腹膜透析患者精神症状和健康状况的相关性分析及护理干预

目的:探讨腹膜透析患者的精神症状即焦虑、抑郁症状与健康状况的关系及相应的护理干预措施。方法:选取75例透析>3个月的稳定腹膜透析患者,调查其主观生存质量、睡眠质量、乏力程度;记录Karnofsky评分(代表患者的客观生存质量/健康状况);分别使用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估患者的抑郁、焦虑症状,并分为抑郁组与非抑郁组、焦虑组与非焦虑组,同时比较各项指标在组间差异。结果:本组抑郁症状的发生率为37.3%,焦虑症状的发生率为49.3%。抑郁、焦虑评分与乏力程度、睡眠质量、主观生存质量、客观生存质量负相关,精神症状越重健康状况越差(P<0.05,P<0.01)。各项指标在抑郁组、焦虑组均低于无相应精神状况组的患者(P<0.05,P<0.01)。结论:本研究表明腹膜透析患者的精神症状较常见,并且与健康状况相关。     

住院患者夜间睡眠质量及其影响因素的调查

目的了解住院患者夜间睡眠状况及其影响因素,并比较护理人员和患者关于住院患者夜间睡眠状况和影响因素的不同看法。方法采用匹兹堡睡眠质量指数（Pittsburgh sleep quality index,PSQI）量表和自行设计的住院患者夜间睡眠状况调查表（患者卷和护士卷）分别对397例患者（内科254例,外科143例）和101位夜班护士进行调查。结果在397例患者中,45.6%的住院患者存在睡眠质量问题。单因素分析结果显示：护士护理别的患者发出的声响、夜间治疗护理、电话铃声、空调发出的声音、护士交谈声、治疗仪器发出的声音、护士脚步声是干扰住院患者夜间睡眠的环境因素;疾病本身带来的不适、夜间起来上厕所、药物的夜间服用是生理及病理生理方面的影响因素;对病情的担心、情绪厌烦、想念亲人、难以自控等心理因素导致患者难以入睡。Logistic回归分析结果显示：影响住院患者夜间睡眠的因素包括对病情的担心、疾病本身带来的不舒适、夜间起来上厕所和护士的脚步声等。91.1%的护士能够意识到大部分住院患者的夜间睡眠状况较正常人差;患者和护士认为睡眠影响因素的排序在总体上比较一致,但在各自总体中所占的比例仍有较多项目存在统计学差异。结论大部分住院患者存在睡眠质量问题,其影响因素是多方面的;护理人员应从患者角度出发,系统了解住院患者的睡眠状况,采取个体化护理对策,改善住院患者的睡眠质量,促进其身心早日康复。     

Perceived sleep quality of psychiatric patients

This paper aims at acquiring knowledge about the quality of sleep of adult and elderly psychiatric patients who receive clinical or outpatient nursing care, and identifying key factors in perceiving a sleep problem. To do so, a sample of 1699 psychiatric patients were asked whether they perceived a sleep problem and were invited to fill in the Pittsburgh Sleep Quality Index (PSQI) and additional questions. Five hundred and sixty (33%) questionnaires were returned. As a result, we find that 36% of the patients perceived a sleep problem, while the PSQI assessed 66% of the sample as being 'bad sleepers'. Forty-nine per cent of the respondents used sleep medication one or more times a week. Five items of the PSQI were shown to be predictors of a perceived sleep problem. Four of these are insomnia symptoms, while the fifth is the use of sleep medication. Moreover, the patients who used sleep medication most scored significantly worse on all PSQI components than patients who used sleep medication less than once a week. In conclusion, many psychiatric patients perceive a sleep problem and all nurses could be confronted not only with the night-time consequences of this, but also with daytime consequences. Therefore, sleep problems must not be viewed as an isolated problem but must be seen in relation with social functioning.     

Fatigue in Peritoneal Dialysis Patients and an Exploration of Contributing Factors: A Cross-Sectional Study

ContextFatigue is a common and detrimental symptom in dialysis patients; however, our understanding of it and investigation of its contributing factors is still very limited, especially in peritoneal dialysis (PD) patients.ObjectivesTo assess fatigue in PD patients and identify contributing factors.MethodsOne hundred eight PD patients in a comprehensive hospital in China were recruited. The fatigue severity of the participants was assessed using the Chalder Fatigue Scale 11. Demographic factors and results of physiological tests were collected. Quality of sleep, mental health, and social support were assessed with the Pittsburgh Sleep Quality Index, Symptom Checklist 90, and Social Support Rating Scale, respectively. Multiple linear regression models were conducted with candidate variables with a P-value of less than 0.1 on univariate analysis and variables that were clinically relevant to identify contributing factors for fatigue.ResultsThe fatigue level in PD patients was significantly higher than the community population, and 78.7% of them were suffering from fatigue. The factors that were significantly associated with fatigue were quality of sleep, normalized protein nitrogen appearance, transferrin, alkaline phosphatase, and total cholesterol (adjusted R squared 0.86). Among them, quality of sleep, transferrin, alkaline phosphatase, and total cholesterol were significant contributors for physical fatigue, whereas the quality of sleep and normalized protein nitrogen appearance were contributing factors for mental fatigue.ConclusionFatigue is a common symptom in PD patients, suggesting that increased awareness of this symptom is required. The identification of correlates by extensive exploration of multidimensional factors in this study may help practitioners to identify patients at higher risk and to develop a multidimensional and targeted intervention plan.     

住院老年痴呆病人睡眠质量分析及护理干预

[目的]调查轻度、中度住院老年痴呆病人睡眠行为障碍的患病率及其影响因素,为提出有效护理干预提供依据。[方法]2003年1月—2006年8月采用国际通用的神经精神科问卷,调查住院老年痴呆病人睡眠行为障碍,包括是否存在睡眠障碍、频度和严重程度。同时采用自制影响睡眠因素调查表了解其影响因素。[结果]74.60%住院老年痴呆病人有睡眠行为障碍,影响睡眠主要因素为陌生环境、不良心理、日间活动及光照减少等。[结论]住院老年痴呆病人睡眠质量差,应从心理护理、改善环境、增加光照及运动等方面采取积极合理的护理措施来改善睡眠质量,提高病人的生活质量,延缓痴呆进展。     

腹膜透析患者全程护理管理的做法与效果

目的 探讨对腹膜透析患者的全程护理管理的做法与效果.方法 对2008年1月至2011年10月进行维持性腹膜透析的31例患者进行全程护理管理,并在入院当日、出院前1d、出院后1周测评患者疾病知识掌握情况和心理健康状况.结果 通过实施全程护理管理,患者掌握了腹膜透析知识;出院后1周,除躯体化、偏执和精神性因子外,其他因子得...     

Health of the elderly with regard to sleep and nocturnal micturition.

A questionnaire study was carried out among pensioners in J?mtland County, Sweden. The questionnaire was answered by 1,115 persons, representing a response rate of 74%. It covered various aspects of health, with emphasis on sleep, fatigue, thirst, and other symptoms that may interfere with night-time sleep. The data were analysed with regard to the stated number of night-time disturbances due to urination. Nocturnal micturition was often associated with increased sleep disorders, a poorer quality of sleep, increased thirst, particularly at night, and increased fatigue in the daytime. All the relationships were clearer in women than in men. There was no relationship between reported enuresis in childhood and an increased frequency of voiding when the subject became older.     

The prevalence of nocturnal hypoxemia in advanced cancer

Nocturnal hypoxemia is associated with excessive daytime sleepiness in patients with chronic respiratory disease. This relationship has not been explored in patients with cancer. This study examined the prevalence of nocturnal hypoxemia in patients admitted to a specialist palliative care unit, and explored relationships with demographic and physiological parameters, opioid or other sedative drug use, and daytime sleepiness, fatigue, and quality of life. Demographic details, diagnosis, performance status, body mass index, opioid or other sedative drug use, hemoglobin, spirometry, and sniff nasal inspiratory pressures were obtained, along with Epworth Sleepiness Scale, Multidimensional Fatigue Inventory, and Short Form-36 health questionnaire scores. An oximeter recorded resting daytime oxygen saturation (SaO2); overnight SaO2 was recorded for a minimum of five hours. Nocturnal hypoxemia was defined as SaO2<90% for >or=2% of the monitored nighttime. Of 100 patients, 35 had nocturnal hypoxemia. These were more likely to have lung disease (P<0.05), a lower forced expiratory volume in one second % predicted (P=0.01), lower daytime SaO2 (P=0.01) and higher levels of mental fatigue (difficulty concentrating) (P=0.02), compared to those without nocturnal hypoxemia. Both groups exhibited abnormal levels of daytime sleepiness. Nocturnal hypoxemia is common in this group of patients and may contribute to mental fatigue (difficulty concentrating).     

住院稳定期慢性阻塞性肺疾病患者睡眠质量及影响因素调查分析

目的：探讨住院稳定期慢性阻塞性肺疾病（COPD）患者的睡眠质量现状及其影响因素。方法：采用匹兹堡睡眠质量指数量表（PSQI）、睡眠个人信念与态度量表（DBAS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）、自制夜间症状调查表对146例住院稳定期COPD患者进行问卷调查,评估其睡眠质量,并分析睡眠质量的影响因素。结果：住院稳定期COPD患者的PSQI总分为（7.05±2.27）分,显著高于国内常模;78例（53.42%）患者存在睡眠质量问题;夜间症状、焦虑、抑郁、睡眠个人信念和态度、吸烟、合并其他慢性病是稳定期COPD患者睡眠质量的主要影响因素。结论：慢性阻塞性肺疾病患者睡眠质量较差;临床医务人员可根据影响因素,开展有针对性的睡眠管理,进而改善患者睡眠质量。     

医科大学男护生睡眠质量及心理健康状况研究

目的探讨医科大学男护生睡眠质量及其与心理健康的关系。方法采用症状自评量表(SCL-90)和匹兹堡睡眠质量指数(PSQI)量表对某医科大学2005-2008级105名男护生及同期的105名女护生进行测评。结果(1)以PSQI总分≥8分作为判断睡眠质量问题的界限,19.8%的男护生有睡眠质量问题,睡眠不佳主要体现在日间功能障碍(43.6%)、睡眠质量差(17.8%)和入睡时间长(17.8%)。本、专科男护生和男女护生在PSQI总分上差异均无统计学意义,但本科男护生的日间功能得分显著高于专科生(t=2.066,P0.05),男护生入睡时间得分显著低于同期调查的女护生(t=-2.965,P0.01)。(2)男护生与普通大学男生、医科大学男生的PSQI总分差异均无统计学意义(P0.05),但睡眠时间及睡眠障碍的得分显著高于普通大学男生,入睡时间和睡眠时间的得分显著低于医科大学男生。(3)不同睡眠质量状况的男护生SCL-90均分及各因子得分(除敌意因子外)差异均有统计学意义。(4)男护生SCL-90均分及各因子得分与PSQI总分呈正相关(0.265≤r≤0.513),与PSQI各项目得分中的睡眠效率、睡眠障碍、日间功能等均呈正相关(0.229≤r≤0.482)。结论学校应重视男护生的睡眠质量问题,促进男护生心理健康。     

透析病人的疲劳状态测定和相关因素分析

目的 了解透析患者疲劳状态的严重程度,并筛选出影响透析患者疲劳的可能相关因素。方法 使用SF-36量表中的活力维度测量312例透析患者的疲劳得分,采用二元分析和多元线性回归方法筛选影响透析患者疲劳感受的独立危险因素。结果 在透析人群中,轻度、重度疲劳人群比例分别是46.2%,22.4%;血白蛋白水平、是否服用抗焦虑药物和睡眠质量得分是透析患者疲劳状态的独立危险因素。结论 尿毒症人群存在较严重的疲劳体验,应该主要从营养状况、情绪状态、睡眠质量三个角度来加以干预,从而减轻透析患者的疲劳状态。     

舒适护理对癌痛患者止痛效果及睡眠质量的影响

目的探讨舒适护理对晚期癌痛患者止痛效果及睡眠质量的影响。方法选择2012年1-10月海军总医院收治的癌症患者108例,患者住院期间给予舒适护理,采用疼痛评估量表以及匹兹堡睡眠质量指数量表(Pillsburgh sleep quality in-dex,PSQI)评估患者的疼痛情况及睡眠质量。结果经舒适护理干预后,患者的疼痛评分及暴发痛次数、PSQI总分及睡眠质量、入睡时间、睡眠障碍、安眠药物和日间功能等各因子均分均较干预前降低,差异均有统计学意义(均P<0.01)。结论将舒适护理渗透于各项护理行为中,使癌痛患者感受到医护人员、家庭及社会的关爱,以愉快的身心状况配合癌痛治疗,能显著提高患者的睡眠质量。     

冠心病住院病人睡眠质量的影响因素分析与个性化心理护理干预对其改善作用的研究

[目的]分析冠心病住院病人睡眠质量的影响因素,并探讨个性化心理护理干预对于睡眠质量的改善效果。[方法]收集冠心病伴睡眠障碍病人134例,随机分为观察组与对照组各67例,调查分析其睡眠质量影响因素。对照组实施常规护理,观察组在对照组的基础上实施个性化心理护理干预,对比两组病人的干预效果。[结果]冠心病住院病人睡眠质量影响因素主要与疾病不适症状、心理因素、病区环境不适、疾病强迫体位等有关;观察组干预后SPIEGEL评分及睡眠进程参数均较干预前及对照组显著改善(P0.05);两组干预后焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数量表(PSQI)评分均显著降低,且观察组显著低于对照组(P0.05)。[结论]个性化心理护理干预有利于改善冠心病住院病人的心理状态及睡眠质量,促进病情康复。     

腹膜透析患者生存质量的影响因素分析

目的:分析影响腹膜透析患者生存质量的因素,旨在探讨提高患者生存质量的途径。方法:90例透析>3个月的稳定腹膜透析患者纳入本研究。调查患者的主观生存质量、睡眠质量、躯体症状评分;记录Karnofsky评分;使用Hamilton抑郁量表评估患者的抑郁症状;采用Charlson并发症指数评估患者的并发症状况;检查患者的透析充分性指标尿素清除指数(Kt/Vurea)以及相应的生化指标,分析影响患者生存质量的可能因素。结果:年龄、躯体症状、睡眠质量与主观生存质量正相关,躯体症状越轻、睡眠质量越好生存质量越高,而抑郁程度越重主观生存质量越差,者负相关。客观生存质量与透析龄、Charlson并发症指数、抑郁评分负相关,而与躯体症状正相关,也就是躯体症状越轻,患者的健康状态越好,多元线性回归分析结果表明,年龄、抑郁评分、躯体症状及睡眠质量是主观生存质量的显著预测因子,而抑郁评分、Charlson并发症指数、躯体症状是客观生存质量的显著预测因子。结论:抑郁和躯体症状是影响腹膜透析患者生存质量的因素,将康复干预与医疗干预摆在同等重要位置才是提高生存质量的途径。     

Effects of sleep loss in men and women with insufficient sleep suffering from chronic disease: a model for supportive nursing care

This study evaluated self-reported subjective health and effects of sleep loss according to perceived interfering cognitive anxiety related to falling asleep in patients with and without insufficient sleep and gender differences in these aspects 5 years after coronary artery bypass graft and transluminal coronary angioplasty. A total of 145 patients, five years after intervention, responded to a mailed questionnaire. Nearly 60% had severe combined sleep disturbances; 35.9% of these had complained of insufficient sleep and 15% also perceived difficulty falling asleep related to cognitive anxiety. Measurable gender differences were small. A theoretical framework is presented which can increase understanding among nurses, patients and their relatives concerning the quality and quantity of sleep and sleep loss related to quality of life. These results suggest that there are significant relationships between sleep quality, resilience to stress and coping strategy in patients with a chronic disease, indicating the need for more individualised supportive nursing care.     

人文关怀对居家腹膜透析病人生存质量的影响

目的探讨对社区腹膜透析病人实施人文关怀,提高依从性后对其生存质量的影响。方法将100名腹膜透析病人按手术序号的单号和双号随机分为两组,实验组50名病人在常规护理的基础上加强人文关怀,对照组50名病人仅接受常规护理,即出院后不进行社区随访,要求病人每1~2个月来医院复诊1次,复诊时进行健康教育,检查病人对导管出口处的护理情况。结果加强人文关怀后,实验组病人抑郁、焦虑情绪明显减轻,遵医行为提高,并发症减少,存活率及生活质量高于对照组,差异具有统计学意义(P<0.05)。结论对居家腹膜透析病人实施人文关怀干预后,其住院率、死亡率明显降低,改善了病人的生存质量。     

医护患一体化护理对腹膜透析患者自我管理能力、并发症及生活质量的影响

目的:探讨医护患一体化护理对腹膜透析患者自我管理能力、并发症及生活质量的影响。方法:2017年6月至2019年6月选取惠州市第一人民医院腹膜透析患者94例,根据患者入院时间分为观察组(2017年6月至2018年5月)和对照组(2018年6月至2019年6月),各47例。对照组实施常规性健康指导,观察组实施医护患一体化护理管理,比较两组干预前后自我管理能力、并发症发生率及生活质量情况。结果:干预后观察组患者腹膜透析操作技术、饮食管理、服药管理、病情监测、水钠摄入及自我管理评分均高于对照组,低血压、腹膜炎、透析感染、心肌缺血、心律失常等并发症发生率低于对照组,躯体症状、肾病影响、肾病负担、认知功能、工作状态、社交质量、睡眠质量、性功能、社会支持、患者满意度及总生活质量评分较对照组明显提高,差异均有统计学意义(均P<0.05)。结论:医护患一体化护理能有效提高腹膜透析患者自我管理能力,降低患者并发症发生率,提高患者生活质量。