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1.
目的探究不同血液净化方法对血液透析患者钙、磷、甲状旁腺激素(iPTH)、营养状态及生活质量的影响。方法前瞻性选取2019年6月至2021年1月汕头市中心医院血液净化中心收治的60例血液净化患者作为研究对象,按随机数表法将患者分为普通血液透析(HD)、透析+血液透析滤过(HD+HDF)、透析+血液灌流(HD+HP),每组各20例。观察3个月,比较3组患者的血钙、血磷、iPTH、营养状态及生活质量改善情况。结果治疗前,3组患者血钙、血磷、iPTH水平比较,差异无统计学意义(P>0.05);治疗后,HD+HDF组血磷较治疗前显著下降,差异有统计学意义(P<0.05);HD+HP组iPTH水平显著低于HD+HDF组及HD组,差异有统计学意义(P<0.05)。治疗前,3组患者的白蛋白、前白蛋白、血红蛋白水平比较,差异无统计学意义(P>0.05);治疗后,HD+HDF组及HD+HP组白蛋白、前白蛋白、血红蛋白水平明显优于HD组,差异均有统计学意义(P<0.05)。治疗前,3组患者各项生活质量评分差异比较,差异无统计学意义(P>0.05);治疗后,HD组改善不明显,HD+HDF及HD+HP组均高于治疗前,且HD+HP组、HD+HDF组高于HD组,差异均有统计学意义(P<0.05)。结论HD+HP及HD+HDF治疗均能够对患者钙磷代谢水平及骨代谢、营养状态起到改善作用,有利于提高生活质量,HD+HDF清除血磷效果最好,HD+HP能有效降低患者iPTH水平,值得临床推广应用。  相似文献   
2.
目的:探究焦点解决取向团体辅导对血液透析患者焦虑、抑郁情绪和医学应对方式的影响。方法:将60名血液透析患者分为对照组(n=30)和干预组(n=30),对照组接受常规护理,干预组在此基础上接受为期五周的焦点解决取向团体辅导。干预开始前和结束后,分别采用焦虑自评量表、抑郁自评量表、医学应对方式问卷评定被试情绪及医学应对方式。结果:干预后,干预组的抑郁和焦虑水平较同期对照组显著降低。在医学应对方面,干预后,干预组的面对水平较同期对照组显著提升;屈服水平较同期对照组显著下降。结论:焦点解决取向团体辅导能降低血液透析患者的焦虑、抑郁情绪,改善其医学应对方式。  相似文献   
3.
ObjectiveEnd-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population.MethodsThe Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation.ResultsFour-three persons living with haemodialysis, mean age± SD= 56.58 ± 10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated.ConclusionsEnd-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies.Practice implicationStatement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.  相似文献   
4.
目的分析维持性血液透析患者发生结核感染的影响因素及临床特点。方法回顾性调查2018年5月-2019年8月北京清华长庚医院肾内科收治的长期规律血液透析患者共150例,收集患者的年龄、性别、合并疾病、血常规、生化、透析充分性等检验结果和影像学资料,归纳分析血液透析患者发生结核感染的影响因素。结果150例血液透析患者,男性91人,女性59人,平均年龄(62.7±14.2)岁,发生结核感染者共11例(7.33%),其中肺外结核比例高(54.5%),以浆膜腔积液为主要表现(54.5%),血红蛋白(94.7±11.6)g/L、血清白蛋白(34.6±2.0)g/L、血肌酐(593.6±221.4)umol/L低于无结核感染者,差异具有统计学意义(P<0.05);血小板(228.7±103.5)×109/L高于无结核感染者,差异具有统计学意义(P<0.05)。两组患者年龄、透析充分性、淋巴细胞、血糖、血脂、血钙、血磷、全段甲状旁腺激素无统计学差异。结论血红蛋白<110g/L、白蛋白<35g/L是MHD患者发生结核感染的高危因素,MHD患者发生结核感染以肺外结核为主,临床表现具有隐匿性和不典型性,临床工作应提高警惕避免漏诊。  相似文献   
5.
何丽芳  李倩倩  甘香 《中华护理杂志》2022,57(21):2585-2591
目的 探讨自尊在中青年维持性血液透析患者病耻感与心理痛苦之间的中介效应,以及家庭亲密度在其中的调节效应。 方法 采用便利抽样法,利用病耻感量表、自尊量表、家庭亲密度量表及心理痛苦温度计于2021年6月—12月对福建省福州市、莆田市4所三级甲等医院382例中青年维持性血液透析患者进行调查,应用SPSS 26.0软件进行相关分析,运用PROCESS宏程序中的Model 4进行中介效应分析和Model 58进行调节效应分析。 结果 中青年维持性血液透析患者心理痛苦检出率为59.7%,病耻感、自尊、家庭亲密度、心理痛苦之间存在两两相关关系(均P<0.001)。自尊在病耻感与心理痛苦间起部分中介作用(β=-0.22,t=-3.85,P<0.001),家庭亲密度调节了这一中介过程的前半路径(β=0.19,t=5.08,P<0.001),高的家庭亲密度会减弱病耻感对自尊的影响,反之,则增强。 结论 中青年维持性血液透析患者病耻感不仅能直接正向预测心理痛苦,还能通过自尊对其产生间接的影响,家庭亲密度调节了这一过程。可采取叙事家庭疗法降低患者病耻感,提高家庭亲密度,保护自尊,减轻心理痛苦。  相似文献   
6.
Background and aimsIntermittent fasting reduces risk of interrelated cardiometabolic diseases, including type 2 diabetes and heart failure (HF). Previously, we reported that intermittent fasting reduced homeostasis model assessment of insulin resistance (HOMA-IR) and Metabolic Syndrome Score (MSS) in the WONDERFUL Trial. Galectin-3 may act to reduce insulin resistance. This post hoc evaluation assessed whether intermittent fasting increased galectin-3.Methods and resultsThe WONDERFUL Trial enrolled adults ages 21–70 years with ≥1 metabolic syndrome features or type 2 diabetes who were not taking anti-diabetic medication, were free of statins, and had elevated LDL-C. Subjects were randomized to water-only 24-h intermittent fasting conducted twice-per-week for 4 weeks and once-per-week for 22 weeks or to a parallel control arm with ad libitum energy intake. The study evaluated 26-week change scores of galectin-3 and other biomarkers. Overall, n = 67 subjects (intermittent fasting: n = 36; control: n = 31) completed the trial and had galectin-3 results. At 26-weeks, the galectin-3 change score was increased by intermittent fasting (median: 0.793 ng/mL, IQR: ?0.538, 2.245) versus control (median: ?0.332 ng/mL, IQR: ?0.992, 0.776; p = 0.021). Galectin-3 changes correlated inversely with 26-week change scores of HOMA-IR (r = ?0.288, p = 0.018) and MSS (r = ?0.238, p = 0.052). Other HF biomarkers were unchanged by fasting.ConclusionA 24-h water-only intermittent fasting regimen increased galectin-3. The fasting-triggered galectin-3 elevation was inversely correlated with declines in HOMA-IR and MSS. This may be an evolutionary adaptive survival response that protects human health by modifying disease risks, including by reducing inflammation and insulin resistance.Trial registrationClinicaltrials.gov, NCT02770313 (registered on May 12, 2016; first subject enrolled: November 30, 2016; final subject's 26-week study visit: February 19, 2020).  相似文献   
7.
Background and aimsAlthough antithrombotic treatments are established for coronary artery disease (CAD), they increase the bleeding risk, especially in malnourished patients. The total thrombus-formation analysis system (T-TAS) is useful for the assessment of thrombogenicity in CAD patients. Here, we examined the relationships among malnutrition, thrombogenicity and 1-year bleeding events in patients undergoing percutaneous coronary intervention (PCI).Methods and resultsThis was a retrospective analysis of 300 consecutive CAD patients undergoing PCI. Blood samples obtained on the day of PCI were used in the T-TAS to compute the thrombus formation area under the curve. We assigned patients to two groups based on the geriatric nutritional risk index (GNRI): 102 patients to the lower GNRI group (≤98), 198 patients to the higher GNRI group (98<). The primary endpoint was the incidence of 1-year bleeding events defined by Bleeding Academic Research Consortium criteria types 2, 3, or 5. The T-TAS levels were lower in the lower GNRI group than in the higher GNRI group. Kaplan-Meier analysis showed worse 1-year bleeding event-free survival in the lower GNRI group compared with the higher GNRI group. The combined model of the GNRI and the Academic Research Consortium for High Bleeding Risk (ARC-HBR) had good calibration and discrimination for bleeding risk prediction. In addition, having a lower GNRI and ARC-HBR positivity was associated with 1-year bleeding events.ConclusionA lower GNRI could reflect low thrombogenicity evaluated by the T-TAS and determine bleeding risk in combination with ARC-HBR positivity.  相似文献   
8.
Chronic kidney disease (CKD) is a global health challenge, with a reported prevalence of around 10%. Prescribing for patients receiving hemodialysis (HD) is challenging and complicated by polypharmacy, comorbidities, and changes in clearance of medications. The aim of this study was to evaluate antibiotics utilization patterns and dosage appropriateness in patients receiving HD at a tertiary hospital. A retrospective study was carried on 287 adult inpatients, who received HD and at least one antibiotic in a tertiary hospital in Oman. Data were extracted using the hospital’s electronic patient information system. Dosage appropriateness was assessed by identifying the dosage and frequency of prescribed antibiotics and comparing them with international guidelines. The main outcome measures were antibiotics utilization patterns and dosing inappropriateness. The most commonly prescribed parenteral antibiotic was piperacillin + tazobactam (20%), while the most common prescribed oral antibiotic was azithromycin (41.7%). For prophylaxis, cefazolin (54.6%) was the main antibiotic prescribed. The most commonly used antibiotic for external use was mupirocin ointment (38.5%). The overall dosing inappropriateness was 29.5%. Vancomycin was the most common parenteral antibiotic subjected to dosing inappropriateness (19.8%). However, trimethoprim + sulfamethoxazole was more inappropriately prescribed among the oral route (28.6%).In conclusion, the most utilized antibiotic was piperacillin + tazobactam followed by vancomycin. The study reported some inappropriate dosing of antibiotics. Such a study opens the door for the establishment of local guidelines for the improved practice of antibiotics use in HD patients.  相似文献   
9.
Background and aimsThe prevalence of type 2 diabetes (T2D) in Italy is increasing and cardiovascular disease (CVD) represents the leading cause of death in this population. CAPTURE was a multinational, multicentre, non-interventional, cross-sectional study assessing the prevalence of CVD, atherosclerotic CVD (AsCVD) and CVD subtypes among patients with T2D, across 13 countries. Here we report the results from Italy.Methods and resultsOverall, 816 patients with T2D (median age, 69 years [interquartile range: 62–75]; median duration of diabetes, 11.2 years [interquartile range: 5.7–18.7]) were recruited during routine clinical visits at secondary care centres in Italy between December 2018–September 2019. The prevalence of CVD was estimated at 38.8%, largely accounted for by AsCVD (33.1%). The most prevalent CVD subtype was coronary heart disease (20.8%), followed by carotid artery disease (13.2%). Most patients (85.9%) were prescribed oral glucose-lowering agents (GLAs), particularly biguanide (76.7%). Insulin use was higher in patients with CVD (41.3%) than in patients without CVD (32.9%). Sodium-glucose co-transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were prescribed to 20.2% vs 14.6%, and 14.5% vs 16.6% of patients with CVD compared to those without CVD, respectively.ConclusionThe results show that, in Italy, more than one in three patients with T2D attending secondary care centres have CVD, 85% of whom have AsCVD, yet only a minority are treated with SGLT2is and GLP-1 RAs, in discordance with the recommendations of current national and international guidelines.  相似文献   
10.
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