老年髋部骨折围手术期医疗风险的分析与对策

髋部骨折是老年人的常见病之一,髋部骨折对老年人生命的危害最大.随着人口老龄化,老年髋部骨折发病率呈逐年上升趋势.老年骨质疏松髋部骨折围手术期的医疗风险临床较常见,如何降低老年骨质疏松髋部骨折围手术期的医疗风险,是临床骨科需要解决的问题.分析存在的风险问题,明确各种风险因素,尽可能降低老年髋部围手术期的医疗风险.     

导言:股骨转子间骨折的治疗策略

股骨转子间骨折是髋部常见骨折约占45％～55％,主要发生于骨质疏松的老年患者,围术期病死率高,伤后1年内病死率达14％～36％,老年人转子间骨折常因骨质量下降、内固定不稳、易发生内固定松动断裂等问题.如何正确选择内固定、减少并发症、提高治疗效果是目前研究的重点. 转子间骨折治疗策略:(1)保守治疗:对于那些长期卧床肢体无法活动的患者,全身感染疾患的患者,严重内科疾患不能耐受手术和手术切口周围有软组织条件差的患者应采用保守治疗.     

石河子地区老年人骨质疏松性骨折影响因素调查分析

分析石河子地区骨质疏松性骨折老年人的影响因素。采用现场调查的方法,对2010年10月～2011年7月在石河子大学医学院第一附属医院和石河子市人民医院住院的60岁及以上400名骨质疏松性骨折患者进行一对一问卷调查。单因素分析,性别、年龄、父亲髋部骨折史、母亲髋部骨折史、当前是否吸烟、糖尿病史、高血压病史、类风湿性关节炎病史、既往骨折史、是否每日饮用浓茶、是否进行体育锻炼是影响本地区骨质疏松性骨折的因素。多元线性逐步回归分析,性别、父亲髋部骨折史、母亲髋部骨折史、当前是否吸烟、类风湿性关节炎病史是影响本地区骨质疏松性骨折的主要因素。影响石河子地区骨质疏松性骨折的因素是多方面的,其影响因素可为干预本地区未骨折的社区老年高危人群提供科学参考依据。     

围手术期医疗质量管理策略

围手术期是手术患者在医院诊疗过程中的最重要时期,隐患多、风险大,历来是医疗质量管理的重点和难点。本文介绍了中国医科大学附属盛京医院加强围手术期管理的措施,只有加强对手术全程的监管,促进围手术期抗菌药物的合理使用,提供术后规范化的护理,加强质量教育和培训,才能确保围手术期的医疗质量。     

心脏病患者非心脏手术风险的规避

社会老龄化,老年人口的相对比例以及绝对值不断增长,外科手术患者中合并心脏病的患者比例也在不断增加。这类患者都具有较高的围手术期心肌梗死、心衰及心源性死亡的危险。如何评价这些患者的围手术期风险,细致调整心脏病用药,使患者获得最佳治疗,保证患者的医疗安全,同时避免术前不必要的检查。     

心脏病患者非心脏手术风险的规避

社会老龄化,老年人口的相对比例以及绝对值不断增长,外科手术患者中合并心脏病的患者比例也在不断增加.这类患者都具有较高的围手术期心肌梗死、心衰及心源性死亡的危险.如何评价这些患者的围手术期风险,细致调整心脏病用药,使患者获得最佳治疗,保证患者的医疗安全,同时避免术前不必要的检查.     

内固定治疗老年股骨粗隆间骨折

老年股骨粗隆间骨折的手术治疗正在逐步被接受,手术方法也因为骨折具体情况有多种选择,本文对老年股骨粗隆间骨折的临床特点、内固定选择、围手术期注意事项进行阐述,为临床治疗提供帮助.     

老年患者的外科治疗决策及围手术期处理

泌尿外科老年患者多,老年患者必然手术并发症多,手术死亡率高。虽然现在泌尿外科近70％的手术已进入了微创时代,手术时间大幅缩减,但是老年患者的临床决策仍常常是个非常纠结的问题,手术要达到什么目的？何时要做适当的放弃？除了充分的围手术期准备,医生要敢于承担,家属要充分理解和合作。     

老年患者的外科治疗决策及围手术期处理

泌尿外科老年患者多,老年患者必然手术并发症多,手术死亡率高.虽然现在泌尿外科近70％的手术已进入了微创时代,手术时间大幅缩减,但是老年患者的临床决策仍常常是个非常纠结的问题,手术要达到什么目的?何时要做适当的放弃?除了充分的围手术期准备,医生要敢于承担,家属要充分理解和合作.     

围手术期血糖控制

糖尿病患者围手术期血糖控制是临床糖尿病处理的一大难题,围手术期血糖控制状况对术后病死率及感染等并发症有重要影响。良好的血糖控制可以改善患者预后,但严格控制血糖也会增加低血糖和多项不良事件发生的风险。目前对围手术期血糖控制的目标尚无统一标准,缺乏充分的前瞻性对比研究和循证证据。本文作者对近几年关于围手术期血糖控制相关文献...     

Prediction of foot clearance parameters as a precursor to forecasting the risk of tripping and falling

Tripping and falling is a serious health problem for older citizens due to the high medical costs incurred and the high mortality rates precipitated mostly by hip fractures that do not heal well. Current falls prevention technology encompasses a broad range of interventions; both passive (e.g., safer environments, hip protectors) and active (e.g., sensor-based fall detectors) which attempt to reduce the effects of tripping and falling. However the majority of these interventions minimizes the impact of falls and do not directly reduce the risk of falling. This paper investigates the prediction of gait parameters related to foot-to-ground clearance height during the leg swing phase which have been physically associated with tripping and falling risk in the elderly. The objective is to predict parameters of foot trajectory several walking cycles in advance so that anticipated low foot clearance could be addressed early with more volitional countermeasures, e.g., slowing down or stopping. In this primer study, foot kinematics was recorded with a highly accurate motion capture system for 10 healthy adults (25-32 years) and 11 older adults (65-82 years) with a history of falls who each performed treadmill walking for at least 10 min. Vertical foot displacement during the swing phase has three characteristic inflection points and we used these peak values and their normalized time as the target prediction values. These target variables were paired with features extracted from the corresponding foot acceleration signal (obtained through double differentiation). A generalized regression neural network (GRNN) was used to independently predict the gait variables over a prediction horizon (number of gait cycles ahead) of 1-10 gait cycles. It was found that the GRNN attained 0.32-1.10 cm prediction errors in the peak variables and 2-8% errors in the prediction of normalized peak times, with slightly better accuracies in the healthy group compared to elderly fallers. Prediction accuracy decreased linearly (best fit) at a slow rate with increasing prediction horizon ranging from 0.03 to 0.11 cm per step for peak displacement variables and 0.34 × 10(-3) - 1.81 × 10(-3)% per step for normalized peak time variables. Further time series analysis of the target gait variable revealed high autocorrelations in the faller group indicating the presence of cyclic patterns in elderly walking strategies compared to almost random walking patterns in the healthy group. The results are promising because the technique can be extended to portable sensor-based devices which measure foot accelerations to predict the onset of risky foot clearance, thus leading to a more effective falls prevention technology.     

康复队伍建设对实现残疾人康复服务的影响

老年股骨颈骨折是常见的骨科病,但其治疗方案的选择并没有统一的标准。本文回顾了骨折治疗原则的发展历程和股骨颈骨折现有的治疗方法,旨在从系统论的最优化原则角度,初步讨论治疗老年股骨颈骨折的最优方案,认为应结合患者的生理年龄、预期寿命、骨的质量、骨折情况和经济条件等因素来选择治疗方案。     

老龄患者人工关节置换术时骨水泥反应综合征的危害及其应对策略

人工关节置换术在老龄化社会中的客观需求性愈来愈突出,而老龄患者在人工关节置换术时发生的骨水泥反应综合征是一个不容忽视的严峻问题。笔者指出了老龄患者人工关节置换术时骨水泥反应综合征的严重危害性,剖析了这种并发症的可能原因,并且对它的有效预防措施和急救处理策略进行了深刻的思考。     

髋关节置换术治疗股骨颈骨折围手术期应用整体护理途径与常规护理的对照研究

在利用人工髋关节置换术治疗股骨颈骨折的围手术期,应用整体护理途径与常规护理模式进行对照研究,发现整体护理途径能显著减少住院、手术等待时间,降低卧床并发症。在股骨颈骨折的围手术期应用整体护理途径这一治疗策略体现了哲学之事物的整体辩证观、发展观、因果论。     

Dairy-product intake and hip fracture among older women: issues for health behavior

The purpose of this study was to examine the association between dairy-product intake and hip fracture among a national sample of women aged 50 years and older. Univariate analyses using SAS procedures showed dairy-product intake was significantly associated with hip fracture. Women who had suffered hip fracture reported higher dairy use than women who had not experienced these fractures, a finding that is dramatically inconsistent with the literature. This finding may reflect positive behavioral changes resulting from the hip fracture event. Further research must focus on changes in health behavior after fracture, which may assist in understanding the roles of specific theories of health behavior. Application of principles of health behavior could improve the effectiveness of preventive treatment programs for osteoporosis.     

癌症患者对医疗风险的感知及对临床决策的影响

由于医学的复杂性和癌症疾病的不确定性,癌症的临床决策存在着一定的风险性。癌症患者对医疗风险的感知也因人而异,继而影响着临床决策。本研究应用癌症患者医疗风险感知问卷对唐山市4家三级综合医院内住院治疗的320名癌症患者进行调查,调查结果显示,癌症患者对于经济风险（67．5％）的感知和社会心理风险（40．3％）的感知均高于对身体功能风险的感知（21．6％）,患者的性别、家庭月收入和年龄影响患者对医疗风险的感知,患者对经济风险和社会风险的感知影响患者对临床决策的意愿。临床医护人员应注重评估癌症患者对医疗风险感知的特点,帮助患者制定适宜的临床决策。     

The Order of Widows: what the early church can teach us about older women and health care.

This article argues that the early Christian "order of widows" provides a fruitful model for Christian ethicists struggling to address the medical and social problems of elderly women today. After outlining the precarious state of the "almanah"--or widow--in biblical times, it describes the emergence of the order of widows in the early Church. Turning to the contemporary situation, it argues that demographics both in the United States and around the globe suggest that meeting the needs of elderly women will become an enormous challenge in the years to come. The order of widows illustrates a three-fold conception of solidarity that has immediate implications today. That conception of solidarity encourages us: 1) to identify the unique medical needs of elderly women (e.g., osteoporosis); 2) to find ways of overcoming their societal isolation, which can increase their risk of medical and psychological problems; and 3) to develop strategies for enabling them to remain contributing members of the community for as long as possible.     

医疗风险、责任与对策

医疗风险是医疗实践中客观存在的一种具有不确定性、损害性事件,对患者、医院和医学的发展有着不利的影响。医疗风险的存在有着复杂的原因,因此,对医疗风险管理与防范也应该采取包括提高医疗技术水平、加强风险教育、实行医疗责任保险等多种手段。     

骨折治疗方法与原则的最优化历程

多年来骨折治疗,新旧技术、新旧理论相互融合,相互碰撞,产生了新的理论和方法,使得临床疗效显著提高,现阶段理智的临床医生应该融汇各家之长,多方互补,对每一位骨折患者的治疗都应该按照最优化的原则进行.但是在医疗过程中总存在着如方法选择不当或者错误,过度治疗,医患信任危机,医疗伦理道德的丧失等情况,我们应该用矛盾分析的方法来思考这些问题.