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Effect of Levofloxacin Combined with Azithromycin on Refractory Respiratory Tract Infection in Elder Patients

【摘要】　目的　探討左氧氟沙星聯合阿奇霉素治療老年難治性呼吸道感染的療效及安全性。　方法　選擇2005年2月-2010年9月收治的高齡難治性呼吸道細菌感染患者68例，隨機分為治療組和對照組。治療組34例，給予左氧氟沙星聯合阿奇霉素；對照組34例，給予左氧氟沙星，兩組總療程皆為15 d。觀察兩組患者的臨床療效、細菌清除率和不良反應。　結果　治療組的總有效率為64.71%，對照組總有效率為32.35%，兩組差異有統計學意義（Plt;0.05） 。治療組細菌清除率為76.19%，對照組細菌清除率為36.36%，兩組差異有統計學意義（Plt;0.05） 。治療組和對照組的不良反應發生率分別為5.88%和8.82%，差異無統計學意義（Pgt;0.05）。結論　左氧氟沙星聯合阿奇霉素治療老年難治性呼吸道感染療效高， 能有效清除細菌， 不良反應較少， 值得臨床推廣應用。【Abstract】　Objective　To evaluate the efficacy and safety of levofloxacin combined with azithromycin on refractory respiratory infections in elder patients.　Methods　A total of 68 elder patients with refractory respiratory infections in our hospital from February 2005 to September 2010 were randomly divided into two groups: treatment group (n=34) and control group (n=34). The patients in treatment group were treated with levofloxacin combined with azithromycin; while the patients in the control group were treated with levofloxacin alone. The total treatment periods of both groups were 15 days. The therapeutic efficacy, eradication rate of pathogens and the rate of aelverse reactions were observed.　Results　The therapeutic effect rate was 64.71% in the treatment group and 32.35% in the control group, and the difference between the two groups was statistically significant (Plt;0.05). The eradication rate of pathogens was 76.19% in the treatment group and 36.36% in the control group, and the difference was significant (Plt;0.05). The rate of the adverse reaction was 5.88% in the treatment group and 8.82% in the control group, and there were no significant differences between the two groups (Pgt;0.05).　Conclusion　Levofloxacin combined with Azithromycin is effective on refractory respiratory tract infection in elder patients, which can effectively remove the bacteria with few adverse reaction.

老年患者原發性視網膜脫離60例分析

老年人潰瘍病急性穿孔外科治療19例體會

健康管理對老年高血壓患者血壓控制影響的研究

目的　探討健康管理對老年高血壓患者血壓控制的效果。 方法　選取2011年1月－12月體檢中心進行健康體檢老年高血壓患者200例，分為試驗組和對照組。試驗組給予藥物治療、用藥指導和健康管理，對照組給予藥物治療和用藥指導，但未給實施健康管理。健康管理實施1年后隨訪，對比試驗組和對照組在血壓控制方面的效果。 結果　隨訪1年后，試驗組有88例和對照組有94例納入比較。試驗組患者血壓變化情況為：收縮壓（15.13 ± 2.12）mm Hg（1 mm Hg=0.133 kPa），舒張壓（10.84 ± 1.91）mm Hg；對照組患者血壓變化情況為 ：收縮壓（17.45 ± 2.24）mm Hg，舒張壓（12.89 ± 1.53）mm Hg。兩組患者降壓效果相比較，差異有統計學意義（P＜0.05）。 結論　健康管理對于控制老年高血壓有明顯的作用。

老年重癥急性膽管炎59例報告

Efficacy of Beta-Lactam/Macrolide or Fluoroquinolone on Outcomes in Elderly Patients in ICU with Severe Community-Acquired Pneumonia

Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.

鋼板內固定聯合人工全髖關節置換治療 老年移位性髖臼骨折

目的總結鋼板內固定聯合人工全髖關節置換治療老年移位性髖臼骨折的臨床療效。 方法2004年5月－2009年5月，采用鋼板內固定聯合人工全髖關節置換治療32例老年單髖移位性髖臼骨折。男27例，女5例；年齡60～83歲，平均67歲。致傷原因：交通事故傷12例，跌傷14例，高處墜落傷6例。受傷至手術時間為3～16 d，平均7 d。髖臼骨折根據Letournel 分型標準：前柱骨折9例，前壁骨折8例，T型骨折12例，前柱合并后半橫型骨折1例，后壁合并橫型骨折2例。合并骨質疏松12例。 結果術后切口均Ⅰ期愈合，無相關并發癥發生。患者均獲隨訪，隨訪時間25～89個月，平均42.2個月。術后2～4個月患者均能完全負重行走，平均3.5個月。末次隨訪時髖關節Harris 評分為78～91分，平均85分。6例發生異位骨化，1例發生骨溶解；其余患者隨訪期間均無假體松動和下沉。 結論鋼板內固定聯合人工全髖關節置換適用于治療合并創傷性關節炎、股骨頭骨折、股骨頸骨折、軟骨損傷的老年移位性髖臼骨折，臨床療效滿意。

老年膽囊炎膽囊結石88例外科治療體會

雷珠單抗治療滲出型老年性黃斑變性的護理

目的　探討針對性護理在滲出性老年性黃斑變性（AMD）治療中的作用。 方法　對2012年6月－12月在門診經熒光素眼底血管造影和光相干斷層掃描，確診為滲出型AMD并行雷珠單抗玻璃體腔內注射的83例患者治療護理情況進行回顧性分析。 結果　83例患者經治療及護理，術后均未發生眼內炎，21例有少許結膜下出血，3～7 d后吸收。術后8例眼壓略高于正常，但監測3 d后恢復至正常范圍內。 結論　良好的護理配合是AMD治療成功的關鍵，在減輕醫生負擔的同時，也為患者的治療與康復提供了應有的指導與幫助。

Perioperative Management of Gastric Carcinoma in 41 Elderly Patients with Diabetes Mellitus

目的探討老年胃癌患者合并糖尿病的圍手術期處理。方法對我院1990年1月至2004年2月期間收治的297例老年胃癌中41例合并糖尿病患者的臨床資料進行回顧性分析。結果術后并發感染率、吻合口漏、死亡率及住院時間，血糖正常者分別為19.9%（51/256）、0.4%（1/256）、0.8%（2/256）和（19.1±4.3） d，糖尿病患者分別為34.1%（14/41）、7.3%（3/41）、7.3%（3/41）和（24.3±5.1） d，后者均明顯高于前者（P均＜0.05）。結論老年胃癌患者合并糖尿病術后并發癥及病死率較高，其圍手術期處理至關重要，應引起外科醫生的高度重視。