家庭健康教育对脑卒中假性球麻痹鼻饲患者的影响

脑卒中患者并发假性球麻痹可导致吞咽功能障碍,经鼻胃管给食是保证患者营养、减少并发症的首选方法。自2006年1月我们对脑卒中假性球麻痹带鼻饲管出院患者开展了家庭健康教育,收到很好的效果。现报告如下。     

家庭干预对慢性心力衰竭患者的影响

慢性心力衰竭（chronic heart failure，CHF）是心脏病终末期的主要表现，疾病反复发作使病人生活质量下降，是住院率和死亡率增高的主要原因。国内CHF的住院率只占同期心血管病的20％，但病死率却占40％，提示预后严重。近20年诊疗水平虽有提高，但CHF患者生活质量改善有限，5年死亡率仍然高达50％。因此如何提高病人的生存质量是值得医护人员重视和亟待解决的问题。进行更深入广泛的CHF研究和干预可以减少CHF并发症的发生率。家庭干预是指对患者家庭成员进行相关疾病知识教育，以及由医务人员定期家访进行干预性训练相结合的方法，以提高患者治疗的依从性和改善患者的生活质量。     

鼻饲患者常见并发症分析及预防

鼻饲饮食广泛应用于颅脑损伤昏迷、吞咽困难、失去咀嚼能力及神经性厌食症患者等。2006年1月-2008年5月，我们共为150例患者行鼻饲饮食治疗，现将其并发症发生情况及护理体会报告如下。     

护理干预对减少糖尿病患者相关并发症的影响分析

目的探讨研究护理干预对减少糖尿病患者相关并发症的影响分析。方法选取2011年1月—2012年1月期间至该院就诊的320例糖尿病患者随机分为对照组和实验组各160例,对照组患者采用医院对症治疗配合常规护理,实验组患者采用对症治疗基础上的综合护理措施,包括对患者饮食、心理、运动、健康教育及后续治疗监督等,对比两组患者在出院后血糖情况及并发症发生情况。结果通过2年的观察,实验组160例患者中血糖控制情况显著优于对照组160例患者,空腹血糖及餐后2 h血糖达标率51.9%和40.6%均显著高于对照组35.0%和26.3%,差异有统计学意义(P<0.05);2年后实验组患者并发症发病率为14.3%显著低于对照组并发症的发生率30.0%,差异有统计学意义(P<0.05)。结论通过护理干预可以显著提高患者血糖控制情况及显著减少糖尿病患者相关并发症的发生,对临床工作具有重要意义。     

持续性植物状态患者长期鼻饲并发症的临床分析及护理

植物状态是一种特殊的意识障碍，主要表现为自身和外界的认知功能完全丧失，能睁眼，有睡眠一醒觉周期，下丘脑和脑干功能基本保存，这种状态持续超过1个月为持续植物状态（persistent vegetative state，PVS）。PVS患者呈高代谢，高分解状态，PVS患者的能量消耗是正常人的140％～250％，足够的营养支持是患者康复的基本条件。对吞咽障碍明显或完全不能吞咽的PVS患者，     

老年鼻饲患者发生反流误吸原因及护理对策

目的：探讨老年病人鼻饲发生反流及误吸的原因和护理对策.方法：对我科2012年1月~2012年10月收治40例昏迷鼻饲病人的临床资料进行分析,找出鼻饲过程中发生反流误吸的相关因素.结果：40例老年鼻饲病人中发生明显反流6例,可疑反流2例,其中误吸2例中有1例出现急性呼吸衰竭.反流及误吸的发生与病人体位、胃管插入深度及粗细、鼻饲方式、腹胀胃潴留及吸痰刺激等有关.结论：老年病人鼻饲过程中反流、误吸的发生率高,可导致严重呼吸系统并发症,明显增加病人死亡率及致残率,护理过程中采取有效护理措施是可以预防的.     

妊娠期糖尿病产前护理干预对患者并发症的影响

目的:探究产前护理干预应用于妊娠期糖尿病,对其效果以及对患者并发症的影响进行具体的分析.方法:选择妊娠期糖尿病120例,随机分为两组.分别为对照组和观察组,每组60例.对照组采用常规护理方式进行护理,观察组在此基础上应用护理干预.实验结束后将两组数据进行整合和分析.结果:观察组患者的血糖水平低于对照组,观察组的患者的并...     

护理干预对脑卒中吞咽障碍患者家庭康复的影响

目的探讨家庭康复护理对脑卒中吞咽障碍患者吞咽功能恢复的影响。方法将30例脑卒中吞咽障碍患者随机分为干预组16例和对照组14例。用才藤7级分类法作为评价标准,对干预组患者进行以吞咽功能训练为主的家庭康复护理。对照组采用神经科常规护理治疗。结果两组患者4周康复护理训练后评分间差异有统计学意义（P〈0．01）。干预组治疗后评分较治疗前明显改善,并且与对照组比较有明显差异（P〈0．01）。干预组和对照组显效率和有效率分别为50％、100％和0、64．3％。结论对脑卒中吞咽障碍患者进行以吞咽功能训练为主的家庭康复护理干预。能显著改善患者的吞咽功能。     

护理干预对重度颅脑损伤昏迷患者鼻饲并发症的影响

目的观察护理干预对重度颅脑损伤昏迷患者鼻饲并发症的影响。方法将92例重度颅脑损伤患者随机分为观察组和对照组,各46例,对照组采取常规护理,观察组采取护理干预,观察并比较两组患者并发症的发生情况。结果观察组患者并发症发生率与对照组比较,差异有统计学意义(P<0.05)。结论护理干预可减少重度颅脑损伤昏迷患者鼻饲并发症的发生。     

探讨循证护理对重型脑外伤病人鼻饲并发症及营养状态的影响

目的 探讨循证护理对重型脑外伤病人鼻饲并发症及营养状态的影响.方法 选取2017年1月-2019年10月在本院收治的重型脑外伤病人76例,根据随机数字表法将其分为观察组和对照组,各38例.对照组病人应用常规护理,观察组在对照组基础上应用循证护理.比较两组病人鼻饲并发症及营养不良发生率.结果 观察组病人鼻饲并发症发生率为7.9%,对照组为26.3%(P<0.05);观察组病人营养不良发生率为5.3%,对照组为21.2%(P<0.05).结论 循证护理在常规护理基础上可有效降低重型脑外伤病人鼻饲并发症发生率,改善病人营养状态.     

Management of complications in patients receiving home parenteral nutrition

Patients receiving long-term home parenteral nutrition tend to fall under the care of adult and pediatric gastroenterologists. This article reviews the management of potential infectious, mechanical and metabolic complications and describes common psychosocial issues related to the therapy. The point at which to refer the patient to an intestinal failure program offering autologous bowel reconstruction and small bowel transplantation is discussed.     

强化家庭干预对改善长期鼻饲致胃食管反流诱发哮喘发作的效果评价

目的探讨强化家庭干预对改善长期鼻饲致胃食管反流诱发支气管哮喘急性发作的效果。 方法选取2010年1月至2014年1月山东省荣成市人民医院收治的49例有哮喘病史留置胃管时间1个月以上,且由于胃食管反流刺激出现1次以上哮喘急性发作而需要社区医疗救助的患者,其中观察组24例（3例退出）,对照组25例（1例退出）。由社区医护人员组成家庭管理小组,以集中培训、电话随访、家庭访视等形式,对观察组患者及其家属进行教育、培训、指导、督导;对照组按照社区医疗服务常规电话随访1次/月,家庭访视1次/6个月。干预结束后,对两组患者的反流症状评分、哮喘用药方式、哮喘控制情况及照顾者负担评分进行比较分析。两组间反流症状及照顾者负担评分的比较采用t检验,主要给药方式的比较采用χ²检验,症状控制情况的比较采用秩和检验。 结果经1年的强化家庭干预,观察组患者胃食管反流评分明显低于对照组（2.7±0.4,3.5±0.8;t=4.15,P<0.01）;观察组控制哮喘的主要用药方式为粉剂吸入和雾化吸入,对照组主要为口服;观察组哮喘控制水平明显优于对照组（观察组控制、部分控制、未控制分别为7、14、0例,对照组分别为0、14、10例;r=16.93,P<0.01）;观察组家庭照顾者个人负担、角色负担、总负担评分均明显优于对照组（27.9±6.4、10.2±3.4、38.9±5.1,32.6±5.1、12.7±4.1、43.2±7.4;t=2.74、2.22、2.24,P<0.05或0.01）。 结论强化家庭干预能提高家庭照顾者的照顾和管理能力,减轻患者胃食管反流症状,减少患者哮喘急性发作次数,明显减轻家庭照顾者负担。     

Community-acquired pneumonia in patients receiving home care

OBJECTIVES: To describe the features of community-acquired pneumonia (CAP) requiring hospitalization in subjects receiving home care. DESIGN: Prospective study from November 15, 2000, to November 14, 2002. SETTING: Six hospitals in the Edmonton, Canada, area. PARTICIPANTS: Two thousand four hundred sixty-four subjects aged 17 years and older with CAP, 21.9% of whom were receiving home care. MEASUREMENTS: Pneumonia attack rates, demographic features, severity of illness, medication, length of stay, mortality, in hospital complications, and time to achieve physiological stability. RESULTS: The overall rate of CAP requiring a visit to an emergency department in home care recipients was 25 per 1,000 person years, 90.8% of whom were admitted to the hospital for treatment. Patients who were receiving home care at the time of admission were older and less likely to be current tobacco smokers, had higher in-hospital mortality (11%) and a longer length of stay, were receiving more medications, and had more comorbidity and fewer symptoms except for shortness of breath and altered mental state than those who were not receiving home care. Home care patients had four times as many myocardial infarctions and recurrent aspiration as the non-home care patients. Falls occurred five times more often, and urinary catheters were inserted twice as often. Except for oxygen saturation, time to achieve physiological stability was the same for the two groups of patients. Half (51.2%) of the home care patients passed the get-up-and-go test, compared with 75% (P<.001) of the non-home care patients. CONCLUSION: Home care patients with CAP had an 11% mortality rate and a higher rate of complications than those who did not receive home care.     

Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home

BACKGROUND: Home mechanical ventilation (HMV) and long-term oxygen therapy (LTOT) are the two treatment alternatives when treating respiratory insufficiency in patients with kyphoscoliosis. We aimed to study the effect on survival with regard to HMV or LTOT alone in patients with respiratory insufficiency due to kyphoscoliosis. METHODS: Swedish patients with nonparalytic kyphoscoliosis (ie, scoliosis not related to neuromuscular disorders) who started LTOT or HMV between 1996 and 2004 were followed up prospectively until February 14, 2006, with death as the primary outcome. Treatment modality, arterial blood gas levels, the presence of concomitant respiratory diseases, and age were recorded at the onset of treatment. No patient was lost to follow-up. RESULTS: One hundred patients received HMV, and 144 patients received oxygen therapy alone. Patients treated with HMV experienced better survival, even when adjusting for age, gender, concomitant respiratory diseases, and blood gas levels, with a hazard ratio of 0.30 (95% confidence interval, 0.18 to 0.51). CONCLUSION: The survival of patients with kyphoscoliosis receiving HMV was better than that of patients treated with LTOT alone. We suggest HMV and not oxygen therapy alone as the primary therapy for patients with respiratory failure due to kyphoscoliosis, regardless of gender, age, and the occurrence of concomitant respiratory diseases.     

Long-term effects and complications of home nasal CPAP therapy for obstructive sleep apnea patients]

We treated 23 patients with obstructive sleep apnea syndrome (OSAS) by nasal continuous positive airway pressure (NCPAP) at home, and examined the long-term compliance, clinical effects, and complications after NCPAP therapy. Nineteen patients continued and four patients discontinued the therapy during the mean observation period of 15 months, and the compliance was 83%. There was no significant difference in age, weight, and sleep data between the compliant group (C) and non-compliant group (NC). The causes of discontinuation of therapy were lack of adaptation to the apparatus (2 cases), improvement of clinical symptoms due to weight reduction (1 case), and induction of asthma attack (1 case). Disappearance of excessive daytime sleepiness, improvement of sleep quality, and disappearance of nocturia were observed in most cases, and disappearance of morning headache and improvement of sexual ability and emotional instability were also observed in several cases. Nine cases (39%) complained of discomfort due to the nasal mask and 6 cases (26%) complained of dryness of the mouth and nose, whereas 10 cases (43%) experienced no adverse effects. No serious complications were observed. These findings suggest that long-term home NCPAP is an effective and safe treatment for OSAS patients.     

GI complications in patients receiving mechanical ventilation

Mechanical ventilation (MV) can be lifesaving by maintaining gas exchange until the underlying disorders are corrected, but it is associated with numerous organ-system complications, which can significantly affect the outcome of critically ill patients. Like other organ systems, GI complications may be directly attributable to MV, but most are a reflection of the severity of the underlying disease that required intensive care. The interactions of the underlying critical illness and MV with the GI tract are complex and can manifest in a variety of clinical pictures. Incorporated in this review are discussions of the most prevalent GI complications associated with MV, and current diagnosis and management of these problems.     

基于授权理论的家庭访视护理对社区老年糖尿病患者积极度及家庭功能的影响

目的探讨基于授权理论的家庭访视护理对社区老年糖尿病(DM)患者积极度及家庭功能的影响。方法在宁夏银川市嘉园、塞上骄子2个社区卫生服务站分别随机选取67例符合纳入标准的老年DM患者,根据所在社区分为干预组和对照组。干预组实施6个月的基于授权理论的家庭访视护理干预;对照组采用常规家庭访视护理。干预前及干预6个月后分别评价两组患者的积极度及家庭功能得分。结果家庭访视护理干预后,干预组积极度各维度得分及总分、积极度总体水平分布均明显优于对照组(P<0.05),且干预组患者家庭功能总分、合作度、成长度得分均明显高于对照组(P<0.05)。结论基于授权理论的家庭访视护理可有效提高社区老年DM患者的积极度,并明显改善患者家庭功能的合作度、成长度。     

Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care

OBJECTIVES: To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care.
DESIGN: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model.
SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center.
PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.
INTERVENTION: Treatment in a substitutive HaH model.
MEASUREMENTS: Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care.
RESULTS: The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean ± standard deviation 1.7 ± 1.8 vs 4.3 ± 3.1, P <.001; median 1 vs 4, P <.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05–0.30).
CONCLUSION: HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.     

Catheter-related septicaemia in patients receiving home parenteral nutrition

Forty-three patients received home parenteral nutrition (HPN) for 4 to 13 months (median, 30 months) with a total treatment period of 153 patient-years. All patients had central venous catheters; 71 PVC subclavian catheters, 138 Broviac catheters, and 16 other catheters were used. Broviac catheters were introduced into the central veins via a tunnel on the chest (94 catheters) or on the thigh (44 catheters). Eighty-two episodes of catheter septicaemia occurred in 28 (65%) of the patients, corresponding to an incidence of catheter septicaemia of 1 in 1.9 patient-years. The commonest microorganisms grown from the blood were coagulase-negative staphylococci, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Candida species. Septicaemia incidence was 1 in 2.6 catheter-years with the Broviac catheter on the chest and 1 in 1.6 catheter-years with the Broviac catheter on the thigh. In 49 cases the patient was treated with both antibiotics and change of the catheters, in 26 cases with antibiotics alone, and in 5 cases with change of the catheter alone. The antibiotic therapy was given for 3 to 15 days (median, 7 days). No patient died of catheter septicaemia. The relapse rate was low (less than 10%) and did not differ significantly between the three treatment groups. It is concluded that catheter septicaemia is a common complication of HPN. In most cases it runs a mild course. Bacteriaemia can often be eradicated by a brief antibiotic therapy without catheter exchange.     

E-cigarette use in patients receiving home oxygen therapy

Current smokers who are prescribed home oxygen may not benefit from the therapy. In addition to being an obvious fire hazard, there is some evidence that the physiological mechanisms by which home oxygen is believed to operate are inhibited by smoking. Although their effectiveness is yet to be demonstrated, electronic cigarettes (e-cigarettes) are often regarded as an aid to smoking cessation. However, several burn accidents in e-cigarette smokers receiving home oxygen therapy have also been reported, leading Health Canada to release a warning of fire risk to oxygen therapy patients from e-cigarettes. It is the authors’ position that patients receiving oxygen should definitely not use e-cigarettes. The authors provide suggestions for addressing the delicate issue of home oxygen therapy in current cigarette and/or e-cigarette smokers.