrey-640,thee study included 51 patients(71 eyes)in dry type,AMD,23 patients(27 eyes)in wet type and 16 normal elderly(21 eyes). RESULTS:In 2.5 degree of macula:the mean light sensitivity(MLS)was 35.61plusmn;1.37 in normal elderly.33.30plusmn;2. 49 in dry type group and 20.67plusmn;8.30 in wet type group,and differences were highly significant statistically among them. In S degree the MLS is 34.93plusmn;1.46 in normal elderly.32.95plusmn;1.82 in dry type group, 22.11plusmn;7.74 in wet type group ,and the differences were highly significant statistically among them. CONCLUSIONS:The MLS of DMMM declined at early stage of dry type AMD and there was relatively high sensitivity of MLS of DMMM in evaluating the visual function in early AMD. （Chin J Ocul Fundus Dis,1996,12: 217-219 ）