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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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    适时诱导干预对阴道分娩初产妇产后排尿效果的影响

    郭丹凌敏王子敬毕嫣...
    401-406页
    查看更多>>摘要：目的 探讨适时诱导干预对阴道分娩初产妇产后排尿效果的影响，为临床有效预防阴道分娩初产妇产后尿潴留的发生，减轻产妇痛苦提供依据。 方法 采用随机对照试验设计，便利抽样法选取2021年6月至2022年9月大连市妇女儿童医疗中心（集团）体育新城院区产科收治行阴道分娩的初产妇400例作为研究对象，采用随机数字表法分为干预组和对照组各200例。对照组产妇采取常规的产后护理，指导产后6 h内主动排尿；干预组产妇采用适时诱导排尿干预，分别于产后2、4、6 h进行一般状况和膀胱尿量评估，并实施个性化的指导，包括按摩宫底的频率、饮水量的控制、诱导排尿的方法和时机的选择等，至产妇完成首次排尿且无不适主诉时，给予常规的产后护理。比较2组产妇产后首次排尿时间、首次排尿量、首次排尿有无膀胱刺激征及产后不同时段尿潴留的发生率。 结果 对照组年龄（29.60 ± 3.20）岁，干预组年龄（28.81 ± 3.42）岁。干预组产妇产后首次排尿时间为（6.89 ± 2.18）h，短于对照组的（9.11 ± 3.86）h，差异有统计学意义（t=-2.49，P<0.01）；干预组产妇产后首次排尿量为（322.36 ± 120.15）ml，多于对照组的（262.93 ± 105.68）ml，差异有统计学意义（t=3.39，P<0.05）；干预组产妇首次排尿膀胱刺激征发生率为22.0%（44/200），低于对照组的33.5%（67/200），差异有统计学意义（χ2=6.60，P<0.05）；干预组产妇产后24 h内尿潴留发生率为5.5%（11/200），低于对照组的11.5%（23/200），差异有统计学意义（χ2=4.63，P<0.05）；干预组产妇产后1周内尿潴留发生率为9.5%（19/200），低于对照组的16.5%（33/200），差异有统计学意义（χ2=4.33，P<0.05），但2组产妇产后24~72 h尿潴留的发生率比较差异无统计学意义（P>0.05）。 结论 采用适时诱导干预可降低阴道分娩初产妇产后尿潴留的发生率，缩短首次排尿时间，增加产后首次排尿量，提高首次排尿舒适度，值得临床推广应用。 Objective To explore the effect of timely induction intervention on postpartum urination in primipara during vaginal delivery, so as to provide the evidence for preventing the occurrence of postpartum urinary retention and relieving the pain of primipara. Methods This study adopted a randomized controlled trial design, and selected 400 cases of primipara who were hospitalized for vaginal delivery in the Obstetric Department of Dalian Women and Children's Medical Group Sports New Town Hospital from June 2021 to September 2022 as the study objects by convenience sampling method. They were divided into the intervention group and the control group with 200 cases each by random number table method, and the control group received routine postpartum care. Instruct active urination within 6 hours after delivery. The intervention received timely induction urination intervention. The general condition and bladder urine volume of the women in the intervention group were evaluated at 2, 4, 6 h after delivery, respectively, and personalized guidance was implemented, including the frequency of massage of the bottom of the uterus, the control of water intake, the selection of methods and timing of inducing urination, etc., and routine postpartum care was given when the women completed their first urination and had no complaints of discomfort. The first urination time, first urination volume, first bladder irritation during the first urination and the incidence of postpartum urinary retention in different periods were compared between the two groups. Results The patients in the control group were (29.60 ± 3.20) years old, while the patients in the intervention group were (28.81 ± 3.42) years old. The first urination time in the intervention group was (6.89 ± 2.18) h, which was shorter than that in the control group (9.11 ± 3.86) h, and the difference was statistically significant (t=-2.49, P<0.01). The first urination volume in the intervention group was (322.36 ± 120.15) ml, which was higher than that in the control group (262.93 ± 105.68) ml, and the difference was statistically significant (t=3.39, P<0.05). The incidence of the first bladder irritation in the intervention group was 22.0%(44/200), which was lower than that in the control group 33.5%(67/200), and the difference was statistically significant (χ2=6.60, P<0.05). The incidence of postpartum urinary retention within 24 h in the intervention group was 5.5%(11/200), which was lower than that in the control group 11.5%(23/200), and the difference was statistically significant (χ2=4.63, P<0.05). The incidence of postpartum urinary retention within 1 week in the intervention group was 9.5%(19/200), which was lower than that in the control group 16.5%(33/200), and the difference was statistically significant (χ2=4.33, P<0.05). There was no significant difference in the incidence of postpartum urinary retention within 24 to 72 h between the two groups (P>0.05). Conclusions Timely induction intervention can reduce the incidence of postpartum urinary retention, shorten the time of first urination, increase the volume of first urination and improve the comfort of first urination, which is worthy of clinical application.

    尿潴留初产妇适时诱导首次排尿

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    悬吊运动治疗对机械通气患者呼吸机相关膈肌功能障碍的干预效果

    关春婷欧康丽李冬利
    407-413页
    查看更多>>摘要：目的 探讨悬吊运动治疗对机械通气患者呼吸机相关膈肌功能障碍（VIDD）的干预效果，为VIDD的防治提供参考。 方法 采用前瞻性随机对照试验方法，便利抽样法选择2022年7月至2023年7月广州市红十字会医院收治的74例机械通气患者，按照随机数字表法分为试验组和对照组，每组37例。2组患者均给予常规护理，在此基础上对照组实施早期康复锻炼，试验组实施悬吊运动治疗。评价2组患者干预不同时间膈肌功能、呼吸功能以及终点事件的差异。 结果 最终试验组纳入34例，其中男22例，女12例，年龄（55.50 ± 12.03）岁；对照组纳入36例，其中男25例，女11例，年龄（54.78 ± 12.81）岁。2组患者干预前膈肌功能、呼吸功能比较差异均无统计学意义（均P>0.05）。干预7 d，试验组患者膈肌移动度、膈肌厚度分数分别为（1.59 ± 0.21）cm、（45.90 ± 5.20）%，高于对照组患者的（1.49 ± 0.21）cm、（42.78 ± 5.51）%，差异均有统计学意义（t=2.13、2.44，均P<0.05）。干预5、7 d试验组患者浅快呼吸指数分别为（81.47 ± 6.97）、（77.29 ± 8.91）次·min-1·L-1，低于对照组患者的（88.36 ± 9.04）、（84.67 ± 9.64）次·min-1·L-1，干预3、5、7 d试验组患者氧合指数分别为（230.79 ± 44.79）、（241.59 ± 23.79）、（258.56 ± 23.09）mmHg（1 mmHg=0.133 kPa），高于对照组患者的（197.25 ± 21.21）、（212.72 ± 21.81）、（242.75 ± 24.37）mmHg，差异均有统计学意义（t值为2.78~5.30，均P<0.05）。试验组患者机械通气时间、ICU住院时间分别为（225.29 ± 47.31）h、（12.47 ± 3.71）d，少于对照组患者的（260.53 ± 56.32）h、（14.64 ± 4.53）d，差异均有统计学意义（t=2.83、2.18，均P<0.05）。试验组患者VIDD发生率为5.9%（2/34），低于对照组患者的22.2%（8/36），试验组患者脱机成功率为91.2%（31/34），高于对照组患者的72.2%（26/36），差异均有统计学意义（χ2=4.18、4.15，均P<0.05）。 结论 悬吊运动治疗可提高机械通气患者膈肌功能和呼吸功能，缩短机械通气时间和ICU住院时间，并有效预防VIDD的发生。 Objective To investigate the intervention effect of sling exercise therapy on ventilator-induced diaphragm dysfunction (VIDD) in patients with mechanical ventilation, and to provide the reference for prevention and treatment of VIDD. Methods By a prospective randomized controlled study method, a total of 74 mechanical ventilation patients in Guangzhou Red Cross Hospital from July 2022 to July 2023 were convenient selected, they were divided into the experimental group and the control group according to the random number table method with 37 cases in each group. Both groups were given routine nursing care, the control group carried out early rehabilitation exercise, the experimental group implemented sling exercise therapy. The diaphragm function, respiratory function after the different time of intervention, and outcome events were compared between two groups. Results Finally, the experimental group included 34 cases, 22 males and 12 females, aged (55.50 ± 12.03) years old. The control group included 36 cases, 25 males and 11 females, aged (54.78 ± 12.81) years old. There was no significant difference in the diaphragm function, respiratory function before intervention(all P>0.05). After 7 d of intervention, the diaphragmatic excursion, diaphragm thickening fraction were (1.59 ± 0.21) cm, (45.90 ± 5.20) % in the experimental group, which were higher than those in the control group (1.49 ± 0.21) cm, (42.78 ± 5.51) %, the differences were statistically significant (t=2.13, 2.44, both P<0.05). After 5, 7 d of intervention, the rapid shallow breathing index was (81.47 ± 6.97), (77.29 ± 8.91) times. min-1.L-1 in the experimental group, which were lower than those in the control group (88.36 ± 9.04), (84.67 ± 9.64) times.min-1.L-1 after 3, 5, 7 d on intervention, the oxygenation index was (230.79 ± 44.79), (241.59 ± 23.79), (258.56 ± 23.09) mmHg(1 mmHg=0.133 kPa) in the experimental group, which were higher than those in the control group (197.25 ± 21.21), (212.72 ± 21.81), (242.75 ± 24.37) mmHg, the differences were statistically significant (t values were 2.78-5.30, all P<0.05). The mechanical ventilator time and the length of stay in ICU were (225.29 ± 47.31) h, (12.47 ± 3.71) d in the experimental group, which were lower than those in the control group (260.53 ± 56.32) h, (14.64 ± 4.53) d, the differences were statistically significant (t=2.83, 2.18, both P<0.05). The incidence rate of VIDD was 5.9%(2/34) in the experimental group, which was lower than that in the control group 22.2%(8/36), and the weaning success rate was 91.2%(31/34) in the experimental group, which was higher than that in the control group 72.2% (26/36), the differences were statistically significant (χ2=4.18, 4.15, both P<0.05). Conclusions Sling exercise therapy can effectively promote diaphragm function and respiratory function, shorten mechanical ventilator time and the length of stay in ICU of patients with mechanical ventilation, and reduce the occurrence of VIDD.

    康复悬吊运动治疗机械通气呼吸机相关膈肌功能障碍

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    讲解-模拟-练习-沟通-支持护理模式对腹腔镜胃癌根治术患者围手术期应激反应和术后康复的影响

    解思崔孟姗李冬利
    414-419页
    查看更多>>摘要：目的 研究讲解-模拟-练习-沟通-支持（ESPCS）护理模式对腹腔镜胃癌根治术患者围手术期应激反应和术后康复的影响，为ESPCS护理模式应用于胃癌根治术患者提供依据。 方法 采用类实验研究方法，便利抽样法选取2019年5月至2023年5月在中国医科大学附属第一医院择期行腹腔镜胃癌根治术患者212例，按随机数字表法分为观察组和对照组，每组106例。对照组采用常规护理干预，观察组在此基础上采用ESPCS护理模式干预，干预时间3个月。比较2组患者围手术期应激激素（血清皮质醇和肾上腺素）水平、抑郁自评量表（SDS）评分、焦虑自评量表（SAS）评分、胃肠道功能指标以及简明健康生活量表（SF-36）评分。 结果 2组患者每组各失访2例，最终每组104例患者。对照组男65例，女39例，年龄（61.59 ± 3.42）岁；观察组男61例，女43例，年龄（60.78 ± 3.63）岁。观察组患者术后6 d血清皮质醇、肾上腺素水平分别为（221.46 ± 24.15）nmol/L、（28.11 ± 3.47）pmol/L，低于对照组的（261.84 ± 27.91）nmol/L、（31.49 ± 3.86）pmol/L，差异均有统计学意义（t=11.16、6.64，均P<0.05）。术后1周，观察组SDS、SAS评分分别为（41.39 ± 2.21）、（39.62 ± 2.31）分，低于对照组的（45.27 ± 2.34）、（44.35 ± 2.37）分，差异均有统计学意义（t=12.29、14.58，均P<0.05）。观察组首次排气时间、首次排便时间、肠鸣音出现时间、首次固体进食时间分别为（55.38 ± 6.23）、（68.84 ± 7.92）、（38.73 ± 4.31）、（62.31 ± 7.67）h，短于对照组的（67.51 ± 8.39）、（84.17 ± 9.25）、（48.43 ± 5.79）、（75.65 ± 8.52）h，差异均有统计学意义（t值为11.84~13.71，均P<0.05）。干预后，观察组SF-36的生理功能、生理职能、总体健康、精神健康、社会功能评分及总分分别为（82.17 ± 4.12）、（83.21 ± 3.67）、（75.27 ± 3.64）、（80.63 ± 4.31）、（77.58 ± 4.13）、（73.89 ± 4.86）分，高于对照组的（75.61 ± 4.39）、（74.24 ± 3.88）、（69.45 ± 4.38）、（71.28 ± 4.05）、（72.35 ± 3.84）、（68.81 ± 5.14）分，差异均有统计学意义（t值为7.32~17.13，均P<0.05）。 结论 ESPCS护理模式可有效减轻腹腔镜胃癌根治术患者的围手术期应激反应，促进胃肠道功能恢复，改善生命质量。 Objective To investigate the effect of the explain-simulate-practice-communication-support (ESPCS) nursing model on perioperative stress and postoperative rehabilitation in patients undergoing laparoscopic radical gastrectomy for gastric cancer. Provide a basis for the application of ESPCS nursing model in patients undergoing radical gastrectomy for gastric cancer. Methods This was a quasi-experimental study. A total of 212 patients who underwent laparoscopic radical gastrectomy for gastric cancer in the First Affiliated Hospital of China Medical University from May 2019 to May 2023 were selected by convenience sampling and divided into the observation group and the control group by random digital table method, with 106 patients in each group. The control group received routine nursing intervention, while the observation group received ESPCS nursing intervention for 3 months. The perioperative stress hormones (serum cortisol and epinephrine), Self-rating Depression Scale (SDS) score, Self-rating Anxiety Scale (SAS) score, gastrointestinal function indicators, and the 36-item Short Form Health Survey Questionnaire (SF-36) score were compared between the two groups. Results Two groups of patients were lost to follow-up, with a total of 104 patients in each group. The control group consisted of 65 males and 39 females, aged (61.59 ± 3.42) years old, while the observation group consisted of 61 males and 43 females, aged (60.78 ± 3.63) years old. Six days after operation, serum cortisol and epinephrine levels in the observation group were (221.46 ± 24.15) nmol/L and (28.11 ± 3.47) pmol/L, respectively, which were lower than those in the control group (261.84 ± 27.91) nmol/L and (31.49 ± 3.86) pmol/L, respectively, and the differences were statistically significant (t=11.16, 6.64, both P<0.05). After 1 week of operation, the SDS and SAS scores in the observation group were (41.39 ± 2.21), (39.62 ± 2.31) points, respectively, which were lower than those in the control group (45.27 ± 2.34), (44.35 ± 2.37) points, and the differences were statistically significant (t=12.29, 14.58, both P<0.05). The time of first exhaust, first defecation, intestinal ringing and first solid eating in the observation group were (55.38 ± 6.23), (68.84 ± 7.92), (38.73 ± 4.31), (62.31 ± 7.67) h, respectively, which were lower than those in the control group (67.51 ± 8.39), (84.17 ± 9.25), (48.43 ± 5.79), (75.65 ± 8.52) h, the differences were statistically significant (t values were 11.84-13.71, all P<0.05). After intervention, the scores of physiological function, role physical, general health, mental health, social function and the total score of SF-36 in the observation group were (82.17 ± 4.12), (83.21 ± 3.67), (75.27 ± 3.64), (80.63 ± 4.31), (77.58 ± 4.13), (73.89 ± 4.86) points, respectively, which were higher than those in the control group (75.61 ± 4.39), (74.24 ± 3.88), (69.45 ± 4.38), (71.28 ± 4.05), (72.35 ± 3.84), (68.81 ± 5.14) points, the differences were statistically significant (t values were 7.32-17.13, all P<0.05). Conclusions The ESPCS nursing model can effectively alleviate the perioperative stress reaction of gastric cancer patients undergoing laparoscopic radical gastrectomy, promote the recovery of gastrointestinal function and improve the quality of life.

    腹腔镜应激胃癌根治术ESPCS护理模式胃肠道功能

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    肌萎缩侧索硬化患者呼吸道管理的最佳证据总结

    王旭李丽周宝华李葆华...
    420-426页
    查看更多>>摘要：目的 检索、评价和总结国内外肌萎缩侧索硬化患者呼吸道管理的相关证据，为临床护理提供参考。 方法 系统检索国内外相关指南网、专业学会及数据库中关于肌萎缩侧索硬化患者呼吸道管理的最佳实践、指南、专家共识等证据。检索时限为2016年1月1日至2023年4月15日。经过文献质量评价后，对符合质量标准的文献进行证据提取。 结果 最终纳入12篇文献，包括3篇指南、1篇专家共识、1篇证据总结、4篇系统评价和3篇随机对照试验。从肌萎缩侧索硬化患者的呼吸评估、机械通气、呼吸道分泌物管理和呼吸康复4个方面总结出25条证据。 结论 该研究总结了肌萎缩侧索硬化患者呼吸道管理的最佳证据，便于临床医护人员对肌萎缩侧索硬化患者进行更有针对性、科学性的呼吸评估、干预及指导。 Objective To retrieve, evaluate and summarize the relevant evidence for respiratory management in patients with amyotrophic lateral sclerosis (ALS), and provide reference for clinical nursing. Methods The best practices, guidelines, expert consensus and other evidence on respiratory management in ALS patients were systematically retrieved from dometic and foreign relevant guide websites, professional associations and databases. The retrieve period was from January 1, 2016 to April 15, 2023. After the literature quality evaluation, the evidence was extracted from the literature that meets the quality standards. Results A total of 12 references were included, including 3 guidelines, 1 expert consensus, 1 evidence summary, 4 systematic reviews, and 3 randomized controlled trails. The 25 pieces of evidence were summarized from the patients with ALS, including respiratory assessment, mechanical ventilation, secreta management, and respiratory rehabilitation. Conclusions This study summarizes the best evidence on respiratory tract management in patients with ALS, which is convenient for clinical medical personnel to carry out more targeted and scientific respiratory assessment, intervention and guidance for patients with ALS.

    肌萎缩侧索硬化呼吸道证据总结循证护理

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    成年重症患者肌肉质量床旁超声评估实践的最佳证据总结

    李嘉琪徐瑶左俊焘韩珍...
    427-433页
    查看更多>>摘要：目的 检索并筛选利用床旁超声评估成年重症患者肌肉质量的相关证据，并对最佳证据进行总结。 方法 计算机检索BMJ最佳临床实践、UpToDate、PubMed、中国知网等国内外数据库、指南网和专业协会网站中有关成年重症患者床旁超声测量肌肉质量的相关文献。检索时限为建库至2023年8月30日。由4名经过系统循证课程培训的研究人员根据文献类型分别对文献质量进行评价。 结果 共纳入15篇文献，包括2篇指南、4篇专家共识、5篇系统评价和4篇随机对照试验。共总结22条证据，包括体位及患者准备、护理人员实施可行性、探头选择及注意事项、肌肉定位、超声对肌肉形态学进行评估及超声评估肌肉质量的指导意义6个方面。 结论 该研究总结的床旁超声评估成年重症患者肌肉质量的最佳证据具有科学性和系统性，为临床建立标准化超声评估流程提供了循证依据。 Objective The evidence on the use of bedside ultrasound to assess muscle mass in critically ill adults was retrieved and screened, and the best evidence was summarized. Methods A computer search was conducted for relevant literature on ultrasound measurement of muscle mass in critically ill adults in domestic and foreign databases such as BMJ Best Clinical Practice, UpToDate, PubMed, CNKI, and guide website and professional association website. The search time limit was from the establishment of the database to August 30, 2023. Literature quality was evaluated by four researchers trained in systematic evidence-based courses according to literature type. Results A total of 15 literatures were included, including 2 guideline, 4 expert consensus, 5 systematic reviews and 4 randomized controlled studies. A total of 22 pieces of evidence were summarized, including 6 aspects: position and patient preparation, feasibility of implementation by nursing staff, selection of probe and matters needing attention, muscle positioning, evaluation of muscle structure by ultrasound and the guiding significance of ultrasound evaluation of muscle mass. Conclusions The best evidence summary of bedside ultrasound assessment of muscle mass in critically ill adults summarized in this study is scientific and systematic, and provides evidence-based basis for establishing standardized ultrasound assessment procedures in clinic.

    超声检查重症患者肌肉质量肌减少症循证护理

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    围绝经期综合征患者二元应对水平及其影响因素研究

    徐杰聂宏陈着张萌...
    434-440页
    查看更多>>摘要：目的 探讨围绝经期综合征患者二元应对现状及其影响因素，为提高二元应对水平提供参考。 方法 便利抽样法选取2022年12月至2023年6月黑龙江中医药大学附属第一医院就诊的围绝经期综合征210例患者及配偶，采用一般资料调查表、二元应对问卷和改良Kupperman评分表等进行横断面调查。并采用单因素分析和方差分解模型分析探究围绝经期综合征患者二元应对水平的影响因素。 结果 回收有效问卷200份。200例患者年龄（50.52 ± 2.89）岁，二元应对得分为（79.64 ± 22.74）分；方差分解模型分析显示，患者婚龄、医疗保险类型、子女数量、受教育水平、家庭月收入、配偶受教育水平、配偶有无合并重大及慢性疾病、改良Kupperman评分、配偶是否存在广泛性焦虑是围绝经期综合征患者二元应对的主要影响因素（均P<0.05）。 结论 围绝经期综合征患者二元应对得分低于正常水平，并且考虑到患者配偶的影响和参与，护理人员应特别重视婚龄较短、子女数量较多、受教育水平和家庭月收入较低的患者。此外对存在广泛性焦虑、受教育水平较低、合并重大及慢性疾病的配偶应该给予关注，通过制订和实施综合性的干预措施，提高患者改良Kupperman评分和二元应对水平,促进双方更好的相互支持,从而改善围绝经期患者的夫妻关系。 Objective To explore the current situation of binary coping in patients with perimenopausal syndrome and analyze its influencing factors, in order to provide a basis for improving the level of binary coping. Methods Using convenience sampling method, a total of 210 patients with perimenopausal syndrome and their spouses from the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine were cross-sectional surveyed by a general data questionnaire, the Binary Coping Scale, and the Modified Kupperman Score Scale. The influencing factors of binary coping level in patients with perimenopausal syndrome were explored by univariate analysis and variance decomposition model analysis. Results A total of 200 valid questionnaires were retrieved.The patients aged (50.52 ± 2.89) years old. The binary coping score was (79.64 ± 22.74) points. The variance decomposition model analysis showed that marriage age, type of medical insurance, number of children, education level, family monthly income, spouse′s education level, presence of major comorbidities in spouse, modified Kupperman score, presence of generalized anxiety in spouse were the main influencing factors of binary coping in patients with perimenopausal syndrome (all P<0.05). Conclusions The binary coping scores of patients with perimenopausal syndrome are lower than normal, and considering the influence and involvement of patients' spouses, nursing staff should pay special attention to patients who are married relatively early, have more children, have lower education levels, and have lower family monthly incomes. Additionally, attention should be given to spouses who experience widespread anxiety, have a lower level of education, and suffer from major chronic diseases. By developing and implementing comprehensive intervention measures aimed at improving the Kupperman score and the level of binary coping, both parties can be encouraged to support each other more effectively, thereby improving the marital relationships of patients during the perimenopausal period.

    围绝经期Kupperman评分二元应对影响因素方差分解

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    晚期肺癌患者依恋对应对方式的影响：疾病感知与希望的链式中介作用

    马良慧李玉红袁德慧翁慧...
    441-448页
    查看更多>>摘要：目的 探讨晚期肺癌患者疾病感知和希望在依恋与应对方式之间的链式中介效应，为改善晚期肺癌患者应对方式提供理论依据。 方法 便利抽样法选取2021年10月至2022年6月安徽医科大学第一、二附属医院收治的354例晚期肺癌患者为研究对象。采用一般资料调查表、亲密关系经历量表、简易疾病感知问卷、Herth希望量表、医学应对问卷进行横断面调查。采用SPSS 25.0软件及Bootstrap法构建并验证链式中介模型。 结果 最终纳入336例晚期肺癌患者，其中男214例，女122例，年龄27~79（59.43 ± 8.61）岁。晚期肺癌患者依恋回避得分为（3.31 ± 1.01）分，依恋焦虑得分为（3.86 ± 1.17）分，疾病感知得分为（40.07 ± 12.01）分，希望得分为（34.05 ± 5.87）分，面对应对得分为（18.75 ± 5.34）分，回避应对得分为（15.47 ± 1.97）分，屈服应对得分为（9.62 ± 3.85）分。晚期肺癌患者依恋回避和依恋焦虑均与屈服应对呈正相关（r=0.448、0.747，均P<0.01），与疾病感知呈正相关（r=0.356、0.627，均P<0.01），与希望呈负相关（r=-0.406、-0.670，均P<0.01）；疾病感知与屈服应对呈正相关（r=0.744，P<0.01），与希望呈负相关（r=-0.628，P<0.01）；希望与屈服应对呈负相关（r=-0.769，P<0.01）。中介模型表明，晚期肺癌患者依恋回避→疾病感知→希望→屈服应对的链式中介作用显著，效应值为0.009，效应量为13.95%，依恋焦虑→疾病感知→希望→屈服应对的链式中介作用显著，效应值为0.010，效应量为8.27%。 结论 依恋既能直接预测晚期肺癌患者屈服应对，又可以通过疾病感知和希望的链式中介作用间接预测屈服应对。 Objective To explore the mediating chain effect between attachment and coping style of disease perception and hope in patients with advanced lung cancer, and to provide theoretical basis for improving coping style in patients with advanced lung cancer. Methods From October 2021 to June 2022, 354 patients with advanced lung cancer in the First and Second Affiliated Hospitals of Anhui Medical University were selected by convenience sampling. The general information questionnaire, the Experiences in Close Relationships Inventory, the Brief Illness Perception Questionnaire, the Herth Hope Index, and the Medical Coping Modes Questionnaire were used to conduct cross-sectional questionnaire survey. SPSS 25.0 software and Bootstrap method were used to construct and verify the chain mediation model. Results Finally, 336 patients with advanced lung cancer were included, including 214 males and 122 females, aged 27-79(59.43 ± 8.61) years old. Attachment avoidance score was (3.31 ± 1.01) points, attachment anxiety score was (3.86 ± 1.17) points, illness perception score was (40.07 ± 12.01) points, hope score was (34.05 ± 5.87) points, and face coping score was (18.75 ± 5.34) points in patients with advanced lung cancer. The avoidance coping score was (15.47 ± 1.97) points, and the yielding coping score was (9.62 ± 3.85) points. In patients with advanced lung cancer, attachment avoidance and attachment anxiety were positively correlated with yield coping (r=0.448, 0.747, both P<0.01), positively correlated with illness perception (r=0.356, 0.627, both P<0.01), and negatively correlated with hope (r=-0.406, -0.670, both P<0.01). Illness perception was positively correlated with yield coping (r=0.744, P<0.01), and negatively correlated with hope (r=-0.628, P<0.01). Hope was negatively correlated with yield response (r=-0.769, P<0.01). The mediation model showed that the chain mediating effect of attachment avoidance, illness perception, hope and yield coping was significant in patients with advanced lung cancer, with an effect value of 0.009 and an effect size of 13.95%. The chain mediating effect of attachment anxiety, illness perception, hope and yield coping were significant, with an effect value of 0.010 and an effect size of 8.27%. Conclusions Attachment can not only directly predict submission coping in advanced lung cancer patients, but also indirectly predict submission coping through the chain mediation of illness perception and hope.

    肺肿瘤癌症晚期依恋疾病感知希望应对方式

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    基于Kano模型的椎间孔镜手术患者手术室服务需求的研究

    孔娜杨岩岩张聚王静...
    449-456页
    查看更多>>摘要：目的 基于Kano模型对椎间孔镜手术患者手术室服务需求进行定性分析，计算各项需求的满意度影响力，为制订针对性改进策略提供依据。 方法 采用横断面研究方法，2022年1月至2023年6月便利抽样选取青岛大学附属医院510例椎间孔镜手术患者，从手术环境需求、信息知识需求、手术安全需求、手术护理质量需求及情感支持与心理需求5个维度编制Kano双因素问卷进行调查，确定需求属性归类，绘制椎间孔镜手术患者手术室服务需求重要度-满意度矩阵图。 结果 最终纳入472例椎间孔镜手术患者，男217例，女255例，年龄（57.78 ± 12.61）岁。椎间孔镜手术患者42项手术室服务需求中，魅力属性12项占28.57%，期望属性7项占16.67%，必备属性17项占40.48%，无差异属性6项占14.29%。重要度-满意度矩阵图显示，首优改进需求2项，中优改进需求2项，次优改进需求15项。 结论 Kano模型能够明确局部麻醉椎间孔镜手术患者需求属性及其对满意度影响力的大小，进而对需求的优先改进顺序进行有效引导，便于管理者科学、精准地提升手术患者满意度。 Objective To conduct a qualitative analysis of the operating room service demands of patients undergoing foraminal endoscopic surgery based on the Kano model, and the influence of satisfaction on each demand was calculated to provide a basis for the development of targeted improvement strategies. Methods A cross-sectional study method was adopted to select 510 patients from the Affiliated Hospital of Qingdao University with foraminal endoscopic surgery from January 2022 to June 2023 by convenient sampling method. Kano two-factor questionnaire was compiled from five dimensions of surgical environment needs, information and knowledge needs, surgical safety needs, surgical nursing quality needs, emotional support needs and psychological needs for investigation, and the attribute classification of needs was determined. The service demand importance-satisfaction matrix of patients undergoing foraminoscopic surgery was drawn. Results Finally, 472 patients were enrolled. with 217 males and 255 females, aged (57.78 ± 12.61) years old. Among the 42 operating room service needs of patients undergoing foraminal endoscopic surgery, 12 were attractive attributes (28.57%), 7 were expected attributes (16.67%), 17 were necessary attributes (40.48%), and 6 were indifferent attributes (14.29%). The importance-satisfaction matrix shows that there were 2 improvement needs for the first best, 2 improvement needs for the middle best and 15 improvement needs for the second best. Conclusions Kano model can clearly define the demand attributes of patients undergoing local anesthesia foraminal endoscopic surgery and the influence on their satisfaction, effectively guide the priority improvement sequence of demands, and facilitate managers to scientifically and accurately improve surgical patient satisfaction.

    手术室Kano模型椎间孔镜手术服务需求

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    中青年脑卒中患者配偶照顾者自我护理贡献与二元应对的相关性分析

    王冰冰侯睿马英芝孙小卫...
    457-463页
    查看更多>>摘要：目的 了解中青年脑卒中患者配偶照顾者自我护理贡献及二元应对水平，并探讨二者之间的关系，为提升配偶照顾者对中青年脑卒中患者自我护理贡献的质量提供参考。 方法 采取一般资料调查表、照顾者对脑卒中患者自我护理贡献量表、二元应对量表对2023年1—6月新疆维吾尔自治区人民医院200名中青年脑卒中患者配偶照顾者进行横断面调查。分析配偶照顾者自我护理贡献与二元应对的相关性，筛选影响配偶照顾者自我护理贡献的因素。 结果 最终纳入192名中青年脑卒中患者配偶照顾者，男70名，女122名，年龄18~59岁。中青年脑卒中患者配偶照顾者自我护理贡献总分为（75.43 ± 6.80）分，二元应对总分为（117.12 ± 9.59）分，两者呈正相关（r=0.691，P<0.05）。分层线性回归分析显示，控制一般资料的影响后，二元应对能解释中青年脑卒中患者配偶照顾者自我护理贡献28.4%的变异（P<0.05）。 结论 中青年脑卒中患者配偶照顾者二元应对水平可正向预测其对中青年脑卒中患者自我护理贡献的质量。医护人员应评估中青年脑卒中患者及配偶二元应对水平，针对性地开展二元干预措施，以提高配偶照顾者对中青年脑卒中患者自我护理贡献的质量。 Objective To investigate the self-care contribution and binary coping level of spouse caregivers for middle-aged and young stroke patients and explore the relationship between the two, in order to improve the quality of self-care contribution of spouse caregivers to middle-aged and young stroke patients. Methods A cross-sectional survey was conducted among 200 middle-aged and young stroke patients′ spouse caregivers in the People′s Hospital of Xinjiang Uygur Autonomous Region from January to June 2023 by the general data questionnaire, the Caregiver Contribution to Self-care of Stroke Patient Scale, the Dyadic Coping Inventory. The correlation between self-care contributions and binary coping strategies of spousal caregivers was analyzed, and the factors that affect their self-care contributions were screened. Results Finally, 192 middle-aged and young stroke patients′ spouse caregivers were included, including 70 males and 122 females, aged 18-59 years old. The total score of self-care contribution of spousal caregivers of middle-aged and young stroke patients was (75.43 ± 6.80) points, and the total score of binary coping was (117.12 ± 9.59) points, both of which were positively correlated (r=0.691, P<0.05). Hierarchical regression analysis showed that after controlling for the influence of general data, binary coping could explain 28.4% variation in the self-care contribution of spouse caregivers of middle-aged and young stroke patients (P<0.05). Conclusions The duality coping level positively predicts the quality of spouse caregivers′ self-care contribution to middle-aged and young stroke patients. Medical staff should assess the dual coping level of middle-aged and young stroke patients and their spouses, and carry out targeted dual intervention measures to improve the quality of caregivers' contribution to stroke patients′ self-care.

    配偶自我护理中青年脑卒中贡献二元应对

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    我国危重症与生命终末期患者预立医疗照护计划实施障碍因素的范围综述

    陈绪娜张立文乔敏梁海珍...
    464-471页
    查看更多>>摘要：目的 系统整合我国危重症与生命终末期患者实施预立医疗照护计划的障碍因素，为预立医疗照护计划在我国危重症与生命终末期患者中实施提供参考。 方法 检索中国知网、中国生物医学文献数据库、万方数据库、维普数据库、PubMed、Web of Science数据库中关于我国危重症与生命终末期患者预立医疗照护计划的文献，检索时限为建库至2023年1月15日。对符合纳排标准的文献进行分析。 结果 共纳入18篇文献，我国危重症与生命终末期患者预立医疗照护计划实施障碍因素包括社会文化因素（4种）、患者因素（4种）、家属因素（5种）、医护人员因素（8种）、人际交互因素（4种）、政策法律因素（2种）六大类（共27种）。 结论 预立医疗照护计划在我国危重症与生命终末期患者中的实施受多种障碍因素的影响，应针对可改变的障碍因素，制订改进措施，促进预立医疗照护计划在我国危重症与生命终末期患者中的应用。 Objective To explore the barrier factors in the implementation of advance care planning for critically ill and end-life patients in China. Provide reference for the implementation of advance care planning in critically ill and end-life patients in China. Methods The literature from CNKI, Chinese Biomedical Literature Database, Wanfang database, VIP, PubMed and Web of Science database on the implementation of advance care planning for critically ill and end-life patients in China were searched. The search deadline was from database establishment to January 15, 2023. To analyze the literature meeting the inclusion and exclusion criteria. Results A total of 18 literatures were included, and the barrier factors to the implementation of advance care planning for critically ill and end-life patients in China included six categories (27 types): social and cultural factors (4 types), patient factors (4 types), family factors (5 types), medical staff factors (8 types), interpersonal interaction factors (4 types), policy and legal factors (2 types). Conclusions The implementation of advance care planning for critically ill and end-life patients in China is affected by a variety of barrier factors. The improvement measures should be formulated according to the modifiable barrier factors to promote the implementation of advance medical care plan for critically ill and end-life patients in China.

    预立医疗危重症生命终末期障碍因素范围综述

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