肾移植病人不遵医行为原因分析与教育对策

调查分析肾移植病人不遵医行为的相关因素，探讨行之有效的教育对策。方法：对１６５例肾移植病人或家属进行交谈与问卷调查，针对存在的问题提出相应的教育对策。结论：只有对患者进行有效的健康教育，才能提高肾移植病人的遵医行为的，从而提高其存活率。     

老年慢性心力衰竭患者家属健康教育对患者遵医行为的影响

目的:探讨患者家属的健康教育对改善老年慢性心力衰竭(CHF)患者遵医行为的影响.方法:选择2008年7月～2010年12月住院的慢性心力衰竭患者214例,采用随机配对的方法将患者分为对照组110例和观察组104例.两组病人均进行常规治疗护理和健康教育及出院指导,对观察组患者家属进行健康教育.出院后6个月对2组患者医嘱依从性和再住院情况进行比较,采用X2检验和t检验.结果:观察组患者的医嘱依从性显著高于对照组,再住院率低于对照组.结论:对老年CHF患者家属的健康教育可以提高患者的遵医行为,降低再住院率.     

健康教育路径对提高急性胰腺炎患者遵医行为的研究

目的:探讨健康教育路径对提高急性胰腺炎(AP)患者遵医行为依从程度及其对疗效和患者生活质量的影响。方法:将60例确诊为AP患者随机分为实验组和对照组各30例,对照组采用传统健康教育方式,实验组按照健康教育路径进行健康教育。比较两组患者对AP基本知识知晓率、遵医行为及再次入院率等。结果:实验组对AP知识知晓率为100%,对照组为73.3%,实验组显著高于对照组(P<0.05)。对医嘱的遵从率实验组高于对照组(P<0.05)。结论:健康教育路径可提高患者对AP知识的认知,提高遵医行为,减少疾病的复发,提高患者的生活质量。     

肾移植术后不遵医行为的原因与干预

目的 分析肾移植术后不遵医行为的影响因素,以采取有效对策,为提高其遵医行为提供参考依据.方法 采用肾移植术后遵医行为调查表,对100例肾移植术后1个月以上的门诊或住院患者的遵医行为进行调查.结果 有89%的患者存在不遵医行为.不遵医行为的原因与患者的文化程度、对疾病及治疗的认知态度、健康教育知识掌握程度、就医条件、经济状况、肾移植术后时间以及亲属的配合、社会支持等因素相关.结论 应采取有效的对策,加强对肾移植患者的健康教育,制定简单有效的治疗方案,充分发挥社会、家庭支持系统,以指导肾移植术后患者行为,从而延长肾移植术后人肾存活时间,并提高其生存质量.     

健康教育对混合痔患者遵医行为的影响

从2012年1月始,我们实行优质护理,入院患者由责任护士进行健康教育,出院后进行电话回访,以了解患者健康教育执行情况,并纠正其不良生活方式。临床资料：将入院混合痔患者168例随机分为对照组和观察组各84例。观察组中。男36例,女48例;年龄20~66岁,     

开展家长健康教育提高癫癎患儿遵医行为研究

目的探讨患儿家长健康教育对癫患儿遵医行为及用药依从性的影响。方法随机将癫住院患儿家长分 为观察组和对照组各22人。采取多种健康教育方式对观察组进行针对性的健康教育;对照组只根据其所提问题, 做简单、必要的解释。用问卷调查对患儿家长入院后、出院时,出院3个月后进行癫知识问卷调查并评分,观察 两组患儿遵医依从性及疗效。结果入院时,两组癫知识知晓率比较,差异无显著性意义(P>0.05)。出院时和 出院后3个月,观察组知晓率高于对照组(均P<0.01);观察组患儿遵医依从性、疗效高于对照组(P<0.05,P< 0.01)。结论健康教育不但能提高癫患儿家长对相关知识的认知,亦能提高患儿治疗的依从性及临床疗效。     

人工心脏瓣膜置换术后患者服药遵医行为的调查

目的了解人工心脏机械瓣膜置换术后患者的服药遵医行为,分析其相关因素,为采取有效的护理对策提供依据。方法对84例人工心脏机械瓣膜置换术后6个月及以上的患者进行服药遵医行为调查。结果 84例患者的遵医率为61.90%,患者服药遵医行为的影响因素包括教育程度、经济收入、家属监督（P〈0.05,P〈0.01）。结论人工心脏瓣膜置换术后患者的服药遵医行为有待提高。加强健康教育,发挥家属的监督支持作用,为患者提供经济的复查方案等有利于提高患者的服药遵医行为。     

社区护理干预对糖尿病患者遵医行为的影响

目的观察社区护理干预对糖尿病患者遵医行为的影响。方法将56例2型糖尿病患者随机分为干预组（26例）与对照组（30例）。对照组仅住院时进行糖尿病知识宣教；干预组患者增加社区护理干预，并定期评价其遵医行为，及时纠正不健康的生活方式并给予指导。结果干预组遵医率明显高于对照组；空腹血糖值显著低于对照组（P〈0.05，P〈0.01）。结论实行社区护理干预，能有效提高2型糖尿病患者的遵医行为，降低空腹血糖。     

人工心脏瓣膜置换术后患者服药遵医行为的调查

目的了解人工心脏机械瓣膜置换术后患者的服药遵医行为,分析其相关因素,为采取有效的护理对策提供依据。方法对84例人工心脏机械瓣膜置换术后6个月及以上的患者进行服药遵医行为调查。结果 84例患者的遵医率为61.90%,患者服药遵医行为的影响因素包括教育程度、经济收入、家属监督(P0.05,P0.01)。结论人工心脏瓣膜置换术后患者的服药遵医行为有待提高。加强健康教育,发挥家属的监督支持作用,为患者提供经济的复查方案等有利于提高患者的服药遵医行为。     

Impact of clinical pharmacy services on renal transplant patients'' compliance with immunosuppressive medications

BACKGROUND: Non-compliance with immunosuppressive medications may result in allograft rejection and is regarded as an important impediment to post-transplant care. This randomized, controlled trial evaluates the impact of clinical pharmacy services on renal transplant patients' compliance with immunosuppressive agents. METHODS: Patients who received a renal transplant at the Medical College of Georgia from February 1997 through January 1999 were randomized in the intervention or control group provided they met study criteria. In addition to routine clinic services at each clinic visit, patients in the intervention group received clinical pharmacy services, which included medication histories and review of patients' medications with an emphasis on optimizing medication therapy to achieve desired outcomes and minimizing adverse medication events. The clinical pharmacist also provided recommendations to the nephrologists with the goal of achieving desired outcomes. To promote medication compliance by using compliance enhancement strategies, the clinical pharmacist counseled patients concerning their medication therapy and instructed them how to properly take their medications. Patients in the control group received the same routine clinic services as the intervention group except that they did not have any clinical pharmacist interaction. Compliance rate (CR) was calculated and patient's compliance status was determined from the CR. The CR, the fraction of patients remaining compliant for each month, and the mean time patients were compliant were compared between groups. Whether there was a difference in the frequency of patients achieving 'target' immunosuppressive levels in the control and study groups was evaluated. RESULTS: The mean CR for patients who had clinical pharmacist intervention (n=12) was statistically higher than the control group's (n=12) mean CR (p<0.001). During the 12-month post-transplant study period, patients in the intervention group had a longer duration of compliance than patients in the control group (p<0.05). Additionally, patients who had clinical pharmacy services had a greater achievement of 'target' levels than patients who did not receive these services (p<0.05). CONCLUSIONS: Patients who received clinical pharmacy services with traditional patient care services had better compliance with immunosuppressants than patients who only received traditional patient care services. Results of this study suggest a multidisciplinary team that includes a clinical pharmacist as part of the care for post-transplant patients is beneficial for enhancing medication compliance.     

Impact of obesity on renal transplant outcomes

Obesity is a frequent and important consideration to be taken into account when assessing patient suitability for renal transplantation. In addition, posttransplant obesity continues to represent a significant challenge to health care professionals caring for renal transplant recipients. Despite the vast amount of evidence that exists on the effect of pretransplant obesity on renal transplant outcomes, there are still conflicting views regarding whether obese renal transplant recipients have a worse outcome, in terms of short- and long-term graft survival and patient survival, compared with their non-obese counterparts. It is well established that any association of obesity with reduced patient survival in renal transplant recipients is mediated in part by its clustering with traditional cardiovascular risk factors such as hypertension, dyslipidaemia, insulin resistance and posttransplant diabetes mellitus, but what is not understood is what mediates the association of obesity with graft failure. Whether it is the higher incidence of cardiovascular comorbidities jeopardising the graft or factors specific to obesity, such as hyperfiltration and glomerulopathy, that might be implicated, currently remains unknown. It can be concluded, however, that pre- and posttransplant obesity should be targeted as aggressively as the more well-established cardiovascular risk factors in order to optimize long-term renal transplant outcomes.     

Impact of race on renal transplant outcome

The influence of race on the outcome of cadaver renal transplantation (CRT) continues to be controversial even in the cyclosporine era. The present study examines the effect of race in 343 adult CRT performed from 1/1/82 through 10/1/88 with regard to the incidence of delayed function (DF), graft survival (GS), and patient survival (PS). Blacks constituted 38% of the patients. A history of nephrosclerosis secondary to hypertension was more common in blacks, with 51% (67/130) vs. 8% (17/213) in whites, while glomerulonephritis and Type 1 diabetes mellitus were more common in whites. There was no significant difference in the number of HLA (A,B,DR) matches or DR mismatches between whites and blacks. With azathioprine immunosuppression DF was more common in blacks than in whites, 54% (14/26) vs. 20% (11/55) respectively (P less than 0.01). The higher incidence of DF in blacks than in whites on Aza was associated with a significantly lower dose of intraoperative albumin, 0.25 g/kg vs. 0.44 g/kg, respectively (P less than 0.01). Of the Aza treated black recipients who had DF, 79% (11/14) had graft loss within three months, significantly worse than 25% (3/12) with graft loss when immediate function was present (P less than 0.005). Currently, all patients receive at least 0.80 g/kg of albumin intraoperatively and CsA quadruple induction therapy. With the current regimen, black and white recipients of primary CRT recipients have a comparable low incidence of DF of 18% and 22%, respectively. However, DF remains high among repeat black or white recipients: 33% (10/30) and 57% (8/14), respectively. The incidence of rejection within 30 days was similar for black and white recipients during the Aza and CsA eras, 62% vs. 75% and 34% vs. 42% respectively. GS and PS at three months for blacks on Aza were 54% and 89%, respectively, reflecting the corresponding high incidence of DF. This compares with 71% and 97% GS and PS for whites on Aza. Blacks and whites receiving CsA had equivalent 1-year GS and PS: 76% and 92%, respectively. We conclude that, in our center during the Aza era, blacks had a higher incidence of DF and lower GS than whites. With our current intraoperative fluid replacement and CsA immunosuppression, the incidence of DF and GS and PS are equivalent in black and white recipients.     

Impact of dyslipidaemia in renal transplant recipients

The evidence that lipid disorders in patients following renal transplantation play a major role in the pathogenesis of atherosclerosis and chronic renal allograft rejection is circumstantial. The absolute rate of clinical vascular disease and cardiovascular complications in transplant patients, the high prevalence of an atherogenic lipid profile and the evidence from the large HMG-CoA reductase inhibitor (statin) regression trials in the general population suggest that lipid lowering treatment is necessary in most patients after renal transplantation. Furthermore, animal models and observational studies in patients have found correlations between plasma lipid levels and both acute and chronic rejection. Animal transplant models and clinical trials in heart transplant patients also suggest that statin treatment decrease the incidence of chronic rejection in a manner that may also be independent of lipid lowering. Although the mechanisms behind this protective effect remains unclear, statins may be the first agents to be effective in preventing chronic rejection and in reducing the rate of cardiovascular complication in renal transplant recipients.     

同伴教育对稳定期COPD患者长期家庭氧疗依从性的影响

目的探讨同伴教育对稳定期慢性阻塞性肺疾病（COPD）患者长期家庭氧疗依从性的影响。方法将87例COPD患者按纳入顺序编号,采用随机数字表法分为对照组43例与观察组44例。对照组采用COPD氧疗知识的常规健康教育,观察组在此基础上接受同伴教育1年,包括同伴教育者的选择、成立同伴教育者培训小组及同伴教育活动的实施等。连续6个月后评价患者长期家庭氧疗依从性、生活质量评分（SGRQ）,统计2年内急性发病再住院率。结果观察组长期家庭氧疗依从性显著高于对照组,肺功能及血气指标显著好于对照组,2年内再住院率显著低于对照组（均P〈0.05）。结论同伴教育能有效提高COPD患者长期家庭氧疗的依从性,改善肺功能,减少COPD急性发作,从而改善患者生活质量。     

同伴教育对稳定期COPD患者长期家庭氧疗依从性的影响

目的探讨同伴教育对稳定期慢性阻塞性肺疾病(COPD)患者长期家庭氧疗依从性的影响。方法将87例COPD患者按纳入顺序编号,采用随机数字表法分为对照组43例与观察组44例。对照组采用COPD氧疗知识的常规健康教育,观察组在此基础上接受同伴教育1年,包括同伴教育者的选择、成立同伴教育者培训小组及同伴教育活动的实施等。连续6个月后评价患者长期家庭氧疗依从性、生活质量评分(SGRQ),统计2年内急性发病再住院率。结果观察组长期家庭氧疗依从性显著高于对照组,肺功能及血气指标显著好于对照组,2年内再住院率显著低于对照组(均P0.05)。结论同伴教育能有效提高COPD患者长期家庭氧疗的依从性,改善肺功能,减少COPD急性发作,从而改善患者生活质量。     

Impact of homocysteinemia on long-term renal transplant survival

AIM: We prospectively followed a cohort of 202 renal transplant recipients for 5 years to examine the impact of fasting homocysteinemia on long-term patient and renal allograft survival. METHODS: Cox proportional hazards regression analysis was used to identify independent predictors of all-cause mortality and graft loss. RESULTS: Hyperhomocysteinemia (tHcy >15 micromol/L) was present in 48.7% of the 202 patients, predominantly among men (55.8%) as opposed to women (37.1%). At the end of the follow-up period, 13 (6.4%) patients had died including 10 from cardiovascular disease, and 23 had (11.4%) had lost their grafts. Patient death with a functioning allograft was the most prevalent cause of graft loss (13 recipients). Levels of tHcy were higher among patients who died than among survivors (median 23.9 vs 14.3 micromol/L; P = .005). Median tHcy concentration was also higher among the patients who had lost their allografts than those who did not (median 19.0 vs 14.1 micromol/L; P = .001). In a Cox regression model including gender, serum creatinine concentration, transplant duration, traditional cardiovascular risk factors, and associated conditions, such as past cardiovascular disease, only tHcy concentration (ln) (HR = 5.50; 95% CI, 1.56 to 19.36; P = .008) and age at transplantation (HR = 1.07; 95% CI, 1.02 to 1.13; P = .01) were independent predictors of patient survival. After censoring data for patient death, tHcy concentration was not a risk factor for graft loss. CONCLUSIONS: This prospective study shows that tHcy concentration is a significant predictor of mortality, but not of graft loss, after censoring data for patient death.     

Impact of intensive interventions on therapeutic compliance of patients with stroke and impaired glucose tolerance

目的 探讨强化护理干预对脑卒中并存糖耐量异常患者依从性的影响.方法 将210例脑卒中并存糖耐量异常患者随机分为观察组和对照组各105例.两组住院期间均接受相同的健康教育,但观察组接受护理人员的监督,确保干预措施的强化和落实.测评两组出院时依从性情况及出院后6个月的血糖.结果 观察组患者出院时治疗依从性显著高于对照组(均P＜0.01),出院后6个月血糖控制情况显著优于对照组(P＜0.01).结论 强化干预可提高脑卒中并存糖耐量异常患者治疗依从性,有利于血糖控制.     

强化干预对脑卒中并存糖耐量异常患者治疗依从性的影响

目的探讨强化护理干预对脑卒中并存糖耐量异常患者依从性的影响。方法将210例脑卒中并存糖耐量异常患者随机分为观察组和对照组各105例。两组住院期间均接受相同的健康教育,但观察组接受护理人员的监督,确保干预措施的强化和落实。测评两组出院时依从性情况及出院后6个月的血糖。结果观察组患者出院时治疗依从性显著高于对照组(均P<0.01),出院后6个月血糖控制情况显著优于对照组(P<0.01)。结论强化干预可提高脑卒中并存糖耐量异常患者治疗依从性,有利于血糖控制。     

肾移植受者环孢素A治疗窗浓度的临床研究

为了探讨肾移植后患者全血ＣｓＡ谷浓度（ＴＬ）与临床的关系，寻求适合国人肾移植受者ＣｓＡ理想治疗窗浓度范围。应用ＦＰＩＡ法特异性单克隆试剂盒测定口服ＣｓＡ１２小时后全血谷浓度。结果表明，肾移植后在应用标准三联免疫抑制治疗中，ＣｓＡ理想治疗窗浓度范围应为：术后第１个月全血ＣｓＡＴＬ为３５０～４５０μｇ／Ｌ；第２个月为２５０～３５０μｇ／Ｌ；第３个月为２５０～３００μｇ／Ｌ；第４个月以后ＣｓＡＴＬ应维持在１５０～２５０μｇ／Ｌ范围内。此浓度范围既能达到满意的免疫抑制效果，又能减少ＣｓＡ的肝、肾毒性作用及排斥反应。因此，可视为国人肾移植受者ＣｓＡ的理想治疗窗浓度范围。