Renin-angiotensin system inhibitors prescriptions in Chinese hospitalized chronic kidney disease patients

BACKGROUND Many guidelines have recommended renin-angiotensin system inhibitors(RASI)as the first-line treatment for patients with chronic kidney disease(CKD).We studied RASI prescription trends from 2010 to 2019,and analyzed the characteristics associated with RASI prescription in Chinese hospitalized CKD patients.AIM To study the prescription of renin angiotensin system inhibitors in hospitalized patients with CKD in China.METHODS It was retrospectively,cross-sectional reviewed RASI prescriptions in hospitalized CKD patients in China from 2010 to 2019.RASI prescribing trends were analyzed from 2010 to 2019,and bivariate and multivariate logistic regression analyses were conducted to identify characteristics associated with RASI prescription.RESULTS A total of 35090 CKD patients were included,with 10043(28.6%)RASI prescriptions.Among these patients,18919(53.9%)met the criteria for RASI treatments based on the 2012 kidney disease:Improving global outcomes guidelines.Of these,7246(38.3%)patients received RASI prescriptions.RASI prescriptions showed an initial rapid increase from 2011 to 2012,reached its peak around 2015 and 2016,and then exhibited a subsequent slight decreasing trend.Both bivariate and multivariate analyses showed that several characteristics,including the male gender,age less than 60-year-old,nephrology department admission,lower CKD stage,history of hypertension or diabetes,proteinuria,glomerulonephritis as the CKD etiology,and non-acute kidney injury were associated with RASI prescriptions.CONCLUSION The frequency of RASI prescriptions showed an initial increase but a slight decreasing trend in more recent years.CKD patients with certain characteristics such as elderly age,advanced disease stage,surgery department admission,or acute kidney injury were less likely to receive RASI prescriptions.In the application of RASI in hospitalized CKD patients is insufficient.The actual clinical practice needs to be improved.The development of related research is helpful to guide the correct choice of clinical treatment strategy.

Performance of Dexcom G5 and FreeStyle Libre sensors tested simultaneously in people with type 1 or 2 diabetes and advanced chronic kidney disease

BACKGROUND Advanced chronic kidney disease(CKD) is a common complication for people with type 1 and 2 diabetes and can often lead to glucose instability. Continuous glucose monitoring(CGM) helps users monitor and stabilize their glucose levels. To date, CGM and intermittent scanning CGM are only approved for people with diabetes but not for those with advanced CKD.AIM To compare the performance of Dexcom G5 and FreeStyle Libre sensors in adults with type 1 or 2 diabetes and advanced CKD.METHODS This was a non-randomized clinical trial that took place in two outpatient clinics in western Sweden. All patients with type 1 or 2 diabetes and an estimated glomerular filtration rate(eGFR) of < 30 mL/min per 1.73 m^(2) were invited to participate. Forty patients(full analysis set = 33) carried the Dexcom G5 sensor for 7 d and FreeStyle Libre sensor for 14 d simultaneously. For referencing capillary blood glucose(SMBG) was measured with a high accuracy glucose meter(HemoCue®) during the study period. At the end of the study, all patients were asked to answer a questionnaire on their experience using the sensors.RESULTS The mean age was 64.1(range 41-77) years, hemoglobin A1 c was 7.0% [standard deviation(SD) 3.2], and diabetes duration was 28.5(SD 14.7) years. A total of 27.5% of the study population was on hemodialysis and 22.5% on peritoneal dialysis. The mean absolute relative difference for Dexcom G5 vs SMBG was significantly lower than that for FreeStyle Libre vs SMBG [15.2%(SD 12.2) vs 20.9%(SD 8.6)], with a mean difference of 5.72 [95% confidence interval(CI): 2.11-9.32;P = 0.0036]. The mean absolute difference was also significantly lower for Dexcom G5 than for FreeStyle Libre, 1.21 mmol/L(SD 0.78) and 1.76 mmol/L(SD 0.78), with a mean diffrenec of 0.55(95%CI: 0.27-0.83;P = 0.0004).The mean difference(MD) was-0.107 mmol/L and-1.10 mmol/L(P = 0.0002), respectively. In all, 66% of FreeStyle Libre values were in the no risk zone on the surveillance error grid compared to 82% of Dexcom G5 values.CONCLUSION Dexcom G5 produces more accurate sensor values than FreeStyle Libre in people with diabetes and advanced CKD and is likely safe to be used by those with advanced CKD.

Impact of continuous positive airway pressure therapy for nonalcoholic fatty liver disease in patients with obstructive sleep apnea

BACKGROUND Obstructive sleep apnea(OSA)has been suggested as an independent risk factor for nonalcoholic fatty liver disease(NAFLD),and continuous positive airway pressure(CPAP)is the first-line therapy for OSA.AIM To clarify the efficacy of effective CPAP therapy on NAFLD of OSA patients by serum markers and transient elastography(TE)using FibroScan®(Echosens,Paris,France).METHODS We prospectively enrolled 123 consecutive patients with OSA who met the indications for CPAP.Liver fibrosis and steatosis were assessed using TE.Before and after 6 mo of CPAP therapy,serum markers and TE were assessed for all patients.The mean usage rate of CPAP therapy for 6 mo was arbitrarily calculated in each patient and expressed as“mean compliance index”(m-CI).RESULTS In 50 OSA patients with NAFLD,both aspartate aminotransferase(AST)and alanine aminotransferase(ALT)levels were significantly decreased after 6 mo of CPAP therapy.Univariate analysis showed that decreased body weight(BW),decreased body mass index(BMI),decreased AST level,decreased hemoglobin A1c,and high m-CI were significantly related with improved ALT level.In multivariate regression model adjusted for quantities of BW change during 6 mo of CPAP therapy,high m-CI tended to improve ALT level(P=0.051).All 17 OSA patients with NAFLD,high m-CI and no BMI changes showed significant improvements in AST and ALT levels.Meanwhile,no significant changes in TE data or serum fibrosis markers were seen.CONCLUSION Some NAFLD could be associated with chronic intermittent hypoxia due to OSA independent of BW changes.In those cases,adequate reoxygenation from effective CPAP therapy may improve NAFLD.

The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

Utilising continuous glucose monitoring for glycemic control in diabetic kidney disease

In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.

Analysis of the Effect of Continuous Nursing Care in Patients with COPD

Objective:to study the effect of continuous nursing intervention in patients with chronic obstructive pulmonary disease(COPD).Methods:In this paper,56 COPD patients were selected and grouped by drawing lots,with 28 cases in each group.The study group underwent continuous nursing intervention,while the control group underwent conventional care,and the parameters of both groups of patients were compared.Results:Compared with the control group,the patients in the study group had a significantly higher forced expiratory volume in one second to forced vital capacity ratio(FEV1/FVC),a significantly lower COPD Assessment Test(CAT)score,and Hamilton Depression(HAM-D)score,and a significantly higher 6-Minute Walk Test(6WMT)score after nursing care.Besides,their self-care ability score and SaO_(2)were significantly higher,while their PaCO_(2)and coagulation indexes were significantly lower(P<0.05).Conclusion:Continuous nursing intervention is beneficial for COPD patients.

Changes in Brachial and Central Blood Pressure after Short Term Continuous Positive Airway Pressure Treatment of Patients with Moderate-to-Severe Obstructive Sleep Apnoea and Impaired Renal Function

Background: Previous studies of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) have shown conflicting results on the effect on blood pressure (BP), and patients with chronic kidney disease (CKD) have not been included in these studies. As OSA is a frequent comorbidity in patients with CKD, it is of relevance to evaluate the effect of CPAP treatment on BP in this population. Aim: In this prospective follow-up study, we measured the effect of short term CPAP treatment of moderate-to-severe OSA on brachial and central BP, plasma level of syndecan-1 and vasoactive hormones, renal handling of sodium, subjective sleepiness, and quality of life in patients with impaired renal function. Methods: From December 2015 until March 2017, 25 patients were invited to participate in the study at the University Clinic in Nephrology and Hypertension, Aarhus University and Holstebro Hospital. At baseline and at follow-up after three to four months of CPAP treatment, we performed 24 h brachial and central ambulatory BP measurement, blood sampling measurements of plasma concentrations of syndecan-1, renin, angiotensin II, aldosterone, vasopressin, creatinine, haemoglobin A1c, and cholesterol, cardio respiratory monitoring, 24 h urine collection for measurement of urinary excretion of albumin, aquaporin-2, and epithelial sodium channel, Epworth Sleepiness Scale (ESS), and SF-36 (quality of life). Results: At follow-up, the 17 included patients with mean baseline estimated glomerular filtration rate 66 mL/min/1.73 m2 had a significant decrease in systolic office-, 24 h- and daytime-BP (13, 7, and 8 mmHg, respectively, p Conclusion: Short-term CPAP treatment of patients with moderate-to-severe OSA and reduced renal function decreased 24 h- and daytime-BP significantly and reduced urinary albumin excretion. Our results underline the importance of treatment of OSA in hypertensive patients with impaired renal function.

以互动达标理论为指导的延续性护理结合家属赋权理论干预对慢性萎缩性胃炎患者疾病自我管理能力及疾病感知压力的影响

目的探讨以互动达标理论为指导的延续性护理结合家属赋权理论干预对慢性萎缩性胃炎患者疾病自我管理能力及疾病感知压力的影响。方法选取2021年9月至2022年8月收治的90例慢性萎缩性胃炎患者为研究对象,按照随机数字表法将其分为对照组与观察组,各45例。对照组接受常规护理,观察组在对照组基础上接受以互动达标理论为指导的延续性护理结合家属赋权理论干预。比较两组的干预效果。结果干预后,观察组的疾病沟通能力、病情应急处理能力、服药管理能力、饮食管理能力评分高于对照组(P<0.05)。干预后,观察组的疾病感知压力程度优于对照组(P<0.05)。观察组的病情控制率高于对照组,病情复发率低于对照组(P<0.05)。结论以互动达标理论为指导的延续性护理结合家属赋权理论干预可提高慢性萎缩性胃炎患者的疾病自我管理能力,降低疾病感知压力,提高病情控制率,降低复发风险,值得在临床实践中推广及应用。

基于“醇正和缓”理论自拟方剂治疗脾肾气虚型慢性肾脏病2~3期的临床研究

目的探究基于“醇正和缓”理论自拟方剂治疗脾肾气虚型慢性肾脏病(CKD)2~3期的临床效果。方法选取江苏省常州市武进中医医院2021年11月至2023年4月收治的2~3期CKD患者88例,采用随机数字表法将其分成对照组和观察组,各44例。对照组予以复方α-酮酸片治疗,观察组予以复方α-酮酸片联合自拟方剂和缓养肾方治疗,两组均以2个月为1个疗程,共治疗2个疗程。比较两组疗效及用药安全性,比较两组治疗前后的中医症状、体征积分及肾小管、肾功能。结果观察组疗效优于对照组(P<0.05)。治疗后,两组中医症状、体征积分均低于治疗前,且观察组低于对照组(P<0.05)。治疗后,两组N-乙酰-β-D-葡萄糖苷酶、α_(1)-微球蛋白、β_(2)-微球蛋白、视黄醇结合蛋白、血尿素氮、血肌酐、血尿酸、半胱氨酸蛋白酶抑制剂C、24 h尿蛋白定量均低于治疗前,且观察组α_(1)-微球蛋白、视黄醇结合蛋白、血尿素氮、血肌酐、血尿酸、半胱氨酸蛋白酶抑制剂C、24 h尿蛋白定量均低于对照组(P<0.05)。两组治疗期间均未发生不良反应,两组治疗前后谷丙转氨酶、总胆红素比较,差异无统计学意义(P>0.05)。结论基于“醇正和缓”理论的自拟中药和缓养肾方用于2~3期CKD患者临床治疗,可明显提升效果,改善患者临床中医症状,提升肾小管功能,促进肾功能恢复,且用药安全可控。

慢性病延续性照护模式与政策引导双轨融合的研究

目的:构建并推广慢性病三元联动延续性照护模式,为慢性病防控相关政策的制定提供依据。方法:参照WHO慢性病创新照护模式,以“医院、社区、家庭”为三界面,以“信息、管理、关系”为核心关系,构建慢性病“医院-社区-家庭”三元联动延续性照护模式;通过优质护理资源向基层辐射、个案管理、“互联网+护理服务”、慢性病健康科普等促进机制破除模式运行壁垒;以慢性病单病种为例,基于“结构-过程-结局”构建脑卒中患者延续性护理质量评价指标体系,为规范慢性病延续性护理的有效落实提供评价工具。结果:通过模式的运行,引导了优质护理资源下沉、护士多点执业、社区护理中心建设、科普工作纳入职称考评等政策的制定;优化了医疗资源配置,提升了社区护理服务能力;改善了慢性病患者健康结局,提高了其自我管理能力。结论:慢性病“医院-社区-家庭”三元联动延续性照护模式的构建和运行在引导慢性病政策制定、优化医疗资源分配、提高社区护理能力和改善患者健康结局等方面发挥着重要作用,政府、医院、社区、家庭及患者须协同发力,真正实现慢性病患者出院后连续化、全程化的照护。

经方丹栀逍遥丸对代谢相关脂肪性肝病小鼠巨噬细胞抗慢炎状态的调节作用

目的 评价经方丹栀逍遥丸(JF-DZXYW)对代谢相关脂肪性肝病小鼠巨噬细胞抗慢性炎症的调控作用,对巨噬细胞吞噬能力、巨噬细胞表面标志物MHC-Ⅱ、CD86、CD80、TLR4表达及巨噬细胞内活性氧表达(ROS)的影响,并阐述其诱导免疫系统发挥抗炎症作用。方法 40只体质量18~22 g雄性昆明种小鼠,随机分为对照组(生理盐水组)、JF-DZXYW低剂量组(125μg/mL)、JF-DZXYW中剂量组(250μg/mL)和JF-DZXYW高剂量组(500μg/mL),灌胃0.4 mL/t/d,共15 d。第16天小鼠行腹腔注射0.2 mL 10%蛋白胨,3 d后小鼠腹腔注射新配制的5%鸡红细胞各0.5 mL,提取小鼠腹腔巨噬细胞进行巨噬细胞吞噬功能检测、细胞表面标志物流式细胞分析及ROS表达检测。结果 3个剂量组的JF-DZXYW汤剂吞噬百分率及吞噬指数均显著高于对照组(P<0.01)。JF-DZXYW低、中、高剂量组小鼠腹腔巨噬细胞表面标志物MHC-Ⅱ、CD86、CD80表达明显高于对照组(P<0.01),JF-DZXYW中、高剂量组小鼠腹腔巨噬细胞表面标志物TLR4表达均明显高于对照组(P<0.01)。JF-DZXYW低剂量组小鼠腹腔巨噬细胞内ROS表达明显高于对照组(P<0.05),JF-DZXYW中、高剂量组小鼠腹腔巨噬细胞内ROS表达均明显高于对照组(P<0.01)。结论 JF-DZXYW可以通过上调巨噬细胞功能、促巨噬细胞表面标志物MHC-Ⅱ、CD86、CD80、TLR4及巨噬细胞内活性氧表达提升机体免疫功能从而抑制慢性炎症状态。

基于态靶辨治理论诊疗慢性阻塞性肺疾病

慢性阻塞性肺疾病是常见的呼吸系统气道慢性病,严重影响患者的生活质量。传统的中医辨证论治体系存在对疾病的发生发展规律认识不足,对检查化验指标改善欠佳的问题。仝小林院士经过多年的临床实践,提出“态靶辨治”的现代中医诊疗体系,并将其用于慢性疾病临床诊疗过程中。基于此,以“态靶辨治”理论为指导,结合临床经验与现代药理学研究成果,将慢性阻塞性肺疾病发病过程分为“痰、阻、瘀、衰”四态(四期),每态下进行分证,并结合治疗靶点,确定各阶段相应的靶方靶药,构建慢性阻塞性肺疾病的态靶辨治体系,为提高该病的中医治疗效果提供新的路径。

持续气道正压通气依从性对慢阻肺-阻塞性睡眠呼吸暂停重叠综合征患者肺功能和急性加重的影响

目的观察持续气道正压通气(CPAP)依从性对阻塞性睡眠呼吸暂停(OSA)和慢性阻塞性肺疾病(简称慢阻肺)重叠综合征(OS)患者肺功能和急性加重的影响。方法选取2021年2月至2023年2月的OS患者80例,向其宣教良好遵守CPAP和日常正确使用装置的说明,≥70%的夜晚平均每晚使用CPAP≥4h者40例定义为依从性良好,纳入观察组,其余40例纳入对照组。比较两组治疗前后肺功能、血气参数、慢阻肺相关症状和急性加重情况。结果中位CPAP治疗时间观察组为5.5(4.6,6.7)h/夜,对照组为0.6(0,3.3)h/夜。治疗后观察组PaO 2、FEV 1预测值%、FVC预测值%、TLC预测值%、6MWT均高于治疗前及对照组治疗后,PaCO 2和HCO-3、RV/TLC、CAT和mMRC均低于治疗前及对照组治疗后。观察组治疗后12个月内急性加重和加重入院次数较前降低,且低于对照组治疗后。CPAP使用时间与慢阻肺加重次数呈负相关(r=-0.259,P=0.047)。CPAP依从性差的患者比依从性好的患者更易发生慢阻肺急性加重(β=0.362,95%CI:0.075~0.649,P=0.015)。结论CPAP依从性好的OS患者治疗期间慢阻肺急性加重次数较前减少,肺功能和慢阻肺相关症状有所改善。

和缓养肾方治疗慢性肾脏病2~3期患者的效果

目的探讨2~3期慢性肾脏病患者应用和缓养肾方治疗的效果及其对肾功能、肾小管功能的影响。方法选取2021年6月至2023年6月常州市武进中医医院88例2~3期慢性肾脏病患者为研究对象,将其按照电脑随机数字表分成两组。对照组44例给予常规治疗,观察组44例增加和缓养肾方治疗。治疗3个月后,对比两组患者临床疗效、肾功能、肾小管功能、不良反应。结果两组临床疗效比较(Z=3.112,P=0.002<0.05);且观察组总有效率95.45%高于对照组81.82%(χ^(2)=4.062,P=0.044<0.05)。治疗后,观察组胱抑素-C(CysC)水平(0.95±0.17)mg/L、血尿素氮(BUN)水平(5.42±0.98)mmol/L、血肌酐(Scr)水平(98.23±11.70)μmol/L,均低于对照组(1.23±0.28)mg/L、(7.31±1.39)mmol/L、(121.16±17.92)μmol/L(P<0.001)。治疗后,观察组N-乙酰β-D氨基葡萄糖苷酶(NAG)水平(16.72±3.58)U/L、α1-微球蛋白(α1-MG)水平(3.08±0.75)mg/L、β2-微球蛋白(β2-MG)水平(0.30±0.06)mg/L,均低于对照组(20.81±4.02)U/L、(4.12±0.96)mg/L、(0.36±0.08)mg/L(P<0.001)。两组治疗期间均未出现明显不良反应。结论和缓养肾方联合常规治疗能够有效改善2~3期慢性肾脏病患者肾功能及肾小管功能,提高治疗效果,且安全性高。

基于国医大师郭子光“人-症-病-证”体系探析慢性萎缩性胃炎临床辨治路径

慢性萎缩性胃炎(Chronic Atrophic Gastritis,CAG)中常见的肠上皮化生、异型增生属于胃癌前状态。中医在逆转肠上皮化生及异型增生方面具有治疗优势。笔者系国医大师郭子光教授学术传承人,在郭师学术思想指导下,初步提出基于“人-症-病-证”体系慢性萎缩性胃炎临床辨治路径。以病为纲,抓住CAG“脾气胃阴亏虚,湿热瘀阻胃络”的共性核心病机;兼顾个性,结合患者不同证型的个性病机。以“益气养阴,清热燥湿,和胃通络”为基本治则,创制了“益胃复萎”方这一验方,基于此方,分型分期加减论治。病证结合,最大化地优化临床疗效,更能发挥中医特色优势。

补肺息喘方结合常规西药治疗COPD稳定期(肺脾气虚证)患者的效果

目的探讨补肺息喘方结合常规西药治疗慢性阻塞性肺疾病(COPD)稳定期(肺脾气虚证)患者的效果及对肺功能和免疫功能的影响。方法本研究纳入2021年8月至2023年1月在河南大学第一附属医院就诊的100例COPD稳定期(肺脾气虚证)患者,以随机数字表法分成观察组和对照组。对照组接受乌美溴铵维兰特罗吸入粉雾剂治疗,观察组在此基础上联合补肺息喘方治疗,均治疗2个月。观察两组临床疗效、中医肺脾气虚证证候积分、COPD患者自我评估测试量表(CAT)评分、6 min步行测试(6MWT)、改良英国医学研究学会呼吸困难指数量表(mMRC)评分、肺功能指标[第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC]、免疫功能指标[CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)]水平和不良反应。结果治疗2个月后,观察组总有效率、6MWT、FEV_(1)、FVC、FEV_(1)/FVC、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05),肺脾气虚证证候积分、CAT评分、mMRC评分、CD8^(+)低于对照组(P<0.05),两组均未发生与治疗药物相关的不良反应事件。结论补肺息喘方结合常规西药治疗COPD稳定期(肺脾气虚证)的效果显著,能够有效缓解临床症状,减轻呼吸困难程度,提高活动耐力,改善机体免疫功能,安全有效。

传统体育养生融入社区慢病管理发展现状与动力考查

文章运用文献资料法和逻辑分析法,系统回顾和考察了传统体育养生在当代的发展情况及其融入社区慢病管理的动力因素,旨在为解决社区慢病管理面临的问题提供理论依据。研究发现:传统体育养生在学校体育和全民健身方面获得了稳定发展。作为一种非医疗健康干预手段,已逐渐成为社区、医疗、体育和养老等领域开展健康促进活动的重要途径。传统体育养生融入社区慢病管理具有国家政策扶持和自身技术内容的双重动力,展现出运动促进健康在居民健康管理和慢病防治方面的显著优势,并提出未来应加强与相关领域和部门的合作,深入探讨传统体育养生在社区慢病管理中的应用策略和效果评估,从而推动传统体育养生技术在体医、体卫融合领域的有效应用。

肾衰Ⅱ号方颗粒联合西医一体化方案治疗原发性慢性肾脏病3~4期患者临床疗效及对血清自噬相关蛋白的影响

目的观察肾衰Ⅱ号方颗粒联合西医一体化方案治疗原发性慢性肾脏病(CKD)3~4期脾肾气虚证、湿浊瘀阻证患者临床疗效及对血清自噬相关蛋白的影响。方法采用随机数字表法将88例患者分为治疗组、对照组各44例。2组均予西医一体化方案治疗,治疗组在此基础上予肾衰Ⅱ号方颗粒,对照组予肾衰Ⅱ号方免煎安慰剂,每次1袋,每日2次,口服。2组均连续治疗24周。观察2组临床疗效,比较2组治疗前后中医症状评分、血肌酐(Scr)、血尿素氮(BUN)、尿酸(UA)、血钙(Ca^(2+))、血磷(P^(3-))、甲状旁腺激素(PTH)、24 h尿蛋白定量(24 UPro)水平;ELISA法检测2组治疗前后血清自噬相关蛋白Beclin-1、Atg7、LC3-Ⅱ水平;监测2组安全性指标。结果治疗过程中治疗组、对照组各脱落4例。治疗组总有效率为55%(22/40),对照组为30%(12/40),治疗组疗效优于对照组(P<0.01)。与本组治疗前比较,治疗组治疗后各项中医症状评分降低(P<0.01),Scr、BUN、UA、P3-、PTH和24 UPro水平下降(P<0.05,P<0.01),肾小球滤过率(e GFR)上升(P<0.01),对照组治疗后Scr上升(P<0.05),eGFR下降(P<0.01);2组治疗后比较,治疗组各项中医症状评分、Scr、BUN、UA、P^(3-)、PTH和24 UPro水平低于对照组(P<0.01,P<0.05),eGFR高于对照组(P<0.01)。与本组治疗前比较,治疗组治疗后血清Beclin-1、Atg7、LC3-Ⅱ水平上升(P<0.01,P<0.05),对照组治疗后血清Beclin-1水平下降(P<0.01);2组治疗后比较,治疗组上述指标改善均优于对照组(P<0.01,P<0.05)。相关性分析显示,Beclin-1、Atg7、LC3-Ⅱ与Scr、BUN呈负相关(P<0.05),与eGFR呈正相关(P<0.05)。2组治疗过程中均未见明显不良反应。结论肾衰Ⅱ号方颗粒联合西医一体化方案治疗原发性CKD 3~4期脾肾气虚证、湿浊瘀阻证患者疗效显著,可有效减轻临床症状,改善肾功能,延缓CKD进展,其作用机制可能与改善肾脏自噬水平有关。

简版患者延续性护理评估问卷的汉化及其在慢性病患者中的信效度检验

目的汉化简版患者延续性护理评估问卷(patient continuity of care questionnaire,PCCQ-12),并在慢性病患者中检验其信效度,以期为慢性病住院患者出院后延续性护理的评估提供可靠工具。方法按照Brislin翻译模型进行问卷的正译、回译及文化调适,形成中文版PCCQ-12。2023年12月至2024年3月,于河南省郑州市某三级甲等医院招募202例调查对象,对问卷的信效度进行检验。结果中文版PCCQ-12共12个条目,条目内容效度指数为0.833~1.000,问卷内容效度指数为0.917;问卷总分与简式健康相关生活质量问卷的生理健康总评分、心理健康总评分的相关系数分别为0.197、0.583(均P<0.01);方差分析结果显示不同性别、文化程度的得分差异有统计学意义(均P<0.05)。中文版PCCQ-12的Cronbach’sα系数为0.853,重测信度为0.912。结论中文版PCCQ-12具有良好的信效度,可作为评估慢性病住院患者出院后延续性护理看法的可靠工具。

肾功能不全患者处方审核规则的优化与实践

目的:构建我院肾功能不全患者处方审核规则库,提高处方审核系统适用性,保障患者合理用药。方法:通过引入定量评价指标,优化患者肾功能评估流程,从剂量调整和药物选择两方面细化相关审核规则,对比优化前后系统规则的适宜性与临床认可度。结果:优化后,系统规则的假阳性率和假阴性率均下降(P<0.05),系统审核后医生修改率提高(P<0.05)。结论:通过处方审核规则库的二次构建,可以有效提高审方系统的临床契合度,在保障患者合理用药的同时有利于处方审核工作的可持续开展。