慢性阻塞性肺疾病患者失能的研究进展

对慢性阻塞性肺疾病失能模型、影响因素、测评工具及干预措施进行综述,建议提高护理人员对慢性阻塞性肺疾病患者失能的认知,对患者进行综合评估,扩展研究内容,优化测评工具,全面考虑失能影响因素,从提高患者疾病预防和管理能力角度构建护理干预措施。     

慢性盆腔炎患者疾病相关知识认知调查

目的了解慢性盆腔炎患者对疾病相关知识的认知,为护士有效实施健康教育提供参考。方法采用自行设计调查表对60例慢性盆腔炎患者进行疾病相关知识认知调查。结果80．0％患者对保持经期卫生有较好认知,35．0％对正常分娩、流产及妇科手术有正确认知,65．0％患者对正确的会阴清洁方法了解不确切或方法错误,仅5．0％患者了解影响疾病的因素。不同文化程度、家庭收入及年龄患者疾病相关健康知识认知得分比较,差异有统计学意义（P〈0．05,P〈0．01）。结论慢性盆腔炎患者对经期卫生有较好的认知,但其总体健康知识水平仍普遍偏低,尤其欠缺对治疗措施的了解、疾病预后及疾病影响因素的认知。护士临床工作中可根据患者健康知识水平,加强有针对性的健康教育指导,帮助其获取健康知识。。     

影响社区护士对居家慢性阻塞性肺疾病患者管理的质性研究

目的探讨影响社区护士对居家慢性阻塞性肺疾病(COPD)患者管理的因素。方法采用分层抽样与立意取样法抽取桂林市社区卫生服务中心已取得社区护士资格且在岗人员30人,运用深入访谈法收集资料,采用Colaizzi的现象学资料7步分析法分析资料。结果经分析提炼出影响社区护士对居家COPD患者管理的因素是护士自身COPD防治知识严重缺乏,卫生行政部门重视不够,培训教材滞后,继续教育缺乏。结论提高社区护士COPD知识水平,重视对居家COPD患者的管理,加强社区护士的职后教育及培训材料知识的更新,可提高社区护士对居家COPD患者的管理质量。     

视频结合回馈教学应用于慢性阻塞性肺疾病患者呼吸功能锻炼

目的探讨视频结合回馈教学在慢性阻塞性肺疾病(COPD)患者呼吸功能锻炼中的应用及效果。方法采用便利抽样选取120例住院COPD患者为研究对象,按病区不同分为对照组和观察组各60例。对照组按照常规健康教育方法指导患者呼吸功能锻炼,观察组采用视频结合回馈教学指导患者呼吸功能锻炼。结果出院前观察组呼吸功能锻炼依从性显著高于对照组;干预后7d、出院前COPD评估测试量表得分显著低于对照组(均P0.01)。结论视频结合回馈教学,可有效提高COPD患者呼吸功能锻炼依从性和生活质量。     

慢性阻塞性肺疾病患者基于微信的三主体双轨道交互式护理

目的 探索基于微信平台的三主体双轨道交互式护理模式应用于慢性阻塞性肺疾病患者的效果.方法 将138例慢性阻塞性肺疾病出院患者随机分为常规组和干预组各69例.常规组给予常规出院后护理.干预组实施基于微信平台的三主体双轨道交互式护理,即由医院专科护士、社区护士、患者三主体构成医院延续护理干预轨道和社区干预轨道.干预前及干预...     

慢性心力衰竭专病护士团队的组建及实践

目的 探讨专病护士团队在慢性心力衰竭患者治疗护理中的作用。方法 将2017年6～12月收治的300例慢性心力衰竭患者作为对照组，实施常规治疗护理和出院后随访；2018年1～6月收治的300例慢性心力衰竭患者作为观察组，由专病护士团队针对患者进行评估、跟踪，筛查临床前期患者，对临床期患者制定个性化的健康指导和出院后的团队延续护理，帮助终末期患者选择合适的治疗方案、实施急救措施、心理支持及社会援助；同时重视质量控制和专病护士的考评和管理，协助心力衰竭治疗中心和示范基地的建设。于干预6个月后比较两组疾病自我管理能力评分、再住院情况，以及医护患满意度。结果 干预6个月后，观察组疾病自我管理能力、患者对护理工作满意度显著高于对照组，再住院率和再住院时间显著降低和缩短（均P<0.01）。医生、护士对专病护士团队的工作满意度较高。结论 专病护士团队针对慢性心力衰竭不同阶段进行分工分期管理，可以提高患者生活质量和临床结局，有利于护士职业发展。     

呼吸专科护士核心能力评价指标体系的构建及信效度检验

目的构建呼吸专科护士核心能力评价指标体系并进行信效度检验,为呼吸专科护士核心能力评价提供有效的测评工具。方法在文献分析、参考相关量表及指南的基础上,以质性访谈、专家函询等方法构建呼吸专科护士核心能力评价指标体系,并以构建的指标体系为依据,编制自评式问卷,采用此问卷对160名呼吸专科护士进行调查,以检验指标体系的信效度。结果构建的呼吸专科护士核心能力评价指标包括4个一级指标(呼吸专科理论知识、呼吸专科实践技能、沟通协调能力、呼吸专科拓展能力)、15个二级指标和64个三级指标,指标体系总体Cronbach′sα系数为0.961,总体内容效度指数(S-CVI)为0.970,一级指标与指标体系总体相关系数为0.790～0.943(均P0.01)。结论构建的呼吸专科护士核心能力评价指标体系具有较好的信效度,可作为呼吸专科护士核心能力培养考核和评价的工具。     

远程护理对慢性阻塞性肺疾病患者症状及远程照护感知的影响

目的探讨远程护理对慢性阻塞性肺疾病患者症状及远程护理感知的影响。方法将256例慢性阻塞性肺疾病患者随机分为研究组和对照组各128例,对照组给予常规护理,研究组在常规护理基础上,给予远程护理指导。比较两组患者干预前及干预8周后的慢性阻塞性肺疾病评估测试评分,同时采用远程照护感知问卷对研究组患者进行调查。结果干预后,研究组慢性阻塞性肺疾病评估测试评分显著低于对照组(P<0.05);患者的远程照护感知问卷得分(62.48±4.50)分。结论远程护理可有效改善慢性阻塞性肺疾病患者症状,患者对远程照护的感知持积极态度,但仍有较大提升空间。     

慢性阻塞性肺疾病老年居家患者主观幸福感及影响因素分析

目的了解慢性阻塞性肺疾病老年居家患者主观幸福感水平并分析其相关因素,为采取针对措施提高其主观幸福感水平提供依据。方法采用自制一般资料调查问卷和纽芬兰纪念大学幸福度量表,对110例老年居家慢性阻塞性肺疾病患者进行问卷调查。结果老年居家慢性阻塞性肺疾病患者主观幸福感得分30．45±6．09,79．09％患者自我幸福感处于中下水平;月收入、婚姻状况、病程、照顾者及伴随并发症为影响患者主观幸福感的主要因素（均P〈0．05）。结论老年居家慢性阻塞性肺疾病患者主观幸福感偏低,应根据不同影响因素采取相应干预策略,以提高其主观幸福感水平和生活质量。     

社区COPD患者家庭疾病管理现状调查

目的了解上海市社区慢性阻塞性肺疾病家庭（患者及照顾者）的疾病管理相关知识和行为的现状,为针对性干预提供参考。方法采用自行设计的患者及照顾者疾病管理相关知识、行为调查表,对上海市COPD患者及其照顾者各84例进行问卷调查。结果COPD疾病管理一般知识和氧疗知识得分率：患者分别为51.09%、19.34%,照顾者分别为38.99%、10.42%;疾病管理行为得分率：患者为39.93%,照顾者为38.51%。患者及照顾者疾病管理知识与其行为的相关系数r为0.575、0.523,均P〈0.01。结论社区COPD家庭疾病管理知识及管理行为处于中低水平,管理知识水平较高者管理行为较好。社区医护人员应寻求有效的干预策略提高COPD家庭疾病管理相关知识和行为,以控制COPD患者疾病进展,提高其生活质量。     

慢性呼吸系统疾病肺康复护理质量评价体系的构建

目的构建慢性呼吸系统疾病肺康复护理质量评价体系,为评价肺康复护理质量提供工具。方法以"结构-过程-结果"三维结构模型为依据,通过文献回顾、结构式访谈、专家函询,确定慢性呼吸系统疾病肺康复护理质量评价指标的内容,采用专家重要性评价及优序图法确定各指标权重。结果 27名护理专家参与2轮函询,专家积极性均为100%,权威系数(Cr)为0.889,Kendall和谐系数分别为0.284和0.311,差异有统计学意义(均P0.05);形成的指标体系包括一级指标3个,二级指标17个,三级指标114个。结论慢性呼吸系统疾病肺康复护理质量评价体系具有较好的可靠性,进一步验证后可用于慢性呼吸系统疾病肺康复护理质量评价。     

Undiagnosed amyotrophic lateral sclerosis and respiratory failure

Two patients suffering from exacerbation of chronic respiratory insufficiency due to previously undiagnosed amyotrophic lateral sclerosis are reported. Both patients had a false diagnosis of asthma with a restrictive component. The diagnosis had been made after pulmonary function studies, and both patients had also treatment for asthma. A central etiology was suspected when weaning from mechanical ventilation proved unsuccessful during respiratory failure, necessitating intensive care. A neurologic examination and a typical electroneuromyography recording confirmed the diagnosis of amyotrophic lateral sclerosis. Neuromuscular disorders must be excluded when treating patients with respiratory failure, even if they already have the diagnosis of chronic pulmonary disease.     

Permanent tracheostomy for long-term respiratory studies

BACKGROUND: We describe a modified surgical technique for permanent, anterior tracheal-wall stoma for chronic, repeat respiratory studies in trained, conscious dogs. These cannula-free tracheostomies require minimal daily maintenance, permit repeat intubation with endotracheal tubes modified for airflow respiratory measurement, and facilitate up to 6 h continuous administration of aerosol agents during long-term or repeat respiratory studies. METHODS: In 20 dogs, during a 30 to 40 min procedure, portions of tracheal rings 2-4 were removed to create an oval stoma, approximately 2 x 1 cm. The dermis was secured to the transected cartilage and tracheal mucosa in such a manner that skin covered the sternohyoid muscles and grew-in flush with the tracheal mucosa at the stomal opening. Stomas were cleaned daily, and fur was clipped weekly around the stomal site. No other maintenance procedures or environmental modifications were needed. Animals breathed through both the stoma and the upper airway and barked normally. RESULTS: Stomas remained viable in long-term animals (n = 4) ongoing for 70.3 +/- 32.2 mo (mean +/- SEM), with an ongoing maximum of 126 mo. Postmortem examinations were performed on shorter-term animals (n = 16) sacrificed at 16.7 +/- 7.3 mo. Thirteen showed no appreciable tracheal stenosis and three showed <10% stenosis at the level of the stoma. Histopathological examination of the stomal opening and surrounding tissue revealed minimal chronic inflammation and no evidence of necrosis or infection. CONCLUSIONS: During long-term respiratory studies, this practical and dependable tracheal stoma provides a means for examining acute and chronic effects of environmental and pathophysiological influences on the respiratory system of conscious dogs.     

Home care for chronic respiratory failure in children: 15 years experience

BACKGROUND: Advances in paediatric intensive care have reduced mortality but, unfortunately, one of the consequences is an increase in the number of patients with chronic diseases. It is generally agreed that home care of children requiring ventilatory support improves their outcomes and results in cost saving for the National Health Service. METHODS: Since 1985, the Children's Hospital Bambino Gesù of Rome has developed a program of paediatric home care. The program is performed by a committed Home Health Care Team (HHCT) which selects the eligible patients for home care and trains the families to treat their child. During the period January 1985 to January 2001, 53 children with chronic respiratory failure were included in the home care program. Of these, seven patients were successively excluded and six died in our intensive care unit (ICU), while one still lives in our ICU since 1997. The results obtained in the remaining 46 children are reported. RESULTS: The pathologies consisted of disorders of respiratory control related to brain damage (26%), upper airways obstructive disease (26%), spinal muscular atrophy (22%), myopathies and muscular dystrophies (6.5%), bronchopulmonary dysplasia (6.5%), tracheomalacia (6.5%), central hypoventilation syndrome (4.3%) and progressive congenital scoliosis (2.2%). Of these 46 patients, 34 children are mechanically ventilated and the median of their ICU stay was 109.5 days (range 54-214 days), while the remaining 12 children were breathing spontaneously and the median of their ICU stay was 90.5 days (range 61-134 days). We temporarily readmitted six patients to our ICU to perform scheduled otolaryngological surgery, eight patients for acute respiratory infections and two patients for deterioration of their neurological status due to high pressure hydrocephalus for placement of a ventriculoperitoneal shunt; these 16 patients were discharged back home again. Two other patients were readmitted for deterioration of their chronic disease and died in our ICU, while seven patients died at home. CONCLUSIONS: Thirty-seven children are still alive at home and four of them improved their respiratory condition so that it was possible to remove the tracheostomy tube. Our oldest patient has now achieved 15 years of mechanical ventilation at home.     

Pathophysiology of respiratory disease and its significance to anaesthesia

Significant changes occur in the respiratory physiology of healthy patients during anaesthesia. In patients with underlying respiratory pathology (e.g. chronic obstructive airways disease) these changes in respiratory physiology may lead to clinical problems during the conduct of anaesthesia and the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anaesthetist to account for the potential complications of these conditions and manage the anaesthetic accordingly.     

Potential therapeutic role for statins in respiratory disease

Statins reduce cholesterol levels by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase and have an established role in the treatment of atherosclerotic disease. Recent research has identified anti-inflammatory properties of statins. Statins appear to reduce the stability of lipid raft formation with subsequent effects on immune activation and regulation, and also prevent the prenylation of signalling molecules with subsequent downregulation of gene expression. Both these effects result in reduced cytokine, chemokine, and adhesion molecule expression, with effects on cell apoptosis or proliferation. This review considers the evidence for the anti-inflammatory properties of statins in the lung, and how these effects are being applied to research into the role of statins as a novel treatment of respiratory diseases.     

Nontrauma fracture increases risk for respiratory disease among adults with cerebral palsy

Individuals with cerebral palsy (CP) manifest skeletal fragility problems early in life and are vulnerable to nontrauma fracture (NTFx), which may exacerbate the risk of respiratory disease (RD)– the main cause of premature mortality for this population. The purpose of this study was to determine if adults with CP had a greater 12-month risk of RD post-NTFx compared to adults without CP. Data from 2011 to 2017 were leveraged from Optum Clinformatics Data Mart; a claims database from a single private payer in the United States diagnostic codes were used to identify adults (≥18 years) with and without CP, NTFx, incident RD, and pre-NTFx cardiometabolic diseases. Cox proportional hazards regression models were used to compare 12-month RD incidence following NTFx with adjustment for sociodemographics and cardiometabolic diseases. Mean age (SD) at baseline was 57.5 (18.4) for adults with CP (n = 646) and 61.8 (19.7) for adults without CP (n = 321,482). During the follow-up, 172 adults with CP (26.6%) and 73 937 adults without CP (23.0%) developed RD. Adults with CP had higher 12-month post-NTFx RD incidence compared to adults without CP (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.03-1.37). When stratified by the RD subtype, adults with CP had a higher incidence of pneumonia (HR = 2.15; 95% CI = 1.56-2.95), interstitial/pleura disease (HR = 2.13; 95% CI = 1.53-2.96), and other RD (eg, respiratory failure; HR = 2.33; 95% CI = 1.82-2.98), but not acute respiratory infection (HR = 0.93; 95% CI = 0.75-1.15) or chronic obstructive pulmonary disease (HR = 1.15; 95% CI = 0.86-1.53). Among privately insured adults with CP, NTFx is associated with greater risk of RD among adults with vs without CP.     

Stress and lambliasis in patients with respiratory allergic disease

The association between stress, humoral and cellular immune response and intestinal parasites was evaluated in 102 patients in a randomized double-blind study. Sixty-four (62.7 per cent) presented respiratory allergic disease (RAD) at the time of the clinical and laboratory tests; the other 38 (37.3 per cent) were normal individuals. Higher levels of IgE associated with RAD were observed in patients with family dysfunction (p < 0.05). All the other immunological parameters that were measured — total B and T lymphocytes, helper (CD4) and suppressor/cytotoxic (CD8) T lymphocytes as well as IgG and IgA levels — were similar in both the allergic and the control groups. Twenty-two patients (22.5 per cent) were positive for Giardia lamblia, 86.3 per cent of them suffering RAD (p < 0.03). Regression analysis showed that patients with high levels of IgE and eosinophilia were associated with G. lamblia infection. This study indicates a higher frequency of lambliasis in RAD and shows that family stress was significantly associated with this allergic condition.     

纳美芬拮抗先天性心脏病患儿术后呼吸抑制的效果

目的 评价纳美芬拮抗先天性心脏病（先心病）患儿术后阿片类药物所致呼吸抑制的效果.方法 选择行先心病择期手术的患儿60例,采用随机数字表法分为3组（每组20例）：对照组（C组）、Ⅰ组、Ⅱ组.手术结束后,患儿带管送入胸外科重症监护室,待生命体征平稳10 min后：C组（对照组）不给予任何拮抗药;Ⅰ组静脉注射纳美芬0.25 μg/kg;Ⅱ组静脉注射纳美芬0.25μg/kg,观察5 min,再次静脉注射纳美芬0.25μg/kg.记录给药前即刻（T1）、给药后5 min（T2）、给药后30 min（T3）、呼吸恢复时（T4）、拔管时（T5）、拔管后1 h（T6）、拔管后3 h（T7）患儿的平均动脉压（mean arterial pressure,MAP）、心率（heart rate,HR）、脉搏血氧饱和度（pulse oxygen saturation,SpO2）和血气分析结果,记录患儿的呼吸恢复时间、拔管时间及心脏病加强监护病房（cardiac intensive care unit,CICU）监护时间,并观察术后恶心、呕吐、发热、躁动、伤口疼痛等副作用的发生率.结果 C组患儿术后呼吸恢复时间、气管导管拔出时间和CICU监护时间分别为（2.9±1.0）、（3.6±1.4）、（18.5±5.8）h,Ⅰ组分别为（1.8±0.6）、（2.3±0.6）、（8.2±3.1）h,Ⅱ组分别为（1.7±0.5）、（2.1±0.7）、（7.9±2.9）h;与C组比较,Ⅰ组和Ⅱ组的各时间均缩短（P＜0.05）.C组患儿术后恶心、呕吐的发生率为15％,Ⅰ组和Ⅱ组的发生率降低,分别为5％和0（P＜0.05）.结论 纳美芬可安全有效地拮抗先心病手术患儿术后阿片类药物所致呼吸抑制作用,且能减少术后副作用发生率.     

Detection of influenza D virus in bovine respiratory disease samples,UK

Influenza D is a newly described virus of cattle, pigs and small ruminants first detected in North America during 2011. Cattle have been shown to be the main viral reservoir and mounting evidence indicates that infection with influenza D may contribute to the development of bovine respiratory disease. The virus has been detected across the United States, Europe and Asia. To date, influenza D has not been reported in the UK. During the winter and spring of 2017/2018, we performed molecular testing of cattle submitted for post‐mortem examination where respiratory disease signs were present. We detected influenza D virus in 8.7% of cases, often as the sole viral agent and always in conjunction with bacterial co‐infection with one or more agents. Viral RNA was present in both the upper and lower respiratory tract and pathological changes in lung tissues were observed alongside signs of concurrent bacterial infections. Sequencing of one UK isolate revealed that it is similar to viruses from the Republic of Ireland and Italy.