Mediating role of social support in dysphoria,despondency,and quality of life in patients undergoing maintenance hemodialysis

BACKGROUND Dysphoria and despondency are prevalent psychological issues in patients undergoing Maintenance Hemodialysis(MHD)that significantly affect their quality of life(QOL).High levels of social support can significantly improve the physical and mental well-being of patients undergoing MHD.Currently,there is limited research on how social support mediates the relationship between dysphoria,despondency,and overall QOL in patients undergoing MHD.It is imperative to investigate this mediating effect to mitigate dysphoria and despondency in patients undergoing MHD,ultimately enhancing their overall QOL.AIM To investigate the mediating role of social support in relationships between dysphoria,despondency,and QOL among patients undergoing MHD.METHODS Participants comprised 289 patients undergoing MHD,who were selected using a random sampling approach.The Social Support Rating Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and QOL Scale were administered.Correlation analysis was performed to examine the associations between social support,dysphoria,despondency,and QOL in patients undergoing MHD.To assess the mediating impact of social support on dysphoria,despondency,and QOL in patients undergoing MHD,a bootstrap method was applied.RESULTS Significant correlations among social support,dysphoria,despondency,and quality in patients undergoing MHD were observed(all P<0.01).Dysphoria and despondency negatively correlated with social support and QOL(P<0.01).Dysphoria and despondency had negative predictive impacts on the QOL of patients undergoing MHD(P<0.05).The direct effect of dysphoria on QOL was statistically significant(P<0.05).Social support mediated the relationship between dysphoria and QOL,and this mediating effect was significant(P<0.05).Similarly,the direct effect of despondency on QOL was significant(P<0.05).Moreover,social support played a mediating role between despondency and QOL,with a significant mediating effect(P<0.05).CONCLUSION These findings suggest that social support plays a significant mediating role in the relationship between dysphoria,despondency,and QOL in patients undergoing MHD.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Evaluation of the Application Effect of Psychological Nursing Intervention on Maintenance Hemodialysis Patients with Uremia

Objective:To evaluate the application effect of psychological nursing intervention on maintenance hemodialysis(MHD)patients with uremia.Methods:Sixty cases of uremic patients admitted to the hospital between May 2023 and May 2024 were selected for MHD treatment and divided using the random number table method into 30 cases in each group.The observation group implemented psychological nursing intervention,while the reference group received conventional nursing intervention,after which the nursing effects were compared.Results:After nursing,the psychological state score of the observation group was lower than that of the reference group;the treatment compliance of the observation group was higher than that of the reference group;the self-care ability score of the observation group was higher than that of the reference group,and the quality-of-life score of the observation group was higher than that of the reference group(P<0.05).Conclusion:Psychological nursing intervention for uremic MHD patients can improve their negative psychology,enhance treatment compliance,and comprehensively improve patients’self-care ability and quality of life.

土黄连水剂外敷在MHD患者Ⅰ型内瘘狭窄开放手术后的应用效果

目的:评价土黄连水剂外敷在维持性血液透析(MHD)患者Ⅰ型内瘘狭窄开放手术后的应用效果。方法:选取2019年4月—2021年5月桂林市中医医院收治的120例MHD期间因自体血管内瘘出现Ⅰ型狭窄而行开放手术治疗者为研究对象,根据随机数字表法分为对照组(n=60)和观察组(n=60)。对照组术后给予莫匹罗星软膏治疗,观察组术后则给予土黄连水剂外敷治疗。比较两组尿素清除率(URR)、尿素清除指数(Kt/V)、血常规、血栓相关因子水平及内瘘血管内径、血流量,统计两组半年内内瘘再狭窄率及并发症发生率。结果:治疗7 d后,两组URR、Kt/V均较治疗前明显升高,C反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞百分比(N%)、纤维蛋白原(FIB)、D-二聚体(D-D)均较治疗前明显下降,且观察组血栓相关因子(FIB、D-D)和CRP均明显低于对照组(P<0.05);治疗7 d后,两组URR、Kt/V、WBC、N%比较,差异均无统计学意义(P>0.05)。治疗2周后,两组内瘘血管内径、血流量均较治疗前明显升高,且观察组内瘘血管内径、血流量均明显高于对照组,差异均有统计学意义(P<0.05)。两组半年内内瘘再狭窄率及并发症发生率比较,差异均无统计学意义(P>0.05)。结论:土黄连水剂外敷可有效改善MHD期间Ⅰ型内瘘狭窄开放手术后患者内瘘血管内径、血流量,并且可抑制患者炎症反应,防止血栓形成。

罗沙司他联合蔗糖铁治疗对MHD患者铁代谢及氧化应激的影响

目的:探讨罗沙司他联合蔗糖铁治疗对维持性血液透析(MHD)患者铁代谢及氧化应激的影响。方法:按照治疗方法不同将104例MHD患者分为蔗糖铁组(蔗糖铁治疗)和罗沙司他组(蔗糖铁+罗沙司他治疗),每组各52例,两组患者均治疗12周。比较两组治疗前后的血小板计数(PLT)、铁代谢指标[血清铁(SI)、总铁结合力(TIBC)、血清铁饱和度(ISAT)]、贫血指标[血红蛋白(Hb)、红细胞计数(RBC)、血细胞比容(Hct)和Hb达标率]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)及谷胱苷肽过氧化物酶(GSH-Px)]及不良反应发生情况。结果:治疗后,两组患者PLT、SI、TIBC、SIAT、Hb、RCB、Hct和Hb达标率,且罗沙司他组高于蔗糖铁组(P<0.05);血清MDA均较治疗前升高,但罗沙司他组低于蔗糖铁组(P<0.05);血清SOD、GSH-Px均较治疗前降低,但罗沙司他组高于蔗糖铁组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:罗沙司他联合蔗糖铁注射液治疗MHD疗效较明确,能提升PLT,改善铁代谢异常、贫血和氧化应激反应,且不良反应较少,值得临床推广。

Meta analysis on the effectiveness of auricular therapy combined with modern medicine in the treatment of depression/anxiety disorders in maintenance hemodialysis patients

Objective:We used meta-analysis to explore the clinical efficacy of auricular point therapy combined with modern medicine in improving depression/anxiety in maintenance hemodialysis patients.Methods:We searched CNKI,Wanfang,Weipu,CBM,The Cochrane Library,PubMed,Web of Science,Embase through computer to build a randomized controlled trials of auricular therapy combined with modern medicine in the treatment of depression/anxiety disorders in China and abroad since 2022.Two evaluators independently screened the studies,extracted and cross-checked the key data in the studies independently after determining the included studies,and then evaluated the quality of the studies respectively.Finally,we used RevMan 5.3 platform for statistical processing of data.Results:This meta-analysis included a total of 12 clinical randomized controlled trials,including a total of 899 patients.The results showed that the observation group was more effective in reducing the scores of Hamilton Anxiety Scale,self rating Anxiety Scale,self rating Depression Scale,Pittsburgh sleep quality index score of maintenance hemodialysis patients.In addition,there was no statistical difference between the observation group and the control group in improving the total clinical effective rate.Conclusion:The observation group has a more obvious effect on the improvement of anxiety or depression in maintenance hemodialysis patients.However,due to the limitation of the quantity and quality of the included studies,the real efficacy of auricular therapy combined with modern medicine in improving anxiety or depression disorder after maintenance hemodialysis still needs to be supported by more carefully designed and standardized multi-center,large-sample clinical studies.

透析中卧位操运动对MHD伴肌肉衰减综合征患者的作用研究

目的探讨透析中卧位操运动调控对慢性肾脏病维持性血液透析(maintenance hemodialysis,MHD)发生肌肉衰减综合征患者肌肉状态、身体功能的影响。方法选取2022年1月-2023年9月在我院行MHD治疗的慢性肾脏病合并肌肉衰减综合征患者82例;按入组时治疗时间分为观察组(周一、三、五治疗)42例、对照组(周二、四、六治疗)40例。对照组实施MHD常规护理,观察组在常规护理基础上行透析中卧位操运动调控,干预24周。比较2组患者干预前后肌肉状态[握力、四肢骨骼肌指数(appendicular skeletal muscle mass index,ASMI)]、身体功能[简短机体功能测试(short physical performance battery,SPPB)、座椅前伸试验距离、睁眼单腿站立时间]、生活质量[肾脏疾病相关生活质量(kidney disease targeted areas,KDTA)]。结果干预24周后,观察组患者的握力、ASMI大于对照组,SPPB评分高于对照组,座椅前伸试验距离小于对照组,睁眼单腿站立时间大于对照组,且生活质量指标中肾病影响、肾病负担、睡眠质量、满意度评分高于对照组,差异均有统计学意义(均P<0.05)。结论透析中卧位操运动调控能够改善慢性肾脏病MHD合并肌肉衰减综合征患者的肌肉状态和身体功能,提高生活质量。

血液透析滤过和血液灌流对MHD患者钙、磷、甲状旁腺激素及营养状态的影响分析

目的探究不同血液透析滤过(HDF)、血液灌流(HP)治疗频率对维持性血液透析(MHD)患者血钙、血磷、甲状旁腺激素及营养状态的影响。方法选取135例MHD患者作为研究对象,采用随机数字表法分为A组、B组和C组,每组45例。A组为每4周行低通量血液透析(LFHD)12次治疗;B组为每4周行LFHD 10次、HDF 1次、LFHD+HP 1次治疗;C组为每4周行LFHD 8次、HDF 2次、LFHD+HP 2次治疗。比较三组患者的血钙、血磷、甲状旁腺激素及营养状态指标[血清白蛋白(ALB)、血红蛋白(Hb)]。结果治疗前,A组甲状旁腺激素、血磷、血钙水平分别为(357.79±235.00)pg/ml、(2.01±0.72)mmol/L、(1.82±0.28)mmol/L,B组分别为(343.44±225.90)pg/ml、(2.11±0.77)mmol/L、(1.87±0.27)mmol/L,C组分别为(395.10±267.41)pg/ml、(2.32±0.80)mmol/L、(1.95±0.26)mmol/L;治疗后,A组甲状旁腺激素、血磷、血钙水平分别为(380.51±307.68)pg/ml、(2.22±0.86)mmol/L、(1.86±0.26)mmol/L,B组分别为(264.58±131.71)pg/ml、(1.85±0.58)mmol/L、(1.99±0.20)mmol/L,C组分别为(304.38±191.63)pg/ml、(1.93±0.50)mmol/L、(2.02±0.23)mmol/L。三组治疗前甲状旁腺激素、血磷及血钙水平对比,差异均无统计学意义(P>0.05);三组治疗后甲状旁腺激素、血磷及血钙水平有统计学差异(P<0.05)。A组治疗前后血钙、血磷、甲状旁腺激素水平组内对比无统计学意义(P>0.05)。B组、C组治疗后血磷、甲状旁腺激素水平比治疗前低(P<0.05),血钙水平比治疗前高(P<0.05),但B组与C组治疗后甲状旁腺激素、血磷及血钙水平对比,差异无统计学意义(P>0.05)。治疗前,A组ALB、Hb水平分别为(36.44±5.25)、(75.89±18.52)g/L,B组分别为(35.10±5.76)、(80.02±18.61)g/L,C组分别为(37.12±5.77)、(79.90±18.17)g/L;治疗后,A组ALB、Hb水平分别为(37.45±4.89)、(84.93±23.54)g/L,B组分别为(39.87±4.70)、(100.16±19.48)g/L,C组分别为(40.03±4.62)、(100.02±21.08)g/L。治疗前,三组ALB、Hb水平对比无显著差异(P>0.05);治疗后,三组Hb水平较治疗前均有升高,有统计学意义(P<0.05);A组治疗后ALB水平较治疗前有升高,但差异无统计学意义(P>0.05);B组、C组治疗后ALB水平较治疗前升高,有统计学差异(P<0.05),但B组与C组治疗后ALB水平对比,差异无统计学意义(P>0.05)。结论对MHD患者单纯采取LFHD治疗未能有效改善患者钙磷代谢紊乱及继发性甲状旁腺功能亢进,而结合HDF和HP治疗能更好清除血磷、甲状旁腺素及升高血钙。增加HDF和HP的频率,不会增加患者营养不良的发生,但对改善患者钙磷代谢紊乱及继发性甲状旁腺功能亢进无进一步疗效。

赋能教育配合无缝隙护理预防MHD患者AVF并发症的临床价值

目的 观察赋能教育配合无缝隙护理模式预防维持性血液透析(maintenance hemodialysis disease,MHD)患者动静脉内瘘(arteriovenous fistula,AVF)并发症的价值。方法 选取2021年6月—2023年6月于福建医科大学附属第二医院东海院区接受MHD的280例患者。按收治时间进行分组,其中2021年6月—2022年5月收治的患者纳入对照组(n=140),2022年6月—2023年6月收治的患者纳入研究组(n=140)。对照组行常规护理,研究组在其基础上予以赋能教育配合无缝隙护理。观察2组内瘘闭塞、动脉瘤样扩张情况、AVF发生情况,评估2组患者干预前后的生活质量。结果 干预后,研究组内瘘闭塞发生率、动脉瘤样扩张发生率分别为4.29%、7.86%,低于对照组的10.71%、16.43%(P <0.05)。研究组患者AVF并发症总发生率为5.71%,低于对照组的17.14%(P <0.05)。干预后2组健康、情感以及心理评分均增加,且研究组高于对照组(P <0.05)。结论 赋能教育配合无缝隙护理模式能够有效预防MHD患者AVF并发症的发生,同时有利于MHD患者生活质量的提高。

日记式饮食健康教育对MHD患者的护理效果观察

目的:探究日记式饮食健康教育模式对维持性血液透析(MHD)患者护理效果。方法:选取2022年3月~2023年3月本院收治的维持性血液透析MHD82例患者为研究对象,采用随机数字表法将患者分为接受常规教育干预的对照组(41例)和接受日记式饮食健康教育干预的观察组(41例)。比较两组患者营养状态、饮食健康信念及自我管理能力。结果:观察组营养良好患者占比显著高于对照组,且观察组重度营养不良患者占比显著低于对照组(P<0.05)。干预后两组患者自觉行动效益、自觉行动障碍、自觉疾病严重性、自觉疾病易感性及自觉自我效能均较干预前有显著升高,且干预后观察组患者自觉行动效益、自觉行动障碍、自觉疾病严重性、自觉疾病易感性及自觉自我效能均显著高于对照组(P<0.05)。干预后两组患者饮食与液体摄入、身体活动、心理调节、治疗行为以及自我管理水平评分均较干预前有显著提高,且干预后观察组患者饮食与液体摄入、身体活动、心理调节、治疗行为以及自我管理水平评分均显著高于对照组(P<0.05)。结论:采用日记式饮食健康教育模式对维持性血液透析MHD患者进行干预效果显著,可显著改善患者营养状态,同时提高患者饮食健康信念并提高患者自我管理水平,值得临床推广。

Hepc/25(OH)D3、EPO、sTfR-F与慢性肾衰竭MHD患者肾性贫血关系及联合预测并发感染的ROC分析

目的:探讨铁调素与维生素D3比值[Hepc/25(OH)D3]、促红细胞生成素(EPO)、可溶性转铁蛋白受体/铁指数(sTfR-F)与慢性肾衰竭维持性血液透析(MHD)患者肾性贫血的关系及联合预测并发感染的价值。方法:选取2018年1月-2020年12月我院139例慢性肾衰竭MHD患者,根据透析1个月内是否并发感染分为感染组(n=32)、非感染组(n=107),比较两组Hepc/25(OH)D3、EPO、sTfR-F、血红蛋白(Hb)、转铁蛋白饱和度(TSAT)、血细胞比容(HCT),分析Hepc/25(OH)D3、EPO、sTfR-F与肾性贫血相关指标关系、感染相关影响因素及各指标预测感染的价值。结果:感染组Hepc/25(OH)D3、sTfR-F高于非感染组,EPO低于非感染组(P<0.05);感染组Hb、TSAT、HCT低于非感染组(P<0.05);Hepc/25(OH)D3、sTfR-F与Hb、TSAT、HCT呈负相关,EPO与Hb、TSAT、HCT呈正相关(P<0.05);Hepc/25(OH)D3、EPO、sTfR-F均为慢性肾衰竭MHD患者发生感染的影响因素(P<0.05);Hepc/25(OH)D3、EPO、sTfR-F预测慢性肾衰竭MHD患者并发感染的曲线下面积(AUC)分别为0.810、0.784、0.765,各指标联合预测的AUC最大,为0.864。结论:Hepc/25(OH)D3、EPO、sTfR-F与慢性肾衰竭MHD患者肾性贫血密切相关,且是感染发生的影响因素,各指标联合在预测感染发生方面具有较高应用价值。

不同颈内静脉隧道式导管封管液对预防MHD患者CRBSI及导管功能不良的影响

目的探讨不同颈内静脉隧道式导管封管液对预防维持性血液透析(MHD)患者导管相关性血流感染(CRBSI)、导管功能不良的影响。方法选取2020年1月~2021年7月在本院接受治疗的MHD患者100例,采用随机数表法分为A组(35例)、B组(31例)、C组(34例)。其中A组患者给予肝素钠盐水封管,B组患者采用定期尿激酶、肝素联合封管,C组患者采用4%枸橼酸钠封管,记录并对比3组患者的CRBSI、栓塞发生情况以及其他相关指标。结果3组患者的一般资料比较差异无统计学意义(P>0.05),A组导管栓塞率均高于B、C组(P<0.05),3组患者耳鸣、低血压差异无统计学意义(P>0.05)。相较于透析前,3组透析后的凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、凝血酶时间(TT)差异均无统计学意义(P>0.05),且3组同一时间的以上凝血功能指标差异均无统计学意义(P>0.05)。A组患者尿素清除指数(Kt/V)、导管有效血流量均低于B、C组,A组导管使用时间长于B、C组(P<0.05),B、C组间以上指标差异均无统计学意义(P>0.05)。3组患者治疗后2、4个月的无CRBSI生存率差异均无统计学意义(P>0.05),A组治疗6个月无CRBSI生存率低于B、C两组(P<0.05)。结论肝素钠盐水、定期尿激酶联合肝素、4%枸橼酸钠均可作为MHD患者颈内静脉隧道式导管封管液,但定期尿激酶联合肝素以及4%枸橼酸钠可以降低CRBSI以及导管功能不良的发生风险,且相较于肝素钠盐水封管可以延长导管使用寿命。

Association between serum cartilage oligomeric matrix protein and coronary artery calcification in maintenance hemodialysis patients

Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.

Effects of Lanthanum Carbonate on Vascular Calcification in Elderly Maintenance Hemodialysis Patients

Summary： The effect of lanthanum carbonate on abdominal aortic calcification （AAC） in the elderly maintenance hemodialysis （MHD） patients was investigated. Fifty-four cases subjected to routine MHD complicated with skin pruritus admitted to our hospital were selected and randomly divided into case group （n=28） and control group （n=26）. The control group was given routine MHD alone. The case group was given lanthanum carbonate additionally on the basis of routine MHD. The changes of itching degrees at first and third month, and serum calcium, phosphorus, calcium-phosphorus products, intact parathyroid hormone （iPTH） levels and AAC scores at third month after treatments were compared be- tween the two groups. The correlation between calcium-phosphorus products and AAC scores was also analyzed. There was no significant difference in the baseline of blood urea nitrogen （BUN）, serum creatinine （Scr）, uric acid, albumin, hemoglobin, C reactive protein （CRP）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, triglyceride, total cholesterol between case group and control group （P〉0.05 for all）. There was also no significant difference in the baseline itching scores between the case group and the control group （P〉0.05）. At 1st and 3rd month after treatment, the itching scores in the case group were 14.2±3.2 and 10.5±2.3, respectively, which were significantly lower than the baseline and those in the control group （P〈0.05 for all）. At 1 st and 3rd month after treatment, the itching scores in the control group were 23.6v5.9 and 24.8±6.3, respectively, which were significantly higher than the baseline （P〈0.05）. There was no significant difference in the baseline of serum calcium, phos- phorus, calcium-phosphorus products, iPTH levels between the case group and control group （P〉0.05）. At 3rd month after treatment, serum phosphorus, calcium-phosphorus products and iPTH levels in the case group were decreased significantly as compared with the baseline （P〈0.05）, and the serum calcium, phosphorus, calcium-phosphorus products, and iPTH levels were statistically decreased as compared with those in the control group （P〈0.05）. The AAC scores showed statistically significant difference between the case group and the control group （P〈0.05）. The serum phosphorus and AAC scores showed a positive correlation in both two groups. It was suggested that the administration of lanthanum carbon- ate in the elderly MHD patients can effectively relieve itching, and simultaneously reduce serum phos- phorus and iPTH levels, resulting in the attenuation of vascular calcification.

The effect of Levocarnitine on nutritional status and lipid metabolism during long-term maintenance hemodialysis

Objective To investigate the effect of Levocarnitine on lipid metabolism and nutritional status of maintenance hemodialysis(MHD)patients and possible mechanism.Methods A total of 40 MHD patients [mean age(53.5±7.1)years] who underwent normal hemodialysis more than 6 months were randomly classified into two groups,Levocarnitine supplemented group(LS-G)(n=20;Levocarnitine supplementation after each normal hemodialysis session,at a dose of 1.0 g/day by intravenous administration)and control group(C-G)(n=20;normal hemodialysis).Before treatment,one month and three months after treatment we respectively measured or observed the following items,the tolerance to hemodialysis,carnitine level in plasma,C-reactive protein,IL-6,TNF-α,percentage of neutrophil,and some relevant nutritional parameters,such as lipid profile,transferrin,total protein,albumin and prealbumin levels.Comparative analysis was conducted between the two groups.Results In LS-G three months after treatment,the levels of carnitine,hemoglobin,and prealbumin in plasma were significantly increased(P<0.05),but C-reactive protein,neutrophil percentage,low-density lipoprotein and triglyceride were significantly decreased(P<0.05)in contrast to those in C-G and before treatment.Transferrin,total protein,and albumin were elevated in LS-G,with no statistical significance.Conclusion There was a significant improvement of lipid metabolism and nutritional status for the long-term maintenance hemodialysis patients with Levocarnitine supplementation.And this improvement is related to the decrease of inflammatory factors.

Current status and influencing factors of post-traumatic growth in maintenance hemodialysis

Objective:To study the post-traumatic growth level and influencing factors in patients with maintenance hemodialysis.Methods:A total of 179 patients receiving maintenance hemodialysis from a third-level grade A hospital in Tianjin,China were investigated using Post-traumatic Growth Inventory(PTGI),Perceived Social Support Scale,and Medical Coping Modes Questionnaire.Results:The total score for the PTGI was 53.73±16.45.Multiple linear regression analysis showed that social support,coping style,marital status,and family income significantly influenced the post-traumatic growth level in patients undergoing maintenance hemodialysis.These factors explained 41.4%of the variance.Conclusion:Medical staff should help patients under maintenance hemodialysis to fulfill their potentials by boosting the level of social support and to effectively cope with internal conflicts.In addition,nursing staff should provide relevant psychological health education to patients to improve their post-traumatic growth.

Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis:A systematic review and meta-analysis

BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease,a group of patients known to be particularly susceptible to infectious complications.AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODS We searched PubMed/MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Web of Science databases for relevant terms and imported the results into the Covidence platform.From there,studies were assessed in two stages for relevance and quality,and data from studies that satisfied all the requirements were extracted into a spreadsheet.The data was then analyzed descriptively and statistically.RESULTS Of the 920 studies identified through the initial database search,only 17 were included in the final analysis.The studies included in the analysis were mostly carried out during the first wave.We found that COVID-19 incidence among patients on hemodialysis was significant,over 10%in some studies.Those who developed COVID-19 infection were most likely going to be hospitalized,and over 1 in 5 died from the infection.Intensive care unit admission rate was lower than the infection lethality rate.Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections,and a significant proportion was infected during the first wave.Their prognosis is overall much worse than in the general population,and every effort needs to be made to decrease their exposure.

碳酸钙D_(3)与碳酸司维拉姆治疗对MHD患者矿物质及骨代谢异常的临床疗效对比

目的对比碳酸钙D_(3)与碳酸司维拉姆治疗对维持性血液透析(maintenance hemodialysis,MHD)患者矿物质及骨代谢异常的疗效。方法随机选取2020年1月—2021年12月期间在厦门大学附属福州第二医院接受血液透析治疗的60例MHD患者为研究对象,依据患者的治疗药物差异将其分入观察组(30例)和对照组(30例),对照组MHD患者采用碳酸钙D_(3)治疗,观察组MHD患者采用碳酸司维拉姆治疗。比较两组MHD患者治疗优良率和骨代谢异常、血钙及矿物质水平改善情况、不良反应发生率。结果观察组优良率为96.67%,高于对照组的73.33%,差异有统计学意义(χ^(2)=4.706,P=0.030)。治疗前两组抗酒石酸酸性磷酸酶5b、骨特异性碱性磷酸酶、Ⅰ型胶原羧基端交联端肽、骨钙素表达水平等骨代谢水平、血钙和血清甲状旁腺素、磷等矿物质水平相比,差异无统计学意义(P>0.05);治疗后两组各指标均显著改善,且观察组抗酒石酸酸性磷酸酶5b、骨特异性碱性磷酸酶、Ⅰ型胶原羧基端交联端肽、骨钙素表达水平等骨代谢水平、血钙和血清甲状旁腺素、磷等矿物质水平改善情况优于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论碳酸司维拉姆对MHD患者矿物质及骨代谢异常改善的效果明显优于碳酸钙D_(3),能有效提升总体疗效,是一种安全高效的治疗药物。

基于SHEL分析法的综合管理模式在提高MHD患者血管通路护理质量中的应用

目的:探讨基于SHEL分析法的综合管理模式在提高维持性血液透析(MHD)患者血管通路护理质量中的应用效果。方法:选取2020年4月1日~2022年5月31日收治的100例MHD患者作为研究对象。将2020年4月1日~2021年4月30日采用常规护理管理的50例患者作为对照组,将2021年5月1日~2022年5月31日采用基于SHFL分析法的综合管理模式的50例患者作为观察组;比较两组血管通路再循环情况、并发症发生情况、干预前后自我管理行为及生活质量[采用健康调查简表(SF-36)]。结果:观察组血尿素氮(BUN)再循环率及血肌酐(Cr)再循环率均低于对照组(P<0.01);观察组并发症发生率低于对照组(P<0.01);干预后,两组自我管理量表中情绪处理、自我护理、问题解决、伙伴关系评分及总分均高于干预前(P<0.05),且观察组高于对照组(P<0.01);干预后,两组SF-36中总体健康、生命力、心理健康、躯体疼痛、生理机能、社会职能、情感职能、生理职能评分均高于干预前(P<0.05),且观察组高于对照组(P<0.01)。结论:采用基于SHEL分析法的综合管理模式对MHD患者进行干预,可降低血管通路再循环率、并发症发生率,提升患者自我管理行为、生活质量,提高患者血管通路的护理质量。

团体认知行为干预对MHD患者认知功能和生活质量的影响

目的探讨团体认知行为干预对MHD患者认知功能和生活质量的影响。方法按照随机数字表法将80例MHD患者分成对照组和观察组,各40例。对照组采用常规临床干预,观察组在对照组基础上联合团体认知行为干预。观察2组治疗前后心理状态评估焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、心理韧性量表(CD-RISC)评分、血液透析患者压力源表(HSS)评分、蒙特利尔认知评估量表(MoCA)评分、日常生活能力量表(ADL)评分及生活质量量表(SF-36)评分的变化情况;比较2组护理满意度。结果观察组治疗后SAS评分、SDS评分、HSS评分、ADL评分均低于对照组(P<0.05);CD-RISC评分、MoCA评分、SF-36评分高于对照组(P<0.05);观察组护理满意度为92.5%,明显高于对照组护理满意度72.5%(P<0.05)。结论团体认知行为干预能够调节MHD患者心理状态,增强心理韧性,提高患者认知功能和生活质量,改善护理满意度。