社区综合护理对提高慢性心力衰竭患者生存质量的效果

目的 研究社区综合护理对提高慢性心力衰竭患者生存质量的效果。方法 70例慢性心力衰竭患者,随机分为观察组和对照组,每组35例。对照组接受常规门诊医护服务,观察组在此基础上开展社区综合护理干预,对比两组临床治疗情况以及生存质量评分。结果 观察组患者的规范化疗效为97.1%、疾病认知率为97.1%、住院率为14.3%、病死率为2.9%,明显优于对照组的74.3%、77.1%、40.0%和20.0%(P<0.05)。观察组患者的生存质量评分明显优于对照组(P<0.05)。结论 社区综合护理干预有利于提高患者对疾病的认知率,降低慢性慢性心力衰竭患者发病率,改善其生活质量,值得推广应用。     

呼吸机相关性气管支气管炎对慢性阻塞性肺疾病预后的影响

目的探讨呼吸机相关性气管支气管炎(VAT)对慢性阻塞性肺疾病(COPD)患者预后的影响,为临床治疗提供参考依据。方法选取2012年1月-2013年12月RICU住院进行有创机械通气治疗的COPD患者136例,其中13例确诊为VAT,设为VAT组,配对病例13例,设为对照组,比较两组患者预后。结果 13例VAT患者送检标本检出细菌共19株,其中18株为多药耐药菌,占94.7%,对照组7株占77.8%(P<0.05);VAT组混合感染患者6例占46.2%,对照组3例占23.1%(P<0.05);VAT相关的常见病原菌为铜绿假单胞菌、鲍氏不动杆菌和MRSA;VAT组机械通气时间明显延长,为22d,对照组仅为13d(P<0.05);VAT组患者ICU住院时间也明显延长为28d,对照组仅为16d(P<0.05);VAT组中使用恰当抗菌药物治疗的患者为6例占46.2%,与使用非恰当抗菌药物的患者相比,机械通气时间较短,分别为12d和20d,ICU住院时间较短,分别为17d和23d,但上述差异无统计学意义。结论 VAT会导致COPD患者机械通气和ICU住院时间延长,恰当的初始抗菌药物治疗有助于改善VAT患者预后。     

重症监护室护士慢性疲劳综合征与职业紧张的相关性

目的 调查重症监护室护士职业紧张现状与慢性疲劳综合征(CFS)发生率,并探讨其相关性.方法 选取2013年7月-2014年7月在荆州市10所综合性医院任职共235名ICU护士为研究对象,采用自制一般情况调查表、职业紧张量表(OSIR)和疲劳量表-14(FS-14)对其进行调查.结果 ICU护士职业紧张度最高发生在30～39岁年龄段,护龄在10～19 a、学历中专、常白夜班倒班、在编护士以及离婚和丧偶护士群体中,CFS的发生与年龄无关(P＞0.05);疲劳总分、躯体疲劳、脑力疲劳得分分别与职业任务、个体紧张反应得分呈正相关,与个体应变能力得分呈负相关,差异有统计学意义(P＜0.05).结论 ICU护士职业紧张情况较为严重,可通过缓解其职业紧张水平,从而降低患CFS的风险.     

Chronic rejection after liver transplantation: Opening the Pandora’s box

Chronic rejection (CR) of liver allografts causes damage to intrahepatic vessels and bile ducts and may lead to graft failure after liver transplantation. Although its prevalence has declined steadily with the introduction of potent immunosuppressive therapy, CR still represents an important cause of graft injury, which might be irreversible, leading to graft loss requiring re-transplantation. To date, we still do not fully appreciate the mechanisms underlying this process. In addition to T cell-mediated CR, which was initially the only recognized type of CR, recently a new form of liver allograft CR, antibody-mediated CR, has been identified. This has indeed opened an era of thriving research and renewed interest in the field. Liver biopsy is needed for a definitive diagnosis of CR, but current research is aiming to identify new non-invasive tools for predicting patients at risk for CR after liver transplantation. Moreover, the minimization or withdrawal of immunosuppressive therapy might influence the establishment of subclinical CR-related injury, which should not be disregarded. Therapies for CR may only be effective in the “early” phases, and a tailored management of the immunosuppression regimen is essential for preventing irreversible liver damage. Herein, we provide an overview of the current knowledge and research on CR, focusing on early detection, identification of non-invasive biomarkers, immunosuppressive management, re-transplantation and future perspectives of CR.     

Exploration of nucleos(t)ide analogs cessation in chronic hepatitis B patients with hepatitis B e antigen loss

BACKGROUNDNucleos(t)ide analogs (NAs) cessation in chronic hepatitis B (CHB) patients remains a matter of debate in clinical practice. Current guidelines recommend that patients with hepatitis B e antigen (HBeAg) seroconversion discontinue NAs after relatively long-term consolidation therapy. However, many patients fail to achieve HBeAg seroconversion after the long-term loss of HBeAg, even if hepatitis B surface antigen (HBsAg) loss occurs. It remains unclear whether NAs can be discontinued in this subset of patients.AIMTo investigate the outcomes and factors associated with HBeAg-positive CHB patients with HBeAg loss (without hepatitis B e antibody) after cessation of NAs.METHODSWe studied patients who discontinued NAs after achieving HBeAg loss. The Cox proportional hazards model was used to identify predictors for virological relapse after cessation of NAs. The cut-off value of the consolidation period was confirmed using receiver operating characteristic curves; we confirmed the cut-off value of HBsAg according to a previous study. The log-rank test was used to compare cumulative relapse rates among groups. We also studied patients with CHB who achieved HBeAg seroconversion and compared their cumulative relapse rates. Propensity score matching analysis (PSM) was used to balance baseline characteristics between the groups.RESULTSWe included 83 patients with HBeAg loss. The mean age of these patients was 32.1 ± 9.5 years, and the majority was male (67.5%). Thirty-eight patients relapsed, and the cumulative relapse rate at months 3, 6, 12, 24, 36, 60, 120, and 180 were 22.9%, 36.1%, 41.0%, 43.5%, 45.0%, 45.0%, 45.0%, and 52.8%, respectively. Twenty-six (68.4%) patients relapsed in the first 3 mo after NAs cessation, and 35 patients (92.1%) relapsed in the first year after NAs cessation. Consolidation period (≥ 24 mo vs < 24 mo) (HR 0.506, P = 0.043) and HBsAg at cessation (≥ 100 IU/mL vs < 100 IU/mL) (HR 14.869, P = 0.008) were significant predictors in multivariate Cox regression. In the PSM cohort, which included 144 patients, there were lower cumulative relapse rates in patients with HBeAg seroconversion (P = 0.036).CONCLUSIONHBeAg-positive CHB patients with HBeAg loss may be able to discontinue NAs therapy after long-term consolidation, especially in patients with HBsAg at cessation < 100 IU/mL. Careful monitoring, especially in the early stages after cessation, may ensure a favorable outcome.     

Malnutrition by GLIM criteria in chronic pancreatitis: Prevalence,predictors, and its impact on quality of life

IntroductionMalnutrition in chronic pancreatitis (CP) has prognostic value and there is limited data on the prevalence, predictors of malnutrition in CP and its effect on Quality of life (QoL).MethodsA retrospective study was conducted in patients with CP to assess the prevalence of malnutrition as per the Global Leadership Initiative on Malnutrition (GLIM) criteria. Multivariable-adjusted regression was used to identify independent predictors of both malnutrition and global QoL.ResultsA total of 297 patients were included and the most common etiology of CP was idiopathic (75%) and alcohol (25%). The prevalence of malnutrition was 46.4% as per GLIM criteria. On univariate analysis, the risk of malnutrition was significantly higher in alcoholic etiology (p = 0.001), current alcohol consumption (p = 0.001), smokers (p < 0.001), those having higher cumulative days of pain in last 6 months (p < 0.001) and lower daily calorie intake (p = 0.019). On multivariate analysis, malnutrition was independently associated with current alcohol consumption (Odds ratio: 3.22, p = 0.017), current smokers (OR: 2.23, p = 0.042) and those having higher cumulative days of abdominal pain (OR: 1.01, p < 0.001), while higher daily calorie intake (per 100 kcal) (OR:0.94, p = 0.023) has reduced risk of malnutrition. Malnutrition (p = 0.015) and higher cumulative days of abdominal pain (p < 0.001) were independently associated with lower global QoL in patients with CP.ConclusionMalnutrition is frequent in patients with CP; and current alcohol consumption, smoking and higher cumulative days of abdominal pain independently predicts risk of developing malnutrition. Patients with malnutrition and higher cumulative days of pain has poorer quality of life.     

Morphological and functional recovery following acute and acute recurrent pancreatitis in children: A prospective sequential 2-point evaluation

BackgroundThe functional and morphological recovery following an episode of acute pancreatitis (AP) in children still remains ill understood as research exploring this is limited. We aimed to characterize the morphological and functional changes in pancreas following AP and ARP (acute recurrent pancreatitis) in children.MethodsChildren with AP were followed prospectively and assessed at two time points at least 3 months apart, with the first assessment at least 3 months after the AP episode. Exocrine and endocrine functions were measured using fecal elastase and fasting blood sugar/HbA1c levels respectively. Morphological assessment was done using endoscopic ultrasound (EUS) and magnetic resonance imaging and cholangiopancreatography (MRI/MRCP).ResultsSeventy-three children (boys:59%; mean age:8.4 ± 3.2years) were studied and 21 of them (29%) progressed to ARP. Altered glucose homeostasis was seen in 19 (26%) at first and 16 (22%) at second assessment and it was significantly more in ARP group than the AP group at first (42.8%vs19.2%; p = 0.03) as well as second assessment (38.1%vs15.3%; p = 0.03). Twenty-one children (28.7%) at first and 24 (32.8%) at second assessment developed biochemical exocrine pancreatic insufficiency. EUS detected indeterminate and suggestive changes of chronic pancreatitis in 21% at first (n = 38) and 27.6% at second assessment (n = 58). On MRCP, main pancreatic duct and side branch dilatation were seen in 15 (20.5%) and 2 (2.7%) children respectively.ConclusionsMore than one-quarter of children have evidence of altered glucose homeostasis and biochemical exocrine pancreatic insufficiency following an episode of AP. Similarly, morphological features of chronicity seen in some of the children suggest that a fraction of subjects may develop chronic pancreatitis on longer follow-up.     

Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial

Backgrounds/ObjectivesPatients with chronic pancreatitis may develop pancreatic duct stones that can obstruct outflow leading to ductal hypertension and pain. Both endoscopic retrograde pancreatography (ERP) with per-oral pancreatoscopy (POP) and intraductal lithotripsy and extracorporeal shock wave lithotripsy (ESWL) are feasible options to attempt ductal stone clearance. This study aims to compare POP-guided lithotripsy with ESWL in the management of refractory symptomatic main pancreatic duct stones.MethodsThis is an open-label, multi-center, parallel, randomized clinical trial. Patients with chronic pancreatitis and main pancreatic duct stones ≥5 mm who fail standard ERP methods for stone removal will be eligible for this study. In total, 150 subjects will be randomized 1:1 to either ESWL or POP. A maximum of 4 sessions of either ESWL or POP will be allowed in each arm, with crossover permitted thereafter. The primary outcome is complete stone clearance and secondary outcomes include quality of life, pain scores, number of interventions, and daily opiate requirements.ConclusionsThis study aims to answer the question of which lithotripsy method is superior in removing refractory pancreatic duct stones while addressing the effects of lithotripsy on quality of life and pain in patients with chronic calcific pancreatitis (ClinicalTrials.gov NCT04115826).     

测定心衰患者血清胰岛素样生长因子Ⅱ和肾上腺髓质素的意义

目的:探讨慢性心力衰竭患者血清胰岛素样生长因子Ⅱ(IGFⅡ)和肾上腺髓质素(ADM)的变化及其临床意义。方法:用放射免疫法测定了92例慢性心力衰竭(CHF)患者和40例非慢性心力衰竭患者的血清IGF Ⅱ和ADM水平,并进行对照统计分析。结果:CHF组患者血清IGFⅡ和ADM水平均显著高于对照组(P<0.01),相互间呈显著正相关(r=0.391,P<0.05)。在心功能Ⅱ、Ⅲ、Ⅳ级组间,血清ADM水平依次递增(方差F检验,P<0.05),且Ⅳ级组显著高于Ⅱ级组(P<0.01)。住院期间死亡组患者血清IGFⅡ和ADM水平均显著高于好转出院组(P分别<0.01,<0.05)。结论:CHF患者血清IGF Ⅱ和ADM水平显著升高,相互间成正相关,Ⅳ级组血清ADM显著高于Ⅱ级组,死亡组血清IGFⅡ和ADM水平均显著升高。     

Persistent Perineal Sinus After Ileoanal Pouch Excision in Inflammatory Bowel Diseases: Incidence,Risk Factors,and Clinical Course

Purpose  This study was designed to determine the incidence of persistent perineal sinus after pouch excision in inflammatory bowel disease, risk factors, and long-term clinical course. Methods  The study included 35 consecutive patients who underwent pouch excision at St. Mark’s Hospital, London, between 1996 and 2006. Incidence of persistent perineal sinus and its long-term clinical course were reported. Sixteen variables were analyzed to determine their association with persistent perineal sinus. Results  There were 17 men and 18 women with median age of 37 (range, 20–57) years. The final diagnosis was ulcerative colitis in 28 and Crohn’s disease in 7 patients. The indications for pouch excision included pelvic or perineal sepsis in 60 percent, pouchitis in 23 percent, and poor pouch function in 17 percent. Persistent perineal sinus was diagnosed in 14 patients (40 percent). Pouch excision for fistula or abscess in the pelvis or perineum (odds ratio, 8; 95 percent confidence interval, 1.4–45.5) was an independent predictor for persistent perineal sinus. Twenty-six procedures were performed in patients with persistent perineal sinus and resulted in healing in 64 percent. Curettage was the most common procedure used. Conclusions  Pouch excision for pelvic or perineal sepsis was an independent predictor for persistent perineal sinus. Poster presentation at the meeting of the Association of Coloproctology of Great Britain and Ireland, Birmingham, United Kingdom, June 30 to July 3, 2008. Reprints are not available.