目的探究多形式的健康教育模式对腹型肥胖型高血压患者腹围及体重指数(Body Mass Index,BMI)的干预效果.方法回顾性选取2019年1月-2022年7月丰台区宛平社区卫生服务中心管理慢病病例中100例腹型肥胖型高血压患者作为此次研究对象,根据...目的探究多形式的健康教育模式对腹型肥胖型高血压患者腹围及体重指数(Body Mass Index,BMI)的干预效果.方法回顾性选取2019年1月-2022年7月丰台区宛平社区卫生服务中心管理慢病病例中100例腹型肥胖型高血压患者作为此次研究对象,根据不同健康教育方法将其分为观察组50例与对照组50例.观察组实施多形式的健康教育模式干预,对照组实施常规健康教育模式干预.比较两组患者干预前后腹围变化情况、BMI、血压变化情况及治疗依从性情况.结果观察组干预后男性腹围(89.25±1.31)cm、女性腹围(84.48±1.31)cm,均短于对照组男性腹围(91.53±1.54)cm、女性腹围(86.67±1.42)cm(t=7.974、8.381,P均<0.05);观察组干预后男性BMI(23.45±0.44)kg/m^(2)、女性BMI(23.38±0.31)kg/m^(2),均小于对照组男性BMI(24.32±0.58)kg/m^(2)、女性BMI(24.15±0.53)kg/m^(2)(t=8.450、8.867,P均<0.05);观察组干预后SBP(131.25±5.71)mmHg、DBP(79.48±6.22)mmHg,低于对照组SBP(142.53±5.64)mmHg、DBP(86.65±6.35)mmHg(t=9.938、5.704,P均<0.05);观察组治疗依从率96.00%(48/50)显著高于对照组的84.00%(42/50)(χ^(2)=4.000,P=0.046).结论多形式的健康教育模式应用于腹型肥胖型高血压患者中能有效缩短患者腹围与降低BMI,控制血压,提升患者治疗依从性,值得临床推广.展开更多
AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment s...AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS）.METHODS： Patients （η = 44） with AP recruited in this study were divided into two groups （ACS and non-ACS） according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems： Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score, and Multiorgan Dysfunction Score （MODS）. The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic （ROC） curve analysis.RESULTS： The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 （18.5-25.0） mmHg and 9.25 （3.0-12.4） mmHg in the non-ACS group （P 〈 0.01）. Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores （APACHE Ⅱ, Glasgow-Imrie and MODS） on admission and higher maximal scores during hospitalization （P 〈 0.01）. ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis （SAP）.CONCLUSION： IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP （APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3）.展开更多
This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese ...This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units （ICUs）. A total of 108 （76.6%） questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation （APACHE）II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure （IAP）. Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over- whelming majority （88.0%） only measured lAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for lAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab- domen （92%）, worsening oliguria （80%）, and increased ventilatory support requirement （68%）. Common causes for IAH/ACS were ＂third-spacing from massive volume resuscitation in different settings＂ （88%）, ＂intra-abdominal bleeding＂, and ＂liver failure with ascites＂ （52% for both）. Though 60% respondents would recommend surgical decompression when the lAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re- spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases.展开更多
Increased intra-abdominal pressure(IAP) is common in intensive care patients,affecting aerated lung volume distribution.The current study deals with the effect of increased IAP and decompressive laparotomy on aerated ...Increased intra-abdominal pressure(IAP) is common in intensive care patients,affecting aerated lung volume distribution.The current study deals with the effect of increased IAP and decompressive laparotomy on aerated lung volume distribution.The serial whole-lung computed tomography scans of 16 patients with increased IAP were retrospectively analyzed between July 2006 and July 2008 and compared to controls.The IAP increased from(12.1±2.3) mmHg on admission to(25.2±3.6) mmHg(P<0.01) before decompressive laparotomy and decreased to(14.7±2.8) mmHg after decompressive laparotomy.Mean time from admission to decompressive laparotomy and length of intensive-care unit(ICU) stay were 26 h and 16.2 d,respectively.The percentage of normally aerated lung volume on admission was significantly lower than that of controls(P<0.01).Prior to decompressive laparotomy,the total lung volume and percentage of normally aerated lung were significantly less in patients compared to controls(P<0.01),and the absolute volume of non-aerated lung and percentage of non-aerated lung were significantly higher in patients(P<0.01).Peak inspiratory pressure,partial pressure of carbon dioxide in arterial blood,and central venous pressure were higher in patients,while the ratio of partial pressure of arterial O2 to the fraction of inspired O2(PaO2/FIO2) was decreased relative to controls prior to laparotomy.An approximately 1.8 cm greater cranial displacement of the diaphragm in patients versus controls was observed before laparotomy.The sagittal diameter of the lung at the T6 level was significantly increased compared to controls on admission(P<0.01).After laparotomy,the volume and percentage of non-aerated lung decreased significantly while the percentage of normally aerated lung volume increased significantly(P<0.01).In conclusion,increased IAP decreases total lung volume while increasing non-aerated lung volume.Decompressive laparotomy is associated with resolution of these effects on lung volumes.展开更多
文摘目的探究多形式的健康教育模式对腹型肥胖型高血压患者腹围及体重指数(Body Mass Index,BMI)的干预效果.方法回顾性选取2019年1月-2022年7月丰台区宛平社区卫生服务中心管理慢病病例中100例腹型肥胖型高血压患者作为此次研究对象,根据不同健康教育方法将其分为观察组50例与对照组50例.观察组实施多形式的健康教育模式干预,对照组实施常规健康教育模式干预.比较两组患者干预前后腹围变化情况、BMI、血压变化情况及治疗依从性情况.结果观察组干预后男性腹围(89.25±1.31)cm、女性腹围(84.48±1.31)cm,均短于对照组男性腹围(91.53±1.54)cm、女性腹围(86.67±1.42)cm(t=7.974、8.381,P均<0.05);观察组干预后男性BMI(23.45±0.44)kg/m^(2)、女性BMI(23.38±0.31)kg/m^(2),均小于对照组男性BMI(24.32±0.58)kg/m^(2)、女性BMI(24.15±0.53)kg/m^(2)(t=8.450、8.867,P均<0.05);观察组干预后SBP(131.25±5.71)mmHg、DBP(79.48±6.22)mmHg,低于对照组SBP(142.53±5.64)mmHg、DBP(86.65±6.35)mmHg(t=9.938、5.704,P均<0.05);观察组治疗依从率96.00%(48/50)显著高于对照组的84.00%(42/50)(χ^(2)=4.000,P=0.046).结论多形式的健康教育模式应用于腹型肥胖型高血压患者中能有效缩短患者腹围与降低BMI,控制血压,提升患者治疗依从性,值得临床推广.
文摘AIM： To assess the value of widely used clinical scores in the early identification of acute pancreatitis （AP） patients who are likely to suffer from intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS）.METHODS： Patients （η = 44） with AP recruited in this study were divided into two groups （ACS and non-ACS） according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems： Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE-Ⅱ） score, and Multiorgan Dysfunction Score （MODS）. The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic （ROC） curve analysis.RESULTS： The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 （18.5-25.0） mmHg and 9.25 （3.0-12.4） mmHg in the non-ACS group （P 〈 0.01）. Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores （APACHE Ⅱ, Glasgow-Imrie and MODS） on admission and higher maximal scores during hospitalization （P 〈 0.01）. ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis （SAP）.CONCLUSION： IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP （APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3）.
基金supported by the Medical Scientific Research Foundation of Zhejiang Province, China (No. 2010KYA109)the Administration of Traditional Chinese Medicine of Zhejiang Province, China (No. 2010ZB080)
文摘This survey was designed to clarify the current understanding and clinical management of intra-abdominal hypertension （IAH）/abdominal compartment syndrome （ACS） among intensive care physicians in tertiary Chinese hospitals. A postal twenty-question questionnaire was sent to 141 physicians in different intensive care units （ICUs）. A total of 108 （76.6%） questionnaires were returned. Among these, three quarters worked in combined medical-surgical ICUs and nearly 80% had primary training in internal or emergency medicine. Average ICU beds, annual admission, ICU length of stay, acute physiology and chronic health evaluation （APACHE）II score, and mortality were 18.2 beds, 764.5 cases, 8.3 d, 19.4, and 21.1%, respectively. Of the respondents, 30.6% never measured intra-abdominal pressure （IAP）. Although the vast majority of the ICUs adopted the exclusively transvesicular method, the over- whelming majority （88.0%） only measured lAP when there was a clinical suspicion of IAH/ACS and only 29.3% measured either often or routinely. Moreover, 84.0% used the wrong priming saline volume while 88.0% zeroed at reference points which were not in consistence with the standard method for lAP monitoring recommended by the World Society of Abdominal Compartment Syndrome. ACS was suspected mainly when there was a distended ab- domen （92%）, worsening oliguria （80%）, and increased ventilatory support requirement （68%）. Common causes for IAH/ACS were ＂third-spacing from massive volume resuscitation in different settings＂ （88%）, ＂intra-abdominal bleeding＂, and ＂liver failure with ascites＂ （52% for both）. Though 60% respondents would recommend surgical decompression when the lAP exceeded 25 mmHg, accompanied by signs of organ dysfunction, nearly three quarters of re- spondents preferred diuresis and dialysis. A total of 68% of respondents would recommend paracentesis in the treatment for ACS. In conclusion, urgent systematic education is absolutely necessary for most intensive care physicians in China to help to establish clear diagnostic criteria and appropriate management for these common, but life-threatening, diseases.
文摘Increased intra-abdominal pressure(IAP) is common in intensive care patients,affecting aerated lung volume distribution.The current study deals with the effect of increased IAP and decompressive laparotomy on aerated lung volume distribution.The serial whole-lung computed tomography scans of 16 patients with increased IAP were retrospectively analyzed between July 2006 and July 2008 and compared to controls.The IAP increased from(12.1±2.3) mmHg on admission to(25.2±3.6) mmHg(P<0.01) before decompressive laparotomy and decreased to(14.7±2.8) mmHg after decompressive laparotomy.Mean time from admission to decompressive laparotomy and length of intensive-care unit(ICU) stay were 26 h and 16.2 d,respectively.The percentage of normally aerated lung volume on admission was significantly lower than that of controls(P<0.01).Prior to decompressive laparotomy,the total lung volume and percentage of normally aerated lung were significantly less in patients compared to controls(P<0.01),and the absolute volume of non-aerated lung and percentage of non-aerated lung were significantly higher in patients(P<0.01).Peak inspiratory pressure,partial pressure of carbon dioxide in arterial blood,and central venous pressure were higher in patients,while the ratio of partial pressure of arterial O2 to the fraction of inspired O2(PaO2/FIO2) was decreased relative to controls prior to laparotomy.An approximately 1.8 cm greater cranial displacement of the diaphragm in patients versus controls was observed before laparotomy.The sagittal diameter of the lung at the T6 level was significantly increased compared to controls on admission(P<0.01).After laparotomy,the volume and percentage of non-aerated lung decreased significantly while the percentage of normally aerated lung volume increased significantly(P<0.01).In conclusion,increased IAP decreases total lung volume while increasing non-aerated lung volume.Decompressive laparotomy is associated with resolution of these effects on lung volumes.
