Objective To investigate the prevention and management of perioperative complications of intertrochanteric fractures in elderly in-hospital patients(aged≥80 years).Methods Clinical data of 103 intertrochanteric fracture patients(31 male and 72 female)undergoing surgical treatment at our hospital from May 2010 to Nov.2015 were retrospectively analyzed.Their ages ranged from 80 to 99 years,with an average of 86.2 years.There were 3 Evan type Ⅰ cases,25 type Ⅱ cases,36 type Ⅲ cases,37 type Ⅳ cases and 2 type V cases.Of these,82 received epidural anesthesia and 21 had general anesthesia.Intertrochanteric fractures were treated with proximal femoral nail(PFN) internal fixation in 101 patients and dynamic hip screw(DHS)internal fixation in 2 patients.Results The average operation duration and blood loss were 30 min and 60 ml in the PFN internal fixation group and 60 min and 150 ml in the DHS internal fixation group,respectively.The average hospitalization time was 16.7 days.One patient (0.9％) died after operation,10 (9.7％) had preoperative complications of bed rest with 3 cases involving the central nervous system and 4 cases involving the respiratory system,and 38 cases (36.9％)had postoperative complications with 13 involving the central nervous system.The average time from admission to operation was 6 days,with 65 cases above the average and 38 cases below the average,and there was a statistically significant difference in the incidence of postoperative complications between the two subgroups(30/65 or 46.2 ％for the former and 8/38 or 21.1％ for the latter,x2＝6.49,P＜0.05).Conclusions Elderly patients with intertrochanteric fractures should undergo surgery as soon as possible,preferably with epidural anesthesia.Proficiency in surgical kills,short operation time,close monitoring of preoperative and postoperative conditions,and proper and timely treatment are the key to ensuring surgical success.

Objective To investigate the effect of ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia on knee joint surgery in elderly patients.Methods The 110 elderly patients with spinal anesthetic contraindication and undergoing lower extremity surgery from June 2014 to June 2015 were randomly divided into observation group (n =55) and control group (n =55).The observation group received both ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block,and the control group was given general anesthesia.Anesthesia procedure,sensory block onset time,changes in heart rate and mean artery pressure (MAP) after anesthesia,the total quantity of fluids infusion,dosage of vasopressor and hypotensor,adverse anesthetic reactions,anesthetic fees,anesthetic effect were recorded.Results Anesthetic preparation and practicing time had no difference between the two groups [(8.3 ± 1.7) min vs.(7.7 ± 1.2) min,(t =1.661,P=0.139)].The block onset time was longer in observation group than in control group [(10.3 ± 1.4) min vs.(3.2±0.6) min,t=50.180,P＜0.01].The changes in MAP had significant difference between the two groups [5 min after anesthesia:(89.24 ± 8.30) mmHg and (77.90 ± 8.05) mmHg;after operation:(96.60±8.03) mmHg and (106.22±8.88) mmHg;P＜0.05].There were significant differences in the fluid infusion quantity,dosage of vasopressor and hypotensor,adverse reactions during or after anesthesia,and anesthetic fees between the two groups [(1150.9± 231.6) ml vs.(1400.0±256.5) ml,(3.91±1.21) mg vs.(10.83±2.19)mg,(1.80±0.37) mg vs.(8.27±1.25)mg,3.6％ vs.18.2％,(1239.1±202.9) Yuan vs.(2307.2±205.6) Yuan,all P＜0.05].No significant difference was found in anesthesia effect between the two groups (P =0.198).Conclusions The ultrasound-and nerve stimulator-guided femoral nerve and lateral femoral cutaneous nerve block versus general anesthesia is more simple and safe for the knee joint surgery in elderly patients,with less complications,lower cost and higher satisfaction of patients.

Objective To explore the effect of a multidisciplinary management program led by case managers on the tolerance to enteral nutrition,and the indicators for nutrition and inflammation in critically ill patients.Methods Fifty-one critically ill patients hospitalised in our hospital between January and June 2021 were assigned to a control group and another fifty-one critically ill patients hospitalised in our hospital between July and December 2021 were assigned to an observation group.The patients in control group received conventional nutritional support,while those in the observation group received the enteral nutrition managed with the case manager led multidisciplinary management program for 7 days.The tolerance to enteral nutrition,nutrition index and infection index were compared.Results One patient in the control group was withdrawn due to worsen conditions and another in the observation group was withdrawn as well because of incomplete medical data.It was found that the observation group was significantly better than the control group in the tolerance to enteral nutrition as well as the serum albumin,haemoglobin,white blood cells and C-reactive protein(all P<0.05).Conclusion The case manager led multidisciplinary management program is effective in the enhancement of tolerance to enteral nutrition and in the improvement of nutritional and inflammatory indicators in the critically ill patients.

Objective:To evaluate the effectiveness of remote pulmonary rehabilitation in the elderly COPD patients in order to provide evidence-based basis for the clinical practice and promotion of remote pulmonary rehabilitation.Methods:We searched databases including Web of Science, PubMed, Cochrane Library, Embase, CINAHL,China Biology Medicine disc, China National Knowledge Internet, VIP, and Wanfang and selected all randomized controlled trials (RCTs) that reported the effects of telerehabilitation on the elderly patients with COPD. The retrieval time was from the establishment of the database to April 26, 2023. Meta-analysis was performed by RevMan 5.3.Results:A total of 24 RCTs involving 2 980 patients with COPD were finally included. Meta-analysis results showed that telerehabilitation in the elderly patients with COPD can improve the lung function (FEV 1/FVC) ( MD=2.09, 95% CI 0.30-3.89, P<0.05), quality of life ( MD=-0.66, 95% CI -1.05--0.26, P<0.05), anxiety ( MD=-0.69, 95% CI -1.32--0.05, P<0.05) and depression ( MD=-0.81, 95% CI -1.59--0.04, P<0.05), and the subgroup for the lung function (FEV 1/FVC) of the elderly patients with COPD emphasized that physical activity, intervention time ≤24 weeks, intervention frequency 1-3 times per week, and use of network platform, there were significant differences between those subgroups (all P<0.01). But there was no statistically significant difference in improving the exercise capacity ( MD=-1.54, 95% CI -14.83-11.75, P>0.05). Conclusions:Telerehabilitation in pulmonary can be considered a supplementary intervention for improving the lung function (FEV 1/FVC), the quality of life and the psychological condition on the elderly patients with COPD.