目的 探讨健身气功五禽戏对透析患者肌少症骨骼肌肌肉质量、力量、功能、人体测量指标及疲乏的影响.方法 便利抽样法抽取某三甲医院肾内科透析住院患者80例作为研究对象,按照随机信封法分为对照组和观察组,每组各40例.对照组采用常规治疗护理措施,观察组在对照组常规治疗护理措施基础上进行健身气功五禽戏锻炼.比较2组患者干预前、干预12周后骨骼肌质量指数、握力、体重指数、三角肌皮褶厚度、中臂围、中臂肌围、6 m步速和简易躯体功能量表得分、疲乏程度的差异.结果 观察组干预12周后握力、三角肌皮褶厚度、中臂围、中臂肌围、6 m步速和简易躯体功能量表评分均高于对照组(P＜0.05);疲乏得分低于对照组(P＜0.05);骨骼肌质量指数、体重指数与对照组对比,差异无统计学意义(P＞0.05).结论 健身气功五禽戏可改善透析患者肌少症骨骼肌肌肉力量、人体测量指标、肌肉功能,减轻疲乏程度.

目的 基于维持性血液透析患者运动康复的证据,实施循证实践,并验证其在改善维持性血液透析患者机体功能、运动耐力和生活质量中的作用.方法 基于证据的持续质量改善模型为研究框架,于2021年1月～12月通过证据获取、现状审查、证据引入,构建维持性血液透析患者运动康复的循证方案;选取2022年1月～3月在江苏省中医院肾内科住院且维持性血液透析患者80例,随机分为试验组和对照组,各40例,比较运动干预后2组患者肌肉质量、肌肉力量、6分钟步行试验、生活质量指标的差异,同时比较循证实践前后医务人员对运动康复证据的知晓率变化.结果 最终纳入9条证据,共7条审查指标.运动干预后,试验组较对照组患者肌肉质量提高(t=-3.302,P＜0.01)、肌肉力量提升(t=-2.825,P＜0.001)、6分钟步行增加(t=-5.529,P＜0.001);试验组健康调查简表各维度总分均较对照组提高(P＜0.05);循证实践前后医护人员运动康复证据的知晓率提高40.74％,差异有统计学意义(P＜0.001).结论 基于证据的运动康复循证实践能够改善维持性血液透析患者机体功能、运动耐力,提高生活质量.

目的 探讨血清尿酸变化率(serum uric acid variation rate,UAR)对腹膜透析(peritoneal dialysis,PD)患者主要不良事件(major adverse events,MAE)的影响.方法 采用便利抽样法选取2015年4月至2020年3月在江苏省某医院肾内科腹透中心行PD置管术并长期规律随访的患者185例,随访至2020年12月.比较MAE(全因死亡、主要心血管不良事件及PD相关腹膜炎)发生组与无发生组的临床特征差异,通过Cox回归分析UAR与MAE的相关性,将UAR根据25％、75％分位数分为轻度(<7.88％)、中度(7.88％～20.29％)、重度(>20.29％)增长三组,应用Kaplan-Meier生存曲线及Cox回归分析探究不同UAR增长程度与患者MAE的相关性.结果 UAR增加是PD患者发生MAE的危险因素.Kaplan-Meier生存曲线结果显示,与UAR轻度增长组相比,UAR中度和重度增长组患者MAE发生率显著增加(χ2=23.31,P<0.01),经多变量Cox回归模型校正后仍提示UAR中度和重度增加组相比轻度增加组是PD患者发生MAE的独立危险因素.结论 UAR严重程度具有潜在的MAE风险预测价值.医护人员应动态监测PD患者尿酸变化情况,给予针对性干预措施,帮助患者减少MAE的发生.

ObjectiveTo probe into effects of acupoint massage on maturation and long-term use time of autogenous arteriovenous internal fistula （AVF）.MethodsA total of 66 patients， who underwent AVF for the first time in the department of nephrology of our hospital from January to October 2017，were selected. Patients in one ward were taken as the control group， and patients in the other ward were taken as the observation group，each with 33 cases.Fistula perioperative conventional nursing were given between two groups.Under the guidance of nurses， patients in observation group massaged hand acupoints following hands’three Yin meridians， three Yang meridians starting from third day after surgery.Physical maturity and ultrasonic mature situation of internal fistulas at 4 weeks and 8 weeks after surgery，first AVF puncture time，success rate of first hemodialysis puncture within a needle，incidence of complications within 6 months after AVF and survival time of AVF were compared between two groups of patients.ResultsAt 4 weeks after operation， physical maturity of AVF and ultrasonic maturity of patients in the observation group were 23 cases and 21 cases respectively，which were better than 15 cases and 13 cases in the control group （P<0.05）.At 8 weeks after operation， depth of vein from skin of patients in observation group was（3.89±0.52）mm， while that of the control group was（4.31±0.96）mm. There was statistical difference between two groups（P<0.05）.First AVF puncture time of observation group （43.50±3.92）days was earlier than that of the control group（47.20±4.49）days.One shot success rate of first hemodialysis puncture in observation group （93.75%）was higher than that of the control group（75.76%）.Incidence of complications within 6 months after AVF in observation group was 9.38%，while that of the control group was 30.30%.Incidence of complications within 6 months after AVF was lower than the control group（P<0.05）.Survival time of AVF in the observation group was 25.39±0.42 months，while that in the control group was（23.02±0.92）months.Survival time of AVF in the observation group was higher than that in the control group.Differences between two groups were all statistically significant （P<0.05）.ConclusionAcupoint massage can promote early maturation of AVF， improve one shot- success rate of first puncture of internal fistula， reduce postoperative complications， and increase the long⁃term use time.

目的 观察雷火灸对阳虚证糖尿病肾病下肢水肿的临床疗效.方法 将60例阳虚证糖尿病肾病下肢水肿患者随机分为观察组与对照组,每组30例.对照组采用控制血糖、控制血压、降血脂等基础治疗加中药协定方口服等和健康指导,观察组在此基础上加雷火灸治疗,每周5次,10次为1个疗程,共2个疗程.观察两组干预前后不同时间点的体质量、尿量、双踝部上2 cm周径、水肿程度积分变化.结果 两组干预2周、4周后水肿程度积分比较,观察组显著轻于对照组(均P＜0.01).干预1周、2周、3周后观察组尿量显著多于对照组(均P＜0.05);干预2周、3周后观察组双踝周径显著低于对照组(均P＜0.05).结论 雷火灸对减轻阳虚证糖尿病肾病下肢水肿有较好疗效.

Objective To explore the application effect and nursing method of ECMO combined with me‐chanical ventilation in patient with critical renal disease .Methods Clinical data of four patients with critical renal disease and treated with ECMO combined with mechanical ventilation were analyzed retrospectively . Results Three patient had a smooth withdrawal of ventilator after treatment with ventilator ,and one pa‐tients gave up the treatment due to their economic reasons .Conclusion High‐quality and standardized nursing procedure play an essential role during the treatment of ECMO combined with mechanical ventila‐tion in patient with critical renal disease .

对1例肺、肾功能衰竭患者行组合式体外膜肺联合连续性血液净化治疗,结果患者病情得到控制并最终康复出院。提出多器官功能衰竭患者病情发展迅速,预后极差,在临床上除行体外膜肺联合连续性血液净化治疗的护理外,还应注意预防感染、出血等严重并发症,以积极改善预后,提高患者生活质量。

<正>百草枯(PQ)口服中毒吸收快,可导致肺、肾、肝、肾上腺、脑等器官出现损伤,中毒的特征性改变是肺损伤,可造成急性肺损伤或急性呼吸窘迫综合征,晚期则出现肺泡内和肺间质的纤维化,患者多死于多脏器功能衰竭或呼吸衰竭[1]。应用体外膜肺氧合(ECMO)抢救PQ中毒患者国内已有报道,但采