广西博白县维持性血液透析患者状况调查及分析

目的探讨广西博白县维持性血液透析患者的生活质量状况。方法选择2007年2月～2011年3月在我院接受维持性血液透析的患者120例作为观察组,同时选择在我院体检的健康者50例作为对照组,两组患者均进行生活质量评价。结果观察组的躯体化、强迫症状、人际关系、忧郁和焦虑评分均明显高于对照组（P〈0．05）,表明其生活状况更差。结论广西博白县维持性血液透析患者生活质量状况较差,心理障碍大,需要加强合理的对症支持与心理治疗。     

维持性血液透析患者睡眠质量的影响因素及与氧化应激水平、生活质量和疲乏状况的关系研究

摘要 目的：分析调查维持性血液透析（MHD）患者睡眠质量的影响因素,并分析其与生活质量、氧化应激水平和疲乏状况的关系。方法：研究对象选取自2019年8月~2021年5月在首都医科大学附属北京朝阳医院血液透析室长期规律行MHD治疗的终末期肾脏病患者150例,收集患者的临床资料,采用匹兹堡睡眠指数（PSQI）量表评定睡眠质量。采用修订版Pieper疲劳量表（RPFS）评估所有患者的疲乏程度。采用肾脏病生活质量量表（KDQOL-SF）评估患者生活质量。分析MHD患者睡眠质量的影响因素,并分析其与氧化应激水平、生活质量和疲乏状况的关系。结果：150例MHD患者中有114例PSQI评分>5分,本血液透析室MHD患者睡眠障碍发生率为76.00% (114/150)。根据是否发生睡眠障碍将患者分为睡眠障碍组（n=114）和无睡眠障碍组（n=36）。单因素分析结果显示睡眠障碍组、无睡眠障碍在年龄、透析时间、血红蛋白（Hb）、血清甲状旁腺激素（iPTH）、透析治疗效率标准（Kt/V）、血钙方面组间对比有差异（P<0.05）。透析时间、年龄、Hb、iPTH、Kt/V均是MHD患者睡眠质量的影响因素（P<0.05）。睡眠障碍组的一般健康状况、肾病相关、总分均低于无睡眠障碍组（P<0.05）。睡眠障碍组的疲乏评分高于无睡眠障碍组（P<0.05）。睡眠障碍组的丙二醛（MDA）高于无睡眠障碍组,超氧物歧化酶（SOD）、人谷胱甘肽-过氧化物酶（GSH-Px）低于无睡眠障碍组（P<0.05）。结论：透析时间、年龄、Hb、iPTH、Kt/V均是MHD患者睡眠质量的影响因素,且睡眠质量变差会加重MHD患者疲乏程度,加重氧化应激反应,降低患者的生活质量。     

阶段变化护理干预对慢性肾功能衰竭血液透析患者生活质量的影响

目的：探究阶段变化护理干预对慢性肾功能衰竭血液透析患者生活质量的影响。方法：选取2010年8月至2012年8月我院收治因慢性肾功能衰竭行血液透析的患者72例,采用随机的方法将其分为对照组和观察组,每组36例。对照组患者采取常规护理,观察组在对照组基础上采用阶段变化护理干预,观察比较两组患者的护理效果。结果：两组患者经护理后生活质量均有显著提高,对照组患者的总体生活质量为11.41±1.87,观察组患者的总体生活质量为12.47±2.33。观察组患者的总体生活质量明显高与对照组,存在显著差异,具有统计学意义（P〈0.05）。结论：采取阶段变化护理干预,可以大大提高慢性肾功能衰竭血液透析患者的生活质量,促进患者病情的改善,值得临床借鉴使用。     

营养支持小组对临床维持性血液透析患者营养状况的影响

目的：研究营养支持小组对临床维持性血液透析患者一般营养状况的影响及应用价值。方法：选择武汉大学中南医院收治的进行维持性血液透析患者共180例纳入研究,随机分为观察组和对照组,对照组患者给予常规营养支持,观察组在此基础上由专业的营养支持小组为患者提供专业化营养支持;分析两组患者的营养状况。结果：两组干预前相关指标无统计学差异,干预后观察组患者营养指标明显优于干预前和对照组干预后,差异显著（P＜0.05）。SGA评价结果显示观察组营养状况良好者比例明显高于对照组,差异有统计学意义（P＜0.05）。结论：临床应用专业的营养支持为维持性血液透析患者提供营养支持,可改善患者营养不良情况,促进患者营养全面提升,具有积极临床意义。     

心理干预对维持性血透患者生活质量及肝肾功能的影响

目的:探讨心理干预对维持性血透患者生活质量及肝肾功能的影响。方法:选择2012年3月到2014年3月在我院进行血液透析患者80例,随机分为常规组和干预组各40例,常规组进行常规干预,干预组在常规干预的基础上给予心理干预;采用全自动生化仪对血清尿素氮(BUN)、血清白蛋白(ALB)、血清肌酐(Scr)、血β2微球蛋白(β2-MG)及血红蛋白(Hb)水平对进行检测,并对生活质量问卷MOSSF-36(SF-36)量表进行测评。对比两组干预前后生活质量评分和肝肾功能改善情况。结果:干预后干预组生理健康、心理健康及SF-36总分明显高于干预前,差异有统计学意义(P0.05),而对照组无显著性变化(P0.05);干预后两组BUN、Scr、β2-MG水平均有降低,其中干预组降低更明显,差异均有统计学意义(P0.05);而两组ALB和Hb水平均有升上,其中干预组上升更明显,差异均有统计学意义(P0.05)。结论:心理干预能明显提高维持性血透患者的生活质量,有效调节肝肾功能。     

维持性血液透析患者营养状况的探讨与治疗

由于血液透析技术的广泛开展,慢性肾脏病(chronic kidney disease;CKD)血液透析患者的生活质量得到了明显改善,而血液透析患者的营养不良却仍然是临床医生棘手的问题,并越来越引起人们的重视,它可直接影响血透病人的临床症状、体征、并发症以及存活率等一系列问题.维持性血液透析(Maintenance hemodialysis;MHD)病人发生营养不良时,一般均可出现免疫功能降低,贫血加重,容易感染,心、脑、肺等脏器功能减退,易发生各种严重并发症,导致病人的生活质量下降,长期生存率降低,死亡率增高.营养不良不但影响维持性血液透析患者的生存期和生活质量,同时亦是并发症和死亡率增加的一个重要原因之一,探讨其原因,维持性血液透析病人营养不良的发生,既有血液透析本身的原因,也有血液透析以外的原因,本文从不同角度探讨了MHD患者营养不良的原因、影响因素以及临床上在维持性血液透析(MHD)患者营养不良方面采取的治疗对策.     

透析中卧式脚踏运动辅助血液净化治疗维持性血液透析患者的效果分析

目的：评价透析中卧式脚踏运动辅助血液净化治疗维持性血液透析（MHD）患者的效果。方法：选入2021年12月～2023年6月在我院接受MHD治疗的患者60例,随机分为对照组30例和观察组30例。所有研究对象均接受常规治疗,观察组在此基础上给予透析中卧式脚踏运动治疗。评价两组的生化指标、血压、生活质量等,并进行统计比较。结果：治疗前,两组各生化指标、血压指标、SF-36量表各维度评分以及SDS得分之间无显著性差异（P>0.05）。治疗12周后,观察组Hb、ALB和血Ca明显高于对照组,血P、TC、TG和i PTH显著低于对照组（P<0.05）,透析前DBP、透析前SBP、DBPmax、SBPmax、DBP极差和SBP极差亦明显低于对照组（P<0.05）;观察组PF、PR、RE、VT和GH评分明显高于对照组（P<0.05）,SDS评分显著低于对照组（P<0.05）。结论：透析中卧式脚踏运动能够改善MHD患者的营养状态,促进钙磷及血脂代谢,维持血压稳定,缓解抑郁情绪,提高生活质量。     

综合干预对原发性骨质疏松治疗依从性及生活质量的影响

目的:探讨骨质疏松防治综合干预对特需门诊原发性骨质疏松(POP)患者治疗依从性及生活质量的影响。方法:以2010年5月~2013年5月期间四川大学华西医院国际医疗中心收治的112例POP患者为研究对象,分为干预组和对照组,在药物治疗的同时给予不同的护理措施,6个月后比较两组干预前后POP知识掌握程度(OKT评分)、疼痛(VAS评分)、骨密度(BMD)以及生活质量(OQOLS评分)改善情况;随访1年后评价两组治疗依从性以及骨折发生率。结果:经过6个月的干预,干预组OKT评分、VAS评分以及BMD和治疗前比较差异均有统计学意义(P0.001),和对照组比较差异也均有统计学意义(P0.001)。干预组OQOLS评分的5个维度以及生活质量总评分和干预前比较差异均有统计学意义(P0.001),和对照组比较差异也均有统计学意义(P0.001),对照组心理维度和社会维度和干预前比较差异不大(P0.05)。两组随访1年,干预组完全依存比例明显高于对照组,不依从比例低于对照组(P0.001);干预组病理性骨折发生率低于对照组(P0.05)。结论:对特需门诊收治的原发性骨质疏松患者在药物治疗的基础上实施综合护理干预,能够明显提高患者的治疗依从性,提高骨密度增加比例,减少疼痛,降低骨折发生率,改善患者生活质量。     

益生菌对维持性血液透析慢性肾脏病患者肠道菌群失调的影响

目的 探究益生菌对维持性血液透析慢性肾脏病患者肠道菌群失调的影响,为此类患者的治疗提供参考。 方法 选取2017年4月到2019年4月我院收治的78例维持性血液透析慢性肾病患者,按照随机数字法分为观察组和对照组各39例。对照组患者给予常规治疗,观察组患者给予常规治疗联合益生菌。检测两组患者肠道菌群变化,同时检测血清炎性因子(IL6、TNFα、CRP)、肠道屏障功能(D乳酸、内毒素)及肾功能指标[肌酐(serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)]水平。 结果 治疗后两组患者Scr、BUN水平均下降(均P0.05)。治疗后两组患者肠道双歧杆菌、乳杆菌数量均增加,大肠埃希菌、肠球菌数量均下降,且观察组患者改善情况优于对照组,差异有统计学意义(t=4.226、9.634、6.157、2.739,P结论 益生菌对维持性血液透析慢性肾脏病患者肠道菌群失衡、肠道屏障功能和微炎症状态均具有改善作用,可为该类患者临床治疗提供一定参考。     

血液透析滤过治疗维持性血液透析患者顽固性高血压的临床观察

目的分析血液透析滤过治疗维持性血液透析患者顽固性高血压的临床效果。方法选取2015年1月~2017年2月我院收治的维持性血液透析顽固性高血压患者46例,随机分为对照组与研究组,每组23例。对照组行常规血液透析治疗,研究组采用血液透析滤过方式,观察比较两组患者治疗前后的血压、血浆RA水平及AngII水平变化情况。结果治疗后,研究组的收缩压与舒张压均明显低于对照组(P0.05),血浆RA、AngII水平亦明显低于对照组(P0.05)。结论血液透析滤过治疗维持性血液透析患者顽固性高血压的效果显著,值得临床推广应用。     

Reporting distress and quality of life of patients with diabetes mellitus in primary and secondary care in Greece

Background and aim This study constitutes an initial attempt at elucidating the relationship between quality of life (QoL), health status and psychological distress in patients with diabetes mellitus (DM) in Greece, by comparing patients with DM registered at a rural primary healthcare centre (PHCC) and those attending a diabetes outpatient clinic (DOC) at an urban hospital.Methods Cross-sectional study. Participants were consecutive, consenting patients with a known history of type 2DM(T2 DM), currently registered at either of the two centres. All patients were administered the Short Form-36 version 2 (SF-36 v2) and the Problem Areas In Diabetes (PAID) questionnaire, and information in relation to socio-demographic data and clinical characteristics were also obtained.Results Patients with DM had a lower QoL over all domains when compared with general population normative data. In addition, mean scores for the SF-36 v2 Physical Component Summary (PCS) and Mental Component Summary (MCS) and six subscales of the SF-36 v2 demonstrated significant differences between the two participating centres (P < 0.0001). The mean PAID score was 19.18 (±15.58) for patients from the PHCC, versus 40.19 (±17.36) for the DOC (P < 0.0001). Lower scores on the MCS of the SF-36 v2, and higher scores on PAID in patients with T2 DM were related to major co-morbidities, insulin use and duration of DM.Conclusions Patients with T2 DM from the urban DOC had significantly higher levels of distress and consequently lower levels of QoL compared with patients from the rural PHCC. The findings from this study may have important implications with regard to the individualisation of patient care in Greece, and encouragement of patient participation in the treatment process.     

Health-related quality of life in the patients on maintenance hemodialysis: the analysis of demographic and clinical factors

Health-related quality of life (HRQoL) among hemodialysis (HD) patients recently became a nephrologist's focus of interest. HRQoL is an important predictor of outcome in HD patients and need to be regularly assessed. The aim of the present study was to compare the HRQoL of chronic HD patients with general population and to analyze influencing sociodemographic and clinical factors. We included 255 prevalent HD patients from four dialysis centers. HRQoL was measured with The Medical Outcomes Study Short Form 36 Health Survey Questionnaire (SF-36). This data were compared with control group (N = 132) from the general Croatian population. Comparisons of SF-36 scale scores of HD patients regarding demographic and clinical factors (age, gender, education level, dialysis vintage and diabetes) were also performed and analyzed with a multivariate regression analysis. HRQoL in prevalent HD patients was relatively low (mean Physical Component Summary, PCS = 33.7, mean Mental Component Summary, MCS = 43.0) and was lower compared to the control group from the general population in all HRQoL domains, PCS and MCS scores. Almost 53% of the HD patients had the critical score PCS < 43 + MCS < 51 as the predictor of death and hospitalization. Better HRQoL was revealed in the patients < 65 years old, males, patients with higher educational level and in the patients on maintenance HD less than one year. Age was the only statistically significant predictor of PCS and MCS. Developments of HD technology, treatment of comorbidities, continuous patients' education, social and psychological support and use of other renal replacement modalities, especially kidney transplantation, may improve the HRQoL in these patients.     

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark

doi: 10.1111/j.1741‐2358.2011.00486.x
A cross‐sectional study of oral health and oral health‐related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral‐health‐related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health‐care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross‐sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health‐care programme. Clinical data and data from interviews comprising social factors, life‐style, dental visit habits, oral hygiene practices and self‐perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results: Sixty‐eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1–9 teeth and tooth mobility. Conclusion: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.     

The effect of aortic valve replacement on quality of life in symptomatic patients with severe aortic stenosis

Background

Although symptomatic patients with severe aortic stenosis have a high disease burden and guidelines recommend aortic valve replacement, many are treated conservatively. This study describes to what extent quality of life is changed by aortic valve replacement relative to conservative treatment.

Methods

This observational study followed 132 symptomatic patients with severe aortic stenosis who were subjected to an SF-36v2TM Health Survey.

Results

At baseline 84 patients were treated conservatively, 48 were referred for aortic valve replacement. In the conservatively treated group 15 patients died during a mean follow-up of 18 months (Kaplan-Meier survival was 85 % and 72 % at one and 2 years respectively) and 22 patients crossed over to the surgical group. Of the resulting 70 patients in the surgical group 3 patients died during a mean follow-up of 11 months (survival 95 % at 1 year). Physical functioning, vitality and general health improved significantly 1 year after aortic valve replacement. In conservatively treated patients physical quality of life deteriorated over time while general health, vitality and social functioning showed a declining trend. Mental health remained stable in both groups.

Conclusions

Aortic valve replacement improves physical quality of life, general health and vitality in patients with symptomatic severe aortic stenosis. Besides having a low life expectancy, conservatively treated patients experience deterioration of physical quality of life. Health surveys such as the SF-36v2TM can be valuable tools in monitoring the burden of disease for an individual patient and offer additional help in treatment decisions.     

Investigation of factor affecting health‐related quality of life in head and neck cancer patients

doi: 10.1111/j.1741‐2358.2012.00662.x Investigation of factor affecting health‐related quality of life in head and neck cancer patients Objectives: Head and neck cancer (HNC) patients have profound illness of physical, social and psychological factors that affects quality of life (QOL). The purpose of this study is to investigate the factors affecting HRQL in patients with intra‐oral prostheses. Background: Some cross‐sectional studies have been performed to investigate HRQL in patients with HNC, but these studies did not report in detail how factors affect the HRQL of maxillectomy and mandibulectomy and/or glossectomy patients. Materials and Methods: The University of Washington Quality of Life version 4 questionnaires (Japanese version) was administered to 50 maxillectomy and 50 mandibulectomy and/or glossectomy patients with intra‐oral prostheses who were selected according to inclusion and exclusion criteria. Gathered data were statistically analyzed to investigate how a number of factors, namely, age, sex, pathologic diagnosis, neck dissection, resection size, radiotherapy and dental condition affect HRQL. Results: In the maxillectomy patients, there were no significant differences between malignant and benign tumor in pathological diagnosis or between dentate and edentulous in dental condition. Age, sex, neck dissection and radiotherapy affected HRQL. In the mandibulectomy and/or glossectomy patients, there was no significant difference between dentate and edentulous in dental condition. Age, sex, glossectomy, neck dissection and radiotherapy affected HRQL. Conclusions: The factors affecting HRQL in the maxillectomy patients were different from those in the mandibulectomy and/or glossectomy patients. Though they wore stable prostheses; we were still able to show that resection size, radiotherapy and neck dissection affected HRQL.     

Impairment of sleep quality and quality of life in bimodal chronotype individuals

There is still insufficient data about the characteristics and clinical significance of the bimodal chronotype. We evaluated more than 1000 students with Morningness-Eveningness Questionnaire, Munich Chronotype Questionnaire (MCTQ), Pittsburgh Sleep Quality Index and 36-item Short Form Health Survey. Twelve percent of the sample was bimodal and they showed similar results to intermediate chronotype in MCTQ-chronotype and social jetlag, both different from morning and evening chronotypes. However, their quality of life and sleep quality were similar to evening types, both different from morning and intermediate types. We discuss if being bimodal would be a maladaptive aspect of circadian preference     

The relationship between chronotype,sleep disturbance,severity of fibromyalgia,and quality of life in patients with fibromyalgia

ABSTRACT

Patients with fibromyalgia (FM) report high levels of sleep disturbance and chronic diffuse musculoskeletal pain. These patients experience diminished quality of life (QoL) due to pain and other comorbidities. Chronotype preferences have been suggested as a potential factor connecting increased severity of FM, sleep disturbances, and poor overall QoL. The present study is the first study examining the possible association between chronotype preferences, sleep disturbance, severity of FM, and QoL in patients with FM.

One hundred drug-free patients diagnosed with FM participated in this cross-sectional study. Of them, 79 (79%) were females and 21 (21%) were males. The mean age was 41.65 ± 9.17 years (range: 21–62 years). The severity of FM symptoms, chronotype preferences, and QoL was evaluated using the Fibromyalgia Impact Questionnaire (FIQ), Morningness-Eveningness Questionnaire (MEQ), and World Health Organization Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). The participants’ anxiety/depressive symptoms and sleep problems were assessed using the Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI).

The participants were classified according to their MEQ scores as evening type (score: 16–41), neither type (score: 42–58), and morning type (score: 59–86). It was found that there were significant differences in the FIQ score between the three groups (p < .001). It was determined that the total PSQI score was significantly higher in the evening type than the other two types (p < .05). It was found that there were significant differences in the general health, physical health, psychological, and environmental domain scores of the WHOQOL-BREF between the three groups (p < .05). It was detected that there were significant correlations between MEQ scores, WHOQOL-BREF subscale scores, FIQ scores, HADS-A and HADS-D scores, and PSQI scores. According to hierarchical regression analysis, eveningness preference explained an additional 21.9% of the variation in FM severity, thereby causing a statistically significant change in R-squared.

Our results indicated that eveningness preference was directly related to increased FM symptom severity and poorer QoL. Based on these findings, neglecting to take chronotype preference into account may not result in optimal response to standard treatment for some patients with FM.