腹膜透析相关性腹膜炎诊治的临床决策

腹膜透析相关性腹膜炎的治疗以前主要着眼于抗生素的选择,但其防治应该是从腹透管置管开始的整体策略,包括预防性抗生素的使用、患者的强化培训、腹膜炎的早期快速诊断、给药途径与疗程,以及拔管指征等.肾科医师临床决策是需要根据最新的治疗指南及研究进展,结合患者的个体特点进行综合判断,以期达到最佳的治疗效果.     

终末期肾病患者替代治疗方法的临床决策

血液透析、腹膜透析和肾移植是终末期肾病患者替代治疗的主要方法,三种治疗方法各有优缺点。临床上应根据患者原发病因、替代治疗并发症、卫生经济学、生存质量、所在地医疗条件、非医疗因素等作出科学临床决策,最大限度延长患者生命,提高生存质量。     

肾内科腹透患者的血糖管理

腹膜透析是维持终末期肾脏病患者的主要治疗之一,我国透析患者中糖尿病肾病的比例在快速上升,如何管理进入透析阶段的糖尿病患者的血糖,特别是腹透患者的血糖是重要的临床问题。本文试图简述近年来国内外进展和共识,并结合临床实践,简述糖尿病肾病患者透析方式的选择、血糖控制的目标和胰岛素的用法。     

终末期肾病患者替代治疗方法的临床决策

血液透析、腹膜透析和肾移植是终末期肾病患者替代治疗的主要方法,三种治疗方法各有优缺点.临床上应根据患者原发病因、替代治疗并发症、卫生经济学、生存质量、所在地医疗条件、非医疗因素等作出科学临床决策,最大限度延长患者生命,提高生存质量.     

人文关怀对腹膜透析患者生活质量的影响

腹膜透析患者存在许多心理障碍,迫切需要人文关怀,但整个社会和许多医务人员对此缺乏正确认识和重视,影响了患者身心康复.将我科2009年1月～2011年12月治疗的64例腹膜透析患者列入研究,随机对其中32例患者给予人文关怀,并进行生活质量评估.分析发现人文关怀可以帮助改善患者的抑郁、焦虑情绪,提高患者的幸福指数,减少并发症的发生.建议对腹膜透析患者加强人文关怀,不仅有助于治疗患者心理障碍,增强患者应对不良情绪的能力,更能让患者保持良好心理、生理状态,提高其生活质量.     

新农合制度调整前后豫北地区腹膜透析患者透析质量的比较

腹膜透析是终末期肾脏病的有效替代治疗方法之一。2012年4月,河南省对包括慢性肾衰竭在内的六种疾病的新农合报销比例做出重大调整,腹透患者主要经济花费的透析液报销比例由原来的40％提高至80％。通过研究新农合制度调整前后豫北地区腹膜透析患者的临床资料,报告了制度调整后的患者透析充分性提高,贫血、营养状况较前好转,心血管疾病发生率下降,生存质量改善的现况,论证了老龄、糖尿病、营养不良、心血管疾病、透析不充分、较低的医疗保险支付比例是影响腹膜透析患者预后的重要因素,为腹膜透析患者的预后分析提供了理论依据。     

终末期肾病治疗方法的比较

终末期肾病是各种病因所致的慢性肾脏疾病的最终阶段.血液透析、腹膜透析和肾移植是目前临床上治疗终末期肾病的主要肾脏替代疗法,针对三者的优缺点,从治疗方式、疗效、费用等方面进行比较,研究结果显示肾移植的治疗效果在整体上优于CAPD和血液透析,持续性非卧床腹膜透析(CAPD)的治疗效果略优于血透,肾移植是成本-效果比最好的ESRD替代治疗方法.     

不同透析类型对尿毒症患者超敏C-反应蛋白与甲状腺功能的影响

分析不同透析类型对尿毒症患者的超敏C-反应蛋白与甲状腺功能的变化,并探讨其临床意义.对我院肾脏内科2009年10月～2011年6月的尿毒症维持性透析患者进行回顾性分析,20例血液透析(HD)患者为HD治疗组,20例腹膜透析(PD)患者为PD治疗组,20例健康者为正常对照组,各组检测超敏C-反应蛋白(hsCRP)、血清游离T3(FT3)、血清游离甲状腺激素(FT4)、促甲状腺激素(TSH)的含量等指标,分析各组间hsCRP有无差异性,同时分析hsCRP与FT3、FT4、TSH之间有无相关性.与正常对照组相比,HD组和PD组FT3、FT4显著降低(P＜0.05),hsCRP显著升高(P＜0.05).FT3和FT4在HD组中和PD组中相比差异无显著统计学意义(P＞0.05).PD组中,TSH水平显著高于HD组与正常对照组(P＜0.05).HD组中,hsCRP与FT3存在着负相关,但在PD组中没有发现此相关性.血液透析患者炎症反应与低FT3综合征有关,腹膜透析患者无此关联性,hsCRP及甲状腺功能检测可能有助于判断尿毒症透析患者的病情及预后.     

终末期肾病单病种付费实施现况及个人支付费用影响因素研究

单病种付费对于控制医疗费用的不合理增长与促进机构医疗服务质量的提高具有重要意义.通过对浙江省某市终末期肾病参保患者医疗费用支出、卫生服务利用等数据的收集,运用统计学分析工具,分析不同类型参保患者实际费用支出及卫生服务利用的差异,并探讨个人支付费用的影响因素.建议该市在终末期肾病单病种政策制定中建立动态的定额结算标准;鼓励与引导病情较轻的患者优先进行腹膜透析;并完善多层次的医疗保障制度,鼓励低收入家庭患者尽早就医.     

腹膜透析技术的发展

腹膜透析是一门年轻的学科。随着科学技术的发展,人们对腹膜透析的认识越来越深入。随着新材料新方法不断应用于临床,腹膜透析技术逐渐完善起来,病人的生存期也越来越长,人数越来越多。但伴随腹膜透析的广泛应用又产生了很多问题,通过问题的解决,腹膜透析又会进一步发展。     

腹膜间皮细胞EMT在腹膜纤维化中的研究进展及意义

腹膜透析是终末期肾衰患者肾脏替代治疗的重要手段,腹膜纤维化导致腹透效能下降及超滤衰竭,制约着腹膜透析的应用。腹膜间皮细胞上皮细胞间充质转化是腹膜纤维化的起始和可逆环节,因此预防和逆转EMT的发生发展可能是阻止和延缓腹膜纤维化、超滤衰竭的最佳策略,并将带来巨大的社会和经济效益。     

心理咨询和治疗的知情同意原则及其影响因素

随着心理咨询和治疗的发展,患者的知情同意成为临床心理学实践的一个基本伦理观念和原则.首先提出心理咨询和治疗实践中的知情同意问题,介绍心理咨询和治疗知情同意的要素、过程、内容、意义和影响因素,并附心理咨询和治疗提供给患者的知情同意问卷,旨在引起从业者的注意和重视,并在临床实践中自觉地遵守.     

Illness perceptions in dialysis patients and their association with quality of life

The present study explored illness perceptions of end stage renal disease (ESRD) patients on both haemodialysis (HD) and peritoneal dialysis (PD) treatment, and their associations with quality of life. Leventhal's self-regulation model (SRM) was used as a theoretical framework. Illness perceptions and quality of life were assessed with the IPQ-R and the SF-36 in 91 HD and 42 PD patients participating in the NECOSAD-study. Compared to HD patients, PD patients experienced more personal control and had a better understanding of the illness. Illness perceptions explained from 17 to 51% of the variance in quality of life scores. Perception of more symptoms, more consequences and lower personal control were associated with lower well-being. The concept of illness perceptions is useful in understanding the impact of ESRD and of dialysis treatment on quality of life. Interventions aimed at providing more knowledge about ESRD and dialysis, and provision of skills to coping with the illness and its consequences may improve quality of life in dialysis patients.     

预防导尿管相关性感染的临床问题及决策

留置导尿是一项侵袭性操作,易引起尿道黏膜损伤,且留置导尿时间过长,容易引起泌尿系统的逆行感染。为了预防导尿管相关性感染,我们从临床角度讨论是否需要更换一次性尿袋以及更换尿袋的时间,留置导尿尿道外口的清洗,留置导尿膀胱冲洗的必要性及是否应用抗生素,更换导尿管的时间及导尿管的选择等临床问题,为临床人员做该项操作时提供参考,做出正确的临床决策。     

A discursive analysis of psychosocial issues: Talk in a ‘parent group’ for families who have children with chronic renal failure

Abstract

This paper illustrates a discursive approach to ‘psychosocial issues’ in health care. The analysis examines examples of talk within support groups for parents of children with chronic renal failure. These ran over a 32 month period at a Regional Paediatric Renal Unit within the UK National Health Service. All the parents are directly involved in management of home based peritoneal dialysis of their children. The analysis examines features of the organisation and content of parents' talk about what is commonplace in the management of the demands they face in the difficult circumstances of their child care. Common understandings within the groups are shown to be achieved through the parents' exploration of uncertainties in the care of their children. The value of qualitative analysis of health care talk in the evaluation of support groups for families involved in this form of paediatric care is also discussed.     

The influence of different dialysis modalities on the quality of life of patients with end-stage renal disease: A systematic literature review

Objectives: This study aims to generate evidence regarding the relationships of different dialysis modalities with HR-QOL.

Design: A systematic review was conducted to investigate the HR-QOL of patients treated with different dialysis modalities.

Methods: A literature search was conducted for English language articles in the CINAHL, Medline and PubMed databases published from January 1990 through May 2016. Specifically, we sought articles that would compare the HR-QOL of hemodialysis (HD) and peritoneal dialysis (PD) patients in terms of physiological, psychological and social functioning, as well as disease symptoms. Thirty-four articles met the study inclusion criteria and were included into the analysis.

Results: The research results indicated no significant differences in HR-QOL between HD and PD treatment. However, a higher percentage of patients who received PD had a better HR-QOL in terms of physiological, psychological, social and disease symptoms.

Conclusions: Despite the fact that the results of this study showed no difference in HR-QOL between HD and PD treatment, its review of relevant references can serve as a reference for health professionals. However, patients’ conditions must still be taken into account when making suggestions about which dialysis modality a patient should use.     

急性重症胰腺炎的抗生素治疗策略

继发性感染是导致急性重症胰腺炎(severe acute pancreatitis,SAP)高病死率最重要的因素。继发感染的微生物多为革兰阴性菌。选用抗菌药物需兼顾病原菌敏感性及抗菌药物穿透血胰屏障能力,合理选择用药方式;对于CT证实有胰腺坏死的急性重症胰腺炎,可预防性使用抗生素;氟康唑可作为经验性抗真菌治疗的首选药物。