慢性肾脏病非透析患者血压昼夜节律与甲状旁腺素关系的研究

目的 观察慢性肾脏病非透析患者24小时血压动态变化,探讨血压昼夜节律异常与甲状旁腺素的关系.方法 随机选择承德市中心医院肾内科非透析的慢性肾脏病患者130例.动态血压监测采用携带式动态血压检测仪进行检测及数据分析.24小时平均血压≥130/80 mmHg(1 mmHg＝0.133 kPa)为高血压组102例,＜130/80mmHg为正常血压组28例.同时检测血常规及血肌酐、尿素、血钙、血磷、甲状旁腺素、白蛋白等生化指标.结果 正常血压组夜间收缩压下降率、夜间舒张压下降率、杓型血压比例[M(QR)]分别为6.8(7.3)％、7.3(7.5)％、8(28.6)％,高血压组夜间收缩压下降率、夜间舒张压下降率、杓型血压比例分别为4.2(9.0)％、1.7(7.1)％、25(24.5)％,两组间夜间舒张压下降率差异有统计学意义(P ＜0.01),但夜间收缩压下降率和杓型血压比例在两组间的差异无统计学意义.在高血压组平均舒张压≥90 mmHg的63例患者中夜间收缩压下降率为5.4(10.5)％,血全段甲状旁腺激素为(168.12±113.87) ng/L,两者呈负相关(r=-0.414,P＜0.05).在正常血压组28例中,夜间收缩压下降率和夜间舒张压下降率均和年龄呈负相关(r =-0.690,r=-0.631,均P＜0.01).在高血压组102例中,夜间舒张压下降率和重组人红细胞生成素用量呈负相关(r＝-0.430,P＜0.05).结论 慢性肾脏病非透析患者血压节律异常与血甲状旁腺素呈负相关;还与年龄、重组人红细胞生成素用量等因素有关.     

心房颤动患者焦虑、抑郁情绪与生活质量的相关性研究

目的 探讨心房颤动(房颤)患者焦虑、抑郁情绪与生活质量的相关性,评估不同抗凝治疗方案对房颤患者情绪的影响。方法 选择房颤患者86例行焦虑、抑郁、生活质量问卷调查,先分组为焦虑组22例和非焦虑组64例,再分组为抑郁组28例和非抑郁组58例。结果 焦虑组和抑郁组在躯体功能(PF)、躯体角色(RP)、机体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(MH) 8个方面的得分均分别低于非焦虑组和非抑郁组,差异有统计学意义(P<0.05)。服用华法林的患者更易产生焦虑情绪,而服用新型口服抗凝药能够有效缓解焦虑和抑郁情绪。Spearman相关性分析显示,中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)与生活质量无相关性(P>0.05)。结论 伴有焦虑或抑郁情绪的房颤患者症状负担更重,生活质量更差,服用新型口服抗凝药有助于改善患者焦虑及抑郁情绪。     

Measuring quality of life in chronic kidney disease patients: reflections and prospects

Quality of life is a complex and multidimensional concept. Understanding a patient'squality of life can assist healthcare providers to assess risk factors associated with hospitalization and mortality, and, potentially, delay disease progression. As chronic kidney disease (CKD) symptoms vary during different stages of the disease, instruments must be properly adjusted to measure quality of life accurately. This article explores comprehensively the development and appropriateness of relevant instruments, and recommends specific instruments for use at specific CKD stages.     

Prevalence, patterns of treatment, and control of hypertension in predialysis patients with chronic kidney disease

Background/Aims: Data on the prevalence, treatment and control of hypertension in patients with advanced chronic kidney disease (CKD) are limited. This study aimed to examine the above factors in a cohort of predialysis patients. Methods: During a period of 4 months, we recorded information on blood pressure (BP), comorbidities, medications and related parameters of patients followed up in the Low-Clearance Clinic of our Department. Control rates of hypertension were calculated at two thresholds: <130/80 and <140/90 mm Hg. Univariate and multiple linear regression analyses were employed to assess factors associated with BP control. Results: In the population studied [n = 238, males 58.4%, age 66.21 ± 4.2 years (mean ± SD), estimated glomerular filtration rate 14.5 ± 4.8 ml/min/1.73 m(2)], the prevalence of hypertension was 95.0%. Treatment rate among hypertensives was at 99.1%. On average, 3.04 ± 1.32 antihypertensive drugs were used, ranging from 1 to 7 agents. BP control rates at the <130/80 and <140/90 mm Hg thresholds were 26.5% and 48.2%, respectively. The systolic goal was achieved in 31.0% and 50.4%, whereas the diastolic goal was achieved in 67.7% and 91.2% of patients, respectively. In multivariate analysis, only black race was independently and inversely related with hypertension control (β = -0.187, p = 0.030). No specific antihypertensive class showed independent associations with control. Conclusions: Hypertension is highly prevalent in predialysis CKD patients. An almost universal treatment, employing a multi-agent regime, can help towards improved rates of control. Systolic BP is the main barrier to successful control and black race is associated with poorer control rates.     

围产期孕妇焦虑抑郁状况与生活质量的相关性研究

目的：探讨围产期孕妇焦虑抑郁状况与生活质量的相关性。方法对968名围产期孕妇于孕28周及产后1个月采用焦虑自评量表、爱丁堡产后抑郁量表、生活质量量表进行测评分析。结果孕28周及产后1个月孕妇生活质量量表的精神成分及躯体成分维度分与爱丁堡产后抑郁量表、焦虑自评量表评分呈负相关;爱丁堡产后抑郁量表评分与焦虑自评量表评分呈显著正相关（P＜0．01）。结论围产期孕妇焦虑情绪与抑郁情绪呈正相关,焦虑抑郁情绪与生活质量呈负相关。     

类风湿关节炎患者焦虑抑郁情绪及其与生活质量的相关性

目的观察类风湿关节炎(RA)患者焦虑抑郁情绪及其与主要症状体征、生活质量(QOL)的相关性,探讨RA患者抑郁情绪的机制。方法采用焦虑自评量表(SAS)和抑郁自评量表(SDS)、主要症状体征积分、生活质量量表对100例RA患者进行观察并做相关分析。结果(1)100例RA患者中,SAS标准分为(46.33±7.69),有焦虑症状者为37%;SDS标准分为(51.36±9.10),抑郁情绪的发生率为53%;两者均高于正常人;(2)SAS标准分与关节疼痛、关节压痛、关节重着、症状体征总积分呈正相关;SDS标准分与食欲减退、少气懒言、倦怠乏力、关节重着、症状体征总积分呈正相关,两者均与年龄、病程无关。(3)SAS、SDS标准分均与生理功能、社会功能、心理功能、健康自我认识能力及生活质量总积分呈正相关。结论类风湿关节炎患者存在一定程度的焦虑抑郁情绪,以抑郁情绪为主,RA患者的焦虑、抑郁情绪与病情及生活质量存在一定的相关性,提示其发生机制与生活质量下降有关。     

腹膜透析患者焦虑抑郁状况及其与生活质量的相关性分析

目的探讨腹膜透析患者焦虑、抑郁状况及其与生活质量的相关性。方法对238例腹膜透析患者应用Hamilton焦虑、抑郁量表、生命质量量表(medicaloutcomesstudy36-itemshortformhealthsurvey,MOSSF-36)进行现状调查,了解患者焦虑、抑郁状况及其与生存质量的相关性。结果患者焦虑发生率为48.31%,无焦虑患者生活质量躯体不适(bodilypain,BP)、总体健康感觉(generalhealthphysical,GHP)、社交能力(socialfunction,SF),情感健康(emotionalwell-being,EW)评分均高于焦虑患者(均P0.05);患者抑郁症发生率为55.46%,无抑郁患者生活质量GHP、SF和EW评分均高于抑郁患者(均P0.05);患者焦虑、抑郁情绪与生活质量总分及各维度呈负相关(均P0.01)。结论腹膜透析患者焦虑、抑郁症发生率较高,而且患者焦虑、抑郁情绪越严重者,其生存质量越低。     

乳腺癌患者术后生活质量与焦虑、抑郁情绪的相关性分析

目的探讨乳腺癌患者术后生活质量与焦虑、抑郁情绪的相关性,为临床护士开展心理护理提供依据。方法采用欧洲癌症研究与治疗组织研制的生活质量核心量表（QLQ-C30）、Zung焦虑自评量表（SAS）和Zung抑郁自评量表（SDS）分别测评147例乳腺癌患者的生活质量及其焦虑和抑郁状况,并分析其相关性。结果乳腺癌患者术后QLQ-C30评分中的躯体功能、角色功能、情绪功能、认知功能、社会功能以及总体健康状况分别与SAS评分和SDS评分呈负相关。而症状维度与SAS评分和SDS评分呈正相关（均P〈0．05）。结论乳腺癌患者术后焦虑、抑郁情绪越严重,其生活质量越差。提示临床护士应对其进行相应的心理辅导,提高患者的生活质量。     

Psychological characteristics and quality of life of patients with chronic kidney diseases

AIM: To study quality of life of patients with progressive renal pathology at the stage of conservative treatment. MATERIAL AND METHODS: Quality of life and psychological features were examined in 40 patients with renal diseases (40% males, mean age 48.6 +/- 1.3 years). 77.5% examinees suffered from glomerulonephritis, the rest had diabetic nephropathy. RESULTS: Personality, behavioral features of the patients were characterized as well as relationships between psychological and somatic factors in development of the disease. Factors influencing quality of life of the above patients are described. CONCLUSION: Correction of the variables influencing, primarily, the psychological component of the quality of life and, by this component, satisfaction of the patients with their state as a whole may have a good effect on their rehabilitation.     

Prognostic potential of brain natriuretic peptide (BNP) in predialysis chronic kidney disease patients

In the present study, we investigated the potential of N-BNP (N-terminal B-type natriuretic peptide) as a prognostic marker for risk of CV (cardiovascular) events, overall mortality and progression to ESRD (end-stage renal disease) in a cohort of 83 pre-dialysis CKD (chronic kidney disease) patients without clinical evidence of heart failure. During the study, ten patients reached the combined end point of overall mortality and/or CV event. Univariate factors associated with the combined end point were plasma N-BNP (P < 0.0005), creatinine (P < 0.002), systolic blood pressure (P < 0.009) and age (P < 0.015). N-BNP levels were higher in patients with CV events (P < 0.0005). Cox model regression analysis yielded log10 N-BNP (hazard ratio, 9.608; P < 0.007) and pre-existing CV disease (hazard ratio, 4.571; P < 0.029) as independent predictors of overall mortality or CV events. Kaplan-Meier analysis curves for the subgroup with supramedian creatinine levels (225 micromol/l) showed significant separation of the curves stratified for plasma N-BNP levels above and below the group median (291 pmol/l) for all end points. Receiver-operator-characteristic curves for N-BNP (355 pmol/l cut-off) demonstrated a specificity of 65.8% at a sensitivity of 100% for predicting CV events/overall mortality. The measurement of plasma N-BNP may aid in the risk stratification of pre-dialysis CKD patients. The high sensitivity and negative predictive value (100%) may enable the selection of patients who could safely be excluded from further investigations, resulting in better focusing of resources.     

Post-traumatic stress disorder, depression, anxiety and quality of life in patients with traffic-related injuries

AIMS: This paper reports a study to investigate and follow-up relationships between post-traumatic stress disorder, anxiety, depression and quality of life in patients after traffic-related injuries. BACKGROUND: Worldwide, traffic accidents kill 1.2 million people and injure 50 million people per year. Accidental injuries are fourth in the top five causes of death in Taiwan. For survivors, traffic accidents not only cause physical impairments, but also psychological trauma, such as post-traumatic stress disorder, depression and anxiety, all of which affect the quality of life. METHODS: An exploratory, correlational design was used, and participants were recruited consecutively. Data were collected at 1 and 6 weeks post-injury for 64 patients from two major medical centres in Taiwan. Instruments were the New Injury Severity Scale, Post-traumatic Stress Disorder Reaction Index, Beck Depression Inventory, State Anxiety Inventory and Medical Outcomes Study Questionnaire. The data were collected in 2002. RESULTS: Statistically significant improvements occurred in depression, anxiety and the quality of life between week 1 and week 6 (P<0.05); high levels of post-traumatic stress disorder symptoms at week 1 (87.5%) and at week 6 (82.8%) showed no statistically significant improvement. There was a positive correlation between post-traumatic stress disorder and depression (r=0.70, P<0.001) and between post-traumatic stress disorder and anxiety (r=0.57, P<0.001), and a negative correlation between post-traumatic stress disorder and quality of life (r=-0.47, P<0.001). Depression was the most important variable to predict post-traumatic stress disorder at week 6, with depression levels at week 6 being a more powerful predictor than those at week 1. Regression analysis revealed that depression (19%) at week 1, depression at week 6 (45%), anxiety (3.8%) at week 6 and post-traumatic stress disorder (5.8%) explained a statistically significant amount of the variance at week 6. CONCLUSIONS: The findings suggest that traffic accidents have an impact on people's psychosocial wellbeing. Healthcare professionals need to implement interventions to decrease post-traumatic stress disorder, depression and anxiety to increase the quality of life for patients following traffic injuries.     

Effect of anxiety and depression on self‐care agency and quality of life in hospitalized patients with chronic obstructive pulmonary disease: A questionnaire survey

Chronic obstructive pulmonary disease (COPD) affects the lives of individuals in a number of ways; it causes an increase in the need for help and support and a decline in self‐care agency and quality of life. This research has been conducted in patients with COPD hospitalized in the Pulmonary Department of Erzincan State Hospital in the eastern Turkey to examine the effect of anxiety and depression on self‐care agency and quality of life (n = 135). The results showed that 69.6% and 85.6% of the patients were at risk for anxiety and depression, respectively, and that the mean scores of self‐care agency and quality of life decreased as the mean scores of anxiety and depression increased. It was also established that the mean score of the quality of life increased as the mean score of self‐care agency went up. It could be concluded that the majority of the patients are at risk for anxiety and depression and that presence of anxiety or depression has a negative effect on the self‐care agency and the quality of life. The recognition and treatment of depression and anxiety in patients with COPD provide significant improvements in self‐care agency and quality of life of patients.     

多学科联合护理对慢性肾脏病患者体力活动能力和生活质量的影响

摘要 目的 探索多学科联合护理对慢性肾脏病患者体力活动能力和生活质量的影响。方法 采用随机抽样法选取2018年6月~2020年7月我院123例慢性肾脏病患者作为研究对象,根据护理方法不同进行分组,其中55例实施常规护理,纳入对照组,68例实施多学科联合护理,纳入观察组。比较两组患者干预后入院宣教知晓情况、计划出院情况,入院时、出院6个月后体力活动能力[国际体力问卷（IPAQ）]、生活质量（QOL-100）评分、自我管理能力（自我管理行为量表）变化。结果 干预后,观察组患者入院宣教知晓率、计划出院率均高于对照组（P＜0.05）;出院6个月后,两组患者IPAQ日体力活动消耗量均较入院时提高,且观察组显著高于对照组（P＜0.05）;两组患者QOL-100量表中生理、心理、社会关系、生活状况、独立能力五个方面评分均较入院时提高,且观察组高于对照组（P＜0.05）;两组患者自我管理行为量表遵医嘱、饮食控制、规律锻炼、并发症护理各方面评分均较入院时提高,且观察组高于对照组（P＜0.05）。结论 慢性肾脏病患者实施多学科联合护理,可改善患者入院宣教知晓情况与计划出院情况,提高其自我管理能力,有效患者体力活动能力与生活质量。