肾移植受者术后锻炼意向及其影响因素调查

目的 了解肾移植受者术后锻炼意向及其影响因素,以促进其参与锻炼,改善健康状态。方法 使用锻炼意向量表、锻炼自我效能量表和锻炼社会支持量表对门诊复诊的299例肾移植受者进行调查。结果 肾移植受者锻炼意向得分为(15.32±2.87)分。单因素分析显示移植术后并发症、锻炼自我效能和锻炼社会支持影响肾移植受者的锻炼意向(P<0.05,P<0.01)。多元线性回归分析显示,锻炼自我效能、移植术后并发症、移植术后时间和锻炼社会支持4个变量可解释肾移植受者的锻炼意向总变异的16.0%(P<0.05,P<0.01)。结论 肾移植受者有较高的锻炼意向,影响患者锻炼意向的因素较多。肾移植受者家属和医务人员应提供更多的锻炼支持,提高其锻炼自我效能感,促进其积极参与锻炼。     

肾移植受者体力活动现状及影响因素研究

目的调查肾移植受者体力活动现状,分析其影响因素,为制定针对性的干预措施提供参考。方法采用国际体力活动问卷、慢性病自我效能量表、Piper疲乏修订量表对137例肾移植受者进行调查。结果肾移植受者体力活动总代谢当量(MET)中位数为2 709(MET-min/周),工作、交通、家务及休闲相关的体力活动MET中位数为0、0、180、1 320(MET-min/周)。46.7%的肾移植受者报告了高水平的体力活动。回归分析结果显示,疲乏、自我效能、婚姻状况、有无感染、工作状态及透析时间是肾移植受者体力活动的影响因素(P0.05,P0.01)。结论肾移植受者体力活动水平有待提高,医护人员可通过改善患者疲乏,提高其自我效能,以促进患者进行规律的体力活动。     

首发脑卒中患者康复锻炼行为执行意向及影响因素分析

目的 了解首发脑卒中患者康复锻炼行为执行意向水平及其影响因素,为脑卒中患者康复锻炼行为的干预提供参考.方法 采用一般资料调查表、中文版脑卒中康复自我效能量表、社会支持量表、自行设计的脑卒中患者康复锻炼行为执行意向问卷对177例首发脑卒中患者进行调查.结果 首发脑卒中患者康复锻炼行为执行意向得分62.69±17.27.回...     

乳腺癌化疗患者锻炼行为觉知的影响因素研究

目的 调查乳腺癌静脉化疗患者的锻炼行为觉知水平,分析其影响因素,为临床干预提供参考。方法 采用便利抽样法选取192例乳腺癌静脉化疗患者,使用一般资料调查表、锻炼益处及障碍量表、运动自我效能量表、社会支持评定量表进行调查。分析锻炼益处及障碍评分与运动自我效能、社会支持评分的相关性;采用多元线性回归分析锻炼行为觉知的影响因素。结果 192例乳腺癌患者锻炼益处及障碍评分总分(109.82±14.82)分,运动自我效能评分(61.45±8.59)分,社会支持评分(42.17±5.73)分;锻炼益处及障碍评分与运动自我效能评分、社会支持评分呈正相关(均P<0.05);多元线性回归分析显示,运动自我效能、社会支持、婚姻状况、文化程度、TNM分期是乳腺癌患者锻炼行为觉知水平的影响因素(均P<0.05)。结论 乳腺癌静脉化疗患者锻炼行为觉知水平受到多种因素影响,临床工作者可针对影响因素进行干预,提高患者的锻炼行为觉知水平。     

肾移植长期受者贫血的特征及相关因素分析

目的 分析肾移植长期受者贫血的特征及其影响因素。 方法 以肾移植长期受者258例为研究对象,总结贫血的性质和发生率,分析贫血与红细胞生成素（EPO）、肾小管功能、肾功能、排斥反应、免疫抑制药物及心脑血管并发症的关系。 结果 258例均为首次肾移植受者,贫血的总发生率为41.1％。受者大部分为正细胞正色素性贫血,少部分为小细胞低色素性贫血,极少部分为溶血性贫血。贫血受者中,大部分为EPO缺乏,少部分为EPO抵抗。受者的血红蛋白（Hb）与估算肾小球滤过率（eGFR）、肌酐清除率（Ccr）呈正相关（r = 0.348, P ＜ 0.01;r = 0.351,P ＜ 0.01）;与N-乙酰氨基葡萄糖苷酶（NAG）呈负相关（r = -0.327,P ＜ 0.01）。在Scr正常的情况下,贫血组肾小管病变比非贫血组严重。贫血受者急、慢性排斥反应的发生率显著高于非贫血受者（P ＜ 0.01)。环孢素+硫唑嘌呤+泼尼松方案（CsA+Aza+Pred ）贫血的发生率为69.0％;环孢素+霉酚酸酯+泼尼松方案（CsA+MMF+Pred）贫血的发生率为35.8％;他可莫司+霉酚酸酯+泼尼松方案（FK506+MMF+Pred)贫血的发生率为34.8％;西罗莫司（雷帕霉素）+霉酚酸酯+泼尼松方案 （SRL+MMF+Pred）贫血的发生率为41.7％。骨髓抑制是硫唑嘌呤最常见的不良反应。Hb与硫唑嘌呤的使用时间呈负相关（r = -0.354,P ＜ 0.01);Hb与霉酚酸酯的剂量（2~3 g/d）及使用时间呈负相关（r = -0.285,P ＜ 0.05;r = -0.372,P ＜ 0.01）;Hb与雷帕霉素的剂量（2~5 mg/d）及使用时间呈负相关（r = -0.278,P ＜ 0.05; r = -0.359,P ＜ 0.01）。贫血受者心脑血管病变发生率显著高于非贫血受者（P ＜ 0.01）。 结论 肾移植长期受者贫血的发生率相当高。贫血不仅与肾功能、肾小管间质病变相关,而且也与EPO、排斥反应、免疫抑制药物相关。贫血是肾移植受者出现心脑血管并发症的高危因素。     

运动自我效能在终末期肾脏病患者运动益处及障碍感知与锻炼意向间的中介效应

目的 探讨终末期肾脏病患者运动益处及障碍感知、运动自我效能与锻炼意向的关系,为建立有效的运动康复干预方案提供参考。方法 采用一般资料调查表、透析患者感知运动益处及障碍量表、运动自我效能量表及锻炼意向问卷对249例终末期肾脏病患者进行调查。结果 终末期肾脏病患者锻炼意向得分为14.0（12.0,14.0）分,运动益处感知为37.0（34.0,39.0）分,运动障碍感知为33.0（30.0,35.0）分,运动自我效能为40.0（36.5,44.0）分。结构方程模型结果显示,运动障碍感知对锻炼意向有直接负向作用（β=-0.230,P＜0.05）,运动自我效能对锻炼意向有直接正向作用（β=0.246,P＜0.05）。运动自我效能在终末期肾脏病患者运动益处感知锻炼意向的影响中发挥完全中介效应,在运动障碍感知对锻炼意向的影响中发挥部分中介效应,贡献率为15.13%。结论 运动自我效能在运动益处及障碍感知对终末期肾脏病患者锻炼意向的影响中起中介作用,医护人员应采取措施降低感知到的运动障碍对患者运动意向的影响,帮助其逐步适应运动锻炼并建立自信心,从而使患者有意向参与透析康复锻炼。     

中青年肾移植受者术后早期心理社会适应现状及影响因素分析

目的 探讨中青年肾移植受者术后早期心理社会适应现况及影响因素,为采取针对性干预措施提供参考。方法 采用人口学和疾病相关问卷、疾病心理社会适应问卷、简易疾病感知问卷及社会支持问卷对236例中青年肾移植术后早期受者进行调查。结果 中青年肾移植受者术后早期心理社会适应总分为(65.18±16.39)分;多元线性回归分析结果显示,文化程度低、医疗付费方式为自费、移植术后时间短、有并发症、社会支持少及负性疾病感知是导致患者心理社会适应差的主要因素(均P<0.05)。结论 中青年肾移植受者术后早期心理社会适应水平较差,医护人员应注意进行尽早识别和干预,延长患者的移植物功能,改善心理社会健康状态。     

肾移植受者出院后自我管理行为的调查分析

目的 调查肾移植受者出院后的自我管理行为.方法 采用慢性病自我管理研究测量表中的自我管理行为量表对203例出院后的肾移植受者进行调查.结果 肾移植受者的自我管理行为中耐力锻炼时间较长.为(117.86±98.29)min/周.体能锻炼时间为(27.41±47.61)min/周,认知性症状管理实践得分为1.37±0.84,与医生的沟通得分为1.96±0.93.术后时间为6～12个月组患者体能锻炼、耐力锻炼时间,与医生的沟通评分高于术后时间<6个月、>12个月组的患者(P<0.05,P<0.01).结论 肾移植受者出院后的自我管理行为需要改善,医务工作者对患者进行长期的自我管理健康教育,有助于患者建立良好的自我管理行为.     

体能锻炼对肾移植受者术后早期康复的影响

目的探讨体能锻炼对肾移植受者早期生理、心理功能及并发症的影响。方法将52例肾移植受者随机分为观察组(27例)和对照组(25例)两组。对照组给予常规处理,观察组在常规处理的基础上,于术后6周开始有计划地进行体能锻炼,持续24周。观察两组入组前,入组后6周、12周、18周、24周的血红蛋白、血清肌酐(Scr)、血钙水平,以及高血压、高血脂、高血糖、骨质丢失、肺部感染等并发症的发生情况。采用汉密顿焦虑量表(Hamilton anxiety,HAMA)评价两组入组前后的心理障碍发生情况。结果观察组体能锻炼12周后血红蛋白、血钙水平升高的幅度比对照组更为明显(均为P<0.05)。观察组的高血脂、骨质丢失发生率明显低于对照组(均为P<0.05)。观察组体能锻炼后发生焦虑障碍的例数少于对照组(P<0.05)。结论体能锻炼能显著改善肾移植受者的生理、心理功能,并降低并发症的发生率。     

中青年脑卒中患者运动自我效能及锻炼计划与运动依从性的相关性研究

目的 分析中青年出血性脑卒中患者运动自我效能、锻炼计划与运动依从性的相关性。方法 便利抽样法选择我国中、东、北部4所三甲医院的412例中青年出血性脑卒中患者为研究对象,采用一般资料调查量表、脑卒中功能锻炼依从性量表、运动自我效能量表、锻炼计划量表进行横断面调查。结果 中青年出血性脑卒中患者运动依从性得分为43.52±9.60,运动自我效能得分为54.00（26.00,78.75）,锻炼计划总分为29.45±10.18。分层线性回归分析显示,合并糖尿病、支持利用度、Barthel指数、右上肢肌力是中青年脑卒中患者运动依从性的影响因素（均P＜0.05）,自变量纳入运动自我效能、行动计划后对运动依从性总变异的解释率提升47.5%。结论 中青年出血性脑卒中患者的运动自我效能越高、锻炼计划越完善,运动依从性越高。医护人员应重视患者的自我效能水平,帮助其完善锻炼计划,进而提高运动依从性。     

Factors associated with erectile dysfunction in male kidney transplant recipients

A transversal study was carried out in order to evaluate the prevalence of erectile dysfunction (ED) in adult kidney transplant patients of our region (N=243), and to investigate the sociodemographic, analytic, and clinical factors associated with it. To evaluate ED, the Spanish five items version of the International Index of Erectile Function (IIEF-5) was employed. Sociodemographic, analytic, and clinical data, including 12 cardiovascular risk factors, were also collected. A total of 199 patients (82%) were included. The median age was 52 y (43-62 y); 106 patients (54.9%) presented with ED. Variables associated with ED were: higher age; longer time on dialysis prior to transplantation; higher comorbidity; presence of diabetes mellitus; had undergone prostatic surgery or peripheric artheriopathy; lower diastolic pressure; and some anti hypertensive drugs. Logistic Regression Model performed step by step showed (R(2)=0.52) that factors independently associated with ED were: age, time on dialysis previous to transplant, and peripheric artheriopathy.     

Pregnancy in kidney transplant recipients

PURPOSE: Our aim was to investigate kidney allograft, obstetric, and maternal outcomes in pregnant women undergoing kidney transplantation in our center. METHODS: Retrospective data on 74 pregnancies in 60 patients were reviewed and completed through phone interviews were compared with information on a control group of female kidney recipients. RESULTS: Mean age of patients at transplantation was 26.55 +/- 4.72 years and the median interval between transplantation and pregnancy was 27.5 months. Gestational period was 8 months. Live birth was the outcome in 43.2% of pregnancies; 9.5% led to still birth, 24.3% were aborted, and obstetrical data of the remaining were unavailable. Among the 11 patients who became pregnant within 12 months after transplantation, we observed seven live births and four abortions. None of pregnancies that were accompanied by acute rejection episodes (ARE) were successful. Twenty-six patients experienced at least one ARE versus 23 patients of the control group (P = NS). However, the first ARE occurred later in the pregnant group (P = .028). Chronic rejection and graft loss were seen in 24 and 18 study group cases and 17 and 17 control cases, respectively (P = NS). One-, 3-, 5-, and 10-year graft survivals were 100%, 96.5%, 94.5%, and 77.1% in the pregnant group versus 93.2%, 85.7%, 81%, and 64.7% in the control group, respectively (P = .07). CONCLUSION: Pregnancy in kidney recipients seems to be safe for kidney allograft recipients even within the first year posttransplant. Nonetheless, the outcomes of pregnancy in this group of patients is not always favorable, especially when rejection occurs simultaneously.     

Hypertension in kidney transplant recipients

Arterial hypertension is frequently observed in renal transplant recipients. Its pathogenesis is multifactorial in most cases. Calcineurin inhibitors (CNI) can increase peripheral vascular resistance by inducing arteriolar vasoconstriction and can cause extracellular fluid expansion by reducing the glomerular filtration rate (GFR), activating the renin–angiotensin system (RAS), and by inactivating the atrial natriuretic peptide. Glucocorticoids can impair urinary water and salt excretion. Poor graft function can lead to increased extracellular volume and inappropriate production of renin. Native kidneys, older age of the donor and transplant renal artery stenosis (TRAS) may also contribute to the development of hypertension. Arterial hypertension not only can increases the risk for cardiovascular events but can also deteriorate renal allograft function. A number of studies have shown that the higher the levels of blood pressure are, the higher is the risk of graft failure. On the other hand, a good control of blood pressure may prevent many cardiovascular and renal complications. Appropriate lifestyle modification is the first step for treating hypertension. Calcium channel blockers (CCB) and renin–angiotensin system (RAS) inhibitors are the most frequently used antihypertensive agents, but in many cases, a combination of these and other drugs is required to obtain good control of hypertension.     

Cryoglobulinemia in kidney transplant recipients

The aim of this study was to assess the presence of cryoglobulins, the constitution of the cryoprecipitate, as well as the possible etiology and clinical features in kidney transplant recipients. We excluded patients with clinical or laboratory evidence of autoimmune, liver or neoplasm disease, infections, blood transfusions or immunizations in the previous 3 months. Detection of cryoglobulins was obtained from the peripheral venous blood. In cases of cryoprecipitate formation it was analyzed using anti-IgG, anti-IgM, anti-IgA, anti-C3, and anti-C4 antibodies. The hepatitis C virus (HCV) was detected by the polymerase chain reaction. Thirty-nine patients were selected, of whom 23 were men and the overall mean age was 40.6 +/- 12.7 years. Cryoprecipitate was detected in 74.4% (29/39) patients. Among patients with or without cryoprecipitate formation, the serum creatinine values, the percentage of patients with proteinuria, and the posttransplantation times were similar. In patients with cryoglobulins, 37.9% (11/29) were HCV positive. The etiology was not determined for the other patients. The IgG, IgM, and IgA immunoglobulins and the complement fractions C3 and C4 were found in the cryoprecipitate. Their compositions were similar among patients with or without HCV. Few clinical features were associated with the presence of cryoglobulins, including deep venous thrombosis, cutaneous purpura and peripheral neuropathy. In conclusion, cryoglobulinemia was prevalent in kidney transplant recipients, but appeared to not affect graft function. HCV infection was the most frequently associated etiology and clinical features were infrequent.     

Fatigue in kidney transplant recipients

Fatigue is still present in approximately 40%‐50% of kidney transplant recipients (KTR), rates comparable to that of the hemodialysis population. Correlates of fatigue include inflammation, symptoms of depression, sleep disorders, and obesity. Fatigue in KTR determines a significant severe functional impairment, either when globally considered or when analyzed at the level of the single domains such as sleep and rest, homemaking, mobility, social interaction, ambulation, leisure activities, alertness behavior, and work limitations. In addition, fatigue in KTR is significantly associated with a severe deterioration of quality of life. Fatigue is very common among KTR poorly adherent to immunosuppressive therapy. Unfortunately, there is no evidence of studies about the treatments of this symptom in KTR. Efforts to detect and treat fatigue should be a priority in order to improve quality of life of KTR.     

Aortic reconstruction in kidney transplant recipients

Renal transplantation has increased the longevity of patients with uremia. An increasing number undergo aortic reconstruction, which exposes the transplanted kidney to ischemic injury. To evaluate the risk for renal failure, loss of the transplant, and methods of renal protection, we reviewed our experience. Clinical data were reviewed for 10 consecutive patients (7 men, 3 women; mean age 52.7 years [range 32 to 75 years]) with a transplanted kidney who underwent aortic reconstruction between 1977 and 1994 at our institution. Mean interval between renal transplantation and aortic reconstruction was 5.9 years (range 1 month to 12.7 years). Seven patients required emergency repair because of dissection (2 patients), aneurysm rupture (4 patients), or symptomatic aneurysm (1 patient); three underwent elective repair. Reasons for reconstruction included aortic dissection (2 patients), aneurysm of the descending thoracic (2 patients), thoracoabdominal (1 patient), or abdominal aorta (3 patients), and aortoiliac occlusive disease (2 patients). Patients with thoracic or thoracoabdominal reconstructions underwent repair with atriofemoral, aortofemoral, or femorofemoral shunt placement or bypass. Of the five abdominal aortic reconstructions, the kidney was protected with aortofemoral shunt placement in one patient and cold renal perfusion in three. In two of them, topical cooling of the kidney also was used. One patient with acute aortic dissection died at 39 days as a result of respiratory failure. Loss of the recently transplanted kidney was caused by acute rejection. One patient had a transient increase in serum creatinine concentration. Eight had no worsening of renal function, and none of the nine survivors lost the transplanted kidney. We conclude that aortic reconstruction can be safely performed in kidney transplant recipients. Patients in whom thoracic or thoracoabdominal aortic reconstruction was required were protected with an atriofemoral or aortofemoral bypass or shunt. Patients undergoing abdominal aortic reconstruction did well when cold renal perfusion with or without local cooling of the transplant was used for renal protection. Transplanted kidneys appeared to tolerate ischemic injury similarly to native kidneys.Presented at the Twentieth Annual Meeting of the Peripheral Vascular Surgery Society, New Orleans, La., June 10, 1995.     

Treating gout in kidney transplant recipients

OBJECTIVE: To review the etiology, treatment, and preventive strategies of hyperuricemia and gout in kidney transplant recipients. DATA SOURCES: Primary literature was obtained via Medline (1966-June 2003). STUDY SELECTION AND DATA EXTRACTION: Studies evaluating treatment and prevention of hyperuricemia and gout in kidney transplantation were considered for evaluation. English-language studies were selected for inclusion. DATA SYNTHESIS: Approximately 14,000 kidney transplantations were performed in the United States in 2003, and of those transplant recipients, nearly 13% will experience a new onset of gout. The prevalence of hyperuricemia is even greater. There are several mechanisms by which hyperuricemia and gout develop in kidney transplant recipients. Medication-induced hyperuricemia and renal dysfunction are 2 of the more common mechanisms. Prophylactic and treatment options include allopurinol, colchicine, corticosteroids, and, if absolutely necessary, nonsteroidal antiinflammatory drugs. CONCLUSION: It is generally recommended to decide whether the risks of prophylactic therapy and treatment outweigh the benefits. Often, the risk of adverse events associated with agents to treat these ailments tends to outweigh the benefits; therefore, treatment is usually reserved for symptomatic episodes of acute gout. Practitioners must also decide if changes in immunosuppressive regimens may be of benefit on a patient-by-patient basis.     

Vascular access in kidney transplant recipients

Vascular access is an important element in the overall care provided to kidney transplant recipients. The transplanted kidney is not indestructible, and chronic kidney disease after transplantation may result in needing another transplant or beginning dialysis. Commonly used vascular accesses, like peripheral and central lines, can preclude the creation of future, permanent dialysis access. Therefore, there is urgent need to preserve vessels for the future access needs for hemodialysis among kidney transplant recipients without functional vascular access for dialysis. Moreover, the proper care of functional vascular access among kidney transplant recipients is crucial. In this review article, we will address the common vascular access procedures and complications among kidney transplant recipients.