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中国实用护理杂志
中国实用护理杂志

王国强

旬刊

1672-7088

huli@yizhe.net

0411-82490723

116013

辽宁省大连市西岗区南石道街丙寅巷3号

中国实用护理杂志/Journal Chinese Journal of Practical Nursing北大核心CSTPCD
查看更多>>中华人民共和国卫生部主管，中华医学会、大连理论医学研究所主办。本刊是国内外公开发行的，《中文核心期刊要目总览》临床医学/特种医学类核心期刊。被“万方数据库”收录。本刊宗旨是“突出实用，面向基层，传递护理学术信息，提高护理理论与技术水平，促进护理学科发展”。报道护理领域的科研成果和护理经验以及对临床护理有指导作用，且与临床护理密切结合的基础理论研究，体现科学性、实用性、新颖性、信息性的统一。主要读者对象为基层护理人员、管理人员及护理学院(系)教师、学生。
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    青少年1型糖尿病患者健康教育效果评价指标体系的构建

    赵梅村黄金蒋凤李若白...
    241-249页
    查看更多>>摘要：目的 构建科学、系统、规范的青少年1型糖尿病患者健康教育效果评价指标体系。 方法 以知信行理论为基础，结合健康信念模式为理论指导，采用文献分析、质性访谈及小组成员反复讨论的方法拟定青少年1型糖尿病患者健康教育效果评价指标体系的专家函询初稿，进行2轮专家函询，研究小组对函询结果进行整理与分析，对指标结构、条目内容及顺序进行反复讨论，确定青少年1型糖尿病患者健康教育效果评价指标体系，采用层次分析法确定各指标的权重。 结果 共21名专家参与函询，均为女性，年龄（43.48 ± 5.84）岁，2轮问卷有效回收率分别为84.00%（21/25）、85.71%（18/21），专家权威系数分别为0.96和0.97，Kendall协调系数分别为0.181、0.256（P<0.05）。层次分析结果显示，6个判断矩阵的一致性系数均<0.1。最终构建的指标体系拥有5项一级指标（健康知识、健康信念、健康行为、生理指标、健康教育满意度）、38项二级指标。 结论 构建的青少年1型糖尿病患者健康教育效果评价指标体系具有较高的科学性与可靠性，可为临床护理人员评价与监测青少年1型糖尿病患者健康教育效果提供参考依据。 Objective To develop an evaluation index system on health education effect for adolescents with type 1 diabetes mellitus (T1DM). Methods Using "knowledge-attitude/belief-practice"model and health belief model as the theoretical framework, the first draft of the expert consulation questionnaire for evaluation index system on health education effect for adolescents with type 1 diabetes mellitus was drawn up through literature review, qualitative interview, and repeated discussions between groups. Two rounds of expert consultation were conducted. The results of the consulation were sorted and analyzed, the index structure, item content, and sequence were discussed repeatedly, and the evaluation index system on health education effect for adolescents with T1DM was determined, and the analytic hierarchy process was used to determine its weight. Results A total of 21 female experts participated in two rounds of survey whose age was (43.48 ± 5.84) years old. The questionnaire response rates of the two rounds of expert consultations were 84.00%(21/25) and 85.71%(18/21), the authoritative coefficients were 0.96 and 0.97, the Kendall coordination were 0.181 and 0.256, respectively (P<0.05). The consistency test of the weight of each indicator showed that the consistency ratios were all <0.1. The evaluation index system on health education effect for adolescents with T1DM was constructed with 5 first-level indicators (health knowledge, health belief, health practice, physiological indexes and health education satisfaction), 38 second-level indicators. Conclusions The method used to construct the evaluation index system on health education effect for adolescents with T1DM was highly scientific and reliable, which provides the basis for clinical nurses to evaluate and monitor the effect of health education in adolescents with T1DM.

    青少年糖尿病,1型健康教育评价研究

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    母婴分离初产妇出院准备护理实践现况的田野研究

    万悦丁丽静姚晓王佳洁...
    250-256页
    查看更多>>摘要：目的 了解母婴分离初产妇出院准备护理实践现况，为构建临床护理方案提供参考和依据。 方法 2023年2—6月，选取同济大学附属妇产科医院产科作为田野地，开展针对母婴分离初产妇出院准备护理实践现况的田野研究。通过参与式观察及非正式访谈收集12名护士的资料并采用质性研究中三级编码的方法进行资料分析。 结果 12名护士均为女性，年龄24~46（33.33 ± 1.83）岁。母婴分离初产妇出院准备护理包括提供新生儿健康信息、母乳喂养、产后康复、心理护理及社会支持共4类内容主题；护士在提供新生儿健康知识、评估母婴分离初产妇心理及社会支持、出院教育质量等方面存在提升空间。 结论 母婴分离初产妇出院准备护理缺乏结构合理的流程及制度，亟需通过制订科学规范的出院准备护理流程，对护士进行规范化培训，提高护士心理社会评估能力，同质化健康教育，提升人文关怀等措施，提高母婴分离初产妇出院准备护理质量，从而促进初产妇康复，并适应母亲角色。 Objective To understand the current status of discharge planning nursing for primipara who separated from their infants during hospitalization and provide a reference basis for constructing a clinical nursing plan. Methods From February to June 2023, a field research about situation of nursing practice in discharge planning service among primiparas who separated from their infants was conducted in the Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Tongji University. Data was collected by field observation and informal interviews with 12 nurses and analyzed by three-level coding method of qualitative research. Results All 12 nurses were female with 24-46 (33.33 ± 1.83) years old. The work content of the observation subjects could be divided into 4 items including providing infants′ health information, breastfeeding, postpartum rehabilitation, psychological care and social support. All the 4 items needed to be improved in providing infants′ health information, evaluating psychological status and social support, and quality of discharge teaching. Conclusions It still needs further development in discharge planning nursing for primipara separated from their infants during hospitalization. It is urgent to improve the quality of discharge planning nursing for primiparas who have separated from their infants by developing scientific and standardized discharge planning nursing process, conducting standardized training for nurses, improving nurses′ psychosocial assessment ability, homogenizing health education, and improving humanistic care, so as to promote the rehabilitation of primiparas and get used to being a mother.

    病人出院母婴护理初产妇田野研究

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    不同频率血糖监测对超重/肥胖中青年糖尿病前期人群血糖控制的影响

    孙桐屠乐琪贾梦溪李敏...
    257-262页
    查看更多>>摘要：目的 探讨在健康教育的基础上，不同频率的血糖监测对超重/肥胖的糖尿病前期人群血糖控制的有效性，为糖尿病前期人群血糖监测管理提供依据。 方法 以随机对照研究，按连续抽样法选取2021年1—3月中国医科大学附属第一医院体检中心、内分泌门诊、内分泌病房的糖尿病前期人群90例，采用抽签法随机分为A、B、C 3组，每组各30例，研究周期为12个月。A、B、C 3组均在入组时、6个月随访和12个月随访进行统一的健康教育指导。A组每6个月进行1次血糖监测，B组每3个月进行1次血糖监测，C组每个月进行1次血糖监测。记录并比较3组参与者入组时、6个月随访时及12个月随访时的糖化血红蛋白水平（HbA1c）、空腹血糖、糖负荷后2 h血糖（2 hPG）及BMI水平。 结果 A组男15例，女15例；B组男14例，女16例；C组男12例，女18例。A、B、C 3组的年龄分别为（48.37 ± 10.80）、（49.20 ± 9.75）、（44.77 ± 12.28）岁。随访12个月时，A、B、C 3组的HbA1c分别为（6.01 ± 0.36）%、（5.82 ± 0.35）%、（5.64 ± 0.27）%，3组比较差异有统计学意义（F=9.72，P<0.05）；空腹血糖分别为（5.64 ± 0.88）、（5.05 ± 0.53）、（4.98 ± 0.48）mmol/L，3组比较差异有统计学意义（F=9.23，P<0.05）；2 hPG分别为（9.38 ± 1.23）、（8.23 ± 0.72）、（7.71 ± 0.86）mmol/L，3组比较差异有统计学意义（F=23.89，P<0.05）；BMI分别为（28.52 ± 4.24）、（27.02 ± 2.67）、（25.56 ± 1.34）kg/m2，差异有统计学意义（F=7.37，P<0.05）。 结论 在健康教育的基础上，与常规每6个月进行1次血糖监测相比，每3个月进行1次血糖监测和每个月进行1次血糖监测，能够改善超重/肥胖的中青年糖尿病前期人群的血糖和BMI水平，为在临床实践中寻求有效、经济的血糖监测模式提供依据。 Objective To explore the effectiveness of blood glucose monitoring at different frequencies on the control of blood glucose in overweight/obese prediabetes population on the basis of health education, and to provide a basis for blood glucose monitoring and management in prediabetes population. Methods A randomized controlled study was used. 90 prediabetes patients from the Physical Examination Center/Endocrine Clinic/Endocrine Ward of the First Affiliated Hospital of China Medical University from January to March 2021 were selected by continuous sampling method, and were randomly divided into the group A, B and C by lottery method, with 30 patients in each group, and the study period was 12 months. Group A, B and C received unified health education guidance at enrollment, 6-month follow-up, and 12-month follow-up. Group A underwent blood glucose monitoring every 6 months, group B underwent blood glucose monitoring every 3 months, group C underwent blood glucose monitoring every month. Recorded and compared the levels of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour post-load blood glucose (2 hPG), and body mass index (BMI) of three groups at the time points of enrollment, 6-month follow-up, and 12-month follow-up. Results There were 15 males and 15 females in the group A, 14 males and 16 females in the group B, 12 males and 18 females in the group C. The ages in the group A, B and C were (48.37 ± 10.80), (49.20 ± 9.25) and (44.77 ± 12.28) years old respectively. At the time point of 12-month follow-up, the HbA1c in the group A, B and C were (6.01 ± 0.36)%, (5.82 ± 0.35)% and (5.64 ± 0.27)%, the difference was significant (F=9.72, P<0.05) the FPG in the group A, B and C were (5.64 ± 0.88), (5.05 ± 0.53) and (4.98 ± 0.48)mmol/L, the difference was significant (F=9.23, P<0.05) the 2 hPG in the group A, B and C were (9.38 ± 1.23), (8.23 ± 0.72) and (7.71 ± 0.86) mmol/L, the difference was significant (F=23.89, P<0.05) the BMI in the group A, B and C were (28.52 ± 4.24), (27.02 ± 2.67) and (25.56 ± 1.34) kg/m2, the difference was significant (F=7.37, P<0.05). Conclusions On the basis of health education, compared with the routine blood glucose monitoring once every six months, blood glucose monitoring once every three months and once every month can improve the blood glucose control and BMI level of overweight/obese young and middle-aged people with prediabetes, and provide a basis for seeking an effective and economic blood glucose monitoring mode in clinical practice.

    糖尿病前期血糖自我监测健康教育超重肥胖症血糖控制

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    家庭赋权模式在首发脑卒中吞咽障碍患者主要照顾者中的应用效果评价

    余红杜静徐倩徐明明...
    263-271页
    查看更多>>摘要：目的 探究家庭赋权模式对首发脑卒中吞咽障碍患者主要照顾者吞咽照护能力及照顾准备度的影响，并进一步探讨其对患者吞咽功能和生命质量的影响。 方法 采用随机对照试验，选择2021年1月至2022年12月深圳市中医院针灸科收治的首发脑卒中吞咽障碍患者主要照顾者80名为研究对象，采用随机数字表法分为对照组和观察组各40名。对照组照顾的患者接受针灸科脑卒中后吞咽障碍常规治疗护理，观察组在对照组基础上实施家庭赋权模式的干预14 d，并随访28 d。应用脑卒中主要照顾者吞咽照护能力评分、主要照顾者照顾准备度评分、患者吞咽功能改善总有效率、患者吞咽障碍特异性生命质量量表（SWALQOL）评价干预效果。 结果 对照组男18名，女19名，年龄（55.61 ± 7.43）岁，观察组男18名，女21名，年龄（58.23 ± 8.22）岁。干预后14 d，观察组主要照顾者吞咽照护能力总分为（143.47 ± 3.96）分，与对照组的（107.44 ± 1.43）分比较差异有统计学意义（t=-26.76，P<0.05）。干预后14 d观察组主要照顾者的照顾准备度得分为（26.11 ± 3.81）分，与对照组的（18.35 ± 4.54）分比较差异有统计学意义（t=-4.11，P<0.05）。干预后14 d观察组照顾的患者的吞咽障碍总有效率和SWALQOL评分分别为97.44%（38/39）和（91.41 ± 8.08）分，与对照组的72.97%（27/37）和（80.33 ± 11.21）分比较差异均有统计学意义（χ2=10.76，t=-2.54，均P<0.05）。 结论 家庭赋权模式有助于提高首发脑卒中吞咽障碍患者主要照顾者吞咽照护能力及照顾准备度，提升居家护理能力，进一步改善患者吞咽功能，最终提高其生命质量。 Objective To explore the effect of family empowerment model on the improvement of swallowing care ability and care preparedness of primary caregivers of first-episode stroke dysphagia patients, further to explore its impact on patients′s wallowing function and life quality. Methods This study was a randomized controlled study. From January 2021 to December 2022, 80 main caregivers of patients with dysphagia caused by manual stroke admitted to the Department of Acupuncture and Moxibustion, Shenzhen Hospital of Traditional Chinese Medicine were selected as the research objects, and 40 cases in the control group and 40 cases in the observation group were selected by random number table method. The control group were treated with conventional nursing care of first-episode stroke dysphagia patients in the acupuncture and moxibustion Department. On the basis of the conventional care in the control group, the observation group were treated with family empowerment model intervention for 14 days and was followed up for 28 days. Primary caregivers′ swallowing care ability, Caregiver Preparedness Scale (CPS), patients′ swallowing function rate, Swallowing Related Quality of Life (SWALQOL) were used to evaluate the effects before intervention and at the end of intervention. Results There were 18 males and 19 females primary caregivers in the control group, aged (55.61 ± 7.43) years old. There were 18 males and 21 females primary caregivers in the observation group, aged (58.23 ± 8.22) years old. The swallowing care ability score showed a statistically significant difference between the observation group (143.47 ± 3.96) and the control group (107.74 ± 1.43) (t=-26.76, P<0.05). After intervention, the caregiver preparedness scale was (26.11 ± 3.81) in the observation group, and (18.35 ± 4.54) in the control group, and the difference was statistically significant (t=-4.11, P<0.05).The patients′ swallowing function rate and SWALQOL score were respectively 97.44% (38/39) and (91.41 ± 8.08) points in the observation group, and 72.97% (27/37) and (80.33 ± 4.21) points in the control group, and the difference was both statistically significant (χ2=10.76, t=-2.54, both P<0.05). Conclusions The implementation of family empowerment model could enhance the swallowing care ability and care preparedness of primary caregivers of the first-episode stroke dysphagia patients, which could further improve patients′ swallowing function and life quality.

    卒中吞咽障碍护理家庭赋权模式主要照顾者照顾准备度

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    腰椎后路减压内固定术后腰背肌锻炼最佳开始时间的研究

    张玉容廖萌露周鑫琰施新炜...
    272-278页
    查看更多>>摘要：目的 探讨腰椎后路减压内固定术后腰背肌锻炼最佳开始时间，以及对患者康复结局和运动恐惧的影响。 方法 采用随机对照试验，以便利抽样法选取2020年2月至2021年12月上海大学附属南通医院（南通市第六人民医院）收治的120例腰椎间盘突出症患者为研究对象，按照入院时间分为早期锻炼组、中期锻炼组和后期锻炼组各40例。3组患者均给予常规术后护理；早期锻炼组从术后第10天开始腰背肌锻炼，中期锻炼组从术后第3周开始腰背肌锻炼，后期锻炼组从术后第6周开始腰背肌锻炼。采用日本骨科协会评分（JOA）、恐动症评分量表（TSK）评价干预效果。 结果 早、中、后期锻炼组分别有3、1、1例失访，3组患者年龄分别为（56.05 ± 11.77）、（57.33 ± 14.64）、（54.23 ± 15.73）岁。开始锻炼后3个月早、中、后期锻炼组的JOA总分分别为（25.32 ± 2.45）、（24.44 ± 2.19）、（22.13 ± 1.58）分，差异有统计学意义（F=23.64，P<0.05）。开始锻炼后3个月早、中、后期锻炼组的TSK评分分别为（37.95 ± 6.81）、（34.18 ± 6.39）、（33.33 ± 7.36）分，差异有统计学意义（F=4.82，P<0.05）。 结论 腰椎后路减压内固定术后第3周开始腰背肌锻炼，既能明显改善腰间盘突出症患者康复结局，又不会增加运动恐惧水平，可作为术后腰背肌锻炼最佳开始时间。 Objective To explore the optimum opportunity for lumbodorsal muscles exercises of patients undergoing posterior lumbar decompression and instrumentation, and investigate its effect on the rehabilitation outcomes and kinesiophobia. Methods A randomized controlled trial was used. By convenient sampling method, a total of 120 lumbar disc herniation patients were prospectively selected from Affiliated Nantong Hospital of Shanghai(Nantong Sixth People′s Hospital) from February 2020 to December 2021. The paitients were assigned to early group, middle group and late group, with 40 cases in each group. All patients were given routine postoperative care and lumbodorsal muscles exercises. The early group started to exercise 10th day after operation, the middle group started to exercise 3 weeks after operation, and the late group started to exercise 6 weeks after operation. The intervention effect was respectively evaluated by Japanese Orthopaedics Association (JOA) and Tampa Scale for Kinesiophobia (TSK). Results There were 3, 1 and 1 missing cases in the early, middle and late group respectively, the age in the 3 groups were (56.05 ± 11.77), (57.33 ± 14.64) and (54.23 ± 15.73) years old in turn. Three months after exercising, the total score of JOA in the early, middle and late group were (25.32 ± 2.45), (24.44 ± 2.19) and (22.13 ± 1.58) in turn, the difference was significant (F=23.64, P<0.05) the score of TSK in the early, middle and late group were (37.95 ± 6.81), (34.18 ± 6.39) and (33.33 ± 7.36) in turn, the difference was significant (F=4.82, P<0.05). Conclusions Lumbodorsal muscles exercises start at 3 weeks after operation can significantly improve the rehabilitation outcome of lumbar disc herniation patients undergoing posterior lumbar decompression and instrumentation, and will not increase the level of kinesiophobia, its can be consider as optimum opportunity for lumbodorsal muscles exercises.

    椎间盘移位手术康复护理运动恐惧

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    多次主动脉瓣手术患者植入新型免缝合生物心脏瓣膜的术后护理1例

    梁宝凤金蕾法天锷李若白...
    279-282页
    查看更多>>摘要：总结全国首例多次主动脉瓣手术患者植入新型免缝合生物心脏瓣膜围手术期的护理经验。护理主要内容包括：容量管理；出血及血小板减少症的预防与控制；心律失常监测与纠正；感染预防与控制；镇痛、镇静；相关并发症的预防；全程心理疏导及营养支持等措施。经过精心治疗与护理，患者恢复良好，4 d后转出ICU，10 d后出院。 To summarize the perioperative nursing experience of a patient with the first multiple aortic valve operation in China implanted a new non-sutured biological heart valve. The main contents of nursing included through capacity management, prevention and control of bleeding and thrombocytopenia, arrhythmia monitoring and correction, infection prevention and control, analgesic sedation, prevention of related complications, whole-course psychological counseling and nutritional support. After careful treatment and nursing, the patient recovered well and was transferred out of ICU in 4 days and discharged in 10 days.

    护理主动脉瓣手术新型免缝合生物心脏瓣膜

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    阻断病原学特性预防呼吸机相关性肺炎媒介管理策略构建与临床实践

    夏欣华王莹燕朋波孙艳玲...
    283-288页
    查看更多>>摘要：目的 从病原学特性的角度构建预防呼吸机相关性肺炎媒介管理策略并验证其应用效果。 方法 在抽样调查的基础上，基于优势菌种的病原学特性，从定植患者及感染患者管理2个方面，构建阻断病原学特性预防呼吸机相关性肺炎（VAP）媒介管理策略。2021年7月至2023年6月，采用非同期随机对照研究，随机抽取天津市泰达医院ICU机械通气患者（对照组59例，试验组57例）证实该策略的有效性。 结果 对照组男35例，女24例，年龄（46.97 ± 18.84）岁；试验组男39例，女18例，年龄（47.49 ± 13.85）岁。研究期对照组发生VAP 9例，试验组发生VAP 2例，2组比较差异有统计学意义（P=0.031）。机械通气时长试验组（122.41 ± 18.36）h，短于对照组的（187.62 ± 18.05）h，差异有统计学意义（t=19.28，P<0.05）；ICU住院时长试验组（8.38 ± 0.79）d，短于对照组的（10.99 ± 1.10）d，差异有统计学意义（t=14.66，P<0.05）；第7天痰培养病原菌阳性试验组为7例，少于对照组的29例，差异有统计学意义（χ2=16.73，P<0.05）。 结论 阻断病原学特性预防VAP媒介管理策略能够降低VAP发生率，缩短机械通气时间与ICU住院时间，减少机械通气患者第7日呼吸道深部组织痰液中病原菌载量。 Objective To establish an environmental management strategy for the prevention of ventilator-associated pneumonia from the perspective of etiological characteristics and to verify its application effect. Methods Based on a sampling survey, this study constructed preventive management strategies for ventilator-associated pneumonia by blocking pathogen characteristics from the perspective of both colonization and infection management in patients. From July 2021 to June 2023, a non-synchronous randomized controlled study was conducted, including a control group of 59 cases and an experimental group of 57 cases from ICU of Tianjin Teda Hospital, all of them were mechanically ventilated patients. The effectiveness of the strategy was confirmed. Results In the control group, there were 35 males and 24 females, with an average age of (46.97 ± 18.84) years. In the experimental group, there were 39 males and 18 females, with an average age of (47.49 ± 13.85) years. During the study period, there were 9 cases of ventilator-associated pneumonia (VAP) in the control group and 2 cases in the experimental group, the difference between the two groups was statistically significant (exact odds ratio=0.031). The duration of mechanical ventilation in the experimental group (122.41 ± 18.36) h, which was shorter than that in the control group (187.62 ± 18.05) h, and the difference was statistically significant (t=19.28, P<0.05). The length of ICU stay in the experimental group was (8.38 ± 0.79) d, in the control group was (10.99 ± 1.10) d, the difference between them was statistically significant (t=14.66, P<0.05). On the 7th day, there were 7 cases of positive pathogenic bacteria in sputum culture in the experimental group, which was significantly different from the 29 cases in the control group (χ2=16.73, P<0.05). Conclusions The vector management strategy for preventing ventilator-associated pneumonia by blocking etiological characteristics can reduce the incidence of VAP, shorten the duration of mechanical ventilation and ICU stay, and reduce the pathogen load in the sputum of mechanically ventilated patients on the 7th day.

    呼吸,人工肺炎,呼吸机相关性病原菌媒介护理策略

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    大面积脑梗死术后患者早期活动循证实践方案的构建与应用

    虞云霞张纯朱丽娟李若白...
    289-295页
    查看更多>>摘要：目的 探讨大面积脑梗死术后患者早期活动循证实践方案的构建与应用。 方法 选取2021年7月至2023年4月温州市中心医院收治的96例大面积脑梗死术后患者作为研究对象进行临床试验，采用随机数字表法分为对照组48例和观察组48例。对照组给予大面积脑梗死术后常规护理，观察组给予基于循证的系统化早期活动训练。2组均随访至患者出院1个月后。比较2组术后住院时间、住院费用，术后48 h的生命体征及疼痛情况，干预前及出院后7 d、1个月的日常生活能力、神经功能缺损评分和随访期间的并发症。 结果 对照组男29例，女19例，年龄43~67（56.87 ± 1.76）岁；观察组男31例，女17例，年龄43~68（57.02 ± 1.82）岁。观察组住院时间为（6.87 ± 0.65）d，对照组为（9.06 ± 0.72）d，2组比较差异有统计学意义（t=15.64，P<0.05）。术后48 h，观察组心率、呼吸频率及平均动脉压分别为（71.65 ± 0.45）、（14.76 ± 0.36）次/min和（76.98 ± 5.65）mmHg（1 mmHg=0.133 kPa），与对照组的（82.76 ± 2.65）、（18.76 ± 2.87）次/min和（93.76 ± 5.93）mmHg相比差异均有统计学意义（t=28.64、9.58、14.19，均P<0.05）。出院后7 d观察组的日常生活能力评分和神经功能缺损评分分别为（84.65 ± 2.45）、（23.65 ± 2.65）分，与对照组的（79.76 ± 1.97）、（28.54 ± 2.73）分比较差异均有统计学意义（t=10.26、8.91，均P<0.05）。出院后1个月观察组的日常生活能力评分及神经功能缺损评分分别为（95.45 ± 1.43）、（18.65 ± 1.98）分，与对照组的（87.87 ± 1.39）、（21.54 ± 2.76）分相比差异均有统计学意义（t=26.33、5.90，均P<0.05）。观察组术后出血、术后感染、低氧血症等并发症发生率合计为20.83%（10/48），与对照组的68.75%（33/48）比较差异有统计学意义（χ2=22.28，P<0.05）。 结论 基于循证的系统化早期活动训练可显著缓解大面积脑梗死患者术后疼痛情况，提高患者日常生活能力及神经功能，有效缩短患者住院时间，并减少并发症的发生。 Objective To explore the construction and application of an evidence-based practice plan for early postoperative activity in postoperative patients with large area cerebral infarction. Methods Ninety-six postoperative patients with large area cerebral infarction admitted to Wenzhou Central Hospital from July 2021 to April 2023 were selected as the study subjects for a Clinical trial. They were divided into the control group (48 cases) and the observation group (48 cases) by random number table method. The control group received routine postoperative care for neurosurgery, while the observation group received evidence-based systematic early activity training. Both groups were followed up until 1 month after the patient was discharged from the hospital. The time of postoperative hospitalization, hospitalization expenses, vital signs and pain investigation 48 h after surgery, daily living ability before intervention and 7 d, 1 month after discharge, neurological function before intervention and 7 d and 1 month after surgery, and complications during follow-up between the two groups were compared. Results In the control group, there were 29 males and 19 females, with an average age of 43-67(56.87 ± 1.76) years. In the observation group, there were 31 males and 17 females, with an average age of 43-68 (57.02 ± 1.82) years. The postoperative hospital stay in the observation group was (6.87 ± 0.65) d, in the control group was (9.06 ± 0.72) d, the difference between them was significant (t=15.64, P<0.05). 48 hours after surgery, the heart rate, breathing rate and mean arterial pressure in the observation group were (71.65 ± 0, 45) times/min, (14.76 ± 0.36) times/min and (76.98 ± 5.65) mmHg(1 mmHg=0.133 kPa), which were different with those in the control group, (82.76 ± 2.65) times/min, (18.76 ± 2.87) times/min and (93.76 ± 5.93) mmHg (t=28.64, 9.58 and 14.19, all P<0.05). Seven days after discharge, the score of Activities of Daily Living and the National Institutes of Health Neurological Impairment Scale in the observation group were (84.65 ± 2.45) and (23.65 ± 2.65), which were different than the (79.76 ± 1.97) and (28.54 ± 2.73) in the control group (t=10.26, 8.91, both P<0.05). A month after discharge, the score of Activities of Daily Living and the National Institutes of Health Neurological Impairment Scale in the observation group were (95.45 ± 1.43) and (18.65 ± 1.98), while in the control group were (87.87 ± 1.39) and (21.54 ± 2.76), the difference between them were significant (t=26.33, 5.90, both P<0.05). The total incidence of complications such as postoperative bleeding, postoperative infection and hypoxemia in the observation group was 20.83% (10/48), which was significant lower than the 68.75% (33/48) in the control group (χ2=22.28, P<0.05). Conclusions Evidence-based systematic early activity training could significantly alleviate postoperative pain in patients with large area cerebral infarction after surgery, improve their daily living ability and neurological function, further effectively shorten their hospitalization time, and reduce the occurrence of complications.

    脑梗死循证护理学方案构建

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    多病共存慢性病患者出院准备度调查及其影响因素分析和护理策略探讨

    张晓静迟玉楠田悦李若白...
    296-302页
    查看更多>>摘要：目的 探讨多病共存患者的出院准备度及其影响因素，并制订相应策略，指导临床工作。 方法 采用横断面研究，2022年2—12月采用便利抽样法通过一般资料调查表、出院准备度量表对北京大学第三医院全科医学科183例多病共存慢性病患者进行问卷调查。采用多元线性回归分析出院准备度的影响因素。 结果 183例多病共存患者中男95例，女88例，年龄（67.34 ± 10.36）岁。出院准备度均分为（109.83 ± 18.40）分。多病共存慢性病患者出院准备度的影响因素中有54.9%来自于感知自理障碍、住院次数、陪住情况及是否做好出院准备4个方面（调整后R2=0.549，P<0.05）。 结论 全科医学科多病共存慢性病患者的出院准备度处于较高水平，临床护理人员对于感知自理障碍、需要陪住、多次住院，以及未做好出院准备的患者应提早给予干预，保证患者处于良好的出院准备状态。 Objective To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work. Methods In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness. Results All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge (R2=0.549, P<0.05). Conclusions The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.

    全科医学多病共存出院准备度对策

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    基于可接受性理论的ICU机械通气患者沟通障碍因素的现象学研究

    杨云静张振宇高明晓李英...
    302-307页
    查看更多>>摘要：目的 从患者和医护人员两个视角探讨导致ICU患者在机械通气期间沟通障碍的因素，并运用可接受性理论识别通过干预可改善的障碍因素。 方法 2022年7—8月采用质性研究中的描述性现象学研究法，运用目的抽样法选取烟台市毓磺顶医院综合ICU 11例机械通气患者和8名医护人员进行访谈，了解机械通气患者沟通障碍的因素。对患者的访谈选在脱机后，结合参与式观察。借助Nvivo12.0 Plus软件，采用Colaizzi现象学7步分析法归纳主题，运用可接受性理论识别通过干预可改善的障碍因素。 结果 11例患者年龄18~66岁，机械通气时长9.5~312.3 h。8名医护人员年龄26~54岁，ICU工作年限2~30年。共提炼出主题14个。患者方面：抵触情绪，信息表达困难，性格内敛，沟通工具使用不便，紧急救治冲突，否定自身沟通能力，思维迟钝；医护人员方面：抵触情绪，认知负荷及时间成本高，人性化沟通策略缺乏，培训欠佳，其他优先工作事宜，丧失有效沟通的信心，对沟通重要性的认知度不高。 结论 可改善的ICU机械通气患者沟通障碍因素较多，建议国内加快对高科技、个性化替代交流工具的研发，减少医患、护患的负向沟通，实施以证据为基础的多模式、渐进式沟通干预策略。 Objective To explore the factors leading to communication disorders in ICU patients during mechanical ventilation from the perspective of both patients and medical staff, and to use the theoretical framework of acceptability to identify the barriers that can be improved by intervention. Methods Using the method of descriptive phenomenology from July to August 2022, 11 patients with mechanical ventilation and 8 medical staff in the comprehensive ICU of a Yuhuangding Hospital in Yantai were selected for interviews by the purpose sampling method, combined with participatory observation. The interviews of patients were conducted off ventilator. With Nvivo12.0 Plus software, the seven-step analysis method of Colaizzi phenomenology was adopted to summarize the theme and the theoretical framework of acceptability was used to identify the obstacle factors that could be improved by intervention. Results The age of 11 patients was 18-46 years old, the duration of mechanical ventilation was 9.5-312.3 h. The age of 8 medical staff was 26-54 years old, the length of service in ICU was 2-30 years. A total of 14 themes were extracted. For patients: defensive mood, difficulty in presenting information, introverted personality, communication tools are hard to use, emergency treatment conflict, deny the ability to communicate, thought slowness. For medical staff: defensive mood, cognitive load, high time cost, lack of humane communication strategies, poor training, other priorities, loss of confidence in effective communication, awareness of the importance of communication was not enough. Conclusions There are many factors that can be improved for patients with mechanical ventilation in ICU. It is suggested to speed up the research and development of high-tech and personalized alternative communication tools in China, reduce negative communication between doctors and patients and nurses and patients, and implement evidence-based multi-mode and progressive communication intervention strategies.

    呼吸,人工定性研究可接受性理论沟通障碍

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