目的 了解"新冠肺炎"期间血液透析患者佩戴口罩的认知和行为,进一步探讨提高其依从性的方法 .方法 利用自行编制问卷对185名规律性血液透析患者在透析治疗期间全程佩戴口罩的依从性进行调查.结果 通过调查全程佩戴口罩的血液透析患者仅占58.92％,41.08％的血液透析患者不能全程佩戴口罩.依从性调查中深入了解原因,其中77.63％的患者认为血液透析室预检严格,室内安全不需佩戴口罩;认为连续佩戴4～5h口罩胸闷、透不过气占31.58％;认为佩戴口罩喝水、吃点心不方便占48.68％.结论 在"新冠肺炎"期间,血液透析患者佩戴口罩的依从性不高,要加强血液透析患者健康教育与佩戴口罩的监管,提高血液透析患者佩戴口罩的依从性,切断传播途径,保护易感人群.

目的:分析影响在线血液透析滤过(HDF)患者置换液剂量的相关因素,探讨护士通过改善工作中的相关因素以达到提高HDF质量的方法.方法:选取2019年10月14日～10月21日血液透析中心398例在线HDF患者的临床资料,记录其一般资料和实验室资料,采用Spearman秩相关分析评估患者临床资料与置换液剂量之间的关系,采用Logistic回归分析置换液剂量的重要影响因素.结果:患者的性别、超滤总量、血流量、总蛋白水平和操作护士的能级是影响在线HDF置换液剂量的因素(P<0.01,P<0.05).Logistic回归分析显示,超滤总量是影响置换液量的重要影响因素(P<0.01).结论:在护士可以干预的因素中,通过严格控制超滤总量,加强操作护士知识技能培训,提升操作护士能级,结合患者自身实际情况提高血流量可提高置换液剂量,以达到改善在线HDF质量的目的.

居家血液透析(home hemodialysis,HHD)是终末期肾病(end-stage renal disease,ESRD)患者在家中自主进行个体化的血液透析治疗方式.该治疗模式相比血液透析中心的治疗,提高了患者的生活质量,无交叉感染的风险并且有效解决了医疗床位供不应求的矛盾.与中心透析相比,居家血液透析的益处逐渐受到医护人员与血液透析(hemodialysis,HD)患者的关注.然而,随着时间的推移,患者及其陪伴者对HHD的最初积极态度往往会发生变化,担心独立执行这一复杂治疗的风险,对可能危及生命的透析相关紧急情况产生恐惧心理[1].没有开展HHD经验的临床医生对患者的安全也有类似的担忧.在居家血液透析开展和完善的过程中,相关风险因素及有效监控需得到更多的关注和研究[2].

目的:总结面肌痉挛患者的术后并发症的发生情况并分析其原因.方法:回顾性分析了1548名在我院行微血管减压术治疗面肌痉挛的患者的临床资料,所有患者接受电话随访或者门诊随访,随访时间均超过2年,总结其临床疗效及术后并发症的发生情况.结果:微血管减压术后痊愈率及明显缓解率分别为92.5％及4.2％.249名(16.09％)患者出现不同的并发症,其中最常见的并发症为面瘫及术后手术区域皮肤感觉障碍,无死亡及重大并发症患者.听力损害发生率为3.5％.其他并发症包括脑脊液漏、后组颅神经损伤、外展神经损伤、颅内出血等.结论:微血管减压术是治疗面肌痉挛的安全有效操作,以手术区域感觉障碍及迟发性面瘫是主要的并发症,持久性的或者严重的并发症比较少见.

目的 本研究旨在了解维持性血液透析患者的营养状况,分析导致营养不良的相关因素,并提出护理对策,以期改善血透患者的营养状况.方法 选取上海交通大学医学院附属仁济医院血液透析中心病情稳定的维持性血液透析患者135例,收集血透前的血液标本,检测患者的血红蛋白(hemoglobin;haemoglobin;Hb;HGB),血清白蛋白(又称清蛋白,albumin,Alb),血清前白蛋白(Prealbumin,PA),高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)等生化指标;测量患者透析前十分钟的肱三头肌皮褶厚度(triceps skinfold thicknes,TSF)、上臂围(mid-upper arm circumference,MAC)、上臂肌围(mid-arm muscle circumference,MAMC);采用改良主观全面营养评价法(modified quantitative subjective global assessment,MQSGA)对患者实施营养评价.并以MQSGA得分进行分组,比较相关影响因素.结果 135例患者中存在贫血现象占38.5％,微炎症状占47.4％,前白蛋白低于300 mg/L的患者有31.1％,MQSGA评价显示需要进行营养干预的患者高达48.1％.以MQSGA得分分组,结果显示营养不良与患者的年龄、透析龄、TSF、MAMC呈正相关,差异有统计学意义(jP＜0.05).结论 维持性血液透析患者普遍存在营养不良,其中年龄大、透析龄长是引起营养不良的主要因素,主要表现为进行性骨骼肌萎缩,应定期对患者进行营养评估,及早发现并进行个性化饮食营养教育和运动康复指导,有利于改善维持性血液透析患者的营养状况,从而提高其生活质量.

Objective To evaluate the feasibility and acceptability of magnetically guided capsule endoscopy (MCE) as a screening or diagnostic means for upper gastrointestinal diseases.Methods One hundred and forty six patients underwent MCE during October 2013 to September 2014.All patients and endoscopists received a feedback survey with a self-administrated questionnaire;the items included the satisfaction of patients and endoscopists,the endoscopic image score,examination results,the endoscopy completion and operation time.Results Among 146 patients,145 completed MCE examination with a completion rate of 99.3％ (145/146).The operation time of MCE was (15.20 ± 4.85) min.The score of patient and endoscopist satisfaction was both 4,and patient tolerance score was 0.The divergence rate score was 3;the cleaness score of stomach was 3;and the vision relative definition was 79.31 ± 14.16.The most common examination result was chronic superficial gastritis (67/145,46.2％),followed by bile reflex gastritis (48/145,33.1％),normal stomach (39/145,26.9％),gastric polyps (20/145,13.8％),chronic atrophic gastritis (18/145,12.4％),bleeding from erosive gastritis (14/145,9.7％),reflux esophagitis (6/145,4.1％),2.7％ (4/145),gastrointestinal ulcer,(3/145,2.1％),upper gastrointestinal cancer (2/145),duodenal bulb inflammation (2/145),yellow melanoma (1/145),esophageal cyst (1/145) and esophageal varices (1/145).All patients expressed their willingness to receive the same type of upper GI endoscopy if necessary.No capsule retention,perforation or bleeding occurred.Conclusions MCE avoids the discomfort of conventional gastroscopy and can improve the compliance and acceptability of patients with excellent safety,maneuverability and feasibility.

目的 探讨血液透析患者两种抗凝方法、不同性别、不同年龄段,在透析间期出血倾向特点和护理对策.方法 将血液透析患者按使用普通肝素和低分子肝素抗凝分成两组,按性别分成两组,按育龄期妇女和非育龄期妇女分成两亚组,分别观察透析患者体外循环的凝血情况、出血倾向、出血状况.结果 ①使用普通肝素和低分子肝素抗凝的患者,体外循环凝血发生率无统计学意义( >0.05);②使用普通肝素和低分子肝素抗凝的患者,在透析间期出血倾向发生率无统计学意义( >0.05);③男女两组在透析间期出血倾向发生率无统计学意义( >0.05);④育龄期妇女在透析间期出血倾向发生率高于非育龄期妇女( <0.05).结论 除外高危出血重症患者,对于门诊维持性透析患者而言,使用普通肝素或低分子肝素抗凝,在透析中体外循环凝血上没有差别,透析间期都存在30%左右不同部位出血现象. 护士对于所有患者均应做好相关健康教育,透析前给予个体化不同剂量的肝素处方,即达到抗凝目的,又不增加透析间期出血倾向. 对于育龄期妇女在透析间期出血发生率高,与经期透析时使用肝素有关,全身肝素化导致经期出血量增多,经期延长,故使用肝素前除关心患者近期有无外伤,育龄期妇女还应注意在经期适当减少肝素用量.

Objective To explore the clinical choice principles of sedated upper gastrointestinal (GI) endoscopy versus conventional upper gastrointestinal (GI) endoscopy.Methods Sedated GI endoscopy group (n =400) and conventional GI endoscopy group (n =400) were respectively set up with patients who had undergone the two procedures from May 13 to July 29,2013.All patients and endoscopists were asked to fill out a self-administered questionnaire about procedure-related discomfort,patient satisfaction and endoscopist satisfaction with endoscopy,and the endoscopic image score.Patients were also asked about whether they would opt for the identical upper GI endoscopy again in the future if required.The endoscopy completion,operation time,and questionnaire results of the two groups were compared and statistically analyzed.Results The completion rates were 100.0％ (400/400) and 98.0％ (392/400) in the sedated GI endoscopy group and the conventional GI endoscopy group,respectively (P =0.004).The operation times of sedated and conventional group were (257.7 ± 133.5) s and (214.2 ± 121.3) s respectively (P ＜ 0.001).And the mean cost was CNY 574.23 and CNY 268.00 per patient in sedated and the conventional group,respectively.Patient satisfaction scores of conventional group and sedated group were 3 (2 ～ 3) and 4 (3 ～4) respectively (Z=-18.98,P ＜0.001),while endoscopist satisfaction was both 4(4 ～4) in two groups (Z=-2.645,P =0.008).The endoscopic image scores were (3.13 ±0.39) points and (3.18 ± 0.50) points for sedated and conventional group (P =0.153),respectively.SpO2 of 20 patients (5.0％) in the sedated group decreased during the procedure.Binary logistic regression analysis predicted correlated factors for a decreased SpO2 in the SES of identified cardiovascular disorders (P =0.004,OR =2.410,95％ CI:0.924 ～6.287) and older age (P =0.002,OR =1.039,95 ％ CI:1.002 ～ 1.077).A total of 381 patients (95.2％) in the sedated group and 145 patients (36.4％) in the conventional group showed willingness to accept the identical upper GI endoscopy again (P ＜0.001).Males (P =0.007) aged above 60 (P =0.031) and BMI≤24 kg/m2(P =0.039) in the conventional group were more willing to repeat conventional GI endoscopy.Conclusion Conventional GI endoscopy remains an indispensable examination of upper gastrointestinal disease in China due to its high completion rates,shorter procedure time and lower cost.Physicians should not only focus on patients' comfort during endoscopy,but also help patients make a balanced decision based on their actual situation and endoscopic indications.

Objective To compare the clinical choosing principles of sedated colonoscopy with con-ventional colonoscopy. Methods Outpatients who were willing to accept colonoscopy with or without seda-tion were prospectively recruited,which were assigned to sedated colonoscopy group(n=362)and conven-tional colonoscopy group(n=323). All patients and endoscopists were asked to answer a self-administered questionnaire. The colonoscopy completion,operation time,procedure-related discomfort,and questionnaire results of the two groups were compared and statistically analyzed. Results The completion rate was 98. 9%in the sedated colonoscopy group(358/362)and 89. 8% in the conventional colonoscopy group(290/323) ( P=0. 337 ). The operation time of sedated and conventional group were( 5. 60 ± 3. 25 ) minutes and (7. 71 ± 5. 70)minutes respectively(P<0. 001). And the average cost was CNY 886. 54 per patient in se-dated group and CNY 386. 00 per patient in the conventional group. Patient satisfaction score of conventional group and sedated group were 4(3-4)and 3(2-3)points(P<0. 001),while endoscopist satisfaction score was 4(3-4)and 4(4-4)(P<0. 001). A total of 354 patients(97. 79%)in the sedated group and 225 pa-tients(69. 66%)in the conventional group showed willingness to repeat the identical colonoscopy( P <0. 001). Patients who were male(P=0. 035),having no past abdominal operations(P<0. 001),or no ab-dominal pain during colonoscopy( P =0. 015 )in the conventional group preferred to repeat conventional colonoscopy. Conclusion Although the examination time of conventional colonoscopy is longer than sedated colonoscopy,it could reduce anesthesia risk and the cost. Conventional colonoscopy remains an irreplaceable examination of colorectal diseases in developing countries. Physicians should not only focus on patients'com-fort during endoscopy,but also help patients make a decision based on their actual situation and endoscopic indications to make the best of medical resources.

背景:肿瘤干细胞是肿瘤组织中—小部分具有自我更新、多向分化以及高度增殖能力的肿瘤细胞.研究发现表皮生长因子(EGF)可促进肿瘤干细胞增殖.目的:探讨EGF及其受体(EGFR)在结肠癌干细胞增殖调控中的作用.方法:结肠癌细胞株HT29、HCT116培养于无血清培养基中,以EGF、碱性成纤维细胞生长因子(bFGF)、胰岛素样生长因子(IGF)分别干预细胞.MTT法检测EGFR抑制剂吉非替尼对结肠癌细胞球细胞的增殖抑制作用,体外实验检测EGFR抑制剂吉非替尼、PD153035对细胞球形成的抑制作用,流式细胞术检测细胞凋亡.体内实验检测结肠癌细胞球和细胞株的成瘤能力,real-time PCR检测两者干细胞标记LGR5、Musashi-1和分化标记CK20表达.结果:EGF组HCT116细胞形成的细胞球数量显著高于空白对照、bFGF、IGF组(P＜0.05).吉非替尼能抑制HCT116细胞球细胞增殖和细胞球形成,并诱导细胞凋亡,作用呈浓度依赖性.HCT116细胞球成瘤时间较细胞株显著缩短,移植瘤体积显著增大(P＜0.05).LGR5、Musashi-1在细胞球中的表达显著高于细胞株,而CK20在细胞株中的表达显著高于细胞球(P＜0.05).结论:EGF对结肠癌细胞株HCT116、HT29形成细胞球具有促进作用.EGFR抑制剂可抑制结肠癌细胞球增殖并诱导细胞凋亡,相关作用可能与调控LGR5、Musashi-1和CK20表达有关.