Objective:To explore the relationship between phase angle and poor prognosis in patients with maintenance hemodialysis (MHD) .Methods:From April 2020 to December 2021, 223 MHD patients in Beijing Friendship Hospital, Capital Medical University were selected as the research objects by the convenience sampling method. Phase angle was measured by bioresistance impedance body component analysis. MHD patients were divided into the normal phase angle group and the low phase angle group. General data, laboratory indicators, infection, cardiovascular and cerebrovascular disease (CVD) and death were compared between the two groups. Kaplan-Meier method and Log-Rank test were used to compare the prognosis differences between the two groups.Results:The body mass index, prealbumin, albumin and total cholesterol of patients in the low phase angle group were lower than those of the normal phase angle group, and the proportion of diabetic nephropathy patients was higher than that of the normal phase angle group, and the differences were statistically significant ( P<0.05). The incidence of infection, CVD and death in the low phase angle group were higher than those of the normal phase angle group, the survival time at the end point of poor prognostis events in the low phase angle group were shorter than those of the normal phase angle group, and the differences were statistically significant ( P<0.05) . Conclusions:Low phase angle is common in MHD patients. The nutritional status of low phase angle patients is worse, and the incidence of infection, CVD and death is higher, and the prognosis is worse.

Objective:To explore the effects of precise management based on human component analysis on blood pressure and nutrition status of elderly hemodialysis patients.Methods:From January 2021 to May 2021, a total of 144 patients undergoing regular hemodialysis in Beijing Friendship Hospital Affiliated to Capital Medical University were enrolled and divided into the control group and the observation group with 72 cases in each group by the random number table method. The control group received routine volume and nutrition management, and the observation group received accurate volume and nutrition management based on human composition analysis for 12 weeks. The differences of water load (OH) , nutrition-related indicators, mean blood pressure before machine operation and incidence of hypotension during the intervention were compared in the two groups.Results:After the intervention, the OH value of the observation group was lower than that of control group, the difference was statistically significant ( P<0.05) . During the intervention period, the average blood pressure of the observation group was lower than that of the control group, the difference was statistically significant ( P<0.05) . The total incidence of hypotension in the observation group and the control group were 13.27% (86/648) and 17.44% (113/648) respectively, the difference was statistically significant (χ 2=4.428, P=0.035) . After the intervention, albumin, muscle mass, body cell mass and lean body weight of the observation group increased, while blood phosphoru and improved Subjective Global Assessment (SGA) score decreased, and the differences were statistically significant ( P<0.05) . After the intervention, albumin, muscle mass, body cell mass and lean body weight of the observation group were higher than those of the control group, while blood phosphorus and improved SGA score were lower than those of the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Precise management of volume and nutrition based on human component analysis can effectively improve volume overload, blood pressure and nutrition status of elderly hemodialysis patients, and reduce the incidence of hyperphosphatemia and dialysis hypotension.

目的 探究正强化干预对急性心肌梗死(AMI)患者心理弹性量表(CD-RISC)评分和健康结局的影响.方法 采用电脑随机数字表法将2018年4月至2020年4月我院收治的144例AMI患者,按照1:1试验设计原则分为两组,各72例.对照组实施常规干预,观察组基于对照组实施正强化干预模式,连续干预1个月.统计两组遵医行为及干预前后CD-RISC、特质应对方式问卷(TCSQ)、社会支持评定量表(SSRS)、健康促进生活方式量表Ⅱ(HPLPⅡ).结果 观察组遵医率88.89％高于对照组73.61％(P<0.05);干预后观察组坚韧、力量、乐观评分高于对照组[(39.91±3.26)分比(34.55±3.12)分;(27.72±3.34)分比(23.34±3.15)分;(10.03±1.21)分比(7.45±1.06)分,均P<0.05];干预后观察组消极应对评分低于对照组[(21.16±4.49)分比(26.63±4.32)分],积极应对评分高于对照组[(33.41±4.04)分比(24.48±4.46)分,P<0.05];干预后观察组主观支持、对社会支持的利用度、客观支持评分高于对照组[(12.12±2.12)分比(10.61±2.17)分;(8.18±0.55)分比(7.55±0.58)分;(11.01±1.44)分比(10.20±1.13)分,均P<0.05];干预后观察组健康责任、营养、运动、自我实现评分高于对照组[(28.81±3.34)分比(24.46±3.18)分;(16.62±2.04)分比(14.48±1.87)分;(22.15±2.53)分比(18.84±3.24)分;(13.33±1.15)分比(12.01±1.26)分,均P<0.05].结论 AMI患者普遍存在心理弹性低下,消极、悲观应对现象,而正强化干预能增强患者心理弹性水平,转变应对方式,发挥主观能动性以积极态度配合治护工作.

Objective:To explore effects of hemoperfusion (HP) with different frequencies on the clearance of serum solutes in patients with maintenance hemodialysis (MHD) , and to provide a practical basis for the reasonable clinical application of HP.Methods:By the convenient sampling method, a total of 132 patients who underwent MHD in Blood Purification Center of Beijing Friendship Hospital Affiliated to Capital Medical University were selected as research objects from January to October 2019 and they were randomly divided into group A, group B, group C and group D. Group A received high-flux hemodialysis. On the basis of group A, HP was added to group B, group C and group D respectively for once every 2 weeks, once per week and twice per week. They were observed for 12 weeks. The serum solute indexes such as calcium, phosphorus, parathyroid hormone (PTH) , C-reactive protein (CRP) , β 2-microglobulin (β 2-MG) and malondialdehyde (MDA) and coagulation function were compared among the four groups. Results:In group D, 2 patients failed to complete the HP frequency of the prescribed plan in the 6th and 10th weeks respectively and were excluded, and the reasons were both gastrointestinal bleeding. Finally, a total of 31 patients in group D completed the study. All patients in group A, B and C were without bleeding and completed the study. After intervention, the indexes of phosphorus, PTH, CRP, β 2-MG and MDA in groups B, C and D were lower than those in group A, and the differences among the 4 groups were statistically significant ( P<0.05) . The calcium, phosphorus and CRP indexes of group B after intervention were lower than before intervention, and the differences were statistically significant ( P<0.05) . The indexes of calcium, phosphorus, CRP, PTH, β 2-MG and MDA after intervention in group C and group D were all lower than before intervention, and the differences were statistically significant ( P<0.05) . SNK- q test showed that except for group C and group D, there were statistically significant differences in blood calcium between the other two groups ( P<0.05) . There were statistically significant differences in blood phosphorus between group A and Group C and between group A and Group D ( P<0.05) . Among the 4 solutes including PTH, CRP, β 2-MG and MDA, there was no statistically significant difference between group A and group B, and between group C and group D ( P>0.05) , while other pair comparisons showed statistically significant differences ( P<0.05) . The prothrombin time in group C after intervention was higher than that before intervention, and the difference was statistically significant ( P<0.05) . The prothrombin time, partial thromboplastin time and fibrinogen after intervention in group D were all higher than those before intervention, and the differences were statistically significant ( P<0.05) . After intervention, the prothrombin time, partial thromboplastin time and fibrinogen in group D were higher than those in groups A, B, and C, and the differences were statistically significant ( P<0.05) . Conclusions:The combination of HP on the basis of high-flux hemodialysis is more conducive to clearing the serum solutes of medium and large molecules in patients, and better results can be achieved with the frequency of once a week. Excessive HP frequency may have the disadvantages of bleeding risk and high cost.

目的 分析2015-2019年北京佑安医院手足口病住院患者病原检测与临床指标间的关联.为提高手足口病不同病原感染的鉴别诊断和预后风险提供一定的科学依据.方法 采用描述性流行病学方法分析2015-2019年北京佑安医院手足口病住院患者的一般情况、临床表现、实验室病原检测及临床指标.结果 2015-2019年北京佑安医院因手足口病住院的患者共计353例,肠道病毒核酸检测阳性的253例(71.67％),分为3组:肠道病毒A组71型(enterovirus A71,EV-A71)阳性50例(19.76％),柯萨奇病毒A组16型(coxsackievirus A16,CV-A16)阳性14例(5.53％),其他肠道病毒阳性189例(74.70％).各组患者年龄均值从大到小依次为CV-A16组(3.88±6.35)岁,EV-A71组(2.84±1.94)岁和其他肠道病毒组(2.05±2.63)岁,3组间差异有统计学意义(x2 =16.755,P＜0.01).3组间重症构成比(EV-A71组84.00％,其他肠道病毒组50.79％,CV-A16组42.86％),差异有统计学意义(x2=18.975,P＜0.01).3组中手部皮疹发生率(EV-A71组92.00％,CV-A16组:71.43％,其他肠道病毒组:77.25％)、臀部皮疹发生率(EV-A71组:66.00％,CV-A16组:42.86％,其他肠道病毒组:40.21％)以及神经系统症状的发生率差异有统计学意义(x2=5.998,P=0.05;x2=10.646,P=0.005;x2=7.351,P=0.025).3组中C反应蛋白升高比例(EV-A71组:12.12％,CV-A16组:40.00％,其他肠道病毒组:70.23％),差异有统计学意义(x2=37,74,P＜0,01).结论 2015-2019年北京佑安医院手足口病住院患者的主要病原是其他肠道病毒.住院患者皮疹发生部位、神经系统症状、C反应蛋白等临床特征及指标在不同病原感染组间差异有统计学意义,提示其具有潜在临床诊断价值.

目的 研究CSVD影像学总负荷与急性脑梗死静脉溶栓远期预后的相关性.方法 回顾性连续收集我院2018年1月-2020年1月收治的发病4.5h之内经重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的急性脑梗死患者124例,收集患者的一般基线资料,发病48 h之内行头颅MRI检查,根据Staals等的评分标准,评估患者CSVD影像学总负荷评分为0～4分,通过电话随访评估患者90 d mRS评分,根据mRS评分将患者分为预后良好组(mRS:0～2分)和预后不良组(mRS:3 ～5分),比较2组患者的一般资料及影像学CSVD评分有无差异.结果 124例脑梗死静脉溶栓患者远期预后基线资料的单因素分析发现预后良好患者82例(66％),预后不良患者42例(34％),静脉溶栓早期有出血转化患者10例,其中HI-1型8例,PH-1型2例,2组出血转化差异无统计学意义(P＞0.05),无死亡患者.2组患者基线资料比较显示溶栓前NIHSS评分、溶栓前舒张压水平、高密度脂蛋白胆固醇水平、既往房颤病史、既往心衰病史、既往脑梗死病史、TOSTA分型、CSVD影像总负荷两组间差异有统计学意义(P＜0.05).其余资料比较两组间差异无统计学意义(P＞ 0.05).多因素Logistic回归分析结果显示溶栓前NIHSS评分(OR=1.241,95％CI 1.125～1.370,P＜0.001)、高CSVD总评分(OR=2.393,95％CI1.493～3.873,P＜0.001)是影响脑梗死静脉溶栓预后的独立危险因素;CSVD不同影像表现中WMH中重度(OR =2.560,95％ CI1.158 ～5.662,P＜0.020)和腔隙性脑梗死(OR=5.030,95％CI 1.579～16.044,P＜0.006)是预后的独立危险因素.结论 急性脑梗死静脉溶栓患者CSVD影像总负荷评分较高者与90 d不良预后相关,影像学表现为腔隙性脑梗死及中重度的WMH是不良预后的独立危险因素.

新型口服抗凝药又称直接口服抗凝药,与传统口服抗凝药华法林相比,起效快,半衰期短,与食物、药物相互作用小,无需频繁监测凝血指标.对于心房颤动相关卒中的预防,新型口服抗凝药抗凝效果不劣于华法林,出血(尤其是颅内出血)风险低,安全性更高,成为目前抗凝领域研究的热点.在隐源性卒中、颈部动脉夹层、脑静脉系统血栓形成、进展性卒中和高危非致残性卒中等脑血管病的治疗过程中,尽管支持应用抗凝的证据强弱不等,但是鉴于新型口服抗凝药拥有更高的安全性,相关探索性研究不断出现.该文对近年来新型口服抗凝药在脑血管病领域中应用的相关研究展开阐述,探讨其未来的研究热点和方向.

目的 探讨脑卒中病人主要照顾者照顾负荷水平对创伤后成长水平的影响.方法 采用便利抽样法,抽取2014年12月至2016年12月首都医科大学附属北京友谊医院收治脑卒中病人的主要照顾者170名作为研究对象,收集其一般资料,采用Zarit负荷量表(ZBI)和创伤后成长评定量表(PTGI)评价照顾负荷和创伤后成长水平.以Pearson相关性分析主要照顾者创伤后成长与负荷水平的相关性.并多元线性回归分析脑卒中病人主要照顾者创伤后成长的影响因素.结果 ZBI总分为(43.87±6.12)分,个人负担和责任负担两个维度得分为(27.76±4.30)分和(16.38±4.26)分,PTGI总分为(61.08±9.66)分,5个维度条目平均分最高的为新的可能性(3.40±0.73)分;Pearson相关分析显示,主要照顾者照顾负荷总分及2个维度评分与创伤后成长水平总分及新的可能性、个人力量及欣赏人生3个维度评分呈正相关(P<0.05);不同性别、年龄、文化程度、家庭人均月收入、与病人关系、医保报销比例及照顾时长的主要照顾者创伤后成长水平比较,差异有统计学意义(P<0.05);多元线性回归分析显示,年龄、文化程度、照顾时长,及照顾负担、个人负担是脑卒中病人主要照顾者创伤后成长水平的影响因素(P<0.05).结论 脑卒中病人主要照顾者创伤后成长水平与照顾负荷存在明显的相关性,同时创伤后成长水平会受负荷水平、年龄、文化程度和照顾时长所影响.

肾意义单克隆免疫球蛋白血症(MGRS)是IKMG(国际肾病和单克隆免疫球蛋白病研究组)在2012年定义的一组单克隆免疫球蛋白相关肾损害的疾病,其克隆来源于低度增殖的B细胞或浆细胞克隆.研究发现其进展为多发性骨髓瘤(MM)的风险高于MGUS,经过针对其相应克隆化疗后肾功能可得到改善.MGRS不同于意义未明的单克隆免疫球蛋白血症(MGUS),也不符合淋巴瘤或MM的诊断标准.2019年IKMG发表了关于MGRS的诊断共识,提出对小于50岁存在M蛋白血症和无法解释肾脏疾病的患者,建议进行肾活检,以明确MGRS的诊断.关于MGRS的治疗决策应遵循包括血液学家、肾病学家和病理学家参与的多学科合作模式来制定,通常采用可以清除引起肾损害的单克隆Ig的B细胞或浆细胞克隆的靶向药物基础的化疗,符合条件的患者造血干细胞移植治疗值得尝试.

目的 通过现场督查,发现医院脑卒中诊疗质量存在问题,提出改进意见.方法 回顾性分析2015年-2017年北京市脑卒中诊疗质量现场督查结果.结果 通过督查发现,各医院优秀率逐年上升,尤其连续3年参加督查的30家医院优秀率从2015年的36.7％上升到2017年的66.7％ (P＜0.05).建立脑卒中诊疗规范制度和应急预案的医院合格率逐年增加,合格率超过80％.开展脑卒中质量控制与改进的医院合格率逐年增加.但建立急诊卒中诊疗平台、脑卒中单元及诊疗团队的医院合格率低于70％;到院-给药时间＜60min的医院合格率均较低.结论 通过现场督查与指导,逐步规范了脑卒中诊疗质控体系,促进了脑卒中质控管理持续改进,但仍存在卒中救治团队建立不完善、DNT合格率较低等问题,需要持续改进.

目的 探索脑微出血(CMB)及其分布与肾功能异常的相关性.方法 回顾性收集2015年6月～2017年3月陆军总医院神经内科收治的、符合纳入标准的缺血性脑卒中患者583例,依据影像学资料分为CMB组154例及非CMB组429例,又依据CMB发生部位分为脑叶CMB 42例、深部CMB 73例及混合CMB 39例,对各组临床资料进行单因素及多因素回归分析.结果 CMB组年龄、肌酐、尿素水平较非CMB组更高;肾小球滤过率、HDL水平较非CMB组低(P＜0.05,P＜0.01).多因素logistic回归分析显示,年龄、男性、肾小球滤过率降低为CMB发生的危险因素(P＜0.05,P＜0.01);年龄是脑叶CMB发生的危险因素(B=0.152,P=0.019);男性是混合CMB发生的危险因素(B=1.216,P=0.017);高血压是深部CMB发生的危险因素(B=1.128,P=0.037);肾小球滤过率降低是深部CMB及混合CMB发生的危险因素(B=4.123,P=0.001;B=3.361,P=0.001),是脑叶CMB发生的保护性因素(B=-0.647,P=0.001).结论 肾小球滤过率降低是CMB发生的危险因素,尤其是深部CMB及混合CMB,监测肾功能相关指标,有助于CMB的监测和预防.

Objective To explore the application effects of nursing centered mobile APP service platform in the rehabilitation of cognitive dysfunction patients after cerebral stroke, so as to provide a theoretical basis for its clinical promotion. Methods A total of 204 patients with cognitive impairment after cerebral stroke in Beijing Friendship Hospital Affiliated to the Capital Medical University from December 2012 to December 2014 were selected by convenience sampling method, and randomly divided into control group and observation group, with 102 cases in each. The control group was treated with conventional oral medication and routine rehabilitation training. On the basis of the treatment of the control group, nursing centered mobile APP service platform was applied in the observation group. The Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) were used to evaluated the patients' outcome of rehabilitation and daily living activity at the time points of before treatment, discharge, the 3rd month and 12th month after the intervention. Results The interaction differences of the main effect of time, the main effect of intervention, intervention and time among the score of MMSE, MoCA and modified Barthel index were statistically significant (P<0.05). Conclusions The nursing centered APP mobile service platform can improve the patients' cognitive function after stroke and the ability of daily activities, with a certain degree of clinical promotion value.

目的探讨不同超滤量对老年血液透析患者血压及心功能的影响并采取针对性的护理措施。方法分别监测2013年6月至2014年6月在本院接受维持性血液透析的老年患者透析前、透析1、2、3、4 h时的血压及心率,计算平均心率。对左心室与左心房舒张末期内径、射血分数(EF)、室内隔与左心室后壁厚度进行测量,根据超滤量的不同,76例老年血液透析患者分为三组:A组、B组、C组,A组:超滤量<2 L/次,26例;B组:2 L/次<超滤量<4 L/次,31例;C组:超滤量>4L/次,19例。结果 A组在透析过程中,血压波动不明显,B、C组患者在血液透析2 h、3 h、4 h血压下降明显,与透析前血压比较,差异有统计学意义(P<0.01),C组患者心律失常、心肌缺血、低血压的发生率及平均心率最高,与其他两组比较差异有统计学意义(P<0.01)。B、C组较A组心室壁增厚,射血分数较低,心腔扩大(P<0.05)。结论超滤量越大,对老年血液透析患者血压及心功能的影响也就越大,容易导致低血压与心功能不全,及时且有针对性的护理措施对恢复患者血压及心功能正常具有重要的意义。