共查询到19条相似文献,搜索用时 171 毫秒
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目的:探究尿毒症患者维持性血液透析(MHD)疲乏与衰弱发生率及其影响因素研究.方法:研究对象采用整群抽样方法,选取我院血液透析室收治的长期血透的维持性血液透析患者,采用实验室指标检测、问卷调查法、相关量表检测等方法收集患者的相关资料,分析血液透析患者疲乏与衰弱发生情况、出现疲乏、衰弱情况的影响因素.结果:血液透析患者疲... 相似文献
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目的 探讨透析中运动对维持性血液透析认知衰弱患者衰弱状况、认知功能和微炎症状态的影响。方法 采用随机数字表法,将符合纳入标准的43例维持性血液透析认知衰弱患者分为干预组21例和对照组22例。对照组接受透析中常规护理;干预组在此基础上接受透析中运动干预。比较两组干预后衰弱相关指标(包括衰弱表型评分、无握力、步数)、简易精神状态检查量表评分、临床痴呆评定量表评分和C反应蛋白水平的差异。结果 两组各21例患者完成全程研究。干预后干预组衰弱表型评分、临床痴呆评定量表评分和C反应蛋白水平显著低于对照组,简易精神状态检查量表评分、握力、步速显著高于对照组(均P<0.05)。结论 透析中运动有利于改善维持性血液透析认知衰弱患者的衰弱状况,提高患者认知功能,减轻患者微炎症状态。 相似文献
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目的 探讨维持性血液透析患者衰弱发生情况及与肌少症、躯体功能的关系,为衰弱预防及管理提供参考。方法 便利抽样法选取303例维持性血液透析患者,采用FRAIL衰弱量表、简易五项评分问卷、简易机体功能评估,进行衰弱、肌少症及躯体功能评估。结果 303例维持性血液透析患者中,无衰弱占27.1%、衰弱前期占60.7%、衰弱占12.2%。肌少症高危者占11.2%,躯体功能下降者占44.9%。多因素logistic回归分析显示,年龄<60岁、体型标准及超重、躯体功能正常、肌少症低危是衰弱的保护因素(P<0.05,P<0.01)。结论 维持性血液透析患者衰弱及衰弱前期占比较高,衰弱的发生受年龄、体型的影响,并与肌少症、躯体功能密切相关。 相似文献
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目的 分析老年维持性血液透析患者衰弱变化轨迹及其影响因素。方法 以便利抽样法选取扬州市3所医院的220例老年维持性血液透析患者为研究对象,采用Fried衰弱表型于基线、6个月、12个月、24个月对患者进行衰弱评分,通过潜类别增长模型识别衰弱变化轨迹的潜在类别,logistic回归分析影响因素。结果 老年维持性血液透析患者衰弱变化轨迹可分为衰弱持续低水平组(29.5%)、衰弱缓慢上升组(65.5%)和衰弱持续高水平组(5.0%)。logistic回归分析显示,年龄、糖尿病史、睡眠障碍和血清白蛋白水平是衰弱变化轨迹分类的影响因素(均P<0.05)。结论 老年维持性血液透析患者衰弱变化存在群体异质性,应依据影响因素实施针对性干预。 相似文献
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目的探讨维持性血液透析患者发生肌少症的危险因素。方法采用病例-对照研究,应用亚洲肌少症诊断标准,将37例存在肌少症的维持性血液透析患者作为病例组,选取同期维持性血液透析无肌少症的74例为对照组。使用Logistic回归分析筛选肌少症的危险因素。结果经Logistic回归分析,调整年龄、糖尿病肾病和骨骼肌质量指数后,BMI、透析龄、血磷、细胞外水分比率、经济状况、认知功能、体力活动为维持性血液透析患者发生肌少症的危险因素(P0.05,P0.01)。结论对年龄较大、透析龄长、认知功能障碍、体力活动不足的维持性血液透析患者,在血液透析期间应采取积极措施,尽量减少肌少症发生。 相似文献
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维持性血液透析( maintenance hemodialysis,MHD)患者普遍存在睡眠障碍,有研究显示睡眠障碍发生率高达81. 1% [1].睡眠质量直接影响MHD患者的生活质量及生存率[2,3] ,但造成睡眠障碍的具体机制目前尚不完全明确,一些影响因素仍存争议.本研究采用匹兹堡睡眠质量指数量表( pittsbu... 相似文献
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目的:探讨引起维持性血液透析患者衰弱的影响因素.方法:收集首都医科大学附属北京中医医院及北京中医医院怀柔医院,两家医院血液透析室维持性血液透析3个月以上的患者163例,依据FRAIL量表得分分为衰弱组91例、非衰弱组72例,收集所有病例评估FRAIL量表同期临床资料,包括年龄、透析龄、每周进行血液透析(HD)、血液透析... 相似文献
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目的探讨基于认知负荷理论的维持性血液透析患者限制液体摄入健康教育策略的应用效果。方法将100例维持性血液透析依从性差的患者按随机数字表法分为对照组和观察组各50例,对照组给予维持性血液透析常规护理及健康教育,观察组采用认知负荷理论构建并实施患者限制液体摄入健康教育策略,观察两组干预前和干预6个月液体摄入依从性及血液透析并发症发生率。结果干预后两组液体摄入依从性总分均较干预前显著提高,且观察组依从性得分显著高于对照组(P0.05,P0.01);观察组高血压、低血压、心律失常、肌肉痉挛发生率显著低于对照组(均P0.01)。结论实施基于认知负荷理论的健康教育策略,可提高维持性血液透析患者限制液体摄入的依从性,降低并发症发生率。 相似文献
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目的 探讨八段锦用于老年高血压伴衰弱患者的效果.方法 将67例老年高血压衰弱门诊患者随机分为干预组33例和对照组34例.对照组行常规治疗与健康教育,干预组在此基础上行八段锦干预,持续12周.比较两组干预前后衰弱评分和SF-12评分、步速值、握力值和血压值.结果 干预12周后,干预组衰弱评分、收缩压、舒张压显著低于对照组(均P<0.05),两组收缩压和舒张压随时间延长而降低;SF-12评分、握力值、步速值显著高于对照组(均P<0.05),两组握力值和步速值随时间延长而增加.结论 八段锦干预可改善老年高血压伴衰弱患者衰弱,降低血压,提高生活质量,效果优于常规方法. 相似文献
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Thomas E. Reeve Rebecca Ur Timothy E. Craven James H. Kaan Matthew P. Goldman Matthew S. Edwards Justin B. Hurie Gabriela Velazquez-Ramirez Matthew A. Corriere 《Journal of vascular surgery》2018,67(5):1512-1520
Objective
Frailty is associated with adverse events, length of stay, and nonhome discharge after vascular surgery. Frailty measures based on walking-based tests may be impractical or invalid for patients with walking impairment from symptoms or sequelae of vascular disease. We hypothesized that grip strength is associated with frailty, comorbidity, and cardiac risk among patients with vascular disease.Methods
Dominant hand grip strength was measured during ambulatory clinic visits among patients with vascular disease (abdominal aortic aneurysm [AAA], carotid stenosis, and peripheral artery disease [PAD]). Frailty prevalence was defined on the basis of the 20th percentile of community-dwelling population estimates adjusted for age, gender, and body mass index. Associations between grip strength, Charlson Comorbidity Index (CCI), Revised Cardiac Risk Index (RCRI), and sarcopenia (based on total psoas area for patients with cross-sectional abdominal imaging) were evaluated using linear and logistic regression.Results
Grip strength was measured in 311 participants; all had sufficient data for CCI calculation, 217 (69.8%) had sufficient data for RCRI, and 88 (28.3%) had cross-sectional imaging permitting psoas measurement. Eighty-six participants (27.7%) were categorized as frail on the basis of grip strength. Frailty was associated with CCI (odds ratio, 1.86; 95% confidence interval, 1.34-2.57; P = .0002) in the multivariable model. Frail participants also had a higher average number of RCRI components vs nonfrail patients (mean ± standard deviation, 1.8 ± 0.8 for frail vs 1.5 ± 0.7 for nonfrail; P = .018); frailty was also associated with RCRI in the adjusted multivariable model (odds ratio, 1.75; 95% confidence interval, 1.16-2.64; P = .008). Total psoas area was lower among patients categorized as frail vs nonfrail on the basis of grip strength (21.0 ± 6.6 vs 25.4 ± 7.4; P = .010). Each 10 cm2 increase in psoas area was associated with a 5.7 kg increase in grip strength in a multivariable model adjusting for age and gender (P < .0001). Adjusted least squares mean psoas diameter estimates were 25.5 ± 1.1 cm2 for participants with AAA, 26.7 ± 2.0 cm2 for participants with carotid stenosis, and 22.7 ± 0.8 cm2 for participants with PAD (P = .053 for PAD vs AAA; P = .057 for PAD vs carotid stenosis; and P = .564 for AAA vs carotid stenosis).Conclusions
Grip strength is useful for identifying frailty among patients with vascular disease. Frail status based on grip strength is associated with comorbidity, cardiac risk, and sarcopenia in this population. These findings suggest that grip strength may have utility as a simple and inexpensive risk screening tool that is easily implemented in ambulatory clinics, avoids the need for imaging, and overcomes possible limitations of walking-based measures. Lower mean psoas diameters among patients with PAD vs other diagnoses may warrant consideration of specific approaches to morphomic analysis. 相似文献13.
《Renal failure》2013,35(9):1246-1250
AbstractThe neurobehavioral syndrome of uremia in chronic kidney disease affects the functioning of the central nervous system. Cognitive impairment is one of the most important manifestations of this dysfunction. The process of hemodialysis is known to bring about conflicting changes in the cognitive status of patients. In the present study an assessment of cognitive status of patients with end stage renal disease was done in comparison to controls before and after a session of hemodialysis using simple bedside paper-pencil tests. Thirty patients of end stage renal disease on maintenance dialysis for at least one month with MMSE score >24 were assessed one hour before and one hour after hemodialysis using Digit Symbol Substitution Test, One Letter and Three Letter Cancellations tasks. Their results were compared to age and sex matched healthy controls. The patients with end stage renal disease had significantly lower performance in cognitive tests in comparison to controls. The performance improved 1 hour after hemodialysis in comparison to pre-dialysis values. However, the values after dialysis were significantly lower than in controls, thereby indicating that though the cognitive functions improved after hemodialysis, they did not reach the control levels. There was also a significant change in the biochemical parameters after dialysis. We conclude that patients with end stage renal disease suffered from cognitive impairment which improved on hemodialysis due to removal of metabolic waste products. 相似文献
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BackgroundThe clinical syndrome of frailty identified through the assessment of weight loss, gait speed, grip strength, physical activity, and physical exhaustion has been used to identify patients with reduced reserves. We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients.MethodsA prospective study was conducted at 2 centers (Singapore and Japan). All patients over 75 years of age undergoing colorectal resection were assessed for the presence of the syndrome of frailty. All these patients had already had their comorbidities optimized for surgery. The outcome measure was postoperative major complications (defined as Clavien-Dindo type II and above complications).ResultsEighty-three patients were studied from February 2008 to April 2010. The mean age was 81.5 years (range 75–93 years). The mean comorbidity index was 3.37 (range 0–11). Twenty-six (31.3%) patients were an American Society of Anesthesiologists (ASA) score of 3 and above. Chi-square analysis revealed that the odds ratio of postoperative major complications was 4.083 (95% confidence interval, 1.433–11.638) when the patient satisfied the criteria for frailty. Albumin <35, ASA >3, comorbidity index >5, and Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scores were not predictive of postoperative major complications.ConclusionsPreliminary findings show that frailty is a potent adjunctive tool of predicting postoperative morbidity. Frailty can be used to identify elderly patients needing further optimization before major surgery. 相似文献
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目的 探讨维持性血液透析患者营养不良-炎症综合征与肌少症之间的关系.方法 选择2014年10月至2015年12月在云南省肾脏病医院及昆明医科大学第一附属医院接受维持性血液透析患者55例,所有入组患者均用MIS评分法进行营养不良-炎症综合征的评估,应用生物电阻抗法进行肌肉质量测量,采用电子握力计测量肌力,空腹检测血生化指标.结果 本研究中肌少症患者26例(47.3%),其中肌少症前期患者10例(18.2%),肌少症期16例(29%),无肌少症29例(52.7%);肌少症前期、肌少症期、无肌少症三组患者年龄、性别差异有统计学意义(P<0.05).按MIS得分将患者分为轻度(0~4分)、中度(5~8分)、重度(>8分)三组.MIS评分与骨骼肌质量、骨骼肌质量指数、握力呈负相关(P<0.05).不同MIS组间骨骼肌质量、骨骼肌质量指数、握力平均值差异有统计学意义(P<0.05).结论 本组患者肌少症与患者年龄、性别相关.随着营养不良炎症得分增加,骨骼肌质量、骨骼肌质量指数及握力平均值呈下降趋势.改善维持性血液透析患者营养不良炎症状态可能会降低肌少症的发生. 相似文献
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Niv Ad M.D. Sari D. Holmes Ph.D. Linda Halpin M.S.N. R.N. Deborah J. Shuman B.S. Casey E. Miller M.S. Deborah Lamont B.S. R.N. 《Journal of cardiac surgery》2016,31(4):187-194
Background
The Society of Thoracic Surgeons (STS) recommends using gait speed as a marker of frailty to identify cardiac surgery patients at risk for adverse outcomes. However, a single marker of frailty may not provide consistently reliable risk information. We evaluated the impact of frailty and gait speed on patient outcomes after elective cardiac surgery.Methods
This was a prospective study of 167 older (≥65 years) coronary artery bypass grafting (CABG) and/or valve surgery patients. Patients were assessed using Cardiovascular Health Study (CHS) Frailty Index criteria: weight loss, exhaustion, physical activity, gait speed, and grip strength.Results
Frailty was identified in 39 patients (23%) using CHS criteria. Frail patients had longer median intensive care unit stays (54 vs. 28 h, p = 0.003), longer median length of stay (8 vs. 5 days, p < 0.001), and greater likelihood of STS‐defined complications (54% vs. 32%, p = 0.011) and discharge to an intermediate‐care facility (45% vs. 12%, p < 0.001) but were not different from nonfrail patients on major outcome, operative mortality, or readmissions. After multivariate adjustment, frail and nonfrail patients were similar on perioperative outcomes. Absolute gait speed and slow gait speed using a cutoff were not related to incidence of STS‐defined complications or major outcome in multivariate analyses. However, higher body mass index was correlated with slower gait speed (rs = 0.30, p < 0.001).Conclusions
The CHS index did not identify “frail” patients at increased risk for adverse outcomes. No relationship was found between gait speed and outcome. There is a need for alternative multidimensional measures to assess frailty in cardiac surgical patients. doi: 10.1111/jocs.12699 (J Card Surg 2016;31:187–194) 相似文献17.
Effect of renal transplantation on cognitive function in hemodialysis patients: a longitudinal study
Chhabra Yogesh K. Sood Sanjay Rathi Omprakash Mahajan Sandeep 《International urology and nephrology》2017,49(11):2071-2078
International Urology and Nephrology - The literature notes high prevalence of cognitive function (CF) impairment among hemodialysis patients. Renal transplantation by reversing metabolic factors... 相似文献
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In this commentary, we describe the sarcopenia spectrum that results in frailty and consider the impact of several components of the frailty definition on its global prevalence. We review proposed operational definitions of sarcopenia and the extent to which they have been shown to predict hard clinical outcomes, such as hip fracture, falls, and mortality. A head-to-head comparison of nine proposed operational definitions of sarcopenia as predictors of falls revealed that the definition involving appendicular lean mass (ALM)/ht2 alone was a significant predictor; the prevalence of sarcopenia by this definition was 11 %. We consider the strengths and limitations of definitions that include functional measurements, such as gait speed and grip strength, along with measures of lean tissue mass. The functional assessments are harder to standardize than the more objective ALM measurements. The prevalence of sarcopenia by definitions that include functional and lean mass measurements tends to be lower than the prevalence by definitions that include lean mass alone. A low prevalence limits opportunity for early identification and application of prevention strategies. For these and other reasons, it seems advantageous to base the operational definition of sarcopenia on ALM/ht2 alone. This commentary addresses the importance of a globally applicable operational definition of sarcopenia and both desirable and undesirable features of such a definition. 相似文献
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Study objectiveOlder surgical patients with cognitive impairment are at an increased risk for adverse perioperative outcomes, however the prevalence of preoperative cognitive impairment is not well-established within this population. The purpose of this review is to determine the pooled prevalence of preoperative cognitive impairment in older surgical patients.DesignSystematic review and meta-analysis.SettingMEDLINE (Ovid), PubMed (non-MEDLINE records only), Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsycINFO, and EMCare Nursing for relevant articles from 1946 to April 2021.PatientsPatients aged ≥60 years old undergoing surgery, and preoperative cognitive impairment assessed by validated cognitive assessment tools.InterventionsPreoperative assessment.MeasurementsPrimary outcomes were the pooled prevalence of preoperative cognitive impairment in older patients undergoing either elective (cardiac or non-cardiac) or emergency surgery.Main resultsForty-eight studies (n = 42,498) were included. In elective non-cardiac surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among 11,676 patients. Within the elective non-cardiac surgery category, elective orthopedic surgery was analyzed. In this subcategory, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%, 49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0% (95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the unrecognized cognitive impairment prevalence across 588 patients was 26.0% (95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389 patients.ConclusionsA substantial number of surgical patients had unrecognized cognitive impairment. In elective non-cardiac and emergency surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants more attention for risk assessment and stratification. 相似文献