Donabedian模型在护理质量评价中的应用研究进展

综述了Donabedian模型的基本内涵、Donabedian模型在护理质量评价中的应用情况,并结合我国的实际情况,对今后护理质量的持续改进如何进一步研究给出建议,为建立更加科学严谨的护理质量持续改进策略提供参考依据。     

乳腺癌患者术后早期功能锻炼的研究进展

正乳腺癌是女性最常见的恶性肿瘤之一。乳房根治术或改良根治术自19世纪末一直是乳腺癌主要的治疗方法~([1])。手术会破坏患肢正常的血液循环、淋巴循环和肌肉,导致不同程度的上肢功能障碍,肩部僵硬,肌肉萎缩和肢体水肿,导致日常活动能力的降低~([2-3])。术后早期合理的功能锻炼在恢复患肢功能、防止废用性肌肉萎缩以及关节强直中发挥着重要作用~([4])。目前,临床关于早期功能锻炼的定义、时间、内容、评价等     

治咳枇杷露的质量标准研究

目的：对治咳枇杷露的质量标准进行研究,提高质量控制水平。方法采用薄层色谱法对枇杷叶、薄荷脑、桔梗进行鉴别,采用气相色谱法测定薄荷脑的含量。结果枇杷叶、薄荷脑、桔梗的薄层色谱斑点清晰,分离度好,专属性强,阴性无干扰;薄荷脑的线性范围为0．4008～2．4050μg（r＝0．9999）,平均加样回收率为99．4％（n＝6）,RSD＝0．19％。结论优化后的质量标准方法易行、准确可靠,可用于治咳枇杷露的质量控制。     

贵州省地方性氟中毒地区人群GSTP1基因Ile105Val位点多态性分析

Objective To investigate plasma glutathione S-transferase(GSTs) activity and GSTP1 gene Ile105Val polymorphism in Bijie City, Guizhou Province, a coal-burning fluorosis endemic area. Methods One hundred and sixty villagers from Yachi Twon using non-improved cooking stoves were selected as the non-intervened group in Bijie City, Guizhou Province where coal-burning fluorosis was prevailing; 153 villagers as the intervented group were chosen from Changchun Twon, where cooking stoves were improved; 151 villagers were served as the control group from Baiyunshan Twon, Changshun County without endemic fluorosis. The activity of GSTs was tested by colorimetric analysis with spectrophotometer. The genotype of the GSTP1 gene Ile105Val polymorphism, presenting as either homozygous wild-type (AA), or heterozygous mutation type (AG), or homozygous mutation type (GG), was detected through the PCR-RFLP procedure. Results The activity of GSTs in plasma of non-intervened group [(12.44±4.97) kU/L]was significantly lower than that of intervened group (P < 0.05), and that of intervened group[(20.78±6.20)kU/L]was significantly lower than that of control group[(24.30±6.27)kU/L, P< 0.05]. The difference of the enzyme activity of three groups were statistically significant (F = 51.71, P < 0.05), but this enzyme activity did not vary significantly in each sex of each grnup(P > 0.05). Compared intervened group [AA:67.3%(103/153), AG:29.4%(45/153),GG:3.3%(5/153)]and non-intervened group[AA:66.9%(107/160), AG:30%(48/160), GG:3.1%(5/160)]with control group[AA:74.8%(113/151), AG:25.2%(38/151), GG:0 (0/151)], the Ile105Val polymorphism site of GSTP1 gene had significant difference(χ2= 6.04,6.07, both P< 0.05), but not significant between intervened and non-intervened groups(χ2 = 0.02, P>0.05). Conclusions Fluorosis can decrease the activity of GSTs and introduce the GSTP1 gene Ile105Val polymorphism, intervention with the fluorine intake will improve the effect of fluoride on the body.     

贵州省地方性氟中毒地区人群GSTP1基因Ile105Val位点多态性分析

Objective To investigate plasma glutathione S-transferase(GSTs) activity and GSTP1 gene Ile105Val polymorphism in Bijie City, Guizhou Province, a coal-burning fluorosis endemic area. Methods One hundred and sixty villagers from Yachi Twon using non-improved cooking stoves were selected as the non-intervened group in Bijie City, Guizhou Province where coal-burning fluorosis was prevailing; 153 villagers as the intervented group were chosen from Changchun Twon, where cooking stoves were improved; 151 villagers were served as the control group from Baiyunshan Twon, Changshun County without endemic fluorosis. The activity of GSTs was tested by colorimetric analysis with spectrophotometer. The genotype of the GSTP1 gene Ile105Val polymorphism, presenting as either homozygous wild-type (AA), or heterozygous mutation type (AG), or homozygous mutation type (GG), was detected through the PCR-RFLP procedure. Results The activity of GSTs in plasma of non-intervened group [(12.44±4.97) kU/L]was significantly lower than that of intervened group (P < 0.05), and that of intervened group[(20.78±6.20)kU/L]was significantly lower than that of control group[(24.30±6.27)kU/L, P< 0.05]. The difference of the enzyme activity of three groups were statistically significant (F = 51.71, P < 0.05), but this enzyme activity did not vary significantly in each sex of each grnup(P > 0.05). Compared intervened group [AA:67.3%(103/153), AG:29.4%(45/153),GG:3.3%(5/153)]and non-intervened group[AA:66.9%(107/160), AG:30%(48/160), GG:3.1%(5/160)]with control group[AA:74.8%(113/151), AG:25.2%(38/151), GG:0 (0/151)], the Ile105Val polymorphism site of GSTP1 gene had significant difference(χ2= 6.04,6.07, both P< 0.05), but not significant between intervened and non-intervened groups(χ2 = 0.02, P>0.05). Conclusions Fluorosis can decrease the activity of GSTs and introduce the GSTP1 gene Ile105Val polymorphism, intervention with the fluorine intake will improve the effect of fluoride on the body.     

急诊优化护理对急性心肌梗死患者预后的影响

目的探讨急诊优化护理对急性心肌梗死患者预后的影响。方法选择2014年11月至2018年11月我院收治的急性心肌梗死患者178例,随机等分为观察组和对照组,对照组患者给予常规的急诊护理,观察组患者给予急诊优化护理。比较两组患者从急诊就诊到确诊时间(T1)、急诊就诊到治疗时间(T2)、住院时间、临床疗效、复发率、SAS评分、满意度评分和并发症发生率。结果观察组患者T1、T2、住院时间短于对照组(P0.05),SAS评分、并发症发生率、复发率、病死率均低于对照组(P0.05),临床疗效及患者对护理人员的满意度评分均高于对照组(P0.05)。结论在急性心肌梗死患者的抢救中优化急诊护理可明显缩短分诊评估时间、急救时间和住院时间,提高临床疗效,改善患者的心理状态和预后,提高患者对护理人员的满意度。     

硬脊膜外腔阻滞复合全身麻醉对髋关节骨折术后认知功能的影响

目的探讨硬脊膜外腔阻滞复合全身麻醉在髋关节骨折手术中的应用价值及对患者术后认知功能的影响。方法选取82例髋关节骨折患者为研究对象,行内固定手术或髋关节置换术治疗,以随机数字表法分为对照组41例,观察组41例。对照组采用气管插管全身麻醉,观察组采用硬脊膜外腔阻滞复合气管插管全身麻醉,记录两组麻醉前15 min(T_0)、麻醉即刻(T_1)、麻醉后30 min(T_2)、术后30 min(T_3)平均动脉压(MAP)及心率(HR);观察两组患者围术期血流动力学变化,术后认知功能及不良反应发生率。结果两组T_0、T_3时HR、MAP比较,差异无统计学意义(P0.05);T_1、T_2时,观察组HR、MAP与对照组比较,差异有统计学意义(P0.05);对照组T_1、T_2时HR、MAP与T_0、T_3时对比,差异有统计学意义(P0.05);两组认知功能术后1 h时,差异无统计学意义(P0.05),术后4 h、术后8 h,观察组蒙特利尔认知评估量表(Mo CA)评分同对照组比较,明显较高,差异有统计学意义(P0.05);术后不良反应发生率观察组为12.20%,同对照组17.07%比较,差异无统计学意义(P0.05),均未出现严重不良反应。结论硬脊膜外腔阻滞复合全身麻醉利于患者术中血流动力稳定,安全性高,且对术后认知功能影响小。     

多学科协作干预应用于预防老年人围术期肺部感染的可行性探讨

预防围术期老年人肺部感染是当前临床医务工作者一项艰巨的课题,本文综述了多学科协作（MDT）干预在预防围术期老年人肺部感染中的可行性和有效性,认为MDT可以使患者在医院得到系统、规范的治疗,减少医疗费用,促进病情较快康复。MDT模式应用于老年人围术期肺部感染的预控,一方面有MDT在其它专科领域应用的成功经验,另一方面,老年人群的特殊性以及所经历的围术期高危风险等因素决定了实施MDT干预方案的紧迫性和必要性。因此,合理组建MDT专业团队,有效构建MDT组织结构和角色定位,优化制定MDT运行程序,个性化实施MDT干预模式,是预防和治疗老年人围术期肺部感染的保证。     

实境横断面培训考核对低年资护士能力提升的影响

目的探讨实境横断面培训考核对低年资护士业务能力提升的影响。方法便利抽样法选择2016年7月至2017年7月苏州市中西医结合医院的60名新入职护士为研究对象,按随机数字表法将其分为对照组和观察组各30名,分别采用护理程序培训考核法、实境横断面培训考核法,评价并比较两组护士的理论知识、临床护理质量、临床综合能力及护士核心能力。结果观察组护士的理论知识、床边考核、护理质量、核心能力方面的得分均优于对照组护士,差异均有统计学意义(均P0.05)。结论采用实境横断面培训考核法有利于提升低年资护士的业务能力。     

语言沟通联合心理护理在精神病患者护理中的应用

目的:探究语言沟通及心理护理在精神患者日常护理中的应用效果。方法:选取精神患者66例,依照随机抽样方式分为常规组与联合组,每组各33例。常规组患者采用基本常规护理,联合组患者则在常规护理基础上采用语言及心理护理。结果:联合组患者护理效果明显好于常规组,差异明显,具有统计学意义,(P<0.05)。结论:对精神患者实施语言及心理联合护理,能够有效引导其心理状态趋于健康方向,有助于消除患者负面情绪,促进身心尽快恢复。