老年与中青年患者下呼吸道感染病原菌的对比分析

目的对比分析老年与中青年患者下呼吸道感染病原菌的分布规律及其耐药性特点,以指导临床合理用药。方法将研究对象分为老年(≥60岁)和中青年(20～59岁)2组;采用API系统进行菌种鉴定;采用K-B法进行药敏试验;采用纸片扩散表型确证法进行超广谱β-内酰胺酶(ESBLs)测定;采用SPSS 13.0进行χ2检验。结果老年组的真菌分离率显著高于中青年组,以白色假丝酵母菌最多;中青年组的G-杆菌分离率显著高于老年组,以铜绿假单胞菌最多;老年组主要致病菌对多数药物的耐药率比中青年组有增高趋势,但差异多无统计学意义;老年组肺炎克雷伯菌的ESBLs阳性率显著高于中青年组。结论老年与中青年患者下呼吸道感染的病原菌分布及耐药性存在一定差异。     

Improving the health behaviours of elderly people: randomised controlled trial of a general practice education programme

ObjectivesTo establish the effect of an educational intervention for general practitioners on the health behaviours and wellbeing of elderly patients.DesignRandomised controlled trial with 1 year follow up.SettingMetropolitan general practices in Melbourne, Australia.Subjects42 general practitioners and 267 of their patients aged over 65 years.InterventionEducational and clinical practice audit programme for general practitioners on health promotion for elderly people.ResultsPatients in the intervention group had increased (a) walking by an average of 88 minutes per fortnight, (b) frequency of pleasurable activities, and (c) self rated health compared with the control group. No change was seen in drug usage, rate of influenza vaccination, functional status, or psychological wellbeing as a result of the intervention. Extrapolations of the known effect of these changes in behaviour suggest mortality could be reduced by 22% if activity was sustained for 5 years.ConclusionsEducation of the general practitioners had a positive effect on health outcomes of their elderly patients. General practitioners may have considerable public health impact in promotion of health for elderly patients.

Key messages

• Few educational interventions for doctors have shown benefit to the health of patients
• Elderly people were identified in the UK health initiatives as in need of additional attention, and levels of health protective behaviours were low in community surveys
• A multifaceted educational intervention for general practitioners was effective in improving walking behaviour, self rated health status, and the frequency of social contacts in elderly patients
• General practitioners are effective in improving health and health behaviours in their elderly patients

     

门诊患者倍他乐克不规范用药分析

目的：针对门诊患者使用倍他乐克不规范的原因进行分析,为临床规范用药提供参考。方法：搜集2011年7月本院心内科普通门诊服用倍他乐克的患者病例,分析其中用药不当的原因以及各种具体表现。结果：373例使用倍他乐克的患者中,不规范用药者占9.39%,包括了用量、用法不正确、擅自减量、停药以及拒绝用药等12种用药不当的具体表现。在不规范用药的患者中,有9人随访间隔时间明显短于其余患者（P〈0.05）,但未被告知调整药物剂量。有8位患者年龄显著高于其余患者（P〈0.05）,由于独居或行动不便,随访间隔时间明显长于其余患者（P〈0.05）。结论：倍他乐克使用不规范的情况并不少见,应当加强临床医师的教育以及对患者的宣教,增加用药的依从性,提高倍他乐克用药的规范性与合理性。     

老年糖尿病患者尿路感染的病原菌分布及耐药性监测

目的：了解我院老年糖尿病患者尿路感染的病原茵分布及耐药情况,指导临床合理用药。方法：选择我院2010-2012年收治的477例老年糖尿病合并尿路感染患者为研究对象,对其中段尿进行细菌培养及药敏分析。结果：本院老年糖尿病患者尿路感染的细菌以革兰氏阴性菌为主,占67．5％,常见致病菌为大肠埃希菌、肠球菌、肺炎克雷伯茵和表皮葡萄球菌,并发现有2种细菌混合感染及真菌并存感染。革兰阴性菌对亚胺培南、阿米卡星和头孢哌酮／舒巴坦的耐药率较低,而对其他抗菌药物的耐药率较高;革兰阳性茵对万古霉索、阿米卡星和呋喃妥因的耐药率较低,表皮葡萄球菌对万古霉素敏感。结论：本院老年糖尿病患者尿路感染的主要病原菌是大肠埃希菌,其对亚胺培南、阿米卡星和头孢哌酮／舒巴坦的耐药率较低,临床可参考应用。     

血清降钙素原(PCT)检测对于老年心衰抗感染治疗的指导意义分析

目的:探讨血清降钙素原(PCT)对于老年心衰患者抗感染治疗中的指导意义。方法:选取我院于2013年1月-2014年6月间收治的130例老年心衰患者,将其随机分为观察组以及对照组,每组65例,对照组根据患者的病情变化决定是否使用抗菌药物,而观察组根据PCT变化决定是否使用抗菌素治疗。比较2组患者的体温、PCT、WBC、CRP变化情况,治疗效果,住院情况以及抗菌素使用情况。结果:观察组在使用抗菌药物当日的PCT水平明显低于入院时,P0.05,而体温、WBC、CRP水平比较无明显差异,使用抗菌药物3 d后,血清PCT水平相比于使用抗菌素当日明显下降,体温相比于入院时显著下降,P0.05。观察组的二重感染率明显低于对照组,P0.05,观察组的抗菌药物使用疗程、费用以及总住院费用均明显低于对照组,组间比较有明显差异,P0.05。结论:PCT指标应用于老年心衰患者应用抗菌素的指导治疗,能够减少抗菌药物的使用量,降低住院费用,减少住院时间,减少二重感染的发生率。     

Drugs and nutrition in old age

Drug effects are influenced by physiologic and pathologic changes that occur as a consequence of aging. The elderly may be more disposed to drug-induced nutrient depletion because of chronic illness, inadequate diet and long-term drug use. Digoxin, isoniazid, corticosteroids, diuretics and psychoactive agents pose special hazards to the nutritional status of elderly patients. On the other hand, dietary factors, such as protein levels or vitamin deficiencies, may be important determinants of age-related changes in drug disposition or toxicity.     

高龄患者血液感染常见革兰阴性杆菌及其耐药性分析

目的分析本院80~100岁高龄患者血液感染常见革兰阴性杆菌的种类及其耐药状况,为本院合理使用抗生素提供依据。方法采用BacT/Alert 3D血培养仪对血液标本进行阳性鉴定;VITEK-2Compact全自动微生物鉴定仪进行鉴定;K-B纸片扩散法对抗菌药物进行敏感性测定;使用WHONET 5.4分析软件分析数据。结果本院高龄患者血液培养阳性标本中共分离出革兰阴性杆菌108株,以肠杆菌科细菌为主,其次为非发酵菌,前者主要为大肠埃希菌52株(48.15%)和肺炎克雷伯菌37株(34.26%),后者主要包括铜绿假单胞菌10株(9.26%)和鲍曼不动杆菌8株(7.41%)。其中大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别为1.92%和13.51%,两者对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢呋辛的耐药率均高于50.00%;铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为20.00%和25.00%,后者对其他抗菌药物的耐药率均高于前者。结论碳青酶烯类抗生素可作为本院高龄患者常见革兰阴性杆菌所致血液感染的首选药物;但在治疗中应考虑细菌的耐药特点及患者的代谢特点合理选择抗生素。     

Improving drug compliance after hospital discharge.

The effect of counselling on medication errors was assessed in 165 elderly patients after leaving hospital. Counselling was effective, with counselled patients making under one-third of the errors made by uncounselled patients. Three types of memory aid were tried to supplement counselling. The pill wheel increased errors, a tablet identification card was unhelpful, and only a tear-off daily calendar seemed to improve results modestly. Counselling was virtually as effective in improving compliance in poorly orientated patients. A designated member of staff should spend about 15 minutes with each elderly patient before discharge to ensure that the discharge drug regimen is fully understood and remembered, that old tablets are destroyed and that other people''s tablets are not taken.     

呼吸内科患者白色念珠菌痰培养阳性的危险因素及耐药性变迁分析

目的分析呼吸内科患者白色念珠菌痰培养阳性的危险因素及对常用抗真菌药物的耐药性,为临床预防、早期诊断及有效治疗提供依据。方法对2007年1月至2009年12月浙江大学医学院附属第一医院呼吸内科白色念珠菌痰培养阳性患者的临床资料进行回顾性调查,统计其年龄分布、可能感染因素、基础疾病、被感染前抗菌药物的使用及近3年对抗真菌药物的耐药性变迁。结果呼吸内科白色念珠菌痰培养阳性的相关因素多,老年、气管插管/切开、机械通气、慢性阻塞性肺疾病及长期多种抗菌药物的使用患者中感染几率明显增高,且3年来,白色念珠菌的耐药性有所升高。结论临床上细心操作、抗菌药谨慎使用是目前减少白色念珠菌感染的重要途径。     

慢性支气管炎患者下呼吸道感染病原菌分布及耐药性分析

目的:研究老年慢性支气管炎患者合并下呼吸道感染病原菌分布以及耐药性。方法:选取2009年1月到2013年12月我院收治的老年慢性支气管炎患者合并下呼吸道感染患者261例,采集所有患者的痰液,然后进行病原菌鉴定和药敏试验。结果:261例患者中,144例革兰阴性杆菌感染(55.2%),51例革兰阳性杆菌感染(19.5%),66例真菌感染(25.3%),其中混合感染者36例(13.8%)。革兰阴性杆菌以肺炎克雷伯菌最多(18.4%),革兰阳性杆菌以金黄色葡萄球菌最多(9.2%)。革兰阴性杆菌对亚胺培南的耐药性最低,其次是头孢哌酮和阿米卡星,对氨苄西林耐药率最高。金黄色葡萄球菌和表皮葡萄球菌对青霉素的耐药率均为100.0%,均对万古霉素敏感,其次是对环丙沙星敏感。结论:老年慢性支气管炎患者合并下呼吸道感染以革兰阴性杆菌感染为主,真菌和混合感染也占一定的比例,应该引起注意。     

68例服胺碘酮的75岁以上老年心律失常患者甲功变化分析

目的：探讨口服小剂量胺碘酮对老年心律失常患者甲状腺功能的作用和影响。方法：回顾性分析老年器质性心脏病心律失常患者68例,记录胺碘酮治疗方案与疗效、甲状腺变化及随访干预措施情况。结果：老年人服用胺碘酮引起甲状腺疾病发生率为31．8％（22／68）,以甲状腺功能减退25．7％（18／68）为主,大致为甲状腺功能亢进（6．1％,4／68）的4倍。采用小剂量胺碘酮方案出现的甲状腺功能紊乱多数经过减量或停药逆转或恢复。结论：老年人服用胺碘酮甲状腺功能紊乱发生率高,但临床表现不典型,应更密切地监测甲状腺功能;甲状腺功能紊乱经胺碘酮及时减量或停药等措施多能逆转或恢复。     

A novel approach to study variable heavy chain gene usage in response to the capsular polysaccharide of Neisseria meningitidis serogroup C

The molecular mechanisms involved in the relatively poor immune response in the elderly are not clearly understood. Qualitative aspects of the immune response could be a possible explanation for the differential response to T-independent antigens in young adults and elderly. This study is directed towards elucidating the differential usage of variable heavy chain by young adult and elderly derived sequences in response to the capsular polysaccharide of Neisseria meningitidis serogroup C. We currently report findings of a preliminary study designed to test the feasibility of a novel approach to isolate antigen-specific B cells. Paramagnetic beads coated with an anti-idiotypic antibody, which mimics the capsular polysaccharide of N. meningitidis serogroup C, were used to select B cells. Analysis of the gene usage data indicates some unexpected differences in the use of variable chain heavy chain in the case of young adult versus elderly sequences. The elderly derived sequences use a more diverse array of V_H gene families in contrast to the young adult sequences, where the V_H gene family usage is restricted. Nearly half the young adult sequences utilize V_H3-15 germline sequence while only 25% of the elderly sequences use this germline sequence. There were interesting differences in the types of JH chain and the composition and length of CDR3 utilized by the two groups. Together, these significant differences may contribute towards the poor immune response to T-independent antigens in the elderly. These data validate the techniques used for these studies and suggest that it is pertinent to use this approach towards future investigations to elucidate gene usage in response to an antigen.     

老年患者阴沟肠杆菌感染的临床特点及耐药性分析

目的了解我院老年患者阴沟肠杆菌感染的临床分布及耐药性变迁,为临床合理用药提供参考依据。方法采用回顾性分析方法,统计临床数据并分析我院2011年9月至2016年4月期间老年患者感染标本中分离出的阴沟肠杆菌的感染现状及耐药性。结果共检出149株阴沟肠杆菌,主要分离于痰液、全血和尿液中,分别占31.54%、24.16%和18.12%。在科室分布中,阴沟肠杆菌感染主要来源于普通外科、重症监护病房和呼吸内科,分别占26.84%、14.10%和14.10%。药敏结果显示阴沟肠杆菌对美罗培南、亚胺培南和阿米卡星具有较好的抗菌活性,敏感率分别为100.00%、96.64%和95.97%,而对阿莫西林/克拉维酸、氨苄西林、头孢替坦、头孢西丁和头孢唑啉的耐药率分别为96.36%、96.36%、97.67%、100.00%和100.00%。结论阴沟肠杆菌易引起呼吸道、泌尿道以及伤口的感染,且其耐药现象较为严重,应加强耐药性的监测,根据药敏结果合理选用抗菌药物,以控制医院感染。     

老年慢性便秘患者社区干预治疗评价

目的:评价老年慢性便秘患者社区干预治疗的疗效。方法:将2010年3月-2011年4月我院门诊收治的62例老年便秘患者随机均分为两组,对照组给予常规药物治疗,研究组在对照组治疗基础上辅以社区干预治疗,治疗半年后观察两组患者疗效。结果:治疗半年后,两组临床症状均有改善,但较对照组,研究组改善更为显著P<0.05;对照组治疗有效率为67.74%,研究组有效率为90.32%,两组比较差异显著P<0.05。结论:老年慢性便秘患者在常规药物治疗基础上辅以社区干预治疗,疗效显著,为老年慢性便秘治疗的有效方法。     

老年髋部骨折合并慢性血吸虫病患者围手术期凝血功能变化的临床研究

目的:探讨合并慢性血吸虫病的老年股骨粗隆间骨折患者围手术期肝功能及凝血功能的变化。方法:2015年9月-2018年6月,我院共治疗老年股骨粗隆间骨折260例,其中合并慢性血吸虫病的患病组患者115例,未合并慢性血吸虫病的正常组患者145例,分析和比较术前术后肝功能指标、凝血功能指标的变化。结果:两组患者术前腹部腹水量(ABD),血清白蛋白(ALB),胆红素(TBIL),丙氨酸转氨酶(ALT),凝血酶原时间(PT),纤维蛋白原定量(FIB)均存在显著性差异。术后两组患者的腹部腹水量(ABD),胆红素(TBIL),丙氨酸转氨酶(ALT),凝血酶原时间(PT),活化部分凝血活酶时间(APTT)、纤维蛋白原定量(FIB)均存在显著性差异。药物调整后患病组肝功能和凝血功能显著改善。结论:与正常组相比,合并慢性血吸虫病的老年股骨粗隆间骨折患者,围手术期术前及术后肝功能、凝血功能均存在明显异常。通过术前药物治疗及围手术期的药物维持,患病组的肝功能及凝血功能指标有明显好转,但术后肝功能、凝血功能仍需要积极的进行治疗干预。同时,术后抗凝药物治疗需要谨慎。     

Effect of Age and Sex on Human Drug Metabolism

The capacity of inpatients in a geriatric hospital to metabolize drugs was measured. The mean plasma half-life values with antipyrine and with phenylbutazone were found to be 45% and 29% greater respectively in patients than in young controls. When women alone were considered the half-life of antipyrine was 78% longer in the elderly group. In a number of elderly individuals the rate of metabolism of these two drugs was found to be extremely slow. This decreased ability to metabolize drugs may contribute to the known high incidence of adverse drug reactions in the elderly.Within the control group a significant sex difference in the rate of antipyrine metabolism was found, the mean half-life being 30% longer in the males. It is clear from these results that the age and sex of subjects must be taken into account in studies of human drug metabolism.     

Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital

doi: 10.1111/j.1741‐2358.2011.00603.x
Prevalence of gingival overgrowth among elderly patients under amlodipine therapy at a large Indian teaching hospital Objectives: To determine the prevalence of amlodipine‐induced gingival overgrowth (GO) among elderly subjects attending an Indian teaching hospital and find any association with demographic factors, drug variables, oral hygiene status and gingival inflammation. Methods: A cross‐sectional pilot study included 157 dentate patients aged 60 years or more, taking Amlodipine for at least 3 months. Data were collected from past medical records and oral examination. Clinical assessment of GO was correlated with patient’s age, gender, drug dosage (2.5, 5 or 10 mg/day), duration of drug therapy (3–4, 4–6, 6–12, 12–24 and >24 months) and also with subjects’ plaque index and gingival index scores. Results: Eight patients (5.09%) had GO. No statistically significant relation was observed between age (p = 0.79), gender (p = 0.56), drug dosage (p = 0.25) and duration of drug intake (p = 0.62) and prevalence of GO. GO prevalence related highly significantly (p < 0.001) with plaque and gingival index scores. Conclusions: Prevalence of amlodipine‐associated GO in the sample of elderly Indian patients was noted higher than that previously reported. Plaque and gingival inflammation were highly correlated with this condition, while demographic characteristics and drug dosage did not relate significantly.     

Effects of Renal Function on Plasma Digoxin Levels in Elderly Ambulant Patients in Domiciliary Practice

An investigation into the relations between the daily dose of digoxin, drug regimen, serum digoxin concentration, and creatinine and digoxin clearance was carried out in a group of elderly ambulant patients in domiciliary practice. Moderate to severe impairment of renal function was found both in patients taking digoxin and in elderly control subjects. Plasma digoxin levels were not related to blood urea concentrations or creatinine clearance. Digoxin clearance was less than creatinine clearance. Now that plasma digoxin levels can be measured relatively easily their estimation should become part of clinical practice.