麻醉科护士工作现状及其对麻醉前访视的认知研究

目的深入了解麻醉科护士工作现状及其对麻醉前访视的认知和建议,为开展麻醉前访视提供参考。方法采用半结构访谈法,对山东省6所三级甲等医院12名麻醉科护士进行个别深入访谈,对访谈资料录音后进行整理分析。结果关于麻醉科护士的工作现状,麻醉前护理包括管理麻醉药品、管理一次性耗材、管理麻醉仪器;麻醉中护理包括辅助麻醉、术中麻醉病人监护;麻醉后护理包括麻醉后监护病人、术后并发症监护和处理、熟知拔管指征、熟知出复苏室条件、麻醉后访视。对麻醉前访视内容的认知,提炼出两大主题:麻醉前评估和麻醉信息宣教。结论麻醉科护士工作局限于麻醉用物的管理和麻醉后复苏,未参与麻醉前访视和术中麻醉护理,对麻醉前访视内容及重要性认识不足,麻醉护理没有覆盖病人麻醉的全程。     

高血压病人运动康复行为影响因素的质性研究

目的:了解高血压病人运动康复行为的影响因素,为临床实施针对性运动干预措施提供依据。方法:采用质性研究中的现象学方法,对18例高血压病人进行半结构式访谈,基于信息-动机-行为技巧模型及主题分析法分析资料和提炼主题。结果:基于信息-动机-行为技巧模型提炼出信息、动机、行为技巧因素3个主题及下属6个亚主题,即运动价值认知、运动康复知识、个人动机、社会动机、运动实施技能、运动自我效能。结论:医护人员应重视对高血压病人运动状态进行评估,改善其对运动锻炼价值的认知与态度,并加强运动宣教与专业指导,提升家庭及社会支持力度,以提高病人运动水平,促进康复。     

实施口腔癌围术期免疫营养方案促进及阻碍因素的质性研究

目的:了解实施口腔癌围术期免疫营养支持管理方案的促进及阻碍因素,为有效推进口腔癌营养护理提供依据。方法:采用质性研究方法,以目的抽样法选取湖南省2所三级甲等医院的13名医护人员和15例病人进行半结构访谈,采用内容分析法整理、分析资料。结果:提炼出医护人员和病人对实施口腔癌围术期免疫营养支持管理方案促进及阻碍因素2个主题,每个主题分为政策支持因素、医护人员因素、患方因素3个亚主题。结论:实施口腔癌围术期病人免疫营养支持管理方案的促进及阻碍因素是多维度的,应重视政府、医护人员、病人和家属共同参与营养护理的重要性,构建适合病人、容易实施的口腔癌围术期病人免疫营养支持管理方案。     

麻醉复苏室护士对全身麻醉术后患者口干症认知与实践的质性研究

目的了解麻醉复苏室护士对全身麻醉术后患者口干症的认知和实践, 为改善口干症提供参考。方法 2021年1—3月, 运用目的取样法, 选取山东省济南市3家三级甲等医院的10名麻醉复苏室护士为研究对象, 采用质性研究中的现象学研究方法进行半结构访谈, 用Colaizzi 7步分析法整理分析资料, 精炼主题。结果共提炼出2个主题及所属的8个亚主题。麻醉复苏室护士对全身麻醉术后患者口干症认知:高度认同与肯定、支持患者参与口干症管理、重点关注患儿口干;患者口干症实践中的障碍因素:护理人力资源紧张、实践氛围缺乏、缺乏规范化评估工具、管理措施不齐全、护士自我效能不足。结论麻醉复苏室护士在全身麻醉术后患者口干症管理中发挥着引导作用, 了解护士对患者口干症的认知及其实践行为的影响因素, 为制订科学、系统的口干症患者管理体系提供参考。     

ICU护士对外科术后危重患者早期活动认知的质性研究

目的:探讨ICU护士对外科术后危重患者早期活动的真实体验。方法:2015年9月1~30日,以本院在职的ICU护士为研究对象,进行深度访谈,现场录音及笔录,访谈22人时资料饱和。运用Colaizzi的7步分析法对资料进行分析。结果:共提炼出4个主题:外科术后危重患者早期活动的风险性高;对外科术后危重患者早期活动的重要性认知不足;外科术后危重患者早期活动执行受限;外科术后危重患者早期活动的流程和方案不确定。结论:制定相关的法律法规,确保ICU医护人员在执业过程中的安全;提高医护人员、病患对术后危重患者早期活动的重要性认知;增加人力资源的配置,提高文书信息化的程度,实现"把时间还给护士,把护士还给病人"的目标;制定切实可行的外科术后危重患者早期活动的流程和实施方案,最终使危重患者得到安全、有效、科学的早期活动护理服务。     

经皮冠状动脉介入术后病人药物素养的质性研究

目的:了解经皮冠状动脉介入(PCI)术后病人药物素养现状,为制定病人药物素养干预措施提供依据。方法:2023年3月—4月采用目的抽样法选取13例PCI术后病人和9名心内科医护人员为研究对象,以健康素养理论为框架,进行半结构访谈,访谈资料根据内容分析法进行分析。结果:共提炼出4个主题,11个亚主题,即药物信念(产生担忧情绪、对服药的认知存在差异、主动学习意愿低)、功能性药物素养(药物知识掌握不足、药物技能缺乏)、互动性药物素养(药物知识获取需求大、医护人员支持、家庭及同伴支持、网络支持利用度低)、评判性药物素养(缺乏正确辨别信息能力、服药依从性低)。结论:PCI术后病人存在服药信念不强、药物知识及技能缺乏、药物知识获取途径单一、服药依从性低等问题,医护人员应关注病人的服药信念,加强医患沟通交流、采用多种方式增加病人药物知识,并通过服药管理平台规范病人服药行为,同时不可忽略同伴、家属支持的重要作用。     

前列腺癌根治术后尿失禁患者心理体验的质性研究

目的了解前列腺癌患者实施前列腺根治术后尿失禁的心理体验,探索促进患者面对疾病的策略与方法。方法采用质性研究中的现象学研究方法,对18例前列腺癌根治术后尿失禁患者进行半结构访谈,并用现象学分析方法进行资料分析。结果经过对访谈内容的剖析和归类,提炼出5个主题,即心理困扰、自我态度的改变、治疗相关知识缺乏、经济负担重、希望获得医护人员的指导及更多的医疗资源。结论前列腺癌根治术后尿失禁患者需要更多的信息和心理支持,医护人员应加强健康宣教和功能锻炼指导,帮助患者提高生活质量。     

颅内肿瘤病人术后住院期间真实体验的质性研究

目的:深入探讨颅内肿瘤病人术后住院期间的真实体验。方法:采用质性研究中的现象学研究方法,对15例颅内肿瘤病人术后进行半结构式访谈,用Colaizzi方法整理分析资料。结果:共提炼出4个主题,9个亚主题,即术后生理不适：疼痛、睡眠障碍;沉重的心理负担：负性情绪、对疾病预后的不确定感、家庭经济压力大、对家人的愧疚伴随自身价值感缺失、社交回避;不同的疾病应对方式充满希望、积极面对、消极应对;缺乏术后康复知识,渴望获得医护支持。结论:颅内肿瘤病人术后面临诸多不适与压力,医护人员应根据颅内肿瘤病人术后的生理状况及心路历程,采取针对性的护理支持,减轻病人痛苦,提高生活质量。     

食管异物取出术后留置胃管病人住院体验的质性研究

[目的]了解食管异物取出术并留置胃管病人的住院体验,为完善食管异物病人临床护理提供依据。[方法]采用质性研究中的现象学分析方法对18例行食管镜检+异物取出术、术后留置胃管的病人进行面对面半结构式深入访谈和资料分析。[结果]共提炼出3个方面的主题:角色适应不良、疾病认知不足、不良心理体验。[结论]医务人员应关注食管异物病人住院治疗的真实体验,提高评估沟通能力,改进健康教育手段,创新护理模式,实现对病人的身心照护。     

甲状腺癌病人围术期疾病感受和体验的质性研究

目的:探讨甲状腺癌病人围术期真实的疾病感受和体验,为护理人员制定针对性干预措施和心理疏导方案提供参考依据。方法:采用目的抽样法,选取西安市某三级甲等医院普通外科16例甲状腺癌围术期病人为研究对象,采用质性研究中的描述现象学研究方法,对病人进行半结构式访谈,运用Novivo 12.0软件,根据Colaizzi现象学7步分析法分析、整理、提炼主题,并对主题及亚主题出现频次进行排序。结果:甲状腺癌病人围术期疾病感受和体验可提炼出3个主题,11个亚主题。术前焦虑情绪：术前心理紧张、生育忧虑、害怕术后出现并发症;术后症候群担忧：呼吸道症状、颈部不适、伤口愈合、喉返神经损伤、甲状旁腺功能减退;康复期多元需求：期待术后病理学诊断结果、担心术后复发、延续护理需求。11个亚主题中排序前3位的分别为：期待术后病理学诊断结果(93.7%)、担心术后复发(87.5%)、术前心理紧张(75%)。结论:甲状腺癌病人围术期缺乏科学的疾病认知、存在多方面的感受和需求,护理人员应提高敏感度,准确评估和识别,并针对性地给予心理疏导,提供有效的情感支持和医疗信息,提高病人围术期生活质量,提升病人体验感。     

气管插管患者术后咽喉痛围术期防治策略的循证实践

目的 通过循证护理的方法,建立全身麻醉气管插管后咽喉疼痛的围术期防治策略,为患者康复及舒适化医疗发展提供参考依据。方法 以循证护理方法学为指导,系统检索UpToDate、BMJ、JBI、Cochrane Library、NICE、SIGN、ASA、AORN、RNAO、PubMed、CINAHL、医脉通、中国知网、万方、中国麻醉官网,筛选后共纳入文献18篇,经专人评价提取汇总后形成全身麻醉气管插管后咽喉痛围术期防治策略,并将该策略应用临床。采用前后对照的方式,选取我院2020年9—11月142例患者为对照组,2021年1—2月共121例患者为观察组,比较2组患者拔管后即时、拔管后24 h末术后咽喉痛的严重程度、术后24 h的舒适度及对气管插管患者围术期防治环节中执行规范情况。结果 与对照组相比,观察组患者在拔管后即时及拔管后24 h末术后咽喉痛的严重程度均下降（P<0.05）,患者术后24 h舒适度提升（P<0.05）,对气管插管患者围术期防治环节中执行规范情况得以改善（P<0.05）。结论 基于循证的围术期咽喉疼痛防治策略能降低术后咽喉疼痛严重程度,提高气管插管患者术...     

Postoperative sore throat: incidence and severity after the use of lidocaine, saline, or air to inflate the endotracheal tube cuff.

Postoperative sore throat occurs in up to 90% of intubated patients and is the most common complaint of patients after endotracheal intubation. A recent study suggested that the use of lidocaine to inflate the endotracheal tube cuff would decrease the incidence of postoperative sore throat. The purpose of this prospective randomized study was to compare the incidence and severity of sore throat after using lidocaine, saline, or air to inflate the endotracheal tube cuff. Variables typically associated with postoperative sore throat, including endotracheal cuff design, endotracheal tube size, intubation technique, laryngoscopy blade, airway placement, suctioning technique, and anesthetic technique, were controlled. The participants were all ASA physical status I, II, or III, female, adult patients undergoing general endotracheal anesthesia for gynecological procedures. The researcher administered the verbal analogue scale, Melzack's Present Pain Intensity Scale of the McGill Pain Questionnaire, to the 75 participants at two intervals, 1 to 3 hours postoperatively and 22 to 25 hours postoperatively, to assess postoperative sore throat. Analysis using the Kruskal-Wallis test suggested that there was no statistical difference in postoperative sore throat among the 3 groups. Lidocaine, saline, and air had similar effects on postoperative sore throat.     

右美托咪定预防全麻术后躁动和咽喉疼痛的作用

目的探讨右美托咪啶在预防全麻术后躁动和咽喉疼痛方面的应用价值,以提高全身麻醉的安全性。方法选取接受全麻手术治疗的患者114例,通过随机数字表法将其分为观察组和对照组各57例。两组均采用相同的药物进行全身麻醉,观察组在手术结束前半个小时静脉泵入右美托咪啶,对照组则静脉泵入相同体积的0.9%氯化钠注射液。对比两组患者恢复自主呼吸的时间和拔除气管插管时间以及术后躁动和咽喉疼痛的发生率。结果两组患者恢复自主呼吸时间、拔除气管插管时间的对比,差异无统计学意义(P0.05)。在术后躁动方面,观察组0级的有53例,躁动率为7.02%;对照组0级的有34例,躁动率为40.35%。观察组躁动率显著低于对照组(P0.05)。在术后咽喉疼痛方面,观察组0级的有46例,咽喉疼痛率为19.30%;对照组0级的有30例,咽喉疼痛率为47.37%。观察组咽喉疼痛率显著低于对照组(P0.05)。结论右美托咪啶对全麻术后躁动和咽喉疼痛具有良好的预防作用,同时不会增加呼吸抑制的风险,值得在临床上推广应用。     

术前应用漱口水对宫腔镜手术患者术后咽喉痛的影响

目的:观察术前应用洗必泰漱口水对宫腔镜手术患者喉罩全麻术后咽喉痛的影响。方法:选取2020年11月至2021年3月110例喉罩全麻下行宫腔镜手术患者,年龄20~60岁,BMI 20~30 kg/m²,ASA I或II级,采用随机数字表将110例患者分成漱口水组(S组)和对照组(C组),每组各55例。在全麻诱导前5~10 min分别让患者漱口1~2min或者做两次空漱口后吞咽的动作。依次使用舒芬太尼、丙泊酚、琥珀胆碱进行麻醉诱导并置入SLIPA喉罩,术中持续泵注丙泊酚维持麻醉。观察术后2h、6h和24h的咽喉痛发生情况。结果:漱口水组患者咽喉痛评分在术后24h时明显低于对照组患者(P<0.05)。术后2h和6h喉罩表面不带血迹的咽喉痛评分低于喉罩表面带血迹的患者(P<0.05)。术后24h内中/重度咽喉痛(NRS＞3)的发生率,S组(9.43%)明显低于C组(35.19%)(P<0.01)。喉罩带血迹的发生率两组相似,在喉罩表面带血的患者中,术后24h内中/重度咽喉痛发生率S组(11.76%)显著低于C组(56.52%)(P<0.01)。漱口水组发生中/重度咽喉痛的几率明显降低(OR=0.258,P =0.02)。结论:术前应用漱口水可以有效预防喉罩全麻下宫腔镜手术患者术后中/重度咽喉痛的发生,尤其是降低咽喉部粘膜损伤患者术后中/重度咽喉痛的发生率。     

Comparison of Intracuff Pressure and Postoperative Sore Throat Following Use of Laryngeal Mask Airway Protector With or Without Nitrous Oxide Anesthesia

PurposeIn general anesthesia, the laryngeal mask airway (LMA) is a frequently used effective option. The effect of nitrous oxide on intracuff pressure of the LMA and postoperative sore throat is well known; however, there are no studies related to the second-generation LMA Protector. The purpose of this study was to determine the differences in intracuff pressure and postoperative sore throat, depending on the use of nitrous oxide during general anesthesia using the LMA Protector.DesignThis randomized double-blind prospective study was conducted among 88 patients aged 20 to 70 years.MethodsThe cuff pressure started with a baseline of 40 cm H₂O and was measured using a digital cuff pressure manometer for 30 minutes. Postoperative sore throat, dysphonia, dysphagia, and numeric rating scale scores were also recorded.FindingsOver time, the intracuff pressure of the nitrous oxide group increased significantly compared with that of the air group. Furthermore, postoperative sore throat and pharyngolaryngeal complications were not significantly different between the two groups.ConclusionsIntracuff pressure of the LMA Protector increased during anesthesia using nitrous oxide. When the anesthesia time was less than 2 hours, however, there was no difference in postoperative sore throat.     

ICU医护人员对患者早期活动信念与态度的调查及影响因素研究

目的调查ICU医护人员对患者早期活动的态度与信念状况,分析其主要影响因素。方法采用方便抽样法选取大连市5家三甲医院ICU的336例医护人员作为研究对象,采用ICU医护人员对患者早期活动信念与态度量表和自行编制的一般资料调查表对其开展调查。结果本研究发放并回收调查问卷361份,其中有效问卷336份,有效回收率为93.07%。ICU医护人员的信念量表总分均值为(3.62±0.48)分,态度量表总分均值为(4.87±1.30)分。多因素分析显示,文化程度、所属关系及日工作时间是ICU医护人员对患者早期活动信念的独立影响因素(△R²=0.13,F=4.19,P=0.04);文化程度、所属关系、日工作时间、性别和职务是ICU医护人员对患者早期活动态度的独立影响因素是(△R²=0.15,F=4.38,P=0.04)。结论ICU医护人员对患者早期活动信念水平不够高,对患者早期活动的态度不够积极。建议医疗卫生部门在开展ICU患者早期活动前可加强相关的人员配置,协调好ICU医护人员工作时长,也要加强医护人员的相关知识培训,以提高医护人员对患者早期活动的信念和态度。     

ICU医护人员对患者早期活动信念与态度的调查及影响因素研究

目的调查ICU医护人员对患者早期活动的态度与信念状况,分析其主要影响因素。方法采用方便抽样法选取大连市5家三甲医院ICU的336例医护人员作为研究对象,采用ICU医护人员对患者早期活动信念与态度量表和自行编制的一般资料调查表对其开展调查。结果本研究发放并回收调查问卷361份,其中有效问卷336份,有效回收率为93.07%。ICU医护人员的信念量表总分均值为(3.62±0.48)分,态度量表总分均值为(4.87±1.30)分。多因素分析显示,文化程度、所属关系及日工作时间是ICU医护人员对患者早期活动信念的独立影响因素(△R²=0.13,F=4.19,P=0.04);文化程度、所属关系、日工作时间、性别和职务是ICU医护人员对患者早期活动态度的独立影响因素是(△R²=0.15,F=4.38,P=0.04)。结论ICU医护人员对患者早期活动信念水平不够高,对患者早期活动的态度不够积极。建议医疗卫生部门在开展ICU患者早期活动前可加强相关的人员配置,协调好ICU医护人员工作时长,也要加强医护人员的相关知识培训,以提高医护人员对患者早期活动的信念和态度。     

The relationship between preintubation lidocaine and postanesthesia sore throat.

A sore throat is the most frequent adverse side effect of general anesthesia. The purpose of this study was to determine the relationship between intravenous lidocaine given during induction of general endotracheal anesthesia and postanesthesia sore throat. In addition, the study examined selected variables (bucking; gender; smoking; type of laryngoscope blade; and use of succinylcholine, condenser-humidifiers, or analgesic medication during the previous hour) in relation to the occurrence of postoperative sore throat. Variables typically associated with postoperative sore throat, including endotracheal tube lubricant, endotracheal tube cuff geometry, endotracheal tube size, local anesthetic spray to the trachea, traumatic intubation, postoperative mechanical ventilation, nasal intubation, nasogastric tubes, and nasal airways, were controlled. The researcher administered the visual analogue scale to 139 subjects at 21 to 27 hours following termination of the anesthetic in order to rate sore throat. A retrospective chart review provided data on the variables selected for study and those that were controlled. Chi-square and independent t-tests revealed that a decrease in the severity of the sore throat, as recorded on the visual analogue scale, was significantly related to use of intravenous lidocaine and condenser-humidifiers.     

Management of patients with sore throats in relation to guidelines: An interview study in Sweden

Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Design. Qualitative content analysis was used to analyse semi-structured interviews. Setting. Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures. Perceived management of sore throat patients. Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. Conclusion. This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.Key Words: General practice, general practitioners, guidelines, qualitative research, sore throat, SwedenSwedish guidelines for treatment of sore throat aim at a rational use of antibiotics by identifying patients in favour of antibiotic treatment but guidelines are not always adhered to. This study shows differences between GPs adherent and GPs non-adherent to current guidelines for sore throat regarding:

• guideline knowledge, preconceptions of bacterial infections and concerns for differential diagnosis;
• patient examination and patient history-taking;
• patient compliance in abstaining from prescribing antibiotics.

     

乳腺癌患者术后肢体功能康复行为的质性研究

目的 探讨乳腺癌患者术后主动参与肢体功能康复的真实感知.方法 采用目的抽样法,选取2021年2月—3月在武汉市某三级甲等医院住院的18例乳腺癌术后患者进行半结构式访谈,采用Colaizzi 7步资料分析法对资料进行分析并提炼主题.结果 乳腺癌术后患者对术后肢体功能康复行为的真实体验归纳出3个主题:行为态度(应激后的负性...