本院护士自我效能感的调查及相关对策研究

目的:对笔者所在医院护士一般自我效能感做调查并研究相关对策。方法:运用《一般自我效能感》调查表对本院387名护士进行调查。结果:本院护士一般自我效能感得分为1.00~3.60分,平均(2.31±0.50)分,明显低于量表常模和护士群体水平,差异有统计学意义(P0.01);本院临床科室、急诊科、ICU护士的一般自我效能感得分比较,差异有统计学意义(P0.05)。护士长和护士的一般自我效能感得分比较,差异有统计学意义;不同年龄、不同学历、不同职称、不同婚姻状况、不同聘用形式、不同工作性质、不同月薪的护士之间的一般自我效能感得分比较,差异无统计学意义(P0.05)。结论:本院护士的一般自我效能感处于较低水平,亟待进一步提高。营造学习氛围,创造良好的护理文化,加强临床实践技能的培养,增加成功的直接体验,并建立竞争机制。培养一支高素质的护理管理队伍,提高管理水平,发扬率先垂范、引领的榜样作用。完善绩效考核制度,建立奖励机制,激发护士的工作热情。合理配置人力资源,改善工作环境,缓解工作压力。组织心理学知识的系列培训,缓解护士的心理压力,防止发生职业倦怠,培养自我调适能力,提高工作效率和质量,从而提高护士的自我效能感和职业成就感。     

中医辨证施护对初产妇母乳喂养自我效能的效果分析

目的 探讨中医辨证施护对初产妇母乳喂养自我效能的影响.方法 选择2015年9月至2016年8月在我院产科分娩的初产妇共120例作为研究对象,经患者知情同意,并签署知情同意书后,将其分为干预组和对照组.2组均予产科常规护理及健康教育.干预组在此基础上,根据母乳喂养自我效能的情况,应用中医辩证施护方法进行有针对性的护理干预,包括情志调护、乳房的辩证施护及饮食调理等.结果 本次研究对象均为初产妇,2组一般资料比较差异无统计学意义(P＞0.05).分娩前2组孕妇母乳喂养自我效能得分、技能维度得分及内心活动维度得分差异无统计学意义(P＞0.05).通过中医辩证施护后,干预组产妇42 d时,母乳喂养自我效能感得分(118.7±19.8)明显高于对照组(102.6±20.7),差异有统计学意义(P＜0.05).与对照组比较,干预组产妇42 d时,技能维度得分、内心活动维度得分较高,差异有统计学意义(P＜O.05).母乳喂养自我效能得分增加值(26.0±9.1)、技能维度得分增加值(17.8±6.8)、内心活动维度得分增加值(8.2±3.8)均大于对照组(8.2±3.0、6.2±2.2、2.0±1.8),差异有统计学意义(P＜0.05).干预组母乳喂养率(58.35％)明显高于对照组(33.3％),差异有统计学意义(P＜0.05).干预组产妇母乳分泌量较对照组多,差异有统计学意义(P＜0.05).结论 中医辨证施护能增强初产妇母乳喂养自我效能,促进乳汁分泌,提高母乳喂养率,值得临床推广.     

某部队官兵人格特征和自我效能感的关系研究

目的 为了探索部队官兵人格特征与自我效能感的相关关系.方法 采用整群抽样法抽取某部队士兵253人,使用艾森克人格问卷(EPQ-RSC)、一般自我效能感问卷(GSES),对部队官兵的人格特征、自我效能感进行调查.结果 不同年龄、不同文化程度在内外向方面,3组差异有统计学意义(P＜0.05);在人格特征的其他方面和自我效能感差异无统计学意义(P＞0.05).不同军龄人格特征、自我效能感无统计学意义(P＞0.05);是否独生子女在人格特征各方面内外向、神经质、精神质、自我效能感差异有统计学意义(P＜0.05).自我效能感同内外向维度呈显著正相关(r=0.129,P＜0.05),自我效能感和神经质、精神质无统计学上的显著相关关系.结论 自我效能感对人格有影响,通过提高自我效能感水平能够促进部队官兵人格健康发展并提高心理健康水平.     

护士职业倦怠与自我效能和工作环境的相关及回归分析

目的 探讨护士职业倦怠现状及其与自我效能和工作环境的关系,为对护士职业倦怠采取有效干预措施提供依据.方法 采用方便抽样法,抽取连云港市2所三级医院护士239名作为调查对象,采用个人资料问卷、护士职业倦怠量表、一般自我效能感量表、专业护理实践环境量表和护士工作压力源量表分别进行测量.对护士职业倦怠各维度和自我效能、专业护理实践环境、护士工作压力源的各维度进行相关和多元逐步回归分析.结果 护士情感衰竭得分为(23.95±11.11)分,去人格化得分为(7.90±6.58)分,均处于中等水平,个人成就感降低采用反向计分,得分为(27.51±10.96)分,处于高度倦怠水平.自我效能和工作环境均与护士职业倦怠有关(P＜0.05或P＜0.01).其中,个人成就感的首要影响因素为自我效能,而情感衰竭和去人格化的主要影响因素为环境.结论 应重视提高护士的自我效能,改善护士工作环境,以更有效地降低其职业倦怠.     

实习护生职业倦怠与自我效能感的相关性研究

目的调查实习护生职业倦怠现状,探讨实习护生职业倦怠与自我效能感的相关性。方法采用中文版职业倦怠量表、一般自我效能感量表对某市3所三级甲等医院600名实习护生进行问卷调查。结果本组护生去人格化与个人成就感降低得分均高于杭州护士常模（P < 0.01）,2组情感耗竭得分差异无统计学意义（P>0.05）。实习护生自我效能感总均分为（25.76±5.05）分,处于中等水平,明显低于全国常模的（29.46 ±5.33）分（P < 0.01）。不同性别、学历、实习时间、获得的支持程度以及有无就业压力、是否独生子女的护生间情感耗竭和人个成就感降低维度得分差异均有统计学意义（P < 0.01）;不同学历、实习时间、获得的支持程度和有无就业压力、是否独生子女的护生去人格化得分差异均有统计学意义（P < 0.01）;不同性别、学历、获得的支持程度和有无就业压力的护生间自我效能感得分差异均有统计学意义（P < 0.01）。护生的自我效能感得分与职业倦怠、情感耗竭及去人格化得分均呈明显负相关关系（r=-0.392、-0.375、-0.519,P < 0.01）,与个人成就感降低维度呈明显正相关关系（r=0.403,P < 0.01）。结论实习护生的职业倦怠状况不容乐观,应针对相关影响因素给予护生多方面支持,采取多种途径提高护生的自我效能感,避免实习护生职业倦怠的产生。     

晚期妊娠妇女焦虑抑郁影响因素分析

目的 了解晚期妊娠妇女焦虑抑郁情绪的发生情况,找出影响心理健康的相关因素.方法 采用“综合性医院焦虑抑郁量表(HAD)”和自制的“妊娠妇女焦虑抑郁影响因素调查问卷”,对500例晚期妊娠妇女进行问卷调查,调查资料进行统计分析.结果 本次调查资料均收回.不同文化程度发病率不同,小学、中学、大学的焦虑合并抑郁发病率分别为57.14％、22.03％、11.86％,比较差异有统计学意义(P＜0.05);产检次数不同发病率不同,很少做产检、基本做、定期产检的焦虑合并抑郁发病率分别为55.32％、19.84％、15.82％,比较差异有统计学意义(P＜0.05);孕妇参与社交的不同频率发病率不同,从不、偶尔、经常参与社交的焦虑合并抑郁发病率分别为31.85％、17.36％、12.5％,比较差异有统计学意义(P＜0.05).结论 晚期妊娠妇女焦虑抑郁与孕妇的文化程度、是否定期做产检、参与社交情况等因素有显著的相关性.     

不同类型护士的成就动机及自我效能感的研究

目的 了解不同类型护士成就动机、自我效能感现状,探讨医院护士和护校学生自我效能感和成就动机的差异.方法 采用成就动机量表和自我效能感综合量表对90名麻醉科、重症监护室、急救部的护士及78名普通护校刚毕业的护士进行调查.结果 （1）急救类护士追求成功的动机分数明显低于护校的护士（t=-2.914,P＝o.044）,而回避失败的动机则明显高于护校护士（t=2.789,P=0.049）;（2）麻醉科护士、重症监护室护士与急救部护士之间成就动机差异无统计学意义（P＞0.05）;（3）急救类护士除希望成功因子明显低于护校护士（P＜0.05）,回避失败、过度努力均明显高于护校护士（P＜0.05）;另12.22％的急救类护士成就动机达中等水平,明显高于护校护士（P＜0.05）;（4）急救类护士一般自我效能感分数、学业自我效能感分数和自我调节学习效能感的分数均显著低于护校护士,差异有统计学意义（P＜0.05）;（5）麻醉科护士、ICU护士与急救部护士之间一般自我效能感分数、学业自我效能感分数和自我调节学习效能感差异均无统计学意义（P＞0.05）.结论 护理管理者应关注在职护士的行为倾向和心理动向,减轻护士工作倦怠的程度,提高自我效能感,从而提高护理工作质量和工作效率.     

围绝经期妇女对骨质疏松症认知及自我效能调查

目的调查围绝经期妇女对骨质疏松症的自我效能情况,为有效预防骨质疏松,加强针对性健康教育提供依据。方法采取便利抽样方法调查280名围绝经期妇女,对骨质疏松症（OP）的自我效能量表及相关知识进行问卷调查。结果围绝经期妇女OP的认知总分偏低,其中对危险因素的认知最低,锻炼及食钙自我效能分数偏低,文化程度及职业情况得分差异有统计学意义（P〈0.05）。结论围绝经期妇女对骨质疏松症的认知及自我效能较低,需进一步开展多种形式的针对性健康教育。     

化疗期卵巢癌患者自我效能感水平及其影响因素调查分析

目的:了解化疗期卵巢癌患者的一般自我效能感水平及其影响因素,探讨可能提高患者一般自我效能感水平的对策。方法:应用便利抽样法,采用患者一般情况调查表和一般自我效能感量表,对山西省某三级甲等医院82例化疗期卵巢癌患者进行调查,分析其一般自我效能感水平及影响因素。结果:82例化疗期卵巢癌患者一般自我效能感平均得分为(23.40±6.46)分,其中仅17例(20.73%)表现出高水平自我效能。不同年龄、长住地、文化程度、家庭人均月收入、疾病临床分期、疾病病程、化疗次数患者的自我效能感水平差异有统计学意义(P0.05)。结论:化疗期卵巢癌患者总体自我效能感水平偏低,护理人员制定护理措施及对患者随访时应该评估患者的一般自我效能感水平,寻找可能的影响因素并给予适当干预以提高自我效能。     

四川省医学院校贫困生一般自我效能感、应对方式及其关系研究

目的 探讨医学院贫困生一般自我效能感、应对方式及两者之间的关系.方法 采用一般自我效能感量表和特质应对方式问卷对成都医学院、泸州医学院和川北医学院454名贫困生进行调查.结果 1)一般自我效能感和应对方式在性别上差异有统计学意义,男生的一般自我效能感高于女生(P＜0.05),女生的积极应对分大于男生(P＜0.05);2)各年级一般自我效能感和应对方式差异有统计学意义,大三学生的一般自我效能感高于大二学生(P＜0.05);大二学生的消极应对方式总分高于大三学生(P＜0.05);3)独生子女和非独生子女的一般自我效能感差异无统计学意义,积极应对方式差异有统计学意义(P＜0.05),非独生子女的积极应对分大于独生子女(P＜0.05);4)一般自我效能感与应对方式中的积极应对呈正相关(P＜0.05),与消极应对无相关性.结论 医学院校贫困生的一般自我效能感对应对方式有一定的预测作用.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.