104例老年单纯收缩期高血压者随访报告（摘要）

１０４例老年单纯收缩期高血压者随访报告（摘要）鞍钢铁西医院王云献,程晓鸥本文报告对１０４例单纯收缩期高血压患者进行２年随访,该组患者收缩压≥１６０ｍｍＨｇ,舒张压＜９５ｍｍＨｇ,而临床上无明显症状,且无心、脑、肾、眼底等脏器并发症;排除继发性高血压;...     

老年高血压病人的护理

高血压是老年人常见疾病之一,随着人们的生活水平不断提高,人均寿命也随之不断延长。据世界卫生组织的权威统计,65岁以上的老年人约占高血压患病群体总数的一半。如今,我国老年人口占总人口的9%,患有高血压疾病的老年人总数接近5000万。高血压是脑血管病及冠心病的重要危险要素。有效地控制高血压,帮助患者正确认识高血压病的治疗对减少或避免患者关键脏器受损有着关键作用。     

老年人肾脏B超检查分析

本文对248例老年人肾脏B超检查进行了分析,对198例60岁以上的老年人正常肾脏长、宽、厚三径线作了B超测量,并与随机抽样的正常肾作了对照。发现长径和宽径均较对照组缩小,统计学处理有显著意义。另就50例老年人各种肾脏病变,特别是单纯性肾囊肿及肾发育不良的诊断进行了分析和讨论。     

老年人单纯性尿路感染病原菌的分布及耐药性分析

【摘 要】 目的 研究引起老年人单纯性尿路感染的病原菌的分布情况及其耐药性。 方法 对新疆医科大学第一附属医院2009年至2012年期间患者尿培养分离出的1035株细菌进行鉴定,并采用K\|B纸片扩散法进行耐药性分析。 结果 致老年人单纯性尿路感染的病原菌以大肠埃希菌为主（54.0%）,其次分别为粪肠球菌（15.1%）、肺炎克雷伯菌（8.7%）、金黄色葡萄球菌（7.2%）;大肠埃希菌、肺炎克雷伯菌和变形杆菌除对亚胺培南保持100%敏感外,对其他抗生素的耐药率均呈上升的趋势;粪肠球菌、金黄色葡萄球菌和表皮葡萄球菌除同时对万古霉素保持100 %敏感外,对其他抗生素的耐药率也较严重。 结论 老年人单纯性尿路感染的病原菌耐药性严重,不能单凭经验选择抗生素,应该在细菌培养和药敏试验的指导下慎重选用敏感药物。     

老年高血压病的护理与自我保健

高血压是老年人常见病之一,严重影响老年人的心身健康。认真护理及指导病人坚持保健预防是提高老年人生命质量的重要环节。1临床资料本组20例,男12例,女8例,年龄54~76岁;有高血压病史者最短1年,最长3年。经做好护理工作及指导病人坚持自我保健,20例患者血压稳定,未出现高血压并     

丽水市缙云县农村地区老年人高血压患病率及影响因素

目的:通过对丽水市缙云县农村地区老年人高血压患病率及影响因素的调查,以期对当地老年人高血压的预防提供理论依据。方法:用随机抽样的方法对丽水市缙云县的五云镇、壶镇镇、新建镇、胪膛镇共4个镇共1260名老年人进行义诊血压测量并当面进行问卷调查,然后对其结果进行分析。结果:1260名被调查老年人中有689名患高血压,其患病率为54.68%。结论:丽水市缙云县农村地区高血压患病率较高,需引起相关部门的重视,并采取积极的预防和治疗措施。     

老年人单纯性尿路感染病原菌的分布及耐药性分析

目的 研究引起老年人单纯性尿路感染的病原菌的分布情况及其耐药性.方法 对新疆医科大学第一附属医院2009年至2012年期间患者尿培养分离出的1035株细菌进行鉴定,并采用K-B纸片扩散法进行耐药性分析.结果 致老年人单纯性尿路感染的病原菌以大肠埃希菌为主(54.0％),其次分别为粪肠球菌(15.1％)、肺炎克雷伯菌(8.7％)、金黄色葡萄球菌(7.2％);大肠埃希菌、肺炎克雷伯菌和变形杆菌除对亚胺培南保持100％敏感外,对其他抗生素的耐药率均呈上升的趋势;粪肠球菌、金黄色葡萄球菌和表皮葡萄球菌除同时对万古霉素保持100％敏感外,对其他抗生素的耐药率也较严重.结论 老年人单纯性尿路感染的病原菌耐药性严重,不能单凭经验选择抗生素,应该在细菌培养和药敏试验的指导下慎重选用敏感药物.     

H型高血压合并阻塞性睡眠呼吸暂停低通气综合征的观察

目的:探讨H型高血压与阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的相互关系。方法:选择2013年10月至2014年8月在上海市浦南医院心内科就诊的78例高血压住院患者,血浆同型半胱氨酸(Hcy)水平≥10μmol/L为H型高血压、血浆Hcy水平10μmol/L为单纯性高血压。两者分别用便携式睡眠监测仪(PMD)检测,比较两组结果的差异。结果:H型高血压组的呼吸暂停低通气指数(AHI)高于单纯性高血压组(P0.05),H型高血压组的OSAHS发病率与单纯组无差异(P0.05),在有OSAHS的高血压病人中,H型高血压组有较高的中重度OSAHS的发病率(P0.01)。结论:在高血压患者中,没有发现血浆Hcy水平与OSAHS相关。但是一旦存在OSAHS,则合并H型高血压患者中出现中重度OSAHS的概率较高。     

蝮蛇抗栓酶治疗老年高血压的临床观察

高血压病是老年人常见病，是老年人致死致残的首要原因，临床上应加强防治。我们在原治疗高血压的药物不变的情况下，伍用蝮蛇抗栓酶，观察其对老年高血压的治疗作用，现报告如下。１资料与方法１．１病例选择与分组按照１９９３年ＷＨＯ与国际高血压协会标准，陆续选择了...     

吉林省二道白河地区农村老年人营养健康状况调查研究

摘要：目的：了解吉林省安图县二道白河地区农村老年人营养健康状况和存在的主要问题,为科学、全面地开展农村老年人营养健康保健体系的建设提供支撑。方法：按照分层整群随机抽样原则,以农村为单位随机抽取调研点60岁以上老年,对其基本情况、体格情况、生活习惯、患病情况等进行问卷调查和体格检查。结果：吉林省二道白河地区农村老年人消瘦发生率为3.40%,超重发生率为23.76%,男性消瘦发生率高于女性,女性超重发生率高于男性,吸烟的老年人比例为13.43%,饮酒的老年人比例为61.42%,主要以啤酒、白酒为主,烹调方法主要以煎炒、蒸煮为主。高血压、慢性胃病、血脂异常是吉林省二道白河地区农村老年人患病率较高的疾病,患病率分别为25.46%、7.41%、6.48%。结论：吉林省二道白河地区农村老年人超重率较高,饮酒现象严重,烹调方式中煎炒比例较高,高血压的发生率较高。应该重视加强老年人营养,改善老年人生活习惯,降低老年人高血压、慢性胃病、血脂异常等疾病的发生。     

Management of elderly patients with sustained hypertension.

OBJECTIVE--To assess the clinical benefits of treating hypertension in elderly patients and to derive practical guidelines regarding indications, goals, and forms of treatment. DESIGN--Review of six published randomised trials. RESULTS--Active treatment of hypertension in elderly patients was associated with significant improvements in several indices of cardiovascular morbidity and mortality, particularly the incidence of fatal and non-fatal strokes. On the basis of the trial data, combined systolic and diastolic hypertension was defined as a sustained systolic pressure greater than 160 mmHg and diastolic pressure greater than 90 mmHg. There is convincing evidence that efforts should be made to reduce both systolic and diastolic pressures to below these levels in patients up to the age of 80 years. Isolated systolic hypertension was defined as a systolic pressure greater than 160 mmHg in the presence of a diastolic pressure less than 90 mmHg. Two trials reported benefit from the treatment of isolated systolic hypertension in patients up to the age of 80, and further trials are underway to support or refute this recommendation. Diuretics have an established role in the management of hypertension in elderly patients; beta adrenoceptor antagonists have given variable results, and the benefits are less impressive than with diuretic based regimens. Newer agents show promise in the treatment of elderly patients, particularly in the presence of coexisting disease, but their effects on morbidity and mortality have not been evaluated in large randomised trials. CONCLUSIONS--Diuretics rather than beta blockers are the treatment of choice for patients with uncomplicated hypertension, but combinations of drugs may be required in as many as 50% of patients.     

老年高血压患者颈动脉内膜中膜厚度与动态血压参数的相关性

目的:探究老年高血压患者颈动脉内膜中膜厚度(IMT)与动态血压参数间的相关关系,为老年高血压患者的临床治疗提供理论基础。方法:选取2015年1月至2016年1月在我院接受治疗的老年高血压患者204例,根据超声检查结果分为A、B、C三组,每组68例。24 h无创检测患者动态血压参数,包括24h平均收缩压(24h SBP),24 h平均舒张压(24h DBP)、白天平均收缩压(d SBP)、白天平均舒张压(d DBP)、夜间平均收缩压(n SBP)、夜间平均舒张压(n DBP),24h脉压(24h PP)及白天脉压(d PP)、夜间脉压(n PP),记录冠心病的发生率、杓型与非杓型高血压比例,利用Person相关性分析IMT与冠心病发生率及动态血压参数的相关性。结果:收缩压和脉压比较差异均有统计学意义(P0.05),其中B组、C组高于A组,C组高于B组,差异具有统计学意义(P0.05)。非杓型高血压在A组占54.41%,B组占60.29%,C组占79.41%,各组间差异有统计学意义(P0.05);A组、B组、C组冠心病发病率分别为41.18%、54.41%和91.18%,组间比较差异有统计学意义(P0.05)。IMT同冠心病发生率和24h SBP、d SBP、n SBP、24h PP、d PP、n PP呈正相关(r=0.876,0.448,0.378,0.476,0.443,0.491,0.438,P0.05)。结论:老年高血压患者收缩压,脉压升高以及非杓型高血压是造成颈动脉内膜中膜厚度增加的主要原因,同时,IMT与冠心病发病率和动态血压参数间呈正相关关系。     

坎地沙坦酯治疗老年患者原发性高血压的疗效及安全性分析

目的:探讨坎地沙坦酯治疗老年高血压患者的疗效和安全性。方法:选取我院110例老年原发性高血压患者,随机分为观察组(坎地沙坦酯治疗)和对照组(依那普利治疗),对比分析两组患者药物治疗前、后的动态血压监测及相关指标。结果:经两个月治疗后,两组患者坐位收缩压(SBP)及舒张压(DBP)谷值均较基线明显降低,观察组下降幅度明显大于对照组,差异有统计学意义(P0.05);观察组的总有效率为90.91%,明显高于对照组的76.36%,差异有统计学意义(P0.05)。结论:坎地沙坦酯治疗老年患者原发性高血压疗效显著,可明显降低收缩压和舒张压,是治疗老年性高血压理想的制剂。     

Perspective on hypertension in the elderly.

More than half of elderly men and women have hypertension, leading to a significant risk of increased morbidity and mortality. The cause of hypertension in this age group is unknown. Left ventricular hypertrophy is frequently present, often associated with diastolic dysfunction. Systolic hypertension in the elderly increases the risk of cardiovascular disease, but there are no good data to show that the treatment of isolated systolic hypertension reduces the morbidity or mortality. Good evidence indicates that antihypertensive treatment in this group decreases cardiovascular morbidity and mortality up to age 80, so most elderly hypertensive patients should be treated. An empiric trial of nonpharmacologic therapy can be initiated in those with mild hypertension and no cardiovascular disease, but most patients will require drug therapy. Most elderly hypertensive patients have accompanying illnesses for which they may or may not be taking medications. Some antihypertensive drugs exacerbate coexisting diseases while others augment treatment regimens. Similarly, drugs may interact in a beneficial or adverse way. Finally, drug metabolism is altered by age, leading to problems with toxicity or diminished efficacy. The choice of medication should be based on all such considerations, including the cost and convenience of the drugs available.     

Changes in renal autacoids and hemodynamics associated with aging and isolated systolic hypertension

The aging kidney is characterized by a decrease in renal blood flow and glomerular filtration rate mainly due to glomerulosclerosis. Nevertheless, even in the presence of these changes, the kidney maintains its functionality until advanced age. However, there is a tendency towards greater renal vasoconstriction in the elderly as compared with young individuals. This occurs either in physiological circumstances such as physical exercise, or in disease manifestations, such as the effective circulatory volume depletion that develops, for example, in heart failure. This tendency may be secondary to the reduction of renal autacoid modulatory capacity, particularly at the vasodilating prostaglandin level. In an acute experimental model we could demonstrate that, in the healthy elderly, the renal response to adrenergic activation by mental stress is characterized by a prolonged and pronounced vasoconstriction. In addition to this, in elderly patients affected by isolated systolic hypertension, we demonstrated an impairment of renal hemodynamic and humoral adaptation capacity in response to adrenergic activation and blood pressure increase. In the presence of sudden blood pressure increase, the kidney of these patients responds with a passive vasodilation and a glomerular filtration rate increase without any activation of humoral modulatory substances. The impairment in renal adaptation capacity may predispose these patients to renal injury, particularly in the presence of the many hypertensive peaks which characterize everyday life of elderly individuals. In conclusion, these results show that renal adaptation capacity of elderly patients with isolated systolic hypertension is completely lost. Further studies will elucidate whether antihypertensive treatment per se, or specific classes of antihypertensive drugs, are able to revert this impairment.     

老年原发性高血压患者脉搏波传导速度与心脑血管危险因素关系的研究

目的:探讨老年原发性高血压患者脉搏波传导速度与心脑血管危险因素关系。方法:随机选取2012年5月至2012年8月在我院体检的160例新诊老年原发性高血压患者及120例健康个体,所有个体均未接受治疗,采用动脉硬化检测仪测定患者肱踝脉搏波传导速度(baPWV),同时测量身高、腰围、体重、血压、总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FBS)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、尿酸(UA)、肌酐(Cr)等指标,探讨老年原发性高血压患者高脂血症、吸烟、肥胖、糖尿病等危险因素与baPWV指标变化的关系。结果:不同血压分级的老年原发性高血压患者之间肱踝脉搏波传导速度值存在显著差异(P0.01)。合并冠心病、肥胖、糖尿病、吸烟、高脂血症等危险因素的高血压患者baPWV值显著高于单纯性原发性高血压患者(P0.01)。多元回归分析表明:吸烟史(P0.01)、冠心病史(P0.01)、糖尿病史(P0.01)、年龄(P0.01)、腰围(P0.01)、血压(P0.01)、HDL-C(P0.01)、TC(P0.01)、FBS(P0.01)、LDL-C(P0.01)、Cr(P0.01)是baPWV升高的独立风险因素。结论:老年原发性高血压患者存在不同程度的的动脉僵硬增高,常见心脑血管风险因素同样影响老年原发性高血压患者僵硬度。     

Predictors of normotension on withdrawal of antihypertensive drugs in elderly patients: prospective study in second Australian national blood pressure study cohort

ObjectivesTo identify simple long term predictors of maintenance of normotension after withdrawal of antihypertensive drugs in elderly patients in general practice.DesignProspective cohort study.Setting169 general practices in Victoria, Australia.Participants503 patients aged 65-84 with treated hypertension who were withdrawn from all antihypertensive drugs and remained drug free and normotensive for an initial two week period; all were followed for a further 12 months.ResultsThe likelihood of remaining normotensive at 12 months was greater among younger patients (65-74 years), patients with lower “on-treatment” systolic blood pressure, patients on single agent treatment, and patients with a greater waist:hip ratio. The likelihood of return to hypertension was greatest for patients with higher “on-treatment” systolic blood pressure.ConclusionsAge, blood pressure control, and the number of antihypertensive drugs are important factors in the clinical decision to withdraw drug treatment. Because of consistent rates of return to antihypertensive treatment, all patients from whom such treatment is withdrawn should be monitored indefinitely to detect a recurrence of hypertension.

What is already known on this topic

Systematic reviews have identified predictors of success of withdrawal of antihypertensive medicationThe reviewed studies have mainly been in a hospital or specialist clinic setting, and their recommendations may not be practical in general practice

What this paper adds

This study has identified simple predictors of success that are readily available to general practitionersOn-treatment systolic blood pressure, the number of blood pressure lowering drugs, and the age of the patient are reliable indicators of who may successfully stop taking their drugsGeneral practitioner practitioners should not be dissuaded from offering drug withdrawal to patients with greater waist:hip ratios     

苯磺酸左旋氨氯地平在治疗老年轻中度高血压中的作用

目的：观察探讨苯磺酸左旋氨氯地平治疗老年轻中度高血压患者的临床疗效和安全性。方法：160例老年轻中度高血压患者随机分为研究组与对照组,研究组给予苯磺酸左旋氨氯地平;对照组给予苯磺酸氨氯地平,治疗过程中进行24h血压监测,总治疗8周为一疗程。结果：研究组4周末和8周末的总有效率分别为78.75%和96.25%,显著高于对照组的53.75%和86.25%,差异有统计学意义（P〈0.05）。治疗前后两组的舒张压和收缩压均有明显降低,其中研究组收缩压平均下降（29.0±3.2）mmHg,舒张压平均下降（15.3±2.3）mmHg,对照组则分别下降（18.5±2.8）mmHg和（9.0±2.5）mmHg,差异具有统计学意义（P〈0.05）。治疗8周末的24h、白昼和夜间的收缩压和舒张压均有明显降低,差异有统计学意义（P〈0.05）,但治疗组下降更明显,与对照组比较差异有统计学意义（P〈0.05）。治疗后两组的脉压均有明显降低,差异具有统计学意义（P〈0.05）,但研究组下降更明显。结论：苯磺酸左旋氨氯地平治疗老年轻中度高血压临床疗效好,不良反应少,且对心脏具有保护功能。     

脉压差预测中老年脑白质病变的临床价值

目的:研究脉压差等危险因素在中老年脑白质病变(WMLs)中的作用及临床意义。方法:入选213例无神经病学症状及体征的中老年病人(年龄>50岁),根据MRI影像学诊断标准分为中重度WMLs组(125例)及轻无WMLs组(88例),通过回顾性分析,记录年龄、性别、高血压史、糖尿病史、吸烟史、脉压差、收缩压、舒张压、血脂水平、左房内径,比较两组间各项指标差异,并做Binary Logistic回归分析,筛选出WMLs的独立危险因素。结果:在控制了高血压、年龄及其他混杂因素后,脉压差仍与WMLs密切相关,且独立于年龄和高血压,是WMLs的独立危险因素,OR值为2.954,95%CI 1.032~8.453。结论:压差在预测中老年人亚临床脑血管事件中可能起到重要作用。     

苯磺酸左旋氨氯地平在治疗老年轻中度高血压中的作用

目的:观察探讨苯磺酸左旋氨氯地平治疗老年轻中度高血压患者的临床疗效和安全性。方法:160例老年轻中度高血压患者随机分为研究组与对照组,研究组给予苯磺酸左旋氨氯地平;对照组给予苯磺酸氨氯地平,治疗过程中进行24h血压监测,总治疗8周为一疗程。结果:研究组4周末和8周末的总有效率分别为78.75%和96.25%,显著高于对照组的53.75%和86.25%,差异有统计学意义(P<0.05)。治疗前后两组的舒张压和收缩压均有明显降低,其中研究组收缩压平均下降(29.0±3.2)mmHg,舒张压平均下降(15.3±2.3)mmHg,对照组则分别下降(18.5±2.8)mmHg和(9.0±2.5)mmHg,差异具有统计学意义(P<0.05)。治疗8周末的24h、白昼和夜间的收缩压和舒张压均有明显降低,差异有统计学意义(P<0.05),但治疗组下降更明显,与对照组比较差异有统计学意义(P<0.05)。治疗后两组的脉压均有明显降低,差异具有统计学意义(P<0.05),但研究组下降更明显。结论:苯磺酸左旋氨氯地平治疗老年轻中度高血压临床疗效好,不良反应少,且对心脏具有保护功能。