品管圈在消化道肿瘤术后疼痛控制中的应用

目的：探讨品管圈干预在肿瘤患者术后疼痛控制中的作用。方法：对2013年1~7月82例我院收治消化道肿瘤患者进行评估，随机等分为观察组和对照组，对照组患者接受常规护理，观察组患者进行品管圈干预，包括组建疼痛管理团队，确立活动主题，进行现状调查，分析护理中存在问题，制定疼痛管理制度及疼痛优化护理措施并实施。对两组患者术后疼痛强度、自我护理能力、生活质量进行评估。结果：品管圈干预能够显著减轻术后疼痛症状，观察组患者在疼痛认知、自我护理活动认知、自我护理处理、自我护理活动及HRQOL均显著提高（P〈0.05）。结论：品管圈干预能够有效缓解肿瘤患者术后疼痛程度，提高了患者自我护理认知和自我护理能力，同时也增强了护士的护理水平，明显地提高了护理的有效性，使患者的生活质量显著增强。

Health-related quality of life in gastroesophageal reflux patients with noncardiac chest pain: Emphasis on the role of psychological distress

AIM To investigate the effects of depression and anxiety on health-related quality of life(QoL)in gastroesophageal reflux disease(GERD)patients and those suffering from cardiac(CCP)and noncardiac(NCCP)chest pain in Wuhan,China.METHODS In this cross-sectional study,a total of 358 consecutive patients with GERD were enrolled in Wuhan,China,of which 176 subjects had complaints of chest pain.Those with chest pain underwent coronary angiography and were divided into a CCP group(52 cases)and NCCP group(124 cases).Validated GERD questionnaires were completed,and the 36-item Short-Form Health Survey and Hospital Anxiety/Depression Scale were used for evaluation of Qo L and psychological symptoms,respectively.RESULTS There were similar ratios and levels of depression and anxiety in GERD with NCCP and CCP.However,the QoL was obviously lower in GERD with CCP than NCCP(48.34±17.68 vs 60.21±20.27,P<0.01).In the GERD-NCCP group,rather than the GERD-CCP group,the physical and mental QoL were much poorer in subjects with depression and/or anxiety than those without anxiety or depression.Anxiety and depression had strong negative correlations with both physical and mental health in GERD-NCCP(all P<0.01),but only a weak relationship with mental components of QoL in GERD-CCP.CONCLUSION High levels of anxiety and depression may be more related to the poorer QoL in GERD patients with NCCP than those with CCP.This highlights the importance of evaluation and management of psychological impact for improving QoL in GERD-NCCP patients.

Effect of NCPB and VSPL on pain and quality of life in chronic pancreatitis patients

AIM: To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.METHODS: Forty-eight small duct CP patients were treated invasively with NCPB (n = 30) or VSPL (n = 18) in two non-randomized, prospective, case-controlled protocols due to chronic pain syndrome, and compared to a control group who were treated conservatively (n = 32). Visual analog scales were used to assess pain and opioid consumption rate was evaluated. In addition, the quality of life was measured using QLQ C-30 for NCPB and FACIT for VSPL.Although both questionnaires covered similar problems,they could not be compared directly one with another.Therefore, the studies were compared by meta-analysis methodology.RESULTS: Both procedures resulted in a significant positive effect on pain of CP patients. Opioids were withdrawn totally in 47.0% of NCPB and 36.4% of VSPL patients,and reduced in 53.0% and 45.4% of the respective patient groups. No reduction in opioid usage was observed in the control group. In addition, fatigue and emotional well-being showed improvements. Finally, NCPB demonstrated stronger positive effects on social support, which might possibly be attributed to earlier presentation of patients treated with NCPB.CONCLUSION: Both invasive pain treatment methods are effective in CP patients with chronic pain.

Therapeutic observation of tuina manipulation for lumbar intervertebral disc herniation

Objective: To observe the clinical efficacy of balance-impact tuina therapy for lumbar intervertebral disc herniation (LIDH). Methods: A total of 118 eligible LIDH patients were randomized into an observation group and a control group by the random number table method, with 59 cases in each group. The observation group was intervened by balance-impact tuina therapy, while the control group was intervened by conventional tuina therapy, both for consecutive two weeks. The scores of visual analog scale (VAS), Oswestry disability index (ODI)Z quality of life questionnaire-core 30 (QOL-C30) were observed before and after treatment;the relapse rate was estimated at the sixth month and twelfth month following the treatment. The data were statistically an a lyzed. Results: After intervention, the total effective rate was 96.6% in the observation group versus 91.5% in the control group, and the between-group differenee was statistically significant (P<0.05). The VAS and ODI scores declined significantly after treatment in both groups (all Pv0.05), and the observation group was markedly lower than the control group (P<0.05, P<0.01). The QOL-C30 score in creased significantly after treatme nt in both groups (both P<0.05), and the observatio n group was markedly higher than the control group (P<0.05). The relapse rates at the post-treatment sixth month and twelfth month in the observation group were lower than those in the control group (P<0.05, P<0.01). Conclusion: Compared with the conventional tuina therapy, the balance-impact tuina therapy shows advantage in lessening pain, improving the function and enhancing the quality of life in the treatment of LIDH, and it has a lower relapse rate. Thus, this therapy is worth promoting in clinic.

Clinical study on mild moxibustion for knee osteoarthritis

Objective: To observe the clinical effect of mild moxibustion for knee osteoarthritis (KOA) and to explore the role of mild moxibustion in relieving pain, reducing stiffness and improving joint dysfunction in patients with KOA. Methods: Eighty patients with KOA were randomly allocated into either a moxibustion group or a medication group by the random number table, with 40 cases in each group. The moxibustion group used mild moxibustion at Neixiyan (EX-LE 5), Dubi (ST 35), Xuehai (SP 10) and Liangqiu (ST 34), 30 min each time, 3 times a week;the medication group was given celecoxib capsule (celebrex), 0.2 g each time, once a day. Both groups were treated for 4 weeks. The visual analog scale (VAS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores were evaluated before and after treatment. The efficacy of the two groups was compared after treatment. Results: After treatme nt, the overall efficacy of the moxibustion group was sign ificantly differ ent from that of the medication group (P<0.05). The VAS and WOMAC scores of the two groups were lower than those before treatment (both P<0.01). The changes in the VAS and WOMAC scores after treatment in the moxibustion group were significantly different from those in the medication group (both P<0.05). After treatment, in single item of WOMAC, the changes in pain and joint dysfunction in the moxibustion group were more statistically significant than those in the medication group (both P<0.05). Conclusion: Mild moxibustion and oral celebrex can reduce the VAS and WOMAC scores of patients with KOA. Mild moxibustion is superior to oral celebrex in relieving pain and improving joint function.