早产儿母乳喂养评价体系的构建与应用策略

目的建立早产儿母乳喂养评价体系,为早产儿母乳喂养的实施与评价提供理论依据。方法采用理论研究、临床凋研、专家咨询等方法对评价体系框架进行初步拟订;采用专家会议法、德尔菲法进行指标的筛选与论证。结果确立早产儿母乳喂养评价指标体系为3级结构模式,设有一级指标3个,二级指标7个,曼级指标18个。结论早产儿母乳喂养评价的目的在于强调早产儿母乳喂养质量的持续改进。     

健康教育及心理护理在烧伤整形患者中的应用

目的评价健康教育及心理护理在烧伤整形患者中的应用效果。方法将86例烧伤整形患者随机分为对照组42例和观察组44例,对照组给予常规护理,观察组在常规护理基础上给予系统的健康教育及心理护理。采用SAS评分及SDS评分评估患者负性情绪,采用生活质量综合评定问卷（GQOLI-74）对患者生活质量进行评定。比较两组患者SAS评分及SDS评分、生活质量及患者满意度。结果干预后观察组患者SAS及SDS评分显著低于对照组（P〈0．05）;观察组患者干预后GQOLI-74各项评分及总分均显著优于对照组（P〈0．05）;观察组患者满意度显著优于对照组（P〈0．05）。结论给予烧伤整形患者健康教育及心理护理,可显著缓解患者负性情绪,提高生活质量及满意度。     

发展性照顾对极低出生体重患儿体重的影响

目的探讨发展性照顾对极低出生体重患儿体重的影响。方法将200例极低出生体重患儿,按入院次序分为对照组和实验组,每组各100例,对照组采用常规护理方法,实验组在常规护理的基础上,实施发展性照顾。比较两组患儿在入院时、入院后7d和15d体重的差异。结果观察组患儿在入院后7d和15d,其体重增长优于对照组患儿,两组比较,均P<0.05,差异具有统计学意义。结论实施发展性照顾可提高极低出生体重患儿体重增长,从而增强患儿的生存能力。     

经外周中心静脉导管置入术在极低出生体重儿中的应用

目的探讨外周刺中心静脉导管、（PICC）置管术在极低出生体重儿（VLBW）中应用的临床意义及价值。方法将98例极低出生体重儿随机分为实验组48例,行PICC置管,对照组50例,行周围静脉留置针,比较两组穿刺次数、留置时间、并发症发生情况及体重变化情况。结果实验组住院期间输液穿刺次数为（6．13±1．4）,留置时间为（28．5±4．6）d;对照组穿刺次数为（27．52±6．5）次,留置时间为（2．9±0．4）d,差异均有统计学意义（t分别为14．3,15．1;P〈0．01）;实验组导管机械性并发症总发生率为10．4％,对照组为48．0％,差异有统计学意义（χ2=16．6,P〈0．01）;实验组无一例发生低血糖,每3天体重增长值大于对照组（P〈0．05）。结论PICC为需要中长期静脉治疗的极低出生体重儿提供了安全、可靠的静脉通路。     

老年门诊患者就诊服务需求调查与分析

目的:调查并分析老年门诊患者就诊服务需求,为更好地为患者服务、提高医疗服务质量提供参考依据。方法:2011年4月以问卷方式调查181例老年门诊患者对就诊服务的需求,包括医生职称、多学科会诊、一站式服务、病例建档、随访及护士诊前就医咨询、诊后检查指导、随访等项目。结果:对医生职称的主要需求是高职人员(93.9%);对专科、专病医生的需求达91.7%;对需多学科会诊所占比例为43.1%;对一站式服务的需求达到96.7%,且对高职(57.5%)、专科专病医生(33.1%)的需求所占比例较高;对病例建档和随访的需求分别占96.1%和80.1%;对护士诊前就医咨询、诊后检查指导、随访的需求为95.0%。结论:老年门诊患者对高职、专科、专病医生需求较高,更需要一站式服务、能够建档及随访,更希望护士给予导诊、咨询。     

晚期早产儿并发症及护理的研究

目的分析晚期早产儿临床并发症发生情况,探讨晚期早产儿护理管理策略。方法选择2005--2010年菏泽市立医院新生儿科收治的胎龄满34周而不足37周的312例晚期早产儿作为实验组,同时期本院产科出生的足月新生儿作为对照组,比较两组新生儿临床征象变化,实验室相关检查,分析其临床并发症发生情况。结果312例晚期早产儿中并发症发生率为83．3％,其中有87例发生了两种或以上并发症,占27．9％。晚期早产儿病理性黄疸发生率为65．7％,足月新生儿为33．5％,两组比较差异有统计学意义（X2=35．772,P〈0．05）,其余9项并发症差异均有统计学意义（P〈0．05）。晚期早产儿组较足月新生儿更易发生呼吸系统并发症,两组新生几呼吸窘迫综合征（NRDS）、新生儿肺炎发生率比较差异有统计学意义（x2分别为24．762,9．720;P〈0．05）。结论晚期早产儿较足月新生儿易发生临床并发症,应该重视晚期早产儿的治疗和护理,并制定相应的护理与治疗策略。     

15例早产儿慢性肺部疾病的护理体会

目的:通过呼吸道的管理,严格控制氧疗指征,加强肺部护理,合理喂养,针对家长的恐惧心理做好相应的心理护理,从而提高早产儿慢性肺部疾病(CLD)的生活质量,减少住院天数,改善预后,降低死亡率的发生。方法:对15例慢性肺部疾病的早产儿采取保持适宜体温、合理喂养、维持有效呼吸、氧疗护理、早期监测血糖、预防感染、发育支持等综合护理干预。结果:本组患儿经过精心护理及治疗后有13例康复出院,1例合并多功能衰竭死亡,1例放弃治疗。结论:建立有效的护理措施,有助于降低死亡率,减少并发症,改善愈后。     

降钙素原在婴幼儿体外循环术后感染监测中价值

目的探讨婴幼儿先天性心脏病（先心病）体外循环术后早期发生呼吸道细菌感染患儿围术期降钙素原的变化。方法 30例在心脏术后早期发生呼吸道细菌感染的先心病患儿（感染组）及30例未发生感染的先心病患儿（非感染组）于体外循环前、体外循环结束、术后24,48h分别检测血浆降钙素原水平。结果 2组体外循环结束时、术后24,48h血浆降钙素原水平明显高于体外循环前（P〈0.05）;感染组术后24,48h血浆降钙素原水平明显高于非感染组与本组体外循环结束时（P〈0.05）。结论心脏术后早期发生呼吸道细菌感染婴幼儿的血浆降钙素原水平增高,有助于临床更早的鉴别出高危患者,提高疗效。     

Diet quality in association to lipidaemic profile in adults of families at high-risk for type 2 diabetes in Europe: The Feel4Diabetes study

Background and aimsThe role of diet in blood lipids is scarcely investigated in adults at risk of Type 2 Diabetes Mellitus (T2DM) and even less studied regarding their socioeconomic status (SES). This study aimed to investigate the associations of diet quality with blood lipids in adults from families at high-risk for developing T2DM from six European countries, considering their SES.Methods and resultsIn total 2049 adults (67% women) from relatively low-SES regions and high T2DM risk families were enrolled. Dietary habits, sedentary behaviour and sociodemographic characteristics were assessed using standardised questionnaires. The associations of tertiles of healthy diet score (HDS) with blood lipids were tested by univariate analysis of variance (UNIANOVA). HDL-Cholesterol (HDL-C) was positively (B 1.54 95%CI 0.08 to 2.99) and LDL-Cholesterol (LDL-C) (B ?4.15 95%CI ?7.82 to ?0.48), ratio of total cholesterol to HDL-C (B ?0.24 95%CI ?0.37 to ?0.10), ratio of LDL-C to HDL-C (B ?0.18 95%CI ?0.28 to ?0.08) and Atherogenic Index of Plasma (B ?0.03 95%CI ?0.06 to 0.00) inversely associated with the highest tertile of diet score compared to the lowest tertile independently of age, sex, Body Mass Index, total screen time and smoking. In sub-analysis of education (<14 and ≥ 14 years of education), these findings were only significant in the high-SES group.ConclusionWhile diet quality was poorer in the low-SES group, an association between diet quality and lipidemic profile was not found, as increased central obesity and smoking prevalence might have confounded this association. These findings indicate the need for tailor-made interventions, guided by the specific risk factors identified per population sub groups.     

Iron status of inner-city African-American infants

The iron status of African-American infants continues to be subject to debate. We characterized the iron status of 198 9-month-old inner-city infants (94% fed iron-fortified formula) using a comprehensive panel of measures and assessing lead and inflammation markers. The proportion with iron deficiency was calculated based on three approaches (> or = 2 abnormal iron measures with or without anemia for MCV model--NHANES II, ferritin model--NHANES III, or Sweden/Honduras study) and a promising new measure-body iron, calculated from ferritin and transferrin receptor (TfR). There were no sex differences for any iron measure. Hb < 110 g/l was observed in 25%; Hb < or = 105 g/l in 10.1%. Free erythrocyte protoporphyrin (FEP) values were elevated without elevated lead concentrations or an inflammatory response: mean FEP = 86.6 microg/dl red blood cells [75.5 micromol/mol heme]; 52.3% were > 80 microg/dl (1.42 micromol/l), almost half of which were accompanied by a second abnormal iron measure. The estimated prevalence of iron deficiency was 14.4, 5.3, and 2.5% for the MCV model, ferritin model, and Sweden/Honduras cutoffs, respectively, and 4.1% for body iron < 0 mg/kg. Regulation of iron storage is immature at < 1 year of age, making estimates of iron deficiency that depend on ferritin, including body iron, suspect in this age period. Thus, the "true" prevalence of iron deficiency could not be established with confidence due to major differences in the results, depending on the guidelines used. Functional indicators of poor iron status in young infants are urgently needed.