ICU失禁患者失禁相关性皮炎风险预测模型

目的 构建适用于ICU患者的失禁相关性皮炎(IAD)风险预测模型,并验证模型的预测效能.方法 前瞻性观察300例失禁患者的IAD发生情况,根据多元Logistic回归分析确定的影响因素,构建适用于ICU患者的(IAD)的风险预测模型,继续收集168例失禁患者,对风险预测模型进行外验证.结果 年龄、急性生理学及慢性健康状...     

液体敷料联合蒙脱石散治疗老年卧床病人失禁性皮炎的效果观察

<正>失禁性皮炎(incontinence-associated dermatitis,IAD)是潮湿相关性皮肤损伤的一种,是由于皮肤暴露于大小便而引起的一种刺激性皮炎,主要发生在会阴部、骶尾部、臀部、腹股沟、阴囊、阴唇、大腿内侧及后部~([1])。主要表现为皮肤发红,伴有或不伴有水泡、渗液、糜烂及皮肤的二重感染~([2])。大小便失禁是老年病人中最为常见的疾病,各个系统的疾病均有可能导致大小便失禁~([3])。IAD是导致压疮的高危因素,不仅造成患者的痛苦、延长住院时间、增加住院费用,而且也增加了护理工作的难度~([4])。如何快速和有效地护理IAD病人已成为护理人员思考和关注的问题,本研究     

血清前白蛋白与重症患者失禁相关性皮炎的相关性

目的研究血清前白蛋白(PA)与重症患者失禁相关性皮炎(IAD)的关联性。方法采用前瞻性队列研究方法,对河南省人民医院呼吸重症监护室符合纳入排除标准的584例IAD患者进行调查,调查结局事件为发生IAD,采用Cox比例风险模型,分析PA与IAD的相关性。结果 PA、血清白蛋白和布里斯托分类(BSFS)是重症患者IAD发生的主要影响因素,在调整BSFS后,PA对其危险度为1.342(95%CI 0.936～1.540,P=0.006)。结论 PA是重症患者IAD发生的重要消极因素,可增加IAD的发生,即PA对重症患者IAD的发生有预测作用。     

藏红花高渗盐水治疗老年糖尿病并发失禁性皮炎的疗效观察

<正>失禁性皮炎(IAD)是大小便失禁引起的并发症,也是失禁病人常见的临床问题〔1〕。老年糖尿病患者由于移动障碍、营养不良及自我保护能力下降等因素易并发IAD,发生IAD创面愈合缓慢或不愈易继发感染,炎症难以控制,延长住院时间,加重其经济负担,严重时会因继发败血症危及生命,导致死亡,也给临床护理带来负担。本研究旨在观察藏红花高渗盐水治疗老     

喷洗法对老年卧床病人大便失禁相关性皮炎预防的效果评价

正失禁相关性皮炎(incontinence-association dermatitis,IAD)是老年大便失禁卧床病人常见并发症,多伴有水疱或皮肤破损,致使疼痛、感染或压疮~([1])。而老年卧床病人疾病复杂,应用抗生素的种类多,造成肠道菌群失调、抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)的发生率为25%～30%~([2])。维持和增强大便失禁病人皮肤完整性是在国际上已达成广泛共识的一项长期护理目标~([3])。皮肤清洁是大便失禁处理尤为关键的第一步,而采用擦洗法清洗皮肤,易损伤皮肤角质层,且皮肤褶皱处易残留粪便,导致皮肤炎症,造成IAD发生。有文献报道,在温盐水瓶瓶     

伤口评估三角联合新型敷料在老年患者压力性损伤中的应用

目的 观察伤口评估三角联合新型敷料在老年患者压力性损伤中的应用效果。方法 选取2019年1月至2020年12月我院院内发生或院外带入的压力性损伤2期、3期、4期老年患者108例,分为试验组与对照组各54例,其中试验组共有伤口62处,对照组共有伤口67处。对照组给予基础治疗、常规护理、新型敷料换药的处理措施;试验组给予基础治疗、常规护理,并运用伤口评估三角工具对伤口进行评估后选择合适的新型敷料换药的处理措施。分别观察两组患者的愈合时间和愈合效果。结果 与对照组比较,试验组总愈合时间明显缩短,愈合率显著提升(P<0.05)。结论 伤口评估三角联合新型敷料可缩短老年患者压力性损伤的伤口愈合时间,提高伤口愈合率,改善患者生活质量,值得临床中推广。     

老年烧伤患者失禁性皮炎发生的相关因素

目的分析老年烧伤患者失禁性皮炎发生的相关因素。方法选择两家医院于2011年1月至2015年2月收治的老年烧伤患者120例,分析其临床治疗,如年龄、性别、意识状态、皮肤保护剂应用情况等,采取非条件Logistic逐步回归分析烧伤患者发生失禁性皮炎发生的相关因素。结果 120例患者中发生失禁性皮炎35例(29.2%)。经分析,患者意识状况、皮肤保护剂、局部潮湿频次、低蛋白血症及是否伴有糖尿病为失禁性皮炎发生相关因素(均P0.05)。结论患者意识状况、皮肤保护剂、低蛋白血症等因素均为失禁性皮炎发生相关因素,应注意预防。     

Norton量表对ICU低温体外循环心脏外科术后患者压力性损伤的预测价值及护理策略

目的分析Norton量表对ICU低温体外循环心脏外科术后患者压力性损伤的预测价值及护理策略。方法选取2017年在新疆医科大学第一附属医院行低温体外循环心脏外科手术并转入ICU的患者322例,根据压力性损伤发生情况分为压力性损伤组108例和非压力性损伤组214例。比较两组患者Norton量表总分及各项评分;Norton量表各项评分与ICU低温体外循环心脏外科术后患者压力性损伤的关系分析采用多因素Logistic回归分析;结合预试验数据计算Cronbach'sα系数以评价Norton量表的信度;绘制ROC曲线以评价Norton量表总分对ICU低温体外循环心脏外科术后患者压力性损伤的预测价值。结果 (1)两组患者Norton量表评分比较,差异无统计学意义(P0.05)。两组患者身体状况、活动能力、失禁情况评分比较,差异无统计学意义(P0.05);压力性损伤组患者精神状况、移动能力评分低于非压力性损伤组(P0.05)。(2)多因素Logistic回归分析结果显示,Norton量表移动能力评分是ICU低温体外循环心脏外科术后患者压力性损伤的独立影响因素〔OR=1.776,95%CI(1.071,2.946),P0.05〕。(3)预试验结果显示,Norton量表的Cronbach'sα系数为0.538。(4)绘制ROC曲线发现,Norton量表总分预测ICU低温体外循环心脏外科术后患者压力性损伤的曲线下面积(AUC)为0.413〔95%CI(0.349,0.476)〕,最佳截断值为15.5分,灵敏度为69.4%,特异度为24.8%。结论 ICU低温体外循环心脏外科术后患者压力性损伤发生率较高,但Norton量表对此类患者压力性损伤的信度、预测价值较低,需结合其他量表以有效评估压力性损伤发生风险及指导护理策略的制定。     

心内直视术后压力性皮肤损伤的回顾性分析

目的通过分析我院心内直视术后3天内压力性皮肤损伤形成的危险因素,探讨有效的预防和护理方法。方法回顾性分析183例需要心内手术的患者资料,包括患者的一般资料、手术类型、手术持续时间、疾病类型、合并糖尿病、体位,压力性皮肤损伤部位、术前营养状况、术中情况、体外循环相关指标,并对所有可能导致压力性皮肤损伤发生的指标进行单因素分析。结果 183例心内直视手术,发生压力性皮肤损伤有8例,手术持续时间、高龄、合并糖尿病、体温、血清白蛋白、心功能分级这些指标的发生率比较,差异有统计学意义(P0.05)。结论心内直视术后发生压力性皮肤损伤的患者其手术持续时间长、高龄、合并糖尿病、低体温、低血清白蛋白、心功能差等是造成心内直视术后压力性皮肤损伤的主要危险因素,因此护理人员应尽早启动此类患者的术前风险评估及相应的预防护理措施。     

孤立性促肾上腺皮质激素缺乏症的诊疗进展

孤立性促肾上腺皮质激素缺乏症(IAD)是一种罕见病, 表现为单纯的下丘脑-垂体-肾上腺轴受累, 血清皮质醇水平降低, 促肾上腺皮质激素水平绝对或相对不足, 甲状腺轴、生长激素轴及性腺轴功能正常。IAD的具体发病机制尚不明确, 可能与机体自身免疫性破坏、垂体缺血性损伤、促肾上腺皮质激素释放激素缺乏、POMC基因缺陷、转录因子基因突变、激素原转化酶1结构突变, 以及药物性损伤有关;IAD的临床表现缺乏特异性, 成人及部分型的IAD患者多表现为乏力、纳差、恶心, 以及不同程度的低血糖、低血钠, 完全型IAD的患者症状相对较重, 常见有严重低血糖、癫痫发作、胆汁淤积性黄疸;IAD的诊断关键在于腺垂体和靶腺激素水平的测定, 治疗以补充糖皮质激素为主。临床上, 很多患者症状反复发作, 长期得不到确诊, 严重影响了生活质量。因此, 本综述通过对IAD临床特点的讨论, 以提高医生对该疾病的认识, 使患者能够得到早期诊断、早期治疗, 获得良好的预后。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

N-acetyl-L-cysteine combined with mesalamine in the treatment of ulcerative colitis： Randomized,placebo-controlled pilot study

AIM： To evaluate the effectiveness and safety of oral N-acetyl-L-cysteine （NAC） co-administration with mesalamine in ulcerative colitis （UC） patients.
METHODS： Thirty seven patients with mild to moderate UC were randomized to receive a four-wk course of oral mesalamine （2.4 g/d） plus N-acetyl-L-cysteine （0.8 g/d） （group A） or mesalamine plus placebo （group B）. Patients were monitored using the Modified Truelove-Witts Severity Index （MTWSI）. The primary endpoint was clinical remission （MTWSI ≤ 2） at 4 wk. Secondary endpoints were clinical response （defined as a reduction from baseline in the MTWSI of ≥ 2 points） and drug safety. The serum TNF-α, interleukin-6, interleukin-8 and MCP-1 were evaluated at baseline and at 4 wk of treatment. RESULTS： Analysis per-protocol criteria showed clinical remission rates of 63% and 50% after 4 wk treatment with mesalamine plus N-acetyl-L-cysteine （group A） and mesalamine plus placebo （group B） respectively （OR = 1.71; 95% CI： 0.46 to 6.36; P = 0.19; NNT = 7.7）. Analysis of variance （ANOVA） of data indicated a significant reduction of MTWSI in group A （P = 0.046） with respect to basal condition without significant changes in the group B （P = 0.735） during treatment. Clinical responses were 66% （group A） vs 44% （group B） after 4 wk of treatment （OR = 2.5; 95% CI： 0.64 to 9.65; P = 0.11; NNT = 4.5）. Clinical improvement in group A correlated with a decrease of IL-8 and MCP-1. Rates of adverse events did not differ significantly between both groups.
CONCLUSION： In group A （oral NAC combined with mesalamine） contrarily to group B （mesalamine alone）, the clinical improvement correlates with a decrease of chemokines such as MCP-1 and IL-8. NAC addition not produced any side effects.     

Delorme's transrectal excision for internal rectal prolapse

Surgical therapy of functional outlet obstruction in patients with internal rectal intussusception may include abdominal, perineal, or transrectal procedures. Because abdominal procedures often result in significant physiologic impact but unrelieved constipation, the authors have elected Delorme's transrectal excision for management of these patients. Since a short-term placebo effect attends many therapies, this report describes results of transrectal excision only after a threeyear postoperative period. Delorme's transrectal excision of internal intussusception accomplished sustained symptomatic relief in over 70 percent of otherwise refractory constipated patients. The association of internal intussusception with other abnormalities underscores the importance of defining both anatomic and functional components when selecting patients whose constipation may require surgical therapy. Critical technical elements, surgical pitfalls, and potential complications of the procedure are discussed.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Toronto, Canada, June 11 to 16, 1989.     

The oral glucose tolerance test: A comparison of the time points on the basis of limit values,normal dispersion,and reproducibility

Summary Time points in the glucose tolerance test (GTT) are compared on the basis of limit values, dispersion within a reference population, and reproducibility. We suggest using the distance between a limit value and the median reference value as a measure of the magnitude of abnormality. The distance between 140 mg/100 ml and the median fasting plasma glucose value is chosen as a standard distance and limits for other points in the GTT are calculated to equal this standard distance of abnormality. We suggest that the probability of correctly interpreting an inividual result is directly related to the reproducibility of the test and inversely related to the percentage of the total range of values which is dispersed among the normal population. The ratio of reproducibility to percentage normal dispersion is proposed as an index of the probability of correctly interpreting an individual result. According to this index, the probability of correct interpretation varies in order: fasting plasma glucose concentration>3-h>2-h>0.5-h>1-h plasma glucose concentration.