创办永久性结肠造口俱乐部“多彩人生”的实践与效果

目的 探讨开设永久性结肠造口俱乐部“多彩人生”的方法及效果。方法: 选取200例永久性结肠造口患者,随机分为观察组（n=100）和对照组（n=100）。对照组患者给予常规延续护理,观察组患者参与“多彩人生”俱乐部活动,连续干预6个月。比较两组患者并发症发生率、自我效能及Herth希望量表（Herth hope index, HHI）评分。结果: 观察组并发症发生率观察组并发症发生率明显低于对照组（14% vs 35%）（P＜0.05）。干预前,两组自我效能及HHI评分比较无统计学差异（P＞0.05）。干预后,观察组自我效能及HHI总评分分别为（128.2±11.5）分、（36.8±5.4）分,对照组分别为（102.2±13.1）分、（27.5±4.2）分。观察组自我效能及HHI总评分较对照组显著提高（P＜0.05）。结论: 开设“多彩人生”俱乐部,有利于提高永久性结肠造口患者自我效能及希望水平,降低造口并发症发生率,值得临床推广应用。     

基于遗忘规律健康教育应用于住院肺癌患者中的效果分析

目的 探究基于遗忘规律健康教育应用于住院肺癌患者中的效果。方法 选取2017年6月至2019年6月如皋市人民医院收治的肺癌患者120例，按随机数字法分为两组，各60例。对照组给予常规教育，观察组给予基于遗忘规律健康教育。对比两组患者干预10 d后自我效能、自我管理行为及负性情绪情况。结果 观察组干预10天后自我效能总评分为（107.85±3.73）分，高于对照组的（83.67±4.15）分；自我管理行为总分为（97.00±4.04）分，优于对照组的（84.81±4.04）分；负性情绪SAS评分及SDS评分均低于对照组，差异均有统计学意义（均P＜0.05)。结论 基于遗忘规律健康教育应用于住院肺癌患者中，可显著提高患者自我效能，改善患者自我管理行为，缓解患者负性情绪。     

赋能教育在肺癌患者自我管理效能感水平中应用的效果观察

目的 探讨赋能教育模式对首次诊断为肺癌的患者自我管理效能感水平的影响。方法 采用方便取样法选取我科收治的肺癌患者80例，问卷由一般资料及中文版癌症自我管理效能感量表构成，以问卷星的方式发放电子问卷。结果 肺癌患者自我效能感的平均得分为（58.39±12.41）分，处于较差水平，在自我决策方面得分最差，仅为（5.34±1.61）分。实施健康教育后，干预组自我效能感的平均得分为（98.24±6.06）分，与对照组相比具有统计学差异（P<0.05）。结论 医护人员在对肺癌患者的健康管理中，结合实际情况，使用赋能教育模式比常规的健康教育模式更能提高患者的自我管理效能感水平，改善患者生活状况。     

基于赋能理论的康复护理教育在创伤性脑损伤患儿照顾者中的应用效果研究

摘要 目的：探讨赋能康复护理教育在创伤性脑损伤患儿照顾者中的应用效果。 方法：采用便利抽样法选取深圳市某儿童医院神经外科就诊的77例创伤性脑损伤患儿照顾者为研究对象,按照入院先后顺序分为对照组（38例）与观察组（39例）。对照组接受常规康复护理教育,观察组接受赋能康复护理教育。比较两组照顾者出院准备度、自我效能和照顾积极感受的情况。 结果：出院当天观察组照顾者出院准备度、自我效能和照顾积极感受得分分别为（22.15±3.92）分、（31.25±3.85）分和（31.92±4.32）分,均高于对照组（20.36±3.16）分、（28.92±3.38）分和（28.94±2.66）分,P＜0.05。出院后1个月,观察组自我效能和照顾积极感受得分分别为（28.72±3.06）分和（28.35±4.09）分,均高于对照组（27.13±2.80）分和（26.21±3.02）分,P＜0.05。重复方差分析结果显示,存在交互作用,随着时间的延长,两组差异仍具有显著性意义（P＜0.05）, 结论：基于赋能理论的康复护理教育,有助于提高照顾者出院准备度、自我效能和照顾积极感受,值得临床借鉴。     

以助产士为主导的孕晚期综合干预对孕产妇自我效能及分娩结局的影响

目的探讨助产士主导的孕晚期综合干预对初产妇分娩自我效能及分娩结局的影响。方法采用便利抽样法,选择2014年9月至2015年3月在重庆医科大学附属第一医院本部及金山医院产科建卡、符合纳入及排除标准的初产妇为研究对象,以院区分为观察组211例、对照组215例。观察组孕产妇从孕34周至分娩前接受助产士主导的孕晚期综合干预,对照组接受传统产科服务模式。比较两组孕产妇的分娩自我效能及分娩结局。结果两组产妇的年龄、孕次、流产、学历及职业等比较差异无统计学意义(均P0.05);孕34周分娩自我效能得分比较,差异无统计学意义(P0.05)。孕38周时观察组产妇分娩自我效能得分高于对照组,差异有统计学意义(P0.01);两组顺转剖数(OR=0.331,95%CI:0.214~0.513)、分娩镇痛数(OR=0.094,95%CI:0.035~0.252)、会阴侧切数(OR=0.447,95%CI:0.250~0.798)对比,差异有统计学意义(P0.01);观察组产程以及产后2 h出血量均少于对照组,差异有统计学意义(均P0.05)。结论以助产士为主导的孕晚期综合干预,能够提高孕产妇分娩自我效能,降低剖宫产率,改善分娩结局,提升产科服务质量。     

基于循证护理的多点连动式护理服务模式在高危孕产妇全病程管理中的应用研究

目的 探讨基于循证护理的多点连动式护理服务模式在高危孕产妇全病程管理中的应用价值。方法 选取 2022 年 4 月至 2022 年 6 月在我院产检自愿参加研究的高危孕妇 400 例。利用简单随机抽样方法将孕妇分成对照组和观察组，每组各 200 例。 对照组孕产妇采用传统管理模式。观察组在常规诊疗护理的基础上实施基于循证护理理念的多点连动式护理。比较两组的分娩 自我效能、分娩应对能力、分娩结局、新生儿并发症。结果 观察组孕产妇分娩自我效能、分娩应对能力评分高于对照组（P<0.05）。 观察组孕产妇自然分娩率高于对照组（P<0.05）。观察组新生儿并发症发生率低于对照组（P<0.05）。结论 高危孕产妇开展多点 连动式护理服务全病程管理模式，能够明显提高孕产妇分娩应对能力，降低新生儿并发症发生率，改善分娩结局。     

同步激励理论在护理管理中的效果分析

目的 探讨同步激励理论在护理管理中的效果。方法 选取正在我院从事临床护理工作的护理人员64例，随机分为观察组和对照组各32例。对照组护理人员采用常规护理管理方法，观察组护理人员在护理管理工作中应用同步激励法。比较两组护理人员自我效能、素质评价和患者满意度。结果 观察组患者自我效能、素质评价分别为（36.47±2.43）分和（92.13±5.14）分，均明显高于对照组的（26.76±2.74）分和（78.04±3.21）分，差异具有统计学意义（P＜0.05）；观察组中患者满意度为93.25%，明显高于对照组的81.25%，差异具有统计学意义（P＜0.05）。结论 在护理管理工作中应用同步激励理论 ，能调动护理人员工作的主动性和积极性，促进科室的良性竞争，提高工作效率和患者满意度，值得推广应用。     

聚焦解决模式在甲状腺癌手术合并气管切开术患者中的应用效果

目的：探讨聚焦解决模式对甲状腺癌手术合并气管切开术患者的应用效果。方法：应用便利抽样的方法,选取行甲状腺癌手术合并气管切开术治疗的患者90例为研究对象。按照入院顺序分为对照组和观察组各45例,对照组实施常规护理方法,观察组在此基础上实施聚焦解决模式,比较两组患者干预前后的焦虑、自我效能以及患者满意度的情况。结果：干预前两组患者的焦虑评分和一般自我效能评分无统计学差异（P＞0.05）。干预后观察组患者的焦虑评分低于对照组,差异有统计学意义（P<0.05）,一般自我效能感得分高于对照组,差异有统计学意义（P<0.05）。结论：聚焦解决模式能够减轻甲状腺癌手术合并气管切开术患者的焦虑水平,提高其自我效能水平。     

核医学ECT检查期间患者接受流程化干预措施的价值分析

摘要：目的 分析核医学ECT检查期间患者接受流程化干预措施的应用效果。方法 选取2019年7月-2020年7月期间在我院进行核医学ECT检查的60例患者为研究对象，按照随机数字表法均分，对照组30例按常规管理方式；予以观察组30例流程化干预。以两组患者等待检查时间、心理状态、护理满意度、核医学检查相关知识了解度以及不良事件发生率等指标为对比项目。结果 观察组等待时间与检查时间均较对照组短（P<0.05）；观察组SAS评分和SDS评分分别为（43.54±4.82）分和（43.25±4.42）分，低于对照组（P<0.05）；观察组核医学检查相关知识了解度与护理满意度评分均高于对照组（P<0.05）；观察组不良事件发生率为3.33%，低于对照组23.33%，差异显著（P<0.05）。结论 流程化干预措施应用于核医学ECT检查中效果明显。     

针对性护理结合健康教育对糖尿病肾病透析患者自体动静脉内瘘维护效果的影响分析

目的：分析糖尿病肾病患者透析治疗中采用针对性护理结合健康教育的护理效果。方法：选取2018年6月~2019年6月接收治疗的糖尿病肾病透析患者60例，按照随机数字表法分为观察组和对照组，各30例。对照组采取健康教育干预，观察组在对照组基础上采用针对性护理干预，比较两组护理满意度、内瘘成熟时间、内瘘使用时间、患者自我维护能力、知识知晓评分。结果：观察组护理满意度为96.7%，高于对照组的70.0%，差异有统计学意义（P＜0.05）。观察组患者内瘘成熟时间为（5.11±0.12）周，短于对照组的（6.23±0.16）周；观察组内瘘使用时间为（25.62±2.31）个月，长于对照组的（20.56±2.25）个月；观察组患者自我维护能力评分为（75.62±3.62）分，高于对照组的（64.58±3.16）分，差异均有统计学意义（P＜0.05）。观察组患者内瘘知识评分、治疗依从性评分分别为（85.33±2.62）分、（95.62±2.64）分，高于对照组的（75.32±2.64）分、（74.22±2.64）分，差异均有统计学意义（P＜0.05）。结论：在糖尿病肾病透析患者治疗中采用针对性护理与健康教育临床护理效果显著，可提高护理满意度，同时延长患者内瘘使用时间。     

ARDS患者血乳酸水平与APACHEⅡ评分相关性研究

目的观察急性呼吸窘迫综合征（ARDS）患者血乳酸水平的变化及其与急性生理学与慢性健康状况评分（APACHEII评分）的关系及意义。方法对48例ARDS患者在入住ICU24h内分别进行APACHEⅡ评分和血乳酸浓度测定,比较不同APACHEII评分分值组与血乳酸浓度。结果 APACHEII评分21～30分组血乳酸浓度明显高于11～20分组（P〈0.05）,APACHEII评分〉30分组血乳酸浓度明显高于21～30分组（P〈0.01）,血乳酸水平与A-PACHEⅡ评分显著相关（r=0.682,P〈0.01）,死亡组血乳酸水平明显高于存活组。结论随着APACHEⅡ评分增高,血乳酸浓度也相应增高;血乳酸浓度与ARDS病情严重程度正相关,是ARDS严重程度的早期、敏感、定量的指标。     

Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients

Purpose

Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how Model for End-Stage Liver Disease (MELD), an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short- and long-term mortality for critically ill cirrhotic patients.

Materials and methods

This was a retrospective cohort study involving seven intensive care units (ICUs) in a tertiary care, academic medical center. Adult patients with cirrhosis who were admitted to an ICU between 2001 and 2008 were evaluated. Severity of illness scores (MELD and Sequential Organ Failure Assessment [SOFA]) were calculated on admission and at 24 and 48 hours. The primary end points were 28-day and 1-year all-cause mortality.

Results

Of 19 742 ICU hospitalizations, 848 had cirrhosis. Relevant data were available for 521 patients (73%). Of these cases, 353 patients (69.5%) were admitted to medical ICU (MICU), and the other 155 (30.5%), to surgical unit. Alcohol abuse and hepatitis C were the most common reasons for cirrhosis. Patients who died within 28 days were more likely to receive mechanical ventilation, pressors, and renal replacement therapy. Among 353 medical admissions, both MELD and SOFA were found to be significantly associated with both 28-day and 1-year mortality. Among the 155 surgical admissions, both scores were found to be not significant for 28-day mortality but were significant for 1 year.

Conclusions

Our results demonstrate that the prognostic ability of a variety of scoring systems strongly depends on the patient population. In the MICU population, each model (MELD + SOFA, MELD, and SOFA) demonstrates excellent discrimination for 28-day and 1-year mortality. However, these scoring systems did not predict 28-day mortality in the surgical ICU group but were significant for 1-year mortality. This suggests that patients admitted to a surgical ICU will behave similarly to their MICU cohort if they survive the perioperative period.     

Changes and their prognostic implications in the abbreviated Vitalpac™ early warning score (ViEWS) after admission to hospital of 18,853 acutely ill medical patients

Background

The best performing early warning score is Vitalpac™ Early Warning Score (ViEWS). However, it is not known how often, to what extent and over what time frame any early warning scores change, and what the implications of these changes are.

Setting

Thunder Bay Regional Health Sciences Center, Ontario, Canada.

Methods

The changes in the first three complete sets of the six variables required to retrospectively calculate the abbreviated version of ViEWS (that did not include mental status) after admission to hospital of 18,853 acutely ill medical patients, and their relationship to subsequent in-hospital mortality were examined.

Results

In the 10.4 SD 20.1 (median 5.0) hours between admission and the second recording the score changed in only 5.9% of patients and these changes were of no prognostic value. By the time of the third recording 34.9 SD 21.7 (median 30.0) hours after admission a change in score was clearly associated with a corresponding change in in-hospital mortality (e.g. for patients with an initial score of 5 an increase between the first and third recording of ≥4 points was associated with an increased mortality (OR 6.5 95% CI 2.3–15.9, p < 0.00001), whereas a reduction of ≤−4 points was associated with a reduced mortality (OR 0.4 95% CI 0.2–0.9, p 0.03)).

Conclusion

After a median interval of 30 h both the initial abbreviated ViEWS recording and subsequent changes in it both predict clinical outcome. It remains to be determined what interventions during this time frame will improve patient outcomes.     

Comparison of the bispectral index monitor with the Comfort score in assessing level of sedation of critically ill children

Objective To compare the value of bispectral index as a monitor of sedation in critically ill children with a validated sedation scoring system.Design Prospective convenience sample.Setting Paediatric intensive care unit in a tertiary paediatric centre.Patients and participants Forty-three critically ill children receiving sedation and mechanical ventilation.Measurements and results Simultaneous recording of bispectral index (BIS) and assessment of depth of sedation using the Comfort score were performed at regular intervals. To determine if BIS could detect episodes of arousal, times of endotracheal suctioning and the corresponding BIS score were recorded. There was an overall moderate correlation between BIS scores and Comfort scores (r=0.50, r²=0.25, p<0.0001). Children who had a neurological reason for their current admission (n=25) showed a weaker correlation (r=0.26, r²=0.06, p<0.007) than those (n=15) with normal neurology (r=0.51, r²=0.26, p<0.0001). There were no significant differences in the rise in BIS following endotracheal suctioning among any of the predefined depths of sedation. There was a correlation of r=0.84 (r²=0.71) (SE of slope 0.49, CI₉₅ 1.79–3.88) for mean BIS values for each individual Comfort score from 8–23. Using Spearman's rank correlation of Comfort versus mean BIS, the correlation coefficient was r=0.92.Conclusions Bispectral index scores correlate with Comfort scores to a moderate degree. BIS is able to discriminate between light and deep levels of sedation, but not between deep and very deep levels of sedation. The BIS monitor may provide a useful method for assessing sedation in critically ill children, especially those receiving neuromuscular blockers.     

IL-8联合序贯器官衰竭评分对非泌尿外科术后尿源性脓毒症休克的预测价值

目的 探讨非泌尿外科术后尿源性脓毒症休克的危险因素及危险因素结合序贯器官衰竭评分（sequential organ failure assessment, SOFA）对该病的预测价值。方法 回顾性收集2018年3月至2021年5月复旦大学附属中山医院收治的57例非泌尿外科术后尿源性脓毒症患者的一般临床资料和细胞因子水平。根据是否发生休克,将患者分为休克组（n=26）和非休克组（n=31）,比较2组的临床特征。采用二分类logistic回归分析非泌尿外科术后尿源性脓毒症休克的危险因素,采用ROC曲线分析各参数预测非泌尿外科术后尿源性脓毒症休克的价值。结果 与非休克组相比,休克组患者入院时SOFA评分及女性占比较高,多器官功能障碍综合征发生率较高,白细胞介素1β(interleukin-1β,IL-1β)、IL-8和IL-10水平较高。调整性别后,高水平IL-8（≥48 pg/mL）为非泌尿外科术后尿源性脓毒症休克的独立危险因素（OR=3.579,95%CI 1.084～11.813,P=0.036）,与SOFA评分联合预测非泌尿外科术后尿源性脓毒症休克的价值最高（AUC=0.818,95...     

Trajectories of the averaged abbreviated Vitalpac™ early warning score (AbEWS) and clinical course of 44,531 consecutive admissions hospitalized for acute medical illness

Background

It is not known how often, to what extent and over what time frame any early warning scores change, and what the implications of these changes are.

Setting

Thunder Bay Regional Health Sciences Center, Ontario, Canada.

Methods

The averaged vital signs measured over different time periods of 44,531 consecutive acutely ill medical admissions were determined and then combined to calculate the averaged abbreviated version of the Vitalpac™ early warning score (AbEWS) during each time period examined.

Results

18% of all in-hospital deaths within 30 days are in patients with a low AbEWS on admission. Those admitted with a low AbEWS are more likely to increase their score and those admitted with a high score are more likely to lower it. Paradoxically, patients who have an averaged score over the first 6 h in hospital that is lower than on admission have increased in-hospital mortality. Thereafter patients with an increase in the averaged score have almost twice the mortality of those with a decreased score. 4.7% of patients have a low averaged score on the day they die.

Conclusion

AbEWS, without clinical judgment, cannot be used to detect those patients who do not need to be admitted to hospital or are suitable for discharge. A period of observation of at least 12 h is required before the trajectory of AbEWS is of prognostic value, and any “improvement” that occurs before this time may be illusory.     

外周血单个核细胞Toll样受体的表达与冠状动脉病变程度的关系

目的观察冠状动脉造影患者外周血单个核细胞Toll样受体（TLR）1～10的表达状况及其与冠状动脉病变程度的关系。方法冠状动脉造影患者436例,根据冠状动脉病变支数,分为多支病变组93例、双支病变组172例、单支病变组98例和冠状动脉造影正常的对照组73例,用流式细胞术检测外周血单个核细胞TLR1～10的表达。用Gensini评分系统对冠状动脉造影结果进行评分。观察TLR1～10在各组中的阳性率的情况,用相关分析研究TLR1～10阳性率与冠状动脉Gensini评分的关系。结果外周血单个核细胞TLR2～6在多支病变组、双支病变组、单支病变组表达的阳性率均显著高于对照组,TLR2（86．36±13．45）％,（81．74±12．68）％,（72．89±10．37）％vs（60．76±11．56）％（均P〈0．01）;TLR3（7．05±2．47）％,（6．94±2．83）％,（7．01±2．21）%vs（5．25±2．06）％（均P〈0．05）;TLR4（39．83±8．34）％,（37．17±8．02）％,（30．35±9．78）%vs（25．86±6．48）％（P〈0．01或〈0．05）;TLR5（18．10±4．46）％,（17．31±4．92）%,（13．62±4．25）％vs（11．34±3．77）％（P〈0．01或〈0．05）;TLR6（9．71±3．60）％,（9．43±3．25）％,（8．62±3．53）％vs（6．84±3．19）％（均P〈0．01）。其中TLR2、4、5在多支病变组、双支病变组的表达阳性率均显著高于单支病变组（均P〈0．01）,其他亚型在各组间差异无统计学意义。相关分析显示,外周血中单个核细胞TLR2～6表达的阳性率与冠状动脉Gensini评分呈正相关,其相关系数分别为0．473,0．327,0．646,0．516,0．304（P〈0．05或〈O．01）。结论冠状动脉病变患者外周血中单个核细胞TLR2～6表达的阳性率增多,TLR2、4、5可反映冠状动脉病变的广泛性;冠状动脉的病变程度与TLR2～6的表达有关。