《炎症性肠病患者在新型冠状病毒肺炎流行期间的管理》解读

新型冠状病毒肺炎于湖北省武汉市及其他地区流行，疫情影响可能造成炎症性肠病患者就医困难，而炎症性肠病患者病毒感染风险高于健康人。为使炎症性肠病患者安全且平稳地度过病毒感染流行期，中华医学会消化病学分会炎症性肠病学组发表了《炎症性肠病患者在新型冠状病毒肺炎流行期间的管理》专家共识。本文对该共识意见进行解读，以期加深临床医师、患者及相关人员对该共识的理解。     

炎症性肠病患者自我报告结局的研究进展

患者的主观感受即自我报告结局研究在炎症性肠病患者中的关注度日益提升,其对监测患者病情进展、指导临床决策等方面均有重要作用。本文分别对炎症性肠病患者自我报告结局的评估工具及临床应用现状进行综述,旨在帮助医护人员选择适合我国炎症性肠病患者的评估工具,规范评估工具的开发与汉化流程,促进炎症性肠病患者自我报告结局在国内的应用与...     

炎症性肠病患者生活质量及影响因素调查

目的调查炎症性肠病患者的生活质量,分析其影响因素。方法采用炎症性肠病生活质量量表、社会支持评定量表、慢性病自我效能问卷对102例炎症性肠病患者进行调查。结果炎症性肠病患者生活质量及各维度均有明显受损;疾病严重程度、自我效能、年龄和疾病活动程度是炎症性肠病患者生活质量的主要影响因素(P<0.01)。结论炎症性肠病患者生活质量有不同程度的受损,应针对影响生活质量的相关因素给予护理干预,从而提高其生活质量。     

炎症性肠病患者用药依从性现况及其影响因素调查

目的调查炎症性肠病患者用药依从性现况及影响因素。方法采用Morisky用药依从性问卷、克罗恩病与溃疡性结肠炎知识问卷、炎症性肠病患者用药信念问卷对141例炎症性肠病患者进行调查。结果炎症性肠病患者用药依从性总分为(6.03±1.12)分,用药依从性好22例,占15.60%;依从性中等66例,占46.81%;依从性差53例,占37.56%;患者的年龄、疾病类型、疾病活动性、疾病知识、用药信念是其用药依从性的主要影响因素。结论炎症性肠病患者用药依从性整体不佳,护理人员应重视患者的用药管理和评估,根据依从性影响因素的不同给予针对性的健康指导与干预,提高用药依从性,促进健康行为,从而改善生活质量。     

自我管理模式在炎症性肠病患者中的应用

目的观察自我管理模式在炎症性肠病患者中的应用效果。方法将80例炎症性肠病患者采用掷硬币法随机分为对照组37例和观察组39例(2例失访、2例再次入院)。对照组采用常规护理措施,观察组在常规护理的基础上实施自我管理模式干预,包括住院期间的健康教育、出院指导以及每个月的电话随访、建立炎症性肠病患者论坛、鼓励患者坚持记健康日记及发挥患者家庭支持系统的作用。比较两组患者自我管理能力及中文版炎症性肠病患者生活质量评分。结果干预6个月后观察组自我管理能力评分及生活质量得分分别为(16.41±0.45)分、(193.64±17.45)分,高于对照组(14.93±0.61)分、(181.32±21.99)分,比较差异有统计学意义(P0.05)。结论自我管理模式能提高炎症性肠病患者的自我管理能力,改善其生活质量。     

炎症性肠病患者生存质量的研究现状

随着近10年我国炎症性肠病患者发病率的不断增高,对炎症性肠病患者这一群体的生存质量的关注和研究突显出其重要意义。本文对国外有关炎症性肠病患者生存质量状况、炎症性肠病患者生存质量的测量工具及炎症性肠病患者的生理、心理行为因素和社会支持对其生存质量的影响等这几个方面的文献进行了回顾和综述,以期为国内学者在该方面的研究提供参考依据。     

炎症性肠病患者担当门诊志愿者服务体验的质性研究

目的了解炎症性肠病患者担当门诊志愿者的服务体验。方法采用质性研究中现象学的研究方法,分析12例炎症性肠病患者担当门诊志愿者服务期间的真实感受。结果通过对访谈资料的分析、归纳、提炼,得出炎症性肠病患者担当门诊志愿者服务期间有成为利他的人和自我成长两大主题。结论炎症性肠病患者担当门诊志愿者有利于患者成长和提升自我管理能力。     

微信在炎症性肠病延续性护理中的应用

目的探讨运用微信平台对炎症性肠病患者实施延续性护理的效果。方法选取21例炎症性肠病患者,将微信运用到炎症性肠病患者的延续护理中,采用炎症性肠病生活质量问卷和克罗恩病和溃疡性结肠炎知识问卷对治疗效果进行评价。结果通过微信平台的干预,患者对疾病相关知识掌握和生活质量均有所改善(P0.05)结论将微信平台运用到炎症性肠病的延续性护理中可以改善患者的生活质量并提高患者与疾病相关的知识水平。     

炎症性肠病患者生活质量与自我效能和社会支持的相关性研究

目的 探讨炎症性肠病患者生活质量与自我效能和社会支持的相关性.方法 应用炎症性肠病生活质量量表(1BDQ)、慢性病自我效能问卷、社会支持评定量表对92例炎症性肠病患者进行调查.结果 炎症性肠病患者生活质量得分(169.01士26.60)分,自我效能得分(6.60士1.25)分,社会支持得分(39.89士7.26)分;生活质量总分及各维度得分均与自我效能和社会支持呈正相关,差异有显著意义(P＜0.01,P＜0.05).结论 炎症性肠病患者生活质量较低,高自我效能和良好的社会支持可提高患者的生活质量.     

炎症性肠病患者疾病接受度现状及其影响因素研究

目的:调查炎症性肠病患者疾病接受度现状并分析其影响因素。方法:使用便利抽样法选取于某三级甲等医院就诊的178例炎症性肠病患者。使用一般资料调查表、疾病接受度量表、炎症性肠病心理韧性量表、认知情绪调节方式问卷、炎症性肠病感知病耻感量表调查患者疾病接受现状。结果:炎症性肠病患者疾病接受度得分为23.79±7.64,30.90%的患者表示无法接受自身疾病。多元线性回归分析结果显示文化程度、疾病活动度、积极认知、灾难化是疾病接受度的影响因素,解释疾病接受度总变异的42.20%。结论:炎症性肠病患者的疾病接受度处于中等偏下水平,医护人员应高度重视对该人群疾病接受度的评估,针对患者文化程度、疾病活动度、积极认知、灾难化水平采取精准干预措施,以提高患者对自身疾病的接受度。     

Diet in Benign Colonic Disorders: A Narrative Review

PurposeDiet plays an important role in common benign colorectal diseases. This article reviews the evidence for diet and supplemental fiber in patients with chronic constipation, irritable bowel syndrome, inflammatory bowel disease, colonic diverticulitis, and fecal incontinence.MethodsWe performed a narrative review of the evidence for diet and supplemental fiber in patients with 5 common benign colonic diseases and summarized guideline recommendations for each condition. We generated tables of practical dietary advice by disease.FindingsDiet advice must be individualized and depends on underlying conditions, disease severity, symptom burden, and nutrition status. Guidance from a registered dietitian is highly recommended when making any dietary changes. Data from trials suggest that soluble fiber is effective for patients with chronic constipation, irritable bowel syndrome, and fecal incontinence. A diet low in select fermentable, oligo-, di-, and monosaccharides, and polyols may benefit patients with irritable bowel syndrome. Patients with inflammatory bowel disease, especially those with active disease, are at risk for malnutrition. Dietary restrictions may further increase that risk. There is limited evidence to recommend increasing or avoiding select food groups in patients with inflammatory bowel disease. Patients who have recovered from diverticulitis should adopt a prudent dietary pattern high in fruits, vegetables, whole grains, legumes, poultry, and fish.ImplicationsClinicians should counsel patients on the contribution of diet to their colorectal condition and the benefits and harms of dietary modification. Dietary advice should be practical and accompanied by realistic expectations for benefit.     

Self-care strategies for the management of bowel symptoms following sphincter-saving surgery for rectal cancer

The primary aim of this article is to identify the self-care strategies that patients use to manage bowel symptoms experienced following sphincter-saving surgery for rectal cancer. Comparisons will be made with self-care strategies used by patients to manage chronic fecal incontinence and the bowel symptoms associated with other chronic bowel diseases, such as irritable bowel syndrome and inflammatory bowel disease. Published studies and conceptual literature from 2000-2010 were the data sources. Three major themes emerged from the literature reflecting the self-care strategies used by patients to manage bowel symptoms: functional self-care strategies (e.g., taking medication), social activity-related self-care strategies (e.g., planning social events), and alternative self-care strategies (e.g., complementary therapies). An analysis of studies highlighted that, through the process of trial and error, patients learned the strategies that were most effective in the management of their bowel symptoms. Knowledge of such strategies will be beneficial to healthcare professionals when educating patients about effective management of bowel symptoms following sphincter-saving surgery.     

The biodiversity and composition of the dominant fecal microbiota in patients with inflammatory bowel disease

Clinical and experimental observations in animal models indicate that intestinal commensal bacteria are involved in the initiation and amplification of inflammatory bowel disease (IBD). As the majority of colonic bacteria cannot be identified by culture techniques, the aim of this study was to use sequence-based methods to investigate and characterize the composition of the dominant fecal microbiota in both patients with inflammatory bowel disease and healthy subjects. Fecal microbiota was isolated and quantified using real-time quantitative polymerase chain reaction. Denaturing gradient gel electrophoresis (DGGE) of 16S rDNA was used to evaluate the diversity of the dominant species. Analysis of individual bacterial groups showed a greater change in the fecal microbiota of patients with IBD, especially in those with active ulcerative colitis and active Crohn's disease. DGGE demonstrated the diversity of microbial flora in ulcerative colitis and Crohn's disease was less than in healthy subjects. Our results provide a better understanding of changes in fecal microbiota among patients with inflammatory bowel disease.     

Anti-tissue transglutaminase antibodies in inflammatory bowel disease: new evidence.

Anti-tissue transglutaminase, previously held to be identical to anti-endomysial antibodies in celiac sprue, has been reported in inflammatory bowel disease patients. To investigate these data further, we evaluated serum and intestinal anti-tissue transglutaminase in inflammatory bowel disease patients, with respect to the Crohn's disease activity index and the integrated disease activity index. Study population comprised: 49 patients with Crohn's disease and 29 patients with ulcerative colitis; 45 patients with celiac sprue and 85 autoimmune patients as disease controls; and 58 volunteers as healthy controls. Immunoglobulin A (IgA) anti-recombinant human tissue transglutaminase and anti-endomysial antibody detection in sera and fecal supernatants were performed. Adsorption of positive sera with recombinant human tissue transglutaminase were also performed. Marked increased anti-tissue transglutaminase concentrations were found in celiac sprue, while low-positive values were also found in Crohn's disease and ulcerative colitis. Anti-endomysial antibodies were detectable only in celiac sprue. Antigen adsorption resulted in a significant reduction of the anti-tissue transglutaminase either in celiac sprue or inflammatory bowel disease sera. A significant correlation between anti-tissue transglutaminase and Crohn's disease activity index or integrated disease activity index scores was found. Anti-tissue transglutaminase was also detectable in fecal supernatants from inflammatory bowel disease patients. Data highlight that both circulating and intestinal anti-tissue transglutaminases are detectable in inflammatory bowel disease, and that they are related to disease activity. These features underline that, in addition to anti-tissue transglutaminase, an anti-endomysial antibody test is necessary in the diagnostic work-up of celiac sprue, especially in patients with known inflammatory bowel disease.     

The role of the Malone antegrade continence enema (MACE) in the management of myelodeysplatic patients

Myelodysplasia is a congenital neural tube defect commonly affecting bladder and bowel function. Management of fecal incontinence is paramount to achieve patient independence and self-confidence. When conservative measures fail alternative invasive methods can be successfully applied. The Malone antegrade continence enema (MACE) was introduced in the late 1980's to treat spina bifida patients with fecal incontinence refractory to conservative management. Since its introduction, multiple successful variations have been described and its role has expanded. Indeed, the MACE has revolutionized the care of myelodysplastic patients, their bowel function, and ultimately their self image.     

脊髓损伤后肠道功能的变化

脊髓损伤后肠道运动的频率降低,大便失禁,结肠功能紊乱,直肠功能障碍,成为影响脊髓损伤患者生活质量的主要障碍。本文将对脊髓损伤后肠道的状况和护理进行综述。     

Antegrade continence enema for the treatment of neurogenic constipation and fecal incontinence after spinal cord injury

OBJECTIVE: To describe the effects of an antegrade continence enema stoma formed in a paraplegic man with intractable constipation and fecal incontinence. DESIGN: Case report. SETTING: Spinal cord injury unit, Veterans Affairs hospital. PARTICIPANTS: Spinal cord injury (SCI) patient with T12 paraplegia. INTERVENTION: Surgical formation of antegrade continence enema stoma. MAIN OUTCOME MEASURES: Time of bowel program care, ease of fecal elimination, safety of procedure. RESULTS: Bowel care time was decreased from 2 hours to 50 minutes daily; 6 bowel medications were discontinued; fecal incontinence was eliminated; and no surgical or medical side effects noted after the procedure. CONCLUSION: The antegrade continence enema procedure is a safe and effective means of treating intractable constipation and fecal incontinence in the adult SCI patient. This option should be considered for those persons in whom medical management of bowel care has been unsuccessful.     

Evaluation of intestinal clearance and faecal excretion of alpha 1-antiproteinase and immunoglobulins during Crohn's disease and ulcerative colitis.

The intestinal clearance of alpha 1-antiproteinase, monomeric IgA and IgG, and the daily fecal output of polymeric IgA and IgM were investigated in patients with inflammatory bowel diseases (inactive and active Crohn's disease, ulcerative colitis) and in a control group. The intestinal clearance of alpha 1-antiproteinase was significantly increased in all patients with inflammatory bowel diseases (p less than 0.01), irrespective of the grade of the disease. In contrast, increases in intestinal clearances of monomeric IgA and IgG were more closely related to the severity of the intestinal lesions. The associate determination of these three quantities should therefore be of interest for monitoring the degree of intestinal bowel inflammation. Faecal output of polymeric IgA was significantly increased in active intestinal disease (p less than 0.01), whereas faecal IgM levels were not. The determination of the faecal output of polymeric IgA should contribute to the assessment of the activity of inflammatory bowel diseases, and may provide insight into the activation of the mucosal immune system.     

Non-invasive Ultrasonographic Score for Assessment of the Severity of Inflammatory Bowel Disease

Intestinal ultrasound and shear wave elastography have gained increasing interest because of their promising results in the assessment of inflammatory bowel disease. The aim of this study was to find an ultrasonographic score to replace invasive endoscopic procedures for the management of these patients. The score includes ultrasound parameters that correlate well with clinical severity scales and inflammatory markers: bowel wall thickness, the Limberg score, disease extension and acoustic radiation force impulse measurements. The score proved to be well correlated with the Harvey Bradshaw Index, the Mayo score, C-reactive protein and fecal calprotectin. For Crohn's disease, a cutoff value of 8 points could identify active disease with 81.81% sensitivity and 83% specificity, while for ulcerative colitis, a cutoff value of 7 points could discriminate between remission and relapse with 86.85% sensitivity and 94% specificity. In conclusion, our ultrasonographic score can differentiate relapse from remission in inflammatory bowel disease.     

Fecal levels of leukocyte markers reflect disease activity in patients with ulcerative colitis

OBJECTIVE: A prominent feature of inflammatory bowel disease (IBD) is the presence of inflammatory cells in the gut mucosa, and which contribute to the ongoing inflammatory process. The aim of the study was to evaluate fecal neutrophil, eosinophil, mast cell and macrophage markers in the assessment of disease activity in patients with ulcerative colitis (UC). METHODS: Twenty-eight patients with active UC; 4 with proctitis, 16 with left-side colitis and 8 with total colitis, were included in the study. Patient history, endoscopy and histopathology were examined and fecal and serum samples were evaluated at inclusion and after 4 and 8 weeks of treatment. Fecal samples were analysed for myeloperoxidase (MPO), eosinophil protein X (EPX), mast cell tryptase, IL-1beta and TNF-alpha using immunoassays. Blood samples were analysed for MPO, EPX, C-reactive protein, orosomucoid and leucocyte counts. RESULTS: Fecal MPO and IL-1beta levels were elevated in all patients at inclusion despite different disease extensions. Striking reductions in fecal levels of MPO, EPX, tryptase and IL-1beta were observed after 4 weeks of treatment in 20/28 patients with complete remission after 8 weeks. No further reductions were seen in 20/27 patients at 8 weeks. Endoscopic score correlated to IL-1beta at all visits (p<0.01), to MPO at visits 2 and 3 (p<0.05, p<0.001), EPX at visit 2 (p<0.05) and tryptase at visit 3 (p<0.01). Levels of fecal markers also related to histological indices of the disease. CONCLUSIONS: Measurements of fecal MPO, EPX and IL-1beta could be objective complements to endoscopical and histopathological evaluations in the daily care of patients with UC.