Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease

BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.

Impact of index admission cholecystectomy vs interval cholecystectomy on readmission rate in acute cholangitis: National Readmission Database survey

BACKGROUND Elective cholecystectomy(CCY)is recommended for patients with gallstone-related acute cholangitis(AC)following endoscopic decompression to prevent recurrent biliary events.However,the optimal timing and implications of CCY remain unclear.AIM To examine the impact of same-admission CCY compared to interval CCY on patients with gallstone-related AC using the National Readmission Database(NRD).METHODS We queried the NRD to identify all gallstone-related AC hospitalizations in adult patients with and without the same admission CCY between 2016 and 2020.Our primary outcome was all-cause 30-d readmission rates,and secondary outcomes included in-hospital mortality,length of stay(LOS),and hospitalization cost.RESULTS Among the 124964 gallstone-related AC hospitalizations,only 14.67%underwent the same admission CCY.The all-cause 30-d readmissions in the same admission CCY group were almost half that of the non-CCY group(5.56%vs 11.50%).Patients in the same admission CCY group had a longer mean LOS and higher hospitalization costs attrib-utable to surgery.Although the most common reason for readmission was sepsis in both groups,the second most common reason was AC in the interval CCY group.CONCLUSION Our study suggests that patients with gallstone-related AC who do not undergo the same admission CCY have twice the risk of readmission compared to those who undergo CCY during the same admission.These readmis-sions can potentially be prevented by performing same-admission CCY in appropriate patients,which may reduce subsequent hospitalization costs secondary to readmissions.

Readmission rate and early complications in patients undergoing total knee arthroplasty:A retrospective study

BACKGROUND Total knee arthroplasty(TKA)can improve pain,quality of life,and functional outcomes.Although uncommon,postoperative complications are extremely consequential and thus must be carefully tracked and communicated to patients to assist their decision-making before surgery.Identification of the risk factors for complications and readmissions after TKA,taking into account common causes,temporal trends,and risk variables that can be changed or left unmodified,will benefit this process.AIM To assess readmission rates,early complications and their causes after TKA at 30 days and 90 days post-surgery.METHODS This was a prospective and retrospective study of 633 patients who underwent TKA at our hospital between January 1,2017,and February 28,2022.Of the 633 patients,28 were not contactable,leaving 609 who met the inclusion criteria.Both inpatient and outpatient hospital records were retrieved,and observations were noted in the data collection forms.RESULTS Following TKA,the 30-day and 90-day readmission rates were determined to be 1.1%(n=7)and 1.8%(n=11),respectively.The unplanned visit rate at 30 days following TKA was 2.6%(n=16)and at 90 days was 4.6%(n=28).At 90 days,the unplanned readmission rate was 1.4%(n=9).Reasons for readmissions included medical(27.2%,n=3)and surgical(72.7%,n=8).Unplanned readmissions and visits within 90 days of follow-up did not substantially differ by age group(P=0.922),body mass index(BMI)(P=0.633),unilateral vs bilateral TKA(P=0.696),or patient comorbidity status(30-day P=0.171 and 90-day P=0.813).Reoperation rates after TKA were 0.66%(n=4)at 30 days and 1.15%(n=8)at 90 days.The average length of stay was 6.53 days.CONCLUSION In this study,there was a low readmission rate following TKA.There was no significant correlation between readmission rate and patient factors such as age,BMI,and co-morbidity status.

Readmission rates and outcomes in adults with and without COVID-19 following inpatient chemotherapy admission:A nationwide analysis

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has received considerable attention in the scientific community due to its impact on healthcare systems and various diseases.However,little focus has been given to its effect on cancer treatment.AIM To determine the effect of COVID-19 pandemic on cancer patients’care.METHODS A retrospective review of a Nationwide Readmission Database(NRD)was conducted to analyze hospitalization patterns of patients receiving inpatient chemotherapy(IPCT)during the COVID-19 pandemic in 2020.Two cohorts were defined based on readmission within 30 d and 90 d.Demographic information,readmission rates,hospital-specific variables,length of hospital stay(LOS),and treatment costs were analyzed.Comorbidities were assessed using the Elixhauser comorbidity index.Multivariate Cox regression analysis was performed to identify independent predictors of readmission.Statistical analysis was conducted using Stata■Version 16 software.As the NRD data is anonymous and cannot be used to identify patients,institutional review board approval was not required for this study.RESULTS A total of 87755 hospitalizations for IPCT were identified during the pandemic.Among the 30-day index admission cohort,55005 patients were included,with 32903 readmissions observed,resulting in a readmission rate of 59.8%.For the 90-day index admission cohort,33142 patients were included,with 24503 readmissions observed,leading to a readmission rate of 73.93%.The most common causes of readmission included encounters with chemotherapy(66.7%),neutropenia(4.36%),and sepsis(3.3%).Comorbidities were significantly higher among readmitted hospitalizations compared to index hospitalizations in both readmission cohorts.The total cost of readmission for both cohorts amounted to 1193000000.00 dollars.Major predictors of 30-day readmission included peripheral vascular disorders[Hazard ratio(HR)=1.09,P<0.05],paralysis(HR=1.26,P<0.001),and human immunodeficiency virus/acquired immuno-deficiency syndrome(HR=1.14,P=0.03).Predictors of 90-day readmission included lymphoma(HR=1.14,P<0.01),paralysis(HR=1.21,P=0.02),and peripheral vascular disorders(HR=1.15,P<0.01).CONCLUSION The COVID-19 pandemic has significantly impacted the management of patients undergoing IPCT.These findings highlight the urgent need for a more strategic approach to the care of patients receiving IPCT during pandemics.

All-cause hospitalizations for inflammatory bowel diseases:Can the reason for admission provide information on inpatient resource use?A study from a large veteran affairs hospital

Background:Inflammatory bowel diseases(IBDs) are group of chronic inflammatory illnesses with a remitting and relapsing course that may result in appreciable morbidity and high medical costs secondary to repeated hospitalizations.The study's objectives were to identify the reasons for hospitalization among patients with IBDs,and compare inpatient courses and readmission rates for IBD-related admissions versus non-IBD-related admissions.Methods:A retrospective chart review was performed on all patients with IBD admitted to the Minneapolis Veterans Affairs(VA) Medical Center between September 2010 and September 2012.Results:A total of 111 patients with IBD were admitted during the 2-year study period.IBD flares/complications accounted for 36.9% of the index admissions.Atherothrombotic events comprised the second most common cause of admissions(14.4%) in IBD patients.Patients with an index admission directly related to IBD were significantly younger and had developed IBD more recently.Unsurprisingly,the IBD admission group had significantly more gastrointestinal endoscopies and abdominal surgeries,and was more likely to be started on medication for IBD during the index stay.The median length of stay(LOS) for the index hospitalization for an IBD flare or complication was 4(2–8) days compared with 2(1–4) days for the other patients(P=0.001).A smaller percentage of the group admitted for an IBD flare/complication had a shorter ICU stay compared with the other patients(9.8% vs.15.7%,respectively); however,their ICU LOSs tended to be longer(4.5 vs.2.0 days,respectively,P=0.17).Compared to the other admission types,an insignificantly greater percentage of the group whose index admission was related to an IBD flare or complication had at least one readmission within 6 months of discharge(29% versus 21%; P=0.35).The rate of admission was approximately 80% greater in the group whose index admission was related to an IBD flare or complication compared to the other types of admission(rate ratio 1.8,95% confidence interval 0.96 to 3.4),although this difference did not reach statistical significance(P=0.07).Conclusion:Identifying the reasons for the patients' index admission,IBD flares versus all other causes,may provide valuable information concerning admission care and the subsequent admission history.

Risk factors for 90-day readmission in veterans with inflammatory bowel disease——Does post-discharge follow-up matter?

Background: Repeat hospitalizations in veterans with inflammatory bowel disease(IBD) are under studied. The early readmission rate and potentially modifiable risk-factors for 90-day readmission in veterans with IBD were studied to avert avoidable readmissions.Methods: A retrospective cohort study was conducted using the data from veterans who were admitted to the Minneapolis VA Medical Center(MVMC) between January 1, 2007, and December 31, 2013, for an IBD-related problem. All-cause readmissions within 30 and 90 days were recorded to calculate early readmission rates. The multivariate logistic regression was used to identify the potential risk factors for 90-day readmission.Results: There were 130 unique patients(56.9% with Crohn's disease and 43.1% with ulcerative colitis) with 202 IBD-related index admissions. The mean age at the time of index admission was 59.8±15.2 years. The median time to re-hospitalization was 26 days(IQR 10-49), with 30-and 90-day readmission rates of 17.3%(35/202) and 29.2%(59/202), respectively. Reasons for all-cause readmission were IBD-related(71.2%), scheduled surgery(3.4%) and non-gastrointestinal causes(25.4%). The following reasons were independently associated with 90-day readmission: Crohn's disease(OR 3.90; 95% CI 1.82-8.90), use of antidepressants(OR 2.19; 95% CI 1.12-4.32), and lack of follow-up within 90 days with a primary care physician(PCP)(OR 2.63; 95% CI 1.32-5.26) or a gastroenterologist(GI)(OR 2.44; 95% CI 1.20-5.00). 51.0% and 49.0% of patients had documentation of a recommended outpatient follow-up with PCP and/or GI, respectively.Conclusion: Early readmission in IBD is common. Independent risk factors for 90-day readmission included Crohn's disease, use of antidepressants and lack of follow-up visit with PCP or GI. Further research is required to determine if the appropriate timing of post-discharge follow-up can reduce IBD readmissions.

Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.METHODS A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.RESULTS Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. Majority(58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age < 40(OR: 1.39; CI: 1.19-1.64), age 40-64(OR: 1.19; CI: 1.09-1.30), Medicaid(OR: 1.21; CI: 1.04-1.41) and Medicare coverage(OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: < 0.001.CONCLUSION Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

Ninety-day readmissions after inpatient cholecystectomy: A 5-year analysis

AIM To determine the incidence of readmission after cholecystectomy using 90 d as a time limit. METHODS We retrospectively reviewed all patients undergoing cholecystectomy at the General Surgery and Digestive System Service of the University Hospital of Guadalajara, Spain. We included all patients undergoing cholecystectomy for biliary pathology who were readmitted to hospital within 90 d. We considered readmission to any hospital service as cholecystectomyrelated complications. We excluded ambulatory cholecystectomy, cholecystectomy combined with other procedures, oncologic disease active at the time of cholecystectomy, finding of malignancy in the resection specimen, and scheduled re-admissions for other unrelated pathologies. RESULTS We analyzed 1423 patients. There were 71 readmissions in the 90 d after discharge, with a readmission rate of4.99%. Sixty-four point seven nine percent occurred after elective surgery(cholelithiasis or vesicular polyps) and 35.21% after emergency surgery(acute cholecystitis or acute pancreatitis). Surgical non-biliary causes were the most frequent reasons for readmission, representing 46.48%; among them, intra-abdominal abscesses were the most common. In second place were non-surgical reasons, at 29.58%, and finally, surgical biliary reasons, at 23.94%. Regarding time for readmission, almost 50% of patients were readmitted in the first week and most second readmissions occurred during the second month. Redefining the readmissions rate to 90 d resulted in an increase in re-hospitalization, from 3.51% at 30 d to 4.99% at 90 d. CONCLUSION The use of 30-d cutoff point may underestimate the incidence of complications. The current tendency is to use 90 d as a limit to measure complications associated with any surgical procedure.

Effect of action research-based exercise training guidance on exercise endurance and readmission rate in patients with stable angina pectoris due to coronary heart disease

Background Stable angina pectoris is a common subtype of coronary heart disease.Patients suffer from chest tightness,chest pain and crushing pain under the inducement of fatigue and emotional agitation.This study aims to investigate the effect of exercise training guidance based on action research on exercise endurance and readmission rate of patients with stable angina pectoris.Methods A retrospective study was conducted on 60 patients with stable angina pectoris due to coronary heart disease admitted to our hospital from February 2020 to November 2023.Patients were divided into a control group of 29 cases(receiving conventional exercise training guidance)and a guidance group of 31 cases(receiving action research-based exercise training guidance).Both groups received continuous training for one month.A comparison was made between the exercise endurance indicators[6-minute walk test distance(6MWT),peak oxygen consumption(peak VO2),anaerobic threshold(AT),exercise duration(ED)],quality of life,and readmission rate within 6 months after intervention in both groups.Results After 1 month of intervention,6MWT,peak VO2,AT and ED were increased in both groups,and those in the guidance group were higher than those in the conventional group(P<0.05).The score of quality of life(The 36-item shot-form health status survey,SF-36)in both groups was increased,and the guidance group scored higher than the conventional group(P<0.05).The readmission rate of patients in the guidance group was 6.45%,which was lower than that in the conventional group(27.59%)(P<0.05).Conclusions The application of action research-based exercise training guidance in patients with stable angina pectoris due to coronary heart disease has significant effects,improving exercise endurance,significantly improving quality of life,and reducing readmission rate,thus having practical value.[S Chin J Cardiol 2024;25(3):162-168]

达格列净对急性心肌梗死合并糖尿病患者经皮冠状动脉介入治疗后糖代谢和心功能的影响

目的探究达格列净对急性心肌梗死合并糖尿病患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后糖代谢、心功能及再入院率的影响。方法将108例急性心肌梗死合并2型糖尿病患者作为研究对象,采用随机数字法将其分为观察组(55例)和对照组(53例)。对照组于PCI术后常规给予抗血小板药物及降糖药物治疗,观察组在对照组治疗的基础上给予达格列净治疗。于治疗3个月后,比较2组治疗疗效及再入院率、血管再狭窄率、心脏不良事件发生率;观察2组患者治疗前后心功能指标[N端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)]、糖代谢指标[空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2-hours postprandial blood glucose,2 hPBG)和糖化血红蛋白(glycosylated hemoglobin,HbAlc)]和炎症因子[髓过氧化物酶(myeloperoxidase,MPO)、白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)]。结果观察组、对照组的治疗总有效率分别为92.73%、81.13%,2组比较差异无统计学意义。治疗后,观察组NTproBNP水平低于对照组[(237.31±20.59)pg·mL^(-1) vs.(251.68±21.17)pg·mL^(-1)],LVEF值大于对照组[(58.04%±3.12%)vs.(56.97%±3.65%)],LVEDD值小于对照组[(52.70±5.09)mm vs.(55.05±4.37)mm,P<0.05];FBG、2 hPBG水平和HbAlc值均低于对照组[(5.14±0.69)mmol·L^(-1) vs.(5.68±0.71)mmol·L^(-1),(8.01±1.65)mmol·L^(-1) vs.(8.79±1.39)mmol·L^(-1),(6.45%±0.69%)vs(.7.04%±0.81%),P<0.05];MPO、IL-6和TNF-α水平均低于对照组(P<0.05);再入院率低于对照组(1.82%vs.11.32%,P<0.05);2组患者血管再狭窄率及心脏不良事件发生率比较差异无统计学意义(0 vs.7.55%,3.64%vs.13.21%,P>0.05)。结论达格列净可降低急性心肌梗死合并糖尿病患者PCI后血糖水平及再入院率,且可改善患者的心功能。

基于生物-心理-社会模型的随访管理路径在慢性心力衰竭病人中的应用研究

目的:探讨基于生物-心理-社会模型的随访管理路径在慢性心力衰竭病人中的应用效果。方法:选取2022年1月—2023年6月江苏省南京医科大学第二附属医院心血管内科的128例慢性心力衰竭病人为研究对象,依据床号单双数分为对照组和观察组,每组64例。对照组给予常规随访管理,观察组实施基于生物-心理-社会模型制定的随访管理路径,比较两组干预后自我护理行为[中文版心力衰竭自我护理行为量表(EHFScBS)]、再入院率及生活质量情况[明尼芬达心力衰竭生活质量问卷(MLHFQ)]。结果:干预后,观察组EHFScBS评分低于对照组;脑钠肽值(B-type natriuretic peptide,BNP)、再入院率也低于对照组;MLHFQ评分低于对照组(P<0.05)。结论:基于生物-心理-社会模型的随访管理路径对改善慢性心力衰竭病人自我护理行为、降低再入院率及优化生活质量等方面均具有积极促进作用。

COPD急性加重期患者出院1个月内非计划性再入院的危险因素调查及护理对策

目的探讨慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者出院1个月内非计划性再入院的危险因素及其护理对策。方法选择医院2020年3月—2022年3月收治的AECOPD患者120例为研究对象,收集患者性别、年龄、吸烟史等一般资料,了解患者基础疾病情况、呼吸困难评分(mMRC)、空腹外周静脉血等实验室指标。以患者出院1个月内非计划性再入院为终点,通过单因素分析、多因素Logistic回归分析筛选1个月内非计划性再入院的影响因素,据此确定护理对策。结果AECOPD患者出院1个月内非计划性再入院23例,单因素分析结果显示,血清C反应蛋白(CRP)、FEF75预计值、FEV1实际值、血清白蛋白(ALB)、气流受限严重程度(GOLD)分级、中性粒细胞与淋巴细胞比(NLR)、呼吸困难评分(mMRC)、血小板与淋巴细胞比(PLR)水平、二氧化碳分压(PaCO_(2))、肺康复锻炼依从性是AECOPD患者出院1个月内非计划性再入院的影响因素(P<0.05)。多因素Logistic回归分析结果显示,FEF75预计值、CRP、ALB、NLR、FEV1实际值和肺康复锻炼依从性是AECOPD患者出院1个月内非计划性再入院的影响因素(P<0.05)。结论针对CRP、PLR、FEF75水平升高和ALB水平、FEV1实际值下降,肺康复锻炼依从性差的AECOPD患者,医院应采取针对性防控措施,提高护理服务质量,减少AECOPD患者非计划性再入院率。

心力衰竭合并肾功能不全患者的高危因素及再住院率分析

目的分析心力衰竭患者临床资料、随访资料和心功能情况,探讨心力衰竭合并肾功能不全患者的危险因素及其1年内的再住院率。方法回顾性分析2022年1月至9月咸宁市中心医院收治的278例心力衰竭患者的临床资料,根据肾功能情况,将其分为单纯心力衰竭组(182例)和心力衰竭合并肾功能不全组(96例),两组患者进行规范治疗,多因素logistic回归分析心力衰竭合并肾功能不全患者的影响因素。结果单因素结果显示,两组的性别、吸烟、饮酒、尿酸、血清肌酐、B型钠尿肽、左室射血分数、左心室舒张末径、再住院率比较,差异有统计学意义(P<0.05)。多因素结果显示,高尿酸血症(β=0.005,OR=0.995,95%CI=0.993~0.997)、低射血分数(β=0.972,OR=0.651,95%CI=0.982~1.609)和纽约心脏协会心功能分级差(β=0.625,OR=0.535,95%CI=0.290~0.987)是心力衰竭合并肾功能不全的危险因素,差异有统计学意义(P<0.05)。结论心力衰竭合并肾功能不全患者内再住院率较高,其受多种因素的影响,高尿酸血症、低射血分数和纽约心脏协会心功能分级差是心力衰竭合并肾功能不全的危险因素。

ARNI联合EECP在PCI术后应用价值及对无创血流动力学指标再住院率的影响

目的:探讨血管紧张素受体脑啡肽酶抑制剂(ARNI)联合增强型体外反搏(EECP)在经皮冠状动脉介入(PCI)治疗术后价值以及对无创血流动力学指标、再住院率的影响。方法:选取2022年10月至2024年3月于山东第一医科大学附属人民医院心血管内科就诊的急性前壁心肌梗死并成功行急诊PCI治疗术后患者100例为研究对象,随机分为试验组和对照组,每组50例,试验组采用ARNI联合EECP进行治疗,对照组采用血管紧张素转化酶抑制剂(ACEI)进行治疗,比较两组的心功能指标、生活质量量表(SF-36)以及血流动力学指标和再住院率。结果:治疗前,两组患者的心功能指标以及血流动力学指均无统计学差异(P>0.05),治疗7周后,两组患者的LVEDV、LVESV、NT-proBNP、ET-1、心率、SBP、DBP以及RS、CMR均降低,LVEF、CO、CI以及LSI、LCI、AC、COM均升高,较治疗前比较,均有统计学差异(P<0.05),且试验组改变幅度大于对照组,两组上述指标比较有统计学差异(P<0.05);治疗后6个月随访,LVEDV、LVESV、NT-proBNP、ET-1、心率、SBP、DBP以及RS、CMR继续降低,LVEF、CO、CI以及LSI、LCI、AC、COM继续升高,但改变幅度变小,两组上述指标比较仍具有统计学差异(P<0.05);治疗前,两组患者的SF-36中的生理职能、生理功能、情感职能、日常活动、精神健康、总体健康、社会功能、躯体疼痛评分比较均无统计学差异(P>0.05),治疗7周后,上述评分均上升,较治疗前比较,均有统计学差异(P<0.05),且试验组改变幅度大于对照组,两组上述指标比较也有统计学差异(P<0.05);治疗后6个月随访,上述指标继续上升,但改变幅度变小,两组上述指标比较仍具有统计学差异(P<0.05);两组患者治疗后6个月总主要不良心血管事件导致再住院率两组比较具有统计学差异(χ^(2)=9.502,P=0.002);再发心肌梗死、心绞痛发作导致再住院率比较,无统计学差异(χ^(2)=0.340,P=0.560;χ^(2)=2.152,P=0.142),心力衰竭导致再住院率比较,差异有统计学意义(χ^(2)=6.353,P=0.012)。结论:ARNI联合EECP在PCI术后可以改善心功能以及患者健康状态,降低阻力,降低术后不良反应发生率,从而降低再住院率。

基于专科护理门诊的延续护理模式在脑卒中出院病人中的应用

目的:探讨基于专科护理门诊的延续护理模式在脑卒中出院病人中的应用效果。方法:将2022年1月—6月湖南省某三级甲等综合医院神经内科出院的184例脑卒中病人为研究对象,按照随机数字表法分为对照组和观察组,对照组实施常规延续性护理,观察组在此基础上采用基于专科护理门诊的延续护理方案。结果:观察组病人干预1个月、3个月、6个月内再入院率均低于对照组(P<0.05),干预6个月末观察组病人生理生化指标(收缩压、舒张压、低密度脂蛋白胆固醇、糖化血红蛋白、同型半胱氨酸)均优于对照组(P<0.05),干预6个月末观察组脑卒中自我管理水平得分高于对照组(P<0.05)。结论:基于专科护理门诊的延续护理模式可降低脑卒中出院病人的再入院率,改善生理生化指标,提升脑卒中自我管理能力。

重组人脑利钠肽联合沙库巴曲缬沙坦治疗对冠心病心力衰竭患者心率变异性和预后的影响

目的:探讨冠心病心力衰竭患者联合应用重组人脑利钠肽、沙库巴曲缬沙坦治疗效果以及对心率变异性、预后的影响。方法:选取2020年9月—2022年9月神木市医院收治的120例冠心病心力衰竭患者作为研究对象,按随机数表法分为对照组(n=60,单用沙库巴曲缬沙坦治疗)和观察组(n=60,联合应用沙库巴曲缬沙坦、重组人脑利钠肽治疗)。比较两组疗效、心率变异性、心肌损伤指标、不良心血管事件、再入院率、不良反应情况。结果:观察组临床治疗效率比对照组高,差异有统计学意义(P<0.05)。治疗前,两组心率变异性、心肌损伤指标比较,差异无统计学意义(P>0.05);治疗后,两组低频分量(LF)、高频分量(HF)升高,LF/HF、乳酸脱氢酶(LDH)、肌红蛋白(Mb)、N末端脑钠肽前体(NT-proBNP)降低,且观察组LF、HF比对照组高,LF/HF、LDH、Myo、NT-proBNP比对照组低,差异有统计学意义(P<0.05);进行3个月动态随访,观察组不良心血管事件发生率与再入院率比对照组低,差异有统计学意义(P<0.05);观察组头晕嗜睡、肌酐升高、乏力、恶心、肌肉痛等不良反应与对照组比较,差异无统计学意义(P>0.05)。结论:冠心病心力衰竭患者应用沙库巴曲缬沙坦治疗基础上加用重组人脑利钠肽,能够显著改善心率变异,减轻心肌损伤,降低不良心血管事件,提高临床疗效,并且未发生严重不良反应。

情绪管理训练为主的延续护理模式对焦虑症患者的影响

目的评价以情绪管理训练为主的延续护理模式在焦虑症患者中的效果。方法选取2021年10月—2022年10月济南市章丘区中医医院收治的焦虑症患者68例。采用信封法分为研究组与对照组,各34例。对照组执行基础护理,研究组执行以情绪管理训练为主的延续护理。评价2组护理前后患者不良情绪变化情况、再住院和就诊情况、生存质量、总满意率。结果护理后,研究组焦虑评分低于对照组(P<0.05)。研究组再住院>3次发生率低于对照组,门诊就诊>3次发生率高于对照组(P<0.05)。2组患者急诊就诊率比较,差异无统计学意义(P>0.05)。研究组生存质量(生理、心理、社会、精神)得分高于对照组(P<0.05)。研究组总满意率(97.06%)高于对照组(70.59%)(P<0.05)。结论以情绪管理训练为主的延续护理可改善患者焦虑症状,改善生存质量,降低再住院就诊率。同时,患者满意率高,有利于创建和谐护患关系。

The Prognostic Value of Red Cell Distribution Width in Critically Ill Cerebral Infarction Patients:A Retrospective Cohort Study

Objective:Red blood cell distribution width(RDW)has been utilized as a prognostic indicator for mortality risk assessment in cardiovascular and cerebrovascular patients.Nevertheless,the prognostic significance of RDW in critically ill patients with cerebral infarction is yet to be investigated.The objective of this study is to examine the association between RDW and the risk of all-cause mortality in cerebral infarction patients admitted to the intensive care unit(ICU).Method:A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV 2.2(MIMIC-IV)intensive care dataset for data analysis.The main results were the all-cause mortality rates at 3 and 12 months of follow-up.Cumulative curves were plotted using the Kaplan-Meier method,and Cox proportional hazards analysis was used to examine the relationship between RDW and mortality rates in critically ill cerebral infarction patients.Results:The findings indicate that RDW serves as a significant prognostic factor for mortality risk in critically ill stroke patients,specifically at the 3 and 12-month follow-up periods.The observed correlation between increasing RDW levels and higher mortality rates among cerebral infarction patients further supports the potential utility of RDW as a predictive indicator.Conclusion:RDW emerges as an independent predictor of mortality risk during the 3 and 12-month follow-up periods for critically ill patients with cerebral infarction.

优质护理在慢性心力衰竭患者护理中的应用效果

目的:分析优质护理在慢性心力衰竭患者护理中的应用效果。方法:选取2021年10月—2023年1月镇江市第一人民医院收治的慢性心力衰竭患者82例,随机分为对照组(n=41,常规护理)和观察组(n=41,优质护理)。对比两组自我护理能力、心功能、再住院率和生活质量。结果:护理后,两组自我护理能力评分升高,与对照组比较,观察组分值更高(P<0.05)。护理后,两组心输出量、每搏输出量、左室射血分数升高,左室收缩末期内径降低,且观察组改善幅度大于对照组(P<0.05)。观察组患者再住院率低于对照组(P=0.045)。护理后,两组症状改善、体力限制、社会限制、情绪控制评分降低,与对照组相比,观察组分值更低(P<0.05)。结论:慢性心力衰竭患者实施优质护理有良好的应用效果,患者的自我护理能力显著提升,心功能有效改善,同时再住院率降低,生活质量提高。

ERAS规范化诊疗在老年髋部股骨粗隆间骨折患者中的应用研究

目的:探讨ERAS(加速康复外科)规范化模式在老年髋部股骨粗隆间骨折的临床应用效果。方法:选取2021年3月—2023年3月我院收治的80例老年髋部股骨粗隆间骨折患者为研究对象,将其分为对照组与观察组,各40例。观察组采用ERAS规范化模式治疗,对照组采用常规诊疗,记录患者的治疗情况。结果:术后1、3、5d,观察组疼痛视觉模拟评分均低于对照组,组间差异有统计学意义(P<0.05)。术后1、6个月,观察组Harris髋关节评分表各个维度评分均高于对照组,组间差异有统计学意义(P<0.05)。观察组并发症发生率、术后12个月内再入院率均低于对照组,组间差异有统计学意义(P<0.05)。观察组术前等待时间、住院时间均短于对照组,组间差异有统计学意义(P<0.05)。术后2周、1、3个月,观察组Barthel指数评定量表评分均高于对照组,组间差异有统计学意义(P<0.05)。结论:针对老年髋部股骨粗隆间骨折患者实施ERAS规范化诊疗,有助于改善患者的疼痛程度,提升髋关节功能,有助于取得较好的治疗效果。