特需病房低年资护士核心能力的培养探讨

目的探讨特需病房低年资护士核心能力的培养方法。方法采用以自愿为原则制定个体化培训计划和自学加个别指导相结合的培训方式。结果实施后护士的理论、技能水平和工作表现均得到提高,与培训前相比,有统计学意义（P〈0．05）。结论实施核心能力的培养,有助于提高特需病房低年资护士的综合素质,增加竞争力。     

手术室专科护士核心能力现状调查

目的了解手术室专科护士核心能力现状,探讨其影响因素,为护理管理者合理安排工作岗位提供依据。方法采用方便抽样方法抽取83名手术室专科护士。采用护士一般情况调查表、中国注册护士核心能力量表进行调查。结果专科护士核心能力总分（169．77±33．86）分,专科护士的核心能力维度中法律／伦理实践均分最高（3．16±0．57）,评判性思维／科研均分最低（2．76±0．62）;多元线性逐步回归结果显示职称影响专科护士核心能力（t=2．89,P=0．01）。结论专科护士核心能力处于中等水平,护士能够胜任临床工作。护理管理者应有针对性的制定干预措施,以提高护理质量,促进护理队伍的整体发展。     

专科护士在护理层级管理中对护理影响力的研究

目的 探讨专科护士在护理层级管理模式中对护理的影响力.方法 选择2009年1月～2011年7月产科特需病房全体在职护士为研究对象,特需病房11病区实施护理层级管理模式,特需病房12区实施传统整体护理.比较两种不同护理模式下病区护理终末质量、病人满意度、各级护士满意度及专科护士专业地位对各级护士职业成长的影响.结果 产科特需病房11区实施护理层级管理模式后与对照病区护理质量比较：基础护理质量（P＜0.001）、特Ⅰ级护理质量（P ＜0.005）、健康教育质量、患者满意度、各级护士满意度均有统计学意义（均P＜0.05）,专科护士专业地位对各级护士职业成长的影响显著.结论 分层级管理有利于提高护理质量,提高患者满意度,专科护士专业地位的确立增强了护士的职业成就感,提高了护士工作满意度,促进护士提高学历并努力向专科护士发展.     

外科优质护理服务病房护士工作满意度现状的调查分析

目的通过对厦门市某三级甲等综合医院外科优质护理服务病房护士对自身工作满意度现状的调查与分析,了解外科优质护理服务病房护士的工作满意度及其影响因素。方法采用分层抽样方法,选取厦门市某三级甲等综合医院100名外科优质护理服务病房的护士进行问卷调查。结果外科优质护理服务病房护士对工作的总体满意度得分为（2．76±0．43）分。护士工作满意度得分由高到低依次排序为：互动合作（3．00±0．56）分、职业地位（2．88±0．54）分、自主性（2．80±0．62）分、工作任务（2．65±0．58）分、组织决策（2．61±0．48）分、收入（2．43±0．43）分。不同年龄、工作年限、学历、职称、婚姻状况的护士,其工作满意度得分比较,差异有统计学意义（19〈0．01）。结论医院外科优质护理服务病房护士工作满意度处于中等,护士的收入、组织决策及工作任务满意度偏低。     

特需病房护士压力源及相关因素调查

目的了解现阶段特需病房护士面临的压力程度及原因，最大限度地缓解护士压力，保持身心健康。方法采用问卷调查法，对60名特需病房护士压力状况进行调查，针对压力来源采取相应对策。结果病人护理方面的问题、工作及时间分配问题、管理和人际关系方面的问题是特需病房护士最主要压力源。结论确定主因并制定对策，通过管理层及护士本身双方的共同努力，最终缓解护士的心理压力以保持良好的心理健康状态。     

特需护士多元文化护理认知与其个性特征的相关性研究

目的探讨上海市特需护士个性心理特征及其与多元文化护理认知水平之间的相关性，寻找影响认知水平的因素，为提高认知水平提供依据。方法采用艾森克个性问卷（EPO）及自行设计多元文化护理调查问卷，对上海市11家综合性具有特需医疗服务的医院从事特需服务的202位护士在同一时间内进行调查，用统计学方法对数据进行统计及分析。结果特需护士EPQ中神经质、精神质、掩饰性因子均值在正常范围（P〉0．05），内外向因子偏高（P〈0．01）；护士多元文化护理认知与艾森克个性问无相关性（P〉0．05）；特需护士与非特需护士多元文化护理认知水平在知识理论、饮食文化及总体认知上均存在差异（P〈0．05）；2种护士每日学习时间存在差异（P〈0．01）。结论护理管理上对护士的学习时间应有一定的要求；同时应为培养护士情绪稳定、态度温和、善于自我控制及与人合作等良好个性营造特需工作氛围。     

精神科特需病房的安全隐患及管理对策

目的：分析精神科特需病房存在的安全隐患,并探讨针对性地、适合精神科特需患者住院的安全管理对策,以最大限度地保障患者的人身安全。方法将2009年4月至2011年3月入住特需病房患者217例作为对照组,给予精神科常规护理,将2011年4月至2012年3月入住特需病房患者113例作为研究组,制定和实施特需病房管理制度,比较两组间意外事件发生率和满意度。结果研究组意外事件发生总数较对照组显著减少;制定和实施特需病房管理制度后,患者满意度显著提高（ P＜0.05）。结论通过对精神科特需病房安全隐患的分析,制定特需病房的管理制度和实施措施,能提高患者对护理工作的满意度,同时有效确保护理安全。     

宁波地区骨科病房护士核心能力及其影响因素

目的调查宁波地区骨科病房护士核心能力及其影响因素,为护理人力资源的合理配置和制定核心能力分层培训方案提供基础资料和循证依据。方法 2014年3-9月,便利抽样法选取宁波地区11所三级以上医院骨科病房的426名护士为调查对象。采用《中国注册护士核心能力量表》对其核心能力现状进行调查。结果宁波地区11所三级以上医院骨科病房护士中存在"双低"现象,初级职称占了73.9%,低工作年限占77.7%;护士核心能力总分为(139.8±38.9)分,处于中下水平。核心能力7个维度中伦理与法律实践能力得分最高,然后依次为人际关系能力、领导能力、临床护理能力、专业发展能力、教育咨询能力、批判性思维和科研能力。条目中得分最高的前3个条目为"对自己的工作负责","认同他人的付出和取得的成绩","尊重患者或委托人的隐私";得分最低的后3个条目为"将相关的研究结果运用于护理实践","拟定适当的新入职护士的职前培训计划","起到改革者的作用,将新的理论和时间相结合"。年龄、工作年限、职称、学历是影响护士核心能力的主要因素。结论宁波地区骨科病房护士核心能力处于中下水平,有较大的提高空间;工作年限、职称和学历是影响其核心能力水平的主要因素,应特别重视批判性思维和科研能力、教育咨询能力和专业发展能力的培养。     

上海市特需护士多元文化护理认知现况的调查

目的探讨上海市特需护士多元文化护理的认知水平及影响因素,为提高多元文化护理水平提供培训课程的依据及管理建议。方珐自行设计特需护士多元文化护理调查问卷（4个维度）,对上海市11家具有特需医疗服务的综合医院从事特需服务的202位护士在同一时间内进行调查,对数据进行统计及分析。结果多元文化护理总体得分为（128．70±14．92）分,其中理论知识维度认知得分最低,为（27．36±6．43）分;大专及以上护士的总体认知水平显著高于中专组（P〈0．01）;通过大学英语3级及以上护士总体认知水平显著高于未通过组（P〈0．01）;不同医院护士的总体认知水平存在显著差异（P〈0．05或P〈0．01）。影响护士多元文化认知水平的因素有护士的学习时间（P〈0．001）、护士所在医院的级别（P〈0．001）及护士的文化程度（P〈0．01）。结论上海市特需护士多元文化护理知识的认知水平亟待提高,必须加强培训及管理。     

人文护理在特需病房的应用

目的探讨人文护理在特需病房患者中的运用。方法结合特需病房的工作特点对住院患者按照人文护理模式实施护理。结果患者及家属对护理的满意度明显提高。结论人文护理在特需病房的应用提高了护理服务质量，并充分发挥了护士的主观能动性。     

成人心血管手术中病人压疮危险因素的研究

目的 确定心血管手术中病人压疮危险因素,为预防压疮提供临床依据。方法采用便利抽样方法,应用自行设计心血管手术中病人压疮危险因素评估表对2690例心血管手术中病人进行回顾性调查。通过Logistic多元相关分析得出心血管手术病人发生压疮的危险因素。结果年龄、性别、体外循环时间、淋巴细胞计数等4个因素与术中病人发生压疮密切相关,差异具有统计学意义（P〈0．05）。结论年龄增长、男性、体外循环时间长及淋巴细胞计数减少会增加病人术中发生压疮的几率。     

体外循环下肾癌伴下腔静脉癌栓取出术的手术配合及护理

目的总结应用体外循环技术切除肾癌伴下腔静脉癌栓的手术配合经验。方法对4例肾癌伴下腔静脉癌栓患者采用体外循环下血管成形和人造血管置换术,并进行回顾性分析。根据不同的手术方式,手术护士有针对性的采取不同的配合方法,并参与术前讨论熟悉手术流程,总结护理经验。结果熟悉手术流程能密切配合手术,有效地缩短手术时间,手术中异常情况得到及时发现和正确处理,本组手术患者均安全度过手术期。结论手术护士参与术前讨论、熟悉手术流程、密切配合是手术顺利进行的关键。     

体外循环液位及压力变化报警装置的设计与临床应用价值

背景:加强体外循环期间的监测可以减少体外循环相关的死亡率.液位、压力监测是体外循环的重要检测项目,是患者的生命线,对体外循环中液位、压力的监测是必不可少的.目的:设计液位、压力报警器并探讨其可行性及临床应用价值.方法:液化、压力报警器由压力传感器、光电发射器、光电探测器、控制核心及液晶显示模块等部分组成.利用光线的折射及反射原理,光线在两种不同介质的分界面将会产生反射或折射现象.压力的大小变化通过压力传感器转换成相应的电信号的强弱变化.根据上述两种原理,设计液位、压力报警器.以30例年龄1～75岁,需体外循环下行心脏手术患者为对象,观察体外循环中不同灌注流量时体外循环管道内压力的变化及低于设定液面时液位是否报警.结果与结论:体外循环管道内泵压随流量增加而增加,HZ-01-A型液位、压力变化报警器及机械压力表测得的压力都随流量增加而增加,具何近乎一致的相关关系,HZ-01-A型液化、压力变化报警器及机械压力表测得数值无统计学差异.当体外循环管通内压力变化超过设定压力及储血器内液面低于设定液面时,HZ-01-A型液位、压力变化报警器可以声光报警.HZ-01-A型液位、压力变化报警器在体外循环中可以安全、准确地监测泵压的变化及液面位置,提高体外循环的安全性.     

体外循环并发急性肾损伤患者的危险因素及血清肌酐连续检测时间分析

目的探讨心脏手术体外循环患者并发急性肾损伤(acute renal injury,AKI)患者的危险因素,明确术前实验室检查及术中体外循环时间等与AKI的发病率之间的关系。方法选取2017年10月至2018年10月期间在广西医科大学第一附属医院住院接受体外循环患者的临床资料进行回顾性分析。采用Logistic回归分析患者既往史、术前实验室检查、术中体外循环时间等对术后并发AKI的影响。同时分析并发AKI患者术后7 d血清肌酐变化,为术后并发AKI的早期诊断提供帮助。结果共纳入370例体外循环患者。Logistic回归分析结果:有糖尿病基础病史(OR=5.226,95%CI1.084~25.191,P=0.039)、年龄(OR=1.041,95%CI1.018~1.065,P<0.001)的增加、体质量指数(body mass index,BMI)(OR=1.127,95%CI1.043~1.218,P=0.003)升高、尿素氮(OR=1.211,95%CI1.077~1.360,P=0.001)升高、体外循环时间(OR=1.013,95%CI1.006~1.020,P<0.001)延长是体外循环患者术后并发AKI的危险因素。术后7 d分析AKI检出率分别为第1天4.19%(9/215),第2天51.63%(111/215),第3天87.91%(189/215),第4天97.67%(210/215),第5天99.07%(213/215),第6天100%(215/215),第7天100%(215/215)。结论有糖尿病史、年龄、BMI、尿素氮、体外循环时间是体外循环患者并发AKI的危险因素。为降低漏误诊率,对于术后血清肌酐的观察至少应该连续4 d。     

Early postoperative monocyte deactivation predicts systemic inflammation and prolonged stay in pediatric cardiac intensive care

OBJECTIVE: Sepsis and systemic inflammatory response syndrome (SIRS) are major causes of morbidity and mortality after cardiopulmonary bypass. Attempts to suppress proinflammatory mediators have failed to improve outcomes in sepsis or in patients undergoing cardiopulmonary bypass. Recent work in adult patients has suggested that the balance between pro- and anti-inflammatory mediators is more important than the level of proinflammatory response alone. This balance may be reflected by the expression of monocyte human lymphocyte antigen (HLA)-DR, with low concentrations indicating an excess of anti-inflammatory stimuli and relative immunodeficiency. We investigated the relationship between monocyte HLA-DR expression and the subsequent development of sepsis/SIRS in children undergoing cardiopulmonary bypass. DESIGN: A prospective, observational, clinical study. SETTING: A tertiary pediatric cardiac center. PATIENTS: Eighty-two infants and children undergoing elective cardiac surgery between March and December 1999. MEASUREMENTS AND MAIN RESULTS: Monocyte HLA-DR expression was assessed before and after surgery and was found to be related to the length of hospital stay and the development of complications including sepsis/SIRS. The inflammatory insult of cardiopulmonary bypass decreased monocyte HLA-DR expression in all children. Lowest concentrations were seen within 72 hrs of surgery and were significantly lower in cases that subsequently required prolonged intensive care support (p <.0001, Mann-Whitney). HLA-DR expression on <60% of circulating monocytes was associated with a greatly increased risk of later (minimum 4 days) development of sepsis/SIRS (odds ratio, 12.9; 95% confidence interval, 3.4-47.5). Low HLA-DR was an independent predictor for the development of sepsis/SIRS after correction for age, bypass time, complexity of surgery, Paediatric Index of Mortality, and surgeon on multiple logistic regression analysis. CONCLUSIONS: Patients with decreased HLA-DR in the early postoperative period represent a subpopulation at greatly increased risk of later sepsis/SIRS. Such patients may benefit from strategies aimed to reduce this risk.     

Neutrophils and platelets accumulate in the heart, lungs, and kidneys after cardiopulmonary bypass in neonatal pigs

OBJECTIVE: Cardiac surgery with cardiopulmonary bypass elicits a systemic inflammatory response. An exaggerated response is associated with organ dysfunction and increased morbidity and mortality. DESIGN: The aim of the present study was to investigate whether the cardiopulmonary bypass procedure in itself results in accumulation of isotope-labeled platelets, polymorphonuclear neutrophils, and fibrinogen at organ levels in neonatal pigs and to monitor changes in organ function. SETTING: Pediatric cardiopulmonary bypass setup with 60 mins of aortic cross-clamp time and 120 mins of hypothermic cardiopulmonary bypass time. SUBJECTS: Thirty piglets were allocated to sternotomy alone (sham group, n = 15) or to sternotomy and cardiopulmonary bypass (n = 15). MEASUREMENTS AND MAIN RESULTS: Isotope-labeled autologous polymorphonuclear neutrophils, platelets, and commercially available fibrinogen were infused, and the specific accumulation at organ level was measured in a gamma counter 4 hrs after termination of cardiopulmonary bypass. Concomitant changes in oxygenation index and cardiac output were registered. Animals exposed to cardiopulmonary bypass showed a significantly higher technetium-99m-polymorphonuclear neutrophil accumulation in the lungs and kidneys, whereas indium-111-platelets accumulated in the heart and kidneys compared with the sham group. There was a significantly larger increase in oxygenation index and significantly larger decrease in cardiac output between the pre- and postcardiopulmonary bypass period in the cardiopulmonary bypass group compared with the sham group. CONCLUSIONS: The cardiopulmonary bypass procedure without cardiac surgery elicits organ dysfunction in terms of impaired respiratory and hemodynamic function. Platelets and polymorphonuclear neutrophils were entrapped in the heart, lungs, and kidneys of cardiopulmonary bypass animals, indicating that cell accumulation may contribute to the developing organ dysfunction.     

A rat model of acute lung injury induced by cardiopulmonary bypass.

Impaired lung function is still a major complication after cardiac surgery with cardiopulmonary bypass. The purpose of the present study was to develop an experimental model of acute pulmonary injury induced by cardiopulmonary bypass in Wistar rats. Cardiopulmonary bypass was performed for 60 min using a non-pulsatile roller pump and a membrane oxygenator (n = 8 for cardiopulmonary bypass group and n = 7 for control rats). We measured tracheal pressure, airflow, and lung volume changes and obtained pulmonary resistance and dynamic elastance. After the cardiopulmonary bypass, lungs were submitted to a quick-freezing protocol and morphometric analysis was performed. There was a time-dependent increase in dynamic elastance, but not pulmonary resistance, only in the rats submitted to cardiopulmonary bypass (P = 0.005). Lungs from animals submitted to cardiopulmonary bypass showed significantly more alveolar hemorrhage (P = 0.025) and edema (P = 0.021), as well as perivascular edema (P = 0.003) when compared to control rats. In our experimental model, rats submitted to cardiopulmonary bypass developed acute pulmonary changes similar to the early phase of acute pulmonary distress syndrome. Cardiopulmonary bypass resulted in an increase in pulmonary elastance without changes in resistance. This experimental model is suitable for studies concerning the mechanisms of acute lung injury induced by cardiopulmonary bypass.     

体外循环手术患者血浆C3和C4的检测及临床意义

目的 了解体外循环手术(CPB)对患者血浆中补体C3、C4的影响.方法 用透射比浊法测定行心脏瓣膜置换术前后患者血浆中C3、C4的浓度,并进行比较.结果 术前与术后血浆中C3、C4差异有统计学意义,血浆中C3、C4降低的谷值在CPB末.结论 CPB导致术后早期大量补体激活,易引起全身性炎症反应综合征(SIRS),减少补体激活程度可降低炎症反应强度.     

江西省二级及以上医院护士长核心能力的调查

目的 探讨不同级别医院护士长核心能力水平,并分析影响因素.方法 采用便利抽样方法对江西省11 所二级及以上医院的234 名护士长进行核心能力的问卷调查.结果 护士长核心能力得分为(113.87±16.58)分;年龄、工作年限、管理年限、医院级别不同的护士长,其核心能力不同.结论 江西省二级及以上医院护士长核心能力水平...     

Changes in biochemical and biophysical surfactant properties with cardiopulmonary bypass in children

OBJECTIVE: The aim of the present study was to characterize pulmonary surfactant properties in children undergoing cardiovascular surgery with cardiopulmonary bypass. DESIGN: Prospective clinical trial. SETTING: University hospital pediatric intensive care unit. PATIENTS: Fifty pediatric patients with congenital cardiac defects undergoing cardiovascular surgery with (n = 35) and without (n = 15) cardiopulmonary bypass procedure. INTERVENTIONS: Tracheal aspirates were collected by saline lavage during routine suctioning before (baseline) and after cardiopulmonary bypass, as well as 4, 8, and 24 hrs after admission to the pediatric intensive care unit. MEASUREMENTS AND MAIN RESULTS: Total protein and phospholipid concentrations were assessed in native tracheal aspirates, in large surfactant aggregates, and in small surfactant aggregates. Phospholipid profiles and phosphatidylcholine fatty acids; surfactant apoproteins SP-A, SP-B, and SP-C (enzyme-linked immunosorbent assay); and surface activity (Pulsating Bubble Surfactometer) were all analyzed in large surfactant aggregates. With cardiopulmonary bypass, an initial increase in total protein content was followed by an increase in phospholipid concentration in tracheal aspirates. Large surfactant aggregates decreased 4 hrs after cardiopulmonary bypass (4 hrs, 22.6 +/- 5.6%; mean +/- SEM; p<.01 compared with baseline, 55.4 +/- 9.2%) but recovered within 24 hrs. The phospholipid-protein ratio of large surfactant aggregates 24 hrs after cardiopulmonary bypass (1.2 +/- 0.2; p<.01) was significantly decreased compared with baseline (2.9 +/- 0.6). The relative amount of phosphatidylglycerol content in the large surfactant aggregates-fraction dropped linearly over time but other phospholipids remained mainly unchanged. Phosphatidylcholine fatty acid profiles remained unaffected by cardiopulmonary bypass. The relative content of SP-B and SP-C in large surfactant aggregates increased approximately three-fold compared with baseline. Altogether, our findings with recovered large surfactant aggregate/small surfactant aggregate ratios and increased phospholipid in tracheal aspirates after 24 hrs represent an approximately ten-fold increase in large surfactant aggregate-associated SP-B and SP-C compared with baseline. Only minor changes were detected in biophysical properties of large surfactant aggregates throughout the observation period. CONCLUSIONS: Cardiopulmonary bypass procedure in children induces profound changes in the surfactant system involving both phospholipid and protein components; biophysical function may have been maintained by compensatory increase in SP-B and SP-C.