鼻内窥镜下泪囊鼻腔造孔术在慢性泪囊炎中的临床疗效及对生活存质量的影响研究

目的:研究与观察鼻内窥镜下泪囊鼻腔造孔术在慢性泪囊炎中的临床疗效及对生活存质量的影响。方法:选取2017年1月-2018年2月期间的90例慢性泪囊炎患者为研究对象,根据随机数字表法分为对照组和观察组,每组各45例。对照组进行泪囊鼻腔吻合术治疗,观察组则进行鼻内窥镜下泪囊鼻腔造孔术。比较两组的临床总有效率、治疗前后的溢泪程度、泪膜破裂时间、泪液分泌实验Ⅰ、疼痛评分及生活质量评分。结果:观察组治疗后1、3个月的临床总有效率显著高于对照组,差异有统计学意义(P<0.05),治疗前两组的溢泪程度、泪膜破裂时间、泪液分泌实验Ⅰ、疼痛评分及生活质量评分比较,差异无统计学意义(P>0.05),治疗后观察组的上述检测与评估方面均优于对照组,差异有统计学意义(P<0.05)。结论:鼻内窥镜下泪囊鼻腔造孔术在慢性泪囊炎中的临床疗效较好,且对患者的生活存质量具有积极的改善作用,因此在慢性泪囊炎患者中具有更高的应用价值。

卧床脑卒中患者便秘的影响因素及护理对策新进展

脑卒中属于临床常见病症,近年来,其发生率有升高倾向,对国民机体健康产生不良影响。脑卒中患者往往病情危急,多需长期卧床,进而因各种因素引发常年便秘,对患者生存质量造成严重影响。脑卒中患者便秘过程中因用力致使腹内压、颅内压升高,从而导致脑血管发生破裂,使得病情进一步加重。便秘不但可以加重脑卒中患者的神经损害,同时还使其活动能力显著降低。因此,对于卧床脑卒中患者的便秘问题,需予以一定重视,分析其影响因素,并提出有效的护理对策,以为临床护理此类患者提供凭据,使更多卧床脑卒中患者受益,尽早回到正常生活状态。本文就卧床脑卒中患者便秘的影响因素与护理对策新进展进行概述,详情报告如下。

Comparison of growth and survival of larvae among different shell color stocks of bay scallop Argopecten irradians irradians(Lamarck 1819)

In order to improve production and breed new broods of bay scallop Argopecten irradians irradians, different-colored orange, purple and white lines were established by two mating methods of self-fertilization and mass spawning at a commercial scallop hatchery in spring, 2002. And then larval growth and survival of different lines was compared to test whether there is a relationship between shell color and growth and survival at early developmental stage. Both growth and survival have no significant differences among different experimental larvae of self-fertilization or mass spawning. Results are as following in the order of orange, purple and white shell stock. For the self-fertilization, growth rates of larvae were 6.174, 6.412, and 6.599 μm/d, respectively. Survival rates of larvae at Day 3 were 74.41%, 76.86%, and 82.05%; Day 6 were 49.14%, 65.63%, and 52.79%; and Day 9 were 25.06%, 20.80%, and 26.47%, respectively. For the mass spawning, the growth rates were 7.836, 7.941, and 7.878 μm/d, respectively. Survival rates at Day 3 were 93.05%, 91.95%, and 92.50%; Day 6 were 79.17%, 78.05%, and 82.50%; and Day 9 were 34.72%, 36.67%, and 38.33%, respectively. The absence of any relationship between shell color and growth and survival at the larval stage may be resulted from their common genetic basis.

Surgical palliation of unresectable pancreatic head cancer in elderly patients

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and themedian overall survival were also signifi cantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

Quality of life in head and neck cancer survivors： A concept analysis

Objective： To identify and clarify the existing definitions of quality of life in head and neck cancer survivors. Thisconcept analysis will inform healthcare professionals of promoting nursing care for head and neck cancer survivors andeventually improve their quality of life. Method： Concept analysis based on Walker and Avant’s framework. Results：Quality of life is a subjective and personally derived cognitive evaluation of global well-being by perceiving a feeling ofoverall life satisfaction in his/her own value, happiness, and the independence to manage daily activities and lifeexperience. Three defining attributes for quality of life were identified： a feeling of overall life satisfaction in his/hervalue, global personal well-being, and independence. An improvement of quality of life means an improvement ofclinical outcome. However, the variety of instruments for measuring life quality makes it difficult for healthcareprofessionals to select a standard one for head and neck cancer survivors. Conclusion： By proposing a comprehensivedefinition of the concept, this analysis contributes to the advancement of knowledge about quality of life in the context ofhead and neck cancer survivorship. Through a sound understanding of the phenomenon, healthcare professions willrecognize or measure head and neck cancer survivors’ life conditions in a more accurate way and to implementintervention where necessary, eventually, improve patients’ life quality in survivorship.

Long-term quality of life after sepsis and predictors of quality of life in survivors with sepsis

Purpose： To evaluate the quality of life among survivors after sepsis in 2 years, comparing with critical patients without sepsis and the general people, analyze the changes and the predictors of quality of life among septic survivors. Methods： This prospective case-control study screened the intensive care unit （ICU） patients in Tianjin Third Central Hospital from January 2014 to October 2017, and the Chinese general population in the previous studies was also included. According to inclusion criteria and exclusion criteria, 306 patients with sepsis were enrolled as the observation group, and another 306 patients without sepsis in 1CU during the same period, whose ages, gender and Charlson Comorbidity Index matched with observation group, were enrolled as the control group. At 3 too, 12 mo, and 24 mo after discharge, the Mos 36-item Short Form Health Survey （SF-36）, the Euroqol-5 dimension （EQ-5D）, and the activities of daily living （ADL） were evaluated in face-to-face for the quality of life among survivors. Results： There were 210 （68.6%） septic patients and 236 （77.1%） non-septic critically ill patients surviving. At 3 months after discharge, the observation and control groups had the similar demographic characteristics （age： 58.8 ± 18.1years vs. 57.5 ±17.6 years, p = 0.542; male： 52.0% vs. 51.4%, p = 0.926）. However, the observation group had higher acute physiology and chronic health evaluation Ⅱ （APACHEⅡ） scores, higher sequential organ failure assessment （SOFA） scores, longer hospital stay, and longer ICU stay than the control group did （p 〈 0.05）. There were no significant differences in the eight dimensions of the SF36 scale, the EQ-5D health utility scores, and the activities of daily life scores between septic survivors and non-septic survivors （p 〉 0.05）. In addition, compared with the quality of life of the Chinese general population （aged 55-64 years）, the quality of life of septic patients were significantly lower at 3 months after discharge （p 〈 0.05）. Comparing the quality of life of the ill patients who had been discharged at 3 mo and 24 mo, the general health improved statistically （p = 0.000） and clinically （score improvement 〉 5 points）. Older age （OR, 1.050; 95% CI, 1.022-1.078, p = 0.000）, female （OR, 3.375; 95% CI, 1.434 -7.941, p = 0.005） and longer mechanical ventilation time （OR, 3.412; 95% CI, 1.413, 8.244, p = 0.006） were the risk factors for the quality of life of septic survivors. Conclusion： The long-term quality of life of septic survivors was similar to that of non-sepsis critically ill survivors. After discharge, the general health of sepsis improved overtime. Age, female and mechanical ventilation time （〉5 days） were the predictors of the quality of life after sepsis.