中青年与老年脑卒中患者发病危险因素及自护行为比较

目的探讨中青年与老年脑卒中患者发病的危险因素及自护行为水平.方法采用一般危险因素调查表、高危因素调查表及自护行为调查表对进行问卷调查初次发病的197例中青年脑卒中患者和128例老年脑卒中患者.结果中青年脑卒中患者的生活压力、不良生活方式得分显著高于老年患者(均P<0.01),Ⅲ期高血压、肥胖发生率显著高于老年患者(均P<0.01),遵医用药、饮食控制、定期监测得分显著低于老年患者(均P<0.01).结论生活压力、不良的生活方式、Ⅲ期高血压、肥胖是中青年脑卒中患者发病的主要危险因素,其遵医用药、饮食控制、定期监测得分低是自护行为低下的主要原因.应对中青年人群加强相关知识教育和技能培训,提高其自护行为水平,以降低脑卒中发生率.     

采用Orem自理模式提高肾移植术后患者的自理能力

目的增强肾移植术后患者的自理能力,提高其生活质量.方法将200例肾移植术后患者随机分为对照组与观察组各100例.对照组采用术后常规护理,观察组应用Orem护理系统中部分补偿系统和辅助教育系统进行护理干预.采用自理能力问卷调查两组患者术后2周及出院后3个月的自理能力.结果两组患者在术后2周时自理能力比较,差异无显著性意义(P>0.05);但出院后3个月观察组患者自理能力显著优于对照组(P<0.05).结论肾移植患者术后自理能力较低,Orem自理模式的应用可提高其术后自理能力.     

自护理论在脑卒中后继发癫痫患者护理中的应用

目的探讨Orem自护理论在脑卒中后继发癫痫患者护理中的应用效果。方法将36例患者随机分成观察组和对照组各18例，对照组予常规整体护理，观察组在此基础上运用Orem自护理论进行护理干预，采用Barthel指数评定两组患者日常生活能力（ADL），观察两组患者护理并发症及护理意外发生情况。结果干预后观察组Barthel指数评定ADL能力得分显著高于对照组（P〈0．01）；观察组护理并发症及护理意外（除压疮外）显著下降（均P〈0．05）。结论自护理论可降低致残率和护理并发症，提高患者的生活质量。     

自护理论在脑卒中后继发癫(疒间)患者护理中的应用

目的 探讨Orem自护理论在脑卒中后继发癫痫患者护理中的应用效果.方法 将36例患者随机分成观察组和对照组各18例,对照组予常规整体护理,观察组在此基础上运用Orem自护理论进行护理干预,采用Barthel指数评定两组患者日常生活能力(ADL),观察两组患者护理并发症及护理意外发生情况.结果 干预后观察组Barthel指数评定ADL能力得分显著高于对照组(P＜0.01);观察组护理并发症及护理意外(除压疮外)显著下降(均P＜0.05).结论 自护理论可降低致残率和护理并发症,提高患者的生活质量.     

慢性移植肾肾病的危险因素及发病机理

随着免疫抑制剂的不断研发,慢性移植肾肾病(chronic allograft nephropathy)已经取代急性排斥成为威胁移植物存活的主要病因.慢性移植肾肾病发病机理复杂,涉及免疫及非免疫因素,而强效免疫抑制剂的使用并不能明显降低慢性移植肾肾病的发生率.本文拟就慢性移植肾肾病的发病机理作一综述,以理清各种因素在慢性移植肾肾病的发病过程中的作用.     

糖尿病足高危患者足部自护行为及影响因素研究

目的 描述糖尿病足高危患者的足部自护行为及其阶段分布,并进行影响因素分析.方法 对343例糖尿病足高危患者应用一般资料问卷、糖尿病患者足部护理行为问卷、行为阶段表、第三版糖尿病态度量表、社会支持评定量表和糖尿病自我效能量表进行横断面调查.结果 糖尿病足高危患者的足部自护行为得分28～68(47.50±7.30)分,百分制标准得分为59.81分.足部自护行为意图前期、意图期、准备期、行动期和维持期分别为11.7％、35.6％、41.7％、5.8％和5.2％.有序Logistic回归分析显示:性别、支付方式、感知社会榜样、疾病认知态度和自我效能是影响患者行为阶段分布的主要因素(P<0.05,P<0.01).结论 糖尿病足高危患者的足部护理行为总体水平低,多数患者的足部自护行为处于前期阶段;患者的足部自护行为受多种因素影响,医务人员应结合相关因素,对不同行为阶段的患者采取针对性干预策略,以促进其足部自护行为的阶段性转变.     

老年肾移植受者贫血的特征及危险因素分析

目的 研究老年肾移植受者贫血的特征及其危险因素.方法 回顾性分析168例首次肾移植的老年肾移植受者的临床资料,采用多因素Logistic回归方法筛选老年肾移植受者发生贫血的危险因素.结果 168例老年首次肾移植受者,贫血的总发生率为45.2％( 76/168).40例为正细胞正色素性贫血;26例为小细胞低色素性贫血;10例为溶血性贫血.76例贫血受者中,51例为红细胞生成素(EPO)缺乏;25例为EPO抵抗.贫血受者营养不良,心、脑血管病变的发生率显著高于非贫血受者(P＜0.01).环孢素、硫唑嘌呤、泼尼松方案( CsA+Aza+Pred)贫血发生率为57.1％,显著高于其他方案(P＜0.01).多因素非条件Logistic回归分析表明,男性、肌酐水平、急性排斥反应、移植肾功能延迟恢复(DGF)是老年肾移植受者贫血发生的独立危险因素,OR值分别为1.089、5.156、6.345、1.876.结论 贫血是老年肾移植受者严重并发症.男性、肌酐水平、急性排斥反应、DGF是老年肾移植受者贫血发生的独立危险因素.     

老年患者皮肤撕裂伤流行特征及危险因素的多中心横断面研究

目的 调查分析我国不同医疗机构老年患者皮肤撕裂伤的流行特征及危险因素,为有效预防老年皮肤撕裂伤提供参考.方法 招募16个省、2个自治区和2个直辖市52所医院或养老院,整群抽取≥60岁的住院患者,从头到脚检查纳入对象的皮肤识别是否存在皮肤撕裂伤及其严重度,并收集人口学、健康状况以及皮肤撕裂伤致伤原因等相关资料.结果 共获...     

中青年脑卒中住院患者戒烟行为影响因素的质性研究

目的了解中青年脑卒中患者在不同戒烟行为阶段的影响因素,为戒烟干预提供参考。方法以行为转变理论为基础,采用质性研究中行为事件访谈法对12例中青年脑卒中住院患者进行访谈,使用Colaizzi内容分析法分析资料。结果提炼出两个主题群,分别是戒烟行为的促进因素和阻碍因素。结论不同戒烟行为阶段中青年脑卒中患者戒烟行为的影响因素不同,需根据患者的戒烟意愿和行为特点,采取相应的戒烟干预措施,以提高戒烟成功率。     

延续护理对提高中青年PCI术后患者自护行为的影响

<正>2014-01—2015-06,我们对40例接受冠状动脉介入术(PCI)治疗的中青年冠心病患者围术期实施延续护理干预,效果满意,报告如下。1资料与方法1.1一般资料本组80例患者,男60例,女20例;年龄26~59岁,平均48.43岁。纳入标准:(1)成功实施PCI术并康复出院的冠心病患者。(2)无认知障碍。(3)无严重慢性疾病或重要器官功能损害。(4)术后无严重并发症。按入院时间排序分为2组,     

Acute Polymyositis Following Renal Transplantation

Myositis is a rare complication following renal transplantation and is most commonly the result of drug-mediated myotoxicity. Other causative disorders include viral infection, electrolyte imbalance and myositis of autoimmune origin. We describe a 60-year-old patient who developed acute polymyositis 4 weeks after a 000 human leukocyte antigen (HLA) mismatch cadaveric renal transplant. Following an uncomplicated transplant course with maintenance triple immunosuppression (prednisolone, mycophenolate mofetil and cyclosporine), the patient presented with severe symmetrical proximal muscle weakness associated with a rise in serum creatine kinase to 46800 U/L. Electromyography confirmed myopathic changes and muscle biopsy demonstrated extensive muscle-fiber necrosis with an inflammatory infiltrate. There were no obviously culpable drugs and viral studies were negative. Prompt initiation of high-dose steroid therapy led to clinical and biochemical recovery. Acute polymyositis may occur following renal transplantation. Potential mechanisms include viral antigen transmission or a localized form of graft vs. host disease.     

Skeletal Complications Following Renal Transplantation

The occurrence of skeletal complications was examined in a series of 204 renal graft recipients who had maintained graft function for more than 12 months. Osteonecrosis was observed in 22 of the patients (11 per cent) from 5 to 46 months after the transplant operation. The lesions were often multifocal, with as many as 40 joints affected. The most common site was the femoral head, necrosis of which was recorded in 24 instances. The lesions here present a major clinical problem, and total hip replacement was deemed necessary in 4 cases, in all of which an excellent result was achieved.

Fractures had occurred after the transplantation in 53 patients (26 per cent), against only 6 before the operation. A total of 109 fractures had been sustained after periods ranging from 1 to 58 months, the most common site being the pelvic bones. The fractures were treated according to standard principles; no complications were encountered.

The skeletal complications were equally common among the males and females; they tended to occur at advanced ages.

They occurred to roughly the same extent whether the graft was from a related or a cadaveric donor and whether the patient had received one or more grafts.     

The Influence of Socioeconomic Deprivation on Outcomes Following Renal Transplantation in the United Kingdom

Socio‐economic deprivation is an important determinant of poor health and is associated with a higher incidence of end‐stage renal disease, higher mortality for dialysis patients and lower chance of being listed for transplantation. The influence of deprivation on outcomes following renal transplantation has not previously been reported in the United Kingdom. The Welsh Index of Multiple Deprivation was used to assess the influence of socio‐economic deprivation on outcomes for 621 consecutive renal transplant recipients from a single centre in the United Kingdom transplanted between 1997 and 2005. Outcomes measured were rate of acute rejection and graft survival. Patients from the most deprived areas were significantly more likely to experience an episode of acute rejection requiring treatment (36% vs. 27%, p = 0.01) and increasing overall deprivation correlated with increasing rates of rejection (p = 0.03). Income deprivation was significantly and independently associated with graft survival (HR 1.484, p = 0.046). Among patients who experienced acute rejection 5‐year graft survival was 79% for those from the most deprived areas compared with 90% for patients from the least deprived areas (p = 0.018). Overall socio‐economic deprivation is associated with higher rate of acute rejection following renal transplantation and income deprivation is a significant and independent predictor of graft survival.     

Outcomes of Renal Transplantation Following Bone Marrow Transplantation

This single center retrospective study was undertaken to determine the outcome of kidney transplantation (KT) after bone marrow transplantation (BMT) and also to determine the need for immunosuppressive therapy after KT when the BMT marrow donor is the KT donor. Kidney transplantation was performed in 10 patients with BMT nephropathy (BMTN). In six patients, the KT donor was the BMT donor; these individuals were given no long-term immunosuppression. Four other patients received KT from donors who were not the marrow donor (two living donors, two cadaveric donors). After median follow up of 34 months, no patient had an episode of acute rejection. All graft losses (n = 4) resulted from patient death. Three were because of infectious processes, including two infectious deaths in patients not on immunosuppression. Median estimated actuarial patient and graft survival (Kaplan-Meier) was 105 months. We conclude that patients with BMTN who receive KT from their marrow donor do not require immunosuppression. Whether immunosuppressive therapy is given or not, outcome appears to be determined largely by BMT-related immune dysfunction.     

Renal Transplantation

Summary BACKGROUND: Clinical renal transplantation has been performed successfully since 1955. With the introduction of Cyclosporin A to the market, 1982, results markedly improved, and allogeneic renal transplantation became a standard therapy in the treatment of end stage kidney failure. Life expectancy and quality of life is superior in kidney recipients in comparison with patients on dialysis. METHODS: In our center 699, renal transplantations have been performed since 1968. 98.1 % of the transplanted kidneys were from cadaveric donors, 1.9 % from living related donors. Mean age of the recipients was 30.7 ± 13.9 years from 1968 to 1983, and is now 45.9 ± 13.1 (1999 to 2002). The kidneys are normally transplanted to the common iliac vessels in end-to-side fashion. A Politano-Leadbetter antirefluxive implantation of the ureter is obligatory. RESULTS: 5-year graft survival was 19.4 % from 1968 to 1983, 74.3 % from 1984 to 1995, and 81.2 % from 1995 to 1998. Typical surgical complications are hematoma, lymphocele, ureter stenosis and ureter necrosis. The rate of necessary reoperations is 3.9 %. 5-year patient survival is 90 %. Heart disease (50 %), cancer (16 %), and sepsis (15 %) are the most frequent causes of death after renal transplantation. CONCLUSIONS: Renal transplantation continues to be the optimal treatment of terminal kidney failure. New immunosuppressive agents have improved the outcome after kidney transplantation. Enlargement of the donor pool is being attempted by the acceptance of older organs and by the acceptance of pediatric organs for adult recipients, too.     

Orem自护理论在腹部手术病人护理中的应用

目的探讨Orem自护理论在腹部手术病人护理中的应用效果.方法将368例行腹部手术的病人按随机原则分为自护组和对照组各184例.对照组按常规术前、术后护理;自护组在常规护理的基础上采用Orem自护理论的3个护理系统,让病人参与健康决策及力所能及的自理.结果自护组术后下床活动时间、术后肛门排气时间及平均住院日显著短于对照组(均P＜0.01);术后并发症发生率显著低于对照组(均P＜0.05).结论在腹部手术病人护理中应用自护理论可降低术后并发症,促进术后身体康复及缩短平均住院日.     

Outcomes and Native Renal Recovery Following Simultaneous Liver–Kidney Transplantation

With the increase in patients having impaired renal function at liver transplant due to MELD, accurate predictors of posttransplant native renal recovery are needed to select candidates for simultaneous liver–kidney transplantation (SLK). Current UNOS guidelines rely on specific clinical criteria for SLK allocation. To examine these guidelines and other variables predicting nonrecovery, we analyzed 155 SLK recipients, focusing on a subset (n = 78) that had post‐SLK native GFR (nGFR) determined by radionuclide renal scans. The 77 patients not having renal scans received a higher number of extended criteria donor organs and had worse posttransplant survival. Of the 78 renal scan patients, 31 met and 47 did not meet pre‐SLK UNOS criteria. The UNOS criteria were more predictive than our institutional criteria for all nGFR recovery thresholds (20–40 mL/min), although at the most conservative cut‐off (nGFR ≤ 20) it had low sensitivity (55.3%), specificity (75%), PPV (67.6%) and NPV (63.8%) for predicting post‐SLK nonrecovery. On multivariate analysis, the only predictor of native renal nonrecovery (nGFR ≤ 20) was abnormal pre‐SLK renal imaging (OR 3.85, CI 1.22–12.5). Our data support the need to refine SLK selection utilizing more definitive biomarkers and predictors of native renal recovery than current clinical criteria.     

The Use of Butorphanol Tartrate for the Prevention of Canine Intussusception Following Renal Transplantation

Butorphanol tartrate (0.05 mg/kg, im) was included in the preanesthetic medication in 15 out of 29 conditioned female mongrel dogs (22.7–27.3 kg body wt) undergoing renal autotransplants as part of a 48-h kidney preservation study. Four postoperative intussusceptions were noted (3 jejunojejunal I ileocolic) among the 14 dogs without butorphanol, whereas no intussusceptions developed in the 15 dogs receiving butorphanol as part of the preanesthetic protocol. In a prior study, 2 out of 18 dogs undergoing renal autotransplants without the use of butorphanol as part of a 24-h kidney preservation study developed intussusceptions (jejunojejunal). With the exception of butorphanol the anesthetic protocol was the same for all 47 dogs receiving transplants. Throughout these studies the surgical team remained constant, and all dogs were negative for parasites and systemic infectious disease pre- and postoperatively. The results indicate that the use of butorphanol tartrate as part of a preanesthetic protocol is effective in preventing canine intestinal intussusception following renal autotransplantation.