先天性巨结肠心形吻合术后患儿生活质量评价及排便功能的远期随访

目的：评估经直肠肛管纵切、心形吻合术式治疗先天性巨结肠患儿术后的远期排便功能状况及生活质量。方法：随访1991／1998采用心型吻合术式根治的先天性结肠62例的临床资料，男52例，女lO例，随访时间2—7年，随访时年龄6～14岁，本组患儿均来院复查，检查内容包括：每日排便次数、粪便性状、有无便意、便秘、失禁及污粪，是否影响日常群体生活，包括饮食、是否缺课、与同伴的关系和情感问题等，并对其进行评分。结果：大部分患儿有较满意的疗效及生活质量评分，排便功能临床评价好组(11．3&;#177;0．7)与～般及差组(7．4&;#177;2．2)比较，评分值差异有显著性意义(t=1．856，P&;lt;0．05)，有污粪及大便失禁患儿的生活质量评分(6．3&;#177;2．4)与没有污粪及大便失禁的患儿(8．7&;#177;2．2)比较差异有显著性意义(t=1．933，P&;lt;0．05)。结论：污粪及大便失禁是影响患儿生活质量评分的主要原因，改良心形吻合术式能减少内括约肌破坏，减少污粪及大便失禁的发生，从而提高患者的生活质量。     

先天性巨结肠根治术后疗效随访

先天性巨结肠 (ＨＤ)是常见的消化道畸型 ,可引起肠梗阻 ,多须手术治疗。本院 1990～ 1998年共施行ＨＤ根治术 158例。作者对其术后 2年以上 ,并获得随访的 12 6例进行综合分析 ,结果如下。1　临床资料1.1　一般资料　本组 12 6例 ,男 99例 ,女 2 7例。 1岁以内 4 2例 ,1～ 3岁 67例 ,3～ 5岁 12例 ,5岁以上 5例。随访 2～ 10年。1.2　手术方法　采用Ｄｕｈａｍｅｌ术即结肠切除 ,直肠后结肠拖出术。心形斜吻合术即结肠翻转拖出 ,直肠肛管背侧纵切 ,正常结肠与直肠肛管作鸡心领式斜吻合术。病理报告 :无或近段仅有少量神经节细胞。1.3　随访…     

先天性巨结肠术后远期排便功能与生活质量研究

目的了解先天性巨结肠患儿术后远期排便功能及生活质量，为探索社区护理干预模式奠定基础。方法对46例符合要求的先天性巨结肠患儿进行随访，采用访谈法及内容分析法、Heikkinen评分法评价排便功能。结果共发现三个主题类别：排便功能、并发症及生活质量。生活质量包括四个亚主题类别：生活饮食、工作学习、社会交往及性功能。89．1％（41／46）的患儿术后远期排便功能为优良，21．7％（10／46）出现并发症，社会交往明显受影响者占30．4％（14／46）。结论先天性巨结肠患儿术后远期排便功能恢复良好，需要发展社区护理于预促进其生活质量改善。     

先天性巨结肠根治术后排便功能及生活质量的研究

目的 评估先天性巨结肠患儿术后排便功能及生活质量,为探素康复干预措施奠定基础.方法 对113例符合要求的先天性巨结肠患儿进行回顾性调查,采用Heikkinen评分标准评价排便功能、小儿肛门直肠术后生活质量评分标准评价生活质量.结果 70.80%（80/113）患儿术后排便功能为优良,24.01%患儿表现不同程度的排便障碍;50例学龄后患儿生活质量评分显示,优者20例占40%,良者23例占46%,差者7例占14%;排便功能与生活质量之间存在显著相关关系.结论 先天性巨结肠患儿术后排便功能障碍和并发症对生活质量有显著影响,需要实施康复干预措施促进其生活质量的提高.     

随访干预对先天性巨结肠根治术后患儿排便功能的影响

先天性巨结肠又称为肠管无神经节细胞症,是由于病变肠管痉挛狭窄导致近端肠管扩张,粪便淤积在结肠内,影响患儿生长发育[1]。手术是目前唯一有效的治疗方法,但手术后远期效果尚不尽如人意。因此术后如何改善患儿排便功能仍然是临床应该关注的问题[2]。本研究对先天性巨结肠根治术后患儿进行定期规范随访,探讨随访干预对患儿手术后排便功能的影响。     

先天性巨结肠患儿钡剂残留与Cajal间质细胞相关性的研究

目的通过比较先天性巨结肠患儿钡灌肠检查24h后钡剂残留情况与肠壁Cajal间质细胞(ICCs)数量之间的关系,探讨钡剂残留对判断肠管切除范围的指导意义。方法研究对象为34例在我院诊断为先天性巨结肠并行根治手术的患儿。从每段切除肠管的近端及远端分别取一块标本行HE染色检测神经节细胞。每例患儿另取3块标本做免疫组化染色观察ICCs,分别位于钡剂残留水平以下3～5cm(A组)、残留处(B组)以及残留水平以上3～5cm处(C组)。采用ImagePro-Plus图像定量检测比较三组标本ICCs数量的差异。结果 HE染色示34例患儿远端标本均未见神经节细胞,且近端标本神经节细胞正常。免疫组化染色后ICCs呈棕黄色,主要位于肠壁肌层及黏膜下层中。A组标本肌层中ICCs较稀疏,黏膜下层ICC几乎消失。B组标本ICCs变异度较大,部分标本ICCs丰富,另有部分标本ICCs显著减少。C组标本肌层、黏膜下层中均可见丰富的ICCs。采用ImagePro-Plus测量三组标本照片的平均光密度,结果A组显著低于C组,两者相比差异有统计学意义。采用配对四格表比较两者相关性结果显示,根据钡剂残留判断ICCs减少的特异度为95.5%,敏感度71.7%。结论先天性巨结肠患儿钡剂残留段肠管ICCs减少,巨结肠根治术肠管切除范围应包括钡剂残留段肠管,否则会因保留ICCs异常肠管而导致便秘复发。     

改良肛周护理方法应用在先天性巨结肠患儿术后的效果

目的研究改良的肛周护理方法对先天性巨结肠术后患儿肛周皮肤的影响,为更好地保护患儿肛周皮肤选择最佳方法。方法选择60例先天性巨结肠术后患儿按抽签法随机分为实验组和对照组各30例。实验组采用改良方法进行肛周护理,对照组采用传统方法进行肛周护理。比较两组先天性巨结肠术后患儿肛周皮肤保护的效果、住院时间及住院费用。结果实验组有效率为93．3％,对照组有效率为46．7％,两组比较差异有统计学意义（X2=15．54,P〈0．05）;实验组平均住院天数（10．22±4．13）d,住院费用（1．33±0．12）万元均少于对照组（15．57±3．26）d和（1．87±0．24）万元,两组比较差异有统计学意义（t分别为2．673,2．846;P〈0．05）。结论采用改良的肛周护理方法大大改善患儿肛周皮肤,同时缩短住院时间,减少住院费用,促进患儿术后康复,可有效提高护理质量,值得推广使用。     

食管癌74例手术后生活质量随访调查

本文前瞻性的调查和分析了本院收治的接受食管癌根治手术的患者手术前后生存质量的动态变化情况以及主要影响因素,现报告如下.……     

超声诊断小儿先天性巨结肠的价值

目的探讨超声在小儿先天性巨结肠(HD)中的诊断价值。方法回顾性分析35例HD患儿的超声影像学资料。结果 35例HD患儿超声扫查均显示痉挛的结肠段瘪陷、走行僵硬,近端肠管有不同程度扩张,其内充满气粪混杂回声,后壁衰减明显。结论超声可作为筛查、诊断小儿HD的首选影像学方法。     

结直肠钉式吻合术后排便功能的评价

目的探讨结直肠钉式吻合术后排便功能的变化。方法对95例应用钉式吻合器行保肛手术的结直肠癌患者按吻合口距齿状线距离分为三组(超低位:<2cm;低位:2cm至腹膜反折处;高位:腹膜反折以上),以徐忠法五项十分制评价标准、自我评价等分别在术后2周、1个月、3个月、6个月、1年对排便功能进行评价。结果在2周、1个月、3个月、6个月、1年时,患者自我评价比徐氏评价分别低1.04±1.05、1.12±1.12、1.00±1.25、0.88±1.21和0.85±1.04(P<0.05);评价优者比例分别为0、2.1%、25.3%、38.9%、53.7%;随吻合口增高及时间推移,评分增加。腹泻与便秘交替:高位组不明显,3个月内超低位组无改善,低位组改善不明显(P=1.00,0.29);随时间推移,低位组改善不明显(P=0.04,0.01,0.00)。结论结直肠钉式吻合术后,患者对排便功能不满意。腹泻与便秘交替现象主要存在于超低及低位组,其中超低位组改善不佳。随着吻合口增高及时间推移,排便功能逐渐好转。     

Long-term mortality and quality of life after septic shock: a follow-up observational study

Purpose

In septic shock, short-term outcomes are frequently reported, while long-term outcomes are not. The aim of this study was to evaluate mortality and health-related quality of life (HRQOL) in survivors 6 months after an episode of septic shock.

Methods

This single-centre observational study was conducted in an intensive care unit in a university hospital. All patients with septic shock were included. Mortality was assessed 6 months after the onset of septic shock, and a comparison between patients who survived and those who died was performed. HRQOL was assessed using the MOS SF-36 questionnaire prior to hospital admission (baseline) and at 6 months in survivors. HRQOL at baseline and at 6 months were compared to the general French population, and HRQOL at baseline was compared to 6-month HRQOL.

Results

Ninety-six patients were included. Six-month mortality was 45 %. Survivors were significantly younger, had significantly lower lactate levels and SAPS II scores, required less renal support, received less frequent administration of corticosteroids, and had a longer length of hospital stay. At baseline (n = 39) and 6 months (n = 46), all of the components of the SF-36 questionnaire were significantly lower than those in the general population. Compared to baseline (n = 23), the Physical Component Score (CS) improved significantly at 6 months, the Mental CS did not differ.

Conclusions

Mortality 6 months after septic shock was high. HRQOL at baseline was impaired when compared to that of the general population. Although improvements were noted at 6 months, HRQOL remained lower than that in the general population.     

Cognitive function and health-related quality of life after delirium in connection with hip surgery. A six-month follow-up

NEED: Delirium is a serious psychiatric disorder, and elderly patients who undergo hip surgery are at higher risk for delirium development. PURPOSE: The purpose was to compare change in cognitive function and health-related quality of life 6 months after hip surgery in patients who experienced postoperative delirium with those who did not. SAMPLE: A total of 115 patients 75 years or older were included. MEASURES: Screening for delirium was done using the Diagnostic and Statistical Manual, 4th ed criteria. Cognitive function was measured with the Mini Mental State Examination and health-related quality of life with the SF-36. RESULTS: Of the 115 patients, 32 became delirious during hospital stay (D group), whereas the remaining patients did not (NonD group). Both D and NonD groups scored lower on the Mini Mental State Examination at follow-up than during hospital stay, but the deterioration was significantly greater in the D group. At follow-up, health-related quality of life was improved in patients who were destined for hip replacement surgery but unchanged or impaired for those with hip fracture. Delirium onset in connection with hip fracture lowered the health-related quality of life even more. At follow-up, low cognitive function correlated with lower scoring in physical function. Greater knowledge about delirious patients' vulnerable positions related to lower cognition and life quality can improve rehabilitation and support for these patients.     

跟进式电话随访对老年冠心病患者出院后生活质量的效果评价

目的探讨跟进式电话随访对老年冠心病患者出院后自我护理能力及生活质量的效果。方法采用纵向研究方法,选取心内科收治的40例诊断为冠心病的患者进行跟进式电话随访,进行有针对性的治疗性健康教育,在患者入院时、出院3个月及6个月后采用患者自护能力测定量表和汉化版简明健康调查量表对随访效果进行评价。结果患者自护能力得分和生活质量得分在干预3个月和6个月后均有不同程度的提升,干预后患者自护能力和生活质量评分高于干预前,差异具有统计学意义(P0.05)。结论与常规电话随访相比,跟进式电话随访可有效改善老年冠心病患者出院后的生活质量,提高患者的自护能力。     

管状胃食管吻合术与全胃代食管吻合术对食管癌患者术后食管反流及生活质量的对比研究

目的：探讨管状胃食管吻合术与全胃代食管吻合术对食管癌患者术后食管反流及生活质量的影响。方法将收治的60例食管癌患者分为研究组和对照组各30例,研究组采用管状胃食管吻合术,对照组采用全胃代食管吻合术;术后随访24周,对比两组患者生活质量、胃食管反流及肺部功能的变化情况。结果两组患者术后主要并发症有肺部感染、胸腔感染、吻合口瘘、残胃瘘等,其中研究组发生率为10．0％,对照组为13．3％,两组相比差异无统计学意义（χ2＝0．529,P ＞0．05）。术后12周及24周研究组生活质量评分显著高于对照组,两组间相比差异具有统计学意义（P ＜0．05）;研究组术后4周、12周 RDQ 评分显著低于对照组（P ＜0．05）,术后两组患者肺功能各指标均明显降低,其中研究组最大通气量（MMV）、一秒钟用力呼气容积（FEV1．0）、肺活量（VC）显著优于对照组,两组间相比差异有统计学意义（P ＜0．05）。结论管状胃食管吻合术可以显著改善患者胃食管反流和肺部功能,提高患者的生活质量,值得临床推广应用。     

Health-related quality of life after revascularization for peripheral arterial occlusive disease: long-term follow-up

AIM: This paper reports a study to measure quality of life, before and after revascularization, in patients with intermittent claudication and critical limb ischaemia from a long-term perspective. BACKGROUND: Patients with peripheral arterial occlusive disease have a number of problems which affect their quality of life and a successful revascularization results in immediate improvements in quality of life. However, knowledge of the durability of the improvements is sparse. Therefore, research on the outcomes of treatment and nursing care should investigate the long-term effects on quality of life and daily activities. METHODS: A quasi-experimental longitudinal follow-up study was conducted with 80 patients with intermittent claudication and 62 with critical ischaemia. Assessment with the Nottingham Health Profile was made before revascularization and 6 months, 12 months and up to 4 years afterwards. The data were collected between 1995 and 2000. RESULTS: Quality of life was improved 6 and 12 months after revascularization in patients with intermittent claudication in energy, pain, emotional reactions and physical mobility, while those with critical limb ischaemia also had improvements in pain and sleep. The improvement in pain was particularly evident for both groups and remained significantly improved up to 4 years after revascularization. Patients with critical limb ischaemia, however, deteriorated significantly with regard to physical mobility between 12 months and 4 years. Being a woman and belonging to the critical ischaemia group was significantly associated with high total Nottingham Health Profile score. Thus, patients with intermittent claudication had more durable benefits from revascularization than those with critical limb ischaemia. However, both groups had less pain than at baseline after 4 years. CONCLUSION: The degree to which quality of life was durable over time seems to depend on the severity of the disease and gender. Patients with critical limb ischaemia were older, had more other diseases and a lower quality of life than patients with intermittent claudication, which confirmed that patients with critical limb ischaemia need more ongoing nursing support to maintain independence in daily life a long time after revascularization.     

先天性心脏病患儿介入治疗前后生存质量的研究

[目的]了解先天性心脏病患儿介入治疗前后的生存质量状况,为临床制定有针对性的护理策略,以进一步提高其生存质量提供依据。[方法]选择2008年3月—2009年1月在哈尔滨市某三级甲等医院心内科住院行介入治疗的先天性心脏病患儿100例为研究对象。应用儿科生存质量量表系列普适性核心量表第4版-中文版(PedsQLTM4.0)为研究工具,分别于介入治疗前24h、治疗后1个月、治疗后6个月进行问卷调查。[结果]治疗前与治疗后1个月之间、治疗后1个月和治疗后6个月之间除社会功能和角色功能外,其余方面均有显著性差异。治疗前与治疗后6个月在总分及其各方面均有显著差异。[结论]先天性心脏病介入治疗能显著改善患儿的早中期生存质量,但生存质量各方面的改善程度不同,生理功能方面的提高更显著。有必要加强先天性心脏病患儿介入治疗前后心理领域的干预,并进一步监测其生存质量变化趋势。     

Long-term quality of life in patients after total gastrectomy.

This study used a questionnaire survey to evaluate the long-term quality of life (QOL) in 51 patients who underwent total gastrectomy. Activities of daily living (ADL) were good in 20, relatively good in 9, relatively poor in 13, and poor in 6 patients. The other 3 patients were treated on an inpatient basis. Of 38 patients who had been employed before surgery, 18 (47%) resumed working. Physically, body weight increased or showed no changes in 38 patients (74%), but decreased in the other 13 patients, of whom 3 showed a 15% or more decrease. Dumping symptoms developed in 13 patients (26%), 2 of whom had a severe condition. Clear decreases in physical strength and mental strength (spiritual energy) were reported by 10 and 8 patients, respectively. Comprehensive QOL was good in 20, slightly poor in 17, and poor in 14 patients. Quality of life was poor in 12 (41%) of the 29 patients with good ADL. The following were suggested as necessary for patients and their families: sufficient preoperative explanation about pathophysiology and nutritional management after total gastrectomy; execution of a continued patient education program until after discharge; and explanations in specific terms about cooking methods, nutritional management, exercise therapy, periodic medical checks, and patients' associations using pamphlets and food models to describe daily living of the patients after discharge.