透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

应用流程处理腹膜透析导管引流不畅

[目的]分析腹膜透析病人导管引流不畅的原因,探讨有效的预防和护理方法.[方法]采用追踪性研究方法,2007年11月-2008年3月在本科行腹膜透析置管术的病人120例.观察开始时间为病人腹膜透析置管术后当天,观察总时间为5个月.分析腹膜透析病人导管引流不畅的原因,制订腹膜透析导管引流不畅的预防和护理流程,对腹膜透析置管术后病人进行教育后,观察病人出现导管引流不畅的时间、运用流程处理后的效果.[结果]120例腹膜透析病人中,发生导管引流不畅13例,发生时间为术后3 d～117 d.引流不畅原因为导管移位8例,腹胀、便秘4例,大网膜包裹1例.运用流程进行处理后9例病人透析管引流恢复正常,4例病人重新手术后亦恢复了正常的透析.[结论]术后早期教育可预防腹膜透析导管引流不畅的发生,如导管发生引流不畅,早期发现并及时应用流程处理可减少重新手术的可能.     

强化健康教育在腹膜透析相关性腹膜炎预防中的作用

目的探讨强化教育预防腹膜透析相关性腹膜炎的效果。方法纳入2006年1月至2009年12月在我院腹膜透析中心参加随访、CAPD〉3个月的991例患者。定期分析腹膜透析相关性腹膜炎危险因素的变化。运用成人教育理论,采用培训与复训、门诊随访、电话随访以及派发健康教育宣传资料等形式对患者进行预防腹膜透析相关性腹膜炎的强化教育。结果患者平均年龄（49．2±16．1）岁,男560例（56．5％）,女431例（43．5％）,腹膜透析持续时间3．0～170．9个月（中位数20．1个月）,第一位原发病为肾小球。肾炎占59．2％。经过持续强化教育后,本中心腹膜透析相关性腹膜炎发病率由57．2个病人月,逐渐延长至61．3个病人月腹膜炎发病率下降。相比2006年,2009年因换液操作环节引起的腹膜炎所占比例下降（χ2=8．229,P=0．004）,因出口处感染诱发的腹膜炎持续维持较低水平（〈5％）,而因胃肠道问题引起的腹膜炎所占比例增加（χ2=9．720,P=0．002）。结论强化教育可以减少腹膜透析相关性腹膜炎的发生,尤其是因换液操作环节引起的腹膜炎发病率。因胃肠道问题引起腹膜炎的预防教育仍值得进一步关注。     

持续不卧床腹膜透析患者食欲不良的影响因素及相关性分析

目的 探讨持续不卧床腹膜透析（CAPD）患者食欲不良的相关临床特征与影响因素,以便改善CAPD患者的营养不良.方法 使用透析症状指数问卷评估192例CAPD患者的食欲不良的状况,分析食欲不良与营养状态、临床特征、社会人口统计学资料及实验室指标的关系.Beck抑郁量表（BDI）与主观综合性营养评估表（SGA）分别用于抑郁与营养状态的评估.将BDI得分≥15分判断为抑郁,SGA得分≤5分定为营养不良.结果 37.9%的CAPD患者出现营养不良.与食欲良好的患者比较,食欲下降的患者有低的血白蛋白水平（36.9±4.5 vs.38.8±3.8,P＜0.01）,高营养不良发生率（43.1% vs.25.4%,P＜0.01）,高抑郁患病率（50.0%vs.21.2%,P＜0.01）,高舒张压水平（86.6±10.5 vs.81.9±11.0,P＜0.01）.在相关性分析中食欲不良与白蛋白（r=-0.24,P＜0.01）及SGA得分（r=-0.31,P＜0.01）、舒张压水平（r=-0.19,P＜0.05）呈负相关,与二氧化碳结合力（CO2CP）（r=0.19,P＜0.05）、抑郁（r=0.38,P＜0.01）呈正相关关系.在二元逻辑回归分析中,血白蛋白水平（OR=0.92,P＜0.05）、舒张压水平（OR=1.04,P＜0.01）和抑郁（OR=1.04,P＜0.05）是食欲不良的独立影响因素.结论 食欲不良与营养不良、抑郁、高血压及酸中毒之间有显著相关性,加强对患者抑郁及高血压的管理有助于提高患者的食欲改善患者的营养状态.     

剖宫产产妇导尿时机探讨

目的：探讨剖宫产产妇术前导尿的时机.方法：选择41例患者实施麻醉后导尿,并与麻醉前30min导尿的患者,比较两组患者在留置导尿前后的收缩压、舒张压以及心率的变化情况.结果：观察组置管后收缩压、舒张压以及心率等与置管前差异无统计学意义（P〉0.05）,对照组置管后收缩压、舒张压均高于置管前（P〈0.05）,心率快于置管前（P〈0.05）.结论：麻醉后导尿对产妇术中的生命体在平稳有积极意义.     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

腹膜透析全天护理热线咨询电话的内涵与实践

科学的发展需要概念的改变。在护理学的发展中 ,正是由于创立 ,发展和应用了一些新概念 ,而使得这门学科面目一新。作者在护理工作中很受下面两个概念的启发 ,特先简单介绍如下。1　新概念的启迪1.1　绿色化学的概念　近十多年来 ,绿色化学的浪潮正越来越重要地影响着人类的未来。绿色是生命的颜色 ,热爱绿色 ,也就是热爱生命。绿色化学认为依靠传统的控制技术对环境的保护和改善是有限的 ,实现环境保护的新水平 ,必须寻找新的途径。绿色化学早已渗透到护理科学中 ,护理科学正在开发和不断寻找新的途径。社区护理和整体护理模式 ,以及Ｏｒｅ…