Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of thi...Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescri展开更多
目的 研究离退休老年人体位性低血压（OH）的患病率及临床特点.方法 通过对2010年广州军区离退休干部体检,筛选出1174例65岁以上的老年患者,对其进行健康问卷普查,并测量卧位及立位后0、2 min血压和心率,并分OH组与非OH组进行比较.OH定...目的 研究离退休老年人体位性低血压（OH）的患病率及临床特点.方法 通过对2010年广州军区离退休干部体检,筛选出1174例65岁以上的老年患者,对其进行健康问卷普查,并测量卧位及立位后0、2 min血压和心率,并分OH组与非OH组进行比较.OH定义为直立位后3 min内收缩压和（或）舒张压下降≥20/10 mm Hg（1 mm Hg=0.133 kPa）.结果 65岁以上老年OH的患病率为25.6%,直立后即刻收缩压下降≥20 mm Hg和（或）舒张压下降≥10 mm Hg（OH-0）者占21.6%;直立2 min后收缩压下降≥20 mm Hg和（或）舒张压下降≥10 mm Hg（OH-2）者占20.7%.OH组和非OH组高血压、心肌梗死、心力衰竭、缺血性脑卒中、糖尿病的患病率分别为83.1%对68.6%、12.0%对6.4%、13.0%对6.3%、22.3%对16.2%、47.2%对39.2%,OH组均高于非OH组,两组比较差异有统计学意义（P〈0.05）;OH组降压药物治疗率虽稍高于非OH组（88.0%对83.6%）,但差异无统计学意义（P=0.115）;两组使用的降压药物种类也无明显差异.结论 OH在离退休老年人较常见,OH患者高血压、糖尿病、心脑血管疾病的患病率较高,降压药物对OH无明显影响.展开更多
The aim of this paper is to give an overview of acute complications of spinal cord injury(SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system...The aim of this paper is to give an overview of acute complications of spinal cord injury(SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperaturecontrol and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation.展开更多
Background The incidence of postural tachycardia syndrome （POTS） has been increasing in children and adolescents,while clinical characteristics of POTS in the pediatric population are not fully understood.Methods An...Background The incidence of postural tachycardia syndrome （POTS） has been increasing in children and adolescents,while clinical characteristics of POTS in the pediatric population are not fully understood.Methods An observational study was performed in 150 pediatric patients aged between 5 and 18 years who underwent head-up tilt test （HUTT） with the diagnosis of POTS at Peking University First Hospital from March 2008 to August 2013.Demographic data,clinical presentation,autonomic parameters,laboratory findings,and treatments were recorded.Results POTS in children commonly occurred in the age of 7-14 years.Dizziness （84.00％） was the most common symptom,followed by weakness （72.00％） and orthostatic syncope （62.67％）.Positive family history of orthostatic intolerance （Ol） was found in 24.64％ of children with POTS.And 33.09％ of them had preceding infection history as precipitating events.Ten percent of them suffered from orthostatic hypertension.Hyperadrenergic status was documented in 51.28％ of 39 patients who were tested for the standing norepinephrine levels.More than half of POTS patients,with 24-hour urinary sodium level ＜124 mmol/24 hours,were suitable for treatment of salt supplementation.At least 25.74％ of POTS patients were of positive acetylcholine receptor （AChR） antibody.Low iron storage in children with POTS was relatively rare.Most patients responded well to treatments,43.51％ of patients recovered,while 7.63％ of them had relapse after symptoms disappeared.Conclusions POTS is a relatively common condition with complex pathophysiology and heterogeneous clinical manifestation.A comprehensive therapeutic regimen is recommended for the treatment.展开更多
The nutcracker phenomenon [left renal vein(LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery.Term of nutcracker syndrome(NCS) is used for p...The nutcracker phenomenon [left renal vein(LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery.Term of nutcracker syndrome(NCS) is used for patients with clinical symptoms associated with nutcracker anatomy.LRV entrapment divided into 2 types:anterior and posterior.Posterior and right-sided NCSs are rare conditions.The symptoms vary from asymptomatic hematuria to severe pelvic congestion.Symptoms include hematuria,orthostatic proteinuria,flank pain,abdominal pain,varicocele,dyspareunia,dysmenorrhea,fatigue and orthostatic intolerance.Existence of the clinical features constitutes a basis for the diagnosis.Several imaging methods such as Doppler ultrasonography,computed tomography angiography,magnetic resonance angiography and retrograde venography are used to diagnose NCS.The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension.The treatment options are ranged from surveillance to nephrectomy.Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.展开更多
目的：观察充气式托架用于预防在腰硬联合麻醉下行剖宫产术时仰卧位低血压综合征（SHS）的临床效果。方法：选择ASAI-II级在腰硬联合麻醉下行剖宫产术的正常足月妊娠产妇120例,采用随机数字表法分为观察组（A组）和对照组（B组）,每组6...目的：观察充气式托架用于预防在腰硬联合麻醉下行剖宫产术时仰卧位低血压综合征（SHS）的临床效果。方法：选择ASAI-II级在腰硬联合麻醉下行剖宫产术的正常足月妊娠产妇120例,采用随机数字表法分为观察组（A组）和对照组（B组）,每组60例。观察组在腰硬联合麻醉成功后,将自制充气式托架放置于产妇右臀部,根据要求通过加压气囊向支撑气囊充气,使其下腹部左倾15°~20°,对照组在麻醉成功后采取正常的平卧位。分别记录两组产妇在麻醉前（T0）、麻醉后1 min（T1）、3min（T2）、5 min（T3）、10 min（T4）等各时点的平均动脉压（MAP）和心率（HR）的变化;记录两组SHS发生的例数,麻黄碱平均用量和新生儿出生后1 min Apgar评分。结果：两组产妇MAP在T1~T3时明显低于T0时（P〈0.05）,且B组MAP明显低于A组（P〈0.05）,T0和T4时两组MAP无统计学意义（P〉0.05）。B组HR在T1-T3时明显快于T0时和A组（P〈0.05）。A组发生SHS 5例（8.3%）明显少于B组28例（40.7%）（P〈0.05）;A组麻黄碱平均用量（4.5±2.1）mg明显少于B组（16.7±6.6）mg（P〈0.05）,新生儿出生后1 min Apgar评分A组（9.5±0.5）分明显高于B组（7.6±0.7）分（P〈0.05）。结论：充气式托架用于预防腰硬联合麻醉下剖宫产术仰卧位低血压综合征（SHS）效果明显,可以维持相对的血流动力学,改善新生儿Apgar评分,提高了麻醉质量和舒适度,使用方便,值得临床推广应用。展开更多
Background Little is known about the prevalence oforthostatic hypertension （OHT） and its effect on long-term mortality in the eld- erly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized...Background Little is known about the prevalence oforthostatic hypertension （OHT） and its effect on long-term mortality in the eld- erly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients. Methods Out of 1852 patients admit- ted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients （48% males） with a mean age of 81.5 ±6.8 years were en- rolled in this study. Blood pressure （BP） was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18th June 2014 were retrieved from the computerized system of the Ministry of the Interior. Results Four hundred and seven patients （86%） were diagnosed with OHT. Those without OHT had a lowerbody mass index and were more likely males, smokers, had a higher rate of Parkinson＇s disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT （P = 0.024）. Hazard ratios （HRs） for mortality in those with OHT adjusted to age and multiple risk factors were： 0.67 [95% confidence interval （CI）： 0.51-0.87] and 0.73 （95% CI： 0.55-0.97）, respectively; a similar tendency was noticed in a sensitivity analysis by gender. Conclusion Hospitalized elderly patients with OHT had a better survival rate than those without OHT.展开更多
Background:Rapid eye movement sleep behavior disorder(RBD)and Parkinson’s disease(PD)are two distinct clinical diseases but they share some common pathological and anatomical characteristics.This study aims to confir...Background:Rapid eye movement sleep behavior disorder(RBD)and Parkinson’s disease(PD)are two distinct clinical diseases but they share some common pathological and anatomical characteristics.This study aims to confirm the clinical features of RBD in Chinese PD patients.Methods:One hundred fifty PD patients were enrolled from the Parkinson`s disease and Movement Disorders Center in Department of Neurology,Shanghai General Hospital from January 2013 to August 2014.This study examined PD patients with or without RBD as determined by the REM Sleep Behavior Disorder Screening Questionnaire(RBDSQ),assessed motor subtype by Unified PD Rating Scale(UPDRS)III at“on”state,and compared the sub-scale scores representing tremor,rigidity,appendicular and axial.Investigators also assessed the Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Mini-Mental State Examination(MMSE),Clinical Dementia Rating(CDR),and Parkinson’s disease Sleep Scale(PDSS).Results:One hundred fourty one PD patients entered the final study.30(21.28%)PD patients had probable RBD(pRBD)diagnosed with a RBDSQ score of 6 or above.There were no significant differences for age,including age of PD onset and PD duration,gender,smoking status,alcohol or coffee use,presence of anosmia or freezing,UPDRS III,and H-Y stages between the pRBD+and pRBD−groups.pRBD+group had lower MMSE scores,higher PDSS scores,and pRBD+PD patients had more prominent proportion in anxiety,depression,constipation,hallucination and a greater prevalence of orthostatic hypotension.Conclusion:pRBD+PD patients exhibited greater changes in non-motor symptoms.However,there was no increase in motor deficits.展开更多
目的探讨高龄老年人体位性血压变化与动脉粥样硬化的相关性。方法连续收集2014年6月~2015年12月在新疆医科大学第一附属医院住院的高龄老年人227例。按照体位性血压的改变分为正常组151例,体位性低血压组52例和体位性高血压组24例。所...目的探讨高龄老年人体位性血压变化与动脉粥样硬化的相关性。方法连续收集2014年6月~2015年12月在新疆医科大学第一附属医院住院的高龄老年人227例。按照体位性血压的改变分为正常组151例,体位性低血压组52例和体位性高血压组24例。所有入选者均进行四肢血流多普勒超声测定。比较3组体位性血压变化与肱踝脉搏波传导速度(baPWV)和踝臂指数(ABI)的关系。结果与正常组比较,体位性高血压组年龄明显增高[(83.93±2.99)岁vs(82.32±3.15)岁,P<0.05],体位性低血压组跌倒评分明显增高[(57.40±17.92)分vs(49.37±17.25)分,P<0.01];右侧ABI和左侧ABI明显降低(0.97±0.14 vs 1.18±0.09,P<0.01;0.89±0.21vs 1.15±0.12,P<0.01)。经多因素非条件logistic回归分析显示,ABI降低是发生体位性低血压的独立危险因素之一(OR=20.776,95%CI:7.449~57.947,P=0.000)。跌倒评分升高发生体位性低血压风险是正常人群的1.035倍(95%CI:1.013~1.057,P=0.002)。年龄是导致体位性高血压发生的独立危险因素之一(OR=1.169,95%CI:1.014~1.348,P=0.031)。结论 ABI降低是高龄老年人发生体位性低血压的独立危险因素之一。年龄是导致体位性高血压发生的独立危险因素之一。跌倒评分值可能预测体位性低血压的发生风险。展开更多
Background Postural orthostatic tachycardia syndrome （POTS） is a common clinical problem in children and adolescents. The previous diagnostic approach to POTS of children and adolescents is based on a series of test...Background Postural orthostatic tachycardia syndrome （POTS） is a common clinical problem in children and adolescents. The previous diagnostic approach to POTS of children and adolescents is based on a series of tests to exclude all other causes, which is time and medical resource consuming. Recently, a new diagnostic approach has been developed. The present study was designed to statistically analyze the results of clinical investigation items and the cost for the diagnosis of POTS in children patients, and evaluate cost changes in the diagnosis of POTS. Methods A total of 315 children patients were divided into two groups according to diagnosis period, including group I diagnosed in 2002-2006 （100 cases） and group II in 2007-2010 （215 cases） and the diagnostic item-based distribution of the cost was analyzed. The diagnostic costs were compared between two groups using SPSS17.0. Results The per-capita cost of diagnosis in group I was （621.95±2.1.10） Yuan, costs of diagnostic tests （head-up tilt test standing test, etc） accounted for 8.68% and the exclusive tests for 91.32%. The per-capita cost of diagnosis in group II was （542.69±2.3.14） Yuan, diagnostic tests accounted for 10.50% and exclusive tests for 89.50%. Comparison of the total cost of diagnostic tests between the two groups showed significant differences （P〈0.05）. Conclusion The cost of POTS diagnosis has been declined in recent years, but the cost of exclusive diagnosis is still its major part.展开更多
文摘Cardiac autonomic neuropathy(CAN)is a serious complication of diabetes mellitus(DM)that is strongly associated with approximately five-fold increased risk of cardiovascular mortality.CAN manifests in a spectrum of things,ranging from resting tachycardia and fixed heart rate(HR)to development of"silent"myocardial infarction.Clinical correlates or risk markers for CAN are age,DM duration,glycemic control,hypertension,and dyslipidemia(DLP),development of other microvascular complications.Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension,DLP,obesity,and unsatisfactory glycemic control in type 2DM.Symptomatic manifestations of CAN include sinus tachycardia,exercise intolerance,orthostatic hypotension(OH),abnormal blood pressure(BP)regulation,dizziness,presyncope and syncope,intraoperative cardiovascular instability,asymptomatic myocardial ischemia and infarction.Methods of CAN assessment in clinical practice include assessment of symptoms and signs,cardiovascular reflex tests based on HR and BP,short-term electrocardiography(ECG),QT interval prolongation,HR variability(24 h,classic24 h Holter ECG),ambulatory BP monitoring,HR turbulence,baroreflex sensitivity,muscle sympathetic nerve activity,catecholamine assessment and cardiovascular sympathetic tests,heart sympathetic imaging.Although it is common complication,the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today.Treatment is based on early diagnosis,life style changes,optimization of glycemic control and management of cardiovascular risk factors.Pathogenetic treatment of CAN includes:Balanced diet and physical activity;optimization of glycemic control;treatment of DLP;antioxidants,first of allα-lipoic acid(ALA),aldose reductase inhibitors,acetylL-carnitine;vitamins,first of all fat-soluble vitamin B1;correction of vascular endothelial dysfunction;prevention and treatment of thrombosis;in severe cases-treatment of OH.The promising methods include prescri
文摘目的 研究离退休老年人体位性低血压（OH）的患病率及临床特点.方法 通过对2010年广州军区离退休干部体检,筛选出1174例65岁以上的老年患者,对其进行健康问卷普查,并测量卧位及立位后0、2 min血压和心率,并分OH组与非OH组进行比较.OH定义为直立位后3 min内收缩压和（或）舒张压下降≥20/10 mm Hg（1 mm Hg=0.133 kPa）.结果 65岁以上老年OH的患病率为25.6%,直立后即刻收缩压下降≥20 mm Hg和（或）舒张压下降≥10 mm Hg（OH-0）者占21.6%;直立2 min后收缩压下降≥20 mm Hg和（或）舒张压下降≥10 mm Hg（OH-2）者占20.7%.OH组和非OH组高血压、心肌梗死、心力衰竭、缺血性脑卒中、糖尿病的患病率分别为83.1%对68.6%、12.0%对6.4%、13.0%对6.3%、22.3%对16.2%、47.2%对39.2%,OH组均高于非OH组,两组比较差异有统计学意义（P〈0.05）;OH组降压药物治疗率虽稍高于非OH组（88.0%对83.6%）,但差异无统计学意义（P=0.115）;两组使用的降压药物种类也无明显差异.结论 OH在离退休老年人较常见,OH患者高血压、糖尿病、心脑血管疾病的患病率较高,降压药物对OH无明显影响.
文摘The aim of this paper is to give an overview of acute complications of spinal cord injury(SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperaturecontrol and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation.
文摘Background The incidence of postural tachycardia syndrome （POTS） has been increasing in children and adolescents,while clinical characteristics of POTS in the pediatric population are not fully understood.Methods An observational study was performed in 150 pediatric patients aged between 5 and 18 years who underwent head-up tilt test （HUTT） with the diagnosis of POTS at Peking University First Hospital from March 2008 to August 2013.Demographic data,clinical presentation,autonomic parameters,laboratory findings,and treatments were recorded.Results POTS in children commonly occurred in the age of 7-14 years.Dizziness （84.00％） was the most common symptom,followed by weakness （72.00％） and orthostatic syncope （62.67％）.Positive family history of orthostatic intolerance （Ol） was found in 24.64％ of children with POTS.And 33.09％ of them had preceding infection history as precipitating events.Ten percent of them suffered from orthostatic hypertension.Hyperadrenergic status was documented in 51.28％ of 39 patients who were tested for the standing norepinephrine levels.More than half of POTS patients,with 24-hour urinary sodium level ＜124 mmol/24 hours,were suitable for treatment of salt supplementation.At least 25.74％ of POTS patients were of positive acetylcholine receptor （AChR） antibody.Low iron storage in children with POTS was relatively rare.Most patients responded well to treatments,43.51％ of patients recovered,while 7.63％ of them had relapse after symptoms disappeared.Conclusions POTS is a relatively common condition with complex pathophysiology and heterogeneous clinical manifestation.A comprehensive therapeutic regimen is recommended for the treatment.
文摘The nutcracker phenomenon [left renal vein(LRV) entrapment syndrome] refers to compression of the LRV most commonly between abdominal aorta and superior mesenteric artery.Term of nutcracker syndrome(NCS) is used for patients with clinical symptoms associated with nutcracker anatomy.LRV entrapment divided into 2 types:anterior and posterior.Posterior and right-sided NCSs are rare conditions.The symptoms vary from asymptomatic hematuria to severe pelvic congestion.Symptoms include hematuria,orthostatic proteinuria,flank pain,abdominal pain,varicocele,dyspareunia,dysmenorrhea,fatigue and orthostatic intolerance.Existence of the clinical features constitutes a basis for the diagnosis.Several imaging methods such as Doppler ultrasonography,computed tomography angiography,magnetic resonance angiography and retrograde venography are used to diagnose NCS.The management of NCS depends upon the clinical presentation and the severity of the LRV hypertension.The treatment options are ranged from surveillance to nephrectomy.Treatment decision should be based on the severity of symptoms and their expected reversibility with regard to patient's age and the stage of the syndrome.
文摘目的：观察充气式托架用于预防在腰硬联合麻醉下行剖宫产术时仰卧位低血压综合征（SHS）的临床效果。方法：选择ASAI-II级在腰硬联合麻醉下行剖宫产术的正常足月妊娠产妇120例,采用随机数字表法分为观察组（A组）和对照组（B组）,每组60例。观察组在腰硬联合麻醉成功后,将自制充气式托架放置于产妇右臀部,根据要求通过加压气囊向支撑气囊充气,使其下腹部左倾15°~20°,对照组在麻醉成功后采取正常的平卧位。分别记录两组产妇在麻醉前（T0）、麻醉后1 min（T1）、3min（T2）、5 min（T3）、10 min（T4）等各时点的平均动脉压（MAP）和心率（HR）的变化;记录两组SHS发生的例数,麻黄碱平均用量和新生儿出生后1 min Apgar评分。结果：两组产妇MAP在T1~T3时明显低于T0时（P〈0.05）,且B组MAP明显低于A组（P〈0.05）,T0和T4时两组MAP无统计学意义（P〉0.05）。B组HR在T1-T3时明显快于T0时和A组（P〈0.05）。A组发生SHS 5例（8.3%）明显少于B组28例（40.7%）（P〈0.05）;A组麻黄碱平均用量（4.5±2.1）mg明显少于B组（16.7±6.6）mg（P〈0.05）,新生儿出生后1 min Apgar评分A组（9.5±0.5）分明显高于B组（7.6±0.7）分（P〈0.05）。结论：充气式托架用于预防腰硬联合麻醉下剖宫产术仰卧位低血压综合征（SHS）效果明显,可以维持相对的血流动力学,改善新生儿Apgar评分,提高了麻醉质量和舒适度,使用方便,值得临床推广应用。
文摘Background Little is known about the prevalence oforthostatic hypertension （OHT） and its effect on long-term mortality in the eld- erly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients. Methods Out of 1852 patients admit- ted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients （48% males） with a mean age of 81.5 ±6.8 years were en- rolled in this study. Blood pressure （BP） was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18th June 2014 were retrieved from the computerized system of the Ministry of the Interior. Results Four hundred and seven patients （86%） were diagnosed with OHT. Those without OHT had a lowerbody mass index and were more likely males, smokers, had a higher rate of Parkinson＇s disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT （P = 0.024）. Hazard ratios （HRs） for mortality in those with OHT adjusted to age and multiple risk factors were： 0.67 [95% confidence interval （CI）： 0.51-0.87] and 0.73 （95% CI： 0.55-0.97）, respectively; a similar tendency was noticed in a sensitivity analysis by gender. Conclusion Hospitalized elderly patients with OHT had a better survival rate than those without OHT.
基金This work was supported by the National Natural Science Foundation of China(NSFC)(81171205,81371410)the Biomedical Multidisciplinary Program of Shanghai Jiao Tong University(YG2014MS31,YG2015QN21,YG2016QN25).
文摘Background:Rapid eye movement sleep behavior disorder(RBD)and Parkinson’s disease(PD)are two distinct clinical diseases but they share some common pathological and anatomical characteristics.This study aims to confirm the clinical features of RBD in Chinese PD patients.Methods:One hundred fifty PD patients were enrolled from the Parkinson`s disease and Movement Disorders Center in Department of Neurology,Shanghai General Hospital from January 2013 to August 2014.This study examined PD patients with or without RBD as determined by the REM Sleep Behavior Disorder Screening Questionnaire(RBDSQ),assessed motor subtype by Unified PD Rating Scale(UPDRS)III at“on”state,and compared the sub-scale scores representing tremor,rigidity,appendicular and axial.Investigators also assessed the Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Mini-Mental State Examination(MMSE),Clinical Dementia Rating(CDR),and Parkinson’s disease Sleep Scale(PDSS).Results:One hundred fourty one PD patients entered the final study.30(21.28%)PD patients had probable RBD(pRBD)diagnosed with a RBDSQ score of 6 or above.There were no significant differences for age,including age of PD onset and PD duration,gender,smoking status,alcohol or coffee use,presence of anosmia or freezing,UPDRS III,and H-Y stages between the pRBD+and pRBD−groups.pRBD+group had lower MMSE scores,higher PDSS scores,and pRBD+PD patients had more prominent proportion in anxiety,depression,constipation,hallucination and a greater prevalence of orthostatic hypotension.Conclusion:pRBD+PD patients exhibited greater changes in non-motor symptoms.However,there was no increase in motor deficits.
文摘目的探讨高龄老年人体位性血压变化与动脉粥样硬化的相关性。方法连续收集2014年6月~2015年12月在新疆医科大学第一附属医院住院的高龄老年人227例。按照体位性血压的改变分为正常组151例,体位性低血压组52例和体位性高血压组24例。所有入选者均进行四肢血流多普勒超声测定。比较3组体位性血压变化与肱踝脉搏波传导速度(baPWV)和踝臂指数(ABI)的关系。结果与正常组比较,体位性高血压组年龄明显增高[(83.93±2.99)岁vs(82.32±3.15)岁,P<0.05],体位性低血压组跌倒评分明显增高[(57.40±17.92)分vs(49.37±17.25)分,P<0.01];右侧ABI和左侧ABI明显降低(0.97±0.14 vs 1.18±0.09,P<0.01;0.89±0.21vs 1.15±0.12,P<0.01)。经多因素非条件logistic回归分析显示,ABI降低是发生体位性低血压的独立危险因素之一(OR=20.776,95%CI:7.449~57.947,P=0.000)。跌倒评分升高发生体位性低血压风险是正常人群的1.035倍(95%CI:1.013~1.057,P=0.002)。年龄是导致体位性高血压发生的独立危险因素之一(OR=1.169,95%CI:1.014~1.348,P=0.031)。结论 ABI降低是高龄老年人发生体位性低血压的独立危险因素之一。年龄是导致体位性高血压发生的独立危险因素之一。跌倒评分值可能预测体位性低血压的发生风险。
文摘Background Postural orthostatic tachycardia syndrome （POTS） is a common clinical problem in children and adolescents. The previous diagnostic approach to POTS of children and adolescents is based on a series of tests to exclude all other causes, which is time and medical resource consuming. Recently, a new diagnostic approach has been developed. The present study was designed to statistically analyze the results of clinical investigation items and the cost for the diagnosis of POTS in children patients, and evaluate cost changes in the diagnosis of POTS. Methods A total of 315 children patients were divided into two groups according to diagnosis period, including group I diagnosed in 2002-2006 （100 cases） and group II in 2007-2010 （215 cases） and the diagnostic item-based distribution of the cost was analyzed. The diagnostic costs were compared between two groups using SPSS17.0. Results The per-capita cost of diagnosis in group I was （621.95±2.1.10） Yuan, costs of diagnostic tests （head-up tilt test standing test, etc） accounted for 8.68% and the exclusive tests for 91.32%. The per-capita cost of diagnosis in group II was （542.69±2.3.14） Yuan, diagnostic tests accounted for 10.50% and exclusive tests for 89.50%. Comparison of the total cost of diagnostic tests between the two groups showed significant differences （P〈0.05）. Conclusion The cost of POTS diagnosis has been declined in recent years, but the cost of exclusive diagnosis is still its major part.
