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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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    体外受精-胚胎移植女性患者非理性生育认知与生育生命质量的关系研究：心理弹性的中介效应

    徐丽丹鄢雨英杨丽松
    561-567页
    查看更多>>摘要：目的 探讨体外受精-胚胎移植（IVF-ET）女性患者心理弹性与非理性生育认知及生育生命质量的关系，并分析心理弹性在患者非理性生育认知与生育生命质量间的中介效应，为不孕症患者提升其心理弹性和生育生命质量提供指导。 方法 采用横断面调查研究方法，便利抽样选取2022年10月至2023年4月就诊于浙江大学医学院附属妇产科医院的460例IVF-ET女性患者作为调查对象。采用一般资料调查表、心理弹性量表、非理性生育认知问卷、生育生命质量量表对其进行问卷调查。 结果 共回收449份有效问卷。患者年龄（33.31 ± 4.99）岁。非理性生育认知总分为（38.73 ± 9.31）分，心理弹性总分为（63.19 ± 15.40）分，生育生命质量总分为（68.18 ± 11.89）分；IVF-ET女性患者非理性生育认知总分与生育生命质量总分呈负相关（r = - 0.513，P<0.01），心理弹性总分与生育生命质量总分呈正相关（r = 0.424，P<0.01）；心理弹性在非理性生育认知和生育生命质量间起部分中介作用，中介效应占总效应的28.01%。 结论 IVF-ET女性患者非理性生育认知处于中等水平，心理弹性和生育生命质量处于较低水平，非理性生育认知对患者的生育生命质量起直接负向预测作用，而心理弹性是生育生命质量的正向预测因子，非理性生育认知可直接或通过心理弹性间接对患者生育生命质量产生影响，临床医护人员应采取有效措施降低患者非理性生育认知水平，并提高其心理弹性，从而改善患者的生育生命质量。 Objective To investigate the relationship between psychologicalresilience and irrational parenthood cognition and fertility life quality in female patients with in vitro fertilization-embryo transfer, and to analyze the mediating effect of psychological resilience on irrational parenthood cognition and fertility life quality, so as to provide guidance for infertility patients to improve their psychological resilience and fertility life quality. Methods A cross-sectional study method was used to conveniently sample 460 female patients with in vitro fertilization-embryo transfer who were admitted to the Women′s Hospital, School of Medicine Zhejiang University from October 2022 to April 2023.General data questionnaire, Connor-Davidson Resilience Scale, Irrational Parenthood Cognitions Questionnaire and the Fertility Quality of Life were used for investigation. Results A total of 449 valid questionnaires were retrieved. Patients aged (33.31 ± 4.99) years old. The total scores of irrational parenthood cognition, psychological resilience and the fertility quality of life were (38.73 ± 9.31), (63.19 ± 15.40) and (68.18 ± 11.89) points respectively for female patients with IVF-ET. The total score of irrational parenthood cognition was negatively correlated with the total score of fertility quality of life (r = - 0.513, P<0.01), and the total score of psychological resilience was positively correlated with the total score of fertility quality of life (r = 0.424, P<0.01). Pychological resilience played a partial mediating role between irrational parenthood cognition and fertility life quality, with the mediating effect accounting for 28.01% of the total effect. Conclusions The irrational parenthood cognition of female patients with IVF-ET is at a medium level, and the psychological resilience and the fertility quality of life are at a low level. The irrational parenthood cognition has a direct negative predictive effect on the fertility life quality of patients, while the psychological resilience is a positive predictor of fertility life quality. Irrational parenthood cognition can directly or indirectly affect patients′ fertility life quality through psychological resilience. Clinical medical staff should take effective measures to reduce patients′ irrational parenthood cognition level and improve their psychological resilience, so as to improve patients′ fertility life quality.

    胚胎移植体外受精心理弹性非理性生育认知生育生活质量中介效应

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    基于健康服务领域研究成果应用的整合性行动促进框架预防无创机械通气患者面部压力性损伤的循证实践

    王霞王海妍宋葵王雪莲...
    568-575页
    查看更多>>摘要：目的 以健康服务领域研究成果应用的整合性行动促进（i-PARIHS）框架为指导，将无创机械通气患者面部压力性损伤预防最佳证据应用于临床，并评价其效果。 方法 采用非同期前后对照研究。采用便利抽样法，选取2019年10月至2021年9月北京医院7个病区进行无创机械通气的患者作为研究对象，将2019年10月至2020年9月收治的575例患者纳入对照组，2020年10月至2021年9月收治的602例患者纳入干预组，对照组采用常规护理措施，干预组应用无创机械通气相关面部压力性损伤预防方案，比较2组压力性损伤发生率以及严重程度；分别在实施干预方案前后对7个病区的护士进行调查，比较方案应用前后护士面部压力性损伤知识水平的变化情况。 结果 对照组患者男354例，女221例，年龄（77.13 ± 14.49）岁；干预组患者男392例，女210例，年龄（75.60 ± 14.27）岁。干预组患者面部压力性损伤的发生率与对照组比较差异无统计学意义（P>0.05）。对照组患者2期及以上面部压力性损伤共计11例，其中2期5例、3期及以上6例；干预组面部压力性损伤共计9例，其中2期8例、3期及以上1例，干预组压力性损伤的严重程度低于对照组，差异均有统计学意义（χ2 = 3.83、4.11，均P<0.05）。护士压力性损伤知识评分由实施前的（6.77 ± 1.53）分提高至实施后的（7.15 ± 1.47）分，差异有统计学意义（t = - 2.31，P<0.05）。 结论 通过循证实践对无创机械通气患者面部压力性损伤的预防进行管理，对降低压力性损伤发生率及其严重程度有积极影响，有利于提高临床护士对于无创机械通气患者面部压力性损伤的预防知识及临床实践水平。 Objective To use the best evidence of noninvasive mechanical ventilation related pressure injury prevention in the clinic guided by integrated promoting action on research implementation in health services framework (i-PARIHS) and evaluate its effect. Methods This study is an unsynchronized before and after control study. Convenience sampling method was used to select patients receiving non-invasive mechanical ventilation from 7 wards of Beijing Hospital from October 2019 to September 2021. A total of 575 patients receiving non-invasive mechanical ventilation from October 2019 to September 2020 were included in the control group and 602 patients from October 2020 to September 2021 were included in the trial group. The control group adopted the usual care measures, and the trial group applied the prevention program for noninvasive ventilation related facial pressure injuries. The incidence of pressure injury was compared between the two groups. Nurses in 7 wards were investigated before and after the intervention program to compare the changes of knowledge level. Results In the control group, there were 354 males, 221 females, aged (77.13 ± 14.49) years old in the trial group there were 392 males, 210 females, aged (75.60 ± 14.27) years old. The incidence of pressure injury in the trial group was lower than the control group, but showed no significant difference (P>0.05). In the control group, 11 cases suffered pressure injury, including 5 cases in stage 2, 6 cases in stage 3 and above. There were 9 cases in the trial group, including 8 in stage 2 and 1 in stage 3 and above. The severity of pressure injury in the trial group was lower than that in the control group, and the difference was significant (χ2 = 3.83, 4.11, both P<0.05). The scores of the nurse′pressure injury knowledge increased from (6.77 ± 1.53) points to (7.15 ± 1.47) points, with a significant difference (t = -2.31, P<0.05). Conclusions Management of the prevention of noninvasive mechanical ventilation related facial pressure injury through evidence-based practice can reduce its incidence, reduce its severity, and it is beneficial to improve the clinical nurses' prevention knowledge and clinical practice level of facial pressure injury related to non-invasive mechanical ventilation.

    通气机,机械压力性溃疡循证实践预防i-PARIHS

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    舒适护理模式干预在晚期癌症患者居家安宁疗护中的应用

    潘春艳吴莹莹纪红梅刘丽秀...
    575-582页
    查看更多>>摘要：目的 探讨舒适护理模式干预在晚期癌症患者居家安宁疗护中的应用效果，为晚期癌症患者居家安宁疗护提供参考。 方法 采用随机对照试验，便利抽样法选取2023年1—2月在哈尔滨医科大学附属肿瘤医院接受治疗的112例晚期癌症患者为研究对象，按照随机数字表法将其分为对照组和干预组各56例。对照组采用常规护理，干预组在此基础上给予舒适护理模式干预，共干预4周。比较2组干预前后姑息照护结局、生命质量及死亡焦虑情况变化。 结果 最终纳入研究对象105例，对照组53例，干预组52例。对照组男25例，女28例，年龄（58.96 ± 10.71）岁；干预组男22例，女30例，年龄（59.82 ± 10.53）岁。干预前，2组患者姑息照护结局、生命质量、癌症死亡焦虑得分比较差异均无统计学意义（均P>0.05）。干预后，干预组姑息照护结局总分（13.34 ± 5.88）分，显著低于对照组的（16.15 ± 5.72）分，差异有统计学意义（t = 2.48，P<0.05）；生命质量总体健康状况得分（68.55 ± 9.34）分，高于对照组的（63.01 ± 9.28）分，差异有统计学意义（t = 3.05，P<0.05）；癌症死亡焦虑总分（8.85 ± 2.72）分，低于对照组的（10.59 ± 3.14）分，差异有统计学意义（t = 3.04，P<0.05）。 结论 舒适护理模式应用于居家安宁疗护中可以改善晚期癌症患者安宁疗护质量，降低其死亡焦虑水平，对提高晚期癌症患者生命质量具有重要意义。 Objective To explore the effect of comfort nursing intervention in hospice care for advanced cancer patients at home, and to provide reference for hospice care for advanced cancer patients at home. Methods A randomized controlled trial was conducted. A total of 105 patients with advanced cancer who were treated in the Cancer Hospital Affiliated to Harbin Medical University from January to February 2023 were selected as the research objects. According to the random number table, they were divided into control group of 53 cases and intervention group of 52 cases. The control group received routine nursing methods, while the intervention group received comfort nursing interventions on this basis. The intervention lasted for 4 weeks. The changes in palliative care outcomes, quality of life and death anxiety were compared between the two groups before and after intervention. Results Totally 105 cases were included, 53 cases in the control group and 52 cases in the intervention group. In the control group, there were 25 males, 28 females, aged (58.96 ± 10.71) years old in the intervention group, there were 22 males, 30 females, aged (59.82 ± 10.53) years old. Before intervention, there was no statistically significant difference in palliative care outcomes, quality of life and cancer death anxiety scores between the two groups of patients (all P>0.05). After intervention, the total score of palliative care outcomes in the intervention group was (13.34 ± 5.88) points, significantly lower than (16.15 ± 5.72) points in the control group, with a statistically significant difference (t = 2.48, P<0.05). The overall health status score of quality of life was (68.55 ± 9.34) points in the intervention group, higher than (63.01 ± 9.28) points in the control group (t = 3.05, P<0.05). The total score of cancer death anxiety was (8.85 ± 2.72) points, significantly lower than (10.59 ± 3.14) points of the control group, with a statistically significant difference (t = 3.04, P<0.05). Conclusions The application of comfort nursing mode in home based hospice care can improve the quality of hospice care for advanced cancer patients, reduce their level of death anxiety, and is of great significance for improving the quality of life of advanced cancer patients.

    护理舒适护理模式居家安宁疗护晚期癌症

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    恶性肿瘤患者失志和生命质量现状：反刍思维的中介作用

    徐永荣杨丽麻玲霞黄遐...
    583-588页
    查看更多>>摘要：目的 探讨反刍思维在恶性肿瘤患者失志综合征与生命质量中的中介作用，为帮助肿瘤患者克服反刍思维、摆脱失志综合征并提高生命质量提供指导借鉴。 方法 2020年2月至2022年6月采用便利抽样法选取广西医科大学第一附属医院肿瘤内科收治的189例恶性肿瘤患者为研究对象，使用一般资料调查表、中文版失志量表、反刍思维量表、癌症患者生命质量测定量表进行横断面问卷调查。 结果 189例恶性肿瘤患者中，男102例，女87例，年龄（43.54 ± 13.12）岁。患者失志总分为（34.37 ± 10.34）分，反刍思维总分为（41.01 ± 17.10）分，生命质量总分（48.51 ± 15.41）分。Pearson分析结果显示，恶性肿瘤患者失志总分与生命质量总分呈负相关（r = - 0.502，P<0.01），反刍思维总分与生命质量总分呈负相关（r = - 0.465，P<0.01），失志总分与反刍思维总分呈正相关（r = 0.628，P<0.01）。Bootstrap中介检验结果显示，反刍思维在恶性肿瘤患者失志和生命质量之间起部分中介效应，中介效应占总效应的30.9%。 结论 反刍思维在恶性肿瘤患者失志和生命质量之间起到部分中介作用，提示临床医务人员可以通过制订系统完善的认知行为干预策略以改善肿瘤患者失志综合征和反刍思维，从而提高其生命质量。 Objective To explore the mediating role of rumination thinking between demoralization and quality of life in malignant tumor patients, provide guidance and reference for helping tumor patients overcome rumination thinking and demoralization and improve quality of life. Methods From February 2020 to June 2022, 189 patients with malignant tumors admitted to the Department of Oncology of the First Affiliated Hospital of Guangxi Medical University were selected by convenience sampling method as the research objects, and a cross-sectional survey was conducted using general information questionnaire, Demoralization Scale-Mandarin Version, Ruminative Responses Scale, Punctional Assessment of Cancer Therapy-General. Results Among 189 malignant tumor patients, there were 102 males, 87 females, aged (43.54 ± 13.12) years old. The total score of loss of demoralization was (34.37 ± 10.34) points, the total score of rumination thinking was (41.01 ± 17.10) points, the total score of quality of life was (48.51 ± 15.41) points. The Pearson analysis results showed that the total score of demoralization in malignant tumor patients was negatively correlated with the total score of quality of life (r = -0.502, P<0.01) the total score of rumination thinking was negatively correlated with the total score of quality of life (r = -0.465, P<0.01), and the total score of demoralization was positively correlated with the total score of rumination thinking (r = 0.628, P<0.01). Bootstrap mediation test results showed that ruminant thinking played a partial mediating effect between demoralization and quality of life of patients with malignant tumors, accounted for 30.9% of the total effect. Conclusions Rumination plays a partially mediating role in the demoralization and quality of life of patients with malignant tumors, suggesting that clinical staff can improve the quality of life of patients with tumors by developing a systematic and comprehensive cognitive-behavioral intervention strategy to improve the demoralization and rumination.

    生活质量肿瘤失志综合征反刍思维中介效应

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    重症患者ICU获得性吞咽障碍风险预测模型的系统评价

    谢喆书周玉梅凡颖刘杏...
    589-595页
    查看更多>>摘要：目的 系统评价重症患者ICU获得性吞咽障碍风险预测模型，为医疗工作者选择或开发适合的风险评估工具提供参考依据。 方法 检索万方数据库、中国生物医学文献数据库、维普、中国知网、PubMed、Embase、CINAHL、Cochrane Library 8个数据库中有关ICU获得性吞咽障碍风险预测模型的横断面研究、病例对照研究、队列研究，语种限定为中文和英文，检索时限为建库至2023年7月5日。由2位研究人员独立筛选文献和提取数据，并应用预测模型研究的偏倚风险评估工具分析纳入文献的偏倚风险和适用性。 结果 共纳入8篇高质量文献，其中包括8项ICU获得性吞咽障碍风险预测模型。模型的AUC为0.750～0.980，其中6项模型报告了校准，2项模型的Hosmer-Lemeshow检验P>0.05，表明一致性较好。2项模型进行了外部验证。多变量模型重复报告的独立预测因子有：年龄≥ 65岁、慢性肺疾病，脑血管疾病、合并心律失常、镇静药物的使用及使用时间、APACHEⅡ评分≥15分、是否存在鼻胃管、留置胃管时间≥ 72 h、气管插管时间≥72 h。样本量（结局事件）较少、对缺失数据关注不足、变量筛选过程不合理以及模型过度拟合增加了模型的偏倚风险。 结论 纳入的模型整体呈现良好的区分、校准性能及适用性，但其偏倚风险较高，仅有极少数研究开展了外部验证。未来研究应参照多变量预测模型的透明报告来开发、更新和验证模型，以得到高质量的ICU获得性吞咽障碍风险预测模型，为制订相关预防策略提供参考依据。 Objective To systematically evaluate the risk prediction model of ICU-acquired dysphagia in critically ill patients, and to provide a reference basis for medical practitioners to select or develop suitable risk assessment tools. Methods Cross-sectional studies, case-control studies, and cohort studies of ICU-acquired dysphagia risk prediction models were searched in eight databases, including Wanfang database, China Biomedical Literature Database, VIP database, China National Knowledge Infrastructure, PubMed, Embase, CINAHL, and the Cochrane Library in both English and Chinese, and the search timeframe was from the construction of the database to July 5th, 2023. and the search was limited to Chinese and English. Literature was independently screened and data were extracted by 2 investigators, and the risk of bias assessment tool for predictive modeling studies was applied to analyze the risk of bias and applicability of the included literature. Results A total of 8 high-quality papers were included, including 8 predictive models of risk of ICU-acquired dysphagia. The area under the subject operating characteristic curve for the models ranged from 0.750 to 0.980, with 6 models reporting calibration and 2 models having a Hosmer-Lemeshow test P>0.05, indicating good agreement. 2 models were externally validated. Independent predictors reported repeatedly for multivariate models were age ≥ 65 years, chronic lung disease, cerebrovascular disease, comorbid arrhythmias, use of sedative medications and duration of use, Acute Physiology and Chronic Health Evaluation Ⅱ score ≥ 15, presence of a nasogastric tube, duration of indwelling gastric tube ≥ 72 h, and duration of endotracheal intubation ≥ 72 h. Smaller sample sizes (outcome events), insufficient attention to missing data, variable screening processes irrationality, and model overfitting increased the risk of model bias. Conclusions The included models showed overall good discrimination and applicability, but their risk of bias was high, and external validation was carried out in only a very few studies. Future studies should refer to transparent reports of multivariate predictive models to develop, update, and validate the models to obtain high-quality predictive models of the risk of ICU-acquired dysphagia, which can provide a reference basis for the development of relevant preventive strategies.

    ICU获得性吞咽障碍预测模型系统评价循证护理学

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    原发性肝癌患者经动脉化疗栓塞术后化疗相关性恶心呕吐风险评估工具的编制及预测效能检验

    祁慧尹国文徐清宇张慧...
    596-603页
    查看更多>>摘要：目的 编制原发性肝癌患者经动脉化疗栓塞术后化疗相关性恶心呕吐风险评估工具，并验证其预测效能，为原发性肝癌患者恶心呕吐的风险评估和护理干预提供参考。 方法 采用横断面研究方法。采用文献分析法、德尔菲专家咨询法、层次分析法编制风险评估工具。便利选取于2022年5月至2023年4月在江苏省肿瘤医院介入科行经动脉化疗栓塞术的153例原发性肝癌患者为评估对象，应用编制的风险评估工具对其进行评估，采用ROC曲线、灵敏度、特异度和约登指数检验风险评估工具的预测效能。 结果 153例患者中，男78例，女75例，年龄（48.44 ± 7.76）岁。3轮函询的专家积极系数均为100%，专家权威系数分别为0.936、0.950、0.960，Kendall协调系数分别为0.490、0.327、0.414（均P<0.01）。编制的原发性肝癌患者经动脉化疗栓塞术后化疗相关性恶心呕吐风险评估工具共包括14个条目。预测效能分析结果显示，AUC为0.938（95%CI 0.903～0.974，P<0.01），当截断分值为56.2分时，风险评估工具的灵敏度为0.926，特异度为0.881，约登指数为0.807，具有最佳预测效能。 结论 原发性肝癌患者经动脉化疗栓塞术后化疗相关性恶心呕吐风险评估工具具有较高的科学性、预测效能和实用性，适合我国原发性肝癌患者经动脉化疗栓塞术后化疗相关性恶心呕吐风险的评估。 Objective To develop a risk assessment tool for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer, and to verify its predictive efficiency, so as to provide reference for risk assessment and nursing intervention of nausea and vomiting in patients with primary liver cancer. Methods A cross-sectional survey was used. The risk assessment tool was compiled by using literature analysis, Delphi expert consultation and analytic hierarchy process. 153 patients with primary liver cancer who underwent transcatheter arterial chemoembolization in the Department of Intervention, Jiangsu Cancer Hospital from May 2022 to April 2023 were selected for assessment by using convenience sampling method. Receiver operating characteristic curve, sensitivity, specificity and Youden index were used to test the prediction efficiency of risk assessment tools. Results Among 153 patients, there were 78 males, 75 females, aged (48.44 ± 7.76) years old. The expert positive coefficient of the three rounds of inquiry letters was all 100%, the expert authority coefficient was 0.936, 0.950 and 0.960 respectively, and the Kendall harmony coefficient was 0.490, 0.327 and 0.414 respectively (all P<0.01). The risk assessment tool for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer included 14 items. The results of prediction efficiency analysis showed that the area under the receiver operating characteristic curve was 0.938 (95%CI 0.903-0.974, P<0.01). When the cut-off score was 56.2, the sensitivity, specificity and Youden index of the risk assessment tool were 0.926, 0.881 and 0.807, which had the best prediction efficiency. Conclusions The risk assessment tool for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer has high scientificity, predictive efficiency and practicability, and is suitable for the risk assessment for chemotherapy induced nausea and vomiting after transcatheter arterial chemoembolization in patients with primary liver cancer in China.

    肝肿瘤恶心呕吐经动脉化疗栓塞风险评估

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    高效群组孕期保健结合信息-知识-信念-行为健康教育对初产妇社会因素剖宫产率及产后母婴健康状况的影响

    杨敏柳海燕王安然杜玲玲...
    604-611页
    查看更多>>摘要：目的 探讨高效群组孕期保健结合信息-知识-信念-行为（IKAP）健康教育对初产妇社会因素剖宫产（CDMR）率及产后母婴健康状况的影响，为降低初产妇CDMR率和提高产后母婴健康提供借鉴意义。 方法 采用前瞻性、单中心、对照研究设计方案。以便利抽样法选取2020年1月至2021年12月于合肥市滨湖医院进行产检并分娩的初产妇82例为研究对象，将2020年1—12月的41例初产妇作为常规组，给予孕期常规保健护理，将2021年1—12月的41例初产妇作为联合组，在常规孕期保健基础上给予高效群组孕期保健结合IKAP健康教育，比较2组初产妇剖宫产分娩认知情况、分娩方式、产妇产后并发症发生率、胎儿及新生儿并发症发生率等指标情况。 结果 常规组年龄（26.71 ± 2.18）岁，联合组年龄（27.16 ± 1.79）岁。联合组初产妇的剖宫产分娩认知情况正确认知、部分认知正确、不正确认知百分率分别为73.17%（30/41）、21.95%（9/41）、4.88%（2/41），常规组分别为53.66%（22/41）、26.83%（11/41）、19.51%（8/41），2组比较差异有统计学意义（Z = 4.22，P<0.05）。联合组剖宫产率、CDMR比例为24.39%（10/41）、1/10，低于常规组的46.34%（19/41）、10/19，2组比较差异均有统计学意义（χ2 = 4.32，P<0.05；Fisher精确概率法P = 0.049）。联合组产妇产后并发症总发生率和胎儿、新生儿并发症总发生率分别为4.88%（2/41）、7.32%（3/41），低于常规组的12.20%（5/41）、12.20%（5/41），2组比较差异均无统计学意义（Fisher精确概率法P = 0.432，0.712）。联合组功能性、沟通性、批判性健康素养评分分别为（85.73 ± 4.09）、（51.93 ± 4.72）、（58.63 ± 4.32）分，均高于常规组的（80.17 ± 5.26）、（46.37 ± 5.11）、（52.71 ± 5.07）分，2组比较差异均有统计学意义（t = 5.34、5.12、5.69，均P<0.01）。联合组产后3个月纯母乳喂养率、奶粉喂养率、混和喂养率分别为58.54%（24/41）、7.32%（3/41）、34.15%（14/41），与常规组的26.83%（11/41）、29.27%（12/41）、43.90%（18/41）比较，差异有统计学意义（χ2 = 10.73，P<0.05）。 结论 高效群组孕期保健结合IKAP健康教育可通过提高初产妇剖宫产正确认知来降低初产妇CDMR率，降低产妇并发症及胎儿、新生儿并发症发生率，提升产妇产后健康素养，提高婴儿母乳喂养率，值得临床推广应用。 Objective To explore the effects of high-efficiency centering pregnancy care (CPC) combined with information-knowledge-attitude-practice (IKAP) health education on cesarean delivery on maternal request (CDMR) rate, maternal and neonatal health status so as to provide referential significance for reducing CDMR rate and improving postpartum maternal and neonatal health status and breastfeeding rate. Methods In the prospective, single-center and controlled study, a total of 82 primiparas undergoing antenatal examination and delivery in South Binhu Hospital of Hefei First People′s Hospital were enrolled as the research objects between January 2020 and December 2021 by convenience sampling method, including 41 cases given routine health care in routine group between January and December 2020 and 41 cases given high-efficiency CPC combined with IKAP health education on basis of routine group in combination group between January and December 2021. The cognition of cesarean section, delivery modes, incidence of postpartum complications, neonatal complications and breastfeeding between the two groups were compared. Results The age of the routine group was (26.71 ± 2.18) years old, and the age of the combination group was (27.16 ± 1.79) years old. The proportions of correct cognition, partially correct cognition and incorrect cognition to cesarean section in combination group were 73.17% (30/41), 21.95% (9/41), 4.88% (2/41), and 53.66% (22/41), 26.83% (11/41), 19.51% (8/41) in routine group, and the difference between the two groups was statistically significant (Z = 4.22, P<0.05). The incidence of cesarean section and CDMR in combination group was 24.39% (10/41) and 1/10, lower than that in routine group [46.34% (19/41), 10/19], and the difference between the two groups was statistically significant (χ2 = 4.32, P<0.05 Fisher′s exact test,P = 0.049 ). The total incidence rates of postpartum complications of primiparas and neonatal complications in the combination group were 4.88%(2/41) and 7.32%(3/41), lower than 12.20%(5/41) and 12.20%(5/41) in the routine group, and the differences between the two groups were not statistically significant (Fisher′s exact test, P = 0.432, 0.712). The scores of functional health literacy, communicative health literacy and critical health literacy in combination group were (85.73 ± 4.09), (51.93 ± 4.72) and (58.63 ± 4.32) points, higher than those in routine group [(80.17 ± 5.26), (46.37 ± 5.11) , (52.71 ± 5.07) points], and the difference between the two groups was statistically significant (t = 5.34, 5.12, 5.69, all P<0.01). At 3 months after delivery, exclusive breastfeeding rate, milk powder feeding rate and mixed feeding rate in combination group were 58.54% (24/41), 7.32%(3/41), 34.15(14/41), higher than 26.83% (11/41), 29.27(12/41), 43.90%(18/41) in routine group, and the difference between the two groups was statistically significant (χ2 = 10.73, P<0.05). Conclusions High-efficiency CPC combined with IKAP health education can reduce incidence of CDMR, decrease maternal and neonatal complications, enhance maternal postpartum health literacy and improve breastfeeding rate in primiparas by improving correct cognition to cesarean section. It is worthy of clinical application.

    初产妇群组孕期保健IKAP健康教育社会因素剖宫产产后母婴健康母乳喂养

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    微视频突破教育与专题工作坊联用于维持性血液透析患者内瘘护理中的效果观察

    林萍吴晓丽陈双双杨丽松...
    612-618页
    查看更多>>摘要：目的 观察微视频突破教育与专题工作坊联用于维持性血液透析患者内瘘护理中的效果，为改善患者预后提供依据。 方法 采用随机对照试验，以便利抽样法选择2022年1—12月就治于浙江中医药大学附属湖州中医院的维持性血液透析内瘘患者90例为观察对象，以随机数字表法将患者分为对照组和试验组各45例，对照组采用维持性血液透析内瘘常规护理，试验组引入微视频突破教育与专题工作坊联合干预机制，对2组干预后的内瘘自护行为等各项观察指标进行比较。 结果 对照组男23例，女22例，年龄（58.07 ± 3.00）岁；试验组男24例，女21例，年龄（58.93 ± 4.07）岁。干预后，试验组内瘘自护行为总分为（49.44 ± 1.84）分，对照组为（38.93 ± 2.19）分，2组比较差异有统计学意义（t = 24.65，P<0.05）；试验组健康管理依从性中液体摄入、透析方案、药疗、饮食评分分别为（15.82 ± 1.37）、（12.87 ± 1.39）、（17.24 ± 1.33）、（21.60 ± 1.03）分，对照组分别为（11.20 ± 0.92）、（9.98 ± 1.14）、（12.11 ± 1.01）、（17.40 ± 1.10）分，2组比较差异均有统计学意义（t值为10.78 ~ 20.62，均P<0.05）；试验组积极心理资本评分中自我效能、韧性、希望、乐观评分分别为（38.69 ± 1.22）、（39.27 ± 1.10）、（33.29 ± 1.52）、（33.40 ± 1.39）分，对照组分别为（31.16 ± 1.26）、（31.04 ± 1.15）、（26.13 ± 1.52）、（27.09 ± 7.28）分，2组比较差异均有统计学意义（t值为5.71 ~ 34.77，均P<0.05）。试验组并发症总发生率为8.89%（4/45），低于对照组的28.89%（13/45），差异有统计学意义（χ2 = 5.87，P<0.05）。 结论 将微视频突破教育与专题工作坊联合应用于维持性血液透析内瘘患者中，利于其内瘘自我护理能力、健康管理依从性、积极心理资本的提升，可降低内瘘并发症发生率。 Objective To observe of the effects of micro-video breakthrough education and thematic workshops in the care of internal fistulae in maintenance haemodialysis patients, to provide a basis for improving prognosis of patients. Methods This study was a randomized controlled trial. A total of 90 cases of maintenance haemodialysis patients with endocardial fistula were selected in Huzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine from January to December in 2022 as the observation samples using convenience sampling method. They were divided into the experimental group and the control group with 45 cases in each group by the method of random number table. The control group used the conventional nursing care for maintenance haemodialysis endocardial fistula to administer nursing care, the experimental group introduced the micro-video breakthrough education and thematic workshop as a combined mechanism of intervention. The self-care behaviors with arteriovenous fistula and other observation indexes between the two groups were compared. Results There were 23 males and 22 females in the control group, aged (58.07 ± 3.00) years old. There were 24 males and 21 females in the experimental group, aged (58.93 ± 4.07) years old. After care, the total internal fistula self-care behaviour score in the experimental group was (49.44 ± 1.84) points, and (38.93 ± 2.19) points in the control group, the difference between the two groups were statistical significant (t = 24.65, P<0.05). For health management adherence, the score of fluid intake, dialysis regimen, medication and dietary dimension were (15.82 ± 1.37), (12.87 ± 1.39), (17.24 ± 1.33) and (21.60 ± 1.03) points in the experimental group, and (11.20 ± 0.92), (9.98 ± 1.14), (12.11 ± 1.01) and (17.40 ± 1.10) points in the control group, the difference between the two groups were statistical significant (t values were 10.78 to 20.62, all P<0.05). For positive psychological capital, the scores of self-efficacy, resilience, hope and optimism were (38.69 ± 1.22), (39.27 ± 1.10), (33.29 ± 1.52) and (33.40 ± 1.39) points, and were (31.16 ± 1.26), (31.04 ± 1.15), ( 26.13 ± 1.52) and (27.09 ± 7.28) points in the control group, the difference between the two groups were statistical significant (t values were 5.71 to 34.77, all P<0.05). The total complication rate of the experimental group was 8.89% (4/45), lower than 28.89% (13/45) in the control group, and the differences were all statistically significant (χ2 = 5.87, P<0.05). Conclusions The combined application of micro-video breakthrough education and special workshops in maintenance hemodialysis patients with internal fistula is beneficial to the improvement of their internal fistula self-care ability, health management compliance and positive psychological capital, and can reduce the probability of internal fistula complications.

    血液透析滤过微视频突破教育专题工作坊内瘘护理

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    肺癌合并慢性阻塞性肺疾病患者术前预康复最佳证据总结

    徐小燕毛燕君严晓霞方雪娥...
    619-626页
    查看更多>>摘要：目的 检索并总结肺癌合并慢性阻塞性肺疾病患者术前预康复的最佳证据，为临床医护人员对肺癌合并慢性阻塞性肺疾病患者术前预康复的管理提供参考。 方法 系统检索指南网站、专业协会网站、循证数据库和综合数据库，文献类型包括临床决策、指南、专家共识、证据总结、系统评价、Meta分析、随机对照试验，检索时限为建库至2023年10月31日，并对纳入文献质量进行评价，提取证据。 结果 最终纳入18篇文献，包括8篇指南、8篇专家共识、2篇系统评价，从预康复的必要性、时机、地点、内容（包括戒烟管理、呼吸功能锻炼、运动锻炼、营养支持、药物管理）4个方面汇总30条最佳证据。 结论 本研究汇总了肺癌合并慢性阻塞性肺疾病患者术前预康复的最佳证据，医护人员在后续证据向临床转化过程中要注意结合临床具体情境，审慎地制订肺癌合并慢性阻塞性肺疾病患者术前预康复方案。 Objective To search and summarize the best evidence for preoperative prehabilitation in patients with lung cancer complicated by chronic obstructive pulmonary disease and to inform the management of preoperative prehabilitation in patients with lung cancer combined with COPD by clinical providers. Methods Systematically guideline websites, professional society websites, evidence-based databases, and comprehensive databases were searched for types of literature including clinical decision making, guidelines, expert consensus, evidence summaries, systematic evaluations, Meta-analyses, and randomized controlled trials. The time for the retrieval was from the inception of databases until October 31th, 2023. And the quality of the included literature was evaluated and evidence was extracted, evaluated the quality of the included literature, and extracted evidence. Results Finally, 18 articles were included, including 8 guidelines, 8 expert consensus, and 2 systematic reviews. Summarized the 30 best evidence in 4 areas of prerehabilitation: need, timing, location, content (including smoking cessation management, respiratory exercise, exercise, nutritional support, and medication management). Conclusions This study summarizes the best evidence for preoperative prehabilitation in patients with lung cancer combined with chronic obstructive pulmonary disease, and healthcare professionals should be mindful of the need to develop preoperative prehabilitation protocols judiciously, taking into account the specific clinical context during the subsequent translation of the evidence to the clinic.

    肺肿瘤肺疾病,慢性阻塞性预康复最佳证据

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    心房颤动患者肺静脉隔离消融术后"空白期"疾病感知现状及影响因素

    谷佳芸丁云美魏丽丽崔岩...
    627-633页
    查看更多>>摘要：目的 调查心房颤动患者肺静脉隔离消融术后"空白期"疾病感知现状并分析其影响因素，为提升患者对疾病的认知、加快康复进程提供参考。 方法 采用横断面调查方法，以便利抽样法，选取2022年8月至2023年5月于青岛大学附属医院320例肺静脉隔离消融术后"空白期"门诊复查的心房颤动患者作为研究对象，采用一般资料调查表、简易疾病感知问卷（BIPQ）和修订版控制态度量表（CAS-R）进行现场调查。 结果 本研究共纳入320例患者，男177例，女143例，年龄（61.64 ± 10.74）岁。调查对象的疾病感知总分为（42.98 ± 10.49）分，感知控制总分为（27.20 ± 5.65）分。多元线性回归分析结果显示，年龄、静息心率、术后病程和感知控制是疾病感知的影响因素（F = 25.24，P<0.05）。 结论 心房颤动患者肺静脉隔离消融术后"空白期"的疾病感知状况亟待改善，医护人员应对高龄、静息心率快、术后病程短及感知控制力低的患者多加重视，采取有效措施以减轻负性疾病感知，促进术后康复。 Objective To investigate atrial fibrillation patients′illness perception during the blanking period after pulmonary vein isolation (PVI) and to analyze its influencing factors, so as to provide a reference for improving patients′cognition of the disease and speeding up the rehabilitation process. Methods This study was a cross-sectional survey. Convenience sampling method was adopted to select 320 patients with atrial fibrillation who were reexamined in the outpatient department during the blanking period after PVI from Affiliated Hospital of Qingdao University from Auguest 2022 to May 2023 as the research subjects. The General Information Questionnaire, the Brief Illness Perception Questionnaire (BIPQ), and the Control Attitudes Scale-Revised (CAS-R) were used for on-site investigation. Results Totally 320 patients were included in this study, including 177 males and 143 females, aged (61.64 ± 10.74) years old. The total score of BIPQ was (42.98 ± 10.49) points, the total score of CAS-R was (27.20 ± 5.65) points. The results of multiple linear regression analysis showed that age, resting heart rate, postoperative course, and perceived control were the influencing factors of illness perception (F = 25.24, P<0.05). Conclusions The illness perception of atrial fibrillation patients during the blanking period after PVI needs to be improved urgently. Medical staff should pay more attention to patients with old age, fast resting heart rate, short postoperative course, and low perceived control, and take effective measures to reduce negative illness perception and promote postoperative rehabilitation.

    心房颤动肺静脉隔离消融术"空白期"疾病感知影响因素

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