急性ST段抬高型心肌梗死患者急诊PCI术后Ⅰ期心脏康复护理研究

目的 探讨Ⅰ期心脏康复七步训练法用于急性ST段抬高型心肌梗死急诊PCI术后患者的效果.方法 将100例急性ST段抬高型心肌梗死直接PCI术后患者随机分为观察组52例和对照组48例,对照组给予急性心肌梗死PCI术后常规护理,观察组在对照组的基础上实施Ⅰ期心脏康复七步法护理.结果 两组住院期间心律失常发生率比较,差异无统计学意义(均P＞0.05),观察组CCU监护时间、住院时间显著短于对照组,PCI术后首次排便时间显著早于对照组(均P＜0.01).结论 对急性ST段抬高型心肌梗死直接PCI术后患者实施个体化的Ⅰ期心脏康复护理有利于缩短CCU监护时间及住院时间,预防便秘发生,促进患者安全.     

预防心肌梗死患者便秘的循证护理

目的 探讨循证护理(EBN)预防急性心肌梗死(AMI)患者便秘的效果.方法 将96例AMI患者随机分为观察组与对照组各48例,对照组给予常规护理,观察组行EBN,即循证后采取早期预防、促进排便训练、心理支持、首次排便监护等干预措施.结果 两组患者首次排便持续时间、排便时心率、心电图S-T段变化以及便秘、心律失常等并发症及再次梗死发生率比较,差异有显著性意义(均P＜0.01).结论采用EBN能显著降低AMI患者便秘发生率,从而降低由此引起的并发症.     

急性ST段抬高型心肌梗死患者急诊PCI术后I期心脏康复护理研究

目的探讨I期心脏康复七步训练法用于急性ST段抬高型心肌梗死急诊PCI术后患者的效果。方法将100例急性ST段抬高型心肌梗死直接PCI术后患者随机分为观察组52例和对照组48例,对照组给予急性心肌梗死PCI术后常规护理,观察组在对照组的基础上实施I期心脏康复七步法护理。结果两组住院期间心律失常发生率比较,差异无统计学意义(均P0.05),观察组CCU监护时间、住院时间显著短于对照组,PCI术后首次排便时间显著早于对照组(均P0.01)。结论对急性ST段抬高型心肌梗死直接PCI术后患者实施个体化的I期心脏康复护理有利于缩短CCU监护时间及住院时间,预防便秘发生,促进患者安全。     

70例急性心肌梗死患者便秘的中西结合护理体会

目的:探讨中西结合舒适护理对急性心肌梗死便秘患者的临床效果.方法:随机选取在我院住院治疗的急性心肌梗142例,根据住院序号分为2组.单号治疗组70例,双号对照组72例.两组均在对症支持治疗及护理基础上,对照组接受常规护理治疗,观察组在此基础上采取中西结合舒适护理,观察2组的首次排便时间及首次排便情况.结果:观察组首次排便时间明显缩短、便秘发生率明显低于对照组治,差异有统计学意义(P＜0.01、P＜0.05).结论:中西结合舒适护理有利于改善急性心肌梗死患者的排便情况,疗效稳定作用,患者乐于接受,优于常规的护理措施,在临床中有较好的实用价值,非常适合于急性心肌梗死便秘患者.     

营养素食预防化疗患者便秘的效果观察

目的 观察营养素食预防化疗患者便秘的效果.方法 选择128例化疗患者,随机分为观察组和对照组各64例,对照组常规正常饮食,观察组于化疗开始当天实施营养素食,连续7～10 d,比较两组患者便秘发生率及体重、血红蛋白、白蛋白等指标.结果 对照组便秘发生率显著高于观察组(P＜0.01);两组化疗后营养指标比较,差异无显著性意义(均P＞0.05).结论 营养素食对化疗患者便秘有较好的预防作用.     

APACHEⅢ在老年急性腹膜炎手术患者护理中的应用

目的 探讨APACHEⅢ对老年急性腹膜炎手术患者护理干预的指导意义.方法 将110例老年急性腹膜炎患者随机分为观察组(66例)和对照组(44例),于入院时及手术后每天行APACHEⅢ评分;对照组行常规护理,观察组根据入院评分分层实施护理干预,并根据术后评分及时调整护理措施.结果 观察组并发症发生率、病死率及住院时间显著低于或少于对照组(均P＜0.05),其中评分41～100分患者效果最为显著(P＜0.05);护士满意度及患者满意度观察组显著高于对照组(均P＜0.05).结论 APACHEⅢ用于老年患者急性腹膜炎手术危险性评估,对采取合理有效的护理干预措施有指导意义.     

基于信息化平台的癌症疼痛管理质量指标的建立与应用

目的 探讨基于信息化平台的疼痛管理质量指标的建立与应用效果。方法 根据住院时间将患者分为对照组（n=387）和观察组（n=484）,对照组按常规进行疼痛评估、镇痛处理及疼痛管理质控；观察组在常规基础上，实施基于信息化平台的癌症疼痛管理质量指标监控，即确立疼痛管理质量指标，并将其与信息化系统联动，利用信息化平台对肿瘤患者进行三级质量监控并实施疼痛质量持续改进。结果 实施疼痛管理后，观察组疼痛评估落实率、镇痛措施落实率、疼痛干预有效率、疼痛管理满意度4项指标显著优于对照组（P＜0.05，P＜0.01）。结论 依托护理管理信息系统进行疼痛管理，有助于实现疼痛管理标准化、规范化，有效提高疼痛护理管理质量。     

预防心肌梗死患者便秘的循证护理

目的探讨循证护理（EBN）预防急性心肌梗死（AMI）患者便秘的效果。方法将96例AMI患者随机分为观察组与对照组各48例,对照组给予常规护理,观察组行EBN,即循证后采取早期预防、促进排便训练、心理支持、首次排便监护等干预措施。结果两组患者首次排便持续时间、排便时心率、心电图S-T段变化以及便秘、心律失常等并发症及再次梗死发生率比较,差异有显著性意义（均P〈0.01）。结论采用EBN能显著降低AMI患者便秘发生率,从而降低由此引起的并发症。     

专人卧位护理干预对急性脑卒中偏瘫患者的影响

目的 探讨实施专人卧位护理干预对急性脑卒中偏瘫患者并发症及日常生活能力的影响.方法 将104例急性脑卒中偏瘫患者按入院时间分为观察组(54例)和对照组(50例).两组均采取常规治疗和护理,观察组在此基础上实施专人卧位护理干预,4周后评定效果.结果 观察组患者肢体继发障碍、压疮、胃肠道反应和导管意外等并发症发生率显著低于对照组,日常生活能力相应提高(P＜0.05,P＜0.01).结论 实施专人卧位护理干预,可降低急性脑卒中偏瘫患者并发症的发生,提高日常生活能力.     

优化呼吸道护理干预在 ICU 大面积重度烧伤患者中的应用效果

目的 探究优化呼吸道护理干预在ICU大面积重度烧伤患者中的应用效果。方法 选取2021年 1月-2022年12月我院收治的100例大面积重度烧伤患者作为对象,随机分为对照组和观察组,各50例。 对照组实施常规护理,观察组实施优化式呼吸道护理,比较两组护理效果、住院时间、护理满意度、烧 伤修复相关指标及并发症发生率。结果 观察组护理总有效率高于对照组（P＜0.05）;观察组各项临床 指标均优于对照组（P＜0.05）;观察组满意度高于对照组（P＜0.05）;观察组烧伤修复指标优于对照 组（P＜0.05）;两组并发症发生率比较,差异无统计学意义（P＞0.05）。结论 实施优化呼吸道护理干预 能够减少住院时间和费用,降低堵管、感染几率,提升患者满意度,提升烧伤修复成功率。     

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。     

Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators

The aim of this study was to provide a systematic overview of available pressure ulcer prevention quality indicators and to evaluate the underlying empirical evidence. A systematic mapping review was conducted with combined searches in Embase and Medline, and websites of relevant institutions and organisations. The eligibility criteria were clear use of the term “quality indicator” regarding pressure ulcer prevention; English or German language; and all settings, populations, and types of resources, including articles, brochures, and online material. In total, n = 146 quality indicators were identified. Most indicators were published in the United States (n = 50). The majority of indicators was developed for the hospital setting (n = 102). Process indicators were the most common (n = 71), followed by outcome indicators (n = 49). Less than half of identified indicators appeared to be practically used. Evidence supporting the validity and reliability were reported for n = 25 and n = 30 indicators respectively. The high number of indicators demonstrate the importance of measuring pressure ulcer prevention quality. This is not an indicator of our ability to accurately measure and evaluate this construct. There is an urgent need to develop evidence‐based and internationally comparable indicators to help improve patient care and safety worldwide.     

The measurement of wound infection after breast surgery

Infection in breast wounds often occurs in the form of cellulitis, but the conventional criteria for wound infection are the presence of either pus or a serous discharge containing pathogens. Wound scoring systems may offer a more quantitative and clinically relevant approach when evaluating the morbidity caused by infection in wounds. The aim of this study was to develop a wound scoring system for patients undergoing breast surgery. The components of previously described wound scoring systems were measured in 218 women undergoing nonreconstructive breast surgery. Using conventional criteria, the incidence of wound infection was 5.5% (12/218). However, 22% of the patients exhibited at least one sign of wound infection, and 11% of the patients received antibiotics for cellulitis without any other indication of a wound infection. The validity of the wound scoring system was supported by its strong content validity, the presence of construct validity as evidenced by concordance with the conventional criteria (p < 0.001), and criterion validity in the form of an association between the presence of a seroma and a positive wound score (p < 0.001). It was also noted that 27% of the patients with an appreciable wound score (more than 40 points) had cellulitis but did not satisfy the conventional criteria for a wound infection. In conclusion, it is advisable to use a wound scoring system that includes cellulitis when evaluating patients who have undergone breast surgery.     

术后谵妄评估和预测的研究进展

术后谵妄（POD）是手术患者常见的并发症,严重影响患者远期认知功能、生理功能和社会功能。既往对POD的评估多以量表为基础,评估结果存在主观性,如何科学客观地进行POD的评估值得深入探究。POD可在早期预测并干预,从而进行有效预防,基于临床预测模型进行POD的风险预测已成为研究热点。本文从神经心理学量表、血清标志物、脑脊液标志物和脑电标志物等多个维度对POD的评估方法进行归纳,并针对POD临床预测模型的预测对象与预测指标进行总结,以期为POD评估和预测提供科学、可行、有效的参考依据。     

Developing a benchmarking process in perfusion: a report of the Perfusion Downunder Collaboration

Improving and understanding clinical practice is an appropriate goal for the perfusion community. The Perfusion Downunder Collaboration has established a multi-center perfusion focused database aimed at achieving these goals through the development of quantitative quality indicators for clinical improvement through benchmarking. Data were collected using the Perfusion Downunder Collaboration database from procedures performed in eight Australian and New Zealand cardiac centers between March 2007 and February 2011. At the Perfusion Downunder Meeting in 2010, it was agreed by consensus, to report quality indicators (QI) for glucose level, arterial outlet temperature, and pCOz management during cardiopulmonary bypass. The values chosen for each QI were: blood glucose > or =4 mmol/L and < or =10 mmol/L; arterial outlet temperature < or = 37 degrees C; and arterial blood gas pCO2 > or =35 and < or =45 mmHg. The QI data were used to derive benchmarks using the Achievable Benchmark of Care (ABC) methodology to identify the incidence of QIs at the best performing centers. Five thousand four hundred and sixty-five procedures were evaluated to derive QI and benchmark data. The incidence of the blood glucose QI ranged from 37-96% of procedures, with a benchmark value of 90%. The arterial outlet temperature QI occurred in 16-98% of procedures with the benchmark of 94%; while the arterial pCO2 QI occurred in 21-91%, with the benchmark value of 80%. We have derived QIs and benchmark calculations for the management of several key aspects of cardiopulmonary bypass to provide a platform for improving the quality of perfusion practice.     

Quality indicators in colonoscopy: an evolving paradigm

The year 1969 marked a revolution in the diagnosis of colorectal cancer (CRC). It is when Dr Wolff developed the colonoscope and quickly realized its potential in both diagnosis and treatment of colonic neoplasms. Over the past 50 years there has been exponential increase in utilization of colonoscopy with over 1 million colonoscopies performed annually throughout Australasia. Endoscopic removal of pre‐malignant lesions has been proven to reduce the incidence and mortality of colorectal. Although timing and frequency of surveillance colonoscopy plays a crucial role in risk reduction of CRC, this is dependent upon the findings of the index colonoscopy. The goal of screening colonoscopy is to detect CRC and identify and remove pre‐malignant neoplasms that risk progression to CRC. With increasing uptake of bowel screening throughout Australasia, there is increasing pressure to ensure all endoscopists and endoscopy units perform at a universal high‐quality. All too often high demand and constant delays compromise colonoscopy quality. Without clear and concise quality indicators with transparent measurement and audit, these flaws can quickly jeopardize screening goals and patient outcomes. This review aims to explore six key quality indicators and explore the evidence behind the current recommended standards. These key indicators include; rate of adequate bowel preparation, caecal intubation rate, adenoma detection rate, withdrawal time, complication rates and surveillance intervals.     

脊柱手术后切口深部感染的早期判断

目的 :观察脊柱术后早期各项感染相关指标的变化情况,为尽早判断切口深部感染的存在提供更为可靠的依据。方法:2001年1月~2012年12月在复旦大学附属华山医院脊柱外科中心行脊柱手术的患者中,术后发生切口深部感染24例(感染组),男20例,女4例;年龄55.0±15.0岁(14~75岁);急性感染14例(术后3个月内发生),迟发性感染10例(术后3个月后发生)。以同时间段行脊柱手术、术后未出现感染的51例患者(男29例,女22例;年龄19~81岁)作为对照组。回顾性分析两组患者术后第3天及术后第5/6天外周血中白细胞总数、中性粒细胞总数、红细胞沉降率(ESR)及C-反应蛋白(CRP)等参数,同时回顾相应时间点患者体温与局部伤口情况。以白细胞总数、中性粒细胞总数、CRP、ESR及体温等参数超过对照组患者相应时间点该参数值的均数+2倍标准差(+2s)作为上述参数异常的标准;局部伤口以出现红肿热痛、伴或不伴渗出作为异常的标准。结果:与对照组比较,切口深部感染组患者术后3d的CRP显著性升高(P=0.005);术后5/6d,CRP(P=0.000)、中性粒细胞总数(P=0.020)及体温(P=0.001)均显著性增高。在术后3d或5/6d时,24例患者中共有8例(33.3%)体温增高;2例(8.3%)白细胞总数升高,11例(45.8%)中性粒细胞总数升高;18例(75%)ESR升高,21例(87.5%)CRP升高;3例(12.5%)在术后短期内(1周)出现手术伤口部位红肿热痛,伴或不伴渗出。CRP及ESR等参数对于切口深部感染诊断的敏感性明显高于体温、伤口局部体征及白细胞总数与中性粒细胞总数等感染相关指标(P0.05)。迟发性切口深部感染患者外周血各项炎症指标与急性切口深部感染患者比较无统计学差异(P0.05)。结论:术后早期定时检测周围血中CRP和ESR有利于早期判断切口深部感染,CRP升高可在早期有效判断切口深部感染。     

Clinicopathological study of brain metastasis in gastric cancer patients

P = 0.0177). Aggressive multidisciplinary treatment, including a resection, for brain metastasis should improve the quality of life and prolong life expectancy. (Received for publication on Aug. 5, 1999; accepted on Jan. 7, 2000)