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生命科学名著 Brocklehurst 老年医学与老年学（原书第八版）（下册） Brocklehurst’s Textbook of Geriatric Medicine and Gerontology (Eighth Edition) 主编〔美〕Howard M. Fillit 〔加〕Kenneth Rockwood 〔英〕John Young 主译白小涓李小鹰 60mm 10.5mm 5mm 4 0 m m 55mm 9.5mm 5mm 5 m m 50mm 8mm 6 mm 8.5mm 4mm 生命科学名著 Brocklehurst 老年医学与老年学（原书第八版）（下册） Brocklehurst’s Textbook of Geriatric Medicine and Gerontology (Eighth Edition) 主编〔美〕Howard M. Fillit 〔加〕Kenneth Rockwood 〔英〕John Young 主译白小涓李小鹰北京 1 图宇: 01-2017-4854 号内容简介 { Brocklehurst老年医学与老年学》是老年医学的经典著作，初版于 1973年，由 JohnBrocklehurst主编，故此得名。本译著为英文原书的第八版，是2017年出版的最新版本。全书分为4个部分:老年学、老年医学、问题导向的老年医学、医疗卫生健康系统和老年医学，共 132章。本书由国际资深老年医学专家倾力完成，全面反映老年医学和老年学的基本理论和最新进展。本书贯穿大量治疗手段和指南，某些特殊老年相关疾病的论述中包含了统计表格及工作流程图，其中更强调对衰弱的重视，各个章节均关注了不同领域与衰弱的联系和拓展，新增内容包括老年医学技术、急诊和院前医疗、HIV和衰老，以及老年患者的个体化治疗、远程医疗和环境构建。每章结尾处的"关键点"简明扼要地概括本章重点。本书不似才从事老年学和老年医学工作的临床、教学和科研人员及研究生提供重要指导，也非常适用于面对老年患者的其他专科医护人员、社区工作者及其他老年社会工作者。图书在版编目 (CIP) 数据 Brocklehurst老年医学与老年学:原书第8版:全2册/ (美) H.M. 菲利特(Howard M. Fillit) , (加) K. 罗克伍德(Kenneth Rockwood) , (英) J. 扬(JohnYoung)主编;臼小涓，李小鹰主译北京:科学出版社，2020.11 (生命科学名著) 书名原文: Brocklehurst's Te汉tbook of Geriatric Medicine and Gerontology (Eighth Edition) ISBN 978-7-03-059837-0 1. ①B… 11. ①H… ②K…③J…④白… ⑤李… III. ①老年病学 N. ( R592 中国版本图书馆CIP数据核字 (2018)第280841号责任编辑:岳浸宇 /责任校对:严娜责任印制:吴兆东 / 封面设计:刘新新 4丰 A牵线后且拱出版北京东黄城根北街16号邮政编码 100717 叫州啊 m 叫川 m 时种龙剖由咿做屯'a3vaLL、化山川于彷m*祷告有耐依新仇华M 司叫，ρ同明蝉 2020年 11月第一版开本: 889x1194 1116 2021年 1 月第二次印刷印张: 76112 字数: 2811 000 定价: 580.00元(全二册) (如有印装质量问题，我社负责调换) ELSEVIER Elsevier (Singapore) Pte Ltd. 3 Killiney Road, #08-01 Winsland House I, Singapore 239519 Tel: (65) 6349-0200; Fax: (65) 6733-1817 Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, 8E Copyright © 2017 by Elsevier, Ltd. All rights reserved. Chapter 7 “Geroscience”: Felipe Sierra is in Public domain. ISBN: 978-0-7020-6185-1 Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, 8E by Howard M. Fillit, Kenneth Rockwood and John Young was undertaken by China Science Publishing & Media Ltd. (Science Press) and is published by arrangement with Elsevier (Singapore) Pte Ltd. Brocklehurst’s Textbook of Geriatric Medicine and Gerontology, 8E by Howard M. Fillit, Kenneth Rockwood and John Young由中国科技出版传媒股份有限公司（科学出版社）进行翻译，并根据中国科技出版传媒股份有限公司（科学出版社）与爱思唯尔（新加坡）私人有限公司的协议约定出版。《Brocklehurst老年医学与老年学》（原书第8版）（白小涓，李小鹰主译） ISBN: 978-7-03-059837-0 Copyright © 2018 by Elsevier (Singapore) Pte Ltd. and China Science Publishing & Media Ltd. (Science Press). All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from Elsevier (Singapore) Pte Ltd. Details on how to seek permission, further information about the Elsevier’s permissions policies and arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by Elsevier (Singapore) Pte Ltd. and China Science Publishing & Media Ltd. (Science Press) (other than as may be noted herein). 注意本译本由Elsevier (Singapore) Pte Ltd. 和科学出版社完成。相关从业及研究人员必须凭借其自身经验和知识对文中描述的信息数据、方法策略、搭配组合、实验操作进行评估和使用。由于医学科学发展迅速，临床诊断和给药剂量尤其需要经过独立验证。在法律允许的最大范围内，爱思唯尔、译文的原文作者、原文编辑及原文内容提供者均不对译文或因产品责任、疏忽或其他操作造成的人身及/或财产伤害及/或损失承担责任，亦不对由于使用文中提到的方法、产品、说明或思想而导致的人身及/或财产伤害及/或损失承担责任。 Printed in China by China Science Publishing & Media Ltd. (Science Press) under special arrangement with Elsevier (Singapore) Pte Ltd. This edition is authorized for sale in the People’s Republic of China only, excluding Hong Kong SAR, Macau SAR and Taiwan. Unauthorized export of this edition is a violation of the contract. 3 目录（上册）第1部分老年学对未来的展望 ··········································· 42 A篇老年学介绍第8章衰老的遗传机制 ·································· 44 第1章引言：衰老、衰弱和老年医学 ··················· 2 介绍 ······················································· 44 第2章衰老的流行病学 ···································· 4 线粒体遗传学、氧化应激与衰老 ···················· 44 介绍 ························································· 4 染色体基因突变与衰老 ······························· 45 健康衰老 ··················································· 6 致谢 ······················································· 47 结论 ······················································· 10 第9章衰老的细胞机制 ·································· 48 第3章老年的未来 ········································ 11 介绍 ······················································· 48 炎症 ······················································· 48 改变人类寿命 ··········································· 11 细胞衰老 ················································· 49 生物医学正在改变衰老的进程 ······················· 12 大分子功能失调 ········································ 50 老年医学的未来 ········································ 15 祖细胞和干细胞功能障碍 ···························· 51 衰弱的未来研究 ········································ 15 干预方法 ················································· 52 致谢 ······················································· 15 第10章早衰综合征：儿童早老症——洞悉正常第4章成功老龄化：百岁老人 ·························· 17 衰老 ················································ 54 百岁老人的人口学 ····································· 17 HGPS：疾病概述 ······································· 54 超高龄老人的报告 ····································· 17 分子遗传学和细胞生物学 ···························· 55 性别差异 ················································· 17 衰老与HGPS ············································ 58 成功老龄化 ·············································· 17 临床诊疗与护理 ········································ 60 表型相关性 ·············································· 19 致谢 ······················································· 60 家族相关性和遗传 ····································· 19 第11章衰老的神经生物学：自由基应激基因决定因素 ··········································· 20 及代谢途径 ······································· 62 全基因组测序 ··········································· 21 I. 衰老神经生物学中的亚硝化应激与氧化应激 ··············································· 62 未来研究方向 ··········································· 21 神经退行性疾病中的蛋白质错误折叠 ·············· 63 B篇老年生物学活性氧和活性氮的生成 ······························· 63 第5章进化学说和衰老机制 ····························· 24 蛋白质S-亚硝化与神经元细胞死亡 ················ 64 衰老的进化论 ··········································· 24 Ⅱ. 胰岛素代谢信号转导对衰老及神经寿命遗传学 ·············································· 25 退行性疾病的影响 ··································· 67 人类早衰综合征 ········································ 26 胰岛素/胰岛素样生长因子信号转导通路进化论的验证 ··········································· 26 和机体衰老 ··········································· 67 结论 ······················································· 27 其他代谢长寿通路在神经退行性改变中的作用 ·· 68 第6章老年人群研究的方法学挑战 ···················· 29 致谢 ······················································· 69 介绍 ······················································· 29 第12章衰老环境下的稳态应变和稳态应变超结论 ······················································· 35 负荷 ················································ 71 第7章老年科学 ··········································· 37 介绍 ······················································· 71 介绍 ······················································· 37 应激、稳态应变、稳态应变负荷和超负荷衰老生物学研究的主要核心 ·························· 37 的定义 ················································· 71 老年科学 ················································· 40 应激反应的两面性——保护与损伤 ················· 71 i 目录稳态应变负荷的检测 ·································· 72 骨骼 ······················································ 124 “压力负荷”——尤其是睡眠不足及其后果 ····· 73 软组织 ··················································· 126 大脑在应对压力中的关键作用 ······················· 73 骨与关节衰老的影响 ································· 126 应用于人体大脑 ········································ 73 未来 ······················································ 127 积极的情感、自尊和社会支持 ······················· 74 第21章衰老与胃肠道系统 ····························· 128 不良早期生活经历的有害作用 ······················· 74 衰老的正常生理 ······································· 128 干预 ······················································· 75 成人胃肠疾病异常表现 ······························ 130 结论 ······················································· 75 老年人独特的肠胃问题 ······························ 131 第13章衰老的神经内分泌学 ··························· 77 总结 ······················································ 132 女性神经内分泌衰老 ·································· 77 第22章泌尿系统的衰老 ································ 134 男性神经内分泌衰老 ·································· 79 介绍 ······················································ 134 神经内分泌衰老和脑代谢：对神经退行性疾病上尿路：肾和输尿管 ································· 134 的影响 ················································· 81 下尿路：膀胱和出口 ································· 135 致谢 ······················································· 82 第23章内分泌系统的衰老 ····························· 139 历史综述 ················································ 139 C篇老年医学激素改变 ················································ 140 第14章衰弱：总体观点 ································· 84 结论 ······················································ 144 衰弱 ······················································· 84 第24章衰老与血液 ······································ 146 衰弱的治疗 ·············································· 87 介绍 ······················································ 146 医疗保健系统中的衰弱································ 88 血细胞形成场所：骨髓和基质······················ 146 总结 ······················································· 89 造血干细胞 ············································· 147 第15章衰老和损伤累积的临床意义 ·················· 90 淋巴组织的形成 ······································· 151 介绍 ······················································· 90 衰老与血细胞 ·········································· 151 基于老年综合评估的衰弱指数的发展 ·············· 93 免疫衰老和癌症 ······································· 152 第16章衰老对心血管系统的影响 ····················· 98 第25章衰老与皮肤 ······································ 154 衰老相关的血管结构改变 ····························· 98 介绍 ······················································ 154 衰老过程中的内皮功能································ 99 内源性衰老 ············································· 154 衰老动脉的硬化 ········································ 99 外源性衰老 ············································· 155 衰老过程对心脏结构的影响 ························· 100 表皮 ······················································ 156 静息状态下衰老心脏的心肌功能 ··················· 100 真皮 ······················································ 157 衰老心脏对运动的反应······························· 101 皮肤附属器 ············································· 159 总结 ······················································ 102 衰老的机制 ············································· 160 第17章呼吸系统年龄相关性变化 ···················· 103 治疗和预防 ············································· 161 呼吸功能检测 ·········································· 103 结论 ······················································ 161 呼吸系统的衰老相关变化 ···························· 103 第26章衰老的药理学 ··································· 162 第18章老年人神经系统症状 ·························· 107 药物使用的流行病学 ································· 162 精神状态 ················································ 107 药代动力学改变 ······································· 163 颅神经功能 ············································· 108 药效学改变 ············································· 165 运动功能 ················································ 108 药物敏感性的改变 ···································· 165 结论性评价 ············································· 110 药物间相互作用 ······································· 165 致谢 ······················································ 111 总结 ······················································ 168 第19章结缔组织与衰老 ································ 112 第27章抗衰老药物 ······································ 170 结缔组织的特性 ······································· 112 抗衰老药物的简明历史 ······························ 170 衰老与结缔组织的性质······························· 117 青春的荷尔蒙之泉 ···································· 172 总结 ······················································ 121 抗氧化剂与衰老 ······································· 173 第20章骨与关节的衰老 ································ 122 光老化 ··················································· 173 关节软骨 ················································ 122 其他原因 ················································ 174 ii 目录结论 ······················································ 174 我们如何研究社会因素对健康的影响？ ·········· 191 成功老龄化 ············································· 192 D篇心理和社会老年学与健康的关系 ·········································· 192 第28章正常认知性衰老 ································ 176 社会因素影响健康的机制 ··························· 194 智力与衰老 ············································· 176 衰弱、排斥和“代理人的沉默” ··················· 195 与认知功能相关的生活方式因素 ··················· 180 政策的影响和干预的潜力 ··························· 195 健康因素 ················································ 181 结论 ······················································ 196 结论 ······················································ 182 第31章衰老人格与自我：多样性和健康问题 ····· 197 第29章社会老年学 ······································ 183 人格阶段和自我发展 ································· 197 介绍 ······················································ 183 人格的社会认知方法 ································· 200 老年人的“问题” ···································· 183 总结和未来方向 ······································· 201 理论方法：功能主义与结构功能主义的关系 ···· 184 第32章生产性老龄化 ··································· 204 增加预期寿命和降低发病率：一个黄金时期 ···· 184 介绍 ······················································ 204 机遇时代：成功老龄化和第三年龄段 ············· 185 美国生产性老龄化的描述 ··························· 204 晚年生活中的不平等：连续性和影响 ············· 186 老年人从事生产活动的前提 ························ 206 结论性评价 ············································· 187 老年人从事生产活动的重要性······················ 207 第30章老年人社会脆弱性 ····························· 189 总结 ······················································ 208 背景和定义 ············································· 189 第2部分老年医学 A篇老年患者的评估诊疗及护理模式 ······································· 243 教育和培训 ············································· 243 第33章疾病在老年人中的表现 ······················· 211 未来的研究领域 ······································· 243 疾病在老年人中的非特异性临床表现 ············· 211 第38章多维老年评估项目的结果评价 ·············· 245 常见疾病在老年人中的不典型表现 ················ 215 老年评估结果和生活质量的判定 ··················· 246 结论 ······················································ 217 标准化评估系统 ······································· 246 第34章多维老年评估 ··································· 218 个体化结果评估和以患者为中心的诊疗老年评估的简史 ······································· 218 及护理 ················································ 247 老年评估的组织结构和流程 ························· 219 结论 ······················································ 248 老年评估程序的有效性······························· 222 致谢 ······················································ 248 结论 ······················································ 223 附录 ······················································ 250 第35章实验诊断学和老年医学：对于老年人不仅仅是参考区间 ····························· 225 B篇心血管系统介绍 ······················································ 225 第39章慢性心力衰竭 ··································· 270 结论 ······················································ 229 流行病学 ················································ 270 第36章老年患者的社会评估 ·························· 230 病程与预后 ············································· 270 社会评估与老年综合评估的关系 ··················· 230 心衰的病因 ············································· 271 执行日常生活活动能力的功能 ······················ 230 病理生理学 ············································· 271 社会功能和评估工具的各个方面 ··················· 231 心衰的诊断 ············································· 272 社会支持与照顾者负担······························· 233 心衰的治疗 ············································· 274 社会评估中的文化因素······························· 234 衰弱、肌少症与心衰 ································· 278 第37章衰弱老年人的麻醉及手术 ···················· 236 其他疾病的相互作用 ································· 279 介绍 ······················································ 236 结论 ······················································ 281 衰弱的老年手术患者 ································· 236 第40章冠状动脉疾病的诊断和治疗 ················· 282 老年患者手术与麻醉的注意事项 ··················· 238 临床表现 ················································ 282 手术转归 ················································ 239 识别与未识别的心肌梗死 ··························· 282 老年患者和手术流程 ································· 239 诊断技术 ················································ 283 术中和术后注意事项 ································· 242 冠状动脉危险因素 ···································· 284 iii 目录稳定型心绞痛的治疗 ································· 286 肢体动脉疾病 ·········································· 355 急性冠脉综合征 ······································· 287 腹主动脉瘤 ············································· 357 第41章衰弱老年心脏病患者诊疗及护理中的颈动脉疾病 ············································· 359 实际问题 ········································· 292 慢性静脉功能不全 ···································· 360 介绍 ······················································ 292 第47章老年人静脉血栓栓塞 ·························· 363 老年人的治疗决策：需要考虑年龄因素吗？ ···· 292 介绍 ······················································ 363 将衰弱评估纳入临床决策 ···························· 293 结论 ······················································ 367 结论 ······················································ 297 C篇呼吸系统第42章高血压病 ········································· 299 第48章哮喘和慢性阻塞性肺疾病 ···················· 370 介绍 ······················································ 299 气流阻塞性疾病 ······································· 370 流行病学 ················································ 299 老年人的哮喘 ·········································· 370 发病机制 ················································ 301 老年人的慢性阻塞性肺疾病 ························ 375 高血压并发症 ·········································· 302 第49章非阻塞性肺疾病和胸部肿瘤 ················· 381 诊断与评估 ············································· 303 呼吸系统感染 ·········································· 381 高血压的药物治疗 ···································· 305 流感 ······················································ 381 降低血压的方法 ······································· 308 肺炎 ······················································ 382 总结 ······················································ 310 结核 ······················································ 382 第43章瓣膜性心脏病 ··································· 312 非结核分枝杆菌感染 ································· 384 主动脉瓣狭窄 ·········································· 312 支气管扩张症 ·········································· 384 主动脉瓣反流 ·········································· 319 胸腔积液 ················································ 384 二尖瓣环钙化 ·········································· 322 气胸 ······················································ 385 二尖瓣狭窄 ············································· 325 间质性肺疾病 ·········································· 385 急性二尖瓣反流 ······································· 326 特发性肺纤维化 ······································· 386 慢性二尖瓣反流 ······································· 326 药物介导的间质性肺疾病 ··························· 386 三尖瓣反流 ············································· 327 结缔组织病 ············································· 386 三尖瓣狭窄 ············································· 327 结节病 ··················································· 387 肺动脉瓣反流 ·········································· 328 肺血管炎 ················································ 387 第44章心律失常 ········································· 330 超敏性肺炎 ············································· 387 室性心律失常 ·········································· 330 职业相关肺疾病 ······································· 387 心房颤动 ················································ 333 肺癌 ······················································ 387 血栓栓塞性脑卒中的危险因素 ······················ 337 非小细胞肺癌 ·········································· 388 心房扑动 ················································ 339 小细胞肺癌 ············································· 389 房性早搏 ················································ 339 恶性间皮瘤 ············································· 390 室上性心动过速 ······································· 339 加速性房室节律 ······································· 339 D篇神经系统阵发性房性心动过速伴房室阻滞 ··················· 340 第50章痴呆的分类 ······································ 393 多源性房性心动过速 ································· 340 综述 ······················································ 393 缓慢性心律失常 ······································· 340 目前分类的局限性 ···································· 393 第45章晕厥 ··············································· 343 痴呆的定义 ············································· 394 介绍 ······················································ 343 危险因素 ················································ 394 直立性低血压 ·········································· 347 与其他疾病相关的痴呆 ······························ 395 血管迷走神经性晕厥 ································· 349 鉴别诊断的临床检查特征 ··························· 398 餐后低血压 ············································· 350 痴呆的实验室研究 ···································· 399 颈动脉窦综合征和颈动脉窦高敏症 ················ 351 总结 ······················································ 400 总结 ······················································ 354 第51章神经心理学在痴呆诊断和治疗中的应用 ·· 401 第46章血管外科 ········································· 355 介绍 ······················································ 401 介绍 ······················································ 355 神经心理学评估的指征 ······························ 401 iv 目录优化诊断标准以检测轻度损伤 ······················ 401 定义和病因 ············································· 457 临床访谈 ················································ 402 智力障碍的流行病学与衰老 ························ 458 痴呆诊断的筛查与简易认知评估 ··················· 402 智力障碍患者的生物学衰老：综合征测试结果用于指导治疗方案及作为研究结局与非综合征 ······································· 459 的判定指标 ·········································· 408 年龄相关疾病：综合征和非综合征模式 ·········· 459 老年人神经心理学评估面临的挑战 ················ 408 老年智力障碍患者的健康评估······················ 461 总结 ······················································ 408 交流沟通 ················································ 463 第52章阿尔茨海默病 ··································· 410 健康促进 ················································ 463 疾病的病理与发病机制······························· 410 智力障碍和衰弱 ······································· 463 流行病学与遗传机制 ································· 411 第58章癫痫 ··············································· 465 临床诊断标准 ·········································· 412 介绍 ······················································ 465 临床评价 ················································ 413 定义 ······················································ 465 治疗 ······················································ 418 流行病学 ················································ 465 致谢 ······················································ 419 分类 ······················································ 465 第53章血管性认知障碍 ································ 421 癫痫发作 ················································ 467 历史综述和术语 ······································· 421 癫痫综合征 ············································· 468 流行病学 ················································ 421 诊断 ······················································ 468 病因和病理生理学 ···································· 422 鉴别诊断 ················································ 469 血管性认知障碍的分类······························· 425 其他考虑 ················································ 470 血管性和神经退行性疾病的重叠与相互影响 ···· 425 病因学 ··················································· 471 临床表现 ················································ 426 检查 ······················································ 472 诊断标准 ················································ 427 抗癫痫药物治疗 ······································· 472 神经精神症状 ·········································· 429 癫痫的影响 ············································· 475 神经病理学 ············································· 429 癫痫患者相关服务 ···································· 475 疾病进展 ················································ 430 研究领域 ················································ 475 预防 ······················································ 430 第59章头痛与面部疼痛 ································ 477 治疗 ······················································ 430 介绍 ······················································ 477 第54章额颞叶变性 ······································ 432 原发性头痛疾病 ······································· 477 介绍 ······················································ 432 面部神经痛 ············································· 481 流行病学 ················································ 432 持续特发性面部疼痛 ································· 483 临床表现 ················································ 432 颈部疾病引起的头痛 ································· 483 神经病理 ················································ 433 鼻窦疾病与口腔疾病 ································· 484 遗传学 ··················································· 434 血管性疾病与头痛 ···································· 484 诊断性检查 ············································· 435 颅内肿瘤 ················································ 486 治疗策略 ················································ 436 低脑脊液容量性头痛综合征 ························ 486 第55章谵妄 ··············································· 438 药物诱发的头痛 ······································· 486 介绍 ······················································ 438 头痛与眼病 ············································· 487 谵妄与痴呆：病理生理学 ···························· 440 多方面原因导致的头痛 ······························ 487 未来的方向 ············································· 443 头痛的诊断方法 ······································· 488 第56章老年精神疾病 ··································· 445 第60章脑卒中：流行病学和病理机制 ·············· 490 介绍 ······················································ 445 脑卒中的流行病学 ···································· 490 老年人抑郁与焦虑 ···································· 445 脑卒中的预防 ·········································· 493 精神病性障碍 ·········································· 448 脑卒中的病理机制 ···································· 494 老年人的人格障碍 ···································· 453 第61章脑卒中：临床表现、管理及服务体系 ····· 496 酒精相关精神障碍 ···································· 454 介绍 ······················································ 496 结论 ······················································ 456 定义 ······················································ 496 第57章老年智力障碍 ··································· 457 脑卒中类型 ············································· 496 v 目录脑卒中和短暂性脑缺血发作的临床表现 ·········· 497 外周神经病变 ·········································· 535 脑卒中的检查 ·········································· 498 神经性跛行与椎管狭窄 ······························ 537 脑卒中服务体系 ······································· 502 炎性肌病（肌炎） ···································· 537 第62章脑卒中的长期照护 ····························· 504 包涵体肌炎 ············································· 539 脑卒中照护途径 ······································· 504 药物引起的肌痛和肌病 ······························ 539 长期康复 ················································ 504 内分泌和代谢性肌病 ································· 540 预测模型 ················································ 505 运动神经元病/肌萎缩侧索硬化 ····················· 541 脑卒中后并发症 ······································· 506 重症肌无力 ············································· 541 养老院居住者 ·········································· 507 第66章颅内肿瘤 ········································· 545 脑卒中幸存者的家庭护理员 ························· 507 介绍 ······················································ 545 职业康复 ················································ 507 临床表现 ················································ 545 可能的服务模式 ······································· 507 诊断 ······················································ 546 第63章自主神经系统疾病 ····························· 509 分类 ······················································ 546 自主神经系统生理学的基本概念 ··················· 509 治疗 ······················································ 548 测量自主神经功能的方法 ···························· 510 结论 ······················································ 549 衰老对于自主神经心血管控制各组分的影响 ···· 512 第67章脊髓和神经根性疾病 ·························· 551 衰老影响自主神经对压力的反应 ··················· 514 颈神经根病和脊髓病 ································· 551 老年人自主神经系统疾病 ···························· 514 脊髓压迫 ················································ 553 直立性低血压的管理 ································· 518 脊髓血管病 ············································· 554 总结 ······················································ 520 脊髓损伤 ················································ 554 第64章帕金森病及其他运动障碍 ···················· 522 佩吉特病 ················································ 555 强直综合征 ············································· 522 腰椎退行性疾病的神经系统并发症 ················ 555 帕金森病 ················································ 522 第68章中枢神经系统感染 ····························· 558 多动性运动障碍 ······································· 529 细菌性脑膜炎 ·········································· 558 第65章神经肌肉疾病 ··································· 531 局部病变、慢性脑膜炎和脑炎······················ 560 神经肌肉疾病患者的管理 ···························· 531 （下册） E篇肌肉骨骼系统关节周围骨折 ·········································· 588 假体周围骨折 ·········································· 589 第69章老年人关节炎 ··································· 566 老年人骨折的预防 ···································· 590 介绍 ······················································ 566 骨折随访 ················································ 590 骨关节炎 ················································ 566 老年医学科-骨科的共同诊疗及护理 ··············· 590 痛风 ······················································ 571 结论 ······················································ 591 软骨钙化 ················································ 572 第72章肌少症 ············································ 592 风湿性多肌痛/巨细胞性动脉炎 ····················· 573 可操作性定义 ·········································· 592 类风湿性关节炎 ······································· 574 流行病学 ················································ 593 脊柱关节病 ············································· 576 病因 ······················································ 593 第70章代谢性骨病 ······································ 578 结局 ······················································ 595 介绍 ······················································ 578 治疗和干预 ············································· 596 骨质疏松 ················································ 578 结论 ······················································ 598 骨软化症 ················································ 583 F篇胃肠病学佩吉特病 ················································ 584 第73章胰腺 ··············································· 601 第71章老年骨科学 ······································ 587 介绍 ······················································ 587 背景 ······················································ 601 骨质疏松 ················································ 587 胰腺肿瘤 ················································ 602 老年人创伤 ············································· 587 急性胰腺炎 ············································· 607 麻醉注意事项 ·········································· 588 慢性胰腺炎 ············································· 609 vi