150例中年高血压患者服药依从性调查分析

高血压是最常见的独立的心血管疾病,又是其他心脑血管疾病的主要危险.目前我国高血压患者有1.6亿多,且有逐年增多的趋势,如果想要有效的控制血压,减少因高血压引起的靶器官损害,致使血压得不到控制.笔者通过对2009-05/2010-05人住我科的150例中年高血压患者住院前服药情况进行问卷调查分析,现报告如下:     

医护人员与患者对高血压服药依从性影响因素的认知比较

目的 比较医护人员与住院患者对高血压服药依从性影响因素的认知差异。方法 应用影响服药依从性因素问卷，分别调查100例高血压患者和80名医护人员，并对其认知程度进行分析。结果 患者对高血压服药依从性影响因素得分普遍低于医护人员。患者认为健康信念、知识方面、身体状况影响程度较高，家庭支持方面影响最小；医护人员认为健康信念、家庭支持、身体状况影响程度较高，医护患关系影响最小。结论 医护人员与患者对影响高血压服药依从性的感知有一定差异，医务人员应重视该问题，采取针对性措施以提高患者服药依从性。     

老年高血压患者服药依从性及其影响因素的研究

目的探讨老年高血压患者服药依从性及其影响因素。方法对206例老年高血压患者采用服药依从性量表、自我效能、高血压防治知识量表进行调查。结果老年高血压患者的服药依从性平均得分为(30.32±6.67)分,37.86%处于高等水平。自我效能、高血压防治知识、家庭关系、年龄是服药依从性的影响因素。结论应针对患者的自我效能、高血压防治知识、家庭关系和患者的年龄采取相应的措施,以提高高血压患者的服药依从性。     

医护人员与患者对高血压服药依从性影响因素的认知比较

目的 比较医护人员与住院患者对高血压服药依从性影响因素的认知差异.方法 应用影响服药依从性因素问卷,分别调查100例高血压患者和80名医护人员,并对其认知程度进行分析.结果 患者对高血压服药依从性影响因素得分普遍低于医护人员.患者认为健康信念、知识方面、身体状况影响程度较高,家庭支持方面影响最小;医护人员认为健康信念、家庭支持、身体状况影响程度较高,医护患关系影响最小.结论 医护人员与患者对影响高血压服药依从性的感知有一定差异,医务人员应重视该问题,采取针对性措施以提高患者服药依从性.     

影响精神分裂症患者服药依从性的因素及护理新进展

精神分裂症是由于大脑功能紊乱而导致思维、情感、意志行为等方面的改变,整个精神活动和周围环境不协调为主要特征的一类最常见的重性精神病.服药依从性是药物治疗的评价指标之一,且与疗效直接关联[1],对预后、转归有着重要影响.提高精神分裂症患者的服药依从性,可降低疾病的复发率.[2]现将病人服药依从性的护理进展概述如下.     

影响肾移植病人服药依从性的相关因素调查分析

为探讨肾移植病人服药依从性的相关因素,并提出相应护理对策.对“肾友会“中108例肾移植术后会员进行问卷调查.结果不同年龄、文化程度及经济收入病人服药依从性比较,差异有显著性意义(均P＜0.05).提出肾移植术后治疗过程中,医护人员应加强相关知识的健康教育,根据病人的经济条件,合理选择用药,同时协助建立社会支持系统,以提高肾移植病人服药依从性.     

影响肾移植术后患者服药依从性的因素调查及护理干预研究

目的调查影响肾移植术后服用免疫抑制剂患者服药依从性的因素,制定针对性的护理干预措施并评定其效果。方法采取向患者和护士分别进行问卷调查的方法找出影响服药依从性的因素,提出针对性的护理干预方法。收集2017年全年肾移植患者100例,分成干预组和对照组。干预组共分为接受单一措施组及接受所有措施组4组。使用修订Morisky服药依从性调查问卷评价干预效果,结果分为依从性好与不好两种。使用卡方检验分析组间差异。结果主要影响服药依从性的因素为:①缺乏按嘱服药的重要性的知识。②服药管理问题。③对患者的出院后的管理不足。经过干预,干预组的合格率为84%,高于对照组的60%(P<0.05)。综合干预组的合格率91.3%,明显高于对照组(P<0.05)。其他各组的两两比较未显示出有统计意义的差异。结论本研究发现了影响肾移植术后服用免疫抑制剂患者服药依从性的几项重要因素。针对性的干预措施能改善服药依从性,综合性的干预措施相对单一干预措施有更为为明确的效果。     

门诊新发高血压患者服药依从性轨迹及影响因素研究

目的 探究门诊新发高血压患者服药依从性轨迹及其影响因素,为制定针对性干预措施提供参考。方法 采用便利抽样法选取337例门诊新确诊的高血压患者为研究对象,应用Morisky服药依从性量表于确诊后4周、3个月、6个月和12个月进行4次调查,采用群组化轨迹模型分析患者服药依从性变化轨迹,并通过多分类logistic回归分析其影响因素。结果 患者在4个时间点的服药依从性得分比较,差异无统计学意义(P>0.05)。服药依从性轨迹分为持续高依从性组(52.82%)、中等波动组(37.09%)及持续低依从性组(10.09%)3类。多分类logistic回归分析显示,与持续高依从组相比,年龄51～60岁、服药种类≥3种更易进入中等波动组(均P<0.05),年龄36～50岁、文化程度大专、家庭人均月收入<1 000元更易进入持续低依从性组,社会支持有利于提高患者服药依从性(均P<0.05)。结论 门诊新发高血压患者在确诊12个月内服药依从性轨迹呈现相对稳定性特征,但存在显著的群体异质性。医护人员应特别关注持续低服药依从性及依从性波动变化的患者,根据影响因素采取针对性干预措施,以提...     

类风湿关节炎患者服药信念与服药依从性调查

目的了解类风湿关节炎患者服药信念和服药依从性现状及其相关性,为制定提高患者服药依从性的护理措施提供理论依据。方法采用风湿病用药依从性问卷(CQR)及服药信念量表(BMQ)对177例类风湿关节炎患者进行调查。结果仅33.9%类风湿关节炎患者的服药依从性好;患者服药信念中位数为1分;患者服药依从性的主要影响因素是服药信念及药物毒性(P0.05,P0.01)。结论类风湿关节炎患者的服药依从性较差,服药信念影响患者服药依从性。应加强对患者服药方面的健康教育,提高其服药信念,减少药物毒性等方面的顾虑,从而提高其服药依从性。     

肾病综合征患者服药信念与服药依从性的调查

目的评估肾病综合征患者的服药信念,并探讨患者的服药信念与服药依从性的相关性。方法选取肾病综合征患者97例,采用服药信念和Morisky服药依从性问卷进行调查。结果患者服药依从性得分为6.71±1.54,处于中等水平;患者的服药信念与服药依从性显著相关(P<0.05)。结论肾病综合征患者的服药信念与服药依从性相关,医护人员可通过了解患者的服药信念,从而帮助选择更合适的方法以提高患者服药依从性。     

年轻三阴性乳腺癌患者戈舍瑞林用药依从性调查及分析

目的了解年轻三阴性乳腺癌(triple negative breast cancer,TNBC)患者使用戈舍瑞林保护卵巢功能的现状。方法回顾性收集2015年1月至2017年12月重庆医科大学附属第一医院乳腺外科经病理确诊为TNBC且有保护卵巢功能意愿的患者共47例,计算患者的戈舍瑞林药物占有比,通过电话随访方式调查患者的用药情况。结果成功随访31例,中位年龄31岁,年龄范围为14~41岁。80.6%(25/31)的患者戈舍瑞林用药依从性好,19.4%(6/31)的患者依从性差。Fisher精确检验显示,文化程度、经济情况和医保类型对戈舍瑞林依从性有影响,差异有统计学意义(P<0.05)。结论医护人员应多关注文化程度较低、经济条件较差TNBC患者的戈舍瑞林用药情况,为患者提供科学的用药指导和个体化的健康教育,做好患者的全程管理,提高患者的用药依从性。     

Cinedefecographic findings in patients with obstructed defecation sindrome. A study in 420 cases

AIM: Obstructed defecation syndrome (ODS) represents a very common clinical problem. The aim of this study was to analyze the cinedefecographic findings in a group of patients with ODS. METHODS: All patients with ODS were prospectively introduced into a database and underwent cinedefecography (CD). The grade of the syndrome was assessed by a new ODS score. The validated Agachan-Wexner Constipation Score System was also used. Four lateral films were taken during resting, squeeze, pushing and postevacuation phases and puborectalis length (PRL), anorectal angle (ARA) and perineal descent were recorded and analysed. The presence of an increased fixed perineal descent (FPD) and dynamic perineal descent (DPD), mucosal rectal prolapse (MRP), recto-rectal intussusception (RRI), recto-anal intussusception (RAI), rectocele (RE), enterocele (ET) and sigmoidocele (SG) were also evaluated. RESULTS: Between February 2002 and March 2005, 420 patients, 404 (96.1%) females and 16 (3.8%) males with a mean age of 49+/-7.7 (range, 21-77) years, underwent CD. In 362 (86.2%) patients CD showed a combination of different cinedefecographic findings. RE, FPD and DPD in association with RAI or RRI were contemporary observed in 118 (26%) patients. MRP, RRI, FPD, RAI and RE were observed as singular finding in 21 (5%), 19 (4.5%), 12 (2.8%), 3 (0.7%) and 3 (0.7%) patients, respectively. In 6 (1.4%) patients a paradoxical contraction of the puborectalis muscle was observed. CONCLUSIONS: CD shows that ODS is largely caused by multiple patterns of different abnormalities of the rectum and pelvic floor. Any treatment in symptomatic patients could be designed to treat multiple combinations of different abnormalities.     

女性OSAHS患者持续正压通气治疗依从性影响因素的质性研究

目的 探讨影响女性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者持续正压通气(CPAP)依从性相关因素.方法 采用现象学研究方法,深入访谈12例女性OSAHS患者使用CPAP治疗的感受,用Colaizzi 7步分析法分析资料.结果 提炼出患者多疑,情绪不稳定;对疾病的危险性缺乏正确认知;对治疗呈积极表现;治疗所致的不适及并发症的影响;社会因素的影响5个主题.结论 医护人员应针对不同因素对女性患者进行有针对性的干预,达到提高CPAP治疗依从性的作用.     

影响肾上腺皮质醛固酮瘤术后血压恢复的相关因素分析

目的 探讨影响肾上腺皮质醛固酮瘤(APA)术后血压恢复的相关因素。方法 对68例APA患者眼底视网膜血管彩色超声,尿微量蛋白、肾穿刺病理及APA腺瘤周围肾上腺组织不同病理变化与术后持续高血压之间的关系进行分析。结果 34例单侧或双侧视网膜中央动脉阻力增高的APA患者术后持续高血压14例(41．2％),24例尿微量蛋白增高者术后持续高血压16例(66．7％)。行肾穿刺活检的15例患者均显示肾脏有不同性质、不同程度的病理变化,其中术后持续高血压者11例(73．3％)。病理学检查显示,APA腺瘤周肾上腺萎缩者45例,其中术后持续高血压者10例(22．2％);20例APA腺瘤周肾上腺正常和增生者20例,其中术后持续高血压者8例(40％)。结论肾脏病理变化和视网膜中央动脉阻力增加与APA术后血压不能恢复正常密切相关。     

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。     

精神分裂症患者服药依从性与家庭环境的相关性研究

目的 了解精神分裂症复发患者的服药依从性状况,并分析服药依从性与家庭环境的相关性.方法 对102例复发入院的精神分裂症患者进行问卷调查.调查表包括一般资料、家庭环境量表和服药依从性问卷.结果 患者服药依从性得分为(12.03±3.19)分,其中约50%患者有不按时服药、自行停药、只在感觉不舒服时才服药等行为,服药依从性...     

Invasive v. non-invasive blood pressure measurements--the influence of the pressure contour

A reasonable correlation exists between invasive and non-invasive methods of measuring systemic blood pressure. However, there are frequent individual differences between these methods and these variations have often caused the validity of the non-invasive measurement to be questioned. The hypothesis that certain invasive systolic blood pressures may represent a pressure impulse rather than a flow-generating pressure was used to classify the invasive pulse pressure contour into various types, and the invasive pressure measurement was then correlated with the non-invasive. There was a significantly greater difference between these two methods of measuring systolic blood pressure in patients exhibiting prominent inotropic pressure pulse phenomena compared with patients without such phenomena. Since non-invasive monitors measure blood pressure by volume displacement or flow detection and invasive ones measure pressure impulses rather than flow, it was concluded that the pressure measured by the non-invasive monitor more accurately reflects the propulsive pressure-causing flow when inotropic pressure pulse phenomena are present.     

Distribution of blood groups in patients with tendon rupture. An analysis of 832 cases

We aimed to determine the distribution of the ABO and Rh blood groups in 832 patients with a tendon rupture. Among these, the frequency of blood group O (52.8%) was significantly higher than in the general population of Hungary (31.1%) and the frequency of group A was significantly lower. Of the 83 cases of multiple ruptures or re-rupture, 57 patients (68.7%) had group O blood. The dominance of group O was found for all sites of tendon rupture, but there was no significant association with the Rh groups. Individuals with blood group O appear to have an increased risk of tendon rupture.     

Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients.

Hypoxic pulmonary disorders and head injuries associated with increased intracranial pressure (ICP) frequently co-exist. Positive end-expiratory pressure (PEEP) improves hypoxemia but has been reported to impede cerebral venous return, potentially causing a further increase in ICP. This study examined the effects of PEEP on ICP at different levels of brain compliance. continuous ICP recordings were obtained after insertion of Scott cannulas to the lateral ventricles of seven comatose patients. Brain compliance was assessed by calculation of the pressure volume index. Patients were maintained in a 30 degrees head-up position. Maintenance of PEEP to levels of 40 cm H2O pressure for as long as 18 hours did not increase ICP in patients with either normal or low intracranial compliance, and did not increase ICP in the absence of pulmonary disease. Central venous pressure and pulmonary artery wedge pressure increased proportionately as PEEP was increased. No consistent changes were found in blood pressure recordings, nor were there any reductions in cardiac output found during the studies. Abrupt discontinuation of PEEP did not result in increased ICP except for a transient rise on two occasions when respiratory secretions became copious and the patients were inadequately ventilated. Improved oxygenation in two patients as a result of PEEP was concomitant with improved intracranial compliance and neurological status. In patients with brain injuries, PEEP improves arterial oxygenation without increasing ICP as previously supposed. Consequently, PEEP is a valuable form of therapy for the comatose patient with pulmonary disorders such as pneumonia or pulmonary edema.     

围手术期肺顺应性影响因素探讨

背景 良好的肺顺应性是维持围手术期呼吸功能的必要条件.随着科研和临床上对肺顺应性研究的逐步深入,围手术期患者肺顺应性的影响因素也越来越受到人们的重视. 目的 对围手术期肺顺应性影响因素的相关文献资料进行分析总结. 内容 主要从麻醉方式、麻醉药物、呼吸机设置、术中体位、特殊手术类型和患者自身因素等进行综述. 趋向 围手术期肺顺应性影响因素的探讨与研究,对患者的术前评估、术中肺保护和术后减少呼吸系统损伤都具有重要意义.