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20 May 2022, Volume 36 Issue 5 Previous Issue    Next Issue

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Relationship between stress hyperglycemia and postoperative pulmonary complications after thoracoscopic lung resection in elderly patients with diabetes mellitus CHEN Zi-xuan, Sara Musa Abdalla Elamin, ZHU Lin-jia, ZHA Tian-ming, XU Si-yang, GUI Bo, ZHANG Yang 2022, 36 (5):  433-436.  doi: 10.3969/j.issn.1003-9198.2022.05.001 Abstract ( 241 )   PDF (1170KB) ( 1110 )   Save Objective To investigate the relationship between stress hyperglycemia (SH) and postoperative pulmonary complications (PPCs) after thoracoscopic lung resection in the elderly patients with diabetes mellitus(DM). Methods A total of 367 elderly DM patients who underwent elective thoracoscopic lung resection in our hospital from January 2017 to July 2020 were enrolled. The data of clinical features, comorbidities, surgeons, intraoperative volume of liquid, duration of operation, levels of creatinine, hemoglobin, white blood cells, glycosylated hemoglobin and blood glucose were collected. Stress hyperglycemia ratio (SHR) was used to assess the intensity of SH. Multivariate Logistic regression analysis was used to analyze the risk factors for PPCs in the elderly patients with DM. Results Among the 367 elderly DM patients, 162 cases (44.1%,complication group) presented with PPCs. There were significant differences in serum fasting plasma glucose(FPG) at admission, preoperative arteria FPG, and SHR at admission between the two groups (all P＜0. 05). Multivariate Logistic regression analysis showed that preoperative FPG and SHR at admission were the independent risk factors of PPCs in the elderly patients with DM. Conclusions The levels of preoperative arterial FPG and SHR at admission show significant effects on the incidence of PPCs in the elderly patients with DM after thoracoscopic lung resection. References | Related Articles | Metrics

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Intraoperative assessment of left-ventricular diastolic function by transesophageal speckle tracking echocardiography in elderly patients undergoing off-pump coronary artery bypass graft surger GONG Chan-juan, GUI Bo, ZHU Lin-jia 2022, 36 (5):  441-444.  doi: 10.3969/j.issn.1003-9198.2022.05.003 Abstract ( 126 )   PDF (1341KB) ( 863 )   Save Objective To explore the evaluation of left-ventricular diastolic function by transesophageal speckle tracking echocardiography after revascularization in the elderly patients undergoing off-pump coronary artery bypass grafting (off-pump CABG). Methods A total of 49 elderly patients undergoing off-pump CABG were recruited. Transesophageal echocardiography examination was performed at T0 (5 min after placement of the transesophageal echocardiography probe) and T1 (30 min after revascularization). The four-, two-, and three-chamber views were obtained for 3 cardiac cycles, and then copied to a Philips QLab workstation. Strain rate during isovolumic relaxation (SRIVR), strain rate during early diastole (SRe) and strain rate during late diastole (SRa) were analyzed. The changes of left-ventricular diastolic function after coronary revascularization were compared. The correlation between strain rate-based indices (SBIs) and pulmonary capillary wedge pressure (PCWP) was analyzed,and the predictive ability of SRIVR,SRe and SRa for the increase of PCWP was also evaluated. Results SRIVR and SRa were significanly improved after revascularization (both P＜0.05). At T0 and T1, SRIVR was negatively correlated with PCWP (r=-0.78, -0.72,all P＜0.001). At T0 and T1, SRIVR showed a strong ability to predict PCWP ≥ 12 mmHg (AUC=0.88, 0.89). Conclusions Strain based indices were more sensitive and accurate predictors for the increase of PCWP, which has a good prospect in clinical application. References | Related Articles | Metrics

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Status of preoperative blood glucose management in elderly diabetic patients and its influence on the prognosis of orthopedic surgery LI Guo-qing, WU Hai-di, JU Chang-ping, SUN Mei-juan, FAN Yao, LIU Huan, YU Yun, TANG Wei, GUI Bo, MO Yong-zhen 2022, 36 (5):  445-448.  doi: 10.3969/j.issn.1003-9198.2022.05.004 Abstract ( 158 )   PDF (1188KB) ( 966 )   Save Objective To investigate the status of perioperative blood glucose management in the elderly patients with diabetes, and to study the correlation between blood glucose control level and prognosis of orthopedic surgery. Methods The level of blood glucose was collected at 5 time-points per day from 2 days before surgery to 3 days after surgery in the elderly patients with type 2 diabetes who underwent orthopedic surgery. The effects of blood glucose levels and blood glucose variations on postoperative complications were analyzed. Results The median HbA1c of 109 patients was 7.3%, and 24 patients (22.02%) presented with HbA1c > 8.5%. The median preoperative peripheral blood glucose was 9.02 mmol/L, and the preoperative peripheral blood glucose coefficient of variation (CV) was 0.28±0.10. There were 14 patients (12.84%) with postoperative complications, including 10 patients (9.17%) with surgical site infection.The incidence of postoperative complications and surgical site infection in the group with a level of preoperative blood glucose >9.02 mmol/L was significantly higher than that in the group with a level of preoperative blood glucose ≤9.02 mmol/L (20.37% vs 5.45%;14.81%vs 3.64%, respectively,all P＜0.05). The incidence of perioperative hypoglycemic events in the group with preoperative CV>0.29 was significantly higher than that in the group with preoperative CV≤0.29 (29.63% vs 9.09 %, P＜0.05). Conclusions The status of perioperative blood glucose management in the elderly patients with diabetes undergoing orthopedic surgery needs to be improved. Strengthening preoperative blood glucose monitoring and management is beneficial to reduce the incidence of orthopedic surgery complications in the elderly diabetic patients. References | Related Articles | Metrics

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Questionnaire survey and analysis of anesthesia for gastrointestinal endoscopy in the elderly in Jiangsu Province XU Ning, RUAN Shan, SHEN Su-ping, YANG Wen, XU Si-yang, CHEN Xia, GUI Bo 2022, 36 (5):  449-452.  doi: 10.3969/j.issn.1003-9198.2022.05.005 Abstract ( 127 )   PDF (1063KB) ( 885 )   Save Objective To investigate and analyze the situation of anesthesia for gastrointestinal endoscopy in the elderly in Jiangsu Province, so as to improve the quality of anesthesia for gastrointestinal endoscopic procedures in this population. Methods The anestheia specification for gastrointestinal endoscopy in the elderly questionnaire was designed, and was conducted among anesthesiologists working in Jiangsu Province via the WeChat group application between February 13-28,2022. The questionnaire was divided into 19 parts, including personal information, hospital information, routine practice of anesthesia and medical safety for the elderly. Results A total of 520 questionnaires were completed, of which 501 were valid with an effective rate of 96.3%. The questionnaire showed that 69.3% of the respondents were from tertiary hospitals and 60.5% of anesthesiologists were chief physicians or senior. 52.1% of the participants listed an upper age limit for elderly patients and 59.7% conducted preoperative evaluation of anesthesia for gastrointestinal endoscopy. 64.3% of the participants chose electrocardiograph(ECG) monitoring and 84.0% chose non-invasive blood pressure monitoring. Blood pressure was measured by noninvasive blood pressure cuff and were cuffed on left upper limb (35.5%). The ratio of humidification during oxygen therapy, liquid infusion intravenously, eye protection was 61.5%,55.1% and 23.6%, respectively.The current status such as no treatment for hypotension during endoscopy (18.4%), providing area for recovery from anesthesia (82.4%), professional staffs for recovery (68.5%), regular first-aid training (61.7%), discharge eligible standardization (90.0%), accompanied without medical staffs when returning to the ward (80.4%) were also recorded. There were higher ratios of tertiary hospitals in no upper age limit for the elderly, conducting preoperative evaluation of elderly anesthesia as well as setting post-anesthesia recovery room, professional staffs, and discharge eligible standardization (P<0.05). However, the ratios of tertiary hospitals in humidification during oxygen therapy and intravenous liquid infusion were lower (P<0.01). Interestingly, residents mostly chosed eye protection (P=0.024). Conclusions There are still many problems in the anesthesia management of gastrointestinal endoscopy in the elderly in Jiangsu Province. It is necessary to improve the standardization and quality management in routine practice of anesthesia, in order to effectively guarantee the safety of anesthesia for the elderly. References | Related Articles | Metrics

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Correlation between thrombospondin-1 and inflammatory reaction and cognitive impairment in elderly patients with post-stroke epilepsy WANG Wei, ZHAO Meng, LI Yun, YIN Hong-yu 2022, 36 (5):  453-458.  doi: 10.3969/j.issn.1003-9198.2022.05.006 Abstract ( 138 )   PDF (1543KB) ( 975 )   Save Objective To investigate the effects of serum exosomal protein thrombospondin-1 (TSP-1) on inflammatory reaction and cognitive function in the elderly patients with post-stroke epilepsy (PSE). Methods A total of 204 elderly patients with ischemic stroke admitted to the emergency department of our hospital from January 2018 to June 2019 were selected and divided into PSE group (n=23) and non-PSE group (n=181) according to whether PSE occurred 7 days after stroke. The expression of TSP-1 was compared between the two groups. Univariate and multivariate Logistic regression was used to analyze the influencing factors of PSE in the elderly. The predictive value of TSP-1 was analyzed by receiver operating characteristic (ROC) curve. Pearson and Spearman correlation analysis was used to analyze the correlation of TSP-1 expression with inflammatory factors and cognitive impairment in PSE patients. Results The expression of TSP-1 in PSE group was significantly higher than that in non-PSE group (P<0.01). Multivariate Logistic regression analysis showed that fever, hypocalcemia, the National Institutes of Health Stroke Scale(NIHSS)score and TSP-1 were independent influencing factors of PSE in the elderly stroke patients. ROC curve analysis showed that the predictive efficacy of TSP-1 was 0.886 (95%CI: 0.829-0.943), the specificity and sensitivity were 81.8% and 87.0%, respectively. According to Pearson correlation analysis, the expression of TSP-1 in PSE patients was positively correlated with the levels of interleukin-6 (IL-6), transforming growth factor beta 1 (TGF-β1) and tumor necrosis alpha (TNF-α) (r=0.699, 0.919, 0.680,respectively, P<0.001). Spearman correlation analysis showed that TSP-1 was negatively correlated with the difference of Mini-mental State Examination (MMSE) (r=-0.768, P<0.001). Conclusion In the elderly patients with ischemic stroke, PSE is more prone to occur in those with high expression of TSP-1, and the high expression of TSP-1 is associated with the inflammation and cognitive impairment of PSE patients. References | Related Articles | Metrics

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Correlation between serum levels of miR-29a, COX-2 and prognosis of chemotherapy in elderly patients with advanced breast cancer WANG Xu-juan, LUO Yong-xin, LI Cheng-qiang, WANG Ru-jin, XIANG Min 2022, 36 (5):  459-462.  doi: 10.3969/j.issn.1003-9198.2022.05.007 Abstract ( 117 )   PDF (1118KB) ( 832 )   Save Objective To observe the relationship of serum levels of microRNA-29a (miR-29a) and cyclooxygenase-2 (COX-2) with prognosis of chemotherapy in the elderly patients with advanced breast cancer. Methods The clinical data of 114 elderly patients with advanced breast cancer who were followed up for at least one month after receiving TAC (paclitaxel + pirarubicin + cyclophosphamide) regimen for chemotherapy from January 2018 to January 2020 in our hospital were retrospectively analyzed. The baseline data of the patients were collected, and the serum levels of crbohydrate antigen 125(CA125),CA153,matrix metalloproteinase-2 (MMP-2), miR-29a, COX-2 of patients were detected before chemotherapy. The prognosis of chemotherapy was evaluated. Regression analysis was used to examine the influencing factors of the prognosis of the elderly patients with advanced breast cancer. Results Among 114 elderly patients with advanced breast cancer, 44 cases had poor prognosis, and 70 cases had good prognosis. Regression analysis showed that the up-regulated expression of CA125, CA153, MMP-2, COX-2, and relative expression of miR-29a were associated with poor prognosis of chemotherapy in the elderly patients with advanced breast cancer. ROC curve was drawn and showed that the AUC of CA125, CA153, MMP-2, relative expression of miR-29a and COX-2 in predicting the risk of poor prognosis were all >0.80, which had certain predictive value. Conclusions The relative expression of miR-29a, CA125, CA153, MMP-2 and COX-2 are closely related to poor prognosis of the elderly patients with breast cancer. References | Related Articles | Metrics

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Correlation between chronic constipation and frailty in elderly inpatients YUAN Wan, ZHANG Yu-lian, YAO Li-pei, XU Cui-xiang, WANG Na-na, ZHANG Hui-ying, MA Yun-miao 2022, 36 (5):  463-467.  doi: 10.3969/j.issn.1003-9198.2022.05.008 Abstract ( 134 )   PDF (1090KB) ( 1135 )   Save Objective To explore the correlation between chronic constipation and frailty in the elderly inpatients and to provide evidence for clinical intervention. Methods From January to May 2021, 612 elderly inpatients hospitalized in Shaanxi Provincial People′s Hospital were selected as the research subjects. The cross-sectional survey was carried out by using the general information questionnaire, Roman IV Diagnostic Criteria for Constipation and the Frail Scale, and the relationship between chronic constipation and frailty was investigated. Results Among the 612 elderly inpatients, 138 cases (22.5%) had chronic constipation, and 474 cases (77.5%) showed no chronic constipation; 163 cases (26.6%) showed frailty, 306 cases (50.0%) showed pre-frailty, 143 cases (23.4%) showed no-frailty. Univariate analysis results showed that there were significant differences in types of long-term drugs, coronary heart disease, hyperlipidemia, digestive system diseases, renal insufficiency, limb dysfunction, degree of frailty, fecal color, fecal hardness, white blood cells (WBC),urea (UREA), creatinine (CR), inorganic phosphorus (P), homopaluminine (Hcy) between the chronic constipation group and non-chronic constipation group (P＜0.05).Multivariate Logistic regression analysis showed that renal insufficiency, FRAIL score, limb dysfunction, fecal hardness and WBC were the independent risk factors for chronic constipation in the elderly inpatients(P＜0.05). Conclusions The incidence of chronic constipation is high in the elderly, and is closely related to frailty. It is necessary to take targeted overall intervention measures to improve the condition of chronic constipation in the elderly. References | Related Articles | Metrics

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Analysis of genomic DNA methylation of peripheral blood in elderly patients with type 2 diabetes mellitus suffering form cardiovascular disease-induced death FAN Yao, WANG Qiang, TANG Ji-hong, LOU Qing-lin, TANG Wei, GU Liu-bao 2022, 36 (5):  468-472.  doi: 10.3969/j.issn.1003-9198.2022.05.009 Abstract ( 122 )   PDF (1694KB) ( 1020 )   Save Objective A genome-wide DNA methylation microarray technique was used to explore the aberrantly methylated sites in the elderly patients with type 2 diabetes mellitus(T2DM) suffering from cardiovascular disease-induced death. Methods The present study was conducted using the data from the Staged Diabetes Targeting Management (SDTM)study. The propensity score method was used to match the control, and the calipers value was set to 0.02. Twelve elderly patients with T2DM who died of cardiovascular disease until October 2017 were selected as case group. Twelve elderly patients with T2DM who survived in the same period were selected as the control group. Whole genome methylation level in periphral blood was detected by Illumina Methylation BeadChip. Gene ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) signaling pathway analysis were performed using the DAVID database. Results A total of 303 CpG sites with statistically significant differences were found. GO function analysis showed that methylation variation positions were involved in such biological process as:(1) Nervous system development, cell adhesion, glucose homeostasis and positive regulation of dendrite development; (2)Cellular component such as integral component of plasma membrane, dendrite and perinuclear region of cytoplasm; (3) Molecular function such as calcium ion binding and sequence-specific DNA binding. KEGG signaling pathway analysis found that methylation variation positions were involved in cyclic adenosine monophosphate(cAMP) signaling pathway and inflammatory mediator regulation of transient receptor potential(TRP) channels. Conclusions DNA methylation modification may be involved in the pathogenesis of the elderly patients with T2DM who die of cardiovascular disease. References | Related Articles | Metrics

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Effects of immunotherapy on airway hyperresponsiveness and pulmonary function in elderly patients with non-small cell lung cancer complicated with COPD HUO Shu-fen, SHANG Wen-li, TIAN Ying-xuan, SUN Li, REN Xiao-ping, WANG Jun, KANG Hui-fang, WEN Hong-xia 2022, 36 (5):  473-477.  doi: 10.3969/j.issn.1003-9198.2022.05.010 Abstract ( 150 )   PDF (1086KB) ( 1146 )   Save Objective To investigate the effects of programmed death-1(PD-1)/ programmed death-ligand 1(PD-L1) inhibitor treatment on airway hyperresponsiveness and lung function in the elderly patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD). Methods A total of 30 NSCLC patients who received PD-1 / PD-L1 inhibitor immunotherapy were divided into COPD group and non-COPD group. The levels of fractional exhaled nitric oxide(FeNO) and the lung function indexes were collected and compared. Results Among the 30 patients, 19 cases were complicated with COPD and 11 cases were not complicated with COPD. There was no statistical difference in the level of FeNO between the COPD group and the non-COPD group before treatment (P>0.05).The level of FeNO was increased significantly in the COPD group affter treatment, and the difference between the two groups was statistically significant(P<0.01).After treatment, the levels of FEV1 and FVC were increased significantly in the COPD group(P<0.05). However, there was no statistically significant difference in FVC and FEV1 before and after treatment in the non-COPD group (P>0.05). There were no significant differences in scores of Modified Medical Research Conncil (mMRC) questionnaire and COPD Assessment Test(CAT) between the two groups before and after treatment (P>0.05). Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was not observed during treatment. Conclusions PD-1/PD-L1 inhibitor immunotherapy can change FeNO level and pulmonary function in the NSCLC patients with COPD, and will not worsen COPD. References | Related Articles | Metrics

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Development of a preliminary version of screening and assessment tool for malnutrition in the elderly JIANG Qian-wen, LI Fei-ka, XU Gang, BAI Ting-ting, WU Fang 2022, 36 (5):  478-482.  doi: 10.3969/j.issn.1003-9198.2022.05.011 Abstract ( 123 )   PDF (1079KB) ( 1058 )   Save Objective To develop a preliminary version of screening and assessment tool for malnutrition in Chinese elderly. Methods An item pool was established after literature review and panel discussion. The items were screened by using Delphi method.Experts in geriatrics and related regions were invited. Two rounds of survey questionnaire were implemented by form of Email. Experts were required to evaluate the items in terms of their importance and provide basis of judgement and degree of familiarity.A preliminary version of screening and assessment tool was determined after the items were screened according to average importance value, coefficient of variation and full score ratio. Results Sixteen and fifteen survey questionnaires were completed for the two rounds of consultation and the coefficients of positivity were 100% and 93.75%. In the first round, the degrees of authority were 0.96±0.05 and 0.95±0.06, the average importance scores of items being 4.53±0.19 and 4.19±0.38, the coefficients of variation being (19.38±4.89)% and (24.67±8.47)%, the full score ratios being (72.62±12.12)% and (51.39 ±17.19)%, and Kendall coordination coefficients being 0.429 and 0.381(P＜0.001) for screening and assessment questionnaire. In the second round, the degrees of authority were 0. 96±0.06 and 0. 95±0.06, the average importance scores of items being 4.65±0.20 and 4.60±0.25, the coefficients of variation being (13.37±6.23)% and (14.43±6.56)%, the full score ratios being (73.83±15.03)% and (71.24±17.36)%, and Kendall coordination coefficients being 0.319 and 0.228 (P＜0.001) respectively. Based on the scores and expert opinions, 10 items were finally selected for the screening tool and 17 items for the assessment tool. Conclusions A preliminary version of screening and assessment tool is established which consists of 10 items and 17 items respectively for malnutrition in the elderly by Delphi method. References | Related Articles | Metrics

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Predictive value of modified early warning score combined with Braden score for the prognosis of emergency elderly critically ill patients MA Yan, ZHANG Yu-qin, ZHANG Chun-yan 2022, 36 (5):  483-486.  doi: 10.3969/j.issn.1003-9198.2022.05.012 Abstract ( 145 )   PDF (1060KB) ( 1424 )   Save Objective To explore the predictive value of modified early warning score(MEWS) combined with Braden score for the prognosis of emergency elderly critically ill patients. Methods A total of 204 emergency elderly critically ill patients admitted to our hospital from June 2018 to June 2020 were selected and were divided into survival group(n=140) and death group(n=64) according to the prognosis. The MEWS score and Braden score were compared between the two groups. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the MEWS score and Braden score for the prognosis of the elderly critically ill patients in emergency department. Results There were no significant differences in the gender ratio, age and other general information between the two groups. The MEWS score was significantly higher and the Braden score was significantly lower in the death group than that in the survival group (P<0.05). The mortality rate of emergency elderly critically ill patients with extremely high risk according to MEWS and Braden score was significantly higher than that of the patients with low risk. ROC curve analysis showed that MEWS and Braden score alone had a certain predictive value for the prognosis, with AUC (95%CI) of 0.732 (0.691-0.894), 0.713 (0.624-0.855) respectively. The predictive efficiency of the combination of two indicators [AUC (95%CI) : 0.895 (0.831-0.945)] for the prognosis was significantly higher than that of a single indicator. Conclusions The MEWS score combined with Braden score is of high value in assessing the prognosis of the elderly critically ill patients in emergency department, and can be used in clinic. References | Related Articles | Metrics

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Clinical study of Danhong injection combined with cerebroside and carnosine in elderly patients with hypertensive intracerebral hemorrhage GAO Pu, LIU Liang, LIU Xing-mian, ZHANG Zi-hao, ZHANG Wen-liang, WU Zhi-bao 2022, 36 (5):  487-491.  doi: 10.3969/j.issn.1003-9198.2022.05.013 Abstract ( 137 )   PDF (1075KB) ( 799 )   Save Objective To investigate the clinical efficacy of Danhong injection combined with cerebroside and carnosine in the treatment of hypertensive intracerebral hemorrhage (HICH),and its effect on the levels of cerebral hemodynamics parameters, serum neuron-specific enolase (NSE), superoxide dismutase(SOD) and interleukin-6 (IL-6). Methods A total of 240 HICH patients admitted to our hospital from July 2019 to July 2020 were selected and randomly divided into the observation group and the control group with 120 cases in the each group. The control group was treated with cerebroside and carnosine, and the observation group was treated with Danhong injection additionally. The course of treatment was 14 days in two groups. The clinical efficacy and safety, the cerebral hemodynamic parameters of the affected side middle cerebral artery [mean blood flow velocity (Vm), pulsatility index (PI) and resistance index (RI)], and the serum levels of NSE, SOD, IL-6 before and after treatment in the two groups were observed and compared. Results The total effective rate of the observation group(92.5%) was significantly higher than that of the control group (83.3%),with significant difference between the two groups (P<0.05). Compared with before treatment, the scores of National Institutes of Health Stroke Scale (NIHSS) and activities of daily living (ADL) and the hematoma volume were significantly decreased in both groups after treatment (P<0.05), especially in the observation group (P<0.05). The Vm of the middle cerebral artery on the affected side and the serum level of SOD was significantly increased, and the PI,RI and the serum levels of NSE and IL-6 were significantly decreased in both groups after treatment (P<0.05), especially in the observation group (P<0.05). There was no significant difference in adverse reaction rate between the observation group and the control group (7.5% vs 5.8%, P>0.05). Conclusions Danhong injection combined with cerebroside and carnosine can significantly improve the state of cerebral hemodynamics and the serum levels of NSE, SOD and IL-6 in the elderly patients with HICH. References | Related Articles | Metrics