冠心病心绞痛患者证候要素与生存质量的相关性

目的探讨冠心病心绞痛患者中医证候要素与其生存质量的关系。方法采用临床流行病学方法,多中心收集233例经冠脉造影证实的冠心病心绞痛患者,以西雅图心绞痛量表(SAQ)评价其生存质量,运用Spearman等级相关分析对SAQ中躯体活动受限程度、心绞痛稳定状态、发作情况、治疗满意度及疾病认识程度5个不同维度得分及总分与证候要素的相关性进行分析。结果气滞、血瘀、痰浊、热蕴、阳虚、阴虚6个因素分别与SAQ中1个或多个维度及总分呈现相关关系,其中痰浊对生存质量的影响呈负相关(P0.05);气滞、热蕴、阴虚对生存质量的影响呈正相关,主要影响患者的心绞痛稳定状态及5项积分之和(P0.05或P0.01);热蕴对心绞痛发作情况具有保护作用(P0.05);痰浊对治疗满意度具有负向影响(P0.05),阳虚为正向影响(P0.05)。结论冠心病心绞痛患者中医证候要素与生存质量存在一定相关性,其结论在一定程度上佐证了中医理论内涵的合理性。     

Correspondence between lung function and symptom measures from the Cystic Fibrosis Respiratory Symptom Diary–Chronic Respiratory Infection Symptom Score (CFRSD-CRISS)

BackgroundPulmonary exacerbations (PEx) in cystic fibrosis (CF) patients reduce quality of life. Lung function, measured by the percent predicted forced expiratory volume in 1 s (ppFEV1), is widely used to evaluate PEx treatments. We analyzed the correspondence of ppFEV1 with 8 patient-reported symptom-based questions from the Cystic Fibrosis Respiratory Symptom Diary–Chronic Respiratory Infection Symptom Score (CFRSD-CRISS).MethodsData were derived from the observational Standardized Treatment of Pulmonary Exacerbations (STOP) study. CF patients who had CFRSD-CRISS and ppFEV1 measurements on ≥2 timepoints were included: 1) day of initial PEx, 2) 7 days later, and/or 3) end of PEx. We calculated age-stratified Spearman correlation coefficients and 95% confidence intervals (95% CIs) between the change in ppFEV1 and change in CFRSD-CRISS items from index to day 7 and from index to the end of PEx treatment.ResultsLung function and symptom scores improved by the end of treatment; however, correlations between ppFEV1 and the specific CFRSD-CRISS measures were mostly weak to moderate. An exception was that among patients <18, we observed moderately strong correlations between changes in ppFEV1 and cough severity (r = ?0.58 (95% CI: ?0.80, ?0.21)), mucus quantity (r = ?0.51 (?0.77, ?0.11)), and wheezing (r = ?0.53 (?0.78, ?0.14)) from index until end of treatment.ConclusionsAs novel treatments are developed for PEx, it is important to ensure that improvement is measured meaningfully. The generally weak associations between patient-reported symptoms and ppFEV1 that we found suggest that these measures capture different aspects of the disease and both metrics are important when evaluating new treatments.     

Chronic factitious illness: recognition and management of deception

Factitious disease is often manifested in the head and neck region. It is only when the oral and maxillofacial surgeon is aware of the existence of this syndrome and has been unable to correlate a patient's history and signs and symptoms with known diseases that factitious illness may be suspected as the diagnosis. Three case histories that help to demonstrate the variety of ruses used by patients to feign illness are presented. The expertise of a psychiatrist will often help to substantiate the diagnosis, but in many instances the main aspects of treatment will remain in the hands of the original clinician. It is important for clinicians to realize that patients with chronic factitious illness are extremely manipulative and unwilling to admit to their fabrications.     

Hypoperfusion as a possible factor in the development of gastrointestinal complications after cardiac surgery

This study has presented the spectrum of postoperative gastrointestinal system complications after open heart surgery at the University of Washington from 1980 through 1983. The frequent necessity for operative intervention and a mortality rate of 17 percent in our study of gastrointestinal complications in patients who have undergone open heart surgery indicates the need for early diagnosis and treatment. The data suggest that bypass times approaching 100 minutes and the presence of postoperative cardiogenic shock are important risk factors in the development of such complications in elective cardiac surgery patients. An incidence of gastrointestinal complications of 8.6 percent in those undergoing repair of acute aortic dissections makes gastrointestinal complaints particularly suspicious in this subgroup.