维持性血液透析患者并发房颤的预防与护理

心律失常是维持性血液透析患者常见的并发症之一,其类型以阵发性房颤多见,是最严重的心房电活动紊乱。近年研究表明[1],血液透析患者房颤的发生率为7.14%,常发生在透析3~4 h后[2],若不积极治疗可导致患者心力衰竭,诱发血栓栓塞等并发症,甚至危及生命。我科2008年以来共有维持性血液透析并发房颤患者17例,经积极预防和及时治疗护理,房颤均得到及时控制,发作次数明显减少。现报道如     

高通量血液透析病人透析充分性临床观察及护理干预

[目的]探讨长期维持性血液透析病人进行高通量血液透析充分性相关因素及相应护理干预的措施.[方法]将46例长期维持性血液透析病人随机分为两组.高通量血液透析组(观察组)23例,给予常规临床观察护理的同时进行护理干预(心理干预、认知干预和行为干预);低通量血液透析组(对照组)23例,给予常规临床观察护理.[结果]两组第1次(单次)透析前、后血清尿素氮、肌酐比较均有统计学意义;观察组第1次透析前后血清β2-微球蛋白(β2-MG)以及治疗1个月、6个月、12个月透析前与第1次透析前β2-MG比较差异均有统计学意义(P<0.05),而对照组差异无统计学意义;透析并发症的发生率观察组低于对照组.[结论]高通量血液透析能有效清除中、大分子毒素物质β2-MG,相应护理干预能预防、降低或延缓长期维持性血液透析病人远期并发症的发生.     

维持性血液透析中低血压管理的持续质量改进

目的探讨持续质量改进方法(CQI)用于维持性血液透析(MHD)患者护理管理中,对于低血压发生的影响。方法选2016年1月-2016年12月在我院血液净化中心MHD患者160例为研究对象,按照透析区域分成对照组和研究组各80例,对照组给予常规透析护理管理,研究组采用CQI进行管理,比较两组干预期间低血压发生率、焦虑抑郁情况、自护能力、护理满意度变化。结果干预3个月,对照组透析次数合计952次,低血压发生75次,发生率为7.88%,研究组共计透析950次,低血压发生36次,发生率为3.79%,研究组低血压发生率低于对照组(P0.05);干预后研究组SAS、SDS量表评分低于对照组(P0.05);干预后研究组ESCA总分及4个维度得分均优于对照组,研究组护理满意度明显高于对照组(96.25%/83.75%),差异均具有统计学意义(P0.05)。结论持续质量改进能有效降低维持性血液透析患者低血压的发生率,改善患者生活质量。     

充分性护理评估在维持性血液透析患者中的应用

目的:探讨充分性护理评估在长期维持性血液透析患者中的应用效果。方法:按随机数字表法选择在我院血液净化中心维持性血液透析1个月以上患者66例,随机分为观察组和对照组各33例。观察组进行透析充分性的护理评估;对照组给予普通透析护理,未进行透析充分性的护理评估。比较两组在护理干预前后尿素清除数(Kt/V)的变化,即透析充分性的变化。结果:经临床观察1个月,观察组Kt/V值高于干预前(P0.05)。结论:通过透析充分性护理评估和干预可提高维持性血液透析患者的透析充分性,提高长期病患的生存质量。     

应用抗阻运动预防患者透析低血压的效果

目的:观察抗阻运动对血液透析患者透析低血压发生次数、接受护理干预次数和透析前血压的影响。方法 :选择2015年8月至2016年3月在大连市某三级甲等医院2所血液净化中心的77名患者作为研究对象,采用抽签法将77名患者分为两组,对照组(n=38)给予常规血液透析护理,实验组(n=39)在常规血液透析护理的基础上,指导患者进行透析中的抗阻运动,每周3次,共12周。收集干预前3个月及干预期间3个月两组患者透析低血压发生次数、透析低血压接受护理干预次数和透析前血压值进行对比。结果 :实验组透析低血压发生次数、因透析低血压接受护理干预次数均少于对照组(P0.05)。12周抗阻运动可降低患者透析前舒张压(P0.05)。结论 :12周抗阻运动对血液透析患者透析低血压有积极的改善作用,可有效减少相关护理干预次数,改善患者血压。     

透析中运动对维持性血液透析患者透析充分性及睡眠质量的影响

目的:研究透析中运动对维持性血液透析患者透析充分性及睡眠质量的影响。方法:将符合纳入条件的维持性血液透析患者,采用随机数字表法分为实验组(n=42)和对照组(n=45)。实验组在常规护理的基础上使用智能运动车进行每周3次透析中个性化的渐进式运动干预,对照组给予常规护理,干预时间为12周。观察两组患者干预12周前后透析充分性和睡眠质量的变化。结果:干预12周后,实验组的KT/V高于对照组(P0.05),睡眠得分低于对照组(P0.05)。结论:透析中运动可提高维持性血液透析患者的透析充分性,改善患者睡眠质量。     

运动干预对维持性血液透析患者的影响

目的探讨运动干预对维持性血液透析患者的影响。方法将2016年1月至2017年6月80例维持性血液透析患者按数字表法随机等分为对照组和观察组,对照组透析过程中给予透析常规护理,观察组在常规护理的基础上给予运动干预,持续3个月。比较两组患者干预3个月时尿素清除指数(Kt/V)、尿素下降率(URR)、残余肾功能(RRF)和血压状况。结果干预3个月后,观察组Kt/V,RRF,URR均优于对照组,观察组收缩压和舒张压均值均高于对照组,两组比较差异有统计学意义(P0.05)。结论血液透析过程中运动干预可以提高血液透析充分性,提升透析效果,改善透析低血压。     

基于酸甘化阴理论乌梅喷雾剂改善血液透析患者口渴症的效果观察

目的 基于酸甘化阴理论,探讨乌梅喷雾剂改善维持性血液透析患者口渴症状的有效性.方法 采用随机对照试验,选取血液透析室有口渴症的维持性血液透析患者60例,通过信封法随机分为干预组和对照组,各30例.干预组在常规治疗与护理的基础上给予乌梅喷雾剂喷雾,对照组在常规治疗与护理的基础上温开水喷雾,收集并比较2组受试者口渴程度评分、唾液静息流率.结果 干预前,干预组及对照组的基线资料及口渴强度比较无统计学意义(P>0.05).干预后,口渴程度评分显示干预组(21.8±1.5)分较对照组(28.7±1.8)分更能有效地降低患者口渴程度(P<0.01).干预组和对照组2 min静态唾液流率分别为(1.0±0.5)mg/min和(0.3±0.1)mg/min.结论 乌梅喷雾剂可有效缓解维持性血液透析患者口渴症状,提高患者唾液静息流率,较少患者的液体摄入量,从而减轻心血管的负担,对于透析患者健康状况具有积极的临床意义.     

三种超滤模式对透析相关性低血压影响的研究

目的探讨联机血容量监测(BVM)对评价透析患者干体重和防治透析患者低血压的作用。方法选择血液透析过程中发生过1次或1次以上低血压的维持性透析患者30例,分为3组,分别采用恒定超滤、阶梯式超滤和血容量监测(BVM)控制超滤三种超滤模式进行血液透析,观察并记录患者超滤量、血压的动态变化及出汗、肌肉痉挛、头疼等不良反应的发生次数,记录护理干预次数,比较三种超滤模式透析不良反应的差异。结果与恒定超滤组、阶梯式超滤组相比,BVM控制超滤组低血压发生率、护理干预次数、血液透析中不良反应发生率明显较少(P(0.05),透析后血压显著降低(P(0.05);恒定超滤组低血压发生率、护理干预次数、血液透析中出汗、肌肉痉挛的发生率显著低于阶梯式超滤组(P0.05)。结论 BVM控制的超滤模式有助于减少血液透析中低血压的发生,并有助于评估患者的干体重。     

加强患者健康教育对控制血液透析患者高血压的影响

目的调查分析维持性血液透析患者高血压的危险因素,加强患者健康教育,提高血压达标率。方法对177例透析患者进行调查问卷。分析血压控制不达标的原因,有针对性进行健康教育和医疗干预。结果合并高血压维持性血液透析患者112例,其中68例血压未达标(>140/90mmHg)。血压未达标患者的透析间期体质量增长率较血压达标患者高,分别为(6.18±1.83)%和(5.19±1.60)%,差异有统计学意义(P<0.01)。加强患者健康教育,进行医疗护理干预2个月后,血压未达标者透析间期体质量增长量较干预前减少,收缩压和舒张压较干预前均有所下降。结论对透析患者进行相关知识的宣教有助于患者控制体质量增长,降低血压。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.