肾移植病人术后心理状态调查及护理干预

[目的]探讨肾移植病人术后心理状态影响因素及相应护理措施.[方法]采用焦虑自评量表(SAS)和抑郁自评量表(SDS)了解肾移植病人术后1周、2周、1个月、3个月、1年的心理状态,并对术后不同时期影响病人心理状态原因进行调查.[结果]肾移植病人在术后1年内各阶段均存在焦虑和抑郁,通过心理干预及随着时间的推移,焦虑、抑郁病例逐渐减少.[结论]针对各阶段的心理问题采取相应的护理措施,有利于改善肾移植病人的心理状态,从而提高肾移植病人的生活质量.     

术前护理干预对肾移植病人术后早期心理状态的影响

[目的]观察术前护理干预对肾移植病人术后早期心理状态的影响。[方法]将100例肾移植病人随机分为对照组和观察组,每组50例,对照组给予常规护理,观察组给予系统的术前护理干预。比较两组病人治疗效果。分别于护理干预前、移植术后2周及4周采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)评估病人的心理状态。[结果]观察组术后2周及4周SAS和SDS评分明显降低且均低于对照组(P<0.05)。[结论]对肾移植病人术前采用系统的护理干预,可以减轻病人术后早期的焦虑、抑郁症状。     

多次体外受精-胚胎移植失败患者心理状态及护理干预

目的:了解多次体外受精-胚胎移植(IVF-ET)失败患者心理状态,在此基础上总结有利于临床妊娠的护理体会。方法:随机选取159例多次(≥2次)IVF-ET失败的患者,采用Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)和自制IVF-ET失败心理问题自评表进行调查,掌握多次IVF-ET失败患者心理状态,总结有利于治疗的心理护理干预措施。结果:患者的焦虑、悲观、忧郁、孤独情绪随着年龄、不孕时间、失败次数、经济收入的增加而逐渐增加,差异有统计学意义(P0.05)。结论:焦虑、抑郁等心理问题在多次IVF-ET失败患者中普遍存在,且受多种因素影响,护理干预有助于改善IVF-ET患者心理状态,提高治疗效果。     

急性胰腺炎病人心理护理干预技巧探讨

[目的]探讨急性胰腺炎病人心理护理干预的技巧及临床效果。[方法]选取我院2009年6月—2010年6月收治的急性胰腺炎心理问题突出的40例病人为研究对象,对该组病人在常规护理的基础上加强心理护理干预,采用医院焦虑自评量表(SAS)及抑郁自评量表(SDS)评价心理干预前后该组病人心理状态。[结果]心理护理干预前该组病人的焦虑、抑郁程度均高于全国常模(P<0.05)。干预后焦虑、抑郁的程度显著下降(P<0.05)。[结论]心理护理干预有利于减轻急性胰腺炎病人的不良心理情绪,保证治疗效果。     

个体化心理干预对心脏瓣膜置换术病人焦虑及抑郁的影响

[目的]探讨个体化心理干预对心脏瓣膜置换术病人焦虑、抑郁状态的影响。[方法]将我院收治的480例心脏瓣膜置换术病人分为观察组和对照组各240例,对照组采用常规护理措施,观察组在此基础上采用个体化心理干预。手术前后采用Zung焦虑自评量表(SAS)及抑郁自评量表(SDS)对两组病人进行评估。[结果]观察组病人术后SAS、SDS评分明显低于对照组(P0.05)。[结论]心脏瓣膜置换术病人存在明显的焦虑、抑郁状态,术前加强心理护理,采用个体化心理干预,能够有效改善病人的焦虑、抑郁状态。     

肠易激综合征病人的心理分析及护理干预

[目的]调查肠易激综合征(IBS)病人的心理焦虑、抑郁状况,并针对病人存在的心理问题进行护理干预。[方法]采用焦虑自评量表(SAS)、抑郁自评量表(SDS)对58例住院IBS病人进行问卷调查,同时给予有效的护理干预,并将护理干预前后SAS、SDS评分进行比较。[结果]护理干预后IBS病人SAS、SDS评分均低于护理干预前(P<0.05)。[结论]针对IBS病人出现的心理问题,在护理中给予有效的护理干预可缓解病人的心理问题。     

心理干预对不孕症病人焦虑抑郁状态的影响

[目的]探讨心理干预对不孕症病人焦虑、抑郁状态的影响。[方法]对100例不孕症病人采用Zung编制的焦虑自评量表（SAS）和抑郁自评量表（SDS）进行焦虑、抑郁状态评定,分别进行针对性心理干预,比较心理干预前后病人SAS、SDS评分。[结果]病人心理干预后SAS、SDS评分降低（P〈0．05）,焦虑、抑郁发生率下降。[结论]焦虑、抑郁是不孕症病人常见的情绪障碍,心理干预可缓解不孕症病人的焦虑、抑郁状态。     

急性冠状动脉综合征病人焦虑、抑郁状况及心理危险因素分析

[目的]了解急性冠状动脉综合征(ACS)与急性胰腺炎(AP)住院病人焦虑、抑郁状况及相关心理危险因素。[方法]应用抑郁自评量表(SDS)、焦虑自评量表(SAS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和自行设计相关心理危险因素调查表,对120例ACS及116例AP住院病人进行问卷调查。[结果]ACS病人焦虑、抑郁发生率明显高于AP病人,家庭因素、经济因素、对病情认知情况、认知干预因素等对心理状态影响更大。[结论]应加强对ACS病人心理干预,给予更多的关爱、照顾和支持,控制焦虑、抑郁症状,改善病人生活质量。     

肾移植受者手术前、后心理状态调查分析及对策

目的了解肾移植手术前后受者的心理状态。方法应用WilliamWKZung编制的焦虑自评量表(SAS)、抑郁自评量表(SDS)及纽芬兰纪念大学幸福量表(MUNSH)对176例肾移植受者于肾移植手术前、后行2次心理状态调查分析。结果(1)肾移植手术前、后受者均存在明显的焦虑、抑郁症,总体幸福度低,但肾移植术后受者焦虑、抑郁明显低于术前,总体幸福度明显提高。(2)移植肾功能恢复情况及受者经济状况对肾移植术后受者的心理状态有极显著影响。(3)肾移植受者性别、年龄及文化程度对其心理状态影响无明显差异。结论肾移植手术前后受者存在严重的心理问题,据原因分析实施有效的围手术期健康教育、帮助病人寻求更多的社会及家庭支持、提高肾移植的成功率、缩短受者等待肾移植的时间等可有效地改善肾移植受者的心理状态。     

心理行为干预对全喉切除术后病人焦虑和抑郁影响的研究

[目的]了解全喉切除术后病人的心理状态,制订可行、有效的全喉切除术后病人心理、行为干预措施.[方法]用Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)进行调查,时干预组在集中培训过程中进行心理行为干预.[结论]喉癌病人普遍存在焦虑和抑郁症状,进行心理行为干预后心理状态明显改善.     

Postoperative multiple organ failure

Cellular damage is the pathophysiologic basis for the postoperative multiple organ failure syndrome. This damage may be caused by pre- and intraoperative shock. Postoperative organ failure is manifested when cellular repair does not occur. Three factors may contribute to this progression to multiple organ failure: inadequate resuscitation, malnutrition, and sepsis.     

Mediators of multiple organ failure

Multiple Organ Failure (MOF) has largely been attributed to bacterial sepsis, though conclusive evidence of an essential role for bacteria and/or their endotoxins is still lacking. On the other hand, MOF and the clinical syndrome of sepsis may be aseptically induced in germfree animals. This paper reviews the evidence that excessive activation of endogenous humoral mediators and inflammatory cells may cause this highly lethal syndrome.     

Hemodynamic aspects of multiple organ failure

Multiple organ failure (MOF) secondary to sepsis is associated with a high mortality. A large body of evidence suggests that the disturbed relationship between oxygen supply and oxygen uptake plays an important role in the pathogenesis of MOF. The relationship between oxygen-supply dependency and MOF and the practical implications of the relationship are reviewed. It is concluded that, apart from the all-important eradication of the source of the sepsis, optimizing oxygen transport is the best method of preventing the development of MOF. Since the effects of hemodynamic and ventilatory treatments on oxygen uptake are often unpredictable, the impact of the treatments on oxygen uptake should be evaluated directly.     

Hemodynamic aspects of multiple organ failure

Multiple organ failure (MOF) secondary to sepsis is associated with a high mortality. A large body of evidence suggests that the disturbed relationship between oxygen supply and oxygen uptake plays an important role in the pathogenesis of MOF. The relationship between oxygen-supply dependency and MOF and the practical implications of the relationship are reviewed. It is concluded that, apart from the all-important eradication of the source of the sepsis, optimizing oxygen transport is the best method of preventing the development of MOF. Since the effects of hemodynamic and ventilatory treatments on oxygen uptake are often unpredictable, the impact of the treatments on oxygen uptake should be evaluated directly.     

The syndrome of multiple organ failure

Current technology has prolonged the life support of patients with organ failures. The onset of MOF follows an inciting event and develops a clinical pattern of lung, liver, and kidney failure. Laboratory evidence of the syndrome includes hyperbilirubinemia, hyperglycemia, increased blood lactate, and reduced levels of hepatic proteins. Energy expenditure in MOF is increased and severe sepsis or septic shock can initiate the process of hypermetabolism and MOF. Current therapy is aimed at source control, restoration of oxygen transport, and metabolic support. Critical care nursing provides a technological and humanistic approach in developing a supportive environment for patients and families. Scientific study of the effects of nursing interventions on patient outcomes is needed to evaluate critical care nursing activities.     

多器官功能衰竭中肾衰的少见症一尿崩

目的　报道因多器官功能衰竭(MOF)产生尿崩症状的病例。方法　MOF14例,在病因治疗和程序化脏器支持的同时,监测其尿量、血、尿晶体渗透量、血电解质、血气分析等指标,观察使用垂体后叶素前、后的变化。结果　2例治愈,12例死亡。病程第2～9d出现尿崩症状,持续时间为43±22h(     

慢性肾衰及并发多脏器功能衰竭患者的护理

目的探讨护理在肾衰及并发多脏器功能衰竭治疗中的作用。方法对慢性肾衰及并发多脏器功能衰竭30例患者在正常治疗的同时配合以综合、饮食及心理护理。结果 29例患者积极配合治疗,1例患者因经济原因放弃治疗,治疗过程中无严重不良反应。结论对慢性肾衰及并发多脏器功能衰竭患者在正常治疗的同时配合以综合、饮食及心理护理,极大地提高了患者的生活质量。     

Septic shock and multiple organ failure

OBJECTIVE: To assess the frequency and mortality rates of septic shock in ICU patients and the clinical course of multiple organ failure associated with septic shock. DESIGN: Retrospective case survey. SETTING: Tertiary care center. PATIENTS: During a 2-yr period, 2,469 consecutive intensive care patients were studied regarding the frequency and hospital mortality rates of septic shock. A subset of 1,311 patients was further analyzed for the occurrence of organ system failures within 48 hrs of the onset of septic shock and again 4 to 7 days later. MEASUREMENTS AND MAIN RESULTS: The frequency rate of septic shock was 1.9% (n = 48), with a mortality rate of 72.9% (n = 35) in patients with septic shock. Deaths due to septic shock represented 14.6% of all deaths in the ICU during the study period. Eighteen patients died within 72 hrs of the onset of septic shock. Refractory hypotension was the cause of death in 15 of these 18 patients. Beyond 72 hrs, multiple organ failure accounted for eight of 17 deaths. The mean +/- SD number of organ systems failing at 48 hrs was 3.3 +/- 1.3 in survivors and 4.0 +/- 1.1 in nonsurvivors, and at 4 to 7 days was 2.1 +/- 1.5 in survivors and 4.0 +/- 1.5 in nonsurvivors (p less than .05). None of the specific organ system failures had prognostic value. The number of organ system failures was not related to the duration of hypotension, but had a weak correlation (r2 = .26, p less than .05) with the duration of vasoactive treatment at 4 to 7 days. The prolonged need for norepinephrine therapy was associated with an increased occurrence of renal failure. Thirty (62.5%) patients had positive blood cultures and a mortality rate similar to the mortality rate of patients with negative blood cultures. Patients with negative blood cultures died more often with hypotension (p less than .02). CONCLUSIONS: Septic shock is a major cause of death in intensive care patients. Refractory hypotension is a main cause of early deaths. Later on, multiple organ failure becomes the primary clinical problem and cause of mortality.