肝硬化腹水合并腹股沟疝修补术28例

目的探讨肝硬化腹水合并腹股沟疝患者手术的风险及并发症。 方法回顾性分析2014年1月至2019年1月,泰州中西医结合医院收治的28例合并肝硬化腹水患者的临床资料,患者均采用手术治疗,手术方式分别为Lichtenstein方法和网塞平片方法。术后观察急性疼痛、慢性疼痛、感染（浅部感染与深部感染）、血肿、血清肿、切口愈合、复发等情况,术后随访1～5年。 结果所有患者顺利手术,随访期间无复发。无感染并发症,无慢性疼痛,3例患者发生切口血肿,保守治疗治愈。 结论腹股沟疝伴腹水不是腹股沟疝手术的禁忌证,在完善术前准备的情况下,可以进行无张力疝修补术。     

单纯肥胖患者腹腔镜袖状胃切除术后生活质量的改善

目的:探讨腹腔镜袖状胃切除术对单纯肥胖患者体重控制及生活质量的影响。方法:选取行腹腔镜袖状胃切除术的51例单纯肥胖患者,平均(32.7±2.7)岁,男女比例为15:36,并进行1年临床随访研究,观察肥胖相关指标的改善状况,并利用《SF-36量表》评估患者术前、术后6个月及术后1年生活质量的变化。结果:与术前相比,术后6个月、12个月,患者的体重指数明显改善(P0.01)。术后6个月,患者生活质量相关维度生理健康总评及心理健康总评两个维度与术前相比明显改善(P0.05),但低于正常人群[均值(50±10)分]。术后6个月、12个月,情感职能、生理机能、生理职能、躯体疼痛、一般健康状况、社会功能及精力较术前明显改善(P0.01),精神健康维度与术前相比差异无统计学意义(P0.05)。结论:单纯肥胖患者接受腹腔镜袖状胃切除术后,体重控制情况及生活质量较术前有明显改善。     

Surgery improves quality of life in patients with “mild” hyperparathyroidism

Background

Surgical treatment of patients with “classic” hyperparathyroidism improves quality of life, but these benefits to patients with “mild” disease remain unclear.

Methods

The SF-36 Health Survey was administered to 174 patients 1 week before, 1 week after, and 1 year after undergoing parathyroidectomy.

Results

One hundred fifty-one patients completed at least 2 surveys. There were 18 and 133 cases of “mild” and “classic” hyperparathyroidism, respectively. Preoperatively, the groups did not differ significantly in the 10 scales. One year after surgery, patients with “classic” and “mild” disease improved significantly in 9/10 and 10/10 scales, respectively (P < 0.05). Those with “mild” disease had a statistically larger improvement than those with “classic” disease in 4 scales.

Conclusions

Quality of life significantly improved in surgically treated patients with both “mild” and “classic” hyperparathyroidism, supporting surgical treatment of “mild” hyperparathyroidism. Moreover, quality of life may improve more in patients with “mild” rather than “classic” disease.     

认知-行为疗法提高糖尿病肾病患者活动量和生活质量的研究

目的探讨认知—行为疗法对糖尿病肾病(diabetic nephropathy,DN)患者活动量和生活质量的影响。方法纳入陆军军医大学大坪医院肾内科108名DN患者,根据随机数字表分成试验组(认知—行为干预组)和对照组(标准护理组)。两组患者均接受相同的标准治疗方案、饮食指导和常规活动指导建议。在此基础上,试验组采用认知-行为干预疗法:(1)建立信任;(2)检验负性思维;(3)重塑认知;(4)巩固意识。入组后0、3、6、12月进行随访,采用体育活动等级量表(PARS-3)评价运动量。记录心血管危险因素、肾小球滤过率,白蛋白,体质量指数等。采用SF-36量表评价两组生活质量评分。结果入组3个月时,认知干预组的运动量(39.6±6.4)分大于对照组(22.4±7.1)分,差异有统计学意义(t=-3.983,P<0.01);试验组每月运动累计时间(79.6±11.2)h大于对照组(32.1±11.6)h,差异有统计学意义(t=-2.015,P=0.021)。入组6个月后实验组糖化血红蛋白、空腹血糖、舒张压和收缩压低于对照组(P<0.05)、实验组肾小球滤过率高于对照组(P<0.05),躯体功能(PF)、由躯体问题所造成的角色限制(RP)分值显著高于对照组(P<0.05)。入组12个月后实验组的PF、RP、躯体不适(BP)分值均高于对照组(P<0.05)。结论认知行为干预可加强DN患者的运动意识,增加其活动量,改善血糖控制水平,提高患者生存质量。     

Inguinal hernioplasty with the Prolene Hernia System

Most tension-free hernia repair techniques achieve 0.1%–0.4% recurrence rates in patients with primary hernias. Currently, the Lichtenstein technique is considered to be the criterion standard. The Prolene Hernia System (PHS) is a recently introduced hernia-repair device that combines three proven mechanisms of action. We retrospectively reviewed early and late complications in 250 patients who underwent inguinal hernioplasties—125 performed with the Lichtenstein technique and 125 performed with the PHS—from March 1998–October 2002. Patients who underwent Lichtenstein hernia repair had nine complications, and those who underwent PHS surgery had only two; none of the complications were serious. Older male patients who underwent Lichtenstein hernia repair were more likely to have complications (P=0.04). One patient in the Lichtenstein group had a recurrence of his hernia, but there were no recurrences in the PHS group. In conclusion, the results of inguinal hernioplasties performed with the PHS are comparable to those achieved with Lichtenstein hernia repair, the criterion standard technique.     

不同术式在腹股沟疝治疗中的应用分析及对患者生活质量的对比研究

目的探讨腹腔镜经腹腹膜前疝修补术（laparoscopic trans-abdominal preperitoneal hernia repair,TAPP）和开放无张力疝修补术在腹股沟疝治疗中的效果及对患者生活质量的影响。 方法选取2014年2月至2018年2月,江苏省南京市溧水区人民医院接受治疗的腹股沟疝患者60例,根据治疗方法不同分为TAPP组（26例）及开放手术组（34例）。随访3个月,比较2组手术指标、并发症发生情况及复发情况及生活质量评分差异。 结果TAPP组术中出血量及术后平均最高体温较开放手术组降低,下床活动时间、术后排气时间及住院时间较开放手术组缩短,但住院费用较开放手术组升高,差异均有统计学意义（P<0.05）;2组手术时间、术后复发率比较,差异无统计学意义（P>0.05）。TAPP组总并发症发生率低于开放手术组,简明健康测量量表（short form-36 health survey questionmaire,SF-36）、改良Rankin量表（Modified Rankin Scale,mRS）和巴塞尔指数（Barthelindex,BI）评分均显著高于开放手术组,差异均有统计学意义（P<0.05）。 结论TAPP治疗腹股沟疝可加速患者预后恢复,降低并发症发生率,提高患者生活质量,但手术时间较长,费用较高。     

肝硬化失代偿期并发肠梗阻患者生存质量及影响因素分析

目的了解肝硬化失代偿期并发肠梗阻患者的生存质量,并分析其影响因素,为临床干预提供依据。方法回顾性收集2018年8月—2019年8月在湖北医药学院附属人民医院收治的39例肝硬化失代偿期并发肠梗阻患者的病例资料,设为观察组,其中男性25例,女性14例,年龄(52.34±2.64)岁,年龄范围39~64岁。采取单纯随机抽样中的随机数字表法,抽取同期42例硬化失代偿期未并发肠梗阻患者的病例资料设为对照组,其中男性30例,女性12例,年龄(51.34±3.45)岁,年龄范围37~68岁。分别对两组患者采用慢性肝病患者生存质量量表——慢性肝病问卷进行调查,比较两组患者的腹部症状、疲劳、全身症状、活动、情感、焦虑各维度得分及生存质量总分,并对影响因素进行分析,其中,正态分布的计量资料采用均数±标准差(Mean±SD)表示,两组间比较采用t检验。计数资料采用χ2检验。生存质量影响因素采用多元线性回归分析。结果观察组患者的腹部症状、疲劳、全身症状、活动、情感、焦虑得分以及总分得分分别为(5.58±1.79)、(4.23±1.74)、(4.93±1.39)、(5.36±1.36)、(4.74±1.05)、(4.26±1.25)、(31.06±6.53)分,对照组得分分别为(6.27±1.12)、(5.47±1.26)、(6.14±0.78)、(5.88±0.93)、(5.45±0.82)、(4.96±0.94)、(33.79±4.01)分,观察组得分均低于对照组,两组间的比较差异均具有统计学意义(P<0.05);多元线性回归结果显示,病程,肝功能Child-Pugh分级,腹痛、腹胀、乏力等不适症状,营养状况,性别,年龄,医疗费用支付方式,家庭人均月收入,焦虑是其影响因素。结论肝硬化失代偿期并发肠梗阻患者的生存质量低于肝硬化失代偿期未并发肠梗阻患者,其影响因素有疾病相关因素,也有非疾病相关因素,医务人员应根据患者情况,给予患者针对性的干预,尽可能改善患者的生存质量。     

腹腔镜食管裂孔疝修补术联合胃底折叠术对胃食管反流病合并食管裂孔疝患者抗反流效果及生活质量的影响

目的探讨腹腔镜食管裂孔疝修补术联合胃底折叠术对胃食管反流病（gastroesophageal reflux disease,GERD）合并食管裂孔疝（hiatus hernia,HH）患者抗反流效果及生活质量的影响。 方法选取新疆维吾尔自治区人民医院消化科住院部自2015年3月至2017年8月收治的78例GERD合并HH患者为研究对象,分为2组。观察组行腹腔镜HH修补术联合胃底折叠术（42例）,对照组行传统开腹术（36例）。随访观察2组患者手术情况、不良反应发生情况以及RDQ和GLQI评分。 结果观察组患者术中出血量和手术时间、术后住院时间、胃肠道功能恢复时间均低于对照组,差异有统计学意义（P<0.05）。术后3及6个月随访中,观察组的RDQ评分低于对照组,GLQI评分高于对照组（P<0.05）,差异均有统计学意义（P<0.05）。观察组术后不良反应发生率为7.14%,对照组术后不良反应发生率为16.67%,但2组差异无统计学意义（P>0.05）。 结论对于GERD合并HH患者,采用腹腔镜HH修补术联合胃底折叠术的手术方案,手术情况及抗反流效果更好,患者生活质量更高。     

全程护理对腹股沟疝修补术患者心理状态与生活质量的影响

目的研究全程护理对腹股沟疝修补术患者心理状态与生活质量的影响。 方法选择2015年6月至2017年6月,湖北文理学院附属医院收治的腹腔镜腹股沟疝修补术患者64例,以随机数字表法分为观察组及对照组,每组32例。对照组给予常规护理,观察组给予全程护理。比较2组患者护理前后的心理状态与生活质量情况。 结果护理前2组SAS评分与SDS评分比较,差异无统计学意义（P>0.05）;护理后2组SAS评分与SDS评分均有所下降,虽然观察组下降程度较对照组明显,但差异均有统计学意义（P均<0.05）。护理前2组生活质量评分比较,差异无统计学意义（P>0.05）;术后首次随访时2组生活质量评分较前均升高,但观察组改善程度优于对照组,差异有统计学意义（P<0.05）。 结论在腹股沟疝修补术的患者应用全程护理可显著改善患者心理状态,并提高生活质量,值得借鉴。     

Surgery for pressure ulcers improves general health and quality of life in patients with spinal cord injury

Study Design:

Prospective clinical study.

Background:

Pressure ulcers interfere with the rehabilitation process in patients with spinal cord injury (SCI) and are a significant deterrent to participation in activities that contribute to independent, productive, and satisfying life.

Objective:

To evaluate the effect of surgery for pressure ulcers on general health and quality of life in patients with SCI.

Setting:

Tertiary care center in northern India.

Methods:

Various types of flap surgery were performed on 30 patients with SCI and 32 pressure ulcers (stages III and IV). Outcome was evaluated using general improvement in health (hemoglobin, serum proteins, and general well-being), patient satisfaction, and global quality of life scores (according to the visual analog scale).

Results:

At admission, the mean values of global quality of life, hemoglobin, serum albumin, and total serum proteins were 50.15 (range, 30–65), 8.75 g/dL (range, 6–12 g/dL), 3.12 g/dL (range, 2.9–4.3 g/dL), and 5.21 (range, 5–6.2 g/dL), respectively. At 6-month follow up, mean values of global quality of life score, hemoglobin, serum albumin, and total serum proteins were 87.36 (range, 44–96), 10.85 g/dL (range, 8.2–13.5 g/dL), 3.89 g/dL (range, 3.2–4.5 g/dL), and 6.43 g/dL (range, 5.85–6.70 g/dL), respectively. The overall rise in quality of life scores, hemoglobin, serum albumin, and total serum proteins was statistically significant. Most of the patients (76.7%) reported improvement in subjective well-being, and 83.3% were satisfied with the ultimate outcome of the surgery.

Conclusion:

Results suggest that surgery for stages III and IV pressure ulcers offers the greatest benefit to the patients in terms of improvement in general health (anemia, hypoproteinemia, and general well-being) and quality of life.     

Health-related quality of life in adult patients with esophageal atresia--a questionnaire study

Background/Purpose

Long-term sequelae caused by associated anomalies or respiratory and gastrointestinal disorders are common after the repair of esophageal atresia (EA). The aim of this study was to assess the effect of these sequelae on the health-related quality of life (HRQoL) of patients with EA.

Methods

A questionnaire including a 36-item Gastrointestinal Quality of Life Index, a 15-item Respiratory Symptoms-Related Quality of Life Index, and a 36-item psychosocial survey and a symptoms query was sent to 159 patients with EA with or without tracheoesophageal fistula (TEF), who were operated on between 1949 and 1979, and to 400 healthy control subjects. A 36-item Health Survey Form was sent to patients with EA only and the results were compared with values of the general Finnish population.

Results

A total of 128 patients with EA (80%) and 162 control subjects (41%) returned the questionnaire. Median age [patients with EA, 38 (range, 24-54) years; control subjects, 36 (20-56) years] and sex distribution (M/F of patients with EA, 57:70; control subjects, 63:99) were comparable. Of the 128 patients, 115 (91%) had EA with a distal TEF, 8 (6%) had EA without TEF, 3 (2%) had EA with proximal and distal TEF, and 2 (1%) had TEF without EA. The types of esophageal repair were distributed as follows: primary end-to-end anastomosis (n = 112), colon interposition (n = 10), gastric tube (n = 3), thoracic skin tube (n = 1), and fistula closure only (n = 2). Thirty-eight patients had significant associated anomalies. Gastrointestinal Quality of Life Index scores did not differ statistically between patients with EA and control subjects. However, the incidence of regurgitation (17% vs 10%) and dysphagia (10% vs 2%) was significantly higher in patients with EA (P < .5). Low Respiratory Symptoms-Related Quality of Life Index was found in 10 of 128 patients with EA and in 3 of 163 control subjects (P < .05). Psychosocial survey scores and the incidence of acquired diseases did not differ between the groups (P = NS). The 36-item Health Survey Form indicated low HRQoL in 19 (15%) of patients with EA (expected value, 16%). Of the 19 patients with EA with low HRQoL, 8 (42%) had significant congenital or EA-associated diseases and 11 (58%) had acquired diseases. The type of EA or esophageal conduit was not related to HRQoL.

Conclusions

Most adult survivors of EA or TEF repair have a normal quality of life. Morbidity from esophageal functional disorders and respiratory disorders with or without acquired diseases impairs HRQoL in 15% of patients with EA.     

Social quality of life for adult patients with anorectal malformations

Background/Purpose

Pediatric surgeons who performed the initial surgery on anorectal malformations (ARM) lose contact with the patients as they become adults. In the present study, we examined 20- to 40-year-old adult patients with a history of surgery for ARM and analyzed them from the points of social quality of life.

Patients and Methods

Twenty-nine patients with ARM, aged 20 to 40, were surveyed by questionnaire or personal interview. Thirteen with high-type and 9 with intermediate-type anomalies underwent abdominoperineal rectoplasty, and 7 with low-type anomalies underwent perineoplasty between 1965 and 1985. Responses were analyzed from the perspectives of bowel, urinary, and sexual functions and social activity.

Results

One third of patients with high- or intermediate-type anomalies occasionally complained of fecal soiling. However, the other patients gained good bowel function and enjoyed occupational or student life without problems. Fecal soiling was the key factor disturbing occupational life, although the problem remained within a socially manageable level. All of the patients with ARM had normal urinary function. Three of the 18 male patients had sexual problems such as erectile or ejaculatory dysfunction because of associated genitourinary anomalies. Nine of the 11 female patients had regular menstruation and the other 2 had irregular menstrual periods. Five female patients were married and 4 of the 5 had children (1-5 children). Modes of delivery were normal vaginal delivery in 8 and cesarean section in 1. Only one of the 5 had a slight sacral anomaly. However, she had no apparent abnormality of bladder function and got through pregnancy and delivery without difficulty.

Conclusion

One third of adult patients with high- or intermediate-type anomalies after abdominoperineal rectoplasty had some problems in bowel function. Fecal soiling was the key factor that disturbed their occupational life. Most of the patients had normal urinary and sexual functions if they did not have associated genitourinary anomalies and enjoyed social activities.     

Quality of life in patients with osteoporosis

Complaints regarding, and morbidity of, osteoporosis are caused by fractures which are associated with pain and decrease of physical function, social function, and well-being. These are aspects of quality of life. Health-related quality of life covers physical, mental, and social well-being. Quality of life may be measured for evaluation of treatment effects in clinical trials, for the assessment of the burden of the disease of osteoporosis, and for estimates of the cost-effectiveness of different treatment scenarios in health care policy. Quality of life has been measured in patients with osteoporosis with generic questionnaires such as SF-36 and EQ-5D, which can be used in many diseases, or with one of the six available osteoporotic-specific questionnaires, e.g., Qualeffo-41 or OPAQ. Every questionnaire has to be validated to assess psychometric properties and discrimination power between patients with osteoporosis and control subjects. The value attached to specific health states (utility) can be assessed with some generic instruments or by systematic questioning of the patient, e.g., the time-trade-off method. This results in one value for health status ranging from 0 (death) to 1 (perfect health). Utility values can be used to calculate loss of quality-adjusted life years (QALY). Most data have been obtained in patients with prevalent vertebral fractures. Scores of specific and generic questionnaires showed significant loss of quality of life with prevalent vertebral fractures. In addition, studies with Qualeffo-41 and OPAQ showed a deteriorating quality of life with increasing number of vertebral fractures. Lumbar fractures had more impact on quality of life than thoracic fractures. Incident vertebral fractures were also associated with a decrease of quality of life especially in the physical function domain. This applied to clinical incident vertebral fractures as well as to subclinical fractures to a lesser degree. Loss of quality of life following hip fracture has been documented with generic and osteoporosis-specific questionnaires. A considerable loss was observed in the 1st year with some improvement in the 2nd year, but not to baseline values. Quality of life depended on comorbidity, mobility, activities of daily life (ADL)–independence, and fracture complaints. Utility loss has been observed following hip fracture, especially disabling hip fracture, hip and vertebral fracture combined, or multiple vertebral fractures. Utility following osteoporotic fractures has been valued by patients, the healthy elderly, and panels of experts. The healthy elderly gave the worse quality-of-life scores (lower utility) to various hip fractures than patients with hip fractures themselves. In conclusion, suitable instruments exist for measuring quality of life in patients with osteoporotic fractures. These instruments are useful for clinical trials and for assessment of the burden of disease.     

良性前列腺增生患者不同疾病维度下的生存质量研究

目的 研究良性前列腺增生（BPH）患者不同疾病维度下的生存质量.方法 对2011年10月～2012年4月被确诊为BPH的110例患者,根据患者是否患有高血压、糖尿病分为单纯BPH组、BPH合并高血压组、BPH合并糖尿病组、BPH合并高血压及糖尿病组4个疾病维度,分别采用国际前列腺症状评分（IPSS）、健康测量量表SF-36来调查4组患者的下尿路症状、生存质量并进行组间比较.结果 4组患者的年龄、下尿路症状比较无显著统计学差异（P =0.150,P=0.088）.生存质量8个维度的组间比较仅总体健康一个维度有显著差异（P=0.008）,进一步分析显示在总体健康维度上BPH合并高血压及糖尿病组显著低于BPH合并高血压组及单纯BPH组（x2 =8.14,0.025＜P＜0.05;x2=10.41,0.01＜P＜0.025）,总体健康维度的其他组间比较均无显著统计学差异（P＞0.05）.结论 BPH患者不同疾病维度下的生存质量有差异,改善BPH患者的生存质量可能需要积极预防和控制高血压、糖尿病等基础疾病.     

Quality of life before and after liver transplantation: experiences with 7 patients with primary biliary cirrhosis in a 2-year follow-up

Seven patients with end-stage primary biliary cirrhosis were evaluated both before and 1 and 2 years after liver transplantation using a clinical psychiatric interview and the self-rating questionaire SCL-90. Neuro-psychological tests were done before and 1 year after operation. Preoperatively, all patients had a poor general condition and overall quality of life. Flattening of emotions and reactions, regression, disturbances of verbal memory and cognitive function, and dependence on close relatives were observed. One year after transplantation, 6 patients had a much better overall quality of life, and with five patients it improved still further during the 2nd year, but only 2 patients felt that their life situation had fully stabilised. However, nearly all of them experienced phases of moderate or even severe depression or anxiety during those 2 years. On neuropsychological tests patients appeared to be near their normal level. The only patient who died during this follow-up (some months after transplantation) had in her life history a prominent sense of insecurity and mistrust. It seems to take more than a year for the majority of patients to give up the regressive mode of experience and turn to adult interests in life again, as well as psychologically experience the new liver as part of oneself.     

综合护理干预对前列腺增生症合并腹股沟疝术后自我护理及生活质量的影响

目的探究综合护理干预对前列腺增生症合并腹股沟疝术后自我护理及生活质量的影响。 方法选取2018年3月至2020年3月于新疆维吾尔自治区人民医院就诊的132例前列腺增生症合并腹股沟疝术后患者,采用随机表法分为对照组和观察组,各66例。比较2组患者术后恢复情况、并发症发生率以及2组患者在护理干预前、出院时的焦虑自评量表（SAS）、自评抑郁量表（SDS）、生活质量调查简表（SF-36）评分,出院时患者对护理工作的满意度调查结果。 结果观察组患者术后恢复时间均短于对照组（P<0.05）。观察组患者术后的并发症发生率（3.03%）远低于对照组术后并发症发生率（9.09%）（P<0.05）。2组患者出院时SAS、SDS评分均比干预前明显降低,且观察组显著低于对照组（P<0.05）。出院时,2组患者生理健康总评（PCS）和心理健康总评（MCS）评分均较干预前有所升高（P<0.05）,且观察组PCS和MCS评分显著高于对照组（P<0.05）。出院时,观察组患者对护理工作各项满意度的评分均显著高于对照组（P<0.05）。 结论综合护理干预对前列腺增生症合并腹股沟疝患者的术后自我护理有着极好的引导作用,患者能够尽快适应术后变化,进而调动患者的自主能动性,提高患者生活质量。     

密固达对骨质疏松患者中短期生存质量的影响

目的 我国老年人数量居于世界首位,骨质疏松是老年人常见的疾病,骨质疏松症的发病率呈上升趋势,使用疗效确切、迅速起效的抗骨质疏松药物减轻疼痛,恢复生活自理能力,提高生活质量尤为必要。方法 回顾分析2010年5月~2012年5月骨质疏松患者52例,随机分为密固达组和福善美组各26例,密固达组每年静脉滴注密固达注射液（诺华公司）5 mg;福善美组口服福善美,1片/次,每周1次,分析治疗前、治疗后1周、2周、1月、6月、1年VAS疼痛指数和诺丁汉健康量表变化。结果 52例患者治疗后VAS疼痛指数均有改善,半年治疗后,VAS改善比较明显,与治疗前比较差异有统 计学意义（P<0.01 ),密固达组的VAS评分改善更为迅速,治疗后1周内VAS指数已有明显的下降 (P<0.05 )。在诺丁汉健康量表分析方面,52例患者经治疗后指数均有不同程度的下降,尤其是在躯 体活动、精力、疼痛这3个条目方面（P<0.01 ),而密固达组下降更为迅速,治疗后1周已有显著性差 异（P<0. 05 );密固达组在治疗后1年社会联系条目指数较治疗前也有明显下降（P<0. 05 );两组在睡眠与情感反应条目治疗前后未见明显变化（P>0. 05 );密固达组治疗1年后,躯体活动、精力、疼痛 条目得分较福善美组低,比较有显著差异,具有统计学意义（P<0.05 )。结论 静脉滴注唑来膦酸盐较口服阿仑膦酸盐有更好的止痛效果,其起效更为迅速,使患者更快的恢复自理,减少了卧床时间,从而减少了因疼痛长期卧床引起废用性骨质疏松的恶性循环。同时,密固达每年仅需要一次静脉滴 注,大大提高了用药的依从性,受到患者及其家属的青睐,是一种高效的人性化的抗骨质疏松药物。     

Differences of prognosis in hemodialysis patients with different quality of life

Objective To compare the one-year survival rates of maintenance hemodialysis(HD) patients with different quality of life, and analyze related factors affecting the prognosis ofpatients. Methods Patients on hemodialysis for at least 3 months were enrolled. A short form 36 health survey questionnaire (SF-36) and Pittsburgh sleep quality index (PSQI) were used to evaluate the quality of life and quality of sleep. To observe one-year all-cause mortality and Cox regression model was used to analyze the factors associated with survival outcomes. Results A total of 159 patients undergoing hemodialysis were included, in which 136 patients completed the follow-up after one - year observation. The one - year survival rate in patients with both high physical component summary (PCS) and mental component summary (MCS) scores was significantly better than the patients with low PCS and MCS scores (P ﹤ 0.05). PCS, hemoglobin and serum albumin were the protection factors for HD patients. Conclusions Quality of life is strongly associated with prognosis in HD patients. Enhancing quality of life is of clinical significance in the improvement of HD patients' survival rate.     

Quality of life in patients after total pancreatectomy is comparable with quality of life in patients who undergo a partial pancreatic resection

Background

Quality of life after total pancreatectomy (TP) is perceived to be poor secondary to insulin-dependent diabetes and pancreatic insufficiency. As a result, surgeons may be reluctant to offer TP for benign and premalignant pancreatic diseases.

Methods

We retrospectively reviewed presenting features, operative characteristics, and postoperative outcomes of all patients who underwent TP at our institution. Quality of life was assessed using institutional questionnaires and validated general, pancreatic disease-related, and diabetes-related instruments (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30 and module EORTC-PAN26], Audit of Diabetes Dependent Quality of Life), and compared with frequency-matched controls, patients after a pancreaticoduodenectomy (PD). Continuous variables were compared using Student t-test or analysis of variance. Categorical variables were compared using χ² or Fisher exact test.

Results

Between 1994 and 2011, 77 TPs were performed. Overall morbidity was 49%, but only 15.8% patients experienced a major complication. Perioperative mortality was 2.6%. Comparing 17 TP and 14 PD patients who returned surveys, there were no statistically significant differences in quality of life in global health, functional status, or symptom domains of EORTC QLQ-C30 or in pancreatic disease-specific EORTC-PAN26. TP patients had slightly but not significantly higher incidence of hypoglycemic events as compared with PD patients with postoperative diabetes. A negative impact of diabetes assessed by Audit of Diabetes Dependent Quality of Life did not differ between TP and PD. Life domains most negatively impacted by diabetes involved travel and physical activity, whereas self-confidence, friendships and personal relationships, motivation, and feelings about the future remained unaffected.

Conclusions

Although TP-induced diabetes negatively impacts select activities and functions, overall quality of life is comparable with that of patients who undergo a partial pancreatic resection.     

生活质量调查表在下肢慢性静脉功能不全术后随访中的应用

目的评估下肢慢性静脉功能不全 (chronicvenousinsufficiency ,CVI)术后的生活质量。方法采用生活质量调查表 (chronicvenousinsufficiencyquestionnaire ,CIVIQ) 4类 2 0项调查内容 ,评价 3种不同术式组 :浅静脉组术式、交通静脉组术式、深静脉组术式 16 9例CVI患者术后的生活质量 ;CIVIQ均值 80分以上定为良好。结果 3种术式CIVIQ均值分别为 :浅静脉组 84± 15 ;交通支组 88± 14 ;深静脉组 82± 16。结论深静脉瓣膜重建术后患者生活质量是满意的 ;CIVIQ的应用是合理和可行的。