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.

Objective:To observe clinical effect of thunder-fire moxibustion with meridian point, including lumbar spinal cordacupoints of bladder meridian and abdominal acupoints of Ren channel, which treating on deficiency of kidney and spleen and blood stasis in chronic kidney diseases (CKD) stage 3.Methods:Totally 60 patients were randomly divided into treatment and control group. 30 patients in control were treated with blood pressure and lipid adjustment, Chinese medicine and nutritional therapy. 30 patients in treatment group were treated with thunder-fire moxibustion with meridian point based on control. A moxibustion-treated course has 2 weeks, patients were treated every other day. Observe blood urea nitrogen (Bun) , creatinine (Scr) , glomerular filtration rate (eGFR) , Chinese medicine syndrome and quantitative score, as well as clinical efficacy.Results:After 4 weeks of intervention, the TCM syndrome score [8 (4,10)] in the treatment group was significantly lower than that in the control group [12 (10,14)], with a statistically significant difference ( Z=-3.706, P = 0.000); in the quantitative score of symptom classification, the patients in the treatment group were significantly lower than those in the control group [2 (0,2)], chills [2 (2,2)], fatigue [2 (2,4)], the difference was statistically significant ( Z=-2.625, -3.593, -4.609, P < 0.01). The frequency of nocturia in the treatment group was significantly higher than that in the control group ( Z=-1.989, P < 0.05), while that in the treatment group was not significantly better than that in the control group ( P > 0.05). In terms of clinical efficacy, the total effective rate of the treatment group was 93.3% (28/30), which was better than73.3% (22/30) of the control group ( χ2= 38.19, P = 0.000). Conclusion:Thunder-fire moxibustion with meridian point improve deficiency of kidney and spleen and blood stasis of patients in CKD stage3, such as weak waist, cold chills, poor appetite, weakness and nocturia, as well as ameliorate renal function.

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:观察电子灸对肾内科使用糖皮质激素治疗患者感冒的预防效果,为此类易患感冒人群提供一种特色的预防方法.方法:60例肾内科使用糖皮质激素治疗患者随机分成治疗组和对照组,对照组采用常规护理,治疗组在此基础上使用电子灸,取穴双侧足三里、双侧肺俞、关元,观察两组患者住院期间及出院后一个月内感冒的发生率;两组患者在治疗前后的血清免疫球蛋白水平.结果:治疗组患者感冒的发生率明显低于对照组,差异有统计学意义(P<0.05);治疗组内比较电子灸后血清IgA、IgG和IgM较电子灸前有明显提高,对照组内血清IgA、IgG和IgM无明显差异,两组患者在采取护理后组间比较有显著性差异(P<0.01).结论:电子灸在防治肾内科使用糖皮质激素患者感冒中有较好的疗效.

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.

目的探讨青敷膏外敷治疗脂肪乳剂渗漏性损伤的疗效。方法按随机原则将40例患者分为对照组和观察组各20例,对照组用50%硫酸镁湿敷脂肪乳剂渗漏处,观察组用青敷膏外敷。结果青敷膏治疗组在渗漏发生后48h内100%痊愈,而硫酸镁治疗组在渗漏发生后48h仍有7例没有痊愈;青敷膏外敷组治疗脂肪乳剂渗漏性损伤痊愈的时间明显短于硫酸镁湿敷组(P<0.05):青敷膏外敷组痊愈的时间为15.500±7.756h、中位时间为12.000±1.491h,硫酸镁湿敷组痊愈的时间为34.800±20.565h、中位时间为26.000±1.112h。结论青敷膏外敷治疗脂肪乳剂渗漏性损伤效果显著,可减轻患者痛苦、减少护患纠纷发生。