维持性血液透析患者不安腿综合征危险因素分析

目的 分析维持性血液透析(MHD)患者不安腿综合征(RLS)的临床特点及危险因素,评估血液透析滤过吸附(HFR)治疗MHD患者RLS及睡眠质量的临床疗效.方法 探讨2020年6月1日至12月31日期间苏州大学附属第二医院MHD患者RLS的相关危险因素.将49例RLS患者随机分为HFR组与血液滤过(HDF)组,观察治疗前...     

维持性血液透析患者矿物质代谢异常与血管钙化的相关性研究

目的 研究维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢异常与血管钙化的关系.方法 纳入四川省人民医院血液透析中心的MHD患者91例,检测其血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、甲状旁腺激素(parathyroid ho...     

维持性血液透析患者自体动静脉内瘘的维护

<正>良好的血管通路是保证血液透析质量的基础,已有大量循证医学研究表明,Kt/V≥1. 2是维持性血液透析患者(MHD)预后的独立影响因素[1]。单次血液透析Kt/V≥1. 2已成为考核治疗充分性的核心指标之一,而要达到该标准首先需要有充足的体外循环血流量[2]。自体动静脉内瘘(AVF)是MHD患者首选的血管通路,在过去10年里,日本AVF使用率≥     

时间平均尿素浓度在预测血液透析间期心力衰竭中的价值

目的 :探讨时间平均尿素浓度 (Time- average Concentration of urea TACurea)在预测血液透析间期 (IHD)心力衰竭 (HF)中的临床价值。方法 :以 TACurea作为评价血液透析 (HD)充分性的客观指标 ,对 82例维持性血液透析(MHD)患者于 IHD发生 HF进行分析。结果 :MHD82例于 9986例次 IHD中发生 HF2 2 9例次 (2 .2 9% ) ,主要原因依次是 HD不充分、感染、高血压控制不良、贫血未纠正。HF组平均 TACurea为 (2 4 .6± 4 .5 ) mmol/ L,表明 TACurea≥ (2 4 .6± 4 .5 ) mmol/ L 易并发 MHD间期 HF。结论 :HD不充分是诱发 HD间期 HF的最主要因素 ,TACurea可以作为 MHD间期 HF的预测指标。     

认知行为干预对血液透析患者控制透析间期体重依从性的影响

目的 探讨认知行为干预(CBT)对维持性血液透析(MHD)患者控制透析间期体重依从性的影响.方法 将60例MHD者随机分为实验组(n=30)和对照组(n=30),实验组在日常血液透析护理常规的基础上行CBT,对照组同期仅行日常血液透析护理常规.干预后1)比较2组患者对健康教育内容掌握程度.2)计算透析后体重与干体重平均差异度,比较2组差异.3)比较2组患者透析间期体重得到控制的比例.结果 试验组与对照组比较均有显著性差异.结论 CBT可改善MHD患者的控制体重依从性,提高透析质量.     

血清骨调素及成纤维细胞生长因子-23水平与血液透析患者血管钙化之间的相关性分析

目的探究血清骨调素(OPN)及成纤维细胞生长因子-23(FGF-23)水平与血液透析患者血管壁钙化之间的相关性。方法回顾性选择2015年9月至2018年9月武汉中心医院收治的维持性血液透析(MHD)患者89例作为研究对象,选择同期体检健康者50例作为研究对象。收集所有研究对象的临床资料,抽取静脉血测量生化指标、OPN、FGF-23水平,X线检查评估患者的血管钙化情况。对MHD患者的血管钙化评分以及相关指标进行相关性分析,并以血管钙化评分作为因变量,分析影响血管钙化的相关因素。结果 MHD组患者的OPN水平显著高于健康对照组[(140. 2±11. 5) ng/ml vs.(35. 6±8. 9) ng/ml,P 0. 001]; MHD组患者的FGF-23水平显著高于健康对照组[(246. 5±54. 8) pg/ml vs.(32. 5±19. 3) pg/ml,P 0. 001]; MHD组患者中,通过Logistic回归分析,OPN、FGF-23均是影响血管钙化的独立相关因素。结论 MHD患者血清OPN、FGF-23水平均显著提高,OPN、FGF-23与血管钙化呈独立相关性。     

维持性血液透析患者发生脑血管意外的危险因素分析及护理措施

我国终末期肾脏病的发病率达10人/10万人口,年增长率8.7%,维持性血液透析(MHD)是终末期肾衰竭(ESRD)患者替代治疗的主要方法之一[1]。随着血液透析技术不断提高和血液透析方法的不断改进,患者的平均生存期和生存质量逐步提高,但脑血管意外的发生率和病死率仍然居高不下,严重影响MHD患者的长期存活,是患者的主要致死原因之一。本文对我院血液透析中心2008年1月～2011年12月并发脑     

活动能力对维持性血液透析患者死亡率的预测价值

目的 探讨活动能力对维持性血液透析(maintenance hemodialysis,MHD)患者死亡率的预测价值. 方法 采用方便抽样法,使用人类活动概况量表(Human Activity Profile,HAP),于2007年2月～2009年12月对广州市5家三级甲等医院维持性血液透析的317例患者进行追踪调查.结果 活动能力可以预测MHD患者的死亡率.HAP的最大活动得分(maximum activity score,MAS)和校正活动得分(adjusted activity score,AAS)是MHD患者的保护因素,其值越高,死亡率越低:年龄是MHD患者的危险因素,其值越高,死亡率越高.结论 活动能力可以预测MHD患者的死亡率,患者的活动能力越高,死亡率越低.本研究提示医护人员应该加强对MHD患者活动能力的评估,并指导患者进行适当的体力活动,从而降低MHD患者的死亡率.     

维持性血液透析口渴患者的非药物干预研究进展

口渴是维持性血液透析(MHD)患者透析期间最常见的并发症之一,严重影响MHD患者的治疗.随着盐酸毛果芸香碱、氨磷汀、西维美林等药物的应用,部分MHD患者口渴的症状得到控制,但仍有很多MHD患者的口渴无法得到有效缓解.文章对维持性血液透析患者口渴的发生机制、影响因素及非药物干预治疗方法的研究进展进行综述,旨在为非药物干预...     

远程健康管理模式对维持血液透析患者自我管理行为、并发症及生活质量的影响

目的探讨远程健康管理模式对维持血液透析(MHD)患者自我管理行为、并发症及生活质量的影响。方法选取2022年1月至2022年12月期间徐州矿务集团总医院收治的MHD患者116例作为研究对象, 应用随机数字表将患者分为观察组(n=58)及对照组(n=58), 对照组行常规管理, 观察组行远程健康管理模式, 比较两组干预前后自我管理行为、血液透析并发症及生活质量。结果干预后观察组自我管理行为总评分及中文版肾脏病生存质量简表(KDQOL-SFTM1.3)评分显著高于对照组(P<0.05)。观察组血液透析并发症发生率为3.45%(2/58), 对照组血液透析并发症发生率为17.24%(10/58), 差异有统计学意义(P<0.05)。结论远程健康管理模式能有效提升MHD患者自我管理行为, 有效预防相关并发症, 提升患者生活质量。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.