结直肠癌术后患者支持性照顾需求现状及影响因素的研究

目的 调查多发性骨髓瘤患者及其配偶恐惧疾病进展现状,并分析其影响因素.方法 采用一般资料调查问卷、恐惧疾病进展简化量表、配偶恐惧疾病进展简化量表对某肿瘤专科医院就诊的多发性骨髓瘤患者及其配偶进行调查,并对患者恐惧疾病进展的影响因素进行单因素和多重线性回归分析.结果 多发性骨髓瘤患者恐惧疾病进展简化量表总分为(35.16±10.95)分;其配偶的恐惧疾病进展简化量表总分为(35.59±10.09)分;多重线性回归分析结果显示,患者家庭人均月收入、有无并发症、心理辅导需求及配偶恐惧疾病进展水平是多发性骨髓瘤患者恐惧疾病进展的影响因素,共同解释患者恐惧疾病进展总变异的49.6％(P<0.001).结论 多发性骨髓瘤患者及其配偶恐惧疾病进展均处于中等水平,患者恐惧疾病进展受患者家庭人均月收入、有无并发症、心理辅导需求及配偶恐惧疾病进展水平影响.     

心脏病患者的心理护理

由于心脏病病程长,疾病常常反复发作,患者常伴随严重的心理问题,如焦虑、恐惧、忧郁等,同时,精神紧张、情绪波动又会对心脏功能产生明显的不良影响.因此,对心脏病患者的心理护理非常重要,心理护理在心脏病患者的治疗和康复过程中具有重要的作用.通过心理护理可以让患者了解自己的问题,学会自我保健的方法,增强应付疾病的信心,减轻精神紧张,积极配合治疗,提高患者的生活质量.我们通过对1 079例心脏病患者手术前后的心理因素分析和实施心理护理,收到满意临床效果,现总结如下.     

口腔颌面部恶性肿瘤病人恐惧疾病进展与心理弹性的相关性研究

目的:了解口腔颌面部恶性肿瘤病人恐惧疾病进展和心理弹性的水平,分析两者间的关系。方法:运用横断面调查法,采用人口学问卷、中文版恐惧疾病进展简化量表、自我形象量表及心理弹性量表对2019年1月—2019年10月诊治的123例口腔颌面部恶性肿瘤病人进行调查,分析影响病人恐惧疾病进展的因子及恐惧疾病进展和心理弹性的关系。结果:本研究123例口腔颌面部恶性肿瘤病人恐惧疾病进展总得分为(38.55±8.07)分,其心理弹性总得分为(69.65±9.12)分,两者间呈负性相关(P<0.05)。病人的收入水平、癌症分期、疾病进展和自我形象是恐惧疾病进展的影响因子。结论:口腔颌面部恶性肿瘤病人有重度的恐惧疾病进展心理,且与心理弹性紧密联系。因此,临床人员可通过提高口腔颌面部恶性肿瘤病人心理弹性来降低其对疾病进展的恐惧。     

糖尿病患者保护性动机及其与疾病恐惧和心理痛苦的相关性

目的探讨基于保护动机理论的护理干预对糖尿病患者疾病恐惧与心理痛苦的影响。方法选取2017年5月-2018年5月在我院治疗的2型糖尿病患者180例,随机分为两组,各90例。对照组给予常规护理,观察组实施基于保护动机理论的护理干预。采用恐惧疾病进展简化量表(FoP-Q-SF)及糖尿病心理痛苦量表(DDS)评估两组患者干预前后疾病恐惧与心理痛苦状况。结果两组患者干预前疾病恐惧、心理痛苦得分无明显差异(P>0.05);干预后观察组疾病恐惧、心理痛苦得分均比干预前明显降低(P<0.05);干预后观察组疾病恐惧、心理痛苦得分低于对照组(P<0.05)。结论基于保护动机理论的护理干预能减轻糖尿病患者的疾病恐惧与心理痛苦,改善患者心理健康状况。     

宫颈癌患者后装治疗期间心理恐惧特征及相关影响因素分析

目的 调查宫颈癌患者后装治疗期间心理恐惧特征,并探讨影响患者恐惧感的相关因素。 方法 选取我院2017年10月~2020年12月收治的接受后装治疗的宫颈癌患者181例,使用恐惧疾病进展简化量表(FoP-Q-SF)评估患者心理恐惧情况。按照患者FoP-Q-SF评分,将评分＞34分者纳入强恐惧组,将评分≤34分者纳入对照组。分析患者心理恐惧特征,并使用Logistic多因素回归分析,总结影响宫颈癌患者后装治疗期间心理恐惧的相关因素。 结果 181例患者FoP-Q-SF量表平均得分为(24.49±6.51)分,其中33例(18.23%)量表得分＞34分;患者心理恐惧主要集中于疾病对家庭的影响,其次为担忧疼痛、因疾病可能进展而焦虑。Logistic多因素回归分析示,年龄≤40岁、文化水平高中以下、确诊至调查时间≤1年是影响宫颈癌患者后装治疗期间心理恐惧的危险因素,事业单位工作为保护因素(P值均<0.05)。 结论 宫颈癌患者后装治疗期间易出现恐惧心理,且对家庭、疼痛及疾病进展的担忧是造成心理恐惧的主要原因;年龄、学历、治疗时间、职业等因素均与患者心理恐惧的形成与加剧有关,护理干预中应强调高危患者的心理调节以帮助患者降低心理恐惧。     

348例传染病患者恐惧疾病进展及影响因素分析

目的探讨传染病患者住院治疗期间恐惧疾病进展现状,并分析其影响因素。方法采用方便抽样的方法 ,于2018年7—8月采用一般资料问卷、恐惧疾病进展简化量表、多伦多述情障碍量表,对湖南省9所二级甲等以上医院的348例传染病住院患者进行调查。采用多元线性回归分析恐惧疾病进展的影响因素。结果 348例传染病患者恐惧疾病进展简化量表与述情障碍量表总分分别为(39.86±9.14)分、(56.37±8.53)分。多元线性回归分析结果显示,性别、有无宗教信仰、有无子女及述情障碍进入回归方程(P0.01)。结论传染病患者恐惧疾病进展心理处于较高水平,受性别、有无宗教信仰、有无子女与述情障碍得分的影响。临床工作者应根据传染病患者的特点,制定相应的干预措施改善传染病患者的述情障碍,从而减轻传染病患者过度恐惧疾病进展心理,提高治疗效果。     

疾病进展恐惧对青年淋巴瘤患者生育忧虑的影响研究

目的调查青年淋巴瘤患者生育忧虑现状并分析影响因素,探讨其生育忧虑和疾病进展恐惧之间的关系。方法采用便利抽样法选取2020年7月至2021年3月在郑州市两所三级甲等医院就诊的199例青年淋巴瘤患者为研究对象,采用一般资料调查表、癌症后生育忧虑量表以及疾病进展恐惧简化问卷对其进行调查。结果青年淋巴瘤患者生育忧虑得分为(57.89±9.80)分,年龄、生育意愿、文化程度和疾病进展恐惧是其生育忧虑的影响因素,可解释总变异水平的70.8%(均P0.01)。青年淋巴瘤患者的生育忧虑与疾病进展恐惧之间呈正相关(r=0.78,P0.01)结论青年淋巴瘤患者生育忧虑水平高,疾病进展恐惧会加剧其生育忧虑。护士应结合影响因素,通过信息支持与积极心理疗法等措施降低青年患者疾病进展恐惧水平,帮助其积极应对生育忧虑。     

家庭坚韧力在多发性骨髓瘤患者社会支持与恐惧疾病进展间的中介效应

目的 调查多发性骨髓瘤患者恐惧疾病进展、家庭坚韧力及社会支持现状,探讨家庭坚韧力在多发性骨髓瘤患者社会支持与恐惧疾病进展间的中介效应。方法 采用便利抽样法,2018年10月—2019年3月选取在广州市某三级甲等肿瘤专科医院血液科病房诊疗的多发性骨髓瘤患者作为研究对象。采用恐惧疾病进展简化量表、家庭坚韧性量表和社会支持量表,对127例多发性骨髓瘤患者进行调查。采用AMOS 22.0构建结构方程模型,检验多发性骨髓瘤患者家庭坚韧力在社会支持和癌症复发恐惧间的中介效应。结果 多发性骨髓瘤患者的恐惧疾病进展总分为（35.05±11.09）分,家庭坚韧性总分为（57.65±7.73）分,社会支持总分为（40.68±7.98）分;多发性骨髓瘤患者社会支持及家庭坚韧力总分与恐惧疾病进展总分均呈负相关（P<0.01）;家庭坚韧力对恐惧疾病进展有直接（负向）效应（β=-0.400,P<0.05）;社会支持对恐惧疾病进展有直接（负向）效应（β=-0.430,P<0.05）,并可通过家庭坚韧力间接影响恐惧疾病进展,家庭坚韧力在社会支持和恐惧疾病进展间存在中介效应（β=-0.125,P<0.05）。结论 56.7%多发性骨髓瘤患者存在恐惧疾病进展心理功能失调,其家庭坚韧力处于中等水平,社会支持度良好;家庭坚韧力在多发性骨髓瘤患者社会支持和恐惧疾病进展间起中介效应。应针对患者家庭坚韧力进行干预,促进家庭和社会支持,能减轻多发性骨髓瘤患者的恐惧疾病进展水平。     

子宫肌瘤腹腔镜剔除术患者术后恐惧疾病进展的现状及影响因素研究

目的 探讨子宫肌瘤患者腹腔镜剔除术后恐惧疾病进展的现状及影响因素.方法 选择2018年6月—2020年9月江西省肿瘤医院收治的80例子宫肌瘤患者作为研究对象.术后3 d,采用自制恐惧疾病进展量表评估患者恐惧疾病进展程度,并分析年轻子宫肌瘤患者腹腔镜剔除术后恐惧疾病进展的影响因素.结果 单因素分析结果显示,无子女、初中及...     

青年鼻咽癌患者疾病进展恐惧现状及其与放疗后症状困扰的相关性研究

目的 ：调查青年鼻咽癌患者疾病进展恐惧现状,并分析其与放疗后症状困扰的相关性。方法 ：采用便利抽样法,选取2020年1月至2021年10月于广西某医院出院的104例青年鼻咽癌患者为调查对象。使用一般资料调查表、疾病进展恐惧简化量表、M.D.Anderson症状调查表-头颈部进行调查。结果 ：青年鼻咽癌患者的疾病进展恐惧简化量表总分为（37.48±10.12）分,M.D.Anderson症状调查表-头颈部总分为95.00(61.25,147.00)分;青年鼻咽癌患者疾病进展恐惧与疼痛、疲劳（乏力）、苦恼、感到悲伤难过、发音或讲话困难等放疗后症状呈正相关（P<0.05）。结论 ：青年鼻咽癌患者疾病进展恐惧达到高度恐惧水平,与放疗后部分症状有相关性。医务人员应重视青年鼻咽癌患者疾病进展恐惧现状,根据其特点及相关因素制定干预措施,以缓解青年鼻咽癌患者疾病进展恐惧程度。     

Celiac disease and autoimmune thyroid disease

Celiac disease (CD) or gluten sensitive enteropathy is relatively common in western populations with prevalence around 1%. With the recent availability of sensitive and specific serological testing, many patients who are either asymptomatic or have subtle symptoms can be shown to have CD. Patients with CD have modest increases in risks of malignancy and mortality compared to controls. The mortality among CD patients who comply poorly with a gluten-free diet is greater than in compliant patients. The pattern of presentation of CD has altered over the past three decades. Many cases are now detected in adulthood during investigation of problems as diverse as anemia, osteoporosis, autoimmune disorders, unexplained neurological syndromes, infertility and chronic hypertransaminasemia of uncertain cause. Among autoimmune disorders, increased prevalence of CD has been found in patients with autoimmune thyroid disease, type 1 diabetes mellitus, autoimmune liver diseases and inflammatory bowel disease. Prevalence of CD was noted to be 1% to 19% in patients with type 1 diabetes mellitus, 2% to 5% in autoimmune thyroid disorders and 3% to 7% in primary biliary cirrhosis in prospective studies. Conversely, there is also an increased prevalence of immune based disorders among patients with CD. The pathogenesis of co-existent autoimmune thyroid disease and CD is not known, but these conditions share similar HLA haplotypes and are associated with the gene encoding cytotoxic T-lymphocyte-associated antigen-4. Screening high risk patients for CD, such as those with autoimmune diseases, is a reasonable strategy given the increased prevalence. Treatment of CD with a gluten-free diet should reduce the recognized complications of this disease and provide benefits in both general health and perhaps life expectancy. It also improves glycemic control in patients with type 1 diabetes mellitus and enhances the absorption of medications for associated hypothyroidism and osteoporosis. It probably does not change the natural history of associated autoimmune disorders.     

Lyme disease

PURPOSE: To review the presentation, treatment, and prevention of Lyme disease in primary care. DATA SOURCES: Selected articles from the scientific literature and the Centers for Disease Control. CONCLUSIONS: Lyme disease is a tick-borne, multisystem inflammatory disease with worldwide distribution caused by the spirochete Borrelia burgdorferi. Lyme disease is initially characterized by a spreading, annular erythema migrans skin rash and can disseminate to the musculoskeletal, neurologic, or cardiovascular system. Stages of the disease present with varying clinical manifestations. IMPLICATIONS FOR PRACTICE: Treatment of Lyme disease with appropriate antimicrobial therapy should be prompt in order to avoid debilitating outcomes. Awareness of the many presentations of Lyme disease in endemic areas may facilitate a timely diagnosis and appropriate treatment.     

Tay-Sachs disease

Tay-Sachs disease (TSD) is a neurodegenerative disease that is caused by mutations in the HEXA gene. These mutation cause low or absent activity of the enzyme beta-hexosaminidase A which leads to GM2 build up in brain and spinal cells causing muscle weakness, regression of milestones, and difficulty with mobility. There are three forms of TSD: infantile, juvenile, and late onset/adult form. This inherited genetic disorder is autosomal recessive and most frequently seen in Ashkenazi Jewish, Old Order Amish, and Cajun populations. It is important for people at high risk for TSD to get genetic counseling/and or screening. There is no cure for TSD, treatment focuses on alleviating symptoms of the disease.     

Inflammatory bowel disease

Crohn disease and ulcerative colitis are the most common forms of inflammatory bowel disease (IBD) likely to be encountered in primary care. Patient-centered care is essential for positive outcomes, and should include long-term continuity with an empathetic primary care provider who can provide skillful coordination of the requisite multidisciplinary approach. Early suspicion of the diagnosis and referral to expert gastroenterologists for confirmation and medical management is essential. Coordinating interdisciplinary consultations, including colorectal surgeons, radiologists, stoma therapists, psychologists, and rheumatologists, in combination with comprehensive patient education, is key to decreasing overall morbidity, mortality, and health care costs associated with IBD.     

Angiography of colonic Crohn's disease

The zoning sign can be demonstrated in 50% of angiographies in colonic Crohn's disease and provides a reliable differential diagnostic aid against ulcerative colitis. The composition of the sign has been enlarged by the recognition of a zone C. The application of angiography in the radiologic diagnosis of inflammatory disease of the colon is discussed.     

Platelets and cardiovascular disease

Platelets play an important, but often under-recognized role in cardiovascular disease. For example, the normal response of the platelet can be altered, either by increased pro-aggregatory stimuli or by diminished anti-aggregatory substances to produce conditions of increased platelet activation/aggregation and occur in active cardiovascular disease states both on a chronic (e.g. stable angina pectoris) and acute basis (e.g. acute myocardial infarction). In addition, platelet hyperaggregability is also associated with the risk factors for coronary artery disease (e.g. smoking, hypertension, and hypercholesterolaemia). Finally, the utility of an increasing range of anti-platelet therapies in the management of the above disease states further emphasizes the pivotal role platelets play in the pathogenesis of cardiovascular disease. This paper provides a comprehensive overview of the normal physiologic role of platelets in maintain homeostasis, the pathophysiologic processes that contribute to platelet dysfunction in cardiovascular disease and the associated role and benefits of anti-platelet therapies.     

帕金森病与阿尔茨海默病患者的经颅超声图像分析

目的 对比分析帕金森病（PD）和阿尔茨海默病（AD）患者的经颅超声（TCS）图像变化特点。方法 对38例PD、28例AD及26名健康志愿者行TCS检查,分析其黑质回声、3脑室宽度及大脑中动脉血流参数变化特点。结果 黑质异常强回声比例PD组（31/38,81.58%）高于AD组（8/28,28.57%）和对照组（3/26,11.54%）,差异均有统计学意义（χ²=18.74、30.41,P均<0.001）,而AD组和对照组间无明显差异（χ²=2.41,P=0.120）;3脑室宽度AD组[（0.82±0.14）cm]大于PD组[（0.63±0.16）cm]和对照组[（0.56±0.16）cm],差异均有统计学意义（P均<0.001）,而PD组和对照组间差异无统计学意义（P=0.098）;双侧大脑中动脉平均流速AD组均低于PD组和对照组,右侧大脑中动脉搏动指数AD组高于PD组和对照组,差异均有统计学意义（P均<0.05）。结论 通过TCS检查,联合黑质回声、3脑室宽度及大脑中动脉血流变化,可为PD及AD的诊断提供有价值的神经影像学信息。     

川崎病并发冠状动脉病变的危险因素分析

目的探讨川崎病并发冠状动脉病变的危险因素。方法对60例确诊为川崎病患儿的临床表现,超声心动图、急性期C-反应蛋白、胆固醇、血沉、血小板、血红蛋白、白细胞等资料进行计量资料t检验、计数资料χ2检验、Logistic多元回归分析。结果60例川崎病并发冠状动脉病变18例(30%)。单因素分析显示:发热天数、血小板、C-反应蛋白、胆固醇与冠状动脉病变发生率有密切关系(P<0.01)。多因素Logistic多元回归分析显示:C-反应蛋白、胆固醇与冠状动脉病变密切相关(P<0.01)。结论对川崎病进行综合分析,可对该病作出及时的预后判断,予早期干预治疗,促进冠状动脉病变的恢复。     

Mycobacterium europaeum lung disease in an immunocompetent patient without underlying lung disease

Mycobacterium europaeum (M. europaeum) was recently identified as a nontuberculous mycobacterium belonging to the Mycobacterium simiae complex. There have been only a few reported cases of M. europaeum lung disease, all of which occurred in patients with immunodeficiency or prior lung disease. We herein report a case of M. europaeum lung disease in an otherwise healthy Japanese individual. A 70-year-old woman who had no apparent immunodeficiency or medical history was diagnosed with M. europaeum lung disease by multiple positive sputum cultures. The patient was successfully treated with clarithromycin, rifampin, ethambutol, and amikacin. This report is the first case of M. europaeum lung disease occurring in an individual without predisposing risk factors.     

运动神经元病及运动神经元病综合征

目的探讨运动神经元病综合征(MNDS)的病因、发病机制、诊断。方法回顾性分析90例运动神经元病(MND)及MNDS的临床特点和诊疗过程。结果MND38例(42.4%),对症及支持治疗,总有效率21.4%;MNDS52例(57.8%),病因为主治疗,总有效率61.5%。两者疗效差异显著(P<0.01)。结论明确MNDS的病因,对治疗及预后极为重要。