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20 September 2023, Volume 37 Issue 9 Previous Issue    Next Issue

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Correlation between RNA damage and 28-d mortality in elderly patients with sepsis GAO Rong, ZHANG Qi-dong, YANG Wen, ZHU Ying, YANG Run-hua 2023, 37 (9):  890-892.  doi: 10.3969/j.issn.1003-9198.2023.09.007 Abstract ( 107 )   PDF (1024KB) ( 689 )   Save Objective To investigate the correlation between RNA damage and 28-d mortality in the elderly patients with sepsis. Methods The elderly patients with sepsis admitted to Department of Emergency were enrolled in this study. The data of age, gender, length of stay, mean arterial pressure, clinical laboratory indicators such as 8-oxoGuo concentration in urine after RNA oxidative damage, the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and Sequential Organ Failure Assessment(SOFA) score were recorded. The mortality rate of the patients was recorded after 28-d follow-up. The differences in the indicators between the survival group and the death group were analyzed, and the risk factors of 28-d mortality were analyze. Receiver operator characteristic curve analysis was used to evaluate the predictive value of the factors for 28-d mortality in the elderly patients with sepsis. Results 8-oxoGuo, APACHE Ⅱ score,SOFA score and dosage of norepinephrine were risk factors for 28-d mortality of the elderly patients with sepsis (OR=1.559, 2.065, 1.223, 11.602, respectively). 8-oxoguanosine had a high predictive value for 28-d mortality (AUC=0.847,Z=6.397,P<0.001), and the specificity and sensitivity was 87.5% and 70.8%, respectively. Conclusions Oxidative RNA damage is associated with 28-d mortality in the elderly patients with sepsis. References | Related Articles | Metrics

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Effects of different depth of sedation on postoperative delirium in elderly patients undergoing hip replacement MA Xue-ping, XU Gui-ping, FU Juan, LI Yu-geng 2023, 37 (9):  893-897.  doi: 10.3969/j.issn.1003-9198.2023.09.008 Abstract ( 81 )   PDF (1011KB) ( 682 )   Save Objective To evaluate the effect of different sedation depth monitored by bispectral index (BIS) on postoperative delirium(POD) in the elderly patients aged 80 years and over undergoing hip fracture surgery. Methods A total of 80 elderly patients with hip fracture who underwent the elective joint replacement from January 2019 to January 2022 were enrolled and randomly divided into the deep sedation group (group D) and the light sedation group (group L),with 40 cases in each group. BIS value was maintained at 60-＜70 in group D and 70-80 in group L. Spinal anesthesia combined with propofol target-controlled infusion (TCI) was performed during operation in both groups, and patient-controlled intravenous analgesia was performed after operation. BIS value, heart rate (HR), mean arterial pressure (MAP), finger pulse oxygen saturation (SpO2) and end-tidal carbon dioxide (PETCO2) were recorded at admission (T1), the beginning of sedation (T2), the beginning of surgery (T3), 30 minutes after surgery (T4), 60 minutes after surgery (T5) and the end of surgery (T6). Adverse reactions during sedation, propofol dosage, postoperative recovery time and the hospital stay of the two groups were observed and compared. The serum level of S100-β was detected by ELISA before anesthesia (TⅠ), 24 hours after surgery (TⅡ), 48 hours after surgery (TⅢ), and 72 hours after surgery (TⅣ) in two groups. Confusion Assessment Scale (CAM) and Delirium Severity Assessment Scale (CAM-S) were used to assess the incidence and severity of POD during 3 days after the surgery. Results Compared with T1, MAP showed a decreasing trend in group D from T2 to T6 (P<0.05). BIS value from T3 to T6 was significantly increased in group L than that in group D (P<0.05). The serum level of S100-β from TⅡ to TⅣ, propofol dosage, postoperative recovery time and the hospital stay in group L were significantly lower than those in group D (P<0.05). There was no significant difference in the incidence rate of POD between the two groups (P>0.05), but the CAM-S score of the patients with POD in group D was significantly higher than that in group L. Conclusions Light sedation, maintaining BIS values at 70 to 80 during the operation can reduce the severity of POD and shorten anesthesia recovery time and hospital stay in the elderly patients undergoing hip replacement. References | Related Articles | Metrics

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Effects of Mulligan's mobilization with movement combined with water-filtered infrared-A in the treatment of primary frozen shoulder in the elderly WANG Jian-jian, MENG Zhao-xiang, FEI Wen-yong, YANG Kang, YUAN Chao-qun, GAO Wei, WANG Xin 2023, 37 (9):  898-901.  doi: 10.3969/j.issn.1003-9198.2023.09.009 Abstract ( 83 )   PDF (996KB) ( 870 )   Save Objective To observe the clinical effect of water-filtered infrared-A (wIRA) combined with Mulligan's mobilization with movement (MWM) in the treatment of frozen shoulder (FS) in the elderly. Methods A total of 58 elderly patients with FS treated in Department of Orthopedics of our hospital from January 2021 to June 2022 were randomly divided into the control group and the observation group, with 29 patients in each group. The control group was treated with MWM, and the observation group was treated with wIRA on the basis of MWM. The Numeric Rating Scale (NRS), shoulder range of motion (ROM), Shoulder Pain and Disability Index (SPADI) and Athens Insomnia Scale (AIS) were evaluated before and after treatment. Results Before treatment, there were no significant differences in NRS score, shoulder ROM, SPADI score and AIS score between the two groups (P>0.05). After treatment, there were significant differences in NRS score, SPADI score and AIS score between the two groups (P< 0.05), but there was no significant difference in shoulder ROM (flexion, posterior extension, abduction, external rotation and internal rotation) (P>0.05). Conclusions wIRA combined with MWM can effectively improve the shoulder pain and sleep quality in the elderly patients with FS, and can promote the rapid recovery of shoulder joint function, which is worthy of clinical application. References | Related Articles | Metrics

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Application of lung protective ventilation in laparoscopic radical nephrectomy in elderly patients ZHU Shan, DING Jia-hui, ZHANG Yan-mei, XU Hai-fei, ZHANG Hui, CAO Han-zhong 2023, 37 (9):  902-906.  doi: 10.3969/j.issn.1003-9198.2023.09.010 Abstract ( 93 )   PDF (1012KB) ( 524 )   Save Objective To investigate the effect of lung protective ventilation in laparoscopic radical nephrectomy in the elderly patients. Methods A total of 106 patients with primary renal cancer who received laparoscopic radical nephrectomy in our hospital from October 2020 to October 2021 were enrolled and randomly divided into the control group and the lung protective ventilation group, with 53 cases in each group. The control group received general anesthesia and routine intraoperative ventilation, while the lung protective ventilation group received general anesthesia and intraoperative lung protective ventilation. Lung compliance[peak pressure (Ppeak), airway plateau pressure (Pplat), oxygenation index (PaO2/FiO2), lung dynamic compliance (Cdyn)], serum inflammation and oxidative stress [interleukin-6(IL-6), interleukin-8(IL-8), tumor necrosis factor α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD)], hemodynamic indicators [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)] and the incidence of complications between the two groups were compared. Results The levels of Ppeak, Pplat, IL-6, IL-8, TNF-α, MDA, SBP, DBP and HR in lung protective ventilation group were lower than those in control group, while the levels of SOD, PaO2/FiO2 and Cdyn levels were higher than those in control group(all P＜0.05) 2 h after pneumoperitoneum and after surgery. The total incidence rate of the complications in lung protective ventilation group was lower than that in control group(P＜0.05). Conclusions The application of lung protective ventilation in laparoscopic radical nephrectomy in elderly patients can improve intraoperative lung compliance, reduce inflammatory stress response, improve hemodynamics and reduce postoperative complications. References | Related Articles | Metrics

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Association of vasoactive intestinal peptides with hypercoagulability, hypoxemia and vascular endothelial function in elderly patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension WANG Shi-fu, OU Zong-xing, FU Sha-sha 2023, 37 (9):  907-910.  doi: 10.3969/j.issn.1003-9198.2023.09.011 Abstract ( 88 )   PDF (1053KB) ( 553 )   Save Objective To investigate the serum level and association of vasoactive intestinal peptide (VIP) with hypercoagulability, hypoxemia and vascular endothelial function in the elderly patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension (PH). Methods The clinical data of age, gender, forced expiratory volume in one second/percentage of forced vital capacity (FEV1/FVC), fibrinogen (FIB), D-dimer (D-D) and arterial partial perssure of oxygen (PaO2) were collected from 226 elderly patients with COPD. According to the pulmonary artery systolic pressure (PASP) measured by cardiac color ultrasound, the patients were divided into COPD with PH group (PASP≥40 mmHg, n=76) and COPD group (PASP<40 mmHg, n=150). The levels of serum endothelin-1 (ET-1) and VIP were detected by enzyme-linked immunosorbent assay (ELISA), and the level of serum nitric oxide (NO) was measured by colorimetry. Results There were no significant differences in age, gender, smoking history, the levels of body mass index (BMI), blood glucose, blood pressure and blood lipid between the two groups (P>0.05). FEV1/FVC in COPD with PH group was lower than that in COPD group (P<0.05). After adjusting FEV1/FVC by covariance analysis, the levels of VIP, NO and PaO2 in COPD with PH group were lower than those in COPD group, and the levels of FIB and D-D were higher than those in COPD group (P<0.05 or P<0.01). Among the patients with PH, VIP was positively correlated with PaO2(r=0.713, P<0.001), and negatively correlated with D-D (r=-0.670, P<0.001). Conclusions The level of VIP in the elderly patients with COPD-PH is closely related to hypercoagulability, hypoxemia and vascular endothelial function. References | Related Articles | Metrics

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Influencing factors of degenerative lumbar scoliosis in elderly patients with lumbar spinal canal stenosis ZHAO Xiao-kui, SHAO Nan, ZHANG Sheng-guo, YANG Wan-shi 2023, 37 (9):  911-914.  doi: 10.3969/j.issn.1003-9198.2023.09.012 Abstract ( 112 )   PDF (998KB) ( 833 )   Save Objective To investigate the influencing factors of degenerative lumbar scoliosis (DLS) in elderly patients with lumbar spinal stenosis (LSCS), and to provide reference for clinical prevention and treatment of DLS. Methods A total of 296 elderly patients with LSCS admitted to our hospital from January 2017 to January 2022 were retrospectively selected and divided into DLS group (74 cases) and non-DLS group (222 cases). Demographic, clinical and imaging data of the patients were collected, and multivariate Logistic regression was used to analyze the risk factors for DLS in elderly LSCS patients. Results The proportions of age ≥70 years old, female, body mass index ≥25, osteoporosis, sarcopenia in DLS group were higher than those in non-DLS group (P<0.05), Pfirrmann grade 4-5, scoliosis Cobb angle, L3 tilt angle, pelvic incidence(PI), pelvic tilt(PT), sagittal vertical axis(SVA) in DLS group were larger than those in non-DLS group, and lumbar lordosis(LL)and sacral slope(SS)in DLS group were less than those in non-DLS group (P<0.05). Logistic regression showed that age ≥70 years, osteoporosis, sarcopenia, Pfirrmann grade 4-5, PI and SVA were risk factors for DLS in elderly LSCS patients (P<0.05), and LL was a protective factor (P<0.05). Conclusions Age, osteoporosis, sarcopenia, Pfirrmann grade 4-5, LL, PI and SVA are related to the occurrence of DLS in elderly LSCS patients. Clinical intervention and treatment for high-risk patients should be strengthened to prevent and reduce the occurrence of DLS. References | Related Articles | Metrics

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Association between hearing impairment and Alzheimer's disease: a Meta-analysis WANG Min, GUO Wen-jun, TANG Zhong-quan, ZHAO Xiao-min, OU Ting, LI Yun-tao 2023, 37 (9):  915-919.  doi: 10.3969/j.issn.1003-9198.2023.09.013 Abstract ( 103 )   PDF (1120KB) ( 671 )   Save Objective To evaluate the association between hearing impairment and Alzheimer's disease. Methods The studies on the correlation between hearing impairment and Alzheimer's disease in PubMed, Web of Science, EmBase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP and SinoMed were retrievaled by computer, and the retrieval time was from database establishment to March 28th, 2022. Review Manager 5.4 software was used for Meta-analysis. The combined risk ratio (RR) and 95% confidence interval (CI) of the included literatures were calculated,and sensitivity analysis and funnel plot bias test were carried out. Results Finally, six English literatures were enrolled. The results of Meta-analysis showed that the combined RR value of Alzheimer's disease in the patients with hearing impairment was 3.00 (95% CI: 1.58-5.70,P=0.0008). Conclusions There is a correlation between hearing impairment and Alzheimer's disease. The risk of Alzheimer's disease in the patients with hearing impairment is significantly increased.For the people presenting with hearing impairment, early intervention measures should be taken to slow down the cognitive decline. References | Related Articles | Metrics

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Comparison of curative effect of femoral neck dynamic cross fixation system (FNS) and total hip replacement in the treatment for femoral neck fracture WANG Hao-ran, QIN Hu, ZHU Qi-fei, FAN Lei, DU Jiang 2023, 37 (9):  920-924.  doi: 10.3969/j.issn.1003-9198.2023.09.014 Abstract ( 97 )   PDF (2479KB) ( 545 )   Save Objective To compare the efficacy of femoral neck dynamic cross fixation system (FNS) and total hip arthroplasty in the treatment of femoral neck fracture. Methods A retrospective analysis was performed on the clinical data of 128 elderly patients with femoral neck fracture admitted to the Second Affiliated Hospital of Nanjing Medical University from January 2020 to October 2022. Among them, 20 cases were treated with total hip arthroplasty and 20 cases were treated with FNS. All cases were GardenⅢtype. The quality of fracture reduction, operation time, intraoperative bleeding, fracture healing time and incidence of postoperative complications were recorded, and visual analogue scale (VAS) for pain perception and Harris hip joint function score were evaluated three months later. Results There were no statistical differences in VAS score and Harris score of hip joint function between the two groups (P>0.05). The operation time and bleeding volume in the FNS group were significantly lower than those in the total joint replacement group (P<0.01). Conclusions Compared with total hip replacement, FNS shows the advantages of less trauma, shorter operation time and less blood loss. References | Related Articles | Metrics

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Correlation of serum 25(OH)D level with blood lipid dyslipidemia and cardio-cerebrovascular events in elderly patients with hypertension CHEN Dong-yun, HE Guo-huan, PENG Jun 2023, 37 (9):  925-928.  doi: 10.3969/j.issn.1003-9198.2023.09.015 Abstract ( 92 )   PDF (995KB) ( 788 )   Save Objective To study the relationship of serum 25-hydroxyvitamin D[25(OH)D] level with dyslipidemia and the risk of related cardio-cerebrovascular events in the elderly hypertensive patients. Methods The clinical data of 309 elderly hypertensive patients in Wuzhou Workers' Hospital were collected and analyzed retrospectively. According to the serum 25(OH)D level, the patients were divided into deficient group (≤ 20 ng/mL, n=96), inadequate group (＞21-29 ng/mL, n=108), and adequate group (＞29 ng/mL, n=105). The serum levels of 25(OH)D, fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG), glycosylated hemoglobin (HbA1c), 24-hour mean systolic blood pressure (24hSBP), 24-hour mean diastolic blood pressure (24hDBP), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) were detected, and the incidence of dyslipidemia and cardio-cerebrovascular events were recorded, The correlation of 25(OH)D with dyslipidemia and the risk of cardio-cerebrovascular events were analyzed. Results The level of serum HDL-C was lower, and the levels of 24hSBP,TC,TG and LDL-C were higher in the deficient group than those in the inadequate group and the adequate group (P<0.05). The level of 25(OH)D was negatively correlated with the level of TC, TG, LDL-C, the incidence rates of dyslipidemia and cardio-cerebrovascular events (r=-0.281, -0.342, -0.189, -0.231, -0.229, all P<0.05), and positively correlated with the level of HDL-C (r=0.193,P=0.008). Conclusions The level of 25(OH)D in the elderly hypertensive patients is associated with the risk of dyslipidemia and cardio-cerebrovascular events. The patients with 25(OH)D deficiency are prone to suffering from dyslipidemia and increased cardio-cerebrovascular events risk. References | Related Articles | Metrics

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Correlation of type Ⅳ collagen and amino terminal peptide of typeⅢ procollagen with pulmonary function and acute exacerbation in elderly patients with idiopathic pulmonary fibrosis SUN Hui, REN Li, HU Jing-xing, LI Xiu-e, HAO Xu 2023, 37 (9):  929-933.  doi: 10.3969/j.issn.1003-9198.2023.09.016 Abstract ( 103 )   PDF (1020KB) ( 860 )   Save Objective To investigate the correlation of type Ⅳ collagen (ⅣC) and amino terminal peptide of type Ⅲ procollagen (PⅢNP) with pulmonary function and acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) in the elderly patients with IPF. Methods From January 2018 to January 2022, 89 elderly patients with IPF (IPF group) and 42 elderly receiving health examination (control group) in our hospital were enrolled in this study. The levels of serum ⅣC, PⅢNP and pulmonary function were detected, and the incidence of AE-IPF was recorded within 1 month follow-up after discharge. Pearson correlation coefficient was used to describe the correlation between ⅣC, PⅢNP and pulmonary function. Multivariate Logistic regression analysis was used to analyze the risk factors of AE-IPF. Receiver operating characteristic curve (ROC) was used to analyze the value of ⅣC and PⅢNP in predicting AE-IPF. Results The serum levels of ⅣC and PⅢNP in IPF group were higher than those in control group (P<0.01), and the levels of FEV1, FVC, FEV1/FVC and MVV in IPF group were lower than those in control group (P < 0.01). ⅣC and PⅢNP were both negatively correlated with FEV1, FVC, FEV1/FVC and MVV (P < 0.01). During the follow-up period, 49 cases of AE-IPF occurred. High levels of ⅣC, PⅢNP and infection were the risk factors for AEI-IPF (P<0.05). The areas under the curve of ⅣC and PⅢNP in predicting AE-IPF were 0.718 and 0.768, and the area under the curve of the combination of ⅣC and PⅢNP in diagnosing AE-IPF was 0.940, which was greater than that of ⅣC and PⅢNP alone (Z=3.941,2.991, all P<0.05). Conclusions The serum levels of ⅣC and PⅢNP are significantly increased in the patients with IPF, which are related to the decline of pulmonary ventilation function and the occurrence of AE-IPF, and can be used as predictive markers of AE-IPF. References | Related Articles | Metrics

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Application of general anesthesia without muscle relaxant through nasal tracheal intubation in elderly patients receiving ERCP ZHANG Ji-gang, CAO Xiao-fei, WANG Lei 2023, 37 (9):  934-937.  doi: 10.3969/j.issn.1003-9198.2023.09.017 Abstract ( 86 )   PDF (994KB) ( 703 )   Save Objective To observe and evaluate the feasibility of general anesthesia without muscle relaxant through nasal tracheal intubation in the elderly patients receiving endoscopic retrograde cholangiopancreatography (ERCP). Methods A total of 180 elderly patients who underwent ERCP in endoscopy center of our hospital from April 2019 to April 2021 were randomly divided into tracheal intubation general anesthesia group using muscle relaxant (group S)and nasal tracheal intubation general anesthesia group without muscle relaxant(group N), with 90 cases in each group. At five time points as entering the room (T0), anesthesia induction (T1), endotracheal intubation(T2),intubation of duodenal papilla or incision of oddis sphincter(T3), post-extubation(T4), the levels of heart rate(HR), mean arterial pressure (MAP), pulse oxygen saturation(SpO2), bispectral index(BIS) value were recorded and the recovery time of spontaneous breathing, extubation time, postanesthesia care unit (PACU) retention time were detected, and the adverse events were recorded. Results In both groups, compared with T0, the levels of HR,MAP and BIS were significantly decreased and the level of SpO2 was significantly increased at T1, T2 and T3, and the level of SpO2 was decreased at T4;Compared with T1, the level of MAP was increased at T3, and the levels of HR, MAP and BIS were increased, while the level of SpO2 was decreased at T4;Compared with T2 and T3, the levels of HR, MAP and BIS were increased and the level of SpO2 was decreased at T4(P<0.05).The level of HR at T1and T2, and the level of SpO2 at T4 showed significant differences between group N and group S(P<0.05).The time of respiratory recovery, extubation and PACU stay in group N were significantly shorter than those in group S,and the incidence rate of postoperative hypoxemia was significantly lower than that in group S. Conclusions In the elderly patients undergoing ERCP,general anesthesia without muscle relaxants can avoid muscle relaxant remnants, which can improve the recovery of the postoperative patients, and be helpful to the transport in endoscopy center. References | Related Articles | Metrics

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Effects of different anesthetic modalities on deep brain stimulation in subthalamic nucleus for Parkinson's disease LYU Kun, CAO Wen-ping, WANG Yu-hang, ZHAO Chun-sheng, CAO Sheng-wu 2023, 37 (9):  938-942.  doi: 10.3969/j.issn.1003-9198.2023.09.018 Abstract ( 78 )   PDF (1014KB) ( 802 )   Save Objective To compare the effects of different anesthetic modalities on deep brain stimulation (DBS) in the subthalamic nucleus (STN) in the patients with Parkinson's disease (PD). Methods The clinical data of 158 patients with PD who underwent bilateral STN-DBS surgery at the First Affiliated Hospital of Nanjing Medical University between October 2017 and October 2022 were retrospectively analyzed. Among them, 81 cases received general anesthesia (general anesthesia group) and 67 cases received local anesthesia (local anesthesia group). The coordinates of the intended preoperative frame targets and the actual postoperative implanted targets in both groups were recorded. The preoperative baseline characteristics and the improvement rate of postoperative Unified Parkinson's Disease Rating Scale motor score (UPDRS-Ⅲ) were also compared between the two groups. Results The anterior-posterior distance (y), medial-lateral distance (x) and vertical distance (z) showed no significant differences between intended preoperative frame targets and the actual postoperative implanted targets in the general anesthesia group. Y showed significant difference between the electrodes on both sides in the local anesthesia group, and the actual implanted electrodes were more posteriorly oriented. The operation time was significantly less in the general anesthesia group than that in the local anesthesia group.Three patients experienced asymptomatic cerebral haemorrhage in the local anesthesia group.The improvement rate of UPDRS-Ⅲ 1 month after operation showed no significant difference between the two groups. Conclusions DBS surgery for PD under general anaesthesia can achieve the same results as local anaesthesia surgery, but with a shorter operative time and better safety, which is worth promoting. References | Related Articles | Metrics

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Effect of morning and afternoon surgery on perioperative complication in elderly patients undergoing elective robot-assisted laparoscopic radical prostatectom CHANG Meng-yue, PENG Liang-yu, GU Xiao-ping 2023, 37 (9):  943-946.  doi: 10.3969/j.issn.1003-9198.2023.09.019 Abstract ( 92 )   PDF (998KB) ( 966 )   Save Objective To investigate the effect of different time points of operation on perioperative complications and length of hospital stays in the elderly patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP). Methods In this study, 358 elderly patients who underwent elective RARP surgery in Nanjing Drum Tower Hospital from April 2018 to June 2021 were divided into the morning group and the afternoon group according to whether the starting time of the operation was before 12:00. There were 141 cases in the morning group and 217 cases in the afternoon group. The differences in the preoperative general clinical data and the incidence of intraoperative and postoperative complications were compared between the two groups. Results There were no significant differences in preoperative clinical data between the two groups (P>0.05). Intraoperative blood glucose levels, incidence rate of hyperglycemia and intraoperative blood loss were significantly higher in the morning group than those in the afternoon group(P<0.05).The incidence rate of postoperative acute kidney injury (AKI) showed no significant difference between the two groups. While the level of creatinine was significantly higher and the glomerular filtration rate was significantly lower in the morning group than that in the afternoon group (P<0.05). Furthermore,there was no significant difference in the postoperative urea nitrogen level, postoperative infection rate,the incidence rate of other complications and the length of hospital stays between the two groups (P>0.05).However, the levels of white blood cell count, Neutrophil count, Monocyte count and C-reactive protein level in the morning group were higher than those in the afternoon group(P<0.05). Conclusions Under the conditions of this study, the elderly patients undergoing RARP in the afternoon were more likely to reduce the occurrence of intraoperative hyperglycemia and intraoperative blood loss, protect kidney function and alleviate immune response. However, the starting time of surgery has no significant effect on the incidence of other complications and length of hospital stay. References | Related Articles | Metrics

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Correlation between sarcopenia and post-stroke swallowing dysfunction in elderly patients with stroke CHEN Li-rong, YE Xiao-li 2023, 37 (9):  947-950.  doi: 10.3969/j.issn.1003-9198.2023.09.020 Abstract ( 99 )   PDF (1042KB) ( 971 )   Save Objective To analyze the correlation between sarcopenia and post-stroke swallowing dysfunction in the elderly patients with stroke. Methods A total of 119 elderly patients with stroke admitted to our hospital from November 2019 to April 2021 were enrolled in this study, and the sarcopenia and post-stroke swallowing dysfunction of the patients was assessed within 24 h after admission using the myalgia simple five-item score questionnaire(SARC-F) and the Standardized Swallowing Assessment scale (SSA) respectively. The patients were divided into swallowing dysfunction group and non-swallowing dysfunction group, and the correlation between sarcopenia and post-stroke swallowing dysfunction was analyzed. Logistic regression analysis was used to analyze the influencing factors of post-stroke swallowing dysfunction. Results The incidence rate of sarcopenia in 119 elderly stroke patients was 21.01%, and the incidence rate of post-stroke swallowing dysfunction was 35.29%. There were significant differences in age, and the proportion of diabetes mellitus, chronic heart failure, malnutrition, activity time ＞30 min and sarcopenia between swallowing dysfunction group and non-swallowing dysfunction group(P<0.05). The score of SARC-F was significantly associated with SSA score in the elderly patients with stroke (r=0.624, P<0.01); Logistic regression analysis showed that age > 70 years, diabetes mellitus, chronic heart failure, malnutrition and sarcopenia were the risk factors for the development of swallowing dysfunction after stroke in the elderly (P<0.05). Conclusions Sarcopenia is a high-risk factor for the development of post-stroke swallowing dysfunction. Assessing the occurrence of sarcopenia can be helpful for clinical judgment of the risk of swallowing dysfunction after stroke in elderly. References | Related Articles | Metrics

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Study on application of case management model in elderly patients with chronic heart failure WANG Jing-song, LIN Song, WAN Ming 2023, 37 (9):  960-963.  doi: 10.3969/j.issn.1003-9198.2023.09.023 Abstract ( 90 )   PDF (1012KB) ( 1052 )   Save Objective To investigate the application of case management model in the elderly patients with chronic heart failure (CHF). Methods Eighty-nine elderly patients with CHF from January to June 2020 were enrolled in this study, who all received routine treatment. They were divided into two groups according to random number table, control group (n=44) receiving routine nursing care and management group (n=45) receiving case management model. The levels of LVEF and six-minute walking distance (6MWD)were detected, and quality of life (MLHFQ), NYHA classification and self-efficacy were assessed, and the readmission rate was recorded in all the patients and were compared between the two groups. Results There were no significant differences in cardiac function and MLHFQ scores between the two groups before the intervention (P>0.05). After the intervention, the levels of LVEF, 6MWD, MLHFQ scores and self-efficacy were significantly higher, and the readmission rate was significantly lower in the management group than those in the control group(P<0.05). Conclusions Case management model based on quality of life can effectively improve the cardiac function and self-efficacy, and reduce the readmission rate in the elderly patients with CHF, which could reduce the social and economic pressure of the patients, and shows high application value. References | Related Articles | Metrics

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Application of underarm pad in prevention of medical adhesive-related skin injury and early postoperative functional exercises in elderly patients with breast cancer XU Dan-dan, ZHOU Zheng, ZHOU Li, WANG Li, LIU Li 2023, 37 (9):  964-967.  doi: 10.3969/j.issn.1003-9198.2023.09.024 Abstract ( 97 )   PDF (1181KB) ( 673 )   Save Objective To design an underarm pad used with breast pressure bandage, and to explore its application effect on preventing medical adhesive-related skin injury and early postoperative functional exercises in the elderly patients with breast cancer. Methods A total of 80 elderly patients who underwent modified radical mastectomy for breast cancer in Drum Tower Hospital from July 2020 to March 2021 were enrolled and divided into the pad group (n=37) and the control group (n=43). The pad group used self-designed underarm pad at the junction of self-adhesive pressure bandage and axilla, while the control group used self-adhesive pressure bandage routinely. The incidence rate of medical adhesive-related skin injury, early functional exercise compliance and wound pain score of the two groups were compared. Results Skin injury occurred in 3 patients (8.1%) in the pad group, and in 11 patients (25.6%) in the control group(χ2=4.206,P=0.04) . In terms of early postoperative functional exercise, 19 patients (51.4%) in the pad group exercised for more than 3 times per day, only 7 patients (16.3%) in the control group exercised for more than 3 times per day(χ2=11.151,P=0.001). And 29 patients (78.4%) in the pad group felt comfortable during exercise, and only 6 patients (14.0%) in the control group felt comfortable during exercise(χ2=33.542, P<0.001). The median wound pain score of the pad group was 1 (0, 2) points, while the median wound pain score of the control group was 3 (2, 4) points(Z=7.106,P<0.001). Conclusions The use of underarm pad combined with breast self-adhesive pressure bandage can reduce the occurrence of medical adhesive-related skin injury in the underarm area of the elderly patients with breast cancer, improve the compliance with early functional exercises, and reduce the wound pain to a certain extent. References | Related Articles | Metrics

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Application of lung ultrasound-guided posture strategy combined with localized lung vibration in elderly patients after cardiopulmonary bypass JI Man-fei, QI Ping, CHEN Jing, XU Huai-jin, ZHANG Guo-xin, CHEN Jiu-dong, HONG Liang 2023, 37 (9):  968-972.  doi: 10.3969/j.issn.1003-9198.2023.09.025 Abstract ( 95 )   PDF (1012KB) ( 725 )   Save Objective To explore the effect of posture strategy combined with localized lung vibration guided by lung ultrasound in the elderly patients after cardiopulmonary bypass. Methods From June to November 2022, 128 elderly patients who were admitted to intensive care unit (ICU) of Nanjing First Hospital after cardiopulmonary bypass were randomly divided into control group(n=64) and observation group(n=64). The control group carried out routine posture placement and lung percussion and vibration, while the observation group carried out personalized posture strategy and targeted lung percussion and vibration under the guidance of lung ultrasound. The lung ultrasound score, oxygenation index, sputum output, mechanical ventilation time and ICU hospitalization time of the two groups were compared. Results The lung ultrasound score was significantly lower, and the oxygenation index was significantly higher in the observation group than that in the control group from the second day after the operation (P<0.05). The sputum output in the observation group 24 h after operation was significantly higher than that in the control group (P<0.05); The mechanical ventilation time and ICU hospitalization time in the observation group were significantly shorter than those in the control group(P<0.05). Conclusions The posture strategy and localized lung vibration guided by lung ultrasound can promote the sputum excretion in the elderly patients after cardiopulmonary bypass, improve lung function and oxygenation status, and shorten the time of mechanical ventilation and ICU hospitalization time. References | Related Articles | Metrics