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Practical Geriatrics

Table of Content

    20 September 2021, Volume 35 Issue 9 Previous Issue    Next Issue
    Effect of phacoemulsification cataract extraction combined with 23G vitrectomy on the stability of tear film
    ZHANG Hui, CHEN Li-xun
    2021, 35 (9):  906-909.  doi: 10.3969/j.issn.1003-9198.2021.09.004
    Abstract ( 151 )   PDF (1029KB) ( 1140 )   Save
    Objective To observe the effect of phacoemulsification cataract extraction combined with 23G vitrectomy on the stability of the tear film. Methods A total of 120 patients with vitreoretinal disease in our hospital from 2017 to 2019 were enrolled, and they were divided into two groups according to the surgical method: 60 patients (60 eyes)were treated with 23G vitrectomy (control group) and 60 patients (60 eyes)were treated with phacoemulsification cataract extraction combined with 23G vitrectomy (observation group). All the patients were examined by the Schirmer I test (SⅠt), break-up time (BUT) and cornea fluorescein staining (CFS) before operation, 7 days, 30 days and 90 days after operation. Results There were no statistical differences in the preoperatively examination results of SⅠt, BUT or CFS between the two groups (P>0.05). The BUT of both groups was shortened significantly 7 days and 30 days after operation (P<0.05), the score of CFS and the value of tear secretion in both groups were significantly increased 7 days after operation (P<0.05), and the changes of the above indexes in the observation group were more significant than those in the control group (P<0.05). 90 days after operation, there was no significant difference in the value of tear secretion, CFS score and BUT between the two groups (P>0.05), and they all recovered to the preoperative level. Conclusions Compared with vitrectomy, the effect of phacoemulsification cataract extraction combined with 23G vitrectomy on tear film stability 7 days after operation is more obvious, and the related indexes can recover to the preoperative level in 90 days after operation.
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    Correlation between sarcopenia and non-enzymatic glycosylation and cardiovascular disease in the community elderly
    FAN Tian-shu, ZHAO Wen-xue, LU Miao, WANGXiang-ming, ZHA Zhi-min, CAO Ya-ru, GUO Yan
    2021, 35 (9):  910-913.  doi: 10.3969/j.issn.1003-9198.2021.09.005
    Abstract ( 154 )   PDF (1087KB) ( 1140 )   Save
    Objective To investigate the characteristics of sarcopenia in the community elderly and the correlation between sarcopenia and non-enzymatic glycosylation level and common cardiovascular diseases. Methods A total of 110 participants who lived in Jiangsu Province Elderly Apartment were selected, and they were divided into sarcopenia group (n=38) and non-sarcopenia group (n=72) according to the guidelines of Asian Working Group for Sarcopenia. The clinical data and the incidence rates of cardiovascular diseases (heart failure, coronary heart disease, hypertension) were compared between the two groups, and the risk factors of sarcopenia were evaluated by Logistic regression analysis.The levels of carboxymethyl lysine(CML) and soluble receptor for advanced glycation end products(sRAGE) in 60 subjects were detected by enzyme linked immunosorbent assay, and the levels of CML, sRAGE,advanced glycation end products (AGEs)/sRAGE in sarcopenia group and non-sarcopenia group were compared. Results Compared with non-sarcopenia group, the age, and the levels of C-reaction protein (CRP) and high density lipoprotein cholesterol (HDL-C) in sarcopenia group were significantly higher, while the levels of body mass index (BMI), skeletal muscle mass index (SMI), grip strength, 4 m walking speed, hemoglobin and albumin were significantly lower(P＜0.05 or P＜0.01). The incidence rates of heart failure and coronary heart disease in sarcopenia group were significantly higher than those in non-sarcopenia group (P＜0.05), but there was no difference in the incidence rate of hypertension between the two groups (P>0.05). After adjustment for gender, age, BMI, SMI, HDL-C and CRP, multivariate Logistic regression analysis showed that coronary heart disease and heart failure were not independent influencing factors for sarcopenia in the elderly. The levels of CML and AGEs/sRAGE in sarcopenia population were significantly higher than those in non-sarcopenia population (P＜0.05), and there was no difference in sRAGE level between the two groups (P=0.587). Conclusions The levels of CML and AGEs/sRAGE in the sarcopenia population are significantly higher than those in the non-sarcopenia population. The community elderly with coronary heart disease and heart failure are more likely to suffer from carcopenia.
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    Predictive value of three kinds of thrombosis risk assessment scale for postoperative deep vein thrombosis in elderly patients with lower limb fracture
    YANG Miao, XIE Jing, MA Liang-ying, LI Guo-hua
    2021, 35 (9):  914-917.  doi: 10.3969/j.issn.1003-9198.2021.09.006
    Abstract ( 134 )   PDF (1037KB) ( 1274 )   Save
    Objective To investigate the predictive value of deep vein thrombosis risk score scale (Wells), venous thromboembolism risk scale (Caprini) and deep vein thrombosis risk factor evaluation scale (Autar) for postoperative deep vein thrombosis (DVT) in the elderly patients with lower limb fracture. Methods A total of 96 elderly patients with lower limb fracture receving surgery in the Seventh Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2019 were enrolled. According to the results of the patients’ color Doppler ultrasound examination, patients with postoperative DVT were selected as the positive group (n=54), and patients without DVT were selected as the negative group (n=42). All the patients’ general clinical data were collected, and they were assessed with Wells, Caprini and Autar. The predictive value of the three kinds of thrombosis risk assessment scales for postoperative DVT in the elderly patients with lower limb fracture was evaluated by receiver operating characteristic (ROC) curve analysis. Results Compared with the negative group, the scores of Wells, Caprini and Autar in the positive group were significantly higher (P<0.01). ROC curve analysis showed that the area under curve (AUC), sensitivity and specificity of Wells were higher than those of Caprini and Autar (0.903 vs 0.792 vs 0.810, 88.9% vs 64.8% vs 77.8%, 90.5% vs 85.7% vs 88.1%, resepectively). Conclusions Wells has the highest predictive value for the risk of postoperative DVT in the elderly patients with lower limb fracture, while Auter and Caprini are lower.
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    Predictive factors of left ventricular systolic dysfunction in elderly patients with acute anterior myocardial infarction after percutaneous coronary intervention
    LIANG Jing-kang, GUO Jun
    2021, 35 (9):  918-922.  doi: 10.3969/j.issn.1003-9198.2021.09.007
    Abstract ( 119 )   PDF (1060KB) ( 1105 )   Save
    Objective To investigate the predictors of left ventricular systolic dysfunction (LVSD) in the elderly patients with acute anterior ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods A total of 374 elderly patients with acute anterior STEMI who underwent primary PCI in the First Affiliated Hospital of Jinan University from January 2013 to September 2019 were divided into LVSD group [left ventricular ejection fraction (LVEF)≤40%, n=120] and control group (LVEF>40%, n=254) according to the lowest LVEF measured by color Doppler echocardiography from post-PCI to discharge. The clinical data, biochemical results, echocardiographic and angiographic data of the two groups were compared. Multivariate Logistic regression analysis was performed to evaluate the independent predictors of LVSD. Results The incidence rate of LVSD in the elderly patients with acute anterior STEMI after PCI was 32.09%(120/374). Multivariate Logistic regression analysis showed that the criminal vessel thrombolysis in myocardial infarction (TIMI) flow grade≤1(OR=2.738, 95%CI:1.516-4.943, P=0.001),admission heart rate (OR=1.028, 95%CI:1.012-1.045, P=0.001), admission systolic blood pressure (OR=0.985,95%CI: 0.976-0.996,P=0.006), left ventricular end-diastolic diameter (OR=1.132,95%CI:1.074-1.192, P<0.001), left main coronary artery lesion (OR=2.571, 95%CI: 1.106-5.974,P=0.028), peak level of N-terminal B-type natriuretic peptide (OR=1.095,95%CI:1.055-1.137, P<0.001) were independent predictors of LVSD in the elderly patients with acute anterior STEMI after PCI. Conclusions Criminal vessel TIMI flow grade≤1, admission heart rate, admission systolic blood pressure, left ventricular end-diastolic diameter, left main coronary artery lesion and peak level of N-terminal B-type natriuretic peptide are independently associated with LVSD in the elderly patients with acute anterior STEMI after PCI.
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    Clinical characteristics of elderly patients with acute pulmonary thromboembolism presenting with low Wells score
    LIU Yi, YIN Shao-jun, KONG Zhi-bin, ZHU Zhen, LI Hong, SONG Shuang, SONG Yi-yi
    2021, 35 (9):  923-926.  doi: 10.3969/j.issn.1003-9198.2021.09.008
    Abstract ( 121 )   PDF (1035KB) ( 1024 )   Save
    Objective To investigate the clinical characteristics of the elderly patients with acute pulmonary thromboembolism (APE) who showed low Wells score. Methods A retrospective analysis was performed on the risk factors, clinical characteristics and auxiliary examination results of 75 elderly patients with low Wells score who were suspected of APE in our hospital from January 2009 to August 2015. Among them, 21 patients finally diagnosed with APE were selected as the case group and the other 54 were selected as the control group. The influencing factors of APE in the elderly patients with low Wells score were analyzed by Logistic regression analysis. Results Compared with the control group, the proportions of the patients with chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) in the case group were higher, and the clinical symptoms were mainly acute dyspnea, chronic dyspnea, chest tightness and chest pain (P<0.05 or <0.01). The levels of arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2) and International Normalized Ratio (INR) in the case group were statistically significant lower than those in the control group (P<0.01). Logistic regression analysis revealed that the independent influencing factors of APE in the elderly patients with low Wells score were COPD (95%CI: 1.421-261.620), PaO2 (95%CI: 0.883-0.984) and PaCO2 (95%CI: 0.782-0.972). Conclusions Clinical workers should pay attention to the elderly patients with low levels of PaCO2 and PaO2, or combined with COPD, even if they Wells score was low, it still need to be alert to the possibility of APE.
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    Comparison of clinical effects between endoscopic submucosal dissection and surgical treatment in elderly patients with single early gastric cancer
    ZHANG Jin, ZHANG Guo-xin
    2021, 35 (9):  927-930.  doi: 10.3969/j.issn.1003-9198.2021.09.009
    Abstract ( 138 )   PDF (1035KB) ( 1112 )   Save
    Objective To investigate the differences between endoscopic submucosal dissection (ESD) and surgical treatment in efficacy, complications, survival benefit in the elderly patients with single early gastric cancer who meet the absolute indications or expanded indications of ESD. Methods From January 2013 to December 2018, the clinical data of the elderly patients with single early gastric cancer who underwent ESD (ESD group, 148 cases) or surgical treatment (surgery group, 339 cases) in the First Affiliated Hospital with Nanjing Medical University were included in this retrospective study. The postoperative fasting time, operation time, hospitalization time, hospitalization expenses of the two groups were recorded and analyzed. The rates of en bloc resection, local recurrence, simultaneous recurrence, metachronous recurrence, and postoperative complications were compared between the two groups. Kaplan-Meier method was used to analyze the overall survival rate of the two groups. Results There were no significant differences in the rates of en bloc resection, local recurrence, simultaneous recurrence and metachronous recurrence. ESD group showed less postoperative fasting time (P＜0.01), operation time (P＜0.01), hospitalization time (P＜0.01), and hospitalization expenses (P＜0.01) than surgical group. The total incidence rate of the complications in ESD group was significantly lower than that in surgical group (3.38% vs 15.04%, P＜0.01). There was no significant difference in the 5-year complete survival rate between the two groups (95.9% vs 96.5%, P=0.531). Conclusions For the elderly patients with single early gastric cancer who meet the absolute indications or the expanded indications, there is no significant difference in efficacy between ESD and surgery treatment, while ESD group shows less postoperative fasting time, operation time, hospitalization time, hospitalization expenses, and lower incidence of complications, so ESD can be used as the preferred treatment.
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    Related factors of the recurrence of stones in patients with urinary system infection after percutaneous nephrolithotomy
    LI Guo-ping, LI Dao-yuan, LIU Yuan-xiao, KANG Xin-li
    2021, 35 (9):  931-934.  doi: 10.3969/j.issn.1003-9198.2021.09.010
    Abstract ( 115 )   PDF (1037KB) ( 1236 )   Save
    Objective To analyze the related factors of the recurrence of stones in the patients with urinary system infection after percutaneous nephrolithotomy. Methods A total of 70 elderly patients with urinary tract infection after percutaneous nephrolithotomy in our hospital from August 2016 to August 2018 were enrolled. The patients were followed up for 2 year, and the stone recurrence rate was counted.The basic data of the patients with relapse and those without relapse were compared. Logistic multivariate analysis was used to determine the independent risk factors affecting the recurrence of stones in the patients with urinary system infection after percutaneous nephrolithotomy. Results After 2 year of follow-up, 16 patients had relapse of stone, with the recurrence rate of 23.19%. There were no statistically significant differences in composition ratio of gender, complications, extent of disease, hydronephrosis,types of infection, and the levels of preoperative serum creatinine, preoperative urea nitrogen, operation time, and hospital stay between the two groups (P>0.05).There were significant differences in age, chemical components of kidney stone, preoperative urine white blood cell, history of endocrine diseases,surgical stone clearance rate, and 24-hour urine volume before operation between the two groups (P<0.05). Logistic multivariate analysis showed that age> 70 years old, infectious stones, preoperative urine routine white blood cells "+++", history of endocrine diseases and surgical stone clearance rate≤80% were independent risk factors that affected the recurrence of stones in the patients with urinary system infection after percutaneous nephrolithotomy. Conclusions Age> 70 years old, infectious stones, and preoperative urine white blood cells "+++", history of endocrine diseases, surgical stone clearance rate≤80% are independent risk factors that affect the recurrence of stones in the patients with urinary system infection after percutaneous nephrolithotomy.
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    Relationship of carotid plaque with body mass index and growth hormone in elderly patients with cardiovascular and cerebrovascular diseases
    GUO Wan-shen, FAN Shuang-yi
    2021, 35 (9):  935-938.  doi: 10.3969/j.issn.1003-9198.2021.09.011
    Abstract ( 155 )   PDF (1038KB) ( 1236 )   Save
    Objective To explore the relationship of carotid plaque with body mass index (BMI) and growth hormone (GH) in the elderly patients with cardiovascular and cerebrovascular diseases. Methods A total of 198 hospitalized elderly patients with cardiovascular and cerebrovascular diseases were selected and divided into plaque group (170 cases) and non-plaque group (28 cases) according to the results of color Doppler ultrasound examination on the carotid artery. The levels of BMI and GH and the related clinical biochemical indexes were observed and compared between the two groups. Multivariate Logistic regression analysis was used to analyze the influencing factors for carotid artery plaque, and Pearson correlation analysis was used to analyze the correlation between the GH,BMI and the biochemical index. Results There were significant differences in age, gender, smoking history, drinking history, the prevalence rate of hypertension and diabetes, the levels of BMI, triglyceride (TG), total cholesterol (TC), fasting plasma glucose(FPG), apolipoprotein A1 and GH between plaque group and non-plaque group (P<0.05). Logistic regression analysis showed that age, smoking history, drinking history, hypertension, diabetes, GH, BMI, TG, TC were the influencing factors for the occurrence of carotid plaque(P<0.05). Pearson correlation analysis showed that GH was negatively correlated with BMI, plaque detection rate, TC, TG and FPG, while BMI was positively correlated with TC, TG and FPG. The results of trend chi-square test showed that plaque detection rate increased with the decrease of GH level and the increase of BMI(P<0.01). Conclusions The occurrence of carotid plaques in the elderly patients with cardiovascular and cerebrovascular diseases is influenced by various factors. Age, history of smoking and drinking, hypertension, diabetes, BMI, TC, TG are the risk factors, while GH level is the protective factor. It is important to pay attention to the rational diet, proper exercise, changes in lifestyle, so as to reduce the incidence of carotid plaques.
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    Predictive value of IL-16 combined with GRACE discharge score for adverse cardiovascular and cerebrovascular events in elderly patients with non-ST elevation acute coronary syndrome
    JI Peng, SUN Wei, JIA Yu-qing
    2021, 35 (9):  939-942.  doi: 10.3969/j.issn.1003-9198.2021.09.012
    Abstract ( 148 )   PDF (1096KB) ( 1055 )   Save
    Objective To explore the predictive value of interleukin-16 (IL-16) combined with global registry of acute coronary events (GRACE) discharge score for major adverse cardiovascular and cerebrovascular events (MACCE) in the elderly patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Methods A total of 182 elderly NSTE-ACS patients who were treated in our hospital from January 2017 to August 2018 were selected. All the patients were followed up for 12 months. According to whether MACCE occurred, the patients were divided into MACCE group (n=38) and non-MACCE group (n=144). The general data and the levels of cardiac function indexes, IL-16 and the GRACE discharge score were observed and compared between the two groups. The risk factors of MACCE were analyzed by multivariate Logistic regression analysis. The predictive value of IL-6 and GRACE score for MACCE in the elderly patients with NSTE-ACS was analyzed by receiver operating characteristic (ROC) curve analysis. Results The age and the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), IL-16 and GRACE discharge score in MACCE group were significantly higher and the left ventricular ejection fraction (LVEF) was significantly lower than that in non-MACCE group (P<0.01). Multivariate Logistic regression analysis showed that LVEF was a protective factor, while age, NT-proBNP, IL-16 and GRACE discharge score were risk factors of MACCE in the elderly NSTE-ACS patients (P<0.05). ROC curve analysis showed that the area under the curve(AUC) of IL-16 was 0.727 (95%CI: 0.640-0.814), the AUC of GRACE discharge score was 0.781 (95%CI: 0.706-0.857), and the sensitivity and Yoden index of combined test were improved. Conclusions IL-16 combined with GRACE discharge score have a high predictive value for the occurrence of MACCE in the elderly NSTE-ACS patients.
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    Predictive value of the neutrophil-to-lymphocyte ratio for perioperative myocardial injury of percutaneous coronary intervention in elderly patients with stable angina pectoris
    YIN Yun-Jie, JIANG Jian-dong, XU Liang, SUN Jun-xiang, ZHAO Xiang-hai, YANG Song, CHEN Yan-chun
    2021, 35 (9):  943-947.  doi: 10.3969/j.issn.1003-9198.2021.09.013
    Abstract ( 138 )   PDF (1287KB) ( 1106 )   Save
    Objective To investigate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and perioperative myocardial injury (PMI) of percutaneous coronary intervention(PCI) in the elderly patients with stable angina pectoris(SAP). Methods A total of 159 elderly patients with SAP hospitalized in our hospital for PCI were retrospectively selected from January 2016 to June 2018. The baseline data were collected and the levels of cardiac troponin T (cTnT), biochemistry parameters and the inflammatory factors before and after operation were detected. The best cut-off value of NLR was determined by receiver operating characteristic (ROC )curve. The patients were divided into high NLR group (NLR>2) and low NLR group (NLR≤2). The baseline data and the incidence rate of PMI between the two groups were observed and compared. Logistic regression analysis was used to analyze the risk factors of PMI. Results The best cut-off value of NLR was 2, with a area under the curve (AUC) of 0.76, with a sensitivity of 78.95%, with a specificity of 65.69%. There were significant differences in age, number of stents, total length of stents and incidence rate of PMI between the high NLR group and the low NLR group (P<0.05). The levels of Cystatin C, high-sensitivity C-reactive protein(hs-CRP), neutrophil count, NLR and platelet-to-lymphocyte ratio were significantly higher and the level of lymphocyte count was significantly lower in the high NLR group than that in the low NLR group(P<0.05). Multivariate Logistic regression analysis showed that smoking history(OR=2.699, 95%CI: 1.016-7.168) and NLR>2 (OR=4.332, 95%CI :1.641-11.433)were risk factors of PMI, while female(OR=0.219, 95%CI:0.073-0.656) and statins history (OR=0.210, 95%CI :0.045-0.982)were protective factors of PMI. Conclusions Preoperative high level of NLR is one of the risk factors for elderly patients with SAP, which can predict the occurrence of PMI in the elderly patients with SAP.
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    The current situation and influential factors of frailty in the hospitalized elderly patients
    GUO Hong-ju, YANG Yi-fan, GAO Yin-feng, SUN Zi-xu, LIU Da
    2021, 35 (9):  948-952.  doi: 10.3969/j.issn.1003-9198.2021.09.014
    Abstract ( 150 )   PDF (1058KB) ( 1220 )   Save
    Objective To investigate the current situation of frailty and explore its influencing factors in the hospitalized elderly patients. Methods A total of 242 patients aged 65 and over who were hospitalized in the Department of Geriatrics of the First Affiliated Hospital, School of Medicine, Shihezi University from November 2019 to June 2020 were collected and divided into frailty group and non-frailty group according to the results of Fried Frailty Phenotype. The general data, laboratory indicators and echocardiographic results of the two groups were collected. Binary Logistic regression analysis was used to analyze the influencing factors of frailty in the hospitalized elderly patients. Results There were significant differences in age, degree of education, hospitalization cost, hospital day, combined with the disease type, ability of daily living (ADL), cognitive function, nutrition state, and the risk of fall/falling out of bed between frailty group and non-frailty group (P＜0.05). The constituent ratios of coronary heart disease, chronic heart failure and cerebrovascular disease in frailty group were significantly higher than those in non-frailty group (all P＜0.05).The levels of red blood cell count, lymphocyte percentage, and albumin were significantly lower, and the levels of neutrophil count, the percentage of neutrophils,uric acid, creatinine, and Cystatin C were significantly higher and the left atrial diameter was Significantly larger in frailty group than that in non-frailty group (all P＜0.05). Binary Logistic regression analysis showed that ADL impairment (OR=7.800, 95%CI:2.205-27.590), malnutrition (OR=3.935, 95%CI:1.636-9.461), high level of Cystatin C (OR=5.937, 95%CI :1.541-22.876), large left atrium inner diameter (OR=1.069, 95%CI: 1.001-1.141), coronary heart disease (OR=2.299, 95%CI :1.087-4.864) were risk factors, but the high albumin level(OR=0.864, 95%CI :0.779-0.958) was a protective factor for frailty hospitalized elderly patients. Conclusions The incidence of frailty in hospitalized elderly patients is high. It is recommended that medical staff should pay attention to the frailty assessment of hospitalized elderly patients and carry out effective interventions for controllable risk factors.
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    Study on influencing factors and countermeasures of hospitalization expenses of patients with end-of-hospice care
    ZHANG Qiu-hui, LI Na, YUAN Ling, YIN Xiao-li
    2021, 35 (9):  953-956.  doi: 10.3969/j.issn.1003-9198.2021.09.015
    Abstract ( 178 )   PDF (1039KB) ( 1455 )   Save
    Objective To analyze the 30 d hospitalization expenses before death in the patients with end-of-hospice care in different medical institutions of the Nanjing Medical Union, so as to provide a reference for the construction of the regional system of end-of-hospice care. Methods The clinical data of 158 hospice patients in two medical institutions from November 2017 to March 2020 were retrospectively analyzed, including 78 cases in a grad A class 3 hospital and 80 cases in a community hospital. The age, gender, length of hospitalization, medical payment method, tumor location, 30 d hospitalization expense before the death (treatment expense, inspection expense, medicine expense, nursing expense, other expenses) were compared between the two medical institutions. The influencing factors of the hospitalization expense for the end-stage palliative care were analyzed by Pearson correlation analysis and multiple regression analysis. Results There were no significant differences in age, gender, length of stay, medical payment method and tumor location between the two medical institutions (P>0.05). The total hospitalization expense, treatment expense, inspection expense, medicine expense, nursing expense and other expenses of the patients in the grade A class 3 hospital were higher than those in the community hospital (P＜0.05).Spearman correlation analysis showed that the hospital grade and the total hospitalization expense had the highest correlation (r=-0.485, P＜0.001), followed by the number of hospitalization days (r=0.442, P＜0.001) and the medical payment method (r=-0.198, P＜0.05). Multivariate regression analysis showed that hospital grade and length of stay were independent influencing factors of the hospitalization expense for end-stage palliative care patients. Conclusions Compared with the hospice care unit in a grade A class 3 hospital, primary medical institutions can provide quality inpatient services for hospice care patients, while significantly reducing their inpatient medical expenses. In the future, we should reform the payment method for hospice care, expanding the scope of hospice care and promoting the development of primary medical institutions, thereby improving the hospice care intervention rate for the patients with end-stage cancer in primary medical institutions.
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    Effect of sequential treatment of recombinant human brain natriuretic peptide, sacubitril/valsartan and tolvaptan on elderly patients with heart failure with reduced ejection fraction
    QUAN Qian-kun, FENG Jian-jun, LI Xi, LI Wan-ni, ZHANG Xiu-li, LIU Chun-tian
    2021, 35 (9):  957-961.  doi: 10.3969/j.issn.1003-9198.2021.09.016
    Abstract ( 175 )   PDF (1062KB) ( 1111 )   Save
    Objective To investigate the curative effect of sequential treatment of recombinant human brain natriuretic peptide, sacubitril/valsartan and tolvaptan on the elderly patients with heart failure with reduced ejection fraction (HFrEF). Methods A total of 40 patients with HFrEF aged 80 to 90 years old were randomly divided into conventional treatment group and sequential treatment group,with 20 cases in each group. The patients in conventional treatment group were treated with conventional anti-heart failure drugs. The patients in sequential treatment group were sequentially treated with recombinant human brain natriuretic peptide, sacubitril/valsartan and tolvaptan on the basis of stopping angiotensin converting enzyme inhibitor (ACEI)/angiotensin Ⅱ receptor blocker (ARB). Minnesota Living with Heart Failure Questionnaire (MLHFQ) and 6-minute walking test (6MWT) were used to evaluate the cardiac function of the patients, and cardiac color Doppler ultrasound was used to detect the left ventricular ejection fraction (LVEF), cardiac output (CO) and stroke volume (SV) of the patients. Additionally, the levels of plasma brain natriuretic peptide (BNP), renal function and serum electrolytes were also detected. Results After 10 days of treatment, the total effective rate of sequential treatment group was significantly higher than that of conventional treatment group (P＜0.05);The MLHFQ score, 6MWT distance, and the levels of LVEF, CO, SV and plasma BNP in both groups were all improved (P＜0.05), especially in sequential treatment group (P<0.05); The serum levels of K+ and Na+ in conventional treatment group were significantly lower than those before treatment (all P＜0.05), whereas there were no significant differences in the serum electrolytes levels of sequential treatment group after treatment (all P＞0.05). In addition, there was no significant change in renal function of both groups after treatment (all P＞0.05). Conclusions The sequential treatment of recombinant human brain natriuretic peptide, sacubitril/valsartan and tolvaptan could improve the cardiac function of the elderly patients with HFrEF effectively.
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    Predictive value of serum S100A12 combined with calcification characteristic score for in-stent restenosis after percutaneous coronary intervention in elderly patients with acute non-ST segment elevation myocardial infarction
    ZHANG Zheng-nan
    2021, 35 (9):  962-966.  doi: 10.3969/j.issn.1003-9198.2021.09.017
    Abstract ( 169 )   PDF (1061KB) ( 1366 )   Save
    Objective To study the predictive value of serum S100A12 combined with calcification characteristic score for in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in the elderly patients with acute non-ST elevation myocardial infarction (NSTEMI). Methods A total of 220 elderly patients with NSTEMI who were treated by PCI in the Department of Cardiology of our hospital from January 2017 to October 2018 were selected. According to whether ISR occurred within one year after PCI, the patients were divided into ISR group and control group, with 34 cases and 186 cases respectively. The clinical data of the patients were collected, the characteristics of the plaque (including calcification, calcification length, calcification radian, calcification plaque type) were observed by intravascular ultrasound, and the calcification characteristic score was calculated. The level of serum S100A12 was measured by enzyme-linked immunosorbent assay. The risk factors for ISR after PCI were analyzed by univariate analysis and multivariate Logistic regression. The predictive value of calcification score, serum S100A12 and the combination for ISR after PCI was analyzed by receiver operating characteristic (ROC) curve. Results There were significant differences in calcification characteristics, calcification characteristics score and serum S100A12 level between the two groups (P<0.05). Multivariate Logistic regression analysis showed that high calcification characteristics score, high serum S100A12 level, long lesion length, calcification, long calcification length, large calcification radian and superficial calcification were the independent risk factors for ISR after PCI. ROC curve analysis showed that calcification characteristic score and serum S100A12 level had high value in predicting ISR after PCI, and the area under the cure (AUC) was 0.738 (0.626-0.870) and 0.736 (0.621-0.873), respectively. The combination of the two indexes showed higher value in predicting ISR after PCI, with an AUC of 0.835 (0.718-0.971). Conclusions Calcification characteristic score and serum S100A12 level are closely related to the occurrence of ISR after PCI, which can be used as independent influencing factors for ISR after PCI. The joint detection of the two indexes is more valuable than the single index in predicting ISR after PCI.
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    Influencing factors of exercise tolerance in elderly patients with single vessel lesion of anterior descending coronary artery after percutaneous coronary intervention
    LIU Hong-qiang, ZHANG Hong-lei, ZHENG Xiao-hui
    2021, 35 (9):  967-970.  doi: 10.3969/j.issn.1003-9198.2021.09.018
    Abstract ( 166 )   PDF (1047KB) ( 1162 )   Save
    Objective To investigate the influencing factors of exercise tolerance in the elderly patients with single vessel lesion of anterior descending coronary artery after percutaneous coronary intervention (PCI). Methods The clinical data of 126 elderly patients with single vessel lesion of anterior descending coronary artery in our hospital from May 2018 to November 2019 were retrospectively analyzed. According to the exercise tolerance after PCI,the patients were divided into the exercise tolerance decreased group and the exercise tolerance normal group. The influencing factors of exercise tolerance in the elderly patients with single vessel lesion of anterior descending coronary artery after PCI were analyzed by multivariate Logistic regression analysis. The patients were followed up for 1 year after PCI, and the incidence rate rate of major adverse cardiovascular events was compared between the two groups. Results The incidence rate of reduced exercise tolerance in the elderly patients with single vessel lesion of anterior descending coronary artery after PCI was 54.76% (69/126).Compared with the normal exercise tolerance group, the levels of left ventricular ejection fraction (LVEF) and peak oxygen uptake (VO2peak) in the reduced exercise tolerance group decreased, the levels of body mass index (BMI), heart rate, left atrial anteroposterior diameter (LAAD) and N-terminal B-type pro-brain natriuretic peptide (NT-proBNP) in the exercise tolerance group increased. And the composition ratios of diabetes, history of myocardial infarction, and perioperative myocardial injury in the exercise tolerance decreased group were significantly higher than those in the normal exercise tolerance group (P＜0.05). Multivariate Logistic regression analysis showed that combined with diabetes, history of myocardial infarction, perioperative myocardial injury and VO2peakwere independent influencing factors of exercise tolerance in the elderly patients with single vessel lesion of anterior descending coronary artery after PCI. One year after PCT, there was no significant difference in the total incidence of major adverse cardiovascular events between the two groups (P>0.05). Conclusions Diabetes mellitus, history of myocardial infarction, perioperative myocardial injury and VO2peak are influencing factors of exercise tolerance in the elderly patients with single vessel lesion of anterior descending coronary artery after PCI.
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    Effect of healthcare failure mode and effect analysis in improving self-care behaviors of elderly patients with chronic heart failure
    LI Ting-ru, WANG Su-ying, GAO Chun-hong, SHI Chao-xiong
    2021, 35 (9):  982-985.  doi: 10.3969/j.issn.1003-9198.2021.09.022
    Abstract ( 134 )   PDF (1298KB) ( 1118 )   Save
    Objective To investigate the effects of healthcare failure mode and effect analysis (HFMEA) in improving self-care behaviors of the elderly patients with chronic heart failure (CHF). Methods The elderly patients with CHF were divided into the control group (n=43) and the experimental group (n=48) by convenience sampling method.The control group was given conventional medical education, and the experimental group was given medical education following HFMEA method. In HFMEA, the critical values of potential failure mode were evaluated, and the causes of failure were analyzed. Based on the HFMEA results, appropriate measures were carried out to avoid those potential failures. The quailty of life and the score of Self-Care of Heart Failure Index (SCHFI) were compared between the two groups after six months of intervention. Results After six months of intervention, the total score and each dimension score of SCHFI in the experimental group were significantly higher than those in the control group (P<0.01), and the score of Minnesota Living with Heart Failure Questionnaire in the experimental group was significantly lower than that in the control group(P<0.05). Conclusions HFMEA can effectively improve the levels of self-care behaviors and the quality of life in the elderly patients with CHF.
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    Development of core nursing outcome indicators for elderly patients with diabetes
    HE Ying-zi, QIAN Yan, SUN Lin-fang
    2021, 35 (9):  986-990.  doi: 10.3969/j.issn.1003-9198.2021.09.023
    Abstract ( 172 )   PDF (1043KB) ( 999 )   Save
    Objective To develop a set of assessment indicators of core nursing outcomes for the elderly patients with diabetes, so as to provide basis for nursing assessment. Methods Delphi expert consultation method was adopted to revise the outcomes and indicators based on nursing outcomes classification. Results Authority coefficient of 2-round expert consultation was 0.87 and 0.91,and Kendall’s W coefficient was 0.189-0.305 and 0.203-0.305 (P<0.05), respectively. The final system consisted of three fields including physiological health, health knowledge and behavior, psychological and social health, with a total of eight outcomes and thirty-five indicators. Conclusions This assessment system is scientific and reliable. It can be used to evaluate nursing outcomes of the elderly patients with diabetes, and provide reference for clinical nursing.
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    Relationship of changes in taste and smell with optimistic tendency and self-perceived burden in elderly patients with gastric cancer
    ZHANG Jie, LI Yan-fei, YANG Wen
    2021, 35 (9):  991-994.  doi: 10.3969/j.issn.1003-9198.2021.09.024
    Abstract ( 145 )   PDF (1036KB) ( 1068 )   Save
    Objective To explore the relationship of the changes in taste and smell with optimistic tendency and self-perceived burden in the elderly patients with gastric cancer. Methods A total of 102 elderly patients with gastric cancer who were admitted to our hospital from August 2016 to August 2019 were selected. All the patients underwent the survey of general information questionaire, taste change evaluation (the Taste and Smell Survey, TSS), optimistic tendency evaluation (Revised Life Orientation Test, LOT-R), and burden sensing evaluation (self-perceived burden scale, SPBS). The incidence rate of taste and smell changes in the patients with different demographic characteristics, and the scores of LOT-R and SPBS in the patients with different taste and smell changes were compared. Pearson correlation coefficient was used to describe the relationship of changes in taste and smell with optimistic tendency and self-perceived burden. Results The TSS scores of 102 elderly patients with gastric cancers was (4.63±0.95) points. Among them, there were 43 cases without taste and smell change, 36 cases with slight change, and 23 cases with moderate to severe change. The incidence rate of taste and smell changes was 57.84% (59/102). Age, gender, household registration type, education level, occupation, marital status, main caregiver, average income, payment type, chronic diseases, tumor location, clinical stages and degree of differentiation were not related to the changes of taste and smell (P>0.05). The TSS score was positively correlated with the times of chemotherapy (r=0.441) and the total score of SPBS (r=0.337), but negatively correlated with the total score of LOT-R (r=-0.309). Conclusions Elderly patients with gastric cancer who receive more chemotherapy are prone to have taste and smell changes. More attention should be paid to the intervention and adjustment of the patients’ psychological state in clinic.
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