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。     

不遵医行为致皮瓣移植术失败的原因分析及应对措施

目的：分析造成皮瓣移植术后患不遵医行为的主要原因，以便采取相应的有效措施，提高遵医率，提高手术治愈率。方法：采用调查访问，结合临床观察的方法，对我科1997年12月－2001年11月收治的27例皮瓣移植术失败的患进行调查，分析其不遵医行为造成治疗失败的主要原因。结果：27例病历56人次不遵医行为，其主要原因为：对自身疾病认识不足20人次，病人对医嘱了解不清14人次，不良生活习惯9人次，治疗方法不妥5人次，对医生不满意2人，经济困难3人次，其他3人次。结论：加强入院指导及该病种的围手术期健康宣教的力度，建立“引导－合作型”和“相互参与型”的护患关系，提高患的保健意识，建立健康的生活方式从而提高患的遵医率，提高皮瓣移植术的治愈率。     

强化考核式健康教育对肾移植患者遵医行为的影响

目的探讨强化考核式健康教育对加强肾移植患者遵医行为的影响。方法将160例肾移植患者按入院时间分为对照组(76例)和观察组(84例)。对照组采用常规健康教育,如集中教育、召开座谈会、家访及个别指导、热线电话咨询;观察组在对照组教育的基础上增加术后及出院前2次强化考核,针对考核结果调整健康教育内容。结果观察组患者术后6个月未按量服药、忘记记录尿量等10项不良事件发生率显著低于对照组(均P<0.05)。结论强化考核式健康教育可促进肾移植患者的遵医行为,减少不良事件的发生。     

认知干预对前列腺增生患者术后遵医行为的影响

目的探讨认知干预提高前列腺增生患者术后遵医行为依从性的效果。方法将160例患者按随机数字表法分为观察组和对照组各80例,对照组采用常规护理,观察组在对照组的基础上进行认知护理干预。结果观察组遵医行为依从性显著高于对照组,并发症发生率显著低于对照组(P0.05,P0.01)。结论认知干预有利于提高前列腺增生患者术后遵医行为的依从性,缩短患者康复进程。     

高压氧治疗患者不遵医行为分析及护理对策

目的 对高压氧治疗适应证患者的不遵医行为进行分析,以采取有效措施提高患者的依从性.方法 收集2010年425例符合高压氧治疗指征的病例,其中126例出现不遵医行为,分析原因,提出相应护理对策.结果 126例高压氧治疗不遵医行为发生原因依次为家属不支持,患者对高压氧不了解,经费紧张,治疗时不方便、不舒适,医护人员对高压氧认识不够.结论 需加强对高压氧治疗知识的健康教育,并不断改进和简化工作流程,以提高患者高压氧治疗的依从性.     

全程护理干预提高老年性痴呆病人遵医行为研究

目的探讨早、中期老年性痴呆 (AD)病人遵医行为的干预方法和效果。方法将确诊为AD的 80例病人随机分为观察组与对照组各 4 0例。对照组不进行遵医行为干预 ;观察组实施 3R训练、体能训练、饮食调整、服药、生活习惯、社会活动等遵医行为的全程护理干预。结果 6个月后 ,观察组遵医率明显优于对照组 (P <0 .0 5 ,P <0 .0 1) ;生存质量综合评分显著高于干预前及对照组 (均P <0 .0 1)。结论全程护理干预能提高早、中期AD病人遵医行为 ,延缓病情的进展 ,提高病人的生存质量     

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。     

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。     

哮喘患儿遵医行为的影响因素及护理干预

目的了解哮喘患儿遵医行为及影响因素，为实施正确的干预措施提供依据。方法采用自行设计的哮喘患儿遵医行为调查问卷．对78例1年内哮喘发作≥2次的患儿及家长进行问卷调查。结果患儿及家属对定期复查、药物治疗、自我监测、记哮喘日记、定期参加知识讲座的完全遵医率为3．8％～12．8％，不遵医行为主要原因有知识缺乏、信心不足、害怕药物不良反应、不能正确掌握吸入技术、哮喘患儿合作性差等。结论哮喘患儿及家长的遵医行为较低，需针对影响因素采取护理干预，以提高其遵医行为，有利于疾病康复。     

106例高血压患者遵医行为的效果评价

目的加强社区高血压患者的遵医行为,有效控制血压,减少心脑血管病的发生。方法调查分析2008～2009年度本社区106例高血压患者的随访资料。结果随访1年后,高血压患者的按时服药率提高19.0,行为生活方式改进达33.0,对疾病知识了解提高19.0,血压稳定率提高20.0。结论加强高血压患者的遵医行为,可以有效降低血压。     

Ureteral necrosis after kidney transplantation: risk factors and impact on graft and patient survival

BACKGROUND: Ischemia, the main cause of ureteral necrosis in renal transplantation, cannot alone explain the late occurrence of some fistulas beyond the first postoperative month. The aim of this study, performed on a cohort of 1,629 consecutive kidney transplantations, was to analyze the risk factors implicated in the occurrence of ureteral necrosis and its impact on graft and patient survival. METHODS: Between January 1990 and December 2001, 1,629 renal transplantations were performed in the authors' center. All biologic and clinical data were computerized in a cross-audited and validated data bank (Données Informatisées et Validées en Transplantation). The parameters studied were donor age, gender, cause of death and serum creatinine before procurement; and recipient age, gender, initial disease, panel reactive antibody, retransplantation, cold ischemia time, delayed graft function, human leukocyte antigen incompatibilities, induction and maintenance immunosuppression, right or left kidney, number of arteries, site of transplantation and the presence or not of a double-J stent. The follow-up parameters were the number and timing of acute rejection episodes, cytomegalovirus (CMV) infection (viremia, polymerase chain reaction), and acute pyelonephritis. Ureteral histologic analysis was performed in 25 cases (necrosis, leukocyte infiltration, and CMV or BK virus inclusions). Uni- and multivariate statistical tests were used (alpha risk at 5%). All of the patients with ureteral necrosis had undergone neoureterocystostomy or ureteral anastomosis with the native ureter but with a systematic double-J stent. RESULTS: Ureteral necrosis occurred in 52 of the 1,629 patients (3.2%) and was significantly and independently correlated with donor age (P=0.041) and delayed graft function (P=0.016). CMV infections were also higher in the necrosis group (P=0.001), but donor CMV status was not statistically different between the two groups (36.2% vs. 36.7%). Ureteral histologic studies showed CMV and BK virus inclusions in 4 and 2 cases, respectively, and arterial and venous thrombosis in 4 and 16 cases, respectively. No pattern of ureteral rejection was observed. Ureteral necrosis did not affect the 10-year patient and graft survival, which were 87% and 66%, respectively, for the necrosis group and 86% and 58%, respectively, for the control group (P=not significant). CONCLUSIONS: The authors' data provide new information concerning a classic surgical complication after kidney transplantation. The link they have identified between the occurrence of ureteral necrosis, donor age, and delayed graft function reemphasizes the interdependence between surgical and medical complications in kidney transplantation.     

Prognostic factors affecting graft and patient survival in cadaveric and living kidney transplantation

Numerous studies have reported various prognostic factors that affect graft and patient survival in living and cadaveric donor kidney transplantation (KT). The purpose of this study was to evaluate the clinical outcomes and prognostic factors affecting graft and patient survivals in living and cadaveric donor KT. Between February 1995 and December 2001, 421 patients who had undergone cadaveric donor KT (group I: 216 cases, 51.3%) or living donor KT (group II: 205 cases, 48.7%), were retrospectively analyzed. Five-year overall graft survival rates in living was significantly better than that in cadaveric donor KT, respectively (P = .0234). There was no difference in patient survival rates between the two groups. Such factors as absence of rejection, female donor, female recipient, adult KT according to recipient age (>14 years), and donor serum creatinine level just before transplantation (< 2.5 mg/dL) were significantly associated with good graft survival among cadaveric donor KT, whereas two factors-absence of rejection and adult KT according to recipient age (>14 years)-influenced graft survival in living donor KT. In multivariate analysis, the only significant prognostic factor related to graft survival was the presence of rejection. In conclusion, we suggest that the presence of rejection is the only factor that impairs graft survival in both cadaveric and living donor KT, while other factors affected graft survival differently in the two groups.     

肾移植后急性排斥反应发生相关术前因素分析

目的探讨影响肾移植术后发生急性排斥反应的相关术前因素,为预防移植肾急性排斥反应的发生提供临床依据。方法回顾性分析2002年1月～2008年12月在浙江大学医学院附属第一医院肾脏病中心首次接受同种异体尸体肾移植受者1316例资料,记录基线资料及术后急性排斥反应发生情况;按群体反应性抗体(PRA)水平10%和≥10%将受者分为PRA阴性组和致敏组;以2005年10月1日为界分为回顾性HLA配型组和前瞻性HLA配型组。统计分析各基线资料对术后急性排斥反应发生的影响以及不同组间急性排斥反应发生率的差异。结果手术时受者年龄、术前PRA水平、热缺血时间、HLA错配数对术后急性排斥反应的发生有显著影响。致敏组术后6个月内急性排斥反应发生率(58.8%比17.9%,P0.001)以及6个月内组织病理学检查证实急性排斥反应发生率(29.4%比11.9%,P=0.028)均显著高于PRA阴性组。采用前瞻性HLA配型后受者HLA错配数减少,且术后6个月内急性排斥反应发生率也降低(20.9%比15.5%,P=0.012)。结论术前检测受者的PRA水平从而准确评估其致敏状态,尽可能选择良好的HLA配型谱可减少移植肾术后急性排斥反应的发生。     

Clinical factors influencing participation in society after successful kidney transplantation

BACKGROUND: Little information is available on the degree of actual social functioning after successful kidney transplantation. Moreover, information on factors that influence participation in social activities is scarce. The aim of this study was to examine the influence of clinical factors on social outcome. METHODS: A retrospective study was performed on a cohort of primary kidney transplantation patients, transplanted between 1996 and 2001. Cross-sectional data on participation in obligatory activities (i.e. employment, education, household tasks), leisure activities (i.e. volunteer work, assisting others, sports, clubs/associations, recreation, socializing, going out) and change in participation were collected by in-home interviews (n=239). Multivariate regression analysis was performed. RESULTS: Thirty-six percent of the patients scored low on obligatory participation and only 52.4% was employed. Patients were actively involved in a wide range of leisure activities. Twenty-six percent participated in sports. Multivariate analysis (age-, sex-, and education-adjusted) of participation in obligatory activities showed negative associations with advanced age (P<0.01), comorbidity (previous cardiovascular events; P<0.01) and cadaveric transplantation (P<0.01). There was a positive association with time since transplantation (P<0.01). Multivariate analysis of diversity of participation in leisure activities and perceived change in participation after transplantation showed no statistically significant associations with clinical factors. CONCLUSIONS: Besides age, clinical factors such as type of donation (cadaveric versus living), comorbidity (previous cardiovascular events), and time since transplantation were associated with participation in obligatory activities such as employment, education and household tasks. Diversity of leisure activities and change in participation was not affected by clinical factors.     

Perioperative factors influencing patient outcome after liver transplantation

Abstract We have previously shown that the development of multiple organ dysfunction syndrome (MODS) after liver transplantation significantly reduced patient survival. Therefore, the question arises of which are the most prominent perioperative donor and recipient factors leading to MODS after transplantation. In total, 634 patients with 700 liver transplants were analyzed. Donor factors included age, increase in transaminases, sex mismatch, requirement for catecholamines, intensive care time, histology, and macroscopic graft appearence. Recipient factors included Child classification, preoperative gastrointestinal (GI) bleeding, mechanical ventilation, hemodialysis, and requirement for catecholamines. MODS was defined by more than two severe organ dysfunctions. The cumulative 2 to 9‐year patient survival was 90.9 % in patients developing less than 3 severe organ dysfunctions following transplantation. Survival decreased to 60.3 % in patients with MODS. Neither any of the donor factors nor the duration of cold ischemia (CIT) was associated with an increase in MODS or decrease in survival. On the other hand, duration of warm ischemia, amount of blood loss, requirement for red packed blood cells, and reoperation had an influence on the development of MODS (40%‐56%) and decreased patient survival to 58%‐69%. Preoperative therapy with catecholamines, GI bleeding, mechanical ventilation, and hemodialysis were associated with the development of MODS in 54 %‐88 %. Patient survival following MODS decreased to 50%‐74%. Initial graft function had a slight influence on the development of MODS, but no influence on the long‐term patient survival. In conclusion, patient survival was significantly influenced by the development of postoperative MODS. The most prominent factors in this were recipient and intraoperative ones. No major influence was observed for donor factors, CIT, and initial graft function. Prevention of MODS will further improve the outcome after liver transplantation.