儿科急诊危重患儿家属对复苏陪伴的态度及相关因素研究

目的:调查急诊危重患儿家属对复苏陪伴的态度和相关影响因素。方法:横断面研究纳入297名急诊危重症患儿家属,采用中文(家属版)复苏时家属在场利弊衡量表进行调查,分析量表总分、利益风险项得分、对各条目认同度和不同认同态度的相关因素。结果:287名(96.6%)家属支持复苏陪伴。不同性别、学历、家庭收入、患儿病程、病情危急程度家属量表总分比较差异无统计学意义(P>0.05),有无复苏经历家属量表总分比较差异有统计学意义(P=0.032)。结论:绝大多数家属赞同复苏陪伴,但对利益及风险相关条目的认同度有明显的倾向性。     

白血病患儿父母照顾能力及其影响因素分析

目的探讨白血病患儿父母照顾能力现状及其影响因素。方法2018年5月至2019年6月,便利抽样法选取某三级甲等儿童医院血液科白血病患儿父母116例为研究对象,采用一般资料调查表、恶性血液病家庭照顾者照顾能力量表、中文版癌症患者照顾者支持性照护需求量表、一般自我效能感量表、医学应对方式问卷、领悟社会支持评定量表、焦虑自评量表对其进行调查。结果父母照顾能力总分为(49.53±15.08)分,疾病认知能力为(7.28±2.57)分,基础照护技能为(5.28±2.18)分,按需照护技能为(9.75±3.80)分,情感管理能力为(8.38±2.38)分,寻求利用支持的能力为(7.44±2.74)分,平衡照顾需求与个人需求能力为(11.41±4.72)分。父母照顾能力各维度的影响因素主要包括其自身文化程度、婚姻状况、共同照顾者数量、患儿年龄、父母日常生活需求、沟通人际需求、经济需求、一般自我效能感、应对方式、焦虑等(均P<0.05)。结论白血病患儿父母照顾能力有待提升,应基于照护能力影响因素给予针对性干预。     

父母陪伴麻醉复苏对小儿全麻苏醒期恢复的影响

探讨父母陪伴麻醉复苏对小儿全麻苏醒期恢复的影响。方法：选择需行全麻择期手术患儿60例,随机分为观察组和对照组各30例,观察组为患儿术后家长进麻醉复苏室陪同,对照组无家长陪同。观察两组患儿苏醒前后血压、脉搏变化和患儿苏醒后躁动评分及两组家长的心理状态评估。结果：对照组比观察组患儿在复苏期血压及脉搏显著增高,苏醒后躁动发生率观察组低于对照组,观察组家长的情绪反应和满意度明显优于对照组,P〈0．05。结论：父母陪伴麻醉复苏不仅减轻患儿苏醒期的燥动,还减轻了家长的焦虑度,提高了患儿及其家长的满意度。     

儿科护士对患儿家长参与患儿安全的态度及其影响因素

目的调查儿科护士对患儿家长参与患儿安全的态度,并分析其影响因素。方法 2018年7-12月,便利抽样法抽取某省16所医院儿科护士(N=1136)为研究对象。采用一般资料问卷及儿科护士对患儿家长参与患儿安全的态度问卷对其进行调查。结果儿科护士对患儿家长参与患儿安全态度的标准总分为(84.18±11.00)分,各维度标准分从高到低依次为对患儿家长主动告知患儿诊疗情况的态度、对患儿家长主动询问患儿诊疗情况的态度、对患儿家长参与患儿安全利弊的态度、对患儿家长参与患儿医疗活动监督的态度。不同年龄、工作年限、职称、编制、医院级别的儿科护士,对患儿家长参与患儿安全态度的得分差异均有统计学意义(均P0.05)。多元线性回归分析显示,职称、医院级别、年龄是影响儿科护士对患儿家长参与患儿安全态度的影响因素(均P0.05)。结论儿科护士对患儿家长参与患儿安全的态度处于高水平,但因情况而异;应有针对性地采取有效的干预措施,以提高儿科护士对患儿家长参与患儿安全的支持程度。     

父母陪伴对全身麻醉术后恢复期患儿苏醒质量的影响

目的 探讨父母陪伴对全身麻醉术后恢复期患儿术后躁动、术后疼痛及苏醒质量的影响。方法 将211例全身麻醉术后恢复期的患儿随机分为对照组和干预组,对照组113例实施传统常规护理,干预组98例在接受常规护理的基础上介入父母陪伴,比较2组Riker镇静-躁动指标、表情-肢体-行为-哭闹-可安慰(FLACC)疼痛指标以及Steward苏醒指标。结果 2组全身麻醉术后患儿的基本临床信息与人口学资料差异无统计学意义(P>0.05); 2组全身麻醉术后患儿的Riker镇静-躁动评分在时间效应、组间效应以及二者的交互效应中差异均有统计学意义(P<0.05); 2组全身麻醉术后患儿的FLACC疼痛指标评分在时间主效应上差异均有统计学意义(P<0.05);相较对照组,干预组患儿在苏醒程度总分以及气道顺畅评分上提高,差异具有统计学意义(P<0.05)。结论 较之于传统的术后护理,全身麻醉术后恢复期患儿进行父母陪伴护理,虽然不能缓解患儿的术后疼痛,但能够有效减轻患儿术后躁动,提高患儿的苏醒程度。     

糖尿病病人糖尿病态度及其影响因素分析

[目的]调查糖尿病病人的糖尿病态度并分析其影响因素。[方法]应用一般情况调查表、中文版第三版糖尿病态度量表(DAS-3)对650例糖尿病病人进行问卷调查。[结果]糖尿病病人糖尿病态度总得分为(118.00±10.28)分;回归分析显示,病程、月收入、职业、吸烟、饮酒是糖尿病病人糖尿病态度的影响因素。[结论]糖尿病病人糖尿病态度呈中等水平,在糖尿病教育者专业培训中应开设交流技巧课程和心理干预课程;在糖尿病教育中应注重提高糖尿病病人严格控制血糖的意识和能动性、自觉性;糖尿病教育者应以不同的影响因素为基础,制定有针对性的措施,促使糖尿病病人形成积极稳定的糖尿病态度,从而提高糖尿病教育效果。     

初诊淋巴瘤患儿父母照护知识和态度现状及影响因素

目的:调查初诊淋巴瘤患儿父母照护知识和态度现状,并分析其影响因素.方法:采用自行设计的问卷于2019年3月—2020年2月采用便利抽样,以医院收治的初诊淋巴瘤患儿父母为调查对象.结果:共回收有效问卷231份.初诊淋巴瘤患儿父母照护知识得分为3～20(10.56±3.46)分.多因素分析显示,家庭所在地、教育程度、与患儿关系、患儿治疗时间为初诊淋巴瘤患儿父母照护知识的影响因素(F=23.014,P<0.001).初诊淋巴瘤患儿父母照护态度得分为17～40(28.56±8.57)分,多因素分析显示,家庭所在地、教育程度、与患儿关系、患儿治疗时间为初诊淋巴瘤患儿父母照护态度的影响因素(F=19.631,P<0.001).结论:初诊淋巴瘤患儿父母照护态度较为积极,然而照护知识仍待提高.不同特征的父母照护知识和态度存在较大差异,护理人员应引起重视.     

西部地区某三级甲等医院住院患者陪伴现状及其影响因素

目的了解西部地区某三级甲等医院住院患者的陪伴现状,分析影响住院陪伴的因素。方法 2010年,采用自行设计的问卷,对四川省某医学院附属医院的住院患者进行非等比随机抽样调查1个月,统计患者的陪伴人数,并采用秩相关分析或成组设计秩和检验分析陪伴人数的影响因素。结果患者陪伴人员以亲戚朋友为主(占73%),陪伴率为77.4%,全天陪伴率为59.0%。每个患者每日的平均陪伴人数为(1.03±0.781)名。患者的婚姻、医保方式、年龄、活动度、居住地到医院的距离以及护理级别对住院患者陪伴人数的影响差异均有统计学意义(均P<0.01),而性别、病情对陪伴人数的影响差异无统计学意义(P>0.05)。结论该医院住院患者的陪伴率高,影响患者陪伴人数的因素较多。     

父母陪伴式麻醉诱导对学龄前手术患儿术前焦虑及麻醉诱导配合度的影响

目的 探讨父母陪伴式麻醉诱导对学龄前手术患儿术前焦虑及麻醉诱导配合度的影响。方法 采用历史对照设计匹配纳入武汉市某三级甲等医院进行手术治疗的101例患儿为研究对象,其中陪伴组50例和对照组51例。陪伴组进行父母陪伴式麻醉诱导,包括父母术前麻醉诱导陪伴宣教和家庭参与式陪伴;对照组按常规由医护人员抚慰患儿。采用协方差分析比较2组手术当日在术前等待间10 min（T₁）和麻醉诱导时（T₂）时的焦虑水平及T₂时麻醉诱导配合程度。结果 2组患儿的基线特征除了手术台次外均具有可比性,在T₁时刻,2组焦虑均上升,2组调整前、调整后差异均无统计意义（P>0.05）。在T₂时刻,2组焦虑进一步上升,组间调整后差异为11.03（95%CI：2.06~20.00）,差异有统计意义（P=0.02）。陪伴组在T₂时麻醉诱导得分为1.04,对照组2.09,调整后差异为0.96（95%CI：0.12~1.78,P=0.03）。结论 父母陪伴式麻醉诱导可降低学龄前手术患儿的术前焦虑,提高手术患儿麻醉诱导合作度,可为下一步构建标准化父母陪伴式麻醉诱导方案提供依据。     

危重患者鼻肠管盲插成功率的影响因素分析*

目的: 分析重症患者盲插鼻肠管成功率的影响因素。方法: 收集2018至2019年应用盲插法行鼻肠管置入的危重症患者,收集其急性生理学与慢性健康状况评分Ⅱ（APACHE Ⅱ）、序贯器官衰竭评分（SOFA）、格拉斯哥昏迷评分（GCS）、Ricker镇静躁动评分（SAS）、血糖、血钾、住院时间、肠鸣音情况、是否有人工气道、是否应用镇静镇痛药物、是否应用血管活性药物、是否手术、是否应用促胃动力药物、是否应用亚低温疗法、是否使用呼吸机以及一般资料,应用Logistic回归分析其影响因素。结果: 共收集鼻肠管盲插置入的危重患者156例,132例患者成功置入鼻肠管（84.6%）,平均置管用时为（15.1±9.4）min。APACHE Ⅱ评分≥20分、使用呼吸机是置管成功的危险因素;有肠鸣音是置管成功的保护因素。结论: 影响危重患者盲插鼻肠管的因素除自身疾病因素外,药物及治疗干预均可能影响置管,医护人员应尽早评估,早期留置合适的喂养管。     

神经外科危重症患者并发下呼吸道感染的高危因素分析及护理对策

目的 探讨研究神经外科危重症患者并发下呼吸道感染的高危因素及护理对策.方法 选取2007年1月至2011年9月进行治疗的672例神经外科危重症患者为研究对象,针对其下呼吸道感染发生率及发生的高危因素进行研究分析,并对其采用针对性的护理方法进行护理.结果 672例患者中发生下呼吸道感染54例,发生率为8.04％.中老年患者、营养较差者、合并基础疾病者感染发生率高于其他患者;接受侵袭性操作者、吸痰者、应用呼吸机者、手术及吸氧时间较长者下呼吸道感染的发生率高于其他患者;住院时间较长者、急诊手术者、应用多种抗生素者及术前合并其他感染者下呼吸道感染的发生率高于其他患者,差异均有统计学意义.54例发生下呼吸道感染的神经外科危重症患者经针对性的治疗护理,感染得到有效控制(4例死于原发疾病).结论 神经外科危重症患者并发下呼吸道感染的高危因素包括个人身体条件、治疗性操作及其他多种因素,配合针对性的治疗护理可得到有效控制.     

白血病患儿父母健康促进生活方式调查及影响因素分析

目的:探讨白血病患儿父母健康促进生活方式水平及其主要影响因素,为提升白血病患儿父母健康促进生活方式提供参考依据。方法:采取便利抽样方法,选取2019年9月—2020年7月于河南3家医院就诊的375名白血病患儿父母作为研究对象,采用一般资料调查表、健康促进生活方式量表-Ⅱ对其进行调查,采用单因素和多重线性回归分析白血病患...     

贵阳市2014-2018年危重孕产妇影响因素的Logistic分析

目的:分析贵阳市2014-2018年危重孕产妇监测结果,了解危重孕产妇的发生情况及相关影响因素,为降低危重孕产妇发生率提供科学依据.方法:选取2014年1月1日至2018年12月31日贵阳市4家孕产妇监测医院产科入院(若妇产科未分开则为妇产科入院或分娩)的孕产妇病例资料进行研究;采用多因素Logistic回归分析危重孕...     

重症监护室危重患者气管切开肺部感染的危险因素分析及护理对策

目的 分析重症监护室危重患者气管切开肺部感染的危险因素,探讨防止院内肺部感染的护理方法.方法 回顾性分析我院2008年3月至2010年3月ICU出现的94例行气管切开后肺部感染患者的临床资料,将其作为观察组,选取同期行气管切开而未发生肺部感染的100例患者作为对照组,统计2组患者的基础情况、诊治护理方法、环境等情况,对比分析气管切开肺部感染的高危因素,总结重症监护室危重患者气管切开后防止肺部感染的护理方法及要点.结果 呼吸系统疾病、有吸烟史、护理人员年资低、长期使用大量抗生素、应用H2受体阻滞剂及制酸剂、多人同处一间病房等是重症监护室危重患者气管切开肺部感染的高危因素.结论 重症监护室危重患者气管切开后肺部感染受多种因素影响,实际操作过程中,应针对性的避免导致感染发生的治疗护理因素、环境因素,尤其对呼吸系统疾病患者应加强肺部感染的防控.     

Lactate measurements in critically ill patients with a hand-held analyser

Objective: To compare a recently introduced hand-held lactate analyser to a reference point of care analyser (POCI) and the hospital laboratory in a critical care setting. Setting: 10-bed surgical/medical intensive care unit in a teaching hospital. Patients and methods: In 39 critically ill patients, 50 convenience measurement cycles consisting of three paired measurements at 30-min intervals were carried out with a hand-held analyser, reference POCI and hospital laboratory using arterial blood samples. Duplicate measurements with the hand-held analyser were done in 129 blood samples. Results: Lactate levels ranged from 1.1 to 21.0 mmol/l. Regression analysis of the hand-held analyser and laboratory showed a slope of 1.01, bias of –0.38 mmol/l, R ² = 0.97 and mean error of 14.9 %. Reference POCI versus laboratory: slope = 1.07, bias = –0.29 mmol/l, R ² = 0.98 and mean error of 6.4 %. Hand-held analyser versus reference POCI: slope = 0.90, bias = 0.09 mmol/l and R ² = 0.92. The hand-held analyser showed acceptable precision. Conclusion: The hand-held lactate analyser can reliably measure arterial blood lactate levels in critically ill patients. Received: 19 January 1999 Accepted: 18 June 1999     

Identification of factors affecting meropenem pharmacokinetics in critically ill patients: Impact of inflammation on clearance

IntroductionThe purpose of this study was to explore factors influencing meropenem pharmacokinetics (PKs) in critically ill patients by developing a population PK model and to determine the optimal dosing strategy.MethodsThis prospective observational study involved 12 critically ill patients admitted to the intensive care unit and treated with meropenem 1 g infused over 1 h every 8 h. Blood samples were collected on days 1, 2, and 5 immediately prior to dosing, and at 1, 2, 4, and 6 h after the start of infusion. Population PK parameters were estimated using nonlinear mixed-effects model software.ResultsMeropenem PK was adequately described using a two-compartment model. Typical values of total and inter-compartmental clearance were 9.30 L/h and 9.70 L/h, respectively, and the central and peripheral compartment volumes of distribution were 12.61 L and 7.80 L, respectively. C-reactive protein (CRP) was identified as significant covariate affecting total meropenem clearance. The probability of target attainment (PTA) predicted by Monte Carlo simulations varied according to the patients’ CRP. The PTA of 100% time above the minimum inhibitory concentration ≤2 mg/L for bacteria was achieved after a dose of 1 and 2 g infused over 4 h every 8 h in patients with CRP of 30 and 5 mg/dL, respectively.ConclusionThe findings of this study suggest that CRP might be helpful in managing meropenem dosing in critically ill patients. Higher doses and extended infusion may be required to achieve optimal pharmacodynamic targets.     

Clinical and pathologic characteristics of pancreatic necrosis in critically ill children

BACKGROUND: Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis.METHODS: We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children’s Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed.RESULTS: The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein (CRP). B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis (AHNP); children 3-5 died of multiple organ dysfunction syndrome (MODS) due to pancreatic necrosis.CONCLUSION: Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.     

Danish parents' experiences when their new born or critically ill small child is transferred to the PICU-a qualitative study

The aim of this study was to describe Danish parents' experiences when their newborn or small child was critically ill. Thirteen parents were interviewed. Data were analysed using qualitative content analysis. The child's transfer to the paediatric intensive care unit (PICU) meant either help or death for the parents. The back transfer was experienced as joy and despair. The parents had confidence in most nurses, and they were kind, helpful, informative and capable. Less capable and distressed nurses made the parents feel uncomfortable and insecure. Parents need help and support during their child's transfer to and from the PICU. Critical care nurses have to discuss the policy of family-centred care.