腹膜透析患者延续护理需求评估问卷的编制及信效度检验

目的编制腹膜透析患者延续护理需求评估问卷并检验其信效度。方法通过微信随访、文献系统评价及专家会议形成问卷初始条目,通过咨询5名专家及调查255例腹膜透析患者行问卷信效度检验。结果探索性因子分析提取7个公因子,解释总变异量的75.183%;该问卷Cronbach′sα系数为0.909,各维度Cronbach′sα系数为0.673～0.885;问卷重测信度为0.905,各维度重测信度为0.689～0.892;问卷的内容效度为0.861,各条目的内容效度为0.840～1.000。最终版问卷共包含7个维度32个条目。结论腹膜透析患者延续护理需求评估问卷编制过程合理,问卷的信效度良好,可用于腹膜透析患者延续护理需求的评估。     

脑卒中症状群评估量表的编制及信效度检验

目的 编制脑卒中患者症状群评估量表,进行信效度检验,为精准护理提供评估工具。方法 以症状管理理论为框架,通过文献回顾、德尔菲法、预调查形成量表初稿后,选取353例脑卒中患者进行调查,采用项目分析、探索性因子分析、信度分析筛选条目、检验信效度。结果 编制的脑卒中症状群评估量表包括躯体活动、认知言语、感知觉、吞咽、消化排泄、情绪心理6个症状群共35个条目,累积方差贡献率为69.095%。量表总Cronbach′s α系数为0.905,折半信度为0.728。量表水平的内容效度指数为0.886,条目水平的内容效度指数为0.920~1.000。结论 脑卒中患者症状群评估量表具有良好的信效度,可用于脑卒中患者症状群的评估。     

痛风患者症状群评估量表的编制及信效度检验

目的 编制痛风患者症状群评估量表,为临床医护人员有效评估痛风患者症状提供工具。方法 以症状经历模型为理论框架,通过文献回顾、半结构式访谈、2轮德尔菲专家函询形成预试量表。选取30例痛风患者进行预调查,根据患者反馈进一步修订量表。第1轮、第2轮正式调查分别便利选取170例、272例痛风患者进行调查检验量表信效度。结果 最终形成的痛风患者症状群评估量表包括22个症状条目,探索性因子分析提取6个公因子（关节症状群、活动受限症状群、心理-睡眠症状群、泌尿系统症状群、全身表现症状群、痛风石症状群）,累积方差贡献率为67.301%。验证性因子分析提示模型拟合良好（χ2/df=2.680、SRMR=0.076、RMSEA=0.079、CFI=0.903、TLI=0.884）。条目水平的内容效度指数为0.833~1.000,量表水平的内容效度指数为0.889。总量表Cronbach′s α系数为0.863,折半信度为0.836,2周重测信度为0.947。结论 痛风患者症状群评估量表具有良好的信效度,适用于痛风患者的症状群评估。     

腹膜透析患者营养状况的评估及护理

目的探讨腹膜透析患者营养状况的评估及护理。方法对38例行葡萄糖腹膜透析液（乳酸液）进行持续性非卧床腹膜透析的患者采用综合性营养评估法进行营养状况评估及护理。结果38例腹膜透析患者中，16例营养不良，占42．1％。结论腹膜透析患者普遍存在营养不良。提出重视透析前营养状况，掌握好透析时机，注重蛋白质和维生素的补充是营养护理的重点。     

终末期肾脏病透析患者营养素养评价量表的编制及信效度检测

目的 编制终末期肾脏病透析患者营养素养评价量表并检验其信效度,为评估终末期肾脏病透析患者营养素养提供参考.方法 采用文献分析、专家讨论和专家咨询法编制终末期肾脏病透析患者营养素养评价量表,采用便利抽样方法,选取行维持性血液透析或腹膜透析的208例终末期肾脏病患者进行问卷调查,并分析量表的信效度.结果 终末期肾脏病透析患...     

腹膜透析患者营养状况的评估及护理

目的探讨腹膜透析患者营养状况的评估及护理。方法对38例行葡萄糖腹膜透析液(乳酸液)进行持续性非卧床腹膜透析的患者采用综合性营养评估法进行营养状况评估及护理。结果38例腹膜透析患者中,16例营养不良,占42.1%。结论腹膜透析患者普遍存在营养不良,提出重视透析前营养状况,掌握好透析时机,注重蛋白质和维生素的补充是营养护理的重点。     

腹膜透析患者营养状况的评价

在终末期肾功能衰竭(ESRD)透析与非透析病人中营养不良普遍存在,它能导致患者高死亡率、高感染率及低康复率。由于腹膜透析(腹透)的特殊性,营养不良尤其明显。Young等对欧美6个透析中心,224例情况加以统计,营养不良发生率达40.6％,其中严重营养不良者占8％。导致腹透病人营养不良的因素有:(1)蛋白质摄入不足:其中厌食是主要原因,若透析不充分,毒素蓄积,影响食欲使蛋白质的摄入减少;其次,腹透时腹膜对糖的吸收(占总热量20％),并且腹腔中加入2升左右的透析液,使患者有饱腹感,胃纳下     

腹膜透析患者症状群特征及其影响因素分析

目的:探讨腹膜透析患者症状群特征,并分析其影响因素。方法:选取2021年09月—2021年12月在杭州市中医院腹膜透析中心规律随访的304例不卧床腹膜透析患者作为研究对象。采用一般资料调查表,透析症状量表对其进行横断面调查,采用主成分分析提取症状群,并分析影响症状群的相关因素。结果:腹膜透析患者单一症状发生率超过半数以上的依次为皮肤干燥、疲惫或乏力、下肢肿胀、皮肤瘙痒,通过主成分分析提取8个症状群(心理不适症状群,性欲减退症状群,睡眠障碍群,活动无力症状群,疼痛症状群,皮肤不适症状群,腿部不适症状群,电解质紊乱症状群)。年龄、透析龄、高敏C反应蛋白、血磷、尿素、血钙是影响症状群的主要因素。结论:多数腹膜透析患者存在多种症状的困扰,医务人员应针对不同症状群进行个体化的干预,以减轻症状,提高生活质量。     

简体中文版老年男性症状量表的信效度检验

目的 检验简体中文版老年男性症状量表(AMS)在前列腺癌内分泌治疗患者中的适用性.方法 对繁体中文版AMS进行文化调适,形成简体中文版AMS,邀请10名专家进行内容效度评定,并对221例前列腺癌内分泌治疗患者进行问卷调查,检验简体中文版AMS的信度和效度.结果 简体中文版AMS的内容效度指数为0.95;量表含17个条目...     

老年快速评估量表的汉化及信效度检验

目的引进并翻译老年快速评估量表(Rapid Geriatric Assessment,RGA),并检验其信效度。方法根据Brislin量表翻译原则对RGA进行翻译和回译,通过专家讨论及预试验进行文化调适,并采用便利抽样方法在社区医院抽取360名老年人进行调查。结果 RGA中文版条目水平内容效度指数(I-CVI)为0.800～1.000,量表水平内容效度指数(S-CVI)为0.988;探索性因子分析提取4个公因子(衰弱、少肌症、营养、认知),累积变异量为58.433%,衰弱、少肌症、营养、认知的Cronbach′sα系数分别为0.511、0.758、0.809、0.663,重测信度分别为0.850、 0.835、 0.802、0.848。结论 RGA中文版条目简洁,信效度可接受,可作为评估老年人健康状况的常规筛查工具。     

Cellular response to peritonitis among peritoneal dialysis patients

White blood cell counts and differential cell counts were performed on 249 peritoneal dialysis effluents from 48 patients using chronic peritoneal dialysis. The finding of more than 50% polymorphonuclear leukocytes in the dialysate was a more sensitive indicator of peritonitis than was an absolute cell count of 100 cells/microL. This finding was true for patients using intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, and continuous cycling peritoneal dialysis.     

Renal transplantation of patients on chronic peritoneal dialysis

A retrospective review of patients transplanted from peritoneal dialysis was performed to assess the risk of this form of dialysis for patients awaiting renal transplantation. Eighteen transplants have been performed in 16 patients, ages 6 to 57 years, undergoing chronic peritoneal dialysis over the past 4 years. Sixteen were from cadaver donors, and two were from living related donors (LRD). The patients had been undergoing intermittent peritoneal dialysis or continuous ambulatory peritoneal dialysis (CAPD) using permanent silastic catheters, from five days to 4 years. No patient had clinical evidence for peritonitis at the time of transplantation. The peritoneal catheter was removed at the time of transplant in all cadaver donor recipients without complication. One recipient of a LRD kidney had the catheter removed two days prior to transplant. Cultures of the catheter were sterile in 16 cases. Two patients had positive peritoneal catheter cultures at the time of transplant but were treated with appropriate antibiotics and never developed clinical peritonitis. Fourteen transplants had postoperative fevers. No definite source was found in 13; one had fever in relation to acute graft rejection. The fevers resolved in all patients either spontaneously or subsequent to therapy. Other complications were similar to those seen in patients transplanted from hemodialysis. Hemodialysis was performed as needed pretransplant and posttransplant using a temporary femoral vein catheter or arteriovenous fistula without complication. Nine patients are alive with a functioning kidney 1 to 36 months posttransplant (mean 17 months). Six transplants rejected (five patients), and one failed secondary to renal vein thrombosis. Two patients died posttransplant, one after a cerebrovascular accident, and one due to an unknown cause 1 month postnephrectomy for rejection. In conclusion, patients undergoing chronic peritoneal dialysis can be successfully transplanted without a significant incidence of complications related to their peritoneal dialysis.     

Comparison of infectious complications in peritoneal dialysis patients using either a twin-bag system or automated peritoneal dialysis.

BACKGROUND: Automated peritoneal dialysis (APD) and twin-bag (TB) systems are two major peritoneal dialysis (PD) modalities. Published data comparing the infectious complications of these modalities is limited. Subjects and methods. Ninety-five patients using APD (the APD group) and 117 patients using TB system (the TB group) were recruited. Among them, 35 patients used both modalities. The two groups' clinical characteristics, incidences of infectious complications, and the time intervals to first PD-related infection were compared. RESULTS: Clinical characteristics, incidence of exit-site infection (ESI), and time intervals to first ESI were similar in the TB and APD groups. The incidence of peritonitis in the APD group (1.22 episodes/100 patient-months) was significantly (P < 0.001) lower than that of the TB group (2.28 episodes/100 patient-months). Using the Cox proportional hazard model, APD was found to have a lower risk of peritonitis relative to TB systems, with marginal significance (RR 0.58, P = 0.051). CONCLUSION: APD was found to have a lower peritonitis rate than the TB system. Since reducing the peritonitis rate helps to maintain technical survival during PD, from this viewpoint, APD may be preferred for patients undergoing PD, unless contraindicated.     

辅助腹膜透析的预后分析

目的比较辅助腹膜透析和自主腹膜透析对腹膜透析(peritoneal dialysis,PD)患者的预后影响。方法回顾性收集1996年3月13日至2016年12月31日在北京协和医院行PD且资料完整的637例成人患者的临床资料,按照患者是否独立完成PD操作将将患者分为自主PD组和辅助PD组,按照PD的模式不同进一步将辅助PD组分为自动化腹膜透析组(automated peritoneal dialysis,APD)和持续非卧床腹膜透析组(continuous ambulatory peritoneal dialysis,CAPD),分别比较辅助PD和自主PD两组间以及辅助APD和辅助CAPD两组间患者生存、技术生存及无腹膜炎生存方面的差异。结果本研究纳入辅助PD组373例(APD 35例,CAPD 338例),自主PD组264例。与自主PD相比,辅助PD患者年龄更大,合并糖尿病、高血压及心血管疾病比例更高,透析开始时血白蛋白、钾、磷、血肌酐、尿素、甲状旁腺素和标准蛋白分解率更低,而血二氧化碳总量和估算肾小球滤过率更高。辅助APD组与辅助CAPD组比较则前者合并心血管疾病比例,护工辅助比例以及透析3个月后残余肾功能水平更高。辅助PD组患者生存不及自主PD组,但经多因素校正后辅助PD不是患者死亡的独立危险因素(HR1.479,95%CI 0.978~2.236,P=0.064),两组在技术生存及无腹膜炎生存方面相当。辅助APD与辅助CAPD比较,两组的患者生存、技术生存及无腹膜炎生存均无差异。结论辅助PD的患者生存劣于自主PD,而技术生存及无腹膜炎生存两组无差异。辅助APD的患者生存、技术生存和无腹膜炎生存与辅助CAPD无差异,可以作为有需求患者的治疗选择。     

居家腹膜透析患儿父母照顾负担水平及其影响因素调查

目的了解居家腹膜透析患儿父母所承受的照顾负担及其影响因素,为建立照顾者培训体系提供参考。方法应用Zarit照顾者负担量表和社会支持评定量表对上海市某三级甲等儿科专科医院腹膜透析中心的110名居家腹膜透析患儿父母进行调查。结果居家腹膜透析患儿父母照顾者负担呈重度水平(42.11±15.01)。患儿父母获得的社会支持评分处于中等水平(38.68±9.68),与国内常模比较,差异有统计学意义(P0.01)。多元逐步回归分析显示,患儿年龄、腹透时间及患儿父母的疾病知识知晓程度是父母照顾负担的预测因素,可解释照顾负担30.6%的变异量。结论腹膜透析患儿父母的照顾负担较重,获得社会支持水平处于中等水平,患儿年龄、腹透时间长短以及患儿父母对疾病知识的知晓度影响照顾者负担,建议临床透析管理人员对在居家治疗初期的患儿父母以及低龄患儿父母给予更多技术支持和情感支持,多渠道提高和强化患儿父母的居家治疗护理知识,协助患儿父母优质化管理腹透患儿的居家治疗。     

Intraperitoneal heparin reduces peritoneal permeability and increases ultrafiltration in peritoneal dialysis patients.

BACKGROUND: Patients on long-term treatment with peritoneal dialysis (PD) suffer from increasing peritoneal permeability and loss of ultrafiltration as a result of persistent inflammation, which may be triggered by bioincompatible dialysis fluids. Heparins have anti-inflammatory and anticoagulant properties. We have examined the effect of intraperitoneal (IP) low-molecular weight heparin (tinzaparin) on peritoneal permeability and ultrafiltration in PD patients. METHODS: By means of a double-blinded cross-over design, 21 PD patients were randomized to receive either placebo or tinzaparin intraperitoneally once a day for two treatment periods of 3 months, separated by a wash-out period. The effect of heparin on peritoneal permeability and ultrafiltration was assessed using the 4 h standard peritoneal equilibration test. RESULTS: IP tinzaparin reduced significantly the dialysate-to-plasma ratios (D/P) of creatinine (P < 0.01), urea (P < 0.01) and albumin (P<0.05). In addition, the ratio of glucose concentration in dialysate at 4 h dwell to that of 0 h dwell (D(4)/D(0)) was increased (P<0.05) along with an increase in ultrafiltration volume (P<0.05). CONCLUSIONS: IP tinzaparin reduces peritoneal permeability to small solutes and increases ultrafiltration in PD patients.