喉癌术后患者创伤后成长现状及影响因素分析

目的探讨喉癌术后患者创伤后成长的现状及影响因素。方法采用一般资料调查表、创伤后成长量表对81例喉癌术后患者进行调查。结果喉癌术后患者创伤后成长总均分为(53.58±7.01)分;术后功能锻炼、手术方式、是否接受放疗、宗教信仰、家庭居住地、婚姻状况是喉癌术后患者创伤后成长的影响因素,可解释总变异的44.2%。结论喉癌术后患者创伤后成长处于中等水平,医护人员应帮助患者术后功能的恢复或重建,加强对患者及其配偶的积极引导,以促进个体创伤后成长的发生。     

骨折患者创伤后成长现状及影响因素调查

目的了解骨折患者创伤后成长现状及其影响因素,为采取措施提高患者创伤后成长水平提供参考。方法对187例骨折患者采用一般资料问卷及创伤后成长评定量表(C-PTGI)进行调查。结果患者C-PTGI得分为(63.71±14.47)分,对生活的欣赏得分最高,其次是个人力量、与他人关系、新的可能性和精神变化。不同性别、年龄、婚姻状况、创伤原因及护理级别患者C-PTGI得分比较,差异有统计学意义(P0.05,P0.01)。结论骨折患者的创伤后成长处于中等水平,影响患者创伤后成长的因素较多,需采取相关干预措有针对性对患者进行心理干预,引导并鼓励患者正性心理的产生,重视社会支持系统的建设,以利于提高患者创伤后成长水平。     

口腔癌患者术后创伤后成长状况及影响因素分析

目的调查口腔癌患者术后创伤后成长状况,分析其影响因素。方法采用一般情况调查表、创伤后成长量表、社会支持评定量表和简易应对方式问卷对96例口腔癌术后患者进行调查。结果口腔癌患者术后创伤后成长总分56.72±8.53、社会支持总分34.82±3.64;术后时间、治疗方式、是否复发、积极应对、客观支持为口腔癌患者术后创伤后成长的影响因素(调整R~2=0.879)。结论口腔癌患者术后创伤后成长处于中等水平,术后时间越长、治疗方式越复杂患者创伤后成长水平越低,复发的患者创伤后成长得分较未复发者低,积极应对与客观支持则促进创伤后成长。护理人员应给予口腔癌术后患者针对性干预与支持,以促进其创伤后成长。     

重大车祸伤存活患者创伤后成长状况调查分析

目的 了解重大车祸创伤存活后患者创伤后成长(PTG)状况及其相关影响因素.方法 对58例重大车祸创伤后存活患者进行一般情况和创伤后成长评定量表(PTGI)调查,并进行统计分析.结果 58例患者PTGI总分为(84.63±15.46)分；不同性别、职业、学历、月收入、损伤程度、创伤处理方式、可预计的康复时间、可预计的康复结局及可预计的康复后工作情况患者PTGI得分比较,差异有统计学意义(P＜0.05,P＜0.01).结论 重大车祸受伤存活患者PTG水平较高,不同类别患者间心理成长水平存在差异.     

血液透析患者创伤后成长状况及影响因素分析

目的探讨血液透析患者创伤后成长状况及其影响因素。方法采用一般资料调查表、创伤后成长量表、心理弹性量表和事件相关反刍性沉思问卷对186例血液透析患者进行调查。结果血液透析患者创伤后成长总分为63.95±12.37;年龄、性别、心理弹性、目的性反刍性沉思和透析龄是血液透析患者创伤后成长的影响因素,共同解释总变异的68.0%。结论血液透析患者创伤后成长处于中等水平,并受多种因素影响。医护人员应采取措施增强血液透析患者心理弹性,引导其建立目的性反刍性沉思,以促进个体的成长。     

儿童肾移植受者术后生存质量和心理状况现状及影响因素分析

目的  探讨儿童肾移植受者术后生存质量和心理状况现状并分析其影响因素。 方法  选取96例儿童肾移植受者为研究对象,收集受者的一般资料,采用儿童生存质量量表（PedsQL^TM3.0）评估其生存质量,采用长处和困难问卷（SDQ）评估其心理状况,对儿童肾移植受者术后生存质量和心理状况的影响因素进行单因素和多因素分析。 结果  儿童肾移植受者术后生存质量总分为（71±14）分,困难总分为（12.4±5.8）分。单因素分析结果显示,性别、术后体质量指数（BMI）和肾移植术后并发症是儿童肾移植受者术后生存质量总分的影响因素（均为P < 0.05）;性别、肾移植术后并发症和肾移植术后随访时间是儿童肾移植受者困难总分的影响因素（均为P < 0.05）。多因素分析结果显示,性别、术后BMI、肾移植术后并发症、肾移植前透析种类是儿童肾移植受者术后生存质量的影响因素,性别、肾移植术后并发症、肾移植术后随访时间是儿童移植受者术后心理状况的影响因素（均为P < 0.05）。 结论  儿童肾移植受者术后生存质量和心理状况较好,临床中应重点关注女性、术后BMI偏低、肾移植术后出现并发症及肾移植术后随访时间较短的患儿,预防性给予干预措施,进一步提高生存质量。     

严重创伤患者创伤后应激障碍现况及影响因素分析

目的 调查严重创伤患者创伤后应激障碍(posttraumatic stress disorder,PTSD)现况,并分析影响因素。方法 将2020年6月至2021年5月江门市新会区人民医院复诊的严重创伤患者作为调查对象,开展横断面调查研究,取得其同意后经医院信息管理系统先收集受伤原因、创伤部位、创伤时间、创伤严重程度评分(injury severity score,ISS);向其发放《社会人口资料调查表》、创伤后应激障碍自评量表(posttraumatic stress disorder self-rating scale, PTSD-SS)、中文版睡眠状况自评量表(self-rating scale of sleep,SRSS)及积极心理资本问卷(positive psychological capital questionnaire,PPQ)分别调查其社会人口学资料、创伤后应激障碍程度、睡眠状况及积极心理状况。结果 共187例纳入分析,PTSD-SS得分5～78分,平均(47.27±11.60)分,诊断为PTSD(PTSD组)53例(28.34%),非PTSD(non-PTSD组)...     

脑瘫患儿家长心理调适及其影响因素研究

目的探讨脑瘫患儿家长积极与消极心理调适现状及其影响因素。方法采用一般资料问卷、心理健康调查表(MHI 38)、中文版创伤后成长问卷(PTGI-C)对122名脑瘫患儿家长进行调查。结果脑瘫患儿家长心理痛苦得分70.75±19.36,心理幸福感得分44.15±13.66,创伤后成长得分68.98±18.72;相关分析显示,创伤后成长与心理痛苦呈负相关,与心理幸福感呈正相关(均P0.01);多元线性回归结果显示,患儿的瘫痪程度是家长心理痛苦的影响因素,解释22.2%的变异量;患儿的瘫痪程度、家长文化程度、创伤后成长是家长心理幸福感的影响因素,共解释42.7%的总变异。结论脑瘫患儿家长心理痛苦与创伤后成长并存,且积极与消极心理调适具有不同的影响因素,医护人员需全面了解脑瘫患儿家长的心理状态以制定针对性的干预措施。     

肾移植患者阴茎勃起功能影响因素分析

目的:研究肾移植对勃起功能的影响,并对相关影响因素进行分析,以期提高移植术后患者的生活质量。方法:对250例肾移植术后移植肾功能良好的已婚男性受者进行勃起功能国际问卷调查,并收集一般临床资料、病史、性生活史和实验室检查资料。应用单因素分析和多因素Logistic回归分析确定对勃起功能有独立的和显著影响的相关因素。结果:212例完成整个调查,114例移植术前为ED(53.8%),移植术后94例被确定为ED(44.3%),两者差异无显著性(P>0.05)。根据ED分度移植前后的变化,91例(42.9%)勃起功能移植前后无变化,93例(43.9%)有改善,28例(13.2%)移植前勃起功能正常的患者移植后减退。Logistic回归分析确定年龄、贫血、糖尿病、周围神经病变、多次移植是独立和显著影响勃起功能的因素,相对危险度分别为3.01、2.01、3.15、3.89、2.67。结论:肾移植后ED的发生率仍较高。移植术后ED的病因是多方面的,年龄、糖尿病、周围神经病变、血红蛋白水平、多次移植是影响勃起功能的主要因素。     

意外创伤截肢患者创伤后成长体验的质性研究

目的深入了解和探讨意外创伤截肢患者创伤后成长体验并发掘相关影响因素。方法采用现象学研究法选取7例意外创伤截肢患者作为研究对象,通过深度访谈法收集资料,运用Giorgi分析步骤分析资料。结果意外创伤截肢患者创伤后成长的体验有心理斗争:负性心理与正性心理并存;人生感悟:重新审视生命、享受生活并延伸利他行为;情感支持:社会支持是坚持下去的动力;有效应对:从比较中获得平衡;榜样学习:个人力量增强,尽己所能实现自己的价值5个主题。结论意外创伤截肢患者的创伤后成长是一个持续过程,发现和引导患者正性心理有助于患者的身心康复。医护人员应了解其所需、关注其正性心理变化并提供相应的心理疏导,使患者达到社会功能的最佳状态。     

Long-term outcomes of en-bloc renal transplantation from paediatric donors into adult recipients

Introduction

Transplant units are exploring strategies to increase the availability of donor kidneys. The use of en-bloc kidney transplantation (EBKT) from paediatric donors represents one potential solution. We present our long-term experience with paediatric EBKT among adult recipients.

Influence of recipient and donor age in pediatric renal transplantation

The influnece of recipient and donor age on the outcome of first cadaver kidney transplants was analyzed in a series of 1325 pediatric recipients and in 4230 transplants from pediatric kidney donors. Graft survival improved significantly with increasing recipient age (P<0.0001) and donor age (P<0.0001). Combined analysis of recipient and donor age groups revealed an overriding effect of donor age on graft outcome. Kidneys from donors younger than 3 years old consistently yielded poor results regardless of recipient age. Kidneys from adult donors gave the best results even in young recipients 0–5 years of age. With adult donor kidneys in cyclosporin-treated patients, high 1-year graft survival rates of 86±9% (SE) in 15 0-to 5-year-old recipients, 85±3% in 137 6-to 12-year-old recipients, and 83±1% in 6027 13-to 40-year-old recipients were observed.     

Influence of recipient and donor age in pediatric renal transplantation

Abstract. The influence of recipient and donor age on the outcome of first cadaver kidney transplants was analyzed in a series of 1325 pediatric recipients and in 4230 transplants from pediatric kidney donors. Graft survival improved significantly with increasing recipient age ( P < 0.0001) and donor age ( P < 0.0001). Combined analysis of recipient and donor age groups revealed an overriding effect of donor age on graft outcome. Kidneys from donors younger than 3 years old consistently yielded poor results regardless of recipient age. Kidneys from adult donors gave the best results even in young recipients 0–5 years of age. With adult donor kidneys in cyclosporin-treated patients, high 1-year graft survival rates of 86 9% (SE) in 15 0-to 5-year-old recipients, 85 3% in 137 6-to 12-year-old recipients, and 83 1% in 6027 13-to 40-year-old recipients were observed.     

Pharmacokinetics of ganciclovir in pediatric renal transplant recipients

Ganciclovir (GCV) is effective in preventing and treating cytomegalovirus (CMV) infection in solid organ transplant recipients. The aims of the present study were to determine the pharmacokinetics of GCV administered intravenously (IV) and orally (p.o.) as pre-emptive anti-CMV therapy in pediatric renal transplant recipients and to monitor trough levels and side-effects during pre-emptive therapy. Eleven pediatric renal transplant recipients (aged 11.0±3.9 years) were included. The diagnosis of CMV infection, based on two positive pp-65 CMV blood antigen tests at 1 week apart, was made at 39±12 days post renal transplantation. They received IV GCV at a dose of 5.0±0.3 mg/kg per 12 h for 15 days, followed by GCV p.o. at a dose of 46.7±8.2 mg/kg per 12 h for 3 months. Pharmacokinetics (PK) were studied at steady state and GCV plasma concentrations were measured by high-performance liquid chromatography. After IV GCV administration, PK parameters were: C₀=0.84±0.66 g/ml; C_max=11.77±2.82 g/ml; AUC_{0–12 h}=42.29±17.57 g/ml per hour; Cl=0.13±0.05 l/h per kg. After p.o. GCV administration, PK parameters were: C₀=1.08±0.68 g/ml; C_max=2.70±1.07 g/ml; AUC_{0–12 h}=18.97±9.36 g/ml per hour; Cl/F=2.97±1.42 l/h per kg. Bioavailability (F) was 4.9±1.2%. Pre-dose concentrations (C₀) measured under p.o. GCV (n=51) were 1.29±0.80 g/ml (8 C₀ values were below 0.5 µg/ml). Pp-65 CMV blood antigen tests became negative after 16±11 days of treatment. GCV was well tolerated. Because of the limited bioavailability, the recommended high doses of p.o. GCV (50 mg/kg per 12 h) were administered and were associated with trough levels over 0.5 µg/ml. In 1 patient who received an erroneously low dosage p.o., CMV resistance to GCV appeared, requiring foscarnet.     

Acyclovir plus CMV immunoglobulin prophylaxis and early therapy with ganciclovir are effective and safe in CMV high-risk renal transplant pediatric recipients

Abstract Cytomegalovirus (CMV) infection is still a major cause of morbidity in high-risk renal transplant recipients. In the present report, we have reviewed our records of renal transplant pediatric recipients (RTPR; mean age 14.1 ± 4.9 years) since 1991, when we started a policy of CMV prophylaxis constituting high-dose oral acyclovir plus CMV hyperimmune immunoglobulins (Hlg) followed by early i.v. ganciclovir therapy in high-risk patients (i.e., CMV donor +/ recipient -). Four patients received a kidney from a living relative (LR), 2 patients had one previous transplant, and 1 had a combined liver -kidney transplant. Thirty-three patients who were negative for CMV antibodies (ab) before transplantation received a kidney from CMV ab positive donors. The immunosuppressive regimen included cyclosporin A and steroids, with the addition of azathioprine in the 4 patients who received an LR kidney. Serial assessments for CMV antigenemia (pp 65) were routinely performed for 6 months after transplantation to define CMV infection. Among the 33 CMV seronegative recipients (R -) who received the graft from a CMV seropositive donor (D +), 18 (54.5 %) experienced CMV infection, whereas among the 28 CMV R +, who received a graft from a CMV D +, 11 (39.3 %) experienced CMV infection. With regard to CMV - related symptoms, only 2 patients suffered from a CMV syndrome (fever and leukopenia in 1 patient, fever and arthralgia in the other). In no case did the spectrum of CMV disease occur; only minor symptoms were present in 7 of the remaining CMV-infected patients (fever in 6 and leukopenia in 1). Rejection episodes and renal function did not differ between CMV-infected and non-CMV-infected patients. Our experiences support the use of prophylactic acyclovir plus CMV HIg followed by early therapy with i.v. ganciclovir to combat the risk of increased morbidity in high risk RTPR.     

Prognostic factors of long-term allograft survival in 632 CyA-treated recipients of a primary renal transplant

A total of 632 cyclosporin (CyA)-treated primary renal allograft recipients with a functioning graft at 6 months were retrospectively evaluated for risk factors correlated with long-term allograft function. Mean follow-up after the 6th month was 68.4 ± 40.6 months. One hundred twenty-one of these patients (19 %) were lost: 29 died (23/29 with a functioning graft), 77 of the remaining 92 (83 %) lost their graft because of chronic allograft dysfunction, 9 due to recurrence of glomerulonephritis, 5 due to renal artery thrombosis, and 1 due to chronic CyA toxicity. At univariate analysis, factors correlated with a better renal (R) and pure renal (PR) allograft survival were: dialysis duration of less than 5 years, fewer than 2 rejections within the 6th post-Tx month, immediate graft function recovery, plasma creatinine below 1.5 mg/dl at the 6th month, age at Tx above 15 years, and receiving a living donor graft. Cox's regression analysis was also performed to obtain relative risks for the same parameters. Long-term dialysis patients had more frequent late recoveries (P = 0.002) and reductions in therapy (P = 0.01) in order to reduce the side effects of steroids. In young patients receiving an initial oral CyA dose of 17 mg/kg per day, steroids were stopped at the 6th month in order to achieve catch-up growth: only one such patient lost his graft. In contrast, 72 % of the young patients who lost their grafts received an initial oral CyA dosage of 13 mg/kg per day. Thus, young patients did worse not because of steroid withdrawal, but because of inadequate initial CyA dosage. These results suggest that although we cannot exclude alloantigen-independent mechanisms as factors that stimulate progression of chronic allograft dysfunction, it would appear that the initial lesions are induced by events mostly mediated by immunological mechanisms. Received: 28 January 1997 Received after revision: 4 April 1997 Accepted: 8 April 1997     

Growth hormone and the skeleton in pediatric renal allograft recipients

Recombinant human growth hormone has been utilized to augment linear growth in pediatric renal allograft recipients. The skeletal changes that accompany growth hormone therapy have not been described in children. Thus, 23 stable prepubertal pediatric kidney recipients, aged 10±3 years, with a mean transplant time of 3.4±2.5 years and histological findings of normal bone formation and adynamic bone on bone biopsies were prospectively randomized into two groups. These comprised a treated group that received 12 months of growth hormone and a control group that did not receive any treatment. Anthropometric measurements and blood for serum calcium, phosphorus, parathyroid hormone (PTH), osteocalcin, and insulin-like growth factor-I (IGF-I) were obtained every 3 months. Measurements of bone mass by dual-energy X-ray absorptiometry were performed at the beginning and end of the study period. All patients underwent an initial and final bone biopsy procedure after double tetracycline labeling. Annual growth velocity increased and standard deviation scores for height improved in the treated group. Serum IGF-I levels increased in the treated group and the increase was evident in patients with normal bone formation who received growth hormone but not in patients with adynamic bone. Serum calcium, phosphorus, osteocalcin, and PTH levels did not differ between the treated and control groups. Bone mass did not change in the treated group, but declined after 12 months in the control group. Bone formation rates did not increase with growth hormone treatment. Thus, growth hormone therapy improves linear growth and maintains bone mass, but does not favorably affect bone formation rates in stable pediatric renal allograft recipients. Received: 8 November 2000 / Revised: 19 December 2001 / Accepted: 20 December 2001     

居家肾移植受者新型冠状病毒肺炎知信行调查及影响因素分析

目的调查居家肾移植受者对新型冠状病毒肺炎(COVID-19)的认知、态度和行为现状,并分析其影响因素。 方法对树兰(杭州)医院随访信息系统中2018年4月至2019年12月接受肾移植的受者进行整群调查。调查问卷包含两部分：(1)受者一般资料,包括性别、年龄、肾移植术后时间、受教育程度和居住地等;(2)COVID-19知信行部分包含3个维度共计25个条目,内容包括对COVID-19的认知和态度以及个人防护措施,各条目均应用Likert 4级评分法。收集纳入受者的临床信息,采用在线问卷调查平台和电话两种方式进行调查。采用t检验或方差分析比较不同性别、年龄、受教育程度、术后时间以及居住地的受者COVID-19知信行3个维度得分和总分;采用多元线性回归进行影响知信行总分的多因素分析。 结果共收到问卷245份,其中电话调查52例,使用在线问卷调查平台193例;有效问卷239份,有效率97.55%。239例肾移植受者COVID-19知信行总分为(81.2±8.1)分,其中知识、态度和行为维度得分分别为(32.3±4.5)、(21.9±1.8)和(26.9±3.6)分。单因素分析结果显示,年龄、受教育程度和居住地不同的肾移植受者知识维度得分差异均有统计学意义(P均<0.05);受教育程度、术后时间和居住地不同的肾移植受者态度维度得分差异均有统计学意义(P均<0.05);居住地不同的肾移植受者行为得分差异有统计学意义(P<0.05)。多因素分析结果显示,居住地是肾移植受者COVID-19知信行总分的影响因素(P<0.05)。 结论在COVID-19疫情期间,肾移植中心需有针对性的加强随访力度、方向以及增加健康教育的方式方法,重点关注老年、受教育程度较低以及居住在农村的肾移植受者。     

肾移植受者术后BK病毒激活危险因素的荟萃分析

目的对国内外报道的肾移植术后BK病毒(BKV)激活的危险因素进行荟萃分析，为临床BKV肾病的防治提供参考。 方法通过系统检索PubMed数据库、中国知网、万方数据库以及中国生物医学数据库从建库至2019年7月公开发表的关于肾移植术后BKV激活危险因素的相关研究论文，并通过其参考文献进行手工补充搜索。采用纽卡斯尔－渥太华量表对纳入文献进行质量评价，运用RevMan 5.3软件进行荟萃分析。 结果最终纳入22篇文献，其中英文15篇、中文7篇。结果显示血液中检测到BKV的危险因素为排斥反应(OR＝1.91，95%CI：1.30～2.80)、移植肾功能延迟恢复(OR＝1.51，95%CI：0.99～2.31)、服用他克莫司(OR＝1.50，95%CI：1.22～1.84)、使用抗胸腺细胞球蛋白(ATG)诱导(OR＝1.75，95%CI：1.02～2.98)、使用输尿管支架(OR＝1.98，95%CI：1.19～3.30)和合并CMV感染(OR＝2.23，95%CI：1.61～3.09)；而尿液中检测到BKV的危险因素为持续服用糖皮质激素(OR＝1.49，95%CI：1.09～2.04)。 结论肾移植术后服用他克莫司、合并CMV感染、使用输尿管支架和ATG诱导的受者发生BKV血症的风险更高，长期服用糖皮质激素的肾移植受者发生BKV尿症的风险更高。