1.Application of psychological intervention and rehabilitation training in patients with cerebral hemorrhage during postoperative recovery stage
Yan YUAN ; Decui LI ; Yuxia WANG
Chinese Journal of Practical Nursing 2012;28(12):1-3
ObjectiveTo investigate the effect of psychological intervention and rehabilitation training on self-care ability and quality of life in patients with cerebral hemorrhage during postoperative recovery stage. Methods180 patients with cerebral hemorrhage in our hospital from October 2008 to December 2010 were randomly divided into the observation group and the control group with 90 cases in each group.The control group was given with routine care and rehabilitation measures.The observation group adopted psychological intervention and rehabilitation training based on the routine care.After treatment,the functional independence measure (FIM)and the quality of life index (QLI)were used for the evaluation of the level of quality of life and self-care ability. ResultsIn the quality of life index,the QLI score after treatment in the observation group improved significantly compared with that before treat ment.The QLI score in the control group before and after treatment showed no statistical difference.In the self-care ability,FIM score after treatment in both of the two groups improved significantly than that before.And FIM score after treatment in the observation group was significantly higher than that of the control group. ConclusionsApplication of psychological intervention and rebabilitation training in patients with cerebral hemorrhage during postoperative recovery stage shows pivotal importance.It can improve self-care ability and quality of life of patients and promote recovery effectively.
2.Role of thromboelastography in assessing the risk of spontaneous bleeding in patients with liver cirrhosis
Decui PEI ; Sisi WEN ; Haichun HU ; Xiuxia ZHENG ; Linfei LI ; Jiewen DENG
Journal of Clinical Hepatology 2021;37(7):1582-1588.
ObjectiveTo investigate the association between thromboelastography (TEG) parameters and bleeding in patients with liver cirrhosis and whether TEG can be used to predict the risk of spontaneous bleeding in patients with liver cirrhosis, and to provide a basis for its preventive treatment. MethodsA retrospective analysis was performed for the clinical data of 174 patients with liver cirrhosis who attended Huadu People’s Hospital from May 2018 to April 2020 and did not receive invasive procedure, and according to the condition of bleeding, they were divided into non-bleeding group(n=64), gastrointestinal bleeding group(n=61), and mucocutaneous/oronasal bleeding group(n=49). The medical record system and laboratory information system were used to collect related information and laboratory test results for statistical analysis. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. MedCalc software was used for receiver operating characteristic (ROC) curve analysis, and the area under the ROC curve (AUC) was calculated for commonly used coagulation markers and TEG parameters in predicting the risk of bleeding in patients with liver cirrhosis. Cut-off value, sensitivity, specificity, positive predictive value, and negative predictive value were determined, and the Z test was used for comparison of indices in predicting mucocutaneous/oronasal bleeding. ResultsOf all 174 patients, 110 (63.2%) experienced spontaneous bleeding, among whom 61 (55.5%) had gastrointestinal bleeding and 49 (44.5%) had mucocutaneous/oronasal bleeding. There were significant differences in maximum amplitude (MA) and K between the bleeding group and the non-bleeding group (t=2.241 and -2.605, both P<0.05). There were significant differences between the mucocutaneous/oronasal bleeding group and the non-bleeding/gastrointestinal bleeding groups in platelet count (PLT) and the TEG parameters of clot formation time, a-angle, MA, and coagulation index (CI) (F=3.947, H=12.867, F=4.007, F=8.498, F=5.420, all P<0.05). Among the TEG parameters, reaction time and Lys30 were generally within the normal range, while there was a prolonged kinetics (K) time and reductions in a-angle, MA, and CI. PLT ≤40×109/L, MA ≤357 mm, K time >4.2 minutes, a-angle ≤51.6, and CI ≤-5.9 could be used to predict spontaneous mucocutaneous/oronasal bleeding in patients with liver cirrhosis (all AUC >0.7), with positive predictive values of 82.4, 88.9, 81.0, 72.7, and 73.7, respectively, and negative predictive values of 68.3, 72.5, 73.0, 69.4, and 66.7, respectively. ConclusionPLT and the TEG parameters of K time, a-angle, MA, and CI can predict spontaneous bleeding caused by abnormal coagulation in liver cirrhosis, while conventional coagulation parameters prothrombin time and activated partial thromboplastin time cannot predict such bleeding, which provides a basis for the treatment of coagulation disorder and transfusion of blood components for patients with liver cirrhosis.