针对性护理配合在膀胱全切原位回肠代膀胱术中的应用效果

目的 观察护理配合在经腹腔镜下膀胱全切原位回肠代膀胱术中的应用效果。方法 回顾性分析2018年3月~2019年3月在我院行膀胱全切除原位回肠代膀胱术实施针对性手术配合的48例膀胱癌患者。观察患者手术时间、术中出血量、肠功能恢复时间、新膀胱功能、并发症发生情况及护理满意度。结果 48例患者手术时间5~9 h,平均手术时间（5.98±0.45）h,术中出血量200~1000 ml,平均出血量（398.50±20.64）ml。术后2~3 d胃肠功能恢复,术后3周回肠代膀胱造影、静脉肾盂造影显示,双肾良好,无输尿管反流、梗阻,充盈良好。所有患者术后均未发生尿失禁、排尿困难等并发症。护理满意度调查,满意28例,一般18例,不满意2例,满意度为95.83%。结论 经腹腔镜下膀胱全切除原位代膀胱术患者采用针对性护理配合,可促进术后恢复,预防并发症发生,且术后膀胱功能良好,值得临床推广应用。     

膀胱全切回肠代膀胱术患者的围术期护理

目的 总结膀胱全切除回肠代膀胱术病人的围术期护理.方法 对12例膀胱肿瘤的患者行膀胱全切回肠代膀胱术,术前做好心理护理、术前准备;术后密切观察病情及生命体征变化,予以对症护理及出院指导.结果 12例膀胱全切回肠代膀胱术无1例并发症发生,患者病情稳定,均取得满意的治疗效果.结论 加强膀胱全切除回肠代膀胱术病人的围术期护理是手术成功的保证.     

女性膀胱癌患者原位回肠和乙状结肠尿流改道效果的比较

背景：原位尿流改道在膀胱癌根治术后具有良好的控尿能力,但针对女性膀胱癌患者行原位回肠重建新膀胱和原位乙状结肠重建新膀胱后疗效及随访方面的研究很少。 目的：比较女性膀胱癌患者原位回肠和乙状结肠尿流改道的临床疗效。 方法：回顾性分析1996至2008年行膀胱癌术后原位回肠尿流改道(回肠组,n=29)和乙状结肠尿流改道(乙状结肠组,n=23)的女性膀胱癌患者的临床资料。比较分析两组患者修复中及修复后的一般情况、尿动力学结果、控尿能力和修复后储尿囊相关并发症等。 结果与结论：平均随访时间回肠组57个月,乙状结肠组55个月。两种修复方式术中失血量、术后控尿效果接近,但两组在手术时间、治疗后下床时间、新膀胱容量等方面差异有显著性意义(P < 0.05)。回肠组治疗后早期及晚期储尿囊相关并发症发生率均高于乙状结肠组。回肠组治疗后储尿囊再发肿瘤2例,乙状结肠组未见发生,说明两种重建方式应用于女性膀胱癌患者疗效均良好。     

主动膀胱功能训练对剖宫产患者术后排尿功能的影响分析

目的探讨主动膀胱功能训练对剖宫产患者术后排尿功能的影响。方法选择2019年2月～2020年1月于我院行剖宫产手术的196例患者作为研究对象,以随机数字表法将其随机分为两组,每组各98例。两组患者均在成功麻醉后留置一次性双腔气囊导尿管,对照组于术后2h采用夹闭尿管措施对膀胱功能进行刺激,当患者有尿意时开放尿管,尿管留置时间为术后24h。研究组在此基础上应用主动膀胱功能训练。对比两组产妇术后首次排尿时间、残余尿量、排尿效果(排尿通畅、辅助排尿、排尿困难)以及膀胱刺激征、尿潴留与尿路感染的发生率。结果研究组术后首次排尿时间与残余尿量均明显低于对照组(P0.01);研究组术后排尿通畅的发生率显著高于对照组,辅助排尿与排尿困难的发生率、尿潴留的发生率显著低于对照组(P0.05);两组产妇术后膀胱刺激征与尿路感染的发生率比较,差异无统计学意义(P0.05)。结论主动膀胱功能训练可以有效促进剖宫产女性术后的排尿功能,减少膀胱刺激征、尿潴留与尿路感染的发生率,值得临床推广。     

家庭认知功能训练对轻中度阿尔茨海默病患者生活质量和认知功能的影响

目的:探讨家庭认知功能训练对轻中度阿尔茨海默病患者的护理方法及实施效果。方法:采用2014年9月至2016年1月在荆州市精神卫生中心老年科住院的轻中度阿尔茨海默病患者80例,随机分为研究组(39例,精神科老年病房常规护理合并家庭认知功能训练)和对照组(41例,精神科老年病房常规护理),训练前后采用生活质量量表简表(WHOQOL-BREF)评定生活质量,采用韦氏成人智力量表(WAIS)及威斯康星卡分类测验(WCST)评价认知功能。结果:训练6月后,(1)研究组WHOQOL-BREF量表在心理领域、社会关系领域改善程度明显优于对照组(t=4.0885,3.7472;P0.05);(2)研究组WAIS量表在言语智商维度改善程度明显优于对照组(t=2.3126,P0.05);(3)研究组WCST量表在总测验数、正确百分数维度改善程度优于对照组(t=-2.1353,2.0571;P0.05)。结论:家庭认知功能训练能明显改善阿尔茨海默病患者的生活质量和认知功能,值得临床推广。     

护理干预对前列腺患者电切术后膀胱痉挛的影响

为了探讨对前列腺电切术后膀胱痉挛患者实施护理干预的临床效果.选择了我院在2013年5月～2014年5月接收的130例前列腺患者作为研究对象,所有患者均采用了电切术治疗,按照抽签的方武将其划分为对照组和实验组,对照组患者仅给予常规护理,而实验组患者在此基础上给予系统性的护理干预,然后对两组患者的焦虑发生情况和术后膀胱痉挛程度给予观察和记录.护理干预前,两组患者的焦虑发生率无明显差异,不具有统计学意义(P＞0 05),经过系统性的护理干预之后,实验组患者焦虑发生率(15 38％)明显低于对照组(64 62％),同时实验组患者膀胱痉挛轻度、中度和重度例数均低于对照组,他们之间的差异具有统计学意义(P＜0 05).对前列腺电切术患者实施系统性的护理干预,不仅可以缓解患者焦虑情绪,而且还能降低术后膀胱痉挛的程度和发生率,促进患者康复.     

心理干预对子宫全切患者的影响研究

目的探讨心理干预对子宫全切患者的康复效果。方法样本来自我院住院的100例子宫全切患者,随机分成两组,观察组和对照组各50例,于患者入院后第2天、术前1天及术后第3天进行SAS评分,观察组和对照组均接受常规护理,而观察组在此基础上由手术室护士实施术前、术中和术后的全程护理措施。结果与全国常模相比,所有子宫全切患者术前均存在明显的焦虑情绪;术前1天的SAS评分结果显示观察组的焦虑分值降低,而对照组则上升,两组有显著性差异（P＜0.01）;术后第3天SAS评分结果显示,两组均有不同程度的下降,但观察组与对照组组间相比仍有显著性差异（P＜0.05）。结论对子宫全切患者实施心理干预可降低病人的焦虑紧张情绪,减轻应激反应程度,调整病人的心理状态,对调动病人的主观能动性和自我控制能力,可产生积极的影响。     

不同频率肌力训练对膝关节镜下半月板成形术后患者功能康复的影响

目的 探讨膝关节镜下半月板成形术后不同频率肌力训练对患者功能康复及生活质量的影响。方法 选择2016年1月~2019年1月我院收治的行膝关节镜下半月板成形术患者84例为研究对象,采用随机数字表分为对照组和观察组,每组42例。对照组肌力训练次数控制在100次以内,观察组肌力训练次数在300次以上,比较两组治疗30 d后的康复程度、治疗前后生活质量（QOL）评分、治疗前与治疗10、20、30 d后膝关节功能评分（Lysholm评分）。结果 治疗后观察组拄拐、肿胀以及跋行情况低于对照组,差异有统计学意义（P＜0.05）;治疗后观察组生理职能、社会功能以及角色功能评分高于对照组,差异有统计学意义（P＜0.05）;治疗后观察组10、20、30 d Lysholm评分高于对照组,差异有统计学意义（P＜0.05）。结论 在膝关节镜下半月板成形术治疗中提高训练频率有助于提升患者功能康复及生活质量,值得应用。     

宫颈锥切术后行子宫全切术的间隔时间对 手术效果的影响分析

目的 探讨宫颈锥切术后再行子宫全切术的手术间隔时间对手术并发症的影响。方法 回顾性分析2012年1月~2018年10月银川市妇幼保健院宫颈锥切术后行子宫全切术76例患者临床资料,按照手术间隔时间不同分为三组,宫颈锥切术后72 h内行子宫全切术的22例患者设为A组;宫颈锥切术后72 h~4周行子宫全切术的患者25例设为B组;宫颈锥切术后4周以上行子宫全切术的29例患者设为C组,比较三组之间术中出血、手术时间、术后体温、手术并发症。结果 三组之间术中出血、手术时间比较,差异无统计学意义（P＞0.05）,而三组之间术后体温≥38℃的天数比较,差异有统计学意义（P＜0.05）,且B组术后体温≥38℃的天数多于A组与C组,差异有统计学意义（P＜0.05）。B组并发症发生率为44.00%,分别高于A组的13.64%和C组的13.79%,差异有统计学意义（P＜0.05）。结论 宫颈锥切术后72 h~4周行子宫全切术,术后并发症发生率高,术后感染率高,应避免在此时间段手术。     

Ⅲ型子宫切除术对患者下尿路功能的影响及其机制研究*

 目的： 通过对Ⅲ型子宫切除手术前后患者尿流动力学指标数据的分析对比,评估术后患者下尿路功能改变情况,探寻其发生机制、主要影响因素和变化趋势。方法: 选取Ⅲ型子宫切除手术患者,于术前后12～14 d和术后3个月分别对患者行尿流动力学检查,分析患者手术前后的尿动力学参数。结果: Ⅲ型子宫切除术后12～14 d残余尿量、尿流时间、排尿感容量和最大膀胱压较术前明显增加（P<0.05）;最大尿流率、平均尿流率、排尿量、膀胱容量、顺应性、逼尿肌压力、最大尿道压和最大尿道闭合压较术前明显下降（P<0.05）。术后3个月残余尿量、尿流时间、排尿感容量和最大膀胱压较术前增加（P<0.05）;而最大尿流率、逼尿肌压力、顺应性、最大尿道压和最大尿道闭合压则下降（P<0.05）。术后3个月与12～14 d相比最大尿流率、平均尿流率、排尿量、膀胱容量、顺应性和逼尿肌压力明显增加（P<0.05）,残余尿量和最大膀胱压明显减小（P<0.05）。结论: Ⅲ型子宫切除术后12～14 d多数患者出现明显的下尿路功能障碍：膀胱顺应性急剧减小所致储尿功能异常、逼尿肌无收缩力导致排尿功能障碍和尿道闭合压降低引起控尿功能下降。膀胱储尿、排尿功能术后3个月有所恢复,但没有恢复到术前状态。     

综合康复锻炼对改善低位直肠癌患者术后前切除综合征的效果

目的:探讨综合康复功能锻炼对改善低位直肠癌术后患者前切除综合征(anterior resection syndrome,ARS)的护理效果.方法:选择低位直肠癌术后并发ARS的98例患者,按住院号的顺序随机分为对照组和综合组,其中对照组49例患者采取常规盆底相关肌肉力量锻炼方案;综合组49例患者采取盆底肌锻炼与神经康复锻炼,分别比较两组患者干预前及干预后1,3,6个月时两组患者的前切除综合征评分(low anterior resection syndrome score,LARSS)及生存质量情况.结果:两组在干预前和干预后1个月时LARSS评分,差异无统计学意义(P＞0.05),综合组在干预后3个月和6个月时LARSS评分明显低于对照组,差异有统计学意义(P＜0.05);两组在时间效应、组间效应及时间组间效应值,差异均具有统计学意义(P＜0.05);两组在干预前及1个月时生活质量各维度评分,差异无统计学意义(P＞0.05);在干预后3个月和6个月时除环境功能外综合组患者的生活质量其他维度评分均高于对照组,差异有统计学意义(P＜0.05);除环境功能组间效应外,两组患者在生活质量所有指标的时间效应、组间效应及时间-组间效应,差异有统计学意义(P＜0.05).结论:通过开展盆底肌力锻炼联合神经康复锻炼较单纯盆底肌力锻炼更能够快速改善低位直肠癌术后ARS症状,对改善患者生存质量更为显著,在临床值得进一步推广.     

Expression of cell cycle-related molecular markers in patients treated with radical cystectomy for squamous cell carcinoma of the bladder

We evaluated the association of p53, p21, p27, cyclin E, and Ki-67 expression with pathologic features and clinical outcomes of patients with squamous cell carcinoma (SCC) of the urinary bladder. Immunohistochemical staining was performed on radical cystectomy specimens with pure SCC from 1997 to 2003. Bright field microscopy imaging coupled with advanced color detection software was used. The relationship between these markers and pathologic parameters as well as clinical outcome was assessed. The study included 152 patients (80.9% with bilharziasis), 99 males and 53 females, with a median age of 51 years (range, 36-74 years). The presenting stage was T2 or higher, and the presenting grade was grade II or lower in 93.4% of patients. Altered cyclin E expression was associated with stages (P = .02), altered p21 with grades (P = .02), and altered p27 with lymphovascular invasion (P = .01). In multivariable analyses, altered p53 expression was the only marker associated with an increased risk of disease recurrence (hazards ratio, 1.77; 95% confidence interval, 1.03-3.38, P = .04; and hazards ratio, 2.28; 95% confidence interval, 1.01-5.70, P = .05) and bladder cancer-specific mortality (hazards ratio, 1.76; 95% confidence interval, 1.06-2.99, P = .05, and hazards ratio, 2.64; 95% confidence interval, 1.05-5.54, P = .05) in all patients and in patients with T1-3N0 tumors, respectively. In conclusion, cell cycle-related molecular markers are commonly altered in SCC of the urinary bladder. Only p53 had a prognostic role in patients treated with radical cystectomy for SCC. Our findings support the need for further evaluation of molecular markers and their signaling pathways in SCC.     

Improving functional outcome in bipolar disorder: A pilot study on metacognitive training

Background

Effective group psychological interventions in bipolar disorder are rare. In this study, we present “metacognitive training (MCT) for bipolar disorder”—an adaption of a group intervention that has proven effective in other severe psychiatric disorders. MCT is a structured, interactive approach that addresses cognitive biases, social cognition, and self‐esteem. In this pilot study, we investigated psychosocial functioning as primary outcome measure, as well as the feasibility of MCT and its acceptance among bipolar patients.

Methods

Thirty‐four outpatients with bipolar disorder were recruited. Inclusion criteria were euthymia and psychosocial functioning with a score >11 assessed by the Functional Assessment Short Test. The subjects received eight weekly MCT sessions. Before and after the intervention, psychosocial functioning, quality of life (QoL), and patient views were assessed.

Results

Patients improved significantly in global psychosocial functioning, with a large effect size from baseline to post‐treatment. Over the intervention period, patient QoL improved significantly in terms of their physical health, however not for other QoL subdomains. Treatment adherence was 80%, and patients' appraisal of the training was positive.

Limitations

As this study lacks a control group, it is not possible to ascertain whether the positive treatment effects are attributable to MCT. Additionally, it is unclear whether gains in psychosocial functioning would have been maintained long term.

Conclusions

This pilot trial conclusively shows that MCT is feasible and provides preliminary evidence for both the acceptance and efficacy of MCT. Further studies with larger samples and control condition will be necessary to build on these findings.     

Effect of intense swimming training on rhinitis in high‐level competitive swimmers

Background Rhinitis is commonly reported by swimmers. Seasonal allergic rhinitis may impair athletes' performance and quality of life (QOL). No data are currently available on the changes of nasal symptoms during and after a swimming season. We aimed to determine in competitive swimmers: (1) the prevalence of rhinitis and its impact on their QOL during an intense training programme, (2) the changes in nasal symptoms and QOL after a resting period and (3) the relationship between rhinitis and airway hyperresponsiveness (AHR). Methods Thirty‐nine swimmers and 30 healthy controls answered the Rhinitis Quality of Life Questionnaire (RQLQ) and scored nasal symptoms on a seven‐point Likert scale during the week preceding their visit. Subjects had allergy skin prick tests and a methacholine challenge. Peak nasal inspiratory flows were also measured. The athletes performed these tests during an intense training period (V1), outside the pollen season and after at least 2 weeks without swimming (V2). Results At V1, rhinitis symptoms were reported by 74% of swimmers and 40% of controls (P<0.01). Eighty‐four percent of swimmers and 72% of controls were atopic (NS). RQLQ score was higher in swimmers compared with controls at V1 (27.3 ± 28.5 vs. 9.5 ± 12.7, respectively, P<0.005). The presence of AHR during training did not correlate with the presence of rhinitis symptoms. At V2, the nasal symptoms and RQLQ scores were similar in swimmers and controls. Conclusion Intense swimming training is associated with an increase in nasal symptoms and impairment in QOL in most competitive swimmers. Such an increase is not related to seasonal allergen exposure in atopic athletes and probably results from chlorine derivative exposure. Cite this as: V. Bougault, J. Turmel and L. P. Boulet, Clinical & Experimental Allergy, 2010 (40) 1238–1246.     

功能性消化不良患者抑郁心理对生活质量的影响

目的探讨功能性消化不良患者抑郁心理对生活质量的影响。方法应用李凌江等编制的生活质量综合评定问卷(gen-eral quality of life inventory,GOLI)评定48例功能性消化不良伴有明显抑郁症状患者的生活质量,并与52例无抑郁症状的功能性消化不良患者以及50例健康人进行比较。结论功能性消化不良伴抑郁症状患者除自尊、住房、收入与消费、生活环境等因素与健康对照组比较差异无显著性外,在生活质量的其他方面,功能性消化不良者均明显较健康对照组差(P<0.05)。与非抑郁组比较;认知功能、躯体不适感、生理功能、运动与感官功能等方面均明显降低(P<0.05),而非抑郁组与健康对照组除身体不适感、工作等方面下降外,其余各方面差异无显著意义。结论功能性消化不良伴抑郁症状患者生活质量明显降低。     

Pathology of flat bladder lesions with emphasis on putative precursors

Flat bladder lesions comprise a spectrum of morphologic changes ranging from reactive atypia to carcinoma in situ (CIS). Differentiating these lesions is important because of differences in patient management and clinical outcome. The precise nature of precursor lesions of bladder cancer remains incompletely understood. Urothelial CIS is the most definitely characterized precursor lesion of high grade bladder cancer. Atypia of unknown significance (AUS) is somewhat controversial. For practical purposes, AUS and reactive urothelial changes should be considered a single entity, since neither lesion has established preneoplastic potential. Simple hyperplasia and papillary hyperplasia are recently identified putative preneoplastic lesions. More recent molecular data also support the precursor nature of intestinal metaplasia and keratinizing squamous metaplasia. In this review, we also discuss the utility of molecular ancillary studies in establishing premalignant lesions, diagnosis, and differential diagnosis of flat bladder lesions.     

功能性电刺激训练对痉挛型脑瘫儿童运动功能的影响

目的:研究功能性电刺激训练（FES）对痉挛型脑瘫（SCP）儿童运动功能的影响。方法:选取2018年10月~2020年6月就诊于郴州市第一人民医院康复科的80例SCP患儿,根据随机数字表法将患儿分为观察组（n=40）和对照组（n=40）,对照组行常规康复训练,观察组在其基础上行FES,治疗3个月。比较治疗前后两组Peabody精细运动发育量表（PDMS-FM）评分、Barthel指数评定量表（BI）评分、婴儿-初中学生社会生活能力量表（S-M）评分。结果:治疗后两组PDMS-FM各项评分显著升高,观察组升高幅度显著大于对照组（P<0.05）;治疗后两组BI评分显著升高,观察组升高幅度显著大于对照组（P<0.05）;治疗后两组S-M各项评分及总分显著升高,观察组升高幅度显著大于对照组（P<0.05）。结论:FES不仅能够有效提高SCP患儿的运动功能,而且对改善患儿日常生活能力、适应行为能力也有着积极的临床意义。     

临床路径式早期康复训练对颅脑创伤术后患者误吸与吸入性肺炎的影响

目的：探究临床路径式早期康复训练对颅脑创伤术后患者误吸与吸入性肺炎的影响。方法：选取我院2015年3月至2016年3月收治的80例颅脑创伤患者作为研究对象,在确定患者或其家属如实掌握此次研究方案内容且签署知情同意书后随机分为对照组(常规护理)及研究组(临床路径式早期康复训练)各40例,比较两组患者临床护理效果。结果：研究组误吸发生率15%、吸入性肺炎发生率10%,而同期对照组误吸发生率30%、吸入性肺炎发生率20%,组间差异有统计学意义(P<0.05)。结论：临床路径式早期康复训练可显著降低颅脑创伤术后误吸与吸入性肺炎发生率,可作为优选护理方案推广使用。