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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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    基于动机、意志理论模型的标准化运动方案在急性心肌梗死患者家庭心脏康复中的应用

    张梅代莉莉孙咏梅黄悦...
    321-328页
    查看更多>>摘要：目的 探讨基于动机、意志理论模型的标准化运动方案在急性心肌梗死患者家庭心脏康复中的应用效果。 方法 采用非同期对照试验方法，便利抽样法选取2021年12月至2023年4月蚌埠医学院直属淮北市人民医院心血管内科收治的60例急性心肌梗死患者为研究对象。按照入院先后顺序进行分组，2021年12月至2022年6月收治的30例患者为对照组，2022年7月至2023年4月收治的30例患者为观察组。对照组采用常规的护理方法，观察组在常规护理的基础上采用基于动机、意志理论模型为框架的标准化运动方案进行干预。3个月后比较2组患者6分钟步行距离、杜克活动状况指数得分、运动自我效能得分、心脏康复运动处方依从性水平的差异。 结果 对照组男23例，女7例，年龄（58.27 ± 10.86）岁；观察组男24例，女6例，年龄（57.07 ± 10.91）岁。干预3个月后，观察组6分钟步行距离、中文版杜克活动状况指数和运动自我效能得分分别为（565.53 ± 66.90）m和（29.80 ± 9.76）、（41.87 ± 11.76）分，均高于对照组的（488.00 ± 91.94）m和（21.63 ± 7.21）、（29.80 ± 8.48）分，差异均有统计学意义（t=3.73、3.69、4.56，均P<0.01）。观察组患者心脏康复运动的依从性好、一般、差所占的比率依次为56.7%（17/30）、36.7%（11/30）、6.7%（2/30），对照组分别为23.3%（7/30）、46.7%（14/30）、30.0%（9/30），2组比较差异有统计学意义（χ2=8.98，P<0.05）。 结论 基于动机、意志理论模型构建的标准化运动方案应用于急性心肌梗死患者家庭心脏康复，可以改善患者运动耐力，提高运动自我效能，提升家庭心脏康复的效果，进一步降低心血管危险因素。 Objective To analyze the application effect of standardized exercise program based on motivation and volitional model in home-based cardiac rehabilitation of patients with acute myocardial infarction. Methods The method of non-simultaneous control trial was used. Using convenient sampling method, 60 patients with acute myocardial infarction treated in the Department of Cardiovascular Medicine of Huaibei People's Hospital Affiliated to Bengbu Medical College from December 2021 to April 2023 were selected as subjects. The patients were divided into two groups according to the order of admission: 30 patients admitted from December 2021 to June 2022 as the control group, and 30 patients from July 2022 to April 2023 as the observation group. The control group received routine nursing methods,on the basis of routine nursing, the observation group was intervened with the standardized exercise program based on the theoretical model of motivation and will. The differences of 6-minute walking distance, Duke Activity Status Index Score, Exercise Self-efficacy Score, compliance level of cardiac rehabilitation exercise prescription between the two groups were compared. Results There were 23 males and 7 females in the control group with age of (58.27 ± 10.86) years old, and 24 males and 6 females in the observation group with age of (57.07 ± 10.91) years old. After 3 months of intervention, 6-minute walking distance, Duke Activity Status Index Score and Exercise Self-efficacy Score in the observation group were (565.53 ± 66.90) m, (29.80 ± 9.76) and (41.87 ± 11.76) points respectively, significantly higher than those in the control group (488.00 ± 91.94) m, (21.63 ± 7.21) and (29.80 ± 8.48) points, the differences were statistically significant (t=3.73, 3.69, 4.56, all P<0.01). The rates of good, average, and poor compliance with cardiac rehabilitation exercise in the observation group were 56.7% (17/30), 36.7% (11/30), and 6.7% (2/30), respectively, while in the control group were 23.3% (7/30), 46.7% (14/30), and 30.0% (9/30), respectively. The difference between the two groups was statistically significant (χ2=8.98, P<0.05). Conclusions The application of standardized exercise program in home-based cardiac rehabilitation of patients with acute myocardial infarction can improve patients′ exercise endurance, improve exercise self-efficacy, enhance the effect of home-based cardiac rehabilitation, and further reduce cardiovascular risk factors.

    心肌梗死家庭医疗保健服务,基于医院的心脏康复运动

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    基于社会认知理论的老年肺癌患者术后运动管理方案构建

    胡银燕赵林芳贺晓映林琳...
    329-337页
    查看更多>>摘要：目的 基于社会认知理论构建老年肺癌患者术后运动管理方案，为提高老年肺癌患者术后运动能力提供指导。 方法 系统检索UpToDate、PubMed、Web of Science、Cochrane Library、医脉通、万方、中国知网等数据库中有关老年肺癌患者术后康复运动的相关文献，检索时间为建库至2023年2月13日。以社会认知理论为指导，在文献研究的基础上初步拟订老年肺癌患者术后运动管理方案初稿，通过专家会议法修订方案内容后形成终稿。 结果 专家会议法问卷回收率为12/12；专家权威系数为0.892；各个条目的重要性变异系数为0~0.150，Kendall协调系数为0.262（P<0.01），最终形成的运动管理方案包含5个一级条目、18个二级条目、42个三级条目。 结论 老年肺癌术后运动管理方案构建的过程具有科学性和可靠性、内容具有合理性和全面性，能为提高老年肺癌术后患者运动康复提供指导。 Objective To construct a postoperative exercise management program for elderly patients with lung cancer based on social cognitive theory, and to provide guidance for improving the postoperative exercise ability of elderly patients with lung cancer. Methods Systematically searched UpToDate, PubMed, Web of Science, Cochrane Library, Medlive, Wanfang, CNKI and other databases for relevant literature on postoperative rehabilitation exercise for elderly patients with lung cancer, with the search time from the establishment of the database to February 13, 2023. Guided by social cognitive theory, a preliminary draft of the postoperative exercise management program for elderly patients with lung cancer was prepared based on the literature research, and the final draft was formed after revising the program content through expert meeting method. Results The questionnaire recovery rate of expert meeting method was 12/12 the expert authority coefficient was 0.892 the importance coefficient of variation of each item was 0-0.150 the Kendall coordination coefficient was 0.262 (P<0.001) the final exercise management program included 5 first-level items, 18 second-level items and 42 third-level items. Conclusions The process of constructing the postoperative exercise management program for elderly patients with lung cancer has scientificity and reliability, and the content has rationality and comprehensiveness, which can provide guidance for improving the postoperative exercise rehabilitation of elderly patients with lung cancer.

    老年人肺肿瘤社会认知理论运动

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    按病种分值付费方式下加速康复外科护理在消化道早癌行内镜黏膜下剥离术患者中的应用效果

    张海燕朱凌楠姜稳妮吴越...
    338-343页
    查看更多>>摘要：目的 探讨按病种分值付费（DIP）方式下，加速康复外科护理在消化道早癌行内镜黏膜下剥离术（ESD）患者中的应用效果。 方法 采用随机对照试验方法，便利抽样法选取2022年1—12月焦作市第二人民医院消化科64例消化道早癌行ESD治疗的患者为研究对象，按照随机数字表法分为常规组和观察组各32例，2组患者均以DIP方式支付医疗费用，常规组采用传统围手术期护理，观察组采用加速康复外科围手术期管理模式进行护理，比较2组患者术后并发症发生率、住院时间、DIP拨付比和患者护理满意率等的差异。 结果 常规组男、女各16例，观察组男14例，女18例。干预后，常规组患者术后并发症发生率为21.88%（7/32），观察组为3.12%（1/32），2组比较差异有统计学意义（χ2=5.14，P<0.05）；常规组患者住院时间为（10.93 ± 2.87）d，观察组为（9.01 ± 1.53）d，2组比较差异有统计学意义（t=4.13，P<0.05）；常规组患者例均住院费用为（20 108.23 ± 6 495.49）元，观察组为（18 589.03 ± 4 439.46）元，2组比较差异有统计学意义（t=20.57，P<0.05）；观察组DIP拨付比为87.98%（303 419.26/344 872.99），常规组为69.33%（244 864.99/353 187.65），2组比较差异有统计学意义（χ2=4.81，P<0.05）；观察组护理满意率为96.88%（31/32），常规组为78.13%（25/32），2组比较差异有统计学意义（χ2=5.14，P<0.05）。 结论 DIP方式下，加速康复外科护理能有效降低消化道早癌行ESD治疗患者的术后并发症、住院时间、例均住院费用，提升ESD病种医疗保险基金拨付比和患者护理满意度，体现了护理工作的价值，可推广应用到其他手术病种的护理管理中。 Objective To evaluate the effect of accelerated rehabilitation surgery (ERAS) under diagnosis-intervention packet (DIP) in patients with early cancer of digestive tract undergoing endoscopic submucosal dissection (ESD). Methods The 64 patients with early cancer of digestive tract treated with ESD in the Gastroenterology Department of the Second People′s Hospital of Jiaozuo were selected by randomized controlled trial and convenient sampling method. According to random number table method, they were divided into routine group and observation group, 32 patients in each group. All patients in the 2 groups paid their medical expenses by DIP method, the routine group was treated with traditional perioperative nursing, and the observation group was treated with ERAS perioperative management mode. The postoperative complication rate, length of hospital stay, DIP allocation ratio, and patient satisfaction with nursing were compared between the two groups. Results There were 16 men and women in the routine group, 14 men and 18 women in the observation group.After intervention, the incidence of postoperative complications was 21.88% (7/32) in the routine group and 3.12% (1/32) in the observation group, and the difference between the two groups was statistically significant (χ2=5.14, P<0.05). The length of stay was (10.93 ± 2.87) d in the routine group and (9.01 ± 1.53) d in the observation group, and the difference between the two groups was statistically significant (t=4.13, P<0.05). The average hospitalization expenses per case was (20 108.23 ± 6 495.49) yuan in the routine group and (18 589.03 ± 4 439.46) yuan in the observation group, and the difference between the two groups was statistically significant (t=20.57, P<0.05). The DIP allocation ratio of the observation group was 87.98% (303 419.26/344 872.99), and that of the routine group was 69.33% (244 864.99/353 187.65), and the difference between the two groups was statistically significant (χ2=4.81, P<0.05). The satisfaction of the observation group was 96.88% (31/32) and the routine group was 78.13% (25/32), and the difference between the two groups was statistically significant (χ2=5.14, P<0.05). Conclusions The accelerated rehabilitation surgical nursing can effectively reduce the postoperative complications, the average length of stay, the average hospitalization expenses per case under DIP in patients with early cancer of digestive tract treated by ESD, improve the DIP allocation ratio of ESD diseases and the patient′s nursing satisfaction, which reflects the value of nursing work and can be applied to the nursing management of other surgical diseases.

    按病种分值付费加速康复外科消化道早癌内镜黏膜下剥离术

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    基于重症喂养流程的早期肠内营养管理在慢性阻塞性肺疾病急性加重机械通气患者中的应用价值

    韩婷佘会林琳
    344-349页
    查看更多>>摘要：目的 探究基于重症喂养流程的早期肠内营养（EEN）管理对慢性阻塞性肺疾病急性加重（AECOPD）机械通气患者营养状态、胃肠道耐受性的影响。 方法 采用类实验研究方法，按照入院时间先后顺序分组，选择六安市中医院2020年1月至2021年6月住院治疗的AECOPD机械通气患者30例为对照组，选择2021年7月至2022年12月的AECOPD机械通气患者30例为观察组。对照组采用常规EEN干预方法，观察组采用基于重症喂养流程的EEN管理干预方法。比较干预后2组患者7 d内热量摄入量及蛋白摄入量，记录患者胃肠道耐受情况及预后情况，比较2组患者干预前及干预第7天的血红蛋白、白蛋白、前白蛋白水平。 结果 对照组男17例，女13例，年龄（66.37 ± 6.09）岁；观察组男16例，女14例，年龄（65.49 ± 6.35）岁。干预后，观察组患者7 d内热量摄入量及蛋白摄入量分别为（3 513.62 ± 94.56）kJ/d、（51.06 ± 5.03）g/d，均高于对照组的（2 859.41 ± 87.23）kJ/d、（36.78 ± 3.14）g/d，差异均有统计学意义（t=27.85、13.19，均P<0.05）；干预前2组患者的白蛋白、血红蛋白、前白蛋白水平比较差异均无统计学意义（均P>0.05）；干预后观察组的白蛋白、血红蛋白、前白蛋白水平分别为（37.16 ± 3.42）、（135.43 ± 12.64）g/L和（218.54 ± 15.38）mg/L，均高于对照组的（34.25 ± 4.01）、（127.51 ± 11.12）g/L和（201.33 ± 15.04）mg/L，差异均有统计学意义（t=3.02、2.58、4.38，均P<0.05）；观察组的反流误吸、肠营养中断率均为6.67%（2/30），低于对照组的26.67%（8/30）和30.00%（9/30），差异均有统计学意义（χ2=4.32、5.46，均P<0.05）；观察组的机械通气时间、ICU入住时间分别为（7.62 ± 1.35）、（11.17 ± 2.04）d，均短于对照组的（8.57 ± 1.01）、（12.83 ± 2.19）d，差异均有统计学意义（t=3.09、3.04，均P<0.05）。 结论 基于重症喂养流程的EEN管理干预能够改善AECOPD机械通气患者的营养状态，提高其胃肠道耐受情况，改善预后。 Objective To explore the effects of early enteral nutrition (EEN) management based on severe feeding process on nutritional status and gastrointestinal tolerance in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after mechanical ventilation. Methods In the quasi trial study, 30 patients with AECOPD undergoing mechanical ventilation between January 2020 and June 2021 and other 30 patients undergoing mechanical ventilation between July 2021 and December 2022 in Liu′an Hospital of Traditional Chinese Medicine were enrolled as control group and observation group, respectively. The control group was given routine EEN intervention, while the observation group was given EEN management based on severe feeding process. The intakes of calorie and proteins within 7 d after intervention were compared between the two groups. The gastrointestinal tolerance and prognosis were recorded. The levels of hemoglobin, albumin and prealbumin were compared between the two groups before intervention and at 7 d after intervention. Results In the control group, there were 17 males and 13 females, with age of (66.37±6.09) years old. In the observation group, there were 16 males and 14 females, with age of (65.49 ± 6.35) years old. After intervention, intakes of calorie and proteins within 7 d in the observation group were (3 513.62 ± 94.56) kJ/d and (51.06 ± 5.03) g/d, more than those in the control group (2 859.41 ± 87.23) kJ/d, (36.78 ± 3.14) g/d, the differences were statistically significant (t=27.85, 13.19, both P<0.05). There were no significant difference in the levels of hemoglobin, albumin and prealbumin before intervention between the two groups (allP>0.05). After intervention, levels of albumin, hemoglobin and prealbumin were (37.16 ± 3.42), (135.43 ± 12.64) g/L and (218.54 ± 15.38) mg/L in the observation group, higher than those in the control group (34.25 ± 4.01), (127.51 ± 11.12) g/L and (201.33 ± 15.04) mg/L, the differences were statistically significant (t=3.02, 2.58, 4.38, all P<0.05). The incidence rates of reflux aspiration and enteral nutrition interruption in the observation group were 6.67% (2/30), 6.67% (2/30), lower than those in the control group 26.67% (8/30), 30.00% (9/30), the differences were statistically significant (χ2=4.32, 5.46, both P<0.05). The mechanical ventilation time and stay time in ICU in the observation group were (7.62 ± 1.35), (11.17 ± 2.04) d, shorter than those in the control group (8.57 ± 1.01), (12.83 ± 2.19) d, the differences were statistically significant (t=3.09, 3.04, both P<0.05). Conclusions EEN management based on severe feeding process can improve nutritional status, gastrointestinal tolerance and prognosis of AECOPD patients after mechanical ventilation.

    肺疾病,慢性阻塞性急性加重期早期肠内营养重症喂养流程营养状态胃肠道耐受性

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    资质过剩感和工作重塑在临床护士平台型领导与职业召唤间的链式中介效应

    姜虹陈浩杰杨英于立明...
    350-356页
    查看更多>>摘要：目的 探讨临床护士的平台型领导、资质过剩感、工作重塑与职业召唤的关系，为制订临床护士职业召唤策略提供参考。 方法 采用便利抽样法，于2023年4—5月选取青岛大学附属青岛市海慈医院（青岛市中医医院）、山东大学齐鲁医院、青岛市市立医院共488名临床护士作为研究对象。采用一般资料调查表、平台型领导量表、资质过剩感量表、工作重塑量表和职业召唤量表对研究对象进行横断面调查，分析平台型领导、资质过剩感、工作重塑与职业召唤之间的关系及中介效应。 结果 488名临床护士中男79名，女409名，年龄23~51（30.37 ± 6.40）岁。临床护士的平台型领导、资质过剩感、工作重塑和职业召唤得分分别为（86.12 ± 9.99）、（21.79 ± 7.29）、（70.61 ± 14.54）、（38.70 ± 7.54）分。平台型领导对职业召唤总效应为0.316。平台型领导对职业召唤的中介路径：平台型领导→资质过剩感→职业召唤；平台型领导→工作重塑→职业召唤；平台型领导→资质过剩感→工作重塑→职业召唤，3个中介效应依次占总效应的17.99%、9.50%和4.56%。 结论 资质过剩感和工作重塑在临床护士平台型领导与职业召唤间存在链式中介效应。护理管理者应实施平台型领导，缓解临床护士资质过剩感和提高工作重塑水平，进而提高其召唤水平。 Objective To explore the relationship between platform leadership, perceived overqualification, job crafting and career calling of clinical nurses, and provide references for formulating occupational calling strategies for clinical nurses. Methods A total of 488 clinical nurses from Qingdao Hiser Hospital Affiliated of Qingdao University(Qingdao Traditional Chinese Medicine Hospital), Shandong University Qilu Hospital, and Qingdao Municipal Hospital were selected as the study subjects by the convenience sampling method from April to May 2023. A general data questionnaire, Platform Leadership Scale, Perceived Overqualification Scale, Job Crafting Scale, and Career Calling Scale were used to conduct a cross-sectional investigation on the research objects, and the relationship and mediating effect between platform leadership, perceived overqualification, job crafting, and career calling were analyzed. Results Among the 488 clinical nurses, 79 were males and 409 were females, aged 23-51 (30.37 ± 6.40) years old. The scores of platform leadership, perceived overqualification, job crafting and career calling of clinical nurses were (86.12 ± 9.99), (21.79 ± 7.29), (70.61 ± 14.54) and (38.70 ± 7.54) points, respectively. The total effect of platform leadership on work engagement was 0.316. The mediating path of platform leadership to career calling included platform leadership→perceived overqualification→career calling platform leadership→job crafting→career calling platform leadership→perceived overqualification→job crafting→career calling. Three mediating effects accounted for 17.99%, 9.50% and 4.56% of the total effect, respectively. Conclusions There is a chain-mediating effect of perceived overqualification and work remodeling on the relationship between platform leadership and the career calling of clinical nurses. Nursing managers should implement platform leadership to alleviate clinical nurses′ perceived overqualification, improve job crafting, and then improve the level of clinical nurses′ career calling.

    护士平台型领导资质过剩感工作重塑职业召唤

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    吞咽障碍患者服药管理最佳证据的临床审查及分析

    刘艺朱丽群庄若倪益益...
    357-364页
    查看更多>>摘要：目的 基于吞咽障碍患者服药管理最佳证据进行临床现况审查，系统分析证据转化过程中存在的障碍因素及促进因素，制订变革策略。 方法 采用循证护理研究方法，以渥太华研究应用模式为指导，基于最佳证据制订审查指标，于2021年7—12月对江苏大学附属医院神经内、外科及老年科的223例患者及75名护士开展临床实践行为的现状审查，基于审查结果，对32名潜在采纳者进行深入访谈，采用内容分析法评估基于证据的变革、潜在采纳者和实践环境三方面证据临床转化的障碍及促进因素，从而制订有效策略。 结果 循证团队基于遴选的22条最佳证据制订了25条审查指标开展临床审查，显示有16条指标依从率<60%，通过分析与归纳潜在采纳者访谈结果，剖析导致护士依从率低的主要障碍因素：基于证据的变革改变了传统工作模式，证据应用不便捷；潜在采纳者层面护士知信行欠佳、工作负担重、患者及照护者认知度不高；实践环境层面为缺乏证据临床转化的护理规范和流程、多学科协作沟通渠道不通畅等。主要促进因素：有完善的循证护理项目监管机制，循证组有丰富的证据转化经验，管理层变革意愿强，实践者善于创新。 结论 吞咽障碍患者服药管理的临床实践与最佳证据间尚存在较大差距，应充分利用促进因素克服障碍，实施改进，以促进证据向临床实践有效转化。 Objective To review the clinical status based on the best evidence of drug administration in patients with dysphagia, systematically analyze the obstacle factors and promoting factors in the process of evidence transformation, and formulate reform strategies. Methods Based on the evidence-based nursing research method and the guidance of the Ottawa Model of Research Use (OMRU), the review indicators were developed based on the best evidence. The current status of clinical practice behaviors of 223 patients and 75 nurses in the Neurology, Neurosurgery and Geriatric departments of the Affiliated Hospital of Jiangsu University were reviewed from July to December 2021.Based on the results of the review, qualitative interviews were conducted with 32 potential adopters, and content analysis was used to assess the barriers and contributing factors to the clinical translation of evidence in three aspects: evidence-based change, potential adopters and practice environment, so as to develop effective strategies. Results Based on the 22 best evidence selected, the evidence-based team developed 25 review indicators to carry out clinical review, showing that the compliance rate of 16 indicators were less than 60%. By analyzing and summarizing the interview results of potential adopters, the main obstacles leading to the low compliance rate of nurses were analyzed as follows: evidence-based reform changed the traditional work mode, and the application of evidence was not convenient at the level of potential adopters, nurses had poor knowledge and practice, heavy work burden, and low awareness of patients and caregivers at the level of practice environment, there was lack of nursing norms and procedures for clinical transformation of evidence, and the channels of multi-disciplinary collaboration and communication were not smooth. The main promoting factors were the perfect supervision mechanism of evidence-based nursing projects, the evidence-based group had rich experience in evidence transformation, the management was willing to change, and the practitioners were good at innovation. Conclusions There is still a large gap between the clinical practice and the best evidence of drug administration in patients with dysphagia. The promoting factors should be fully utilized to overcome the obstacles and implement improvements to promote the effective transformation of evidence into clinical practice.

    吞咽障碍服药管理护理质量审查障碍因素促进因素证据转化循证护理

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    体外心肺复苏院内启动准备流程的最佳证据总结

    王鹏程王迪季学丽张丽...
    365-371页
    查看更多>>摘要：目的 检索、评价并总结体外心肺复苏院内启动准备流程的相关证据，以期为临床开展体外心肺复苏提供循证依据。 方法 采用循证护理研究方法，根据"6S"证据模型，自上而下检索美国指南网、苏格兰院际间指南网、英国国家临床医学研究所指南网等网站及UpToDate、The Cochrane Library、PubMed、Embase、中国知网、万方等数据库中与体外心肺复苏院内启动准备相关的指南、临床决策、专家共识、系统评价等文献，检索日期为建库至2023年5月20日。研究者对检索文献进行筛选、质量评价、证据提取并整合。 结果 最终纳入11篇文献，包括2篇指南，6篇专家共识，1篇系统评价，2篇类实验研究，从医疗条件、团队组建、物品管理、运行机制、启动前救治及启动判断6个方面总结出18条最佳证据。 结论 本研究总结了体外心肺复苏院内启动准备流程的相关证据，可为促进体外心肺复苏推广及实施提供参考。后续研究中仍需要着重关注体外心肺复苏的团队建设、人员培训考核以及管理制度优化，以提高体外心肺复苏的救治效率及准备度。 Objective To retrieve, evaluate and integrate the evidence related to the preparation process for initiating extracorporeal cardiopulmonary resuscitation in hospital, so as to provide reference for clinical implementation of extracorporeal cardiopulmonary resuscitation. Methods According to the evidence-based nursing method and the 6S evidence model, guidelines, clinical decisions, expert consensus, systematic review and other literatures related to the preparation process for initiating extracorporeal cardiopulmonary resuscitation in hospital were searched from National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, and other websites, UpToDate, The Cochrane Library, PubMed, Embase, CNKI, Wanfang and other databases. The retrieval date limit was from the establishment of the database to May 20, 2023. Researchers assessed the quality of the included articles, and extracted and summarized the evidence that met the quality standards. Results A total of 11 articles were included, including 2 guidelines, 6 expert consensuses, 1 systematic review and 2 quasi-experimental studies. A total of 18 pieces of evidences were summarized from 6 aspects, including medical conditions, team building, materials management, operation mechanism, pre-initiating treatment and initiating judgment. Conclusions This study summarizes the evidence of preparation process for initiating extracorporeal cardiopulmonary resuscitation in hospital, which can provide reference for promoting the implementation of extracorporeal cardiopulmonary resuscitation. Future studies still need to focus on team building, personnel training and assessment, and optimisation of the management system, so as to improve the efficiency and readiness of treatment.

    心脏停搏体外膜氧合作用体外心肺复苏启动准备证据总结

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    慢性心力衰竭患者疾病感知对失志的影响：疾病进展恐惧和正性情绪的链式中介作用

    高兴底瑞青李星丹叶琳...
    372-379页
    查看更多>>摘要：目的 探讨疾病进展恐惧和正性情绪在慢性心力衰竭患者疾病感知与失志关系中的中介作用，为医护工作者采取针对性的干预措施提供理论依据。 方法 采用便利抽样法选取2022年10月至2023年3月在郑州大学第一附属医院住院的320例慢性心力衰竭患者为研究对象。使用一般资料调查表、修订版中文失志量表、简易疾病感知问卷、简易恐惧疾病进展量表、正负性情绪量表（正性情绪分量表）进行横断面调查，通过构建结构方程模型，探索疾病进展恐惧与正性情绪在疾病感知与失志间的中介效应。 结果 回收有效问卷268份。268例患者中男168例，女100例，≤40岁占3.36%（9/268），41~65岁占55.22%（148/268），>65岁占41.42%（111/268）。相关分析显示，慢性心力衰竭患者疾病感知与疾病进展恐惧、失志各维度均呈正相关（r值为0.300~0.586，均P<0.01），与正性情绪呈负相关（r=-0.374，P<0.01）；疾病进展恐惧与正性情绪呈负相关（r=-0.318，P<0.01），与失志各维度呈正相关（r值为0.339~0.464，均P<0.01）；正性情绪与失志各维度呈负相关（r值为-0.430~-0.334，均P<0.01）。结构方程模型分析表明，慢性心力衰竭患者疾病感知对失志的直接效应显著（β=0.407，P<0.01），疾病进展恐惧及正性情绪在疾病感知与失志间的中介效应均显著（β=0.074、0.079，均P<0.01），疾病进展恐惧-正性情绪的链式中介效应亦显著（β=0.019，P<0.01）。 结论 疾病感知可直接预测慢性心力衰竭患者的失志水平，亦可分别通过疾病进展恐惧、正性情绪的中介作用或疾病进展恐惧-正性情绪的链式中介作用间接预测慢性心力衰竭患者的失志水平。 Objective To explore the mediating role of disease progression′s fear and positive affect in the relationship between disease perception and demoralization in patients with chronic heart failure. It provided a theoretical basis for targeted interventions for healthcare workers. Methods From October 2022 to March 2023, 320 patients with chronic heart failure in the First Affiliated Hospital of Zhengzhou University were selected as the research objects by convenience sampling. The General Information Questionnaire, Demoralization Scale Redacted Mandarin Version, Brief Illness Perception Questionnaire, Fear of Progression Questionnaire-Short Form, Positive and Negative Affect Schedule (Positive Affect Schedule) were used to conduct the questionnaire survey exploring the mediating effects of fear of disease progression and positive emotions between disease perception and disorientation by construction structural equation model. Results There were 268 valid questionnaires. Of the 268 patients, 168 were male and 100 were female, 3.36% (9/268) were ≤40 years old, 55.22% (148/268) were 41-65 years old, and 41.42% (111/268) were >65 years old. Correlation analysis showed that disease perception was positively correlated with disease progression ′s fear, and every dimension of demoralization (r values were 0.300-0.586, all P<0.01), and negatively correlated with positive affect (r=-0.374, P<0.01) disease progression′s fear was negatively correlated with positive affect (r=-0.318, P<0.01), and positively correlated with every dimension of demoralization (r values were 0.339-0.464, all P<0.01) positive affect was negatively correlated with every dimension of demoralization (r values were -0.430--0.334, all P<0.01). Structural equation model analysis showed that the direct effect of disease perception on demoralization was significant (β=0.407, P<0.01), and both mediating effects of disease progression′s fear and positive affect between disease perception and demoralization in patients with chronic heart failure were significant (β=0.074, 0.079, both P<0.01). The chain mediating effect of disease progression′s fear and positive effect was also significant (β=0.019, P<0.01). Conclusions Disease perception could directly predict the demoralization of patients with chronic heart failure and indirectly predict the demoralization of patients with chronic heart failure through the mediating effect of disease progression′s fear, positive affect, and the chain mediating effect of disease progression′s fear and positive affect.

    慢性心力衰竭疾病感知失志疾病进展恐惧正性情绪中介效应

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    适应性挑战下年龄相关性黄斑变性患者疾病获益感的现象学研究

    荣月芳秦建丽秦玲徐晓耘...
    380-385页
    查看更多>>摘要：目的 了解年龄相关性黄斑变性（AMD）患者在适应视力下降挑战的长期治疗中产生的疾病获益感，为改善患者的生命质量提供思路。 方法 2023年1—3月采用质性研究中的现象学研究方法，对南通大学附属医院眼科通过目的抽样法选取的20例接受药物注射治疗的AMD患者进行半结构式访谈。由2名访谈者反复阅读访谈记录的文字资料，逐字逐句分析其含义并采用Colaizzi 7步分析法对转录资料进行分类整理、编码与归纳。 结果 20例患者中男9例，女11例，年龄56~81岁。AMD患者在适应视力下降挑战的长期治疗中获得的疾病获益感可归纳为4个主题：适度的决策控制感、满意的社会支持、积极的疾病自我管理、改善的生命质量。 结论 AMD患者在适应视力下降挑战的长期治疗中存在疾病获益感，医务人员应引导患者从负性事件中寻求疾病获益感,识别患者面临的适应性挑战并发挥适应性领导技能，多渠道提供低视力康复服务，帮助患者提高适应性改变能力，以期进一步改善患者的生命质量。 Objective To find benefit of adaptive challenges in age-related macular degeneration (AMD) patients of long-term treatment in the challenge of vision decline, and provide new ideas for improving the quality of life of patients. Methods It was a phenomenological study from qualitative research, selected by purpose sampling method and semi-structured interview which involved 20 AMD patients who received intravitreal treatment of drug in the Ophthalmology Department of Affiliated Hospital of Nantong University from January to March 2023.Two interviewees comprehensively read and analyzed the transcript of the interview and its meaning, subsequently Colaizzi seven-step analysis method was used to classify and encode the transcribed data. Results Among 20 patients, there were 9 males and 11 females, aged 56-81 years old. Patients with AMD experience a sense of benefit in their long-term management of the condition, adapting to the challenges posed by declining strength, which could be summarized into four main themes: moderate sense of decision control, satisfactory social support, active self-management of the disease, and an improvement in quality of life. Conclusions Patients with AMD experience a sense of disease-related benefit during the long-term management of visual acuity challenges. Healthcare professionals should guide patients to seek this benefit from adverse events, identify the adaptive challenges patients face, and leverage their adaptive leadership skills. Furthermore, offering multi-channel low vision rehabilitation services can assist patients in enhancing their adaptive capabilities, ultimately contributing to further improving their quality of life.

    定性研究年龄相关性黄斑变性疾病获益感适应性挑战

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    冷藏薄荷水喷雾对胸腔镜下肺叶切除术患者口渴症状和口腔舒适度的影响

    谢鹏李艳梅朱泉余雷...
    386-391页
    查看更多>>摘要：目的 探讨冷藏薄荷水喷雾在胸腔镜下肺叶切除术后患者中的应用效果，旨在为建立有效的口渴管理策略提供依据。 方法 采用随机对照临床研究方法，便利选取2022年5月至2023年5月孝感市中心医院进行胸腔镜下肺叶切除术的100例患者为研究对象，采用随机对照表法分为试验组和对照组，每组50例。2组患者均给予常规麻醉苏醒期护理，在此基础上对照组采用冷藏纯净水（6~10 ℃）喷雾治疗，试验组采用冷藏薄荷水（6~10 ℃）喷雾治疗。比较2组患者的口渴程度、静息唾液流率、唇舌口腔黏膜湿润程度以及口腔舒适度。 结果 对照组患者男28例，女22例，年龄（58.30 ± 16.64）岁；试验组患者男30例，女20例，年龄（58.66 ± 16.68）岁。干预后1、2、4、6 h试验组口渴程度评分分别为（5.96 ± 1.58）、（5.08 ± 1.37）、（4.48 ± 1.18）、（3.76 ± 0.72）分，低于对照组的（6.78 ± 1.04）、（5.60 ± 1.09）、（5.10 ± 1.16）、（4.52 ± 1.09）分，差异均有统计学意义（t值为2.10~4.11，均P<0.05）。干预后2、4、6 h试验组静息唾液流率分别为（0.21 ± 0.04）、（0.23 ± 0.05）、（0.30 ± 0.08）ml/min，高于对照组的（0.18 ± 0.06）、（0.19 ± 0.06）、（0.21 ± 0.08）ml/min，差异均有统计学意义（t=2.31、3.22、6.57，均P<0.05）。干预后2、4、6 h试验组唇舌口腔黏膜湿润评分分别为（2.52 ± 0.93）、（2.26 ± 0.75）、（1.82 ± 0.83）分，低于对照组的（2.98 ± 0.84）、（2.88 ± 0.85）、（2.30 ± 0.76）分，差异均有统计学意义（t=2.59、3.87、2.38，均P<0.05）。干预后3、6 h试验组口腔舒适度评分分别为（4.54 ± 0.39）、（5.68 ± 1.67）分，高于对照组的（3.62 ± 0.21）、（4.76 ± 1.22）分，差异均有统计学意义（t=3.19、3.14，均P<0.05）。 结论 冷藏薄荷水喷雾能有效改善胸腔镜下肺叶切除术后患者口渴程度，提高口腔舒适度，为临床医护人员护理口渴患者提供新的思路。 Objective To investigate applications of cold peppermint water spray in patients undergoing thoracoscopic pulmonary lobectomy, so as to establish a effectively thirst management strategy for patients. Methods By a randomized controlled study method, a total of 100 patients undergoing thoracoscopic pulmonary lobectomy in Xiaogan Central Hospital from May 2022 to May 2023 were convenient collected, they were assigned to experimental group and control group according to the random number table method, with 50 cases in each group. Both groups were implemented routine nursing care, in additional, cold pure water spray (6-10 ℃) was carried out in the control group, while cold peppermint water spray (6-10 ℃) therapy was implemented in the experimental group. The clinical effect was compared by thirst score, salivary flow rate, lip mucosa moistening degree and oral comfort score between the two groups. Results There were 28 males and 22 females in the control group, aged (58.30 ± 16.64) years old 30 males and 20 females in the experimental group, aged (58.66 ± 16.68) years old. At 1, 2, 4, 6 h after intervention, the thirst scores were (5.96 ± 1.58), (5.08 ± 1.37), (4.48 ± 1.18), (3.76 ± 0.72) points in the experimental group, lower than those in the control group (6.78 ± 1.04), (5.60 ± 1.09), (5.10 ± 1.16), (4.52 ± 1.09) points, the differences were statistically significant (t values were 2.10-4.11, all P<0.05). At 2, 4, 6 h after intervention, the salivary flow rate were (0.21 ± 0.04), (0.23 ± 0.05), (0.30 ± 0.08) ml/min in the experimental group, higher than those in the control group (0.18 ± 0.06), (0.19 ± 0.06), (0.21 ± 0.08) ml/min, the differences were statistically significant (t=2.31, 3.22, 6.57, all P<0.05). At 2, 4, 6 h after intervention, the lip mucosa moistening scores were (2.52 ± 0.93), (2.26 ± 0.75), (1.82 ± 0.83) points in the experimental group, lower than those in the control group (2.98 ± 0.84), (2.88 ± 0.85), (2.30 ± 0.76) points, the differences were statistically significant (t=2.59, 3.87, 2.38, all P<0.05). At 3, 6 h after intervention, the oral comfort scores were (4.54 ± 0.39), (5.68 ± 1.67) points in the experimental group, higher than in the control group (3.62 ± 0.21), (4.76 ± 1.22) points, the differences were statistically significant (t=3.19, 3.14, both P<0.05). Conclusions Cold peppermint water spray can effectively improve the thirst of patients undergoing thoracoscopic pulmonary lobectomy, improve the oral comfort of patients, and provide new ideas for clinical medical staff to care for patients with thirst.

    肺肿瘤肺切除术口渴外科护理

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