基于Kumpfer模型的炎症性肠病患者心理弹性保护性因素的质性研究

目的:了解炎症性肠病患者心理弹性的保护性因素,为提高患者心理弹性水平提供依据。方法:于2020年12月—2021年3月采用目的抽样法选择在北京协和医院消化内科病房住院的16例炎症性肠病患者为研究对象,对其进行半结构式深入访谈,使用定向内容分析法对访谈资料进行整理和分析。结果:共提炼出个体内在特征、社会支持网络、环境感知...     

炎症性肠病患者工作体验的质性研究

目的探索炎症性肠病患者工作中的体验及其应对策略。方法采用质性研究中的现象学研究法,于2019年12月至2020年9月对南通市某三级甲等医院的16名炎症性肠病患者进行半结构式访谈,使用Colaizzi 7步分析法对原始资料进行整理分析。结果炎症性肠病患者的工作体验可划分为3个主题,即带病工作患者面临诸多的问题;患者对疾病的认知影响工作态度;患者坚持工作的意愿和行为的驱动力来源。结论炎症性肠病患者工作中面临着来自生理、心理、社会等各方面的感受和体验。医护人员应该在深入了解其工作感受的基础上,明确其在工作中存在的问题,给予针对性的干预和指导。预防和纠正不良应对方式,促进和强化有效应对方式,改善其工作和生活质量。     

炎症性肠病病人病耻感现状及干预的研究进展

对炎症性肠病病人病耻感的研究现状、评估工具及干预策略等方面的研究进展进行综述,旨在提高医护人员及病人家属对病耻感的重视程度,降低病人的病耻感水平,为后续研究提供参考性建议。     

精神疾病病人病耻感体验的质性研究

目的:探讨精神疾病病人病耻感体验及应对方式。方法:对12例病人进行深度访谈以获取资料,用现象学分析法分析资料。结果:精神疾病病人在患病后都会产生羞耻心理;遭遇歧视时被他人躲避而感到无奈,工作、升职受到不公平待遇而痛心;在遭遇歧视后病人多采取回避社交、刻意的隐瞒病情等错误的应对方式;由于精神疾病,有些病人放弃了原本的工作以及对未来生活产生不确定感。结论:对精神疾病病人要加强疾病的健康宣教,改变病人不正确的认知;做好心理护理,提供情感支持;加强对公众精神卫生知识的宣教和普及。     

青少年炎症性肠病患者夏令营体验的质性研究

目的了解青少年炎症性肠病患者参与疾病相关夏令营后的体验和感受。方法 2018年8月,以目的抽样法选取14名参加炎症性肠病青少年夏令营的患者为研究对象,采用描述性质性研究法对其进行半结构式访谈,应用传统内容分析法进行分析。结果通过阅读、分析、反思、分类和提炼,得出2个主题,即教育是最好的药物和同伴的作用很强大;得出7个亚主题,分别为提高疾病相关知识水平、接受患病事实、增加治疗信心、提高自我管理的重视程度、归属感增加、同伴支持增加、让爱延长。结论夏令营对炎症性肠病青少年患者不论是在疾病知识还是心理支持上都产生了较好的影响,值得推广。     

肥胖症病人病耻感的质性研究

目的:了解肥胖症病人的病耻感体验,为临床医护人员制订针对性的干预方案提供理论依据。方法:2021年3月—2021年5月,采用目的抽样法,选择同济大学附属第十人民医院内分泌减重代谢中心收治的16例肥胖症病人为研究对象,采用现象学研究方法对其进行半结构式访谈,使用Nvivo 11.0软件,且根据Colaizzi现象学资料分析法对资料进行分析、提炼主题。结果:肥胖症病人的病耻感体验可归纳为3个类属9个主题。类属一:病耻感体验,即自责与愧疚,负面的刻板印象,自卑感,遭受歧视的经历;类属二:病耻感来源,即亲人、朋友、同学和同事,社会公众;类属三:病耻感的应对,即接纳,社交回避,重塑形象。结论:肥胖症病人存在强烈的病耻感,医护人员应关注肥胖症病人的病耻感体验,予以适当的心理支持,指导其采取正确的应对方式;同时传播正确、科学的肥胖症相关知识;相关部门需制订肥胖症病人相关权益的政策或制度,为肥胖症病人创造人性化的社会环境。     

炎症性肠病－－炎症性肠病的内镜诊断

结肠克罗恩病与溃疡性结肠炎同属非特异性炎症性肠病 ,二者在病因、临床表现和治疗上有一些共同之处。克罗恩病可发生于胃肠道任何部位 ,虽可发生在结肠 ,但小肠和胃、盲肠的病变更为多见。本病在欧美发病率高 ,东方国家较为少见。1980年北京协和医院等北京四家大医院对手术和病理确诊的14 5例克罗恩病分析的结果表明 ,本病单纯分布于结肠者仅占全部病例的 7 6% ,而合并小肠病变者近半数 ,尤其病变好发于回盲肠。溃疡性结肠炎在西方国家多见 ,北欧和北美的年发病率为 2 / 10万～ 10 / 10万人群 ,高发年龄在 3 0～ 60岁 ,女性略高于男性 ,我…     

炎症性肠病患者脊柱关节炎的表现特点

目的 探讨炎症性肠病(IBD)患者的肠外表现—脊柱关节炎的发生情况,为后续炎症性肠病患者的诊断治疗提供借鉴.方法 分析2016年9月至2020年9月本院收治的210例炎症性肠病患者(其中溃疡性结肠炎/UC组138人,克罗恩病/CD组72人)肠道病变分布情况,并分析UC组及CD组患者脊柱关节炎各种分型的发生率及两组之间表...     

炎症性肠病患者心理社会体验和应对策略质性研究的Meta整合

目的系统评价及整合炎症性肠病患者心理社会体验和应对策略的质性研究。方法本研究类型为质性研究的Meta整合。计算机检索Web of Science、PubMed、Cochrane Library、Embase、PsycINFO、CINAHL、Scopus、中国知网、万方数据库、维普网、中国生物医学文献数据库, 筛选关于炎症性肠病患者心理社会体验和应对方式的质性研究, 检索时限为建库至2022年2月1日。采用澳大利亚Joanna Briggs Institute循证卫生保健中心质性研究质量评价标准(2016版)对纳入的文献进行质量评价, 采用汇集性整合的方法对文献结果进行整合。结果共纳入22篇文献, 提炼出59个研究结果, 归纳成8个新类别, 合成3个整合结果, 分别为负性心理社会体验与消极应对、正性心理社会体验与积极应对、支持与需求。结论医务人员应关注炎症性肠病患者的多样性心理社会体验和需求, 提供必要的支持和帮助, 促进患者回归社会, 提高患者的生活质量。     

炎症性肠病患者自我管理体验质性研究的系统评价

目的 整合相关质性研究, 系统评价炎症性肠病患者自我管理过程中的体验。方法 检索PubMed、Em-base、Science Direct、Web of Science、PsycINFO以及中国生物医学数据库、万方、中国知网、维普数据库中从建库至2017年3月31日相关的质性研究。文章质量评价采用澳大利亚JBI循证卫生保健中心（2008）质性研究质量评价标准,采用汇集性整合的方法进行结果整合。结果 共纳入6项研究,提炼35个完整的研究结果,归纳出9个新的类别,得到3个整合结果。①医疗管理：患者持续进行医疗行为调整和疾病知识积累,采取多元化的方式控制疾病,努力维持疾病缓解状态;②情绪管理：患者通过应对炎症性肠病带来的诸多压力和负性情绪,以积极的心态面对生活;③角色管理：患者不断进行认知、行为的调整来适应自己的患者角色,并努力维持生病前的日常生活角色。结论 炎症性肠病患者自我管理涉及多个方面,情绪管理经常被忽视。护理人员应针对患者自我管理过程中的薄弱环节,给予指导和支持,帮助其更好地管理疾病。     

炎症性肠病患者红细胞分布宽度与疾病活动性的关系

目的 探讨IBD患者的RDW与疾病活动性的关系,评价RDW是否可以作为监测IBD活动性的指标.方法 选取IBD患者256例,分为2组:UC患者组:136例,包括活动期80例,缓解期56例;CD患者组:120例,包括活动期75例,缓解期45例;同时选取60例细菌性痢疾患者作为疾病对照组,选取门诊健康体检者80名作为健康对照组.利用Bayer Advia 2120全血细胞分析仪、IMMAGE800双光径免疫浊度分析仪、Vacuette全自动血沉分析仪分别检测各组患者和健康对照者的RDW、Hb、WBC、PLT、CRP、ESR、MCV等指标,判断疾病不同阶段RDW的变化趋势,同时分析RDW与CRP、ESR、PLT、Hb、MCV等指标的相关性.利用ROC曲线分析RDW鉴别IBD活动性的敏感度和特异度,验证其与IBD活动性的关系.结果 UC活动期组RDW值为(16.1±2.7),UC缓解期组为(13.5±2.1),疾病对照组为(13.0±2.0),健康对照组为(12.8±1.8),4组间RDW值差异有统计学意义(F=51.9,P＜0.01),其中UC活动期组RDW值显著高于UC缓解期组、疾病对照组和健康对照组(t值分别为8.12、9.67、11.85,P均＜0.05),UC缓解期组RDW值显著高于疾病对照组和健康对照组(t值分别为2.45、2.67,P均＜0.05).CD活动期组RDW值为(16.9±2.2),CD缓解期组为(13.8±1.1),疾病对照组为(13.0±2.0),健康对照组为(12.8±1.8),4组间RDW值差异有统计学意义(F=113.9,P＜0.01),其中CD活动期组RDW值显著高于CD缓解期组、疾病对照组和健康对照组(t值分别为11.47、18.63、18.72,P均＜0.05),CD缓解期组RDW值显著高于疾病对照组和健康对照组(t值分别为3.60、3.72,P均＜0.05).UC组和CD组RDW与CRP、ESR均呈正相关(r分别为0.484、0.525、0.286、0.358,P分别＜0.01、＜0.01、＜0.05、＜0.01),与Hb、MCV呈负相关(r分别为-0.378、-0.271、-0.329,-0.298,P分别＜0.01、＜0.01、＜0.05、＜0.01).在UC患者组中,与CRP、ESR、PLT、Hb、MCV相比,RDW的曲线下面积(0.854)最大,当RDW的cut-off值为14.0时,判断活动期UC的敏感度为82%(65/80),特异度为72%(40/56);在CD患者组中,RDW的曲线下面积(0.925)也最大,当RDW的cut-off值为14.5时,判断活动期CD的敏感度为88%(66/75),特异度为82%(37/45).结论 IBD患者RDW值的变化可以作为判断IBD活动性及监测病情的有用指标.     

炎症性肠病患者自我形象改变体验的质性研究

目的：了解炎症性肠病患者自我形象改变体验,以期为改善患者自我形象制定合理的干预策略提供参考。方法：采用现象学研究方法对天津市某三级甲等医院收治的11例炎症性肠病患者进行半结构式深入访谈,运用Colaizzi 7步分析法对资料进行整理分析。结果：共归纳提炼4个主题,存在多种负性情绪、难以有所追求、不被理解接受、患病后有所收获。结论：炎症性肠病患者存在积极自我形象和较为严重的负性自我形象,医护人员应注重负性自我形象患者心理疏导,加强健康教育,协助社会力量,改善其自我形象,促进疾病康复。     

CT仿真结肠镜与腹部增强CT对炎症性肠病的对照研究

目的 对比观察CT仿真结肠镜(CTC)与腹部增强CT对炎症性肠病(IBD)的诊断价值,探讨IBD的影像学表现。方法 收集IBD患者36例及非IBD患者36例,IBD患者中17例接受增强CT检查,另19例接受CTC检查;非IBD患者中接受增强CT及CTC检查者各18例。对图像进行盲法阅片,对IBD检出的可信度分5级进行评价,采用ROC曲线进行分析,并以Logistic回归统计方法筛选能预测IBD的相关影像学征象。结果 ROC曲线显示CTC的曲线下面积(Az)为0.9354,明显高于增强CT (Az=0.6841,P=0.009)。多因素Logistic回归分析表明3项影像学改变可预测IBD,包括:①结肠黏膜不光滑、呈颗粒状;②肠壁增厚及强化;③结肠袋消失。以肠壁增厚及强化诊断IBD的敏感度最高,达80.62%;结肠黏膜不光滑、呈颗粒状+结肠袋消失相结合的特异度最高,达97.20%。结论 与腹部增强CT相比,CTC对IBD具有更高的检出率。结肠肠壁增厚伴强化是诊断IBD最具敏感性的征象,IBD最特异性的征象是同时具备结肠黏膜不光滑、呈颗粒状和结肠袋消失。     

Human chorionic gonadotropin and alpha chain of glycoprotein hormones in patients with inflammatory bowel disease

In twenty patients with Crohn's disease and ten patients with ulcerative colitis serum levels of human chorionic gonadotropin and the common alpha-subunit of glycoprotein hormones were determined by radioimmunoassay. In contrast to published data, all serum samples except one revealed levels within the normal range of 148 controls (human chorionic gonadotropin levels up to 3.9 IU/l, alpha-subunit up to 3.8 micrograms/l). Neither the serum levels of human chorionic gonadotropin nor of the alpha-subunit differed significantly between patients with Crohn's disease (median/maximum: 0.9/4.4 IU/l; 0.7/3.6 micrograms/l) and ulcerative colitis (1.0/3.4 IU/l; 0.8/2.2 micrograms/l). Furthermore, the serum levels studied in patients with active (0.9/3.0 IU/l; 0.7/3.5 micrograms/l) and inactive (0.9/4.4 IU/l; 0.8/3.6 micrograms/l) Crohn's disease and in patients with active (1.1/3.4 IU/l; 0.9/2.2 micrograms/l) and inactive (0.9/2.9 IU/l; 0.8/1.3 micrograms/l) ulcerative colitis were not significantly different. There was no relationship of the duration of the disease or a bowel resection to the serum levels of human chorionic gonadotropin or the alpha-subunit. It is concluded that both parameters are not useful as markers in patients with Crohn's disease or ulcerative colitis. The normal serum levels found in patients with inflammatory bowel diseases indicate human chorionic gonadotropin as a highly specific marker for malignant diseases.     

Paradox of simultaneous intestinal ischaemia and hyperaemia in inflammatory bowel disease

This review has focused on evidence regarding intestinal perfusion of inflammatory bowel disease (IBD). Basic investigation has defined an altered microvascular anatomy in the affected IBD bowel, which corresponds with diminished mucosal perfusion in the setting of chronic, long‐standing inflammation. Diminished perfusion is linked to impaired wound healing, and may contribute to the continued refractory mucosal damage, which characterizes IBD. Alterations in vascular anatomy and physiology in IBD suggests additional possible mechanisms by which micro‐vessels may contribute to the initiation and perpetuation of IBD. This begs the following questions: will angiogenesis within the gut lead to sustained inflammation, does the growing vasculature generate factors that transform the surrounding tissue and does angiogenesis generate vascular anastomosis within the gut, with shunting of blood away from the mucosal surface, impairment of metabolism and potentiation of gut damage? Further studies are required to define the mechanisms that underlie the vascular dysfunction and its role in pathophysiology of IBD.     

Detection of liver involvement in inflammatory bowel disease by abdominal ultrasound scan

Summary Fifty patients with ulcerative colitis, 24 with Crohn's disease, and 50 controls were studied by liver function tests and abdominal ultrasound scan. Twentytwo percent of ulcerative colitis patients, 29% of Crohn's disease patients, and none of the controls showed abnormal liver function tests. All subjects with abnormal liver function tests also had changes in ultrasound liver scan, consisting of hepatomegaly and/or a dysechoic liver echo pattern. Furthermore, the same ultrasound changes were observed, in the absence of any liver function test abnormalities, in 58% of ulcerative colitis patients, 50% of Crohn's disease patients and 6% of controls (P<0.0005, inflammatory bowel disease versus controls). Overall, some evidence of liver involvement, as judged by abnormal liver tests and/or abnormal ultrasound liver scan, was detected in about 80% of inflammatory bowel disease patients. Six patients with minor abnormalities of liver function tests underwent liver biopsy and 5 of them had pericholangitis. Ultrasound liver scan may provide a useful tool to evaluate the occurrence of liver involvement in inflammatory bowel disease patients.     

Ultrasonography as a primary diagnostic tool in patients with inflammatory disease and tumors of the small intestine and large bowel

In 240 patients with predefined indications, the validity of ultrasound imaging as a primary diagnostic procedure was examined prospectively. Ultrasonography revealed normal intestinal findings in 150 patients and pathological lesions in 90 subjects. All patients underwent subsequent endoscopic, radiological, or surgical examination. In 7 patients with Crohn's disease and in 2 patients with radiation colitis, the ultrasound findings were false-negative. In the other 9 cases, ultrasonography suggested false-positive results. Ultrasonographic examination of the small intestine and large bowel had a very high overall validity, with a sensitivity of 90% and specificity of 94%. © 1994 John Wiley & Sons, Inc.     

Role of selective cyclooxygenase-2 inhibitors in exacerbation of inflammatory bowel disease: A systematic review and meta-analysis

Background: In the general population, selective cyclooxygenase (COX)-2 inhibitors have been associated with fewer gastrointestinal adverse effects (AEs) than NSAIDs, but whether they are associated with exacerbations in patients with inflammatory bowel disease (IBD) remains controversial.Objective: The aim of this study was to review published and unpublished findings to determine whether the use of COX-2 inhibitors increased the risk for IBD exacerbations relative to placebo in the treatment of IBD.Methods: A systematic search of MEDLINE (1966-July 2007), EMBASE (1980-July 2007), the Cochrane Library (2007 Issue 4), US Food and Drug Administration records, and data on file at Novartis Pharmaceuticals Corporation, Pfizer US Pharmaceutical Group, and Merck & Co., Inc., using the search terms celecoxib, rofecoxib, valdecoxib, etoricoxib, lumiracoxib, cyclooxygenase 2 inhibitor, Crohn's disease, ulcerative colitis, and inflammatory bowel disease, was performed to identify randomized, placebo-controlled clinical trials of 5 COX-2 inhibitors in patients with IBD. The publications were fully reviewed for quality. Data on trial design, patient characteristics, intervention drugs, dosages, and outcomes were collected using a predetermined data-extraction form. A meta-analysis was performed based on the publications that met the inclusion/exclusion criteria.Results: Of 588 studies identified in the electronic search, 574 were excluded after screening the titles and abstracts. Fourteen related to the use of COX-2 inhibitors in patients with IBD were reviewed. Two randomized, controlled trials comparing COX-2 inhibitors with placebo were identified. In the first trial, 82 patients were randomized to receive etoricoxib (60-120 mg/d) and 77 to receive placebo. The exacerbation rates were 10.5% (8/76) in the active-treatment group and 11.4% (8/70) in the placebo group (relative risk [RR], 0.92; 95% CI, 0.37-2.32). In the second trial, 112 patients were treated with celecoxib (200 mg BID) and 110 received placebo. The exacerbation rates were 3.7% (4/107) in the celecoxib group and 2.7% (3/110) in the placebo group (RR, 0.73; 95% CI, 0.17-3.18). Of these patients, 5 were lost to follow-up because of AEs. In the meta-analysis comparing COX-2 inhibitors and placebo, the RR was 0.86 (95% CI, 0.39-1.88). No statistically significant differences in IBD relapse rates were found between COX-2 inhibitors and placebo.Conclusions: The results from this meta-analysis suggest that insufficient data were available to determine the impact of COX-2 inhibitors on IBD exacerbations. The relatively smaller risk for AEs makes the short-term use of COX-2 inhibitors potentially attractive, but the long-term benefits remain unclear. Further studies with sound methodology and large sample sizes are needed to evaluate the tolerability of COX-2 inhibitors in the treatment of IBD.     

Chemiluminescence in inflammatory bowel disease patients: a parameter of inflammatory activity

Background: Reactive oxygen species (ROS) are produced in excess in the inflamed mucosa and peripheral blood of patients with inflammatory bowel disease. These species have emerged as a common pathway of tissue injury in a wide variety of inflammatory and other disease processes. The present study was conducted to assess ROS production and to correlate this with parameters of inflammatory activity. Methods: In 25 patients with Crohn's disease (CD), 20 patients with ulcerative colitis (UC) and 65 age- and sex-matched healthy volunteers ROS production was measured using the whole blood luminol enhanced chemiluminescence assay (LECA). Disease activity was assessed using the Crohn's disease activity index and the Ulcerative Colitis Symptoms Score (UCSS) for CD and UC, respectively. Furthermore, the effect of various scavengers, enzymes and enzyme inhibitors on LECA was studied to assess the contribution of different ROS. Results: LECA was significantly higher in CD and UC patients compared with healthy controls (7.1±4.7 and 9.8±6 vs. 5.2±2.8×10³ counts per minute (cpm), p<0.05 and <0.001). In CD, relative LECA (patient/control) was correlated with the Crohn's disease activity index and C-reactive protein (CRP) (r=0.54, p=0.001 and r=0.51, p=0.01). In UC, CRP but not LECA was correlated with the Ulcerative Colitis Symptoms Score (C-reactive protein: r=0.42, p=0.01). Addition of azide, superoxide dismutase, deferoxamine and dimethylthiourea resulted in a decrease of LECA values. Conclusion: Whole blood LECA is increased in patients with CD and UC. This parameter is correlated with disease activity in CD. The observed chemiluminescence is probably due to generation of superoxide and the hydroxyl radical.