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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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    二元疾病管理理论在卵巢癌化疗患者及其配偶中的应用研究

    张燕丽王霞游菁蔡慧媛...
    481-486页
    查看更多>>摘要：目的 探讨基于二元疾病管理理论的干预方案对卵巢癌化疗患者及其配偶二元应对、照护需求及患者疾病症状的影响，旨在为提升其疾病应对能力和生命质量提供参考。 方法 采用随机对照试验法，便利选取2022年7月至2023年6月在复旦大学附属妇产科医院接受规律化疗的72对卵巢癌患者及其配偶为研究对象，使用随机数字表法分为对照组（36对）和观察组（36对），对照组予常规护理干预，观察组在此基础上予基于二元疾病管理理论的干预方案。比较2组患者及其配偶在干预前（化疗前）、干预后（化疗周期结束后）的二元应对水平、照护需求及患者疾病症状方面的差异。应用SPSS 20.0软件进行分析，采用两独立样本t检验、χ2检验和Wilcoxon秩和检验对2组进行比较。 结果 最终纳入对照组36对，观察组34对，对照组患者年龄为（52.03 ± 9.44）岁，观察组患者年龄为（53.41 ± 10.14）岁。干预后，观察组患者和配偶的二元应对得分分别为（113.50 ± 8.03）、（114.62 ± 10.59）分，高于对照组的（106.64 ± 10.06）、（108.78 ± 10.89）分，差异均有统计学意义（t=-3.14、-2.27，均P<0.05）；干预后观察组患者和配偶的照护需求评分分别为（89.65 ± 8.29）、（95.12 ± 7.25）分，低于对照组的（100.25 ± 10.82）、（110.11 ± 7.58）分，差异均有统计学意义（t=4.58、8.45，均P<0.001）；干预后观察组患者的疾病症状总分为（20.09 ± 4.70）分，低于对照组的（31.53 ± 6.08）分，差异有统计学意义（t=8.77，P<0.001）。 结论 实施基于二元疾病管理理论的干预方案能够有效提升卵巢癌化疗患者及其配偶二元支持应对水平，满足其二元照护需求，缓解患者疾病症状，提高患者的生命质量。 Objective To explore the effects of an intervention strategy based on dyadic illness management theory on dyadic coping level, supportive care needs, and patients' disease symptoms with chemotherapy-stage ovarian cancer patients and their spouses, and to provide reference for improving their disease coping ability and quality of life. Methods This study used the method of randomized controlled trial. Seventy pairs of ovarian cancer patients and their spouses who received regular chemotherapy and their spouses from Obstetrics and Gynecology Hospital, Fudan University from July 2022 to June 2023 were selected using convenience sampling method. They were assigned to the control group (36 pairs) and the observation group (36 pairs) by the random number table method. Participants in the control group received routine nursing care and the observation group received the intervention strategy of dyadic illness management theory. Data were collected and compared the differences in dyadic coping levels, care needs, and disease symptoms between two groups of patients and their spouses before intervention (before chemotherapy) and after intervention (after the end of the chemotherapy cycle). SPSS 20.0 software was used for analysis, and t-tests, χ2 tests, and Wilcoxon rank sum tests were used to compare the two groups. Results Finally, 36 pairs were included in the control group and 34 pairs in the observation group. The age of the control group patients was (52.03 ± 9.44) years old, while that of the observation group patients was (53.41 ± 10.14) years old. After the intervention, the total score of dyadic coping level in the patients and their spouses of the observation group were (113.50 ± 8.03), (114.62 ± 10.59) points, respectively, which were higher than (106.64 ± 10.06), (108.78 ± 10.89) points of the control group with significant differences (t=-3.14, -2.27, both P<0.05) the total score of care needs in the patients and their spouses of the observation group were (89.65 ± 8.29), (95.12 ± 7.25) points, respectively, which were lower than (100.25 ± 10.82), (110.11 ± 7.58) points of the control group with significant differences (t=4.58, 8.45, both P<0.001) the total score of disease symptoms in the patients of the observation group was (20.09 ± 4.70) points, which was lower than (31.53 ± 6.08) points of the control group with significant differences (t=8.77, P<0.001). Conclusions The model of dyadic illness management can improve dyadic coping level and supportive care needs of chemotherapy-stage ovarian cancer patients and their spouses, and alleviate patients′ disease symptoms.

    卵巢肿瘤化疗二元疾病管理二元应对照护需求

      原文链接:
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    患者参与结合互联网+在老年住院患者跌倒预防管理策略中的应用探讨

    彭丽华曾满萍郭晓萍何炳文...
    487-494页
    查看更多>>摘要：目的 探讨患者参与结合互联网+在老年住院患者跌倒预防管理策略中的应用效果，并分析跌倒原因，为跌倒预防的持续改进提供依据。 方法 采用非同期前后对照研究，便利抽样法选取郴州市第一人民医院内科2020年6月1日至2021年5月31日住院的8 480例老年患者为对照组，2021年6月1日至2022年5月31日住院的8 662例老年患者为试验组。对照组采用常规跌倒预防措施，试验组在此基础上，根据患者参与框架"告知、参与、赋权、合作、电子化信息支持"5个阶段的内容制订并实施相应干预方案，并引入互联网+，比较2组患者的跌倒发生率、患者护理满意率。 结果 最终试验组纳入8 662例[男5 110例，女3 552例，年龄（73.96 ± 8.78）岁]，对照组纳入8 480例[男4 918例，女3 562例，年龄（74.11 ± 8.59）岁]。试验组患者跌倒事件发生率为0.092%（8/8 662），低于对照组的0.224%（19/8 480），差异有统计学意义（χ2=4.71，P<0.05），试验组患者护理满意率为98.880%（8 565/8 662），高于对照组的96.450%（8 179/8 480），差异有统计学意义（χ2=106.50，P<0.01）；对患者跌倒进行根本原因分析显示，卫生间蹲便器是应用干预方案后老年患者跌倒的重要隐患。 结论 患者参与结合互联网+的跌倒预防干预方案可以降低老年患者的跌倒发生率，提高患者护理满意率；患者跌倒的根本原因将不断变化，护理管理者应及时追踪，调整改进措施，并对基础设施在老年患者安全中的重要性予以重视。 Objective To explore the effectiveness of patient participation and Internet plus in fall prevention management strategies of elderly inpatients and analyze the causes of falls, so as to provide a basis for continuous improvement in fall prevention to investigate their continuous improvement. Methods A pre- and post-control study was conducted. Totally 8 480 elderly inpatients hospitalized in the Department of Internal Medicine from 1 June 2020 to 31 May 2021 in Chenzhou NO. 1 People′s Hospital were selected by convenient sampling as the control group, and 8 662 elderly inpatients hospitalized in the Department of Internal Medicine from 1 June 2021 to 31 May 2022 were in the experimental group. The routine fall prevention measures were used in the control group, and on this basis, the experimental group formulated and implemented fall prevention management strategies involving patients based on the patient participation framework "informing, participating, empowering, cooperating, and electronic information support" and introduced Internet plus. Then the differences between the two groups in terms of the incidence of falls and the satisfaction rate of nursing care were compared. Results The experimental group included 8 662 cases (5 110 males and 3 552 females) with (73.96 ± 8.78) years old, while the control group included 8 480 cases (4 918 males and 3 562 females) with (74.11 ± 8.59) years old. The incidence of falls in experimental group (0.092%, 8/8 662) was lower than that in control group (0.224%, 19/8 480), and the difference was statistically significant (χ 2=4.71, P<0.05) the nursing care satisfaction rate of experimental group (98.880%, 8 565/8 662) was higher than that of control group (96.450%, 8 179/8 480), and the difference also was statistically significant (χ 2=106.50, P<0.01) the analysis of the fall causes of the patients revealed that the toilet squatting commode was an important hidden risk of falls in elderly patients. Conclusions Fall prevention management strategies based on patient participation can reduce the incidence of falls in elderly patients and improve the satisfaction rate of nursing care. Patient participation introduced "Internet plus" can prevent patient falls. The root causes of patient falls will continue to change, and care managers should continually track real-time changes in the root causes of falls to identify problems, develop and adjust prevention strategies accordingly, and pay attention to the importance of infrastructure in the safety of older patients.

    老年人护理患者参与互联网+跌倒预防基础设施

      原文链接:
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    肠造口患者病耻感风险预测模型的构建与验证

    刘瑞金慧玉梁秀凤
    494-500页
    查看更多>>摘要：目的 调查肠造口患者病耻感危险因素，构建风险预测模型，为病耻感预防提供依据。 方法 本研究为前瞻性调查研究。采用便利抽样法，选取2022年3月至2023年7月中国人民解放军总医院第六医学中心造口门诊300例结直肠癌肠造口患者作为研究对象。通过单因素分析和Logistic回归探索病耻感危险因素，应用R 4.2.2软件构建列线图进行可视化展示，应用受试者操作特征曲线、Hosmer-Lemeshow检验、校准曲线检验模型预测性能。 结果 最终回收有效问卷284份，其中男161例，女123例；年龄20~40岁21例，41~60岁117例，60岁以上146例。284例患者病耻感发生率为69.37%（197/284）。造口排泄物情况（OR=0.63，95%CI 0.42~0.95）、配偶接受造口程度（OR=0.56，95%CI 0.34~0.94）、身体形象改变（OR=0.51，95%CI 0.28~0.91）、微信平台是否有效（OR=0.31，95%CI 0.13~0.78）、朋友支持水平（OR=0.34，95%CI 0.14~0.82）、正常饮食信心（OR=0.37，95%CI 0.19~0.71）6个危险因素构建预测模型并进行验证。建模组ROC曲线下面积为0.837，敏感度0.923，特异度0.649。验证组ROC曲线下面积为0.841，敏感度0.846，特异度0.740。 结论 该模型预测效果较好，可为医护人员快速识别肠造口患者病耻感发生风险，采取预防性管理措施提供借鉴。 Objective To explore the influencing factors of stigma and to construct a nomogram model for stigma perceptionin enterostomy patients. The basis for prevention of stigmatization in enterostomy patients. Methods This was a prospective survey. By convenient sampling, 300 with enterostomy patients from the stoma clinic of the Sixth Medical Center of PLA General Hospital from March 2022 to July 2023 were investigated. Univariate analysis and logistic regression were explored the risk factors of stigma.R 4.2.2 software was constructed a nomogram to achieve the visualization display. Using receiver operating characteristic curve, Hosmer-Leme show test and calibration curves tested model predictive performance. Results Totally 284 valid questionnaires were ultimately collected, including 161 males and 123 females. There were 21 cases aged 20-40, 117 cases aged 41-60, and 146 cases aged 60 and above. The incidence of stigma among 284 patients was 69.37% (197/284). Predictive model was constructed and validated based on six risk factors: fecal status (OR=0.63, 95%CI 0.42-0.95), level of accept from spouse (OR=0.56, 95%CI 0.34-0.94), body image change (OR=0.51, 95%CI 0.28-0.91), effectiveness of WeChat platform (OR=0.31, 95%CI 0.13-0.78), support from friends (OR=0.34, 95%CI 0.14-0.82), confidence diet (OR=0.37, 95%CI 0.19-0.71). The area under the ROC curve of the modeling group was 0.837, with a sensitivity of 0.923 and a specificity of 0.649. The area under the ROC curve of the validation group was 0.841, with a sensitivity of 0.846 and a specificity of 0.740. Conclusions This study had a good prediction effect in constructing a model. The model can provide reference for medical staff to quickly identify the risk of stigma and in a timely manner take preventive management measuresin enterostomy patients.

    肠造口术病耻感危险因素预测模型

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    食管癌术后患者自我管理积极度现状及影响因素分析

    刘思杜慧彭雪兰孙仲文...
    501-506页
    查看更多>>摘要：目的 了解食管癌术后患者自我管理积极度现状，并分析其影响因素。 方法 2022年8月至2023年9月，采用便利抽样法，选取中山大学肿瘤防治中心158例食管癌术后患者为研究对象，使用一般资料调查问卷、患者积极度量表、恐惧疾病进展简化量表、家庭关怀度指数量表进行横断面调查，采用多重线性回归分析食管癌术后患者自我管理积极度的影响因素。 结果 有效回收问卷144份，其中男106例，女38例，年龄18~39岁22例，40~59岁55例，≥60岁67例。食管癌术后患者积极度量表得分为（59.61 ± 16.07）分、恐惧疾病进展量表得分为（40.45 ± 9.76）分、家庭关怀度指数得分为（11.41 ± 2.36）分。多重线性回归分析结果显示，文化程度、恐惧疾病进展、家庭关怀度指数是食管癌术后患者自我管理积极度的影响因素（t=2.54、-13.49、2.45，均P<0.05）。 结论 食管癌术后患者自我管理积极度总体有待提高，临床护理工作者应密切关注食管癌术后患者自我管理积极度现状，制订系统、科学、有效的自我管理积极度干预策略。 Objective To understand the current status of self-management positivity of postoperative patients with esophageal cancer and to analyze its influencing factors. Methods From August 2022 to September 2023, 158 postoperative patients with esophageal cancer at Sun Yat-sen University Cancer Prevention and Control Center were selected by convenience sampling method, and were investigated using a general information questionnaire, Patient Activation Measure (PAM), Fear of Progression Questionnaire Short Form (FOP-Q-SF), and Family APGAR Index (IAPGAR) for a cross-sectional survey, and multiple linear regression was used to analyze the influencing factors of the self-management positivity in patients with postoperative esophageal cancer. Results Totally 144 questionnaires were effectively collected, of which 106 males and 38 females, with 22 cases aged 18-39 years old, 55 cases aged 40-59 years old, and 67 cases aged ≥ 60 years old. Totally 144 patients scored (59.61 ± 16.07) points on the PAM, (40.45 ± 9.76) on the FOP-Q-SF, and (11.41 ± 2.36) on the IAPGAR, and the results of the multiple linear regression analysis showed that the literacy level, fear of disease progression, and family caring index were the influencing factors of the positivity of the patients′ self-management after the surgery of esophageal cancer (t=2.54, -13.49, 2.45, all P<0.05). Conclusions There is always room for improvement in the degree of active self-management of postoperative patients with esophageal cancer. Clinical care workers should pay close attention to the current status of self-management positivity of postoperative patients with esophageal cancer, and formulate a systematic, scientific, and effective intervention strategy for self-management positivity.

    食管肿瘤自我管理恐惧疾病进展家庭关怀影响因素

      原文链接:
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    预防静脉-动脉体外膜肺氧合患者相关下肢缺血并发症的证据总结

    滕建琳戴伟英林瑶杨湘英...
    507-513页
    查看更多>>摘要：目的 检索、评价和整合预防静脉-动脉体外膜肺氧合（VA-ECMO）患者相关下肢缺血并发症的相关证据，为制订科学完整的下肢缺血并发症预防及管理方案提供参考。 方法 采用循证方法学，检索中国知网、万方数据库、PubMed、Cochrane Library等国内外数据库以及相关专业网站中关于VA-ECMO患者相关下肢缺血并发症的临床决策、指南、专家共识、证据总结、系统评价、随机对照试验和类实验研究，文献检索时限为建库至2023年8月，由2名研究者独立进行文献质量评价后，根据主题对证据进行提取与汇总。 结果 初步检索共获得文章27 004篇，经筛选后最终纳入11篇文献，包括1篇指南、2篇专家共识、2篇系统评价、6篇原始研究。通过文献阅读、证据提取归类和专家小组会议，共总结出24条最佳证据，包括团队培训及管理、VA-ECMO上机前评估、VA-ECMO置管的选择、下肢缺血的监护管理4个方面。 结论 该研究总结了预防VA-ECMO患者相关下肢缺血并发症的最佳证据，可为医护人员开展临床实践提供参考。医护人员应结合临床情境、患者意愿，审慎地选择并应用证据，从而保障VA-ECMO治疗安全，降低相关并发症的发生率。 Objective To retrieve, evaluate and integrate the relevant evidence of prevention of lower limb ischemic complications in venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients, and provide reference for the development of scientific and complete prevention and management of lower limb ischemic complications. Methods According to the evidence-based methodology, clinical decisions, guidelines, expert consensus, evidence summary, systematic review, randomized controlled trials and experimental studies related to lower limb ischemia complications in VA-ECMO patients were searched from CNKI, Wanfang, PubMed, Cochrane Library and other domestic and foreign databases as well as relevant professional websites. The literature search period was from the establishment of the database to August 2023. Two researchers independently evaluated the literature quality, and then extracted and summarized the evidence according to the theme. Results A total of 27 004 articles were obtained in the preliminary search, and 11 articles were finally included after screening, including 1 guide, 2 expert consensus, 2 systematic reviews and 6 original studies. Through literature reading, evidence extraction and classification, and expert group meetings, a total of 24 best evidences were concluded in four dimensions, including team training and management, VA-ECMO pre-computer evaluation, VA-ECMO catheter selection, and the monitoring and management of lower limb ischemia. Conclusions This study summarized the best evidence for the prevention of lower limb ischemia complications associated with VA-ECMO patients, and can provide reference for healthcare providers in clinical practice. In order to ensure the safety of VA-ECMO treatment and reduce the incidence of related complications, healthcare professionals should carefully select and apply evidence according to the clinical context and patients′ wishes.

    循证医学体外膜肺氧合下肢缺血

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    下肢动脉硬化闭塞症患者出院准备度现状及影响因素分析

    史文鲍丽丽杨乐梁秀凤...
    514-519页
    查看更多>>摘要：目的 探讨下肢动脉硬化闭塞症患者出院准备度潜在类别，并分析其影响因素，为下肢动脉硬化闭塞症患者出院准备度个体化管理提供理论依据。 方法 采用便利抽样法，于2022年2—12月采用一般资料调查表、出院指导质量量表、家庭关怀度指数问卷对在山东第一医科大学附属省立医院血管外科接受外科治疗的下肢动脉硬化闭塞症患者194例进行横断面调查。采用潜在剖面分析识别不同类别，用Logistic回归分析探讨其影响因素。 结果 回收有效问卷182份。182例研究对象中男127例，女55例，>60岁患者居多，占81.9%（149/182）。本研究识别出3个潜在剖面模型，分别为低出院准备度组（27.47%）、中等出院准备度—高预期支持组（41.21%）、高出院准备度组（31.31%）；Logistic回归分析表明，首次住院（OR=19.218，95% CI 2.949~125.237）、出院指导质量（OR=0.896，95% CI 0.857~0.937）是中等出院准备度-高预期支持组的预测因素（均P<0.05）；家庭功能（OR=0.185，95% CI 0.097~0.353）、出院指导质量（OR=0.823，95% CI 0.764~0.888）是下肢动脉硬化闭塞症患者低出院准备度组的预测因素（均P<0.05）。 结论 下肢动脉硬化闭塞症患者出院准备度存在不同类别，出院指导质量低、家庭功能差的患者更有可能出现低出院准备度趋势；出院指导质量低、首次住院的患者更有可能出现中等出院准备度-高预期支持趋势。对该类患者，医务人员应采取相应的措施，提高其出院准备度。 Objective To explore the latent profile of discharge readiness of patients with lower extremity arteriosclerosis obliterans and analyze its influencing factors, so as to provide theoretical basis for individualized management of discharge readiness in patients with lower limb arteriosclerosis obliterans. Methods From February 2022 to December 2022, 194 patients with arteriosclerosis obliterans of lower limbs who received surgical treatment in the vascular surgery department of Shandong Provincial Hospital Affiliated to Shandong First Medical University were investigated by using general information questionnaire, Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale and Family APGAR Index for a cross-sectional survey. Latent profile analysis was used to identify different categories, and Logistic regression analysis was used to explore its influencing factors. Results Totally 182 valid questionnaires were collected, of which 127 males and 55 females, and patients over 60 years old were the majority, accounting for 81.9%. Three latent profile models were identified in this study, namely, low discharge readiness group (27.47%), medium discharge readiness-high expected support group (41.21%) and high discharge readiness group (31.31%). Logistic regression analysis showed that first hospitalization (OR=19.218, 95% CI 2.949-125.237), the quality of discharge guidance (OR=0.896, 95% CI 0.857-0.937) were the predictive factors of medium discharge readiness-high expected support group (P<0.05) family function (OR=0.185, 95% CI 0.097-0.353) and the quality of discharge guidance (OR=0.823, 95% CI 0.764-0.888) were the predictive factors of the low discharge readiness group of patients with arteriosclerosis obliterans (all P<0.05). Conclusions There are different types of discharge readiness of patients with arteriosclerosis obliterans, and patients with poor quality of discharge guidance and poor family function are more likely to have a trend of low discharge readiness. Patients with low quality discharge guidance and first hospitalization are more likely to have a trend of moderate discharge readiness-high expected support. For this kind of patients, medical staff should take corresponding measures to improve their readiness for discharge.

    闭塞性动脉硬化出院准备度潜在剖面分析

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    基于机器学习的宫颈癌根治术后尿潴留风险预测模型构建

    张惠欧阳艳琼黄秀华梁秀凤...
    520-526页
    查看更多>>摘要：目的 基于机器学习构建宫颈癌根治术患者尿潴留风险预测模型，并进行内部验证评价模型的预测效果，以期为宫颈癌根治术患者尿潴留的早期防治提供参考。 方法 便利抽样法选取2017年6月至2022年2月在安徽医科大学第一附属医院内实施宫颈癌根治手术的981例患者，按7∶3的比例分为训练集（687例）和测试集（294例）。通过文献回顾和危险因素分析，探索宫颈癌根治术后发生尿潴留的影响因素，采用机器学习中XGBoost、随机森林、支持向量机和决策树4种方法构建尿潴留风险预测模型。采用十折交叉验证的方式计算4种机器学习算法的精确率、召回率、F1值和AUC，筛选出预测效能最高的模型。 结果 纳入的981例患者中，宫颈癌根治术后尿潴留发生率为18.86%（185/981），尿潴留组中位年龄为51岁，非尿潴留组为50岁。将单因素分析中有统计学意义的变量和文献回顾总结的影响因素进行特征提取，纳入患者年龄、术中出血量、BMI、癌症分期、手术方式、手术切除范围、是否行盆腔淋巴结清扫术、合并症和残余尿的情况。在机器学习的4种模型构建方法中，随机森林模型效果最好，其训练集F1值为0.94，测试集F1值为0.77，绘制ROC并计算AUC为0.73。年龄、术中出血量、BMI、癌症分期、手术方式等指标对随机森林模型分类贡献较高。 结论 基于随机森林方法建立宫颈癌根治术后尿潴留风险预测模型效能最佳，该模型有助于护理工作人员评估患者发生尿潴留的风险，进而采取有针对性的护理干预积极预防术后尿潴留。 Objective To construct a risk prediction model for urinary retention in patients undergoing radical cervical cancer surgery based on machine learning, and the prediction effect of the model was internally verified and evaluated, in order to provide reference for the early prevention and treatment of urinary retention in patients undergoing radical cervical cancer surgery. Methods A total of 981 patients who underwent radical cervical cancer surgery in the First Affiliated Hospital of Anhui Medical University from June 2017 to February 2022 were selected and divided into the training set (687 cases) and the test set (294 cases) according to a ratio of 7∶3. Through literature review and risk factor analysis, the influencing factors of urinary retention after radical treatment of cervical cancer were explored, and the risk prediction model of urinary retention was constructed by using XGBoost, random forest, support vector machine and decision tree in machine learning. The accuracy rate, recall rate, F1 value and AUC of four machine learning algorithms were calculated by using the method of 10-fold cross-validation, and the model with the highest predictive efficiency was selected. Results Among the 981 patients included, the incidence of urinary retention after radical cervical cancer surgery was 18.86% (185/981). The median age of urinary retention group was 51 years old, and that of non urinary retention group was 50 years old. Statistically significant variables in the univariate analysis and influencing factors summarized by literature review were featured, including patient age, intraoperative blood loss, body mass index (BMI), cancer stage, surgical method, surgical resection scope, whether pelvic lymph node dissection was performed, comorbidities and residual urine. Among the four model building methods of machine learning, the random forest model has the best effect, its training set F1 value was 0.94, the test set F1 value was 0.77, the ROC was plotted and the AUC was calculated to be 0.73. Age, intraoperative blood loss, BMI, cancer stage and surgical method contributed significantly to the classification of random forest model. Conclusions The prediction model of urinary retention risk after radical cervical cancer surgery based on random forest method has the best efficacy. It is useful to help nursing personnel evaluate the risk of the uroschesis for a patient and then take targeted nursing interventions to actively prevent postoperative urinary retention.

    尿潴留机器学习模型构建风险预测宫颈癌根治术

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    超重或肥胖乳腺癌患者化疗期间体质量管理体验的质性研究

    辛向华杨佩晶孙巧梅梁秀凤...
    527-532页
    查看更多>>摘要：目的 了解超重或肥胖乳腺癌患者化疗期间体质量管理体验，为制订针对性护理干预措施提供参考。 方法 采用质性研究中的现象学研究方法，采用目的抽样法，于2023年3—5月选择山东第一医科大学附属省立医院和山东第一医科大学第一附属医院乳腺外科化疗期间10例超重或肥胖乳腺癌患者进行半结构式访谈。运用Colaizzi 7步分析法对资料进行整理分析，提炼主题。 结果 10例超重或肥胖乳腺癌患者平均年龄为43.2岁。提炼出3个主题8个亚主题，分别为：体质量管理动力不足（认知不足、内驱力不足、激励不足）、体质量管理困扰体验（疾病不确定感、化疗期症状困扰、无法识别信息的正确性）、体质量管理调控与支持（掌握正确的体质量调控方法、各方面支持）。 结论 乳腺癌肥胖患者化疗期间体质量管理动力不足、困扰较多，医护人员可以从明晰体质量管理的重要意义、提供针对性的信息支持、建立良好的社会支持系统以及提供有效的体质量管理指导等方面采取有效措施，以提高乳腺癌肥胖患者化疗期间体质量管理的有效性。 Objective To investigate the experience of body quality management in overweight or obese patients with breast cancer during chemotherapy, and to provide reference for formulating targeted nursing interventions. Methods This study was a phenomenological study of qualitative research. Objective selected 10 obese patients with breast cancer from breast surgery of Provincial Hospital Affiliated to Shandong First Medical University and the First Affiliated Hospital of Shandong First Medical University to conduct semi-structured interviews during chemotherapy from March to May 2023. Colaizzi 7-step analysis method was used to sort out and analyze the data and extract the theme. Results The average age of 10 overweight or obese breast cancer patients was 43.2 years. Three themes and eight subthemes were extracted, including insufficient motivation of body quality management (insufficient cognition, insufficient drive, insufficient motivation), disturbing experience of body quality management (uncertainty of disease, symptom distress during chemotherapy, inability to identify the correctness of information), regulation and support of body quality management (mastering correct methods of body quality regulation and support in all aspects). Conclusions The motivation of body quality management in overweight or obese patients with breast cancer during chemotherapy is insufficient and there are many problems. Medical staff can take effective measures from clarifying the significance of body quality management, providing targeted information support, establishing a good social support system and providing effective body quality management guidance, so as to improve the effectiveness of body quality management in obese patients with breast cancer during chemotherapy.

    乳腺肿瘤定性研究超重肥胖化疗体质量管理

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    中青年经皮冠状动脉介入治疗术后患者饮食行为改变影响因素的质性研究

    李跃丽赵霞刘马超岳鹏...
    532-539页
    查看更多>>摘要：目的 从家庭系统的视角探讨中青年经皮冠状动脉介入治疗（PCI）术后患者饮食行为改变的影响因素，为患者的居家饮食干预提供依据。 方法 采用现象学研究方法，通过目的性抽样法于2022年5—10月对首都医科大学宣武医院心脏内科32例中青年PCI患者及其家属进行半结构式深入访谈，运用Colaizzi 7步分析法分析资料。 结果 32例被访谈者中，男17例，女15例，年龄为22~61岁。提炼出中青年PCI术后患者饮食行为改变促进因素和障碍因素2个主题。促进因素包含6个子主题：行为自主性、适应性改变、小型家庭规模、家庭责任动机、家庭内部资源和家庭外部资源；障碍因素因素包含5个子主题：习得性不良习惯、特殊体质状况、营养素养缺乏、饮食环境被动和经济水平受限。 结论 中青年PCI患者术后的饮食行为改变受家庭内个体和家庭因素影响，医护人员应建立以家庭为中心的饮食管理模式，整合家庭资源的优势，给予患者有针对性的个体化营养干预。 Objective To explore the influencing factors of dietary behavior change of young and middle-aged patients after percutaneous coronary intervention (PCI) from the perspective of the family system, so as to provide the basis for home dietary intervention of patients. Methods Using the phenomenological research method, 32 young and middle-aged PCI patients and their family members from Department of Cardiology, Xuanwu Hospital, Capital Medical University were interviewed in a semi-structured in-depth way by purposive sampling method from May to October 2022, and the data were analyzed by Colaizzi 7-step analysis method. Results Among the 32 surveyed individuals, there were 17 males and 15 females, aged 22-61 years old. Two themes of dietary behavior change facilitators and barriers of young and middle-aged patients after PCI were extracted. The facilitators included six subthemes: behavioral autonomy, adaptive change, small family size, motivation for family responsibility, internal family resources, and external family resources. The barriers included five subthemes: bad learned habits, special physical conditions, lack of nutritional literacy, passive dietary environment, and limited economic level. Conclusions Dietary behavior changes in young and middle-aged patients after PCI were affected by individual and family factors in the family. Medical staff should establish a family-centered dietary management model and integrate the advantages of family resources to give patients targeted individualized nutrition intervention.

    定性研究中青年经皮冠状动脉介入治疗饮食行为家庭系统

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    社区老年糖尿病患者电子健康素养潜在剖面分析与体力活动水平的关系

    李红玉张金梅文喆卿赵琼...
    540-547页
    查看更多>>摘要：目的 了解社区老年糖尿病患者电子健康素养的潜在类别，分析各类别与体力活动水平之间的关系，以期为制订提高老年糖尿病患者电子健康素养的干预措施提供理论依据。 方法 本研究为横断面调查，采用方便抽样法于2023年1—6月选取山西省汾阳市3个社区卫生服务中心的老年糖尿病患者为研究对象，采用一般资料调查表、电子健康素养量表及国际体力活动问卷对其进行调查。采用Mplus 8.0进行潜在剖面分析，SPSS 26.0软件比较不同类别电子健康素养在体力活动水平上的差异。 结果 248例社区老年糖尿病患者年龄为60~88（63.8 ± 6.4）岁，男135例（54.4%），女113例（45.6%），电子健康素养得分（17.70 ± 5.30）分，可分为3个潜在类别，分别为普遍低素养组占56.0%（139/248）、高评判能力-中素养组占18.2%（45/248）和高获取能力-高素养组占25.8%（64/248）。3个潜在类别体力活动水平分别为（1 464.74 ± 190.37）、（2 094.40 ± 139.70）、（2 368.44 ± 157.27）代谢当量-min/周，差异有统计学意义（F=118.83，P<0.001）。 结论 社区老年糖尿病患者电子健康素养可分为3个潜在类别，不同电子健康素养类别的患者体力活动水平存在差异，建议基于老年糖尿病患者电子健康素养同质群体，有针对性地进行干预，以期改善其体力活动水平。 Objective To understand the potential categories of e-health literacy of elderly diabetic patients in community, and analyze the relationship between each category and physical activity level, in order to provide theoretical basis for formulating intervention measures to improve e-health literacy of elderly diabetic patients. Methods This study was across-sectional survey. Elderly diabetic patients from 3 community health service centers in Fenyang City, Shanxi Province were selected by convenient sampling method from January to June 2023. General data questionnaire, e-Health Literacy Scale and International Physical Activity Questionnaire were used to investigate the elderly diabetic patients. Mplus8.0 was used for potential profile analysis, and SPSS 26.0 software was used to compare the differences in physical activity levels among different categories of e-health literacy. Results Totally 248 elderly diabetes patients in the community aged 60-88 (63.8 ± 6.4) years, 135 males (54.4%) and 113 females (45.6%). The e-health literacy scores of 248 elderly diabetic patients in community were (17.70 ± 5.30), which could be divided into three potential categories: general low literacy group (56.0%, 139/248), high evaluation ability-medium literacy group (18.2%, 45/248) and high access ability-high literacy group (25.8%, 64/248). Three potential categories of physical activity levels were (1 464.74 ± 190.37), (2 094.40 ± 139.70), (2 368.44 ± 157.27) metabolic equivalent-min per week, and the difference was statistically significant (F=118.83, P<0.001). Conclusions The e-health literacy of elderly diabetic patients in community can be divided into three potential categories, and the physical activity level of patients with different e-health literacy categories is different. It is suggested that targeted intervention should be conducted based on the homogenous group of elderly diabetic patients with e-health literacy to improve their physical activity level.

    糖尿病电子健康素养潜在剖面分析体力活动

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