终末期肾病患者及家属参与预立护理计划体验的Meta整合

目的 系统整合终末期肾病患者及家属参与预立护理计划的质性研究,为预立护理计划在终末期肾病患者及家属中的应用提供参考。方法 计算机检索PsycINFO、PubMed、Cochrane Library、Web of Science、中国知网、中国生物医学文献数据库、万方数据、维普数据库中收录的关于终末期肾病患者及家属参与预立护理计划体验的质性研究,检索时限为建库至2022年8月。结果 共纳入11篇文献,提炼出45个研究结果,形成16个类别,进一步归纳为4个整合结果：终末期肾病患者及家属对预立护理计划的态度,参与预立护理计划的体验,参与预立护理计划的影响因素,对预立护理计划的建议。结论 患者及家属存在预立护理计划认知缺乏、感知障碍,希望与现实存在差异,实践受多种因素影响等体验;医护人员应提供多方面支持,以满足患者参与预立护理计划需求。     

儿童和青少年癌症患者终末期真实体验与需求的Meta整合

目的 对儿童和青少年癌症患者终末期真实体验与需求的质性研究结果进行整合,为更好地开展安宁疗护实践提供参考。方法系统检索中英文数据库关于儿童和青少年癌症患者终末期真实体验与需求的质性研究,检索时限从建库至2023年4月1日。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准进行文献质量评价,采用汇集整合法进行Meta整合。结果共纳入8篇研究,质量等级均为B级。提炼出40个研究结果,将相似结果归纳组合形成 7个新的类别,并整合为3个结果：遭受身心痛苦体验;积极应对疾病,经历正面心理体验及自身成长;对正常生活的渴望,希望得到社会支持。结论儿童和青少年癌症患者终末期经历消极和积极体验,其需求有年龄差异性。医护人员需重视儿童和青少年癌症患者终末期体验和需求,提供心理疏导和必要支持,提升其终末期生活质量。     

成年癌症患者生育力保存决策体验质性研究的Meta整合

目的 系统整合癌症患者生育力保存决策体验的质性研究,为辅助癌症患者做决策及改进现有决策支持体系提供循证依据。方法 计算机检索PubMed、EMbase、The Cochrane Library、CINAHL、Web of Science、PsycINFO、Scopus、中国知网、万方数据库、维普数据库关于癌症患者生育力保存决策的质性研究,检索时限为建库至2022年8月。采用JBI循证卫生保健中心质性研究质量评价标准对文献进行质量评价,采用Meta整合中汇集性整合方法对结果进行整合。结果 共纳入18篇文献,提炼出67个研究结果,将相似结果归纳成7个新的类别,并综合成3个整合结果：对生育力保存风险-收益的艰难权衡,紧迫决策下复杂的心理变化过程,决策过程的干扰。结论 医护人员及相关卫生机构应重视癌症患者生育力保存决策的心理体验和信息需求,优化决策程序、开发决策辅助方案,促进患者尽快完成决策。     

癌症患者抚养未成年子女体验质性研究的Meta整合

目的 探讨癌症患者抚养未成年子女的感受,为临床改善患者心理体验提供参考。 方法 检索国内外数据库中有关癌症患者抚养未成年子女真实体验的质性研究文献,检索时限为建库至2022年10月,采用Meta整合方法对研究结果进行整合归纳。 结果 共纳入12项研究,提炼52个结果,归纳后形成13个类别,整合成4个结果：癌症患者抚养未成年子女情感体验复杂、癌症患者育儿的担忧和挑战、癌症患者适应双重角色并有所收获、癌症患者抚养未成年子女的过程中有多方面的养育需求。 结论 患癌父母育儿体验复杂,心理压力较大,渴望得到帮助。医护人员应重视该群体的特殊需求,并制定针对性护理支持,减轻患者心理压力和负担。     

癌症患者决策辅助工具应用体验质性研究的Meta整合

目的 对成年癌症患者决策辅助工具应用体验进行系统整合,为开发我国本土化决策辅助工具、实现共享决策提供循证指导。方法 计算机检索PubMed、Cochrane Library、CINAHL、Embase、Web of Science、ProQuest、中国知网、万方数据库、维普网、中国生物医学文献数据库中关于癌症患者决策辅助工具应用体验的质性研究,检索时限为建库至2023年7月。采用JBI 循证卫生保健中心质性研究质量评价标准（2020）进行文献质量评价,以Meta整合方法对文献研究结果进行整合。结果 纳入17篇文献,提炼出50个研究结果,归纳出7个类别,最终形成3个整合结果：患者对决策辅助工具总体满意度较高、增强患者决策参与体验、阻碍因素。结论 决策辅助工具可以帮助癌症患者了解治疗方案并积极参与决策,满足患者的决策需求,缓解决策冲突,从而改善患者的临床结局。     

恶性肿瘤患者对善终认知的Meta整合

目的 系统整合恶性肿瘤患者对善终认知的质性研究,为开展高质量的肿瘤临终护理,提高恶性肿瘤患者死亡质量提供依据。方法 计算机检索相关文献数据库,检索有关恶性肿瘤患者对善终认知的质性研究。使用2016版JBI循证卫生保健中心质性研究质量评价标准对文献进行方法学质量评价,采用汇集性Meta整合法对结果进行整合。结果 共纳入16篇文献,提炼出62个研究结果,归纳成11个新的类别,综合成4个整合结果：了解恶性肿瘤诊断及治疗信息并参与临终治疗决策;保持积极心态并为死亡做准备,实现舒适、体面的死亡;不成为家人的负担,并完成对家人的嘱托;得到家庭、宗教、医护团队和社会的支持。结论 临终关怀医护人员应尊重恶性肿瘤患者的知情权并帮助患者参与临终治疗决策,通过高质量的临终护理和多学科协作的临终关怀模式满足患者身、心、社、灵的需求,帮助患者实现善终。     

头颈癌患者患病体验及需求质性研究的Meta整合

目的 系统评价和整合头颈癌患者患病体验及需求的质性研究,为制定针对性的照护方案提供参考。方法 检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库、维普科技期刊数据库和中国生物医学文献数据库,搜集建库至2023年2月关于头颈癌患者患病体验及需求的质性研究,采用JBI质性研究质量评价标准对文献质量进行评价,并对结果进行Meta整合。结果 共纳入13篇文献,提炼出55个主题,归纳形成10个类别,合成3个整合结果：症状困扰影响患者的心理健康和社会适应,患者经历创伤后成长并采取了一系列应对策略,多元化且未得到充分满足的需求。结论 头颈癌患者身心受到严重创伤,为促进患者的创伤后成长,医护人员应该重视患者的患病体验,并以需求为导向制定个性化的延续护理方案。     

肿瘤患者味觉改变体验及应对质性研究的Meta整合

目的 系统评价肿瘤患者味觉改变体验及应对的质性研究,为制订针对性干预方案提供参考。 方法 计算机检索PubMed、CINAHL、Web of Science、Embase、Scopus、ProQuest、中国知网、万方数据等数据库中有关肿瘤患者味觉改变体验及应对的质性研究,检索时限为建库至2022年4月。采用JBI循证卫生保健中心的质性研究质量评价标准进行文献质量评价,采取汇集性整合方法整合研究结果。 结果 纳入14篇文献,提炼出69个主题,归纳成5个类别,综合形成味觉改变体验的复杂多变、多元化的管理策略2个整合结果。 结论 肿瘤患者味觉改变复杂多变,负面影响患者的生活。护士应关注肿瘤患者味觉改变体验,给予持续、动态评估,加强健康教育,协助患者提高症状管理自我效能,提升味觉改变管理能力。     

孕产妇及其伴侣经历严重产科并发症后体验的Meta整合

目的分析及整合孕产妇及其伴侣经历严重产科并发症的体验。方法计算机检索数据库并纳入国内外关于孕产妇及其伴侣经历严重产科并发症的情感体验和照顾体验的质性研究,使用Meta整合方式整理分析。结果共纳入13篇文献并综合成3个结果:严重产科并发症给产妇及伴侣的生理、心理、社会方面造成消极影响,并持续多年;结合外界支持与自我调适实现角色成长,并感恩获得帮助;医疗服务问题及照护需求。结论严重产科并发症对于孕产妇及其家庭造成不良影响,医护人员应关注危重孕产妇及其伴侣心理健康,满足其围生期心理保健需求,提高产科危重症护理质量。     

国内肾移植术后患者心理体验的质性Meta整合

目的系统评价肾移植患者术后心理体验。方法计算机检索数据库中国知网、万方数据库、维普数据库、中国生物医学文献数据库,搜索关于肾移植患者术后真实体验的质性研究,检索时限从建库至2018年5月。进行文献质量评价后,采用Meta整合方法对研究结果进行归纳、诠释。结果共纳入8篇文献,提炼出52个结果、6个类别和3个整合结果,分别为肾移植术后患者消极心理、肾移植术后患者对未来与生命的心理感受、肾移植术后患者的自身健康需求与期望。结论医护人员应充分了解肾移植术后患者心理体验,做好针对性心理干预,引导患者调整认知和行为方式,提高患者的术后生活质量,并且增强患者对未来生活的心理资本。     

特发性肾出血36例诊治分析

目的：探讨特发性肾出血的诊断与治疗,提高其诊治水平。方法：回顾性分析2000年1月～2010年8月我科收治的特发性肾出血36例。结果：36例患者中肾动静脉瘘28例,微小肾盂及。肾盏癌4例,肾动脉瘤3例,肾假性动脉瘤1例。其中29例行选择性肾动脉栓塞术,2例行肾切除术,4例行肾盂癌根治术,所有治疗后患者血尿均消失;1例因肾动静脉瘘多处,未进行治疗。结论：外科常见的特发性肾出血病例以肾血管疾病最为常见,选择性肾动脉造影及肾动脉栓塞术对特发性肾出血的诊治有重要意义。对于难以确诊的特发性肾出血患者,要考虑到微小肾盂肾盏癌的可能,输尿管软镜检查对其诊断有一定帮助。     

Isolated hydatid disease of the native kidney in a renal transplant recipient.

A 43-year-old male renal allograft recipient was admitted tothe hospital for annual check-up. He received a cadaveric renaltransplant 2 years previously. On admission his physical examinationdid not show any abnormalities. Abdominal ultrasonography ofthe patient revealed     

Renal Ischemic Injury Affects Renal Hemodynamics and Excretory Functions in Sprague Dawley Rats: Involvement of Renal Sympathetic Tone

The role of renal sympathetic nerves in the pathogenesis of ischemic acute renal failure (ARF) and the immediate changes in the renal excretory functions following renal ischemia were investigated. Two groups of male Sprague Dawley (SD) rats were anesthetized (pentobarbitone sodium, 60 mg kg^?1 i.p.) and subjected to unilateral renal ischemia by clamping the left renal artery for 30 min followed by reperfusion. In group 1, the renal nerves were electrically stimulated and the responses in the renal blood flow (RBF) and renal vascular resistance (RVR) were recorded, while group 2 was used to study the early changes in the renal functions following renal ischemia. In post-ischemic animals, basal RBF and the renal vasoconstrictor reperfusion to renal nerve stimulation (RNS) were significantly lower (all p < 0.05 vs. control). Mean arterial pressure (MAP), basal RVR, urine flow rate (UFR), absolute and fractional excretions of sodium (U_NaV and FE_Na), and potassium (U_KV and FE_K) were higher in ARF rats (all p < 0.05 vs. control). Post-ischemic animals showed markedly lower glomerular filtration rate (GFR) (p < 0.05 vs. control). No appreciable differences were observed in urinary sodium to potassium ratio (U_Na/U_K) during the early reperfusion phase of renal ischemia (p > 0.05 vs. control). The data suggest an immediate involvement of renal sympathetic nerve action in the pathogenesis of ischemic ARF primarily through altered renal hemodynamics. Diuresis, natriuresis, and kaliuresis due to impaired renal tubular functions are typical responses to renal ischemia and of comparable magnitudes.     

Prevalence of atherosclerotic renal artery stenosis in patients starting dialysis.

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) can lead to end-stage renal failure (ESRF). We determined the prevalence of ARAS in patients 45 years of age or older starting renal replacement therapy. METHODS: Forty-nine of 80 consecutive patients (37 males, 12 females) starting renal replacement therapy in our centre gave informed consent and underwent spiral computed tomographic angiography of their renal arteries. A renal artery diameter reduction of 50% or more assessed by two radiologists was considered as a significant stenosis. RESULTS: Twenty of 49 patients (41%) had an ARAS, and in eight cases (16%) this was bilateral or unilateral with a single kidney. Women were more likely to have an ARAS than men; 75 (9/12) vs 30% (11/37, P<0.01). However, relatively more women declined participation. Non-participants and participants did not differ in respect to other relevant clinical data. Nonetheless, findings in these patients would be negative, the prevalence of ARAS would still be 31% in women and 22% in men (NS). In 13 patients with ARAS the registered diagnosis of ESRF either was hypertension, renovascular disease or unknown. Assuming that in these patients atherosclerotic renovascular disease was the cause of renal failure, a total of 13 patients (13/49, 27%) entered the dialysis programme because of this problem. CONCLUSIONS: These results suggest that ARAS is an important cause of ESRF.     

The use of the hypogastric artery in the anastomosis of multiple renal arteries in the transplant patient

Abstract. Alternative techniques for handling multiple renal vessels in living related kidney transplants by use of the hypogastric artery are presented. This vessel can be used either as a tubular vascular graft or as a Carrel patch graft. Details of these techniques are discussed.     

Indirect computed tomography sign of renal artery injury: Retrograde filling of the renal vein

Computed tomography is a very useful diagnostic tool in children's trauma. In the present case report, retrograde filling of the renal vein during computerized tomographic examination of a patient with renal trauma is presented. This is an indirect sign of traumatic renal artery injury. This finding might assist in the early diagnosis of severe renovascular trauma.     

Etiology of chronic renal failure in Turkish children

The etiology of chronic renal failure (CRF) was studied in 459 Turkish children (205 girls, 254 boys) for the period January 1979-December 1993. Their mean age at onset of CRF was 9.5±4.2 years (range 1–16 years); CRF was defined as a glomerular filtration rate (GFR) below 50 ml/min per 1.73 m² for at least 6 months. When a GFR determination was not available, the serum creatinine concentration was used: greater than 1 mg/dl for children aged 1–3 years, greater than 1.5 mg/dl for those 3–10 years and greater than 2 mg/dl for those 10–16 years. Primary renal disorders were as follows: reflux nephropathy 32.4% glomerular diseases 22.2%, hereditary renal disorders 11.4%, amyloidosis 10.6%, urinary stones 8% and other renal disorders 15.4%. Twenty-three cases of reflux nephropathy (15.4%) were associated with neural tube defects (NTD) and 20 (13.4%) were caused by infravesical obstruction. CRF caused vesicoureteral reflux associated with NTD and amyloidosis are more frequent in our series compared with west European and Nordic countries.     

The Spectrum of Adult Postinfectious Glomerulonephritis in the New Millennium

Background. Postinfectious glomerulonephritis is rare in adults. The characteristics of the disease now differ from what were described decades ago. The goal of this study is to illustrate the clinicopathological spectrum of the disease in the modern era. Methods. Between July 2000 and June 2008, 20 adult cases of postinfectious glomerulonephritis were identified at a medical center in Taiwan. The patients' records were retrospectively reviewed with respect to clinical presentation, microbiology, serology, morphology of renal biopsy, and clinical course. Results. There were 14 males and 6 females. The mean age was 61 years. All patients developed acute renal failure, and the majority (65%) required dialysis support during the disease course. Hypocomplementemia was present in 60% of patients. The most frequently identified infectious agent was Staphylococcus (60%). Histological characteristics showed two distinct patterns of glomerulonephritis: diffuse endocapillary proliferative glomerulonephritis (65%) and focal mesangial proliferative glomerulonephritis (35%). There were no significant differences in the clinical presentation and outcome between the two groups. However, glomerular neutrophil infiltration was more commonly present in diffuse endocapillary proliferative pattern (p = 0.017). The percentage of patients with focal mesangial proliferative pattern significantly increased over time (p < 0.001). At the last follow-up, 6 patients (30%) had died, 6 (30%) were in complete remission, 4 (20%) had partial remission with renal insufficiency, and 4 (20%) were on chronic dialysis. Conclusions. Our data suggested that Staphylococcus had become the leading pathogen in adult postinfectious glomerulonephritis over the past 10 years. Furthermore, atypical histological feature with focal mesangial proliferative pattern was increasingly identified over time. The prognosis was still guarded, carrying a considerable mortality rate and risk for developing chronic renal failure.