脑卒中患者疾病感知变化轨迹及核心影响因素决策树分析

目的 探讨脑卒中患者从发病急性期至恢复期的疾病感知变化轨迹,分析不同轨迹亚型的预测因素,为针对干预提供参考.方法 对192例脑卒中住院患者采用一般资料调查表、简易疾病感知问卷、Herth希望量表、医院焦虑抑郁量表进行基线调查,于调查后1、3、6个月随访患者的疾病感知水平.分析不同时点疾病感知水平差异,采用潜变量增长混合...     

骨科创伤患者自我怜悯水平及影响因素研究

目的了解骨科创伤患者自我怜悯水平,分析其影响因素,为制定针对性的干预措施提供参考。方法采用自我怜悯量表、医院焦虑抑郁量表对长沙市6所医院的396例骨科创伤患者进行调查。结果骨科创伤患者的自我怜悯得分为(67.60±12.80)分。回归分析结果显示,年龄、职业、焦虑、抑郁是骨科创伤患者自我怜悯的主要影响因素,可解释其总变异的10.9%。结论骨科创伤患者的自我怜悯水平处于中等偏下水平,且受多种因素影响,临床医护人员需对其提供个性化的人文关怀,以提高其自我怜悯水平。     

稳定期COPD患者骨骼肌消耗及影响因素分析

目的探讨稳定期慢性阻塞性肺疾病(COPD)患者骨骼肌消耗及其影响因素。方法采用便利抽样法选取141例门诊稳定期COPD患者作为调查对象,采用一般资料调查表、COPD病情综合评价相关指标、生物电阻抗测量、COPD生活质量测评表对其进行调查。结果 COPD患者去脂体重指数水平为(17.19±1.94)kg/m~2,发生骨骼肌消耗44例(31.20%);骨骼肌消耗组患者生活质量总分及日常生活能力、焦虑心理因子得分与正常组比较,差异有统计学意义(P0.05,P0.01);Logistic回归分析显示,体重指数、FEV_1%及呼吸困难评分是患者发生骨骼肌消耗的影响因素(P0.05,P0.01)。结论稳定期COPD患者存在较严重的骨骼肌消耗,对患者生活质量产生影响,骨骼肌消耗的发生与低体质量、严重气流受限及呼吸困难有关。     

膀胱癌术后患者恐惧疾病进展现状及影响因素研究

目的了解膀胱癌术后膀胱灌注化疗患者恐惧疾病进展现状并分析影响因素,为心理护理提供参考。方法采用一般情况调查表、恐惧疾病进展简化量表、简易疾病感知问卷对110例膀胱癌术后首次膀胱灌注化疗患者进行问卷调查。结果患者恐惧疾病进展总分(25.31±5.35)分,7.27%的患者出现心理功能失调;多元回归分析显示,疾病感知、肿瘤复发、肿瘤组织学分级、性别、年龄是膀胱癌术后膀胱灌注化疗患者恐惧疾病进展的影响因素(P0.05,P0.01)。结论膀胱癌术后膀胱灌注化疗患者存在疾病进展恐惧,需重点关注女性、复发及高组织学分级患者,可通过改善疾病感知以降低患者的恐惧疾病进展水平。     

新型冠状病毒肺炎患者焦虑抑郁及影响因素调查

目的了解新型冠状病毒肺炎患者的焦虑抑郁状况及其影响因素,为采取针对性心理护理干预提供参考。方法采用焦虑自评量表及抑郁自评量表,对148例新型冠状病毒肺炎患者进行调查。结果焦虑发生率为21.63%,抑郁发生率为50.00%;多元线性回归分析显示:有无胸闷/心慌的感觉、与世隔绝的感觉、容易激动/感到烦恼、担心家人病情/被传染、担心能否治愈是新型冠状病毒肺炎患者发生焦虑的影响因素(P0.05,P0.01)。睡眠、与世隔绝的感觉、担心家人病情/被传染、担心能否治愈是患者发生抑郁的影响因素(均P0.01)。结论新型冠状病毒肺炎患者存在一定的焦虑与抑郁,临床应启动针对性心理护理干预,缓解患者焦虑、抑郁情绪。     

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。     

住院冠心病患者疾病知识掌握情况及影响因素分析

目的了解住院冠心病患者疾病相关知识水平并分析其影响因素。方法自行编制冠心病相关知识调查表对92例住院冠心病患者进行调查。结果住院冠心病患者冠心病相关知识条目总均分为0．60±0．17（总分为1分）；康复相关知识得分最高（0．85±0．19），药物知识得分最低（0．20±0．20）。主要影响因素是文化程度和经济状况。结论住院冠心病患者药物知识缺乏，健康教育时需考虑患者的文化程度和经济状况。     

社区空巢老人焦虑抑郁状况及其影响因素调查

目的探讨社区空巢老人的焦虑、抑郁状况，并分析其主要影响因素。方法采用焦虑自评量表（SAS）、老年抑郁量表（GDS-15）和一般情况问卷，对上海市闸北区芷江西社区的229名空巢老人进行入户调查。结果229名空巢老人中，63名（27．5％）存在焦虑症状，35名（15．3％）有抑郁症状。Logistic多元回归分析发现，影响空巢老人焦虑症状发生的主要因素为躯体疾病、宗教信仰、娱乐活动；影响其抑郁症状发生的主要因素包括躯体疾病、既往职业、子女探望间隔时间、亲友联系。结论空巢老人的焦虑、抑郁发生率较高，严重影响了其心理健康；主要影响因素为躯体疾病种类多、子女探望时间间隔长、既往无职业、与亲友联系少等；政府、民政部门、医护人员、社区居委会及家庭成员应高度重视空巢老人的心理状况，制定相应的干预体系和干预措施。     

新型冠状病毒肺炎住院患者心理应激状况及影响因素分析

目的调查新型冠状病毒肺炎(COVID-19)住院患者的心理应激状况,并分析其影响因素,为实施心理危机干预提供参考。方法以方便抽样方法选取COVID-19患者652例,采用症状自评量表中的躯体化、抑郁、焦虑、睡眠与饮食4个因子调查患者的心理应激反应,采用认知融合问卷、医学应对方式问卷调查其应对情况。结果患者躯体化、抑郁、焦虑、睡眠与饮食因子得分分别为1.70±0.53、1.58±0.57、1.53±0.60、1.81±0.60;存在躯体化症状172例(26.38%)、焦虑117例(17.94%)、抑郁124例(19.02%)、睡眠与饮食障碍236例(36.20%)。性别、婚姻状况、年龄、认知融合程度、疾病应对方式是患者躯体化、抑郁、焦虑、睡眠与饮食因子的影响因素(P0.05,P0.01)。结论 COVID-19住院患者存在一定程度的心理应激。医护人员应对中老年、女性、离异或丧偶、认知融合程度高的COVID-19患者加强心理干预,帮助患者正确认知疾病,采取恰当的疾病应对方式,以促进其身心健康。     

住院冠心病患者疾病知识掌握情况及影响因素分析

目的 了解住院冠心病患者疾病相关知识水平并分析其影响因素.方法 自行编制冠心病相关知识调查表对92例住院冠心病患者进行调查.结果 住院冠心病患者冠心病相关知识条目总均分为0.60±0.17(总分为1分);康复相关知识得分最高(0.85±0.19),药物知识得分最低(0.20±0.20).主要影响因素是文化程度和经济状况.结论 住院冠心病患者药物知识缺乏,健康教育时需考虑患者的文化程度和经济状况.     

Status and influencing factors of lower limb amputation in patients with diabetic foot ulcer

To investigate the influencing factors of lower limb amputation in patients with diabetic foot ulcers. Patients with diabetic foot ulcers who were hospitalised in a tertiary general hospital in Guizhou Province from January 2019 to March 2022 were retrospectively collected. Sociological information of the general population, comorbidities, laboratory-related indicators, and information on the specialty situation, using univariate analysis and multifactor analysis, compared the influencing factors of amputation and non-amputee patients. A total of 205 patients with diabetic foot and 69 ampute patients (33.7%) were enrolled. The univariate analysis found that the decrease in HDL cholesterol levels was associated with the occurrence of lower extremity amputation, and logistic stepwise regression analysis showed that HDL-C was inversely correlated with the amputation rate of patients with diabetic foot ulcers, and the risk of amputation at low levels of HDL-C was 2.452 times higher than that of high-level HDL-C (95% CI: 1.105–5.846). Decreased HDL cholesterol levels are an independent predictor of amputation in patients with diabetic foot ulcers.     

癌症患者失志综合征现状及影响因素分析

目的 了解癌症患者失志综合征发生现状及影响因素,为癌症患者失志综合征的干预提供参考.方法 选取250例癌症患者为研究对象,采用中文版失志量表-Ⅱ及埃德蒙顿症状评估量表进行调查.结果 癌症患者失志综合征得分为10.0(7.0,12.0)分,中度、重度失志综合征发生率分别为47.20％、4.00％.多元线性回归分析结果显示,性别、受教育程度、月均收入、疼痛、疲乏、抑郁、焦虑、幸福感下降是癌症患者失志综合征的主要影响因素(P＜0.05,P＜0.01).结论 癌症患者失志的发生率较高.临床医务人员应针对失志综合征的影响因素,制订合适的干预措施,降低癌症患者失志水平,提高其生活质量.     

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。     

脑卒中患者照顾者综合照顾能力现状及影响因素分析

目的了解脑卒中患者照顾者综合照顾能力现状及其影响因素,为提高照顾者综合照顾能力提供参考。方法采用一般资料调查表、脑卒中患者照顾者综合照顾能力评估问卷,对105例住院脑卒中患者及其照顾者(家属)进行调查。结果脑卒中患者照顾者综合照顾能力总分89.67±15.53,得分率64.05%;患者婚姻状况、卒中病程及医疗费用支付方式,照顾者年龄及每天照顾时间是照顾者照顾能力的影响因素(P0.05,P0.01)。结论脑卒中患者照顾者综合照顾能力偏低,卒中病程长、已婚及医保患者的照顾者综合照顾能力较强,但随照顾者年龄增长及每天照顾时间的延长照顾能力下降。医护人员应加强对照顾者的知识培训及信息、情感支持;相关部门应给予脑卒中患者及照顾者充分关注,完善相关福利政策,以丰富照顾者应对策略,提高其照顾能力,从而改善照顾者生活质量。     

Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study

Lower limb crush injury is a major source of mortality and morbidity in trauma patients. Complications, especially surgical site infections (SSIs) are a major source of financial burden to the institute and to the patient as it delays rehabilitation. As such, every possible attempt should be made to reduce any complications. We, thus, aimed to compare the outcomes in early vs delayed closure of lower extremity stumps in cases of lower limb crush injury requiring amputation, so as to achieve best possible outcome. A randomised controlled study was conducted in the Division of Trauma Surgery & Critical Care at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi from 1 September 2018 to 30 June 2019 and included patients undergoing lower limb amputation below hip joint. Patients were randomised in two groups, in one group amputation stump was closed primarily, while in the second group delayed primary closure of stump was performed. We compared rate of SSI, length of hospital stay, and number of surgeries in both the groups. Fifty‐six patients with 63 amputation stumps were recruited in the study. Mean age of patients in the study was 34 years, of which about 95% patients were males. The most common mechanism of injury was road traffic injury in 66% of patients. Mean injury severity score was 12.28 and four patients had diabetes preoperatively. Total 63 extremities were randomised with 30 cases in group I and 33 cases in group II as per computer‐generated random number. Above knee amputations was commonest (57.14%) followed by below knee amputations (33.3%). Two patients died in the current study. In group I, In‐hospital infection was detected in 7 cases (23.3%) and in group II 9 cases (27.3%) had SSI during hospital admission (P > .05). Mean hospital stay in group I was 10.32 ± 7.68 days and in group II was 11 ± 8.17 days (P > .05). Road traffic injuries and train‐associated injuries are a major cause of lower limb crush injuries, leading to limb loss. Delayed primary closure of such wounds requires extra number of surgical interventions than primary closure. There is no difference in extra number of surgical interventions required in both the groups. Thus, primary closure can be safely performed in patients undergoing lower limb amputations following trauma, provided that a good lavage and wound debridement is performed.     

Analysis of factors influencing limb amputation in high-voltage electrically injured patients

Background

Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients.

Methods

Eighty-two high-voltage electrically injured patients were admitted to our hospital during a 17-year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed.

Results

A total of 68 patients were enrolled for analysis. Thirteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for day 1 creatine kinase-isoenzyme MB (CK-MB) level. A serum CK-MB level above 80 ng/ml predicted high risk of limb amputation with high specificity (84%) and sensitivity (77%). Only one patient with a remarkable decrease of creatine kinase (CK) and CK-MB levels after fasciotomy avoided a major limb amputation.

Conclusion

Our results suggest that CK-MB level is an independent factor for prediction of limb amputation. We suggest that the addition of CK-MB evaluation to clinical symptoms screening may be a valuable method to early detection of muscle damage.     

Risk factors associated with amputation in civilian popliteal artery trauma

Popliteal artery trauma is uncommon but is associated with a high risk of limb loss depending on the scenario involving blunt or penetrating trauma as well as the severity and extent of injury that has occurred. In our setting there is a significant amount of gang and civilian warfare resulting in Vascular Trauma. There were 32 patients over a decade who sustained traumatic injury to the popliteal artery consisting of 30 males (94%) and 2 females with an age range 16–59 years with a mean of 32. There were 20 cases of penetrating trauma (63%) and 12 cases of blunt trauma (37%). Of the penetrating trauma, 18 were due to gunshot wounds (GSWs) (90%) and 2 stabs. The majority (7/12; 58%) of blunt trauma was due to falls, and 42% (5/12) secondary to motor vehicular accidents (MVAs). In terms of extent of injury, 21 of 32 patients (65%) sustained an isolated popliteal artery injury, whilst 6 (19%) had injury to both the popliteal artery and vein and another 5 (16%) had combined popliteal artery, vein and nerve injuries. There were 14 cases with associated orthopaedic injuries: 7 posterior knee dislocations, 1 fracture/dislocation of the knee, 2 femoral fractures, 2 tibial plateau fractures and 2 tibia/fibula fracture. Methods of repair included 14 reversed vein grafts, 16 polytetrafluoroethylene (PTFE) grafts and 2 primary. The overall amputation rate was 28% (9 patients). Of the penetrating trauma patients 25% required amputations composed of 5 GSWs, 33% of the blunt trauma patients required amputations. It was noted that factors associated with (but not statistically significant) poor outcomes included combined artery/vein injury, artery/vein/nerve injury, concomitant fracture/dislocation and delayed transfer to a Vascular Surgery Unit. The type of graft or repair did not affect outcome. The incidence of popliteal artery trauma was calculated at 2.46 per 100,000 population per year.     

Risk factors for amputation are influenced by competing risk of death in patients with critical limb ischemia

ObjectivePatients with critical limb ischemia (CLI) have a high risk of amputation and death. Death is a competing risk that affects the estimated amputation risk. Our aim was to find the specific risk factors for amputation for patients with CLI using competing risk analyses and compared these results with those from standard Cox regression analysis.MethodsPatients who had undergone revascularization for CLI (2009-2013, with follow-up data until 2017) in Stockholm were identified from the Swedish National Registry for Vascular Surgery. The main outcome was major amputation. The risk factors for amputation were assessed using competing risk analysis and compared with the risk factors for amputation-free survival identified using Cox proportional hazards regression analysis.ResultsOf 855 patients with CLI, 178 had required a major amputation and 415 had died during the 8-year follow-up period. In the competing risk regression, age (subdistribution hazard ratio [sub-HR], 0.98; 95% confidence interval [CI], 0.97-1.00), ambulatory status (independent vs bedridden; sub-HR, 4.10; 95% CI, 2.14-7.86), and ischemic wound vs rest pain (sub-HR, 3.03; 95% CI, 1.72-5.36) were associated with amputation, considering death as a competing risk. In contrast, Cox regression analysis identified female vs male (hazard ratio [HR], 0.77; 95% CI, 0.64-0.94), age (HR, 1.02; 95% CI, 1.01-1.03), renal impairment (HR, 2.08; 95% CI, 1.61-2.67), ambulatory status (independent vs bedridden; HR, 3.45; 95% CI, 2.30-5.18), and ischemic wound vs rest pain (HR, 2.41; 95% CI, 1.78-3.25) as risk factors.ConclusionsThe risk factors associated with amputation differed when analyzing the data using competing risk regression vs Cox regression. The differences between the analyses indicated that a risk exists for biased estimates using standard survival methods when a strong competing risk such as death is present.