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31.
目的探讨脑卒中患者急性应激障碍发生现状及影响因素。方法采用斯坦福急性应激反应问卷对349例脑卒中住院患者进行调查。结果共163例(46.70%)患者发生急性应激障碍;Logistic回归分析结果显示,患者性格、是否存在偏瘫及是否吞咽功能障碍是脑卒中患者发生急性应激障碍的主要影响因素(P0.05,P0.01)。结论脑卒中患者急性应激障碍发生率较高,内向性格及存在偏瘫和吞咽功能障碍的患者更容易发生急性应激障碍。医护人员应及时为高危患者提供个体化治疗及预见性护理,防止脑卒中患者发生急性应激障碍。  相似文献   
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目的:观察非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)患者自体造血干细胞移植(autologous hematopoietic stem cell transplantation,ASCT)术后应用重组人α-2b干扰素(α-2b IFN)进行早期干预治疗的临床疗效。方法:选取18例行ASCT的NHL患者为研究对象,移植前疾病评估均未达到完全缓解(complete remission,CR),试验组血象恢复后给予IFN 3 000 000 U次/隔日干预治疗,3个月后停用;对照组未行干扰素干预治疗,分析总体疗效及两组对比的生存情况。结果:随访中位时间为34(10~50)个月,患者中位生存时间为37(31~45)个月,3年总体无进展生存(progressive free survival,PFS)、总生存(overall survivial,OS)分别为54.7%、66.8%。ASCT后试验组1年内无疾病复发,2年内复发率为12.5%;对照组1年内复发率为20%,2年内复发率为30%。结论:NHL患者在ASCT后给予重组人α-2b IFN早期干预治疗,患者耐受性好,可能降低移植后早期复发率。  相似文献   
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Objective

To examine whether a healthy weight intervention embedded in the Parents as Teachers (PAT) home visiting program, which was previously found to improve mothers’ body mass index (BMI) and obesity-related behaviors, changed the BMI of preschool children or maternal feeding practices.

Methods

This stratified randomized trial included preschool-aged children at risk for overweight whose mothers were overweight or had obesity (n?=?179). The Healthy Eating and Active Living Taught at Home (HEALTH) intervention was based on the Diabetes Prevention Program. Differences were examined using repeated-measures mixed-ANOVA models.

Results

Compared with PAT usual care, the HEALTH intervention had no effect on children's BMI or maternal feeding practices. However, combined analyses showed that children's BMI percentile decreased (P??=?.007), BMI z-scores were maintained (P??=?.19), and 3 of 8 feeding practices improved over time (P < .05).

Conclusions and Implications

Additional research is needed to assess the effectiveness of PAT to prevent preschool-age obesity using rigorous designs (eg, group-randomized trials) and to identify its active components. HEALTH is ready to be scaled up to prevent maternal weight gain through embedding within the national PAT program.  相似文献   
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Objectives

Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.

Methods

Records from 39,812 patients undergoing coronary artery bypass grafting or valve operations (2008-2016) and extubated within 24 hours were stratified according to extubation time between 06:00 and 18:00 (day) or between 18:00 and 6:00 (overnight). Outcomes including reintubation, mortality, and composite morbidity-mortality were evaluated using hierarchical regression models adjusted for Society of Thoracic Surgeons predictive risk scores. To further analyze extubation during the night, a subanalysis stratified patients into 3 groups: 06:00 to 18:00, 18:00 to 24:00, and 24:00 to 06:00.

Results

A total of 20,758 patients were extubated overnight (52.1%) and were slightly older (median age 66 vs 65 years, P < .001) with a longer duration of ventilation (4 vs 7 hours, P < .001). Day and overnight extubation were associated with equivalent operative mortality (1.7% vs 1.7%, P = .880), reintubation (3.7% vs 3.4%, P = .141), and composite morbidity-mortality (8.2% vs 8.0%, P = .314). After risk adjustment, overnight extubation was not associated with any difference in reintubation, mortality, or composite morbidity-mortality. On subanalysis, those extubated between 24:00 and 06:00 exhibited increased composite morbidity-mortality (odds ratio, 1.18; P = .001) but no difference in reintubation or mortality.

Conclusions

Extubation overnight was not associated with increased mortality or reintubation. These results suggest that in the appropriate clinical setting, it is safe to routinely extubate cardiac surgery patients overnight.  相似文献   
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