晚期恶性肿瘤病人护理体会

目的:晚期癌症病人是一个特殊的患病群体,这部分人群身心状况异于普通病人,在临床医疗工作中需要采用特殊的医疗方式,在给予医疗护理处置的同时,还应该注重心理关怀和心理治疗,对患者临终前不同的心理状态施行不同的心理护理结合医疗治疗,以期达到较好的疗效。方法:对50例癌症晚期病人进行心理分析与个性化人文关怀。结果:通过采用心理疗法与医疗工作方法相结合,使病人拥有一个健康心态和平和心理,使病人正确对待死亡,配合治疗提高晚期生活质量。结论:护理人员在日常护理工作中对临终病人给予同情、温暖、关怀、帮助、照顾,能进一步完善护理服务,提高其生活质量。     

糖尿病患者心理问题分析及护理对策

目的 分析糖尿病患者的心理,找出护理应对措施。方法 应用心理护理,配合五套马车治疗,实施对病人的人性化关怀服务。结果 通过接受各种不同心理指导后,病人血糖及其他各项监测指标控制良好。结论 糖尿病的治疗,除需饮食、运动、药物治疗外,还要配合心理治疗,并且贯穿整个治疗过程中,治疗才能完善。     

心理治疗对精神病恢复期的临床意义

目的通过临床研究探讨心理治疗对精神病恢复期的临床意义。方法应用结构性访谈、个案分析和心理测量的方法,对接受心理治疗的精神病恢复期患者35例,进行具体分析精神病恢复期患者的心理状况、心理治疗的策略和心理治疗的效果。结果精神病恢复期患者的心理治疗在充分考虑患者的心理状况和需求后,采用科学的心理治疗的策略,取得了较好的恢复成效。结论精神病恢复期在药物治疗的同时配合心理治疗和人文关怀是其回归社会的必须的治疗手段。     

浅谈住院老年冠心病患者心理问题的护理

目的通过对本组住院老年患者存在的不良心理问题的观察、探讨,了解心理护理与心理治疗在疾病治疗、康复过程中的重要性。方法收集本科103例冠心病患者的临床资料,总结患者的心态特征,得到有益的护理经验。结果通过有效的心理护理,使患者逐渐掌握自我心理调适的方法,达到促进健康的目的。结论心理护理在住院老年冠心病患者的治疗和康复中的作用是不可或缺的。     

临终护理的体会

临终护理及关怀在我国是一门新的学科,旨在对医学无法挽救的濒死患者提供多方面的关怀和帮助。我科自1994-06～1996-12共收治各种急、危、重患者362例,其中临终患者56例,我们对濒死的患者实施临床护理及关怀,现报告如下:1 心理护理 对濒临死亡的患者,生物学治疗已经很困难,而心理治疗则占主导地位,应及时掌握临终患者的心理变化,有针对性地进行护理,使其有比较好的精神     

性病患者的恐惧心理分析及心理治疗与护理

目的探讨性病患者在心理上的恐惧,进行心理治疗与护理.方法2002年5月～2004年4月在我医院皮肤科住院门诊64名性病患者对疾病恐惧,对其前来就诊医治的心理状态进行分析,结合心理思想表现,进行心理治疗与护理.结果通过心理辅导,结合在临床用药物治疗与护理,病人临床症状得到治愈,实验室检查各项检验项目为阴性,全面康复.结论64例性病患者恐惧心理通过心理治疗与护理得到消除,身心状态得到康复.     

人文关怀在口腔修复治疗中的意义

人文关怀在口腔修复治疗中有修复计划中的人文关怀、临床操作人文关怀、修复护理中的人文关怀、宣教口腔卫生的人文关怀。牙痛的恐惧会直接刺激患者导致恐惧与不安,对治疗产生消极影响。在诊治过程中,除了对患者进行口腔医疗服务之外,更要考虑其心理精神层面的感受,这就需要我们口腔医护人员对患者有更多的人文关怀。     

偏瘫患者的心理治疗

<正>心理治疗又称精神治疗,是应用心理学的原则和方法通过治疗者与被治疗者的相互作用关系,医治患者心理、情绪,认识行为等问题。心理治疗的作用是通过语音、表情动作、行为来向患者施加心理上的影响,解决心理上的问题,达到治疗的目的,偏瘫患者的康复不仅需要加强患者的躯体功能,还应重视心理行为方面的康复,心理变化明显影响偏瘫患者的康复过程及结果,临床上对偏瘫患者应从以下几个方面进行心理治疗。     

脑血管患者的心理状态分析、治疗及护理

目的 探讨分析脑血管患者的心理状态,并给与心理治疗,对增强疗效,促进康复具有重要意义.方法 采用我院收治的脑血管患者100例临床资料,通过询问、调查了解其心态变化,进行分类、分析产生的原因,针对性的给予心理治疗及护理.结果 脑血管患者最佳的心理状态是取得治疗效果的必备条件.结论 脑血管患者均存在心里状态的改变,在药物治疗的同时,必须进行有效地心理分析及治疗,使患者以良好的心态面对生活,战胜疾病,早日康复.     

颅内肿瘤放疗患者心理状态调查及心理护理治疗临床疗效研究分析

目的:通过对153例颅内肿瘤放疗患者进行心理状态调查研究分析,以探讨颅内肿瘤放疗患者心理状态特点以及心理护理治疗的临床疗效。方法:选取153例颅内肿瘤放疗患者统一发放《心理问卷调查表》,并根据《医院焦虑抑郁量表》(HAD)的14个条目完成焦虑/抑郁测评,随机抽取103病例接受2周心理治疗,治疗完成后,所有病人(心理治疗组及未治疗组病人)重新填写焦虑抑郁量表。结果:颅内肿瘤患者心理状态具有突出的恐惧、猜疑、焦虑不安、抑郁和绝望等特征;经过系统的心理治疗后,心理治疗组患者焦虑/抑郁等可得到明显改善(P<0.01),而对照组患者焦虑/抑郁无改善无统计学差异(P>0.05)。结论:对颅内肿瘤放疗患者进行心理护理治疗,可保证放疗方案的顺利实施,提高患者生活质量。     

纳洛酮联合无创正压通气治疗中老年慢性阻塞性肺疾病伴呼吸衰竭的疗效

目的：探讨慢性阻塞性肺疾病的临床治疗方法及疗效,为临床治疗提供理论依据。方法：选取2014年5月～2015年3月我院收治的60例慢性阻塞性肺疾病患者作为研究对象,对照组采用盐酸纳洛酮作为治疗药物,观察组在上述基础上给予无创正压通气,对比临床效果。结果：对照组治疗无效7例,有效10例,显效9例,痊愈4例,治疗总有效率为76.7%;观察组治疗无效1例,有效12例,显效11例,痊愈6例,治疗总有效率为96.7%,观察组的治疗总有效率较对照组明显升高（P<0.05）。结论：该治疗方案有效可行,治疗总有效率明显升高。本研究为慢性阻塞性肺疾病的临床治疗提供了理论依据。     

阿司匹林联合辛伐他汀防治缺血性脑血管病临床研究

目的：探讨缺血性脑血管病应用阿司匹林联合辛伐他汀治疗的效果,以丰富临床治疗经验。方法：选择2012年6月～2013年6月在我院接收并确诊的缺血性脑血管病患者100例,根据入院治疗顺序随机分为对照组与观察组各50例,对照组通过给予阿司匹林进行治疗,观察组则通过给予阿司匹林以及辛伐他汀同时治疗,治疗后8周,统计两组患者的治疗总有效率,将结果进行对比。一年以后对所有患者进行随访,了解患者的长期病情。结果：治疗后,患者的临床症状均有明显的改善与缓解,观察组治疗的总有效率为84.00%,优于对照组的68.00%,差异显著（P<0.05）;在治疗一年后,对患者进行随访,观察组心肌梗死、短暂性脑缺血发作以及再发性脑梗死等疾病的发生率为16.00%,远远低于对照组的36.00%,差异显著（P<0.05）。结论：缺血性脑血管病应用阿司匹林联合辛伐他汀治疗,具有疗效确切、安全可靠等优点,值得临床推广。     

A double-blind,randomized, placebo-controlled trial of essential fatty acid supplementation in the maintenance of remission of ulcerative colitis

BACKGROUND: Essential fatty acid supplementation has been found to ameliorate certain chronic inflammatory diseases. This effect is thought to be mediated through the modulation of eicosanoid synthesis. Pro-inflammatory eicosanoids have been implicated in ulcerative colitis. AIM: To investigate the possible therapeutic benefit of essential fatty acids in quiescent ulcerative colitis to reduce the frequency of disease relapse. METHODS: A randomized, double-blind, placebo-controlled study was performed with a treatment duration of 12 months. Patients with quiescent disease received either trial medication (gamma-linolenic acid, 1.6 g, eicosapentaenoic acid, 270 mg, and docosahexaenoic acid, 45 mg, per day) or placebo (sunflower oil, 500 mg/day). The primary end-point was disease activity, assessed by a previously validated clinical index, sigmoidoscopic appearance and histology. RESULTS: Sixty-three patients were randomized, 31 to receive essential fatty acid treatment and 32 to receive placebo. Disease relapse rates were similar at 12 months (placebo, 38%; essential fatty acids, 55%), as were changes in sigmoidoscopic grade from baseline. CONCLUSIONS: The supplementation of the diet with this combination of essential fatty acids does not prolong the period of disease remission of ulcerative colitis.     

牙周病治疗对预防糖尿病患者口腔并发症的临床效果研究

目的:研究牙周病治疗对预防糖尿病患者口腔并发症的临床效果。方法:将某院收治的糖尿病的患者用随机抽签的方式分为对照组和观察组各41例。观察组的患者接受常规的口腔检查治疗,并且对观察组的患者牙体牙髓以及牙周病等相关方面进行检查,给予相应的治疗;对照组的患者则是接受未实施任何治疗措施的健康口腔检查,最后比较两组患者的临床治疗效果。结果:观察组患者的临床治疗整体有效率达到了85.35%,而对照组为65.53%;且观察组口腔并发症发生率明显低于对照组,各项数据的对比差异具有统计学意义(P<0.05)。结论:对牙周病治疗对于预防糖尿病患者口腔并发症具有很好的临床效果,也能降低口腔并发症。     

老年肺炎的危险因素与病原学特点及其治疗分析

目的：调查老年肺炎的危险因素、病原学特点及临床治疗方案，探讨防治老年肺炎的措施。方法：回顾性分析166例老年肺炎住院患者的临床资料，对照分析研究其年龄、基础疾病、临床表现、病原学特点、治疗及转归的特征。结果：本组资料显示临床症状及体征不典型者较多，84．3％的患者有基础疾病，病原菌主要为G^-杆菌（71．1％），且混合感染达80．8％。治疗上建议对老年肺炎患者采用降阶梯疗法，同时应注意抗真菌治疗。结论：对老年肺炎患者要掌握其规律，应针对病原学特征进行治疗，初始经验性抗生素治疗时应考虑使用抗G^-杆菌的抗生素，并要积极治疗原发疾病及对症治疗以提高治愈率。     

Clinical use of Infliximab in Crohn's disease: the Edinburgh experience

Infliximab is an established treatment for steroid-resistant and fistulating Crohn's disease. Although efficacy has been shown in clinical trials, financial implications often limit its use and limited data exist regarding clinical practice. AIMS: To audit the clinical effectiveness of Infliximab. METHODS: We prospectively audited 50 consecutive patients [28 females; median age, 34 years (17-70 years)]. Disease activity and response rates were assessed by the Harvey-Bradshaw index. Clinical and disease data were collected and blood was taken for inflammatory markers, complement and double-stranded DNA antibodies. Patients received Infliximab at 5 mg/kg and were followed for 12 weeks. RESULTS: Indications for Infliximab were refractory Crohn's disease in 39 patients, fistulating Crohn's disease in six, pyoderma gangrenosum in one, pouchitis in two and coeliac disease in two. Thirty-one (79%) of the refractory Crohn's disease patients and four (66%) of the fistulating patients responded at 4 weeks. Twenty-one (54%) of the refractory Crohn's disease patients had a continued response at 12 weeks. Perianal disease was more prevalent in non-responders (7/8 vs. 12/31, P < 0.02). CONCLUSIONS: Response rates to Infliximab in our group are comparable to those of clinical trials. Despite the expense, it remains a useful adjunct to treatment in this otherwise difficult group of patients. Patients with perianal disease responded less well in our cohort.     

Gastro-oesophageal reflux disease in chronic laryngitis: prevalence and response to acid-suppressive therapy

BACKGROUND: Gastro-oesophageal reflux is thought to cause chronic laryngitis through laryngopharyngeal reflux. Response of laryngitis to treatment with acid-suppressive therapy supports this causal link. AIM: To determine the prevalence of gastro-oesophageal reflux disease in patients with chronic laryngitis and response to proton-pump inhibitor therapy. METHODS: Patients with chronic laryngitis were recruited. The frequency and severity of reflux and laryngeal symptoms were scored and laryngitis graded by laryngoscopy. All patients underwent esophagogastroduodenoscopy and 24-h ambulatory pH monitoring before receiving lansoprazole 30 mg b.d. for 8 weeks. RESULTS: The prevalence of gastro-oesophageal reflux disease was 65.6% (21 of 32). Based on positive pH test, the prevalence was 25% (eight of 32). The change in laryngeal symptom score and laryngitis grade was significantly higher in GERD compared with non-GERD patients (P = 0.010 for both). The proportion of patients with marked/moderate improvement in laryngeal symptoms were significantly higher in patients with reflux (14 of 21, 67%) compared to those without reflux (two of 11, 18%; P = 0.026). CONCLUSIONS: The prevalence of gastro-oesophageal reflux disease amongst our patients with chronic laryngitis was high. The response to treatment with proton-pump inhibitors in patients with reflux disease compared to those without underlined the critical role of acid reflux in a subset of patients with chronic laryngitis.     

Antibiotic treatment of small bowel bacterial overgrowth in patients with Crohn's disease

BACKGROUND: Small bowel bacterial overgrowth is common in Crohn's disease but its treatment is not clearly defined. Metronidazole and ciprofloxacin are effective antibiotics in active Crohn's disease. AIM: To investigate the efficacy of metronidazole and ciprofloxacin in the treatment of bacterial overgrowth in patients with Crohn's disease. PATIENTS AND METHODS: We performed the lactulose breath test in 145 consecutive patients affected by Crohn's disease. Patients positive to the lactulose breath test underwent a glucose breath test to confirm the overgrowth. These patients were randomized in two treatment groups: metronidazole 250 mg t.d.s. (Group A) and ciprofloxacin 500 mg b.d. (Group B), both orally for 10 days. The glucose breath test was repeated at the end of treatment. The clinical outcome after therapy was also recorded. RESULTS: Bacterial overgrowth was present in 29 patients (20%). Breath test normalization occurred in 13 out of 15 patients treated by metronidazole and in all 14 patients treated by ciprofloxacin (P = ns). In both groups antibiotic treatment induced an improvement of intestinal symptoms: bloating (Group A 85% and Group B 83%), stool softness (44% and 50%), and abdominal pain (50% and 43%). CONCLUSIONS: Small bowel bacterial overgrowth is a frequent condition in Crohn's disease which can be effectively treated by metronidazole or ciprofloxacin.     

Methotrexate for the treatment of refractory Crohn's disease.

BACKGROUND: Previous studies suggested that methotrexate has beneficial effects in patients with Crohn's disease. We report our experience with this agent in patients with chronic active Crohn's disease who previously failed to improve with conventional treatment, including azathioprine in most cases. METHODS: Between June 1988 and June 1992, 39 patients with refractory Crohn's disease were treated with methotrexate. In patients with active disease, clinical remission was defined by a Harvey-Bradshaw index of less than 4. For patients also taking corticosteroids, the dates of remission and complete steroid withdrawal were recorded. For patients who achieved clinical remission, and those in clinical remission when methotrexate was started, the relapse rate on methotrexate therapy was noted. RESULTS: In the 37 patients with active disease at methotrexate initiation, the probability of remission was 72% at 3 months. The probability of remission and steroid withdrawal was 42% at 12 months. In patients on clinical remission, the probability of relapse on methotrexate was 58% at 12 months. Twenty-two patients experienced side-effects, but these only warranted methotrexate discontinuation in four cases. CONCLUSIONS: Methotrexate appears effective in most patients with refractory Crohn's disease and its short-term toxicity is acceptable, but the long-term benefit seems more limited.     

Review article: joint involvement in inflammatory bowel disease

Peripheral involvement of the joints, including pauciarticular, asymmetrical, transitory and migrating synovitis and enthesiopathy, is observed in 10-20% of affected inflammatory bowel disease patients. Recurrence is common and frequently coincides with a flare-up of intestinal disease. The true prevalence of axial involvement is less well established. Sacroiliitis is a hallmark of spondylitis, but is under-reported due to its insidious onset and sometimes asymptomatic nature. Radiographic evidence of sacroiliitis is present in about 20-25% of patients. Ankylosing spondylitis, as defined by the Rome criteria, is present in 3-10% of inflammatory bowel disease patients, and is thought to have a different genetic predisposition in these patients compared with 'classic' ankylosing spondylitis: whereas the human leucocyte antigen B27 phenotype is present in 90% of patients with 'classic' ankylosing spondylitis, the prevalence decreases to only 30% in patients with ankylosing spondylitis secondary to Crohn's disease. Polymorphisms involving CARD15 appear to be a possible genetic trigger: 78% of patients with Crohn's disease and symptomatic or asymptomatic sacroiliitis carry at least one mutation, compared with only 48% of control Crohn's disease patients. Moreover, in other forms of spondyloarthropathy, a similar association has been reported: 42% of patients with spondyloarthropathy and associated asymptomatic chronic gut inflammation, who are considered likely to develop Crohn's disease and ankylosing spondylitis, are carriers of at least one CARD15 mutation, compared with only 7% of patients with normal histology. In addition to genetic markers, clinical features support the relationship between gut and joint pathophysiology. In cases of spondyloarthropathy, a very rapid, substantial and sustained improvement in symptoms has been reported following treatment with infliximab, suggesting an essential role for tumour necrosis factor-alpha in spondyloarthropathy, similar to that observed in Crohn's disease.