肠造口患者负性情绪的心理干预

通过对58例肠造121患者的恐惧、焦虑、抑郁、自卑等负性情绪进行相关心理干预,消除和缓解了肠造口患者的不良心理,帮助其树立战胜疾病的信心,效果满意,值得推广.     

微信随访对结肠造口患者术后生活质量的影响

目的探讨微信随访对结肠造口患者生活质量的影响。方法选择2011年5月至2013年6月我院普外科行结肠造口患者40例,按随机数字表法分为对照纽和微信组,每组20例。对照组接受常规护理和宣教;微信组在对照组的基础上,出院后与患方建立微信随访。三个月后收集两组资料,对比两组患者生活质量情况,内容包括：造口护理能力、排便规律情况、良性心理建立、正常社交功能恢复。结果微信组患者的生活质量明显高于对照组,差异有铳计学意义（P〈0．01）。结论微信随访能有效改善结肠造口患者的生活质量,减少造口并发症的发生,建立良好正面的心理,帮助患者恢复社会功能,值得借鉴。     

Monitoring feeding tube placement.

The purpose of this literature review is to describe currently available bedside methods to determine feeding tube placement. Described first are methods used at the time of blind insertion to distinguish between gastric and respiratory placement and gastric and small-bowel placement. Discussed next are methods used after feedings are initiated to determine if the tube has remained in the desired position in the gastrointestinal tract. Some of the methods are research-based, whereas others are opinion-based. The level of accuracy of the methods discussed in the review varies widely. No sure non-radiographic method exists to differentiate between respiratory, esophageal, gastric, and small bowel placement of blindly inserted feeding tubes in the fed or unfed state. However, a combination of some of the simpler and more accurate methods may be used to guide feeding tube placement during insertion and help identify the point at which an abdominal radiograph is most likely to confirm the desired location. In addition, methods described in this review can help determine when a radiograph is needed to confirm that a feeding tube has remained in the correct position after the initiation of feedings. Minimizing the number of radiographs taken to assure correct tube placement is important, especially in young children and in the critical care setting where the need for radiographs for other reasons is common.     

Gastroparesis and jejunal feeding.

A kidney transplant patient with diabetic gastroparesis was effectively treated by jejunal feeding. The patient, a 31-year-old woman, has a complicated medical history, with insulin-dependent diabetes mellitus. Complications include kidney failure followed by transplantation, bilateral knee amputations, and being registered blind. She was admitted with nausea and vomiting for the previous 6 days; the provisional diagnosis was diabetic gastroparesis. Various treatments were tried, including several prokinetic drugs and total parenteral nutrition. The total parenteral nutrition provided most of the patient's nutritional requirements, and, only slight weight loss was observed. Nothing seemed to improve the symptoms of vomiting. An endoscopic retrograde cholangiopancreatography, a radiographic examination of the bile and pancreatic ducts, was performed to exclude obstruction. At the same time, having found nothing, a gastrostomy was placed with a jejunal extension. Feeding was established within 3 days. Her weight remained stable after 7 weeks of jejunal feeding. She had started to increase her oral intake of solid foods and fluids. By 8 weeks, she was taking a full oral diet and fluids. Now, 14 weeks after the placement of the gastrostomy tube with the jejunal extension, she is doing well. Her weight remains stable and her oral intake is excellent. Her diabetes is under control. After 22 weeks, the gastrostomy was removed. After this success with jejunal feeding when all other treatments had failed, this treatment could be used to treat future diabetic gastroparesis. Slow introduction of the feed seems to help toleration.     

护患共同参与模式对肠造口患者生存质量的影响

目的 探讨护患共同参与模式对肠造口患者生存质量的影响.方法 50例肠造口患者随机分为2组.24例对照组给予常规出院指导和定期复查;26例观察组除常规护理指导外对患者进行评估,并共同制定护理计划,帮助和鼓励患者及家属积极参与自我护理.在患者出院时及6个月后进行综合生活质量评定问卷(GQOLI)测评并进行比较.结果 观察组的GQOLI评分较干预前有明显提高,在躯体及心理健康、社会功能等维度与对照组比较差异有统计学意义.结论 护患共同参与模式用于肠造口患者的护理有助于提高患者的生存质量.     

Infant feeding practices and obesity.

Selected assumptions regarding associations between artificial feeding and infantile obesity are examined. Although some artificial baby foods (desserts, meats, egg yolks) have considerably greater caloric density than breast milk, a large class of baby foods and most milks and formulas are comparable to breast milk in caloric density. The intake of infant foods seems to be related more to caloric density than volume. Modern day artificial feeding in developed countries tends to produce larger weight gains than breast feeding, although no good data exist to evaluate the composition of these weight gains. Many more data from well planned studies are needed to fully elucidate possible mechanisms of infantile obesity.     

Tube feeding patients with dementia.

As the population ages, the incidence of dementia increases. All types of dementia, whether they are reversible or irreversible, lead to loss of intellectual function and judgment, memory impairment, and personality changes. The skills to feed oneself, use eating utensils, and consume items recognized as food, thereby maintaining nutrition status, may be lost as dementia progresses. Reports indicate that nutrition status may be maintained when patients are hand fed, but this is labor intensive and therefore expensive. Feeding via a percutaneous endoscopic gastrostomy tube is often chosen as an acceptable alternative. Research indicates that there is little benefit in this population when aggressive nutrition support is instituted. Providing tube feeding to patients with dementia does not necessarily extend life, increase weight, or reduce the incidence of pressure ulcers or aspiration. There are many legal and ethical issues involved in the decision to place a feeding tube in demented patients. The primary issue in patients with dementia may be autonomy and the right of an individual to decide whether or not a tube should be placed at all. Legally, there is clear precedent that the courts see the insertion of a feeding tube as extraordinary care that the patient has the right to refuse. However, much of case law is derived from cases of patients who were in a persistent vegetative state. Advance directives help to determine what the patient would want for himself. Considering all the options before the patient can no longer make decisions is the most desirable course.