终末期肾病并存冠心病患者行冠状动脉介入治疗的护理

对6例终末期肾病并存冠心病患者行冠状动脉造影检查和介入治疗，结果患者均顺利完成治疗，心绞痛症状缓解。提出术前加强心理护理、术前准备，充分血液透析，适当水化治疗，术后严密观察病情变化、做好血液透析护理、预防感染等是治疗成功的保证。     

舒适护理在终末期肾病患者血液净化中的应用

目的 探讨舒适护理在终末期肾病患者长期血液透析治疗中的作用.方法 对2007年1～12月在我院血液净化中心进行血液净化治疗的50例终末期肾病患者进行环境、心理、生理、社会适应性护理,观察患者在治疗期间各项指标的变化.评估患者不舒适的原因、程度及心理上负面的应激.结果 通过环境、心理、体位、生理等护理,使患者获得心理上的满足感、安全感和对医务人员的满意感.结论 舒适护理充分体现了"以人为本,以患者为中心"的现代护理理念,使患者在接受护理时充满了希望,主动参与护理活动.在舒适安静的治疗环境、熟练的操作技术、优良的服务态度中与医护人员进行感情沟通,让患者得到家庭和社会的理解和支持,使患者感受到家庭和社会的关爱,以积极乐观的态度主动配合治疗.     

舒适护理在终末期肾病患者血液净化中的应用

目的 探讨舒适护理在终末期肾病患者长期血液透析治疗中的作用.方法 对2007年1～12月在我院血液净化中心进行血液净化治疗的50例终末期肾病患者进行环境、心理、生理、社会适应性护理,观察患者在治疗期间各项指标的变化.评估患者不舒适的原因、程度及心理上负面的应激.结果 通过环境、心理、体位、生理等护理,使患者获得心理上的满足感、安全感和对医务人员的满意感.结论 舒适护理充分体现了"以人为本,以患者为中心"的现代护理理念,使患者在接受护理时充满了希望,主动参与护理活动.在舒适安静的治疗环境、熟练的操作技术、优良的服务态度中与医护人员进行感情沟通,让患者得到家庭和社会的理解和支持,使患者感受到家庭和社会的关爱,以积极乐观的态度主动配合治疗.     

舒适护理在终末期肾病患者血液净化中的应用

目的 探讨舒适护理在终末期肾病患者长期血液透析治疗中的作用.方法 对2007年1～12月在我院血液净化中心进行血液净化治疗的50例终末期肾病患者进行环境、心理、生理、社会适应性护理,观察患者在治疗期间各项指标的变化.评估患者不舒适的原因、程度及心理上负面的应激.结果 通过环境、心理、体位、生理等护理,使患者获得心理上的满足感、安全感和对医务人员的满意感.结论 舒适护理充分体现了"以人为本,以患者为中心"的现代护理理念,使患者在接受护理时充满了希望,主动参与护理活动.在舒适安静的治疗环境、熟练的操作技术、优良的服务态度中与医护人员进行感情沟通,让患者得到家庭和社会的理解和支持,使患者感受到家庭和社会的关爱,以积极乐观的态度主动配合治疗.     

照顾者经济状况对血液透析患者自我护理能力的影响

目的 探讨照顾者经济状况对血液透析患者自我护理能力影响.方法 纳入经我院确诊为终末期肾病需要接受血液透析治疗的患者以及其照顾者100对,根据照顾者经济状况分为两组,其中A组50对,照顾者经济收入较好,月收入大于4千元,B组50对,照顾者经济状况较差,月收入低于3.9千元.评价照顾者经济状况对血液透析患者自我护理能力、生活质量及心理状态的影响.结果 A组6个维度评分以及自我效能总分均较B组好(P＜0.05);A组患者简明健康调查量表评分显著升高(P＜0.05);A组患者抑郁自评量表及焦虑自评量表评分均显著降低(P＜0.05).结论 照顾者良好的经济状况可促进终末期肾病患者的自我效能,提高自我护理行为,改善负性情绪.     

感恩干预对血液透析患者自我感受负担的影响

目的探讨感恩干预对维持性血液透析患者自我感受负担的影响。方法将82例血液透析患者按透析时间分为对照组和观察组各40例;对照组实施常规护理,观察组在常规护理基础上实施感恩干预,持续12周。干预前后采用感恩问卷和自我感受负担量表进行调查。结果干预后观察组自我感受负担总分25.10±4.88,感恩得分为32.08±2.41,对照组分别为37.52±2.44、16.15±2.15,两组比较,差异有统计学意义(均P0.01)。结论对维持性血液透析患者开展感恩干预,可降低其自我感受负担,提高感恩水平。     

糖尿病肾病血液透析病人的护理

目的:探讨糖尿病终末期肾病(DN)患者在维持性血液透析中的特殊护理.方法:对糖尿病终末期肾病患者在维持性血液透析中进行心理、饮食、专科特殊护理.结果:以糖尿病为原发病的终末期肾衰患者患心脑血管疾病和感染性疾病发生率较高,其中脑出血死亡3例,心肌梗塞1例.继续维持性血液透析22例.结论:以糖尿病为原发病的终末期肾衰发病率逐年上升,其死亡率明显高于非糖尿病患者,因此,如何提高糖尿病肾病患者的透析质量,减少透析并发症,提高其生存率,是糖尿患者血良透析护理工作的难点及重点.     

不同水化方法对冠状动脉介入术后对比剂肾病的影响及护理

目的:探讨碳酸氢钠和生理盐水两种水化护理方法对预防冠状动脉介入术后对比剂肾病的疗效.方法:选择本院行冠状动脉介入病例200例.将患者随机分为常规治疗组80例与充分水化组120例,充分水化组又分为碳酸氢钠和生理盐水两个亚组,分别观察两组患者造影前、造影后第3d及造影后第7d血浆肌酐水平及尿 β2-微球蛋白水平及GIN的发生率.结果:充分水化组较常规治疗组患者术后能明显改善肾功能,生理盐水组能更好的改善患者介入术后的肾脏功能.充分水化治疗组中的CIN的发生率明显低于常规治疗组.结论:碳酸氢钠和生理盐水两种水化护理方法均能显著减少对比剂肾病的发生率.     

终末期肾病患者大隐静脉桥血管中细胞外基质相关基因表达的特点

目的探讨终末期肾病(ESRD)患者冠状动脉旁路移植术(CABG)前大隐静脉桥血管中细胞外基质(ECM)基因表达的特点。方法选择复旦大学附属中山医院自2004年7月至2010年12月期间收治的经冠状动脉造影明确诊断为冠心病患者68例进行研究,将68例患者按术前有无ESRD史,筛选出ESRD患者30例作为ESRD组(需维持性血液透析患者),38例无肾病史患者作为对照组。收集整理所有入选患者详细的术前临床资料;术中收集大隐静脉标本,以基因芯片、免疫组织化学和蛋白印迹法(Western blotting)阐明ESRD条件下CABG术前大隐静脉桥血管中细胞外基质基因表达的情况。结果两组术前临床资料除肾病相关数据外,其余临床资料差异无统计学意义(P>0.05)。ESRD组患者CABG术前大隐静脉桥血管中细胞外基质相关基因表达上调3倍以上的基因有16个,而表达下调3倍以上的基因则有3个;ESRD组基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)活性较对照组升高(2.60±0.50 vs.0.70±0.16,1.80±0.40 vs.0.60±0.15,P<0.01),而组织型基质金属蛋白酶抑制剂-2(TIMP-2)和组织型基质金属蛋白酶抑制剂-3(TIMP-3)活性较对照组降低(0.60±0.19 vs.2.20±0.30,0.90±0.28vs.2.40±0.70,P<0.05)。结论与ESRD相关的多种心血管病危险因素,严重影响CABG术前大隐静脉桥血管中细胞外基质基因表达平衡,并且这种平衡的打破,有促进CABG术后静脉桥血管病变发生的危险。     

糖尿病肾病维持性血液透析患者透析充分性的循证护理

目的:探讨循证护理方法在防治糖尿病肾病维持性血液透析患者透析充分性护理问题中的应用效果.方法:对46例糖尿病肾病维持性血液透析患者透析充分性采用循证护理方法,进行原因分析,应用计算机网络检索有关文献,并对证据的真实性、可靠性和应用性作出评分,确定结论,制定防治对策,再施以有效的护理干预.结果:循证护理干预前后糖尿病肾病维持性血液透析患者透析充分性比较,差异有显著性意义(均P＜0.01).结论:循证护理不但为临床护理实践的决策提供可靠的科学依据,提高护理质量,确保患者在透析过程安全、舒适、满意,对患者有益,而且进一步提高了血液透析护士的专业性和技术性.     

Vectorelectrocardiography in Coronary Artery Disease

Objective—According to published data, the ability to prevent various hypertension-related events differs between the various antihypertensive drug groups. Although absolute drug effects differ among studies, relative drug effects could be considered constant. We therefore explored the possibility of drawing statistically valid conclusions about the differences in clinical efficacy between various drug groups by doing an overview of published data.

Design—We made a meta-analysis with a Bayesian fixed effect model in which we related the drug effects to the effects of placebo drugs. We selected 27 clinical trials from the literature according to specific criteria, including results from studies reporting the effects of the newer drugs when tested against diuretics and, β-blockers, and from studies in which diuretics and, β-blockers had been tested against placebo. We calculated the posterior probability distributions of the relative effects of angiotensin-converting enzyme (ACE) inhibitors vs calcium antagonists with three different endpoints: stroke, coronary disease and heart failure with point estimates of effects and with 95% credibility intervals. As an intermediate step in this procedure we obtained similar information about the effects of the three groups of active drugs, ACE inhibitors, calcium antagonists and diuretics or, β-blockers, tested against placebo. For coronary disease we also tested calcium antagonists against diuretics or, β-blockers.

Results—ACE inhibitors and calcium antagonists have an almost identical ability to prevent stroke in hypertensive individuals with a risk ratio (RR) of 1.04. On the other hand, calcium antagonists reduce coronary disease by only 8% relative to placebo. When ACE inhibitors and calcium antagonists are compared with the Bayesian method, the outcome is a 14% difference in favor of the ACE inhibitors to prevent coronary disease, with a credibility interval almost reaching identity. Nor do calcium antagonists do as well as diuretics or, β-blockers in this respect, RR = 1.12 with 95% credibility interval 1.01-1.24. All the tested drug groups have a profound preventive effect on the occurrence of heart failure when given to hypertensive patients, showing reductions of 42-54%. When ACE inhibitors are compared with calcium antagonists RR = 0.79, with a credibility interval 0.65-0.95.

Conclusion—There is statistically an indisputable difference between ACE inhibitors and calcium antagonists in respect of effects on coronary disease and heart failure when treating hypertensive individuals, ACE inhibitors being more efficacious. There are no differences in the effect on stroke. Moreover, ,β-blockers or diuretics are also superior to calcium antagonists in preventing coronary events.     

Reoperation for Coronary Artery Disease

Forty-two reoperations for myocardial revascularization were done in 40 patients. Seventeen of them (1%) are from our series of 1,700 patients. Average number of grafts per patient was 2.27. Complications occurred in 20 patients. There was no operative or hospital (30-day) mortality. Patients classified as improved or asymptomatic constitute 82.5% of the series. Reoperations within one year were done predominantly for technical cause of failure, whereas reoperations done after more than one year were usually for disease progression. The operative technique is described as are maneuvers to help make a reoperation less hazardous. Reoperations have been accomplished relatively safely with results similar to those of initial operation.