老年慢性阻塞性肺疾病缓解期患者对疾病相关知识认知程度调查及影响氧疗依从性的因素分析

目的：了解老年慢性阻塞性肺疾病缓解期患者对疾病相关知识及氧疗知识的认知程度，分析氧疗依从性的影响因素。方法：①选择2001—03／2004—03山东省青岛疗养院门诊就诊老年慢性阻塞性肺疾病缓解期患者60例，男59例，女1例。患者均知情同意。②调查于患者人院时，采用个体访谈法完成。调查使用依据健康信念模式自行设计调查问卷[由三部分组成：个体的健康信念（对疾病的严重程度的认知、对预防性措施所产生效果的认知、对预防性措施障碍的认知）；行动的线索及意向（包括他人的提醒、报刊杂志的宣传、亲朋好友的忠告等）；影响及制约因素（包括性别、人格、文化程度、职业、对疾病的认知程度等），共25项内容1。③分析影响患者对长期氧疗知识的认知程度及影响患者氧疗依从性因素采用Logistic回归分析和直线相关分析。结果：老年慢性阻塞性肺疾病缓解期患者60例进入结果分析，并完成调查。①老年慢性阻塞性肺疾病缓解期患者对疾病知识认知程度较高，其中知道早期呼吸困难及时就医并采取良好治疗措施比例最大（94％）。②患者对氧疗的认知程度偏低，其中不了解每日吸氧时间患者所占比例最大（92％）。③老年慢性阻塞性肺疾病缓解期患者对长期氧疗知识的认知程度与患者文化程度、大众媒体的宣传程度及医护人员的健康教育呈显著正相关（r=0．334。0．487，0．421，P〈0．01）。④文化程度、疾病严重程度、患者对氧疗不适的感受程度、家庭成员的支持程度、大众媒体的宣传程度均影响老年慢阻肺患者氧疗依从性（相对危险度为0．014-1．601，P〈0．05-0．01），其中文化程度对氧疗依从性最大，大众媒体的宣传程度对氧疗依从性最小。结论：①老年慢性阻塞性肺疾病缓解期患者对疾病知识认知程度较高，对氧疗知识认知程度较低。②老年慢性阻塞性肺疾病缓解期患者对长期氧疗知识的认知程度随患者文化程度升高、大众媒体的宣传程度加深和医护人员的健康教育加强而升高。③老年慢性阻塞性肺疾病缓解期患者氧疗依从性主要受患者文化程度、疾病严重程度、患者对氧疗不适的感觉程度、家庭成员的支持程度、大众媒体的宣传程度影响。     

老年COPD病人家庭氧疗依从性的影响因素调查与分析

[目的]了解老年慢性阻塞性肺疾病(COPD)病人家庭氧疗依从性的影响因素。[方法]应用自行设计的调查问卷,对102例接受过家庭氧疗的老年COPD病人进行调查,并行相关因素分析。[结果]102例老年COPD病人中,家庭氧疗依从性佳者仅24例(23.5%),大多数病人对氧疗的认知程度偏低,影响老年COPD病人家庭氧疗依从性的因素包括文化程度、病情、接受健康教育的程度、对生活的满意度和大众媒体宣传程度。[结论]老年COPD病人家庭氧疗依从性较差,对氧疗认知程度偏低,病人病情越重,文化程度越高,接受健康教育程度越高,大众媒体宣传程度越高,对生活的满意程度越高,家庭氧疗依从性越好。     

老年COPD病人家庭氧疗依从性的影响因素调查与分析

[目的]了解老年慢性阻塞性肺疾病（COPD）病人家庭氧疗依从性的影响因素。[方法]应用自行设计的调查问查，对102例接受过家庭氧疗的老年COPD病人进行调查，并行相关因素分析。[结果]102例老年COPD病人中，家庭氧疗依从性佳者仅24例（23．5％），大多数病人对氧疗的认知程度偏低，影响老年COPD病人家庭氧疗依从性的因素包括文化程度、病情、接受健康教育的程度、对生活的满意度和大众媒体宣传程度。[结论]老年COPD病人家庭氧疗依从性较差，对氧疗认知程度偏低，病人病情越重，文化程度越高，接受健康教育程度越高，大众媒体宣传程度越高，对生活的满意程度越高，家庭氧疗依从性越好。     

老年COPD患者家庭氧疗现状调查

目的：了解老年慢性阻塞性肺疾病（COPD）患者家庭氧疗现状,分析影响该类慢性病氧疗普及情况及其影响因素。方法：通过病案调查取得该类患者的信息,并进行回访取得相关资料。结果：96例COPD患者接受家庭氧疗者仅为19例,仅为19.8%。结论：大多数患者对氧疗的认知程度偏低,应大力宣传氧疗对于老年慢性阻塞性肺疾病（COPD）的重要意义,以提高老年慢性阻塞性肺疾病用氧的意义的认识,提高该类患者的生活质量。     

老年慢性阻塞性肺疾病患者家庭氧疗影响因素的调查分析

目的了解老年慢性阻塞性肺疾病（COPD）患者家庭氧疗现状及其影响因素。方法对2012年4月-11月住院的103例老年COPD患者采用自行设计的问卷,对其进行调查分析。结果97例（94．2％）老年COPD患者居家时未按照医嘱吸氧;文化程度、经济状况、医疗费用报销比例、职业对老年COPD患者家庭氧疗依从性有影响,文化程度高、经济状况好、费用报销比例高者家庭用氧依从性高（P〈0．05）;不同职业,其家庭用氧依从性不同,农民家庭氧疗依从性低。结论老年COPD患者家庭氧疗依从性低,应该加强干预。     

循证护理对慢性阻塞性肺疾病患者氧疗依从性的影响

目的 探讨循证护理对慢性阻塞性肺疾病患者氧疗依从性的影响.方法 我院于2009-01--2009-12住院患者196例,临床确诊为慢性阻塞性肺疾病,需长期氧疗的患者.随机分为两组,循证组和对照组各98例.循证组运用循证护理寻找慢性阻塞性肺疾病患者长期氧疗中存在的问题,并组织实施.对照组给予常规护理.比较两组患者对氧疗依从性的影响.结果 循证组氧疗依从性优于对照组.结论 采用循证护理能提高慢性阻塞性肺疾病患者氧疗的依从性.     

全球慢性阻塞性肺疾病防治创议干预计划实施的依从性调查及影响因素分析

目的:探讨影响慢性阻塞性肺疾病患者对全球慢性阻塞性肺疾病防治创议干预计划依从性的因素。方法:①选择2001-06/2003-06江汉大学附属医院呼吸内科门诊及住院慢性阻塞性肺疾病患者80例,均处于慢阻肺稳定期;调查前取得患者知情同意。②对每例患者详细讲解全球慢性阻塞性肺疾病防治创议,还以电话、网络及就诊时健康教育方式跟踪服务,调查内容包括年龄、职业、受教育程度、家庭收入、对全球慢性阻塞性肺疾病防治创议了解、危险因素控制、药物治疗、非药物治疗等。③依从性的判定:调查期间肺功能检查至少2次、完全戒烟者、药物治疗者根据病情需要用药、非药物治疗者至少坚持使用2种以上全球慢性阻塞性肺疾病防治创议提供的方法为依从性好。④计数结果差异比较采用χ2检验。结果:①纳入慢性阻塞性肺疾病患者80例,发放问卷80份,回收67份,其中填写符合全求且或信度高的问卷51份。②被调查中受教育程度中学以上34例,中学以下17例;≥年人均收入(2001年人均6780元、2002年人均7650元、2003年人均8200元)32例,<年人均收入19例。③中学以上文化程度患者肺功能监测、危险因素控制、药物治疗依从性好的患者明显多于中学以下(9,18,9例;3,7,3例,P<0.05)。④≥年人平均收入的患者肺功能监测、危险因素控制、非药物治疗与<年人平均收入患者例数相近。≥年人平均收入的患者对药物治疗依从性好的患者例数明显多于<年人平均收入的患者(8,4例,P<0.05)。结论:患者受教育程度、家庭收入明显影响慢性阻塞性肺疾病稳定期患者对全球慢性阻塞性肺疾病防治创议干预计划的依从性。     

影响慢性阻塞性肺疾病患者无创呼吸机治疗依从性的相关因素分析

目的分析影响慢性阻塞性肺疾病患者无创呼吸机治疗依从性的相关因素。方法选取2017年1月至2019年12月需无创呼吸机治疗的慢性阻塞性肺疾病患者75例。根据患者无创呼吸机治疗依从性的高低分为依从性高组(n=52)和依从性低组(n=23)。收集患者的相关资料,分析影响其无创呼吸机治疗依从性的相关因素。结果单因素分析结果显示,年龄、文化程度、经济收入、疾病认知程度、护理健康宣教、护理操作、面罩不良反应、有无悠气感和心理恐惧是慢性阻塞性肺疾病患者无创呼吸机治疗依从性的影响因素。多因素Logistic回归分析结果显示,疾病认知程度低和憋气感是患者无创呼吸机治疗依从性的危险因素(P<0.05)。结论影响慢性阻塞性肺疾病患者无创呼吸机治疗依从性的影响因素较多,可加强对患者的健康宣教,提高患者无创呼吸机治疗依从性。     

阻塞性睡眠呼吸暂停低通气综合征患者遵医行为及影响因素分析

目的调查分析阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的遵医行为及影响因素。方法使用自编的遵医行为量表和依据Becker提出的健康信念模式自编的影响因素调查问卷,对300例确诊为OSAHS患者进行调查。结果共发放调查问卷300份,有效问卷300份,有效率100％。患者的遵医率为42．67％,患者的学历、收入、医务人员教育程度、大众媒体宣传程度、家庭成员支持程度、疾病严重程度是影响OSAHS患者遵医行为的因素（P〈0．05）。患者对OSAHS相关知识认知程度低,与患者的文化程度、医护人员对患者的健康教育、大众媒体对遵从医嘱知识宣传、疾病严重程度有关（P〈0．05）。通过开放性问题的调查,患者希望医护人员采用多种形式的方法普及相关知识;而医护人员应不断提升自身的素质满足患者的需要和知识需求。结论加强对文化程度较低患者群的宣传,重视大众媒体宣传,强化医务人员有效的健康教育,针对初患病患者加强教育是促进OSAHS患者遵医行为依从性的有效手段。     

全球慢性阻塞性肺疾病防治创议干预计划实施的依从性调查及影响因素分析

目的：探讨影响慢性阻塞性肺疾病患者对全球慢性阻塞性肺疾病防治创议干预计划依从性的因素。方法：①选择2001-06／2003—06江汉大学附属医院呼吸内科门诊及住院慢性阻塞性肺疾病患者80例，均处于慢阻肺稳定期；调查前取得患者知情同意。②对每例患者详细讲解全球慢性阻塞性肺疾病防治创议，还以电话、网络及就诊时健康教育方式跟踪服务，调查内容包括年龄、职业、受教育程度、家庭收入、对全球慢性阻塞性肺疾病防治创议了解、危险因素控制、药物治疗、非药物治疗等。③依从性的判定：调查期间肺功能检查至少2次、完全戒烟者、药物治疗者根据病情需要用药、非药物治疗者至少峰持使用2种以上全球慢性阻塞性肺疾病防治创议提供的方法为依从性好。④计数结果差异比较采用x^2检验。结果：①纳入慢性阻塞性肺疾病患者80例，发放问卷80份．回收67份，其中填写符合全求且或信度高的问卷51份.②被凋查中受教育程度中学以上34例，中学以下17例；≥年人均收入（2001年人均6780元、2002年人均7650元、2003年人均8200元）32例，〈年人均收入19例。③中学以上文化程度患者肺功能监测、危险因素控制、药物治，7依从性好的患者明显多于中学以下（9、18，9例；3，7，3例．P〈0．05）,④≥年人平均收入的患者肺功能监测、危险因素控制、非药物治疗与〈年人平均收入患者例数相近。≥年人平均收入的患者对药物治疗依从性好的患者例数明显多于〈年人半均收入的患者（8．4例．P〈0．05）．结论：患者受教育程度、家庭收入明显影响慢性阻摩性肺疾病稳定期患者对全球慢性阻塞性肺疾病防治创议干预计划的依从性。     

Advances in the assessment of disease activity in inflammatory bowel disease

Knowledge of the severity and extent of the inflammation in inflammatory bowel diseases provides a means of determining rational therapeutic strategies in affected patients. During the past 3 decades, several clinical, laboratory, and combined indices have been proposed for the assessment of inflammatory bowel disease; refinements in radiologic methods and the availability of endoscopy and biopsy have facilitated the accurate assessment of the extent and severity of the disease. In relapsing conditions such as inflammatory bowel disease, however, the use of such procedures is limited by the radiation exposure or the relatively invasive nature of the technique. In this article, we review the proposed methods and recent advances in assessment of patients with inflammatory bowel disease; we also discuss possible strategies at the time of diagnosis, during recurrence, and in evaluation of the efficacy of drug or dietic therapy.     

Attacking the disease spiral in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is the commonest respiratory cause of mortality and morbidity in adults in the UK. Although the condition is initially a pulmonary one, data exist to support the concept that factors associated with COPD, including immobility, gives rise to secondary effects, including a quadriceps myopathy, which in turn cause anaerobic metabolism at low work rates. This, through bicarbonate buffering, leads to CO2 retention which, because of constraints imposed by pulmonary mechanics, cause acidosis and dyspnoea. Various therapeutic strategies to reverse this spiral may be employed including pulmonary rehabilitation, quadriceps strength training and surgical or bronchoscopic lung volume reduction.     

Graves' disease in the elderly

Characterization of elderly (> or = 65) patients with Graves' disease (GD) was discussed. Emaciation was the symptom that was most frequently found in elderly patients. The presence of goiter, exophthalmos and increased appetite decreased with age, while weight loss, anorexia and arrhythmia increased. Elderly patients often have serious complications such as congestive heart failure and atrial fibrillation. Serum levels of free T3, free T4 and TSH receptor antibodies were significantly lower in elderly patients. In addition to fewer clinical signs and symptoms of GD in elderly patients, prominent cardiac or gastrointestinal findings may make the diagnosis more difficult. Elderly GD patients should be treated with antithyroid drugs. Radioiodine therapy may be considered after normalization of serum thyroid hormone levels.     

Renal disease in the elderly

With advancing age and in the absence of any disease, there is a significant alteration in kidney structure and a gradual decline in renal function. While RPF, GFR, and tubular reabsorptive capacity decrease with age, abnormal signs or symptoms cannot be detected under ordinary circumstances. The aging kidneys, however, have limited capacity to cope with rapid hemodynamic changes or disturbances in fluid and water balance, and this results in signs and symptoms of renal dysfunction. In the elderly, the incidence of primary renal diseases declines while the incidence of renal diseases secondary to systemic disease increases. AGN, while essentially a disease of the young, does occur in the older age group. RPGN, however, is the most common form of acute primary glomerulonephropathy, followed by membranous glomerulonephritis and glomerulosclerosis. Glomerulonephritis secondary to vasculitis and Wegener's granulomatosis and amyloidosis constitutes the most common secondary glomerulonephropathy. Drug-induced acute or chronic tubulointerstitial nephropathy is seen more frequently in the geriatric age group because of the high incidence of multiple-drug treatment. There is a high incidence of ARF in the elderly which is frequently precipitated by hypovolemia, hypotension, nephrotoxic drugs, surgery, and anesthesia. Clinical manifestations of renal disease in the elderly are often atypical and nonspecific. Abnormal signs and symptoms are frequently attributed to extrarenal diseases or to previously existing disorders. For these reasons, renal disease in the elderly may go undetected. Serum creatinine level may remain within normal range despite a drop in GFR because of a reduction in muscle mass with aging. Therefore, creatinine clearance is a more accurate test for assessment of renal function. A decrease in creatinine clearance should not be ignored or attributed to aging; it is an indication for further renal evaluation.     

腹部巨大淋巴结增生症(附5例报告并文献复习)

巨大淋巴结增生症是一种病因不明和少见的良性疾病，Castleman等犤１犦于１９５４年首先报道１例，并于１９５６年确定为良性非肿瘤性病变，国内截止１９８８年仅报告６０余例，腹部Castleman’s病更为少见，目前全世界有关该病的CT文献约有２５例。本文综合我院经手术病理证实的５例腹部巨淋巴结增生症，结合文献加以讨论，旨在提高对本病的认识。１材料和方法本组病例中男２例，女３例，年龄１２～５２岁，平均３９岁，临床以低热、血沉加快和贫血为特征，亦有１例无明显症状，体检时发现。发热和腹痛各１例，多汗１例，上腹无痛性包块…     

Thyroid disease in the elderly

As people in our society live longer, it is important for clinicians to know more about problems commonly seen in the elderly. Thyroid problems are especially important to understand because they do occur with rather high frequency, and their mode of presentation is frequently different from those seen in younger patients. The thyroid gland does undergo certain age-related changes in anatomy and physiology, but overall the thyroid is able to produce a normal amount of thyroid hormone throughout the years. Hypothyroidism is frequently difficult to diagnose in the elderly, because many of the symptoms of hypothyroidism can easily be confused with symptoms of aging. When hypothyroidism is looked for in large population studies of elderly patients, the incidence varies from 1% to as high as 17%, with women being more commonly affected than men, and subclinical hypothyroidism being more common than overt hypothyroidism. Virtually all cases of hypothyroidism are due to autoimmune thyroid disease, with most patients having measurable titers of thyroid autoantibodies. The therapy of hypothyroidism is done with extreme caution, as older patients are frequently very sensitive to the effects of excess thyroid hormone. In addition, the metabolism of thyroid hormone slows down with age, making the full replacement dose much less in an older patient than in a younger one. Hyperthyroidism is also quite common, occurring in from 0.5% to 3% of all elderly patients. The presentation is frequently atypical, as patients often lack the hyperdynamic symptomatology and instead have a more sedated, apathetic presentation. Weight loss and cardiac symptoms frequently predominate, and the presence of a goiter is frequently absent, making the diagnosis less obvious than in a younger patient. Therapy is usually radioactive iodine, after an adequate course of antithyroid drugs, to render the patient euthyroid. Thyroid nodules do occur with increasing frequency in the elderly, but most of them are not malignant. Fine-needle aspiration for cytology is very helpful in determining which patients should be referred for surgery. Well-differentiated cancers do predominate, but their course is frequently less predictable than in younger patients. Lymphoma of the thyroid and undifferentiated cancers do occur with increasing frequency in the elderly. Multinodular goiter, usually of longstanding, is frequently seen in elderly patients, and thyroid hormone suppressive therapy not only is not indicated but may contribute to exogenous hyperthyroidism.