生活习惯的调节对顽固性耳鸣患者疗效观察*

目的:研究生活习惯的调整对顽固性耳鸣疗效的影响,并分别探讨生活习惯的调整后,耳鸣严重程度、听力下降、病程、疗程四个单因素和耳鸣疗效之间的关系。方法:选择在我院门诊就诊的125例耳鸣患者为研究对象,按照文献报道的方法指导患者调整生活方式,即合理饮食、改善睡眠、心理疏导、健康锻炼,观察。结果:痊愈10例,显效31例,有效60例,无效24例。痊愈、显效、有效组生活方式调整后平均得分显著高于调整前,差异有统计学意义(P0.05);无效组生活方式调整前后平均得分比较差异无统计学意义(P0.05)。耳鸣病程小于6个月者痊愈率为10.29%,明显高于病程大于6个月者痊愈率5.26%(P0.05);两组总有效率比较,差异无统计学意义(P0.05)。听力下降组治疗总有效率为80.77%,与听力正常组总有效率80.85%比较,差异无统计学意义(P0.05)。耳鸣程度越轻,耳鸣治疗效果越好,痊愈率越高;耳鸣程度越重,痊愈率降低,但总有效率越高。随着疗程的增加,耳鸣的痊愈率、总有效率都会增加,但痊愈率增长相对有效率缓慢,疗程6个月总有效率为92.31%,显著高于疗程1个月的总有效率57.14%,差异有统计学意义(P0.05)。结论:耳鸣病程、耳鸣程度分级、是否伴听力损失以及治疗的疗程在判断顽固性耳鸣的疗效方面是有参考价值的,耳鸣患者只要能长期坚持健康的生活方式,顽固性耳鸣症状一定会有改善的。     

综合护理干预对耳鸣耳聋患者生活质量及睡眠质量的影响

目的:探讨综合护理干预对耳鸣耳聋患者生活质量及睡眠质量的影响。方法:回顾性分析2015年12月~2017年6月于医院诊治的126例耳鸣耳聋患者,根据护理干预方式不同分为对照组59例和研究组67例,对照组采取常规护理,研究组采取综合护理干预。经过干预后对两组患者生活质量、睡眠质量及满意度进行评定,其中患者生活质量采用生活质量综合评定问卷进行评定;睡眠质量采用匹兹堡睡眠质量指标(PSQI)进行评价。结果:经过不同的护理模式干预后,研究组患者生活质量指标中躯体健康、心理健康、社会功能及物质生活方面评分均明显高于对照组(P0.05),研究组患者PSQI评分明显低于对照组(P0.05),研究组患者满意度明显高于对照组(P0.05)。结论:综合护理干预应用于耳聋耳鸣患者,能够显著改善其睡眠质量,提高其生活质量,对临床治疗效果有积极的影响作用。     

不同护理方式对老年睡眠障碍患者的睡眠影响探讨

目的:探讨不同护理方式对老年睡眠障碍患者的睡眠治疗的干预作用。方法:选取2016年10月至2019年9月山东省临沂市兰山区人民医院收治的老年睡眠障碍患者86例作为研究对象,随机分为观察组和对照组,每组43例。观察组采取精细化护理,对照组采取常规护理,比较2组的匹兹堡睡眠指数评分(Pittsburgh Sleep Index Score,PSQI)评分等指标。结果:观察组干预后总睡眠时间为(238.11±54.29) min,对照组为(204.79±53.14) min,观察组显著高于对照组,2组比较差异有统计学意义(P 0.05)。干预后观察组PSQI评分为(7.01±2.05)分,对照组为(10.69±2.18)分,观察组显著低于对照组,2组比较差异有统计学意义(P 0.05)。结论:在老年睡眠障碍中运用精细化护理,可显著改善其睡眠质量,延长总睡眠时间。     

研究老年慢性心力衰竭患者睡眠障碍的护理干预方法

目的:探讨老年慢性心力衰竭患者睡眠障碍的护理干预方法。方法:选取2019年1—12月福建医科大学附属第二医院收治的老年慢性心力衰竭患者40例作为研究对象,给予患者疾病护理、心理干预、辅助睡眠护理等措施,对患者睡眠障碍进行护理干预,并以匹兹堡睡眠质量指数量表(PSQI)比较患者接受护理干预前后的睡眠质量改变情况。结果:护理干预前,患者PSQI评分为(17. 25±3. 25)分,护理干预后,患者PSQI评分为(10. 35±3. 00)分,数据比较差异有统计学意义(P 0. 05)。结论:老年慢性心力衰竭患者睡眠障碍的护理干预方法中,采用综合护理干预措施,有利于改善患者睡眠质量,尽可能排除引发睡眠障碍的多种因素,提高患者睡眠质量的同时促进患者病情稳定,提高患者病情改善效果。     

睡眠障碍在焦虑影响耳鸣病人主观症状中的传递作用

目的:探讨睡眠障碍在焦虑影响耳鸣病人主观症状中的传递作用。方法:采用方便抽样方法对纳入研究的347例耳鸣病人进行问卷调查,收集病人的一般人口学特征,采用耳鸣障碍量表(Tinnitus Handicap Inventory,THI)、焦虑自评量表(Self-rating Anxiety Scale,SAS)及匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)进行调查。结果:根据THI评分,耳鸣病人多数为Ⅱ~Ⅳ级(70.0%),病人睡眠障碍检出率为52.7%,焦虑检出率为47.3%;相比间断性耳鸣,持续性耳鸣病人的耳鸣症状、睡眠障碍及焦虑症状均较严重(P<0.05);相比<6个月的病程,6~12个月病程病人遭受更严重的耳鸣症状、睡眠障碍及焦虑症状(P均<0.05);相比高中及以下学历,接受高等教育的病人感受到的焦虑症状较轻(P<0.05);THI评分与PSQI评分及SAS评分两两间均呈显著正相关关系(P<0.01);建立以睡眠障碍为中介变量的焦虑影响耳鸣病人主观症状的间接效应模型,模型拟合较好[χ²/df=1.78,拟合优度指数(GFI)=0.94,比较拟合指数(CFI)=0.95,近似误差均方根(RMSEA)=0.04];基于非参数百分位Bootstrap分析显示,睡眠障碍在焦虑影响耳鸣病人的主观症状中起部分中介效应(95%CI[0.023,0.685]),中介效应占总效应的比例为52%。结论:耳鸣病人的焦虑和睡眠障碍水平均高于普通人群,焦虑可通过睡眠障碍间接影响病人的耳鸣症状。在今后的耳鸣诊疗中应将改善病人的睡眠质量和减轻焦虑症状纳入诊疗流程。     

银杏叶胶囊联合高压氧治疗耳鸣相关因素分析

目的探讨银杏叶胶囊联合高压氧治疗耳鸣的相关因素分析。方法将103例耳鸣患者作为研究对象,所有患者均采用银杏叶胶囊联合高压氧治疗,疗程20d,将耳鸣改善程度≥0.5分者设为观察组,耳鸣改善程度0.5分者设为对照组,对两组患者的性别、年龄、耳鸣病程、耳鸣频率及治疗前耳鸣程度进行单因素分析及二元logistic分析。结果观察组与对照组耳鸣改善程度分别为0.56±0.077和0.34±0.071,观察组与对照组在年龄、耳鸣病程及治疗前耳鸣程度评分比较,差异有统计学意义(P0.05),而二元logistic分析结果表明,观察组年龄40岁是对照组的2.108倍,95%CI为1.146~4.927;病程20个月,是对照组的1.924倍,95%CI为1.160~3.068;治疗前耳鸣程度评分≥5分,是对照组的0.682倍,95%CI为0.167~1.149。结论银杏叶胶囊联合高压氧疗效可靠,影响耳鸣改善程度的因素有年龄、耳鸣病程及治疗前耳鸣程度。     

普瑞巴林治疗难治性神经病理性疼痛的疗效与耐受性评估

目的评估普瑞巴林治疗难治性神经病理性疼痛的疗效与耐受性。方法采用队列研究,对连续收治的44例难治性神经病理性疼痛患者,予以普瑞巴林可变剂量150～300mg/d(基于药物的反应性和耐受性)治疗4周。采用数字等级评分(NRS)评价基线、第2周、第4周时疼痛强度以及疼痛对睡眠的干扰,应用汉密尔顿抑郁量表(17项)、汉密尔顿焦虑量表和患者总体印象改变(PGIC)进行情绪及总体疗效评定,同时观察普瑞巴林的不良反应。结果 43例患者完成研究,平均普瑞巴林剂量(272.1±59.1)mg。经治疗,疼痛评分由6.3±1.0下降至2周时的4.4±1.4和4周时的3.1±1.6(-50.9%,P<0.01);睡眠干扰评分、汉密尔顿抑郁评分和焦虑评分均明显改善(P<0.01)。24例(55.9%)患者的PGIC为"极为好转"或"明显好转"。不良反应少,仅1例(2.3%)患者因头晕而退出研究。结论普瑞巴林(150～300mg/d)能有效改善难治性神经病理性疼痛以及相关的睡眠及情绪障碍,且耐受性良好。     

护理干预改善老年患者睡眠障碍的临床效果观察

目的:研究护理干预改善老年患者睡眠障碍的效果。方法:选取2018年1月至2019年1月山东省威海市某医院收治的老年睡眠障碍患者58例作为研究对象,按照随机数字表法随机分为观察组和对照组,每组29例。观察组根据老年人睡眠障碍的形成原因予以护理干预,对照组实行常规护理。比较2组睡眠质量的改善情况。结果:患者睡眠障碍的原因主要有工作情况、身体健康状况、日常生活习惯、性别和居住环境等。观察组干预后PSQI评分为(4. 24±2. 18)分,比对照组的(7. 82±2. 16)分低,差异有统计学意义(P 0. 05)。结论:居住环境、运动和自身身体状况都能够对老年患者的睡眠障碍造成比较大的影响,通过对老年患者施以护理干预,有助于改善其睡眠质量,建议临床推广。     

精细护理干预对老年睡眠障碍患者睡眠质量的影响

目的:探讨精细护理干预对老年睡眠障碍患者睡眠质量的影响。方法:选择2014年8月~2016年8月在我院接受治疗的老年睡眠障碍患者120例,将其随机等分为对照组及研究组,对照组通过常规方式进行护理,研究组在常规护理的基础上增加精细护理干预措施,比较两组患者的睡眠质量。结果:研究组患者匹兹堡肿胀质量指数评分低于对照组(P<0.05),潜伏期睡眠时间短于对照组(P<0.05),睡眠时间长于对照组(P<0.05)。结论:对睡眠障碍患者进行精细护理干预能有效提高患者的睡眠质量,值得在临床上推广。     

医用免疫三氧自血疗法治疗睡眠障碍的疗效调查

目的:研究医用免疫三氧自血疗法对康复科患者睡眠障碍的疗效,为临床医师采用医用免疫三氧自血疗法治疗睡眠障碍及进一步实验研究提供参考依据。方法:采用自制睡眠障碍分析量表、匹兹堡睡眠质量指数量表(PSQI)对2014年10月~2017年3月在广州医科大学附属第五医院接受医用免疫三氧自血疗法的702名康复科患者进行问卷调查。结果:702例康复科患者中,失访478例,纳入分析224例,其中合并睡眠障碍者为118例,占52.68%。医用免疫三氧自血疗法治疗睡眠障碍患者118例中,有效62例,有效率为52.54%。性别、治疗次数对疗效无显著性影响(P0.05)。治疗有效的62例患者中,21例完成PSQI量表,治疗前总分为10.94±2.388,治疗后总分为3.72±2.052,有显著性差异(P0.01),其中主观睡眠质量、睡眠持续性、习惯性睡眠效率、白天功能紊乱、睡眠潜伏期、睡眠紊乱等因子治疗前后比较,均有明显改善。结论:康复科患者睡眠障碍的类型以失眠为主,采用医用免疫三氧自血疗法治疗康复科睡眠障碍患者存在明显有效和完全无效并存的矛盾现象,今后的研究应进一步分析有效和无效人群的差异,为精准治疗提供参考。     

突发性感音神经性耳聋患者睡眠状况与其预后的相关性研究

目的探讨突发性感音神经性耳聋(简称突聋)患者睡眠状况与其预后包括听力学和主观症状改善程度的相关关系,为临床保健指导提供科学依据。方法对98例病程3~30 d的突聋患者通过匹兹堡睡眠质量指数(PSQI)量表和自行设计的一般情况调查表收集患者的睡眠状况和主观症状(耳鸣和耳闷堵感)改善情况,通过调查病历收集患者的听力学改善情况,从而综合评估患者的预后信息。结果突聋患者的睡眠状况与听力学改善程度存在趋势相关性(P=0.001),呈现正相关,不同睡眠程度与听力学改善程度存在直线关系趋势。突聋患者的睡眠状况与耳鸣改善程度不存在趋势相关性(P=0.441)。但PSQI4分的突聋患者耳鸣改善总有效率为87.5%,PSQI12分的突聋患者耳鸣改善总有效率为33.3%,突聋患者耳闷堵感治疗总有效率92.3%,突聋患者不同睡眠状况与治疗后耳闷堵感改善情况存在趋势相关性(P=0.000),出院时仅5例仍有耳闷堵感,其中4例集中在PSQI12分的患者中。结论突聋患者的睡眠状况对患者发病后4周内的治疗效果包括听力学和主观症状改善程度有影响,良好睡眠状况有助改善突聋预后。     

延续护理在主观性耳鸣病人中的应用

[目的]探讨延续护理模式在出院主观性耳鸣病人中实施的效果。[方法]选择2015年3月—2015年12月出院的76例主观性耳鸣病人接收延续护理,于出院前3d、接收延续护理6个月后采用耳鸣残疾度量表(THI)、睡眠状况自评量表(SRSS)、满意度调查表对病人耳鸣严重程度、睡眠状况、护理满意度进行评估,对评估结果进行统计学分析。[结果]接受延续护理后病人THI得分、SRSS得分、护理满意度得分均优于实施延续护理前,差异有统计学意义(P0.05)。[结论]延续护理可有效改善出院主观性耳鸣病人的耳鸣程度、生活质量及睡眠状况,增强病人对耳鸣相关知识的认知度,提高病人对医护人员的满意度。     

Sleep disorders in dialysis patients

By means of standardized interviews and a self-rating scale, information was obtained from 51 dialysis patients concerning their duration of sleep, fitness, working capacity, interests, quality of life, etc. 34 of the subjects reported sleep disorders: 2 had difficulties falling asleep, 21 in sleeping through, and 11 experienced both. Severity of the sleeping problems increases with prolonged hemodialysis therapy; the same seems to apply to lack of an active lifestyle. 9 patients, apart from repeated nocturnal urination, no longer complained about sleeping problems following kidney transplantation.     

Factors associated with sleep disorders in Chinese patients on continuous ambulatory peritoneal dialysis.

OBJECTIVE: This study aimed at identifying factors that are associated with sleep disorders in Chinese patients on continuous ambulatory peritoneal dialysis (CAPD). STUDY DESIGN: Questionnaire survey. SETTING: Renal dialysis unit of a tertiary-care hospital. PATIENTS: 179 Chinese patients on CAPD. MAIN OUTCOME MEASURES: The quantity and quality of sleep were compared between CAPD patients with and without self-reported sleep disorders. Demographic variables, personality traits, behavioral factors, somatic symptoms, and clinical parameters were correlated with the presence of sleep disorders. RESULTS: The mean age of the patients was 61 +/- 12 years and the male-to-female ratio was 1:1.3. The mean duration of CAPD was 47 +/- 42 months. 110 patients (61%) had self-reported sleep disorders. Among patients with self-reported sleep disorders, difficulty falling asleep was the most frequent complaint (74.5%), followed by frequent awakening (68%) and early morning waking (68%). The mean duration of sleep among these patients was 4.6 +/- 2.2 hours, versus 7.3 +/- 1.4 hours in patients without self- reported sleep disorders. Three personality traits (anxiety, worry, and sadness) and two somatic symptoms (bone pain and arthralgia) were the factors significantly associated with sleep disorders. Patients with sleep disorders also more frequently reported certain symptoms suggestive of sleep apnea. Demographic variables, behavioral factors (e.g., caffeine or alcohol intake), and clinical parameters (e.g., adequacy of dialysis, body mass index, hemoglobin, albumin, parathyroid hormone levels) did not differ between patients with and without sleep disorders. CONCLUSIONS: Sleep disorders are prevalent among Chinese CAPD patients. Personality traits (anxiety, worry, and sadness) and somatic symptoms (bone pain and arthralgia) were the factors significantly associated with sleep disorders in this patient population. Behavioral factors, demographic variables, and clinical parameters did not appear to predict sleep disorders. Further studies evaluating the impact of various psychological factors on sleep disorders among CAPD patients are warranted.     

Lifestyle practices and nocturnal sleep in midlife women with and without insomnia

Relationships between common lifestyle practices important to sleep hygiene (e.g., smoking cigarettes, drinking alcohol, ingesting caffeine, exercising, bed times, getting-up times) and nocturnal sleep have not been documented for women with insomnia in their home environments. This community-based sample of 121 women, ages 40 to 55 years, included 92 women who had experienced insomnia for at least 3 months and 29 women with good-quality sleep. Women recorded lifestyle practices and sleep perceptions (time to fall asleep, awakenings during sleep, feeling rested after sleeping, and overall sleep quality) in diaries while undergoing 6 nights of somnographic sleep monitoring at home. Compared to women with good-quality sleep, women with insomnia reported greater night-to-night variation in perceived sleep variables, poorer overall sleep quality (M = 2.8, SD = 0.7 vs. M = 1.9, SD = 0.5, P < 0.05), and longer times to fall asleep (M = 25 min, SD = 14.2 vs. M= 12.9 min, SD = 5.8, P < 0.05). Correlations between mean individual lifestyle practice scores and mean perceived or somnographic sleep variables were low, ranging from 0 to 0.20. An aggregated sleep hygiene practice score was not associated with either perceived or somnographic sleep variables. Regression analysis using dummy variables showed that combinations of alcohol, caffeine, exercise, smoking, and history of physical disease explained 9% to 19% of variance in perceived or somnographic sleep variables. Lifestyle practices, and combinations thereof, do warrant consideration when assessing or treating insomnia, but these data fail to support a dominant relationship between lifestyle practices and either perceived or somnographic sleep variables.     

胸腰椎骨折患者睡眠障碍原因分析及护理干预

目的了解脊柱外科住院患者睡眠障碍的原因,探讨相应的护理干预措施。方法回顾性分析80例存在睡眠障碍胸腰椎骨折住院患者、环境、心理、社会、不良生活方式等。结果患者经护理干预后睡眠质量得到一定改善。结论加强睡眠行为护理干预可有效改善胸腰椎骨折住院睡眠障碍患者的睡眠质量。     

Acupuncture for tinnitus: a series of six n = 1 controlled trials

OBJECTIVE: To explore patient perceived benefits of acupuncture for tinnitus. DESIGN: Controlled n=1 trials, with two phases A and B. SUBJECTS: Six patients with tinnitus. OUTCOME MEASURES: Primary outcome was Daily Diary records related to four tinnitus symptoms: loudness of tinnitus; pitch of tinnitus; waking hours affected with tinnitus; quality of sleep. Secondary outcomes were the Tinnitus Handicap Inventory (THI) and Measure Your Medical Outcome Profile (MYMOP). METHODS: Patients received a course of 10 acupuncture treatments over a 2-week period. Daily Diary entries related to the four tinnitus symptoms were recorded by patients for 14 days pre-treatment (phase A) and 14 days post-treatment (phase B). A hierarchical Bayesian model was used to combine the results from the individual patients to obtain estimates of the population and individual patient treatment effects, incorporating random variations at both levels (between patients and within patient). Tinnitus Handicap Inventory (THI) and Measure Your Medical Outcome Profile (MYMOP) were recorded at assessment points pre-treatment and post-treatment. RESULTS: Six patients participated in the trials, each receiving 10 treatments and completing all Daily Diary entries and outcome measures. For the of symptoms of loudness and pitch, there were variable treatment effects between patients, with a trend for the median overall reduction for loudness of -2.49 (-5.04, 0.02) and for pitch -1.39 (-3.74, 0.89), 95% credibility intervals being shown in brackets. For the other two symptoms, the waking hours affected and quality of sleep, patients' responses were more consistent, with amore credible overall median reduction for affected waking hours of -2.76 (-3.94, -1.63) and for quality of sleep -2.72 (-3.45, -2.03). The THI and MYMOP measures showed a trend of improvement after treatment. CONCLUSION: The n=1 trial methodology, with an AB design and Bayesian analysis, can be considered of value in exploring treatment effects for small numbers of patients receiving individualised treatments, as is common within complementary medicine. When the treatment effects from six patients were synthesized, the results of this study suggest that acupuncture may have a beneficial role in the treatment of tinnitus.     

Role of transvenous implantable cardioverter-defibrillators in preventing sudden cardiac death in children, adolescents, and young adults

OBJECTIVE: To evaluate the indications, underlying cardiac disorders, efficacy, and complications involved with transvenous implantable cardioverter-defibrillators (ICDs) in pediatric patients at the Mayo Clinic. PATIENTS AND METHODS: The records of all patients aged 21 years or younger who underwent transvenous ICD placement at the Mayo Clinic, Rochester, Minn, were reviewed retrospectively. RESULTS: Between March 1992 and September 2000, 16 patients (7 females; mean age, 15.4 years; range, 10-21 years) underwent transvenous ICD placement. The ICD was implanted for primary prevention of sudden cardiac death in 7 and for secondary prevention in 9. The underlying cardiac disorders included hypertrophic cardiomyopathy in 6 patients and congenital long QT syndrome in 6 patients. The mean +/- SD follow-up was 36+/-29 months (range, 5-108 months). There was no mortality. Seven patients (44%) received appropriate ICD therapy, including 6 of 9 who had ICDs placed for secondary prevention. Median time free from appropriate ICD discharge was 3 years (range, 0.2-9 years). Three patients (19%) experienced inappropriate ICD discharge. Two patients needed device replacement because of technical problems (lead fracture and device malfunction). Two patients developed pocket infection that required removal and reimplantation of the ICD. CONCLUSION: In adolescents and young adults, transvenous ICDs may prevent sudden death but are not free of complications. Forty-four percent of this cohort received potentially life-saving ICD therapy, including two thirds who received an ICD for secondary prevention.     

维持性血液透析患者睡眠障碍的原因分析及护理干预

目的探讨维持性血液透析（以下简称“血透”）患者睡眠障碍的常见原因及护理干预措施,以提高其睡眠质量。方法采用症状自评量表（SCL-90）对维持性血透至少3个月、匹兹堡睡眠质量指数（PSQI）得分〉7分的睡眠障碍患者进行调查,根据引起其睡眠障碍的身心原因,采取不同的干预措施。结果调查发现,维持性血透睡眠障碍患者睡眠障碍原因有多方面,主要为躯体症状和心理问题。SCL-90调查发现,本组患者总均分、躯体化症状、抑郁、焦虑等4项的得分显著高于国内常模（P〈0．01）。结论血液透析患者睡眠障碍受多种因素的影响,医护人员应根据其不同原因制定不同的干预措施,以改善其睡眠质量和生活质量。     

Associations between sleep and lifestyle behaviours among Australian nursing students: A cross-sectional study

BackgroundNursing students are at risk of inadequate sleep and poor lifestyle behaviours due to academic, clinical and personal stressors faced throughout their training. However, the relationship between lifestyle and sleep in this population is not well understood.AimThe aim of this study was to determine whether inadequate sleep was associated with poor diet, physical inactivity, alcohol consumption and smoking in Australian nursing students.MethodsUsing a cross-sectional design, nursing students (n = 470) completed an online questionnaire that assessed sleep and lifestyle behaviours. One-way ANOVA, t-tests, Pearson’s bivariate correlation and multiple regression testing were used to determine relationships between variables.FindingsMost nursing students experienced inadequate sleep (78%). Patterns of irregular eating, increased intake of discretionary foods, high-risk alcohol consumption and smoking were associated with indicators of inadequate sleep (p < 0.05). Frequent lunch intake (4–7 times per week) was associated with lower global sleep quality scores than irregular lunch intake (β: ?1.060, 95% confidence interval ?2.022, ?0.099), whereas alcohol score was associated with higher global sleep quality scores (β: 0.088, 95% confidence interval 0.011, 0.165) indicating poorer quality sleep, even after adjusting for confounding variables. No significant associations were found between sleep parameters and level of physical activity.ConclusionThis study highlights that nursing students experience inadequate sleep, and that poor lifestyle behaviours were associated with inadequate sleep in this sample. Strategies are needed to address inadequate sleep and poor lifestyle behaviours in nursing students, to support health, academic and clinic performance, as well as the transition to professional nursing practice.