智能化辅助NICU发育支持护理的实施

目的 探讨利用信息手段减少对患儿不良刺激及促进发育支持护理规范化执行的效果。方法 在移动护理终端增加医护人员刺激行为的监控提示及为护理人员按发育支持护理进行评估干预提供辅助决策的功能。对我院NICU出生胎龄<32周,体重<1500g的早产儿共73例进行随机分组,观察组37例借助信息系统进行干预,对照组36例行常规照护使用纸质的发育支持护理表格进行干预,比较两组患儿的操作刺激频次、开始经口喂养时间、完全经口喂养时间、每日体重增长情况、行为神经测定（neonatal behavioral neurological assessment,NBNA）,全身运动评估(general movements,GMs)。结果 观察组的日平均干扰频次明显低于对照组（P<0.05）; 纠正胎龄40周NBNA评分干预组高于对照组（P<0.05）,两组全GMs异常发生率无统计学意义（P>0.05）;干预组开始经口喂养时的纠正胎龄和完全经口喂养时的纠正胎龄均小于对照组（P<0.05）;干预组的平均住院天数低于对照组、体重增长速度明显高于对照组（P<0.05）。　结论 发育支持护理的智能化手段应用,可降低护理对患儿不良刺激的干扰频次,缩短住院时间、促进体重增长,改善早产儿预后。     

新生儿重症监护病房多重耐药菌感染的特征和危险因素分析

目的分析新生儿重症监护病房(NICU)多重耐药菌(MDRO)感染的分布特征,并探讨NICU发生MDRO感染的危险因素,为减少MDRO感染提供临床依据。方法回顾性分析MDRO感染的患儿病历资料。根据《MDR、XDR、PDR多重耐药菌暂行标准定义——国际专家建议》,从NICU选出MDRO感染的151例患儿220株细菌,并以同期该病区非MDRO感染的272例患儿为对照。分析MDRO的分布情况,运用单因素及多因素logistic回归分析MDRO感染相关的影响因素。结果不同年份中,NICU检出的最为常见MDRO为大肠埃希菌、其次为葡萄球菌属。产前母亲使用抗生素、PICC置管、腰椎穿刺、低蛋白血症及淋巴细胞比值是NICU发生MDRO感染的影响因素(P均<0.05)。其中母亲产前1周内使用抗生素者相对于母亲产前1周内没有使用抗生素者感染MDRO的风险增加(OR=2.268,95%CI 1.095～4.700),有低蛋白血症者相对于无低蛋白血症者感染MDRO的风险增加(OR=4.999,95%CI 2.849～8.700),行腰椎穿刺者相对于没有行腰椎穿刺者感染MDRO的风险降低(OR=0.36...     

Measuring neonatal intensive care unit-related parental stress

AIMS: This paper reports a study: (1) to determine the validity and reliability of the Parent Stressor Scale:Neonatal Intensive Care Unit (PSS:NICU) for use with United Kingdom (UK) parents; (2) compare UK scores with those from a contemporary reference sample from the United States (US), (3) to identify the sources of greatest NICU-related stressors for parents and (4) to identify demographic or situational factors influencing NICU-related parental stress. BACKGROUND: Evaluation of the adequacy of nursing care and psychosocial support services for parents of ill infants in the NICU requires valid and reliable measures of parental stress. The PSS:NICU is a well-validated scale developed in the US to measure NICU-related parental stress. However, it has not been tested in the UK. METHODS: Consecutive samples of parents (n = 257) of infants in nine UK NICUs and two reference US units completed the PSS:NICU and the Spielberger State-Trait Anxiety Scale approximately 1 week after admission. Psychometric properties of the PSS:NICU, including internal consistency reliability and construct, concurrent and predictive validity, were evaluated. RESULTS: PSS:NICU scores were similar in the UK and US samples and high internal consistency reliability was found for all metrics (e.g. Overall Stress: 0.94 for both samples). A three-factor principal components solution accounted for 66% of the variance in the scores, with the items grouped into the three a priori scales specified in the PSS:NICU (Infant Behaviour and Appearance, Parental Role Alterations, and Sights and Sounds). Stress Occurrence and Overall Stress were moderately correlated with State Anxiety in both samples (r = 0.46-0.61, P < 0.001). Thirty-one per cent of the variance in Stress Occurrence in the UK sample was explained by State Anxiety, infant severity of illness score, parent gender, and less frequent visitation. CONCLUSIONS: The PSS:NICU demonstrated appropriate psychometrics in a large sample of parents from diverse NICUs in the UK. These findings support its wider use in research and clinical practice to identify parental distress and evaluate the effectiveness of nursing care and psychosocial support services for parents.     

The use of transcutaneous oxygen electrodes in intensive therapy

The use of transcutaneous monitoring of the PO₂ in patients in an adult intensive therapy unit has been found to be a simple and reliable procedure. The electrodes were heated to 44°C in order to obtain a near maximal response. In individual patients, the transcutaneous reading may be up 20 per cent different from the arterial value. However, the difference is reproducible for a given patient and does not detract from the value of the technique in following trends. The ease of use of the non-invasive transcutaneous technique has brought to light numerous instances of marked fluctuations occurring in patients oxygen tensions.     

NICU患儿医源性皮肤损伤的现况调查

目的 调查新生儿重症监护病房（neonatal intensive careunit,NICU）患儿医源性皮肤损伤的现况,并分析其影响因素。方法 2017年7月1日—12月31日,采用自行设计的NICU患儿医源性皮肤损伤资料收集表对某三级甲等医院NICU中384例患儿的医源性皮肤损伤情况进行调查,并分析其影响因素。结果 患儿医源性皮肤损伤的发生率为15.1%;患儿医源性皮肤损伤的原因包括撕拉胶布、持续气道末正压通气以及气管插管压迫鼻部皮肤、经皮血氧饱和度探头压迫皮肤、臂部皮肤保护不当等;多因素Logistic回归分析结果显示,NICU患儿医源性皮肤损伤的独立危险因素为患儿的住院时间及出生体重（P<0.05）。结论 NICU患儿医源性皮肤损伤的发生率高,患儿出生体重越小、住院时间越长,越容易发生医源性皮肤损伤。     

重症医学科护理信息系统应用实践

目的:介绍重症医学科护理信息系统的功能并分析其效果。方法:统计分析使用重症医学科护理信息系统前后给药错误发生情况、书写护理记录时间、危重患者中心静脉导管感染率和死亡率的差异。结果:重症医学科护理信息系统投入使用后,护理不良事件中给药错误发生例数为0例;护理记录书写时间由(76.60±10.37)min缩短到(44.28±9.43)min;危重患者的中心静脉导管感染率由2.43例/千日降至2.01例/千日;死亡率由7.98%降至6.13%。结论:重症医学科护理信息系统的使用确保了医嘱的正确执行,提高了护理工作效率,降低了危重患者的中心静脉导管感染率和死亡率。     

System ergonomic analysis of the morning ward round in an intensive care unit

Objective. Our objective was to find out what is discussed during a bedside morning ward round (MWR), whether there are any weak points, and if a standard work process structure can be recommended.Methods. An intensive care unit (ICU) consultant recorded in a predefined form the topics that were discussed in 225 bedside discussions.Results. The median length of discussions was 5 min. In more than 60% of the discussions, items were considered related to the respiratory, neurological, and cardiovascular systems, as well as to surgical and nursing problems. Specific variables relating to organ system conditions were seldom used (e.g., inspired O₂ concentration, 35%; temperature, 28%; ventilation mode, 25%). We recorded two interruptions per MWR; only 17% of them were related to urgent decisions. Information that could not be found in the patient’s file usually concerned microbiology findings (10%) or surgical procedures (6%).Conclusions. We recommend the following structure: (1) Addressing the patient by saying “hello”; (2) presentation of information related to case history, acute status (findings and strategy) (including the function of the main organ systems), infection status, and nursing problems; (3) patient-related discussion; and (4) discussion of general treatment rules, triggered by individual patient condition.     

重症监护病房病人和护士对病人ICU环境压力源感知的比较

目的:比较ICU内接受治疗的病人感知到的ICU环境压力与护士对于病人所感知到的ICU环境压力源评价的异同。方法:采取目的抽样法抽取北京市某三级甲等医院ICU接受治疗的病人50名以及直接参与其护理的护士50名,采用一般资料问卷、ICU环境压力源量表进行调查。结果:该研究中病人感知到的ICU环境压力与护士评价病人所感知到的ICU环境压力源的部分条目、压力源排序存在差异,且病人组的ICU环境压力源的得分(85.08±21.16)高于护士组(78.08±12.71),两组ICU环境压力源的评价差异有统计学意义(P=0.048)。结论:护士对于病人所面临的ICU环境压力源的评价低于病人自身,ICU护士作为病人的主要照顾者,其对于病人在ICU内所面临的ICU环境压力源的认知直接关系到护士能否为病人提供恰当的医疗、护理服务,应给予足够的重视。     

Anxiety and depression in intensive care patients six months after admission to an intensive care unit: A cohort study

ObjectivesTo measure the prevalence of anxiety and depression in intensive care patients six months after admission to an intensive care unit and to investigate which variables are associated with anxiety and depression at six months.Research methodologyIn this cohort study, patient-reported outcome measures were collected as soon as possible upon admission and at six months. Two logistic regression models were performed to examine variables associated with reporting anxiety and depression above ≥8 at six months.SettingPatients were recruited from six intensive care units in two Norwegian hospitals between 2018 and 2020.Main outcome measuresThe Hospital Anxiety and Depression Scale.ResultsA total of 145 patients was included in the study. The patients reported a prevalence of 18.6% (n = 27) and 12.4% (n = 18) of anxiety and depression, respectively. Higher baseline anxiety scores were associated with both higher odds of reporting anxiety and depression above ≥8. Younger age was associated with higher odds of reporting anxiety, and being female was associated with lower odds of reporting depression.ConclusionSeveral intensive care survivors reported having symptoms of anxiety and depression six months after admission to the intensive care unit. Younger age, and higher anxiety scores at baseline were variables associated with higher odds of reporting symptoms of either anxiety or depression, while being female was associated with a lower odds of reporting depression.Implications for clinical practiceScreening patients for anxiety and depression may help to identify vulnerable patients. Structured follow-ups with intensive care nurses in an outpatient setting may be useful to help patients to work through some of the experiences from the intensive care unit.     

新生儿重症监护病房血培养结果分布及阳性菌耐药性分析

目的：了解青岛某妇女儿童医院新生儿重症监护病房血培养的细菌分布及耐药性特点。方法：对2013.1月-2013.12月青岛某妇女儿童医院新生儿重症监护病房（NICU）送检的血培养结果进行回顾性统计分析。结果：1年时间共收到新生儿重症监护病房血培养标本423例,培养阳性结果57例,占13.48%.其中革兰阳性菌31例,占54.39%,革兰阴性杆菌25例,占43.86%,真菌1例,占1.75%.各种革兰阳性菌均敏感的药物是万古霉素、利奈唑胺、呋喃妥因和替加环素,敏感性为100%;革兰阴性菌主要是大肠埃希菌和肺炎克雷伯菌。大肠埃希菌中产ESBLS株占37.5（3/8）,肺炎克雷伯菌种产ESBLS株为100%;这两种革兰阴性杆菌均敏感的药物是亚胺培南.、哌拉西林/他唑巴坦、厄他培南、阿米卡星和妥布霉素。结论：该院新生儿重症监护病房血培养病原菌中革兰阳性菌以凝固酶阴性菌为主,革兰阴性菌中主要是大肠埃希菌和肺炎克雷伯菌,各种细菌都在不同程度上表现为多重耐药性,应重视新生儿重症监护室血培养及药敏结果,根据药敏结果选用敏感性抗菌药物,以提高疗效,防止耐药菌的产生和传播。     

神经外科ICU病人术前访视的方法及效果评价

目的　评价神经外科ICU术前访视的效果 ,证实其有效性并总结其方法。方法　随机分组 ,收集记录访视组和对照组的相关资料后进行统计学分析。结果　访视组病人对术后采取物理约束、禁食水、保留导尿、谢绝家属探视等护理措施的合作率为 94 .5 % ,对照组是 38.5 % ,在物理约束、禁食水和谢绝家属探视 3个方面差异尤其显著 ;访视组病人中使用镇静剂的有3例 ,占 3.8% ;对照组中则有 19例 ,占 2 3.8%。结论　神经外科ICU术前访视可以有效提高病人及家属与医护人员的合作 ,证明了心理护理在护理工作中的重要性 ,更细致的工作会使护理更加人性化 ,更富有人文关怀的人道主义精神。     

临床照护分类系统在综合ICU护理实践中的应用分析与展望

目的 探索临床照护分类系统（Clinical Care Classification System,CCC）在综合ICU护理实践中的应用情况。方法 使用CCC全智能护理信息系统（以下简称CCC系统）对研究期间的护理记录进行分析,研究数据包括2019年3月—7月的所有护理记录,共计301 358项护理文件条目。结果 从CCC系统中提取的数据显示,患者出现的护理诊断中,生理性要素占45.14%,功能性要素占41.62%,健康行为要素占12.33%,心理性要素占0.91%;照护要素分类中皮肤完整性方面涉及的护理措施最多（24.67%）,其次是活动类（21.55%）、安全类（15.09%）、身体调节类（13.72%）,其中评估监测类的护理措施占总护理措施的一半以上（52.39%）,护理执行类的护理措施占26.56%,而教导指导、管理转介类的措施分别占11.68%和9.36%;护理实际结局与预期护理目标比较,差异有统计学意义（P<0.05）。结论 CCC能够在为重症监护病房的患者提供个性化的临床护理实践中用于记录护理数据和书写护理电子病历,也能分析每项护理措施的频率和次数,有利于护理大数据的分析与应用;应用CCC可以促进综合ICU开展临床护理实践和护理科研。     

An exploration of Neonatal Intensive Care Unit (NICU) staff experiences of attending pre-brief and debrief groups surrounding a patient's death or redirection of care

This paper presents the findings of a service evaluation project exploring staff experiences of Neonatal Intensive Care Unit staff support groups. The Neonatal Intensive Care Unit at a local regional hospital, developed and provided staff support groups before (pre-brief) and after (debrief) a death of an infant on the ward. These groups were run between December 2018 and July 2019. Content analysis was used to understand and summarise patterns and themes within the data. Frequency data was used to identify how these themes linked with staff ratings of the groups. The majority of staff had a positive experience of the group and recommended expanding the support groups to wider intensive care units. A subgroup of staff felt vulnerable in the groups and recommendations were put forward to promote the group's psychological safety. Directions for future service evaluations are discussed.     

共情能力在ICU护士死亡焦虑与临终关怀态度的中介作用

为了探讨ICU护士临终关怀态度与死亡焦虑、共情能力的现状及其相关性,探讨共情能力在死亡焦虑与临终关怀态度间的中介作用,采用一般资料调查表、中文版佛罗梅尔特临终关怀态度量表(FATCOD-B)、中文版死亡焦虑量表(CT-DAS)和人际反应指针量表(IRI)对大连地区某三级甲等医院的165名ICU护士进行问卷调查。结果显示ICU护士临终关怀态度为(97.3±10.4)分,死亡焦虑为(8.5±2.9)分,共情能力为(53.8±10.4)分；临终关怀态度与死亡焦虑呈负相关(r＝﹣0.226,P＜0.01),与共情能力呈正相关(r＝0.232,P＜0.01)；共情能力在死亡焦虑对临终关怀态度的影响中起部分中介作用。因此ICU护士临终关怀态度和共情能力偏低,死亡焦虑较高；改善死亡焦虑和提高共情能力能有效的促进临终关怀态度,提升临终关怀能力。     

氧合作用和血流灌注指标对ICU患者压疮发生的预警作用

目的 了解ICU压疮发病特征及氧合作用和血流灌注指标与压疮发生的相关性,为临床预防压疮提供依据.方法 采用自行设计问卷,通过皮肤检查和查阅病历,收集ICU患者的压疮发病情况及氧合作用和血流灌注指标等资料,将226例分为压疮组52例(为医院获得性压疮),非压疮组174例,并用SPSS15.0对各因素进行统计分析.结果 两组在年龄、动脉血酸碱度、动脉二氧化碳分压、收缩压、舒张压、平均动脉压及Braden评分等方面的差异有统计学意义(P<0.05);经多因素非条件Logistic回归分析,平均动脉压和Braden评分增加为ICU压疮的保护因素,呼吸系统疾病、外伤和其他类型疾病是ICU压疮的危险因素.结论 ICU患者是压疮的危险人群,平均动脉压和Braden评分高者发生压疮的危险较小,呼吸系统疾病、外伤和其他类型疾病的患者发生压疮的危险较大,年龄可能是压疮的间接危险因素.建议临床医护人员加强对ICU患者的血流动力学和动脉血气分析指标的监测,从中获取压疮预警信息,采取适当的预防措施,以降低压疮的发生率.     

儿科重症监护室护理监测数据采集模式的构建及应用研究

目的 构建儿科ICU护理监测数据采集模式,并进行临床应用,旨在提高ICU危重患儿医疗护理数据的记录质量及医护人员的工作效率。方法 以临床决策支持理念为基础,构建儿科ICU抢救、输血、术后复苏数据采集模式,实施现代化、信息化、一体化的移动护理体系。统计2019年1月—2020年1月在ICU不同临床场景下护理监测数据采集模式使用情况及ICU护士对其的满意度。结果 抢救模式启动328例次,输血模式启动8 014例次,术后复苏模式启动1 622例次;采用电子病历记录文书共4 323例,其中儿科ICU 1 793例、新生儿ICU 1 600例、心脏ICU 930例。护士对护理监测数据采集模式的总体满意度得分为（92.47±1.62）分。结论 儿科ICU不同护理监测数据采集模式的构建有效整合了急救、输血、术后复苏时各项文件的书写工作流程,通过人工及信息双重核对保障了ICU床旁数据采集的准确性,简化了护理工作程序,改善了护理文书记录质量,提高了护士的满意度。     

A quality appraisal using the AGREE II instrument of endotracheal tube suction guidelines in neonatal intensive care units

BackgroundEndotracheal tube (ETT) suction is among the most common procedures performed in neonatal intensive care units (NICUs). Although necessary, it is associated with significant risks. To mitigate these risks, clinical practice guidelines are developed to provide evidence-based recommendations.ObjectiveThe aim of the study was to appraise the quality of neonatal ETT suction guidelines from all NICUs in Australia and New Zealand.MethodsAll level III NICUs in Australia and New Zealand were invited to participate. Three researchers graded the methodological quality of the received guidelines using the AGREE II instrument. Item and domain scores were calculated by scaling as a percentage of the total possible score out of 100%. A threshold score of <50% is considered to be of limited potential use.ResultsTwenty-three (79.31%) clinical practice guidelines were received from 29 invited facilities. The scaled results of the AGREE II domains were as follows: Scope and Purpose, mean = 73%, 95% confidence interval (CI) = 63–83%; Stakeholder Involvement, mean = 23%, 95% CI = 15–31%; Rigour of Development, mean = 17%, 95% CI = 12–21%; Clarity of Presentation, mean = 63%, 95% CI = 56–70%; Applicability, mean = 5%, 95% CI = 20–30%; and Editorial Independence, mean = 50%, 95% CI = 50–50%. Overall assessment indicated low methodological quality (31%; 22–39%), with only five clinical practice guidelines scoring >50%, suggesting that they could be recommended for use with modifications. The remaining 18 could not be recommended for use.ConclusionsNeonatal ETT suction guidelines are of a low methodological quality. All guidelines poorly incorporated latest evidence in guideline development. This appraisal highlights the need to improve the quality of neonatal ETT suction guidelines to promote optimal patient care.