ObjectiveTo investigate the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice of elderly patients. MethodsTotally 338 patients with obstructive jaundice underwent ERCP were divided into elderly group (age ≥60 years old) and nonelderly group (age lt;60 years old) based on age. The levels of serum amylase (AMY), ALT, and TBIL in 6, 24, and 48 h after ERCP were detected. The success rate of cholangiopancreatography, accuracy rate of diagnosis, and incidence of complications after ERCP in two groups were analyzed. ResultsThe difference of serum AMY, ALT, and TBIL levels of patients in 6, 24, and 48 h after ERCP were not significant between two groups (Pgt;0.05). The success rate of cholangiopancreatography in nonelderly group was 96.3% (130/135) and in elderly group was 96.1% (195/203), and no difference was found (Pgt;0.05). However, the accuracy rate of diagnosis of ERCP in nonelderly group (84.6%, 110/130) was significantly lower than that in elderly group (98.5%, 192/195), Plt;0.05. The difference of the incidence of complications was not significant between two groups 〔14.8% (20/135) vs. 17.2% (35/203)〕, Pgt;0.05. There was no mortality in two groups patients. ConclusionERCP is a safe, effective, and accurate method, which is of importance to the diagnosis of obstructive jaundice in elderly patients.
ObjectiveTo investigate the epidemiological situation of pre-hospital emergency elderly and non-elderly patients in Chengdu and explore the characteristics of pre-hospital care in the city.MethodAll pre-hospital care records in the Chengdu 120 Emergency System Database in 2017 were retrospectively collected. According to the age of the patients, they were divided into the elderly group (≥60 years old) and the non-elderly group (<60 years old). The disease spectrum, the trends of the number of emergency help calls, the changes in different diseases over time, as well as the disease composition of the patients who died in the two groups were compared.ResultsA total of 179 387 pre-hospital emergency patients were enrolled, including 59 980 elderly patients and 119 407 non-elderly patients. Most of them were male patients in both groups. Patients in the elderly group were mainly between 60 to 89 years old, and the ones in the non-elderly group were mainly between 18 to 59 years old. The pre-hospital emergency patients in the elderly group presented with trauma, nervous system, symptoms and signs, and cardiovascular system diseases mainly, accounting for 29.19%, 14.64%, 13.82%, and 12.86%, respectively. In the non-elderly group, trauma, acute poisoning, and symptoms and signs were predominant, accounting for 50.89%, 10.98%, and 10.08%, respectively. Among the pre-hospital deaths, the number in the elderly group was the larger, accounting for 69.61% (7 043 cases); the mortality rate was 11.74%, with sudden death (28.70%), cardiovascular diseases (25.95%), and respiratory diseases (16.07%) being the major causes. The pre-hospital mortality rate of non-elderly patients was 2.58%, mainly including traumatic diseases (35.41%), sudden death (unknown cause of death) (25.33%), and cardiovascular diseases (17.56%). The number of emergency help calls in the elderly group began to increase gradually from September, reaching a peak in December and hitting the trough in February. While in the non-elderly group, the peak of the emergency help calls appeared in July, and it also fell to the lowest in February. The proportion of the number of emergency help calls in the elderly group was higher in January to February and October to December; while the peak in non-elderly group was in July. The number of emergency help calls in the elderly group were mainly concentrated in the daytime (08:00 to 20:00). In the non-elderly group, the changes in the number of emergency help calls were similar to that of the elderly, however, with another peak (20:00 to 24:00). The proportion of the number of emergency help calls in the elderly group was 06:00 to 09:59, and the peak time of the non-elderly group was in the early morning (00:00 to 04:59) and night (20:00 to 23:59).ConclusionsThe number of pre-hospital care for elderly and non-elderly patients has its own characteristics in terms of the time and the distribution of disease spectrum. Trauma and cardiovascular diseases are the most common causes of pre-hospital care and death in Chengdu. And the pre-hospital mortality in the elderly group is much larger than that in non-elderly group. Relevant departments can allocate emergency resources rationally, and focus on improving the on-site rescue capacity towards related diseases.
ObjectiveTo investigate old (the no less than 60-year-old) inpatient's diseases and cost constitution of a tertiary hospital in West China from 2008 to 2012, so as to provide baseline data for further research.
MethodsThe case records of no less than 60-year-old inpatients in the tertiary hospital were collected from 2008 to 2012, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis, length of hospital stay and hospitalization costs, were analyzed using Stata10.0 software.
Resultsa) The total number of old inpatients was 109 585, and male (59.57%) was more than female (40.43%). The disease spectrum included 18 categories. The percentage of old inpatients increased from 31.57% (2008) to 34.25% (2010). b) The top three systematic diseases were neoplasms, diseases of the circulatory system and diseases of the digestive; the male inpatients were more than the female; the number of inpatients who suffered from the top three systematic diseases got decreased with age increasing; neoplasm was the most common disease, there were 34 944 malignant neoplasm inpatients. c) The cumulative constituent ratio of the top five malignant neoplasms in male and female inpatients were respectively 62.51% and 49.44%; and the top five malignant neoplasms of male inpatients were malignant neoplasm of bronchus and lung, other medical care for neoplasm, malignant neoplasm of esophagus, malignant neoplasm of stomach and malignant neoplasm of prostate. The top five malignant neoplasms of female inpatients were other medical care for neoplasm, malignant neoplasm of bronchus and lung, malignant neoplasm of breast, malignant neoplasm of stomach and malignant neoplasm of cervix uteri. d) The average length of hospital stay decreased from 14.12 days to 11.00 days since 2008, and the average cost per capita increased from ￥14 044.79 yuan to ￥18 932.81 yuan since 2008. The proportion of drug cost of inpatients hospitalization cost decreased from 47.21% to 42.16% since 2008.
ConclusionThe male inpatients are more than female in the tertiary hospital from 2008 to 2012. The most common systematic disease is neoplasm, especially the malignant neoplasms with higher constituent ratio. The top five malignant neoplasms of male inpatients and female are different. The average length of stay in hospitals has declined in five years, however the average cost per capita has increased.
Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.
To evaluate the development prevention and treatment of pneumonic injury after operation on aged patients with abdominal infection. We analyzed 77 aged patients (＞60 y) admitted from Jan. 1991 to Dec. 1992: 38 cases of which with abdominal infection (infection group), 39 cases without abdominal infection (non-infection group). All patients were given oxygen therapy and continuous SaO2 monitoring. Results: There were 28 patients with hypoxemia (SaO2＜95%) in infection group, with an occurrence rate of 73.7%. In non-infection group (12 patients), the rate of hyoxemia was 30.8%, which has significant difference between two groups (Ｐ＜0.001). All patients with hypoxemia were given oxygen therapy and 31 patients′ SaO2 was elevated. The efficient rate was 77.5%. Other 9 patients developed ARDS, the rate was 2.5% (9/40). In the infection group 8 patients developed ARDS with an occurrence rate of 21.1%. There was one patient with ARDS in the non-infection group, the rate was 2.6%. There was significant difference between two group (Ｐ＜0.05). Conclusions: The results suggest that hypoxemia is liable to occur in aged patients with abdominal infection after operation and these patients were liable to develop ARDS. Oxygen therapy and SaO2 monitoring is the important managements to these patients in prevention of pneumonic injury.
ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.
ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and serum inflammatory factors in elderly patients.MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases from inception to April 2017, to collect randomized controlled trials (RCTs) about dexmedetomidine for early POCD in elderly patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 23 RCTs, including 2 026 patients were enrolled. The results of meta-analysis showed that, the incidence of POCD in the dexmedetomidine group was lower than that in the control group (the first day: RR=0.40, 95%CI 0.30 to 0.53, P<0.000 01; the third day: RR=0.33, 95%CI 0.23 to 0.48,P<0.000 01; the seventh day: RR=0.42, 95%CI 0.22 to 0.78,P=0.006). Meanwhile, compared with the control group, the dexmedetomidine group significantly decreased the serum levels of TNF-α (immediately after operation: MD=–5.43, 95%CI –7.44 to –3.42, P<0.000 01; 1 h after operation: MD=–4.64, 95%CI –6.92 to –2.36,P<0.000 1; 24 h after operation: MD=–3.27, 95%CI –4.92 to –1.63,P<0.000 1) and IL-6 (immediately after operation: MD=–30.69, 95%CI –41.39 to –20.00,P<0.000 01; 1h after operation: MD=–20.84, 95%CI –28.87 to –12.80,P<0.000 01; 24 h after operation: MD=–13.42, 95%CI –19.90 to –6.94,P<0.000 1).ConclusionCurrent evidence indicates that dexmedetomidine could relief early POCD in elderly patients, in which the reduction of serum inflammatory factors alleviate inflammation response may play a vital role. Due to the limited quality and quantity of included studies, more high quality RCTs are required to verify the above conclusion.
ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia.
MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients.
ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05).
ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.
