老年急性心肌梗死患者死亡相关因素分析

目的:了解老年急性心肌梗死(AMI)患者死亡的主要影响因素。方法:回归性分析46例老年AMI患者的临床资料,并对死亡组与非死亡组的23项死亡相关因素进行对比研究。结果:心力衰竭、糖尿病、血清心肌酶、梗死后心绞痛、严重心律失常、病变程度及心肌梗死后延展等7项因素在2组间差异具有统计学意义(P<0·05或<0·01)。结论:心力衰竭、糖尿病、血清心肌酶、梗死后心绞痛、严重心律失常、病变程度及心肌梗死后延展等是老年AMI死亡的主要影响因素。     

老年患者医院获得性肺炎耐药性临床分析

目的 分析老年患者医院获得性肺炎致病菌的菌群分布及其对抗生素的耐药情况,为临床合理使用抗生素提供依据.方法 对我院2006年6月至2009年9月160例老年患者医院获得性肺炎的临床资料进行回顾性分析,明确病原学特点及对抗生素的耐药情况.结果 共分离出180株病原菌,其中革兰阴性菌108株(60.0%),革兰阳性菌48株(26.7%),真菌24株(13.3%).革兰阴性菌中铜绿假单胞菌检出率最高(20.5%),革兰阳性菌中金黄色葡萄球菌检出率最高(11.1%).长期使用抗生素、广谱抗生素的慢性患者真菌检出率增高.革兰阴性杆菌对三代头孢菌素均耐药,产超广谱β内酰胺酶的大肠埃希菌、肺炎克雷伯菌对青霉素类、青霉素+酶抑制剂、头孢菌素类和单酰胺类抗生素均耐药,铜绿假单胞菌耐药严重,但对头孢他啶尚敏感.革兰阴性菌对阿米卡星、哌拉西林+他唑巴坦、头孢哌酮+舒巴坦、亚胺培南、美洛培南的敏感性较高.耐甲氧西林金黄色葡萄球菌(MRSA)占92.6%,革兰阳性菌对阿奇霉素、环丙沙星、氨苄西林、氨苄西林+舒巴坦的耐药率多在76%以上,而对万古霉素、利奈唑胺、替考拉宁敏感性高,尚未发现耐万古霉素、利奈唑胺、替考拉宁的葡萄球菌菌株.结论 老年患者医院获得性肺炎以革兰阴性杆菌为优势菌株,产超广谱β内酰胺酶的大肠埃希菌、肺炎克雷伯菌呈逐年增高趋势,且耐药性日趋严重,其对阿米卡星、哌拉西林+他唑巴坦、头孢哌酮+舒巴坦、亚胺培南、美洛培南敏感性较高.革兰阳性球菌感染宜用万古霉素、利奈唑胺或替考拉宁.     

老年脑卒中患者医院内获得性肺炎及其相关独立危险因素的分析

目的 :探讨并分析老年脑卒中患者诱发院内获得性肺炎 (NP或HAP)的相关独立危险因素。方法 :收集我院住院治疗的老年脑卒中患者 381例 ,采用回顾性调查及相关因素统计分析。结果 :381例患者并发NP78例 ,感染率 2 0 5 % ;感染组死亡 4 4例 ,占感染组 5 6 4 % ;非感染组死亡 6 4例 ,占非感染组 2 1 1% ,感染组死亡率明显高于非感染组 (x2 =38 0 3,P <0 0 1)。结论 :年龄 ,住院天数 ,慢性肺疾病史 ,糖尿病 ,心功能不全 ,意识障碍 ,吞咽困难 ,呕吐 ,应激性溃疡预防用药 ,气管插管 ,气管切开 ,留置胃管与老年脑卒中患者并发NP密切相关     

老年女性急性心肌梗死患者死亡相关因素分析

目的了解老年女性急性心肌梗死（AMI）患者死亡的主要影响因素。方法回顾性分析92例老年女性AMI患者的临床资料，并对死亡组及非死亡组的16项死亡相关因素进行对比。结果心力衰竭、心脏破裂、糖尿病、血清心肌酶、梗死后心绞痛、严重心律失常、病变程度及心肌梗死后延展等8项因素，在两组间差异具有显著性（P〈0．05或〈0．01）。结论心力衰竭、心脏破裂、糖尿病、血清心肌酶增高、梗死后心绞痛、严重心律失常、病变程度及心肌梗死后延展等是老年女性AMI死亡的主要影响因素。     

老年与青年急性心肌梗死患者相关因素的分析

目的：探讨急性心肌梗死（AMI）45岁以下患者和60岁以上患者的危险因素和临床特点。方法将确诊为AMI＜45岁的68例患者（青年组）与＞60岁的171例患者（老年组）进行对照研究,分析其危险因素、冠状动脉病变和30天不良事件率等特点。结果青年组男性比例、吸烟者和高脂血症者较老年组多,而青年组糖尿病、高血压和慢性肾功能不全低于老年组,差异均有统计学意义（ P＜0.01）。老年组发生30天不良事件高于青年组（ P＜0.05）。老年组和青年组30天不良事件发生组Killip分级≥3级和多支病变者更多,而LVEF值则更低。老年组中,30天不良事件发生组糖尿病者比例、高脂血症者比例、CKMB高峰值水平皆高于未发生组。结论吸烟、高脂血症和性别为青年AMI的主要危险因素,而老年AMI则较多合并高血压、糖尿病和慢性肾功能不全。killip分级、冠状动脉病变的严重程度和左心室收缩功能仍为影响预后的重要因素。     

老年患者医院获得性肺炎危险因素的研究进展

医院获得性肺炎(hospital-acquired pneumonia,HAP)是指患者在入院时未感染也未处于病原感染潜伏期,而于入院48 h后新发生的肺炎.广义上讲,HAP包括呼吸机相关肺炎(ventilator associated pneumonia,VAP),后者是HAP的特殊类型[1].HAP是最常见的医院获...     

脑卒中患者医院获得性肺炎相关因素分析

目的探讨脑卒中患者医院内获得性肺炎（HAP）的危险因素及病原学特点。方法调查2005年1月-2007年12月住院的996例脑卒中患者,对HAP发生情况进行分析。结果高龄、合并多种疾病、意识障碍、吞咽障碍、侵袭操作、使用H2受体拮抗剂与HAP的发生有关。HAP在夏季、冬季发生率最高。在88例HAP痰培养中分离出144株病原菌,其中革兰氏阴性杆菌（GNB）82株,对多种抗生素均有交叉耐药且耐药率升高,对万古霉素均敏感。结论脑卒中是HAP的高危人群,应对其重点监控,积极预防,尽量在使用抗生素之前做痰培养及药敏试验,选用敏感的抗生素。     

老年急性心肌梗死患者血清降钙素原水平变化与预后的相关性

目的探讨老年急性心肌梗死(AMI)患者血清降钙素原(PCT)水平变化与近期临床预后的关系。方法选择97例老年AMI患者作为病例组,同期体检者80例作为对照组。测定血清PCT和高敏C反应蛋白(hs-CRP)水平,AMI患者根据血清PCT水平分为正常组(<0.5μg/L)23例、轻度升高组(0.5¹.9μg/L)41例和明显升高组(≥2.0μg/L)33例。随访患者30d心源性死亡和主要心血管不良事件(MACE)发生率。结果病例组患者血清PCT、hs-CRP水平明显高于对照组,差异有统计学意义[(3.14±1.59)μg/L vs(0.15±0.04)μg/L,(95.21±20.17)mg/L vs(11.32±9.30)mg/L,P<0.01]。与正常组和轻度升高组比较,明显升高组心源性死亡和MACE发生率显著增加(0%和7.3%vs 24.2%,13.0%和22.0%vs 45.5%,P<0.05)。血清PCT与hs-CRP呈正相关(r=0.4721,P=0.032)。血清PCT可预测老年AMI患者30d心源性死亡和MACE发生率(OR=5.011,OR=4.312,P<0.01)。结论老年AMI患者血清PCT水平升高,对预测近期心源性死亡和MACE有一定参考价值。     

高龄急性心肌梗死患者相关因素分析

目的:探讨高龄急性心肌梗死(AMI)患者临床特点、治疗手段及影响预后的相关因素。方法:AMI患者共119例,分为高龄组(年龄>80岁)和非高龄组(<70岁),分析2组患者的性别、危险因素、梗死部位、临床经过、不同的治疗手段及并发症,比较住院期间不良心脏事件发生率。结果:高龄组患者AMI无症状者14例(22.9%),2个部位以上梗塞19例(31.1%),接受介入治疗2例(3.3%),并发症多,病死率16.3%,以上结果均与非高龄组有明显差异(P<0.01)。结论:高龄AMI患者危险因素多,发病时症状不典型、治疗时矛盾多、并发症多及病死率高。临床上应能因人而异,以平衡的原则选择合适治疗方案,密切观察病情变化,加强护理,及早发现并恰当处理并发症,力争降低病死率。     

监测老年社区获得性肺炎患者血清降钙素原水平的临床意义

目的评价连续监测血清降钙素原(PCT)对老年社区获得性肺炎病原学诊断及判断病情严重程度中的意义。方法治疗前所有入选患者进行痰细菌学培养,肺炎支原体抗体、衣原体抗体及血清PCT测定。治疗后24 h、72 h再次检测血清PCT水平。根据临床肺部感染评分将研究对象分为高评分组及低评分组;按血清PCT0.1μg/L作为界值将研究对象分为两层进行统计分析。结果 1 58例老年肺炎患者痰细菌学培养阳性20例,肺炎支原体抗体阳性10例,肺炎衣原体抗体Ig M阳性2例,痰细菌学培养阴性26例。2痰菌阳性组PCT水平较非典型病原体组及痰菌阴性组高,且随治疗时间的推移呈逐渐下降的趋势,差异有统计学意义(P0.01)。痰菌阴性组及非典型病原体组的血清PCT水平无明显变化规律,差异无统计学意义(P0.05)。3高评分组PCT水平较低评分组高,差异有统计学意义(P0.05),高评分组PCT阳性率较低评分组高,差异有统计学意义(P0.05)。结论连续监测血清PCT水平对老年CAP患者的病原诊断有一定的预测价值;且PCT升高程度有助于评价老年CAP感染的严重程度。     

老年急性脑梗死合并医院获得性肺炎临床特点分析

目的探讨老年急性脑梗死合并医院获得性肺炎(HAP)患者的临床特点,为预防HAP的发生提供依据。方法回顾性分析我院620例老年急性脑梗死患者的临床资料,根据是否发生HAP分成两组,比较两组的神经功能评分和死亡率,分析痰培养细菌学特点。结果620例老年急性脑梗死患者发生HAP118例,合并HAP组的神经功能评分和死亡率分别为29.7±11.3和21.18%,无发生HAP患者神经功能评分和死亡率分别为26.2±12.5和8.36%(P0.05);痰细菌学检查以革兰阴性杆菌为主,占74.1%,多为肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌。结论老年急性脑梗死易合并HAP,感染细菌多为革兰阴性杆菌,死亡率较高。要积极预防HAP的发生,提高老年脑梗死患者的生存率。     

Reperfusion therapy for acute myocardial infarction in elderly patients

Although there has been great progress in reperfusion therapy, the role of coronary reperfusion for elderly patients with acute myocardial infarction has not been fully investigated. In general, mean age of the subjects in major trials was about 60 years old and approximately only 10 to 15% of patients were over age 75. On the other hand, large-scale registries such as the US national registry of myocardial infarction (NRMI) showed a higher prevalence of elderly (especially women) in the clinical setting. This discrepancy may be due to the fact that elderly patients with myocardial infarction have some difficulties in the treatment such as severe multi-vessel coronary lesions, non-cardiac complications and relatively high prevalence of adverse reactions to reperfusion therapy. Here we focus on the situation of elderly patients (especially those 75 years or older) with myocardial infarction in the "real world" clinical setting, showing the clinical changes and outcome of our registry in rural Japan: the Kochi AMI (KAMI) registry.     

Thrombolysis in elderly patients with acute myocardial infarction

The efficacy of thrombolytic therapy in the elderly remains a topic of ongoing debate. Although elderly patients account for a disproportionate amount of cardiovascular mortality, they have typically been underrepresented in randomized clinical trials. A meta-analysis of these trials suggests a survival benefit, albeit small, of thrombolytic therapy in the elderly. Thrombolytic therapy, in combination with either glycoprotein IIb/IIIa inhibitors or low-molecular weight heparin, poses an increased hazard in the elderly. Observational studies of thrombolytic therapy in the elderly portray a far worse outcome than the randomized clinical trials and raise the possibility of increased mortality. To date, no randomized trial has compared thrombolytic and primary coronary intervention in the elderly. However, multiple observational studies indicate a low risk of intracerebral hemorrhage and improved survival when a strategy of primary coronary intervention is employed. Future trials and observational studies should elucidate the ideal reperfusion strategy in the elderly.     

Early beta-blocker therapy for acute myocardial infarction in elderly patients

BACKGROUND: Despite the evidence supporting the importance of early beta-blocker therapy, this intervention has received little attention as an indicator of quality of care. OBJECTIVES: To determine how often beta-blockers are administered as early treatment of acute myocardial infarction in patients 65 years of age or older, to identify predictors of the decision to use beta-blockers, and to evaluate the association between the early use of beta-blockers and in-hospital mortality. DESIGN: Observational study. SETTING: Nongovernment, acute care hospitals in the United States. PATIENTS: Medicare beneficiaries who were 65 years of age or older, were hospitalized with an acute myocardial infarction in 1994 and 1995, and did not have a contraindication to beta-blocker therapy. MEASUREMENTS: Medical chart review to obtain information about the use of beta-blockers, contraindications to these drugs, patient demographics, and clinical factors. RESULTS: Of the 58 165 patients (from a total of 4414 hospitals), 28 256 (49%) received early beta-blocker therapy. Patients with the highest risk for in-hospital death were the least likely to receive therapy. Patients who received beta-blockers had a lower in-hospital mortality rate than patients who did not receive beta-blockers (odds ratio, 0.81 [95% CI, 0.75 to 0.87]), even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the two groups. CONCLUSIONS: Early beta-blocker therapy was not used for 51% of elderly patients who were hospitalized with an acute myocardial infarction and did not have a contraindication to this therapy. Increasing the early use of beta-blockers for these patients would provide an excellent opportunity to improve their care and outcomes.     

Factors associated with change in walking ability in very elderly patients hospitalized for acute myocardial infarction

Background:   The aim of this substudy was to identify the predictors of a lesser ability to walk in very elderly patients with acute myocardial infarction (AMI).
Methods:   Data from 15 acute care hospitals in the Tokai Acute Myocardial Infarction Study (TAMIS)-II sample were used. This is a prospective study of all patients admitted to the hospitals with the diagnosis of AMI from 2001 to 2003. We abstracted the baseline and procedural characteristics including walking ability from detailed chart reviews. In this substudy, patients aged 75 and over were included. Patients were stratified into two categories: 412 patients whose ability to walk was maintained (MA group) and 30 patients whose ability to walk declined (DA group).
Results:   The DA patients were more likely to have a lower body mass index (BMI) score and signs of heart failure on presentation (cardiac shock, 56.7% vs 15.5%; Killip class > or = III, 73.3% vs 36.6%; pulmonary edema, 60.0% vs 27.91%). DA group patients were more likely to receive vasopressors, intra-aortic balloon pump, or mechanical ventilation. After controlling for statistically significant predictors of a declined ability to walk, DA group patients were significantly more slender than MA group patients, with an adjusted odds ratio of 0.75 (95% confidence interval, 0.62–0.91). DA group patients had a higher shock or mechanical ventilation rate than MA group patients, but not significantly.
Conclusions:   Our results suggest that a lower BMI value and severe heart failure are significant predictors of reduced walking ability during hospitalization among very elderly patients with AMI.     

高龄急性心肌梗死的溶栓治疗

目的 观察静脉溶栓治疗高龄(>70岁)急性心肌梗死(AMI)患者的临床疗效及合适的药物剂量。方法 高龄AMI患者68例,经静脉尿激酶溶栓治疗患者38例(溶栓组),其中150万u溶栓I组20例,100万u溶栓Ⅱ组18例,同期未溶栓治疗患者30例(未溶栓组),对比分析溶栓组与未溶栓组临床结果。结果 溶栓I组血管再通率、病死率、出血发生率与溶栓Ⅱ组无统计学差异(P>0.05);溶栓组与未溶栓组比较,除了心力衰竭发生率有明显差异(P<0.05)外,心律失常发生率、病死率均无统计学差异(P>0.05)。结论 溶栓治疗可降低高龄AMI患者心力衰竭发生率;尿激酶100万u是高龄AMI患者溶栓治疗更为安全有效的剂量。     

Clinical studies on hospital acquired pneumonia in the elderly

We compared hospital acquired pneumonia (HAP) with nursing home acquired pneumonia in the elderly. There were no differences in the underlying diseases, clinical signs and symptoms between HAP and nursing home acquired pneumonia, but activities of daily living were poor in HAP than nursing home acquired pneumonia. By the bacterial studies from Transtracheal aspiration (TTA), S. aureus, K. pneumoniae, P. aeruginosa and anaerobes were more isolated in HAP. On the other hand, S. pneumoniae and H. influenzae were isolated more in the nursing home acquired pneumonia. In the laboratory data, no difference was detected in inflammatory reaction between both groups, but in immunological data, especially complement C3 and tuberculin skin test were markedly reduced in HAP. The prognosis were significantly poor in HAP because the fatal rate was higher in HAP than nursing home acquired pneumonia. With regard to HAP in the elderly, severe underlying disease, poor whole body state, aspiration, bacterial resistance to drugs, superinfection and polymicrobial infection were the factors predisposing difficulty in treatment of pneumonia in the elderly. From the above results, prevention is the most necessary in HAP.