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中华现代护理杂志
中华现代护理杂志

沈黎

旬刊

1674-2907

cjmn@cjmn.net

010-83191170

100052

北京市宣武门外大街香炉营东巷2号院1-7-301

中华现代护理杂志/Journal Chinese Journal of Modern NursingCSTPCD
查看更多>>1995年创刊，中国科学技术协会主管，中华医学会主办。本刊是护理学科领域综合性学术期刊，中国科技论文统计源期刊（中国科技核心期刊）。本刊主要以各级各类医疗机构中的护理工作者、高等医（药）院校和科研院所等机构中与护理学科相关的教学、科研人员及护理专业学生为主要的读者、作者对象。主要栏目有述评、论坛、专题报道、论著、讲座、综述、研究荟萃、管理?教育、技术?方法等。
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    二胎阴道分娩产妇产后出血预测模型的构建

    曹琳琳王彩云李葆华倪胜莲...
    899-905页
    查看更多>>摘要：目的 探讨二胎阴道分娩产妇产后出血的相关危险因素并建立风险预测模型。 方法 采用便利抽样法，选取2019年7月—2023年3月在北京大学第三医院规律产检的2 500名二胎阴道分娩产妇为研究对象，根据失血量，将胎儿娩出后24 h内失血量≥500 m1的产妇作为病例组（n=278），同期分娩的胎儿娩出后24 h内失血量<500 ml的产妇作为对照组（n=2 222）。采用单因素分析、二项Logistic回归分析探讨二胎阴道分娩产妇产后出血的影响因素，基于筛选出的危险因素使用R软件建立列线图预测模型，并对模型进行一致性检验。 结果 2 500名二胎阴道分娩产妇产后出血发生率为11.12%（278/2 500）。二项Logistic回归分析结果显示，体外受精-胚胎移植、临产前体重指数、会阴侧切、新生儿体重、前置胎盘、胎盘植入、手取胎盘是二胎阴道分娩产妇发生产后出血的影响因素（P<0.05）。根据影响因素建立预测二胎阴道分娩产妇产后出血发生概率的列线图，预测模型C-index为0.706，受试者工作特征曲线下面积为0.706，Hosmer-Lemeshow拟合优度检验显示χ2值为7.720（P=0.461）。 结论 体外受精-胚胎移植、临产前体重指数、会阴侧切、新生儿体重、前置胎盘、胎盘植入、手取胎盘是二胎阴道分娩产妇产后出血的危险因素。根据危险因素构建的预测模型具有一定的准确性，对于预测二胎阴道分娩产妇的产后出血有一定的临床价值。 Objective To explore the risk factors of postpartum hemorrhage in parturients undergoing vaginal delivery with a second child and establish a risk prediction model. Methods Using the convenient sampling method, a total of 2 500 parturients undergoing vaginal delivery with a second child who underwent regular prenatal examinations at Peking University Third Hospital from July 2019 to March 2023 were selected as the research objects. According to the amount of blood loss, parturients with blood loss greater than or equal to 500 ml within 24 hours after delivery were selected as the case group (n=278), while parturients with blood loss less than 500 ml within 24 hours after delivery in the same period were selected as the control group (n=2 222). Univariate analysis and binomial Logistic regression were used to analyze the influencing factors of postpartum hemorrhage in parturients with vaginal delivery with a second child. Based on the selected risk factors, a nomogram prediction model was established using R software, and the consistency of the model was tested. Results The incidence of postpartum hemorrhage in 2 500 parturients undergoing vaginal delivery with a second child was 11.12% (278/2 500). Binomial Logistic regression analysis showed that in in vitro fertilization-embryo transfer, pre-delivery body mass index, lateral perineal incision, neonatal weight, placenta previa, placenta implantation and manual extraction of placenta were the influencing factors for postpartum hemorrhage in parturients undergoing vaginal delivery with a second child (P<0.05). According to the influencing factors, a nomogram model was established to predict the probability of postpartum hemorrhage in women who gave birth to a second child. TheC-index of the prediction model was 0.706, the area under the receiver operating characteristic curve was 0.706, and the χ 2 value of the Hosmer-Lemeshow goodness-of-fit test was 7.720 (P=0.461) . Conclusions In vitro fertilization embryo transfer, pre-delivery body mass index, perineal lateral resection, neonatal weight, placenta previa, placental implantation and manual extraction of placenta are risk factors for postpartum hemorrhage in parturients undergoing vaginal delivery for a second child. The prediction model constructed based on risk factors has certain accuracy and clinical value for predicting postpartum hemorrhage in parturients with vaginal delivery of a second child.

    产后出血阴道分娩二胎产妇危险因素列线图

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    心房颤动患者射频消融术后参与运动康复障碍和促进因素的混合研究

    严伟于甜栖高敏王洁...
    906-912页
    查看更多>>摘要：目的 探讨心房颤动（房颤）患者射频消融术后参与运动康复的障碍和促进因素。 方法 采用便利抽样法，2022年3—8月从南京医科大学第一附属医院心血管内科"云病房"招募房颤射频消融术后3个月内的285例患者为研究对象，采用心脏康复障碍量表评估患者参与运动康复的障碍、运动自我效能感量表评估患者的运动自我效能。对其中的22例患者进行半结构化访谈，提炼主题。 结果 285例房颤患者中，参与过运动康复项目者202例（70.88%）。研究显示，工作/时间冲突、缺乏心脏康复知识、健康/躯体功能受限影响患者运动康复参与情况（P<0.05）。质性研究提炼出3个影响患者运动康复情况的主题：能力、机会和动机。 结论 房颤患者运动康复参与受到家庭责任、能力、动机、机会多因素影响。医务人员应综合考虑以上因素，全方位、多角度、针对性地制定相应的干预措施，切实改善患者的运动康复参与情况。 Objective To explore the barriers and facilitators of exercise rehabilitation in patients with atrial fibrillation (AF) after radiofrequency ablation. Methods From March to August 2022, 285 patients with atrial fibrillation who underwent radiofrequency ablation within three months were recruited from the "Cloud Ward" of the Department of Cardiovascular of the First Affiliated Hospital with Nanjing Medical University by convenience sampling. The Cardiac Rehabilitation Barriers Scale (CRBS) and the Self-efficacy for Exercise Scale (SEE) were used to evaluate the barriers and self-efficacy of patients participating in exercise rehabilitation, respectively. Among them, 22 patients were subjected to semi-structured interviews to extract themes. Results Among 285 patients with atrial fibrillation, 202 (70.88%) participated in exercise rehabilitation programs. Work/time conflicts, lack of cardiac rehabilitation knowledge, and health/physical function limitations affected the participation of patients in exercise rehabilitation (P<0.05). Qualitative research extracted three themes that affected the patient's exercise rehabilitation, including capability, opportunity, and motivation. Conclusions The participation of atrial fibrillation patients in exercise rehabilitation is influenced by multiple factors such as family responsibility, capability, motivation, and opportunity. Medical and nursing staff should comprehensively consider the above factors, develop targeted interventions from all aspects and multiple angles, so as to effectively improve the participation of patients in exercise rehabilitation.

    心房颤动射频消融运动康复障碍因素促进因素混合研究

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    更正

    912页
    查看更多>>摘要：《中华现代护理杂志》2024年1月6日第30卷第1期2-6页刊载的《新时期护理研究的范畴、选题与科研伦理思考》一文中"国际护士会（International Council of Nurses，ICU）"应为："国际护士会（International Council of Nurses，ICN）"。
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    基于Web of Science数据库的急诊安宁疗护研究的可视化分析

    吴雪菲邹圣强叶云葛春花...
    913-919页
    查看更多>>摘要：目的 基于Web of Science数据库，对急诊安宁疗护研究进行可视化分析。 方法 系统检索Web of Science核心合集中2012—2022年收录的急诊安宁疗护相关文献，借助CiteSpace软件进行可视化分析。 结果 共纳入文献630篇，发文量总体呈上升趋势。发文量最多的国家为美国，发文量排名前10位的机构中8家来自美国；发文量最多的作者为Grudzen；共被引频次排名前10位的期刊多为安宁疗护和急救专刊；关键词分析结果显示，共输出15个聚类标签、20个突现词，反映重点研究对象、主要研究类型和关注区域的改变。 结论 目前国内该领域护理研究正处于发展阶段，可借鉴国外的实践经验，进一步探索基于我国国情的急诊安宁疗护模式和服务体系。 Objective To conduct the visual analysis of emergency palliative care based on the Web of Science database. Methods The literature on emergency palliative care collected from 2012 to 2022 was systematically searched in the Web of Science core collection. CiteSpace software was used for visual analysis. Results A total of 630 articles were included, and the number of publications was on the rise. The country with the highest number of publications was the United States, with 8 out of the top 10 institutions in terms of publication volume coming from the United States. The author with the highest number of publications was Grudzen. The top 10 journals in terms of citation frequency were mostly specialized journals on palliative care and first aid. The results of keyword analysis showed that a total of 15 clustering labels and 20 emergent words were output, reflecting the changes of key research objects, main research types and areas of concern. Conclusions At present, nursing research in this field is in the development stage in China. We can draw on the practical experience of foreign countries to further explore the emergency palliative care model and service system based on China's national conditions.

    急诊科安宁疗护临终关怀文献计量学可视化分析

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    脊髓损伤患者神经源性肠道功能障碍管理的最佳证据总结

    文菁莲唐炜罗玉红唐帆...
    919-925页
    查看更多>>摘要：目的 检索、评价并整合国内外脊髓损伤患者神经源性肠道功能障碍（NBD）管理的最佳证据，为临床开展相关循证实践提供依据。 方法 计算机检索国内外各数据库、专业协会网站中关于脊髓损伤患者NBD管理的证据，包括指南、专家共识、临床决策及系统评价，检索时限为建库至2023年3月31日。 结果 共纳入文献13篇，包括指南5篇、证据总结5篇、专家共识2篇、临床决策1篇。从脊髓损伤患者NBD管理的病史评估、药物管理、物理治疗、饮食运动及健康教育5个方面总结了33条推荐意见。 结论 本研究汇总的脊髓损伤患者NBD管理最佳证据具有科学性和实用性，医护人员应结合临床实际情况选择性应用最佳证据。 Objective To retrieve, evaluate, and integrate the best evidence for the management of neurogenic bowel dysfunction (NBD) in spinal cord injury patients both domestically and internationally, providing a basis for relevant evidence-based practices. Methods The guidelines, expert consensus, clinical decision-making, and systematic review of NBD management for spinal cord injury patients were electronically searched in various databases and professional association websites at home and abroad. The search period was from database establishment to March 31, 2023. Results A total of 13 articles were included, including five guidelines, five evidence summaries, two expert consensus, and one clinical decision-making. A total of 33 recommendations for NBD management in spinal cord injury patients were summarized from five aspects of medical history assessment, medication management, physical therapy, diet and exercise, and health education. Conclusions The best evidence for NBD management in spinal cord injury patients summarized is scientific and practical. Medical and nursing staff should selectively apply the best evidence based on clinical practice.

    脊髓损伤神经源性肠道功能障碍证据总结循证护理

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    临床护士心理韧性在结构性授权与工作投入间的中介效应

    刘智慧朱玉花李雪张全英...
    926-931页
    查看更多>>摘要：目的 探讨临床护士心理韧性在结构性授权与工作投入间的中介效应。 方法 本研究为横断面研究。采用便利抽样法，于2023年3—5月选取河南省3所三级甲等医院的1 723名护士为研究对象。采用一般资料调查表、工作效能条件量表、护士心理韧性量表、工作投入量表对其进行调查。采用Pearson相关性分析探讨结构性授权、心理韧性与工作投入间的相关性；采用AMOS 24.0软件建立结构方程模型并分析中介效应。 结果 本研究共发放问卷1 723份，回收有效问卷1 590份，问卷有效回收率为92.28%。1 590名临床护士的结构性授权、心理韧性、工作投入总分分别为（70.42±15.61）、（96.84±13.15）、（62.24±11.02）分。Pearson相关性分析结果显示，工作投入与结构性授权、心理韧性呈正相关（r值分别为0.637、0.670，P<0.01）。结构方程模型结果显示，心理韧性在结构性授权与工作投入间起部分中介效应，中介效应值为0.321，占总效应的48.86%。 结论 本研究中临床护士结构性授权、心理韧性、工作投入均处于中等偏上水平，心理韧性在结构性授权与工作投入间起部分中介作用，护理管理者应从组织层面充分授权，采取针对性措施提高护士心理韧性，增强其工作投入水平。 Objective To explore the mediating effect of psychological resilience between structural empowerment and work engagement of clinical nurses. Methods This study was a cross-sectional study. Using the convenient sampling method, a total of 1 723 nurses from three Class Ⅲ Grade A hospitals in Henan Province were selected as the research objects from March to May 2023. The survey was conducted using general information questionnaire, Conditions of Work Effectiveness Questionnaire-Ⅱ (CWEQ-Ⅱ), Nurses Psychological Resilience Scale and Utrecht Work Engagement Scale (UWES). Pearson correlation analysis was used to explore the correlation between structural empowerment, psychological resilience and job engagement. AMOS 24.0 software was used to establish the structural equation model and analyze the mediating effect. Results A total of 1 723 questionnaires were sent out in this study, and 1 590 were effectively collected, with an effective recovery rate of 92.28%. The total scores of structural empowerment, psychological resilience and job engagement of 1 590 clinical nurses were (70.42±15.61), (96.84±13.15) and (62.24±11.02), respectively. Pearson correlation analysis showed that job engagement was positively correlated with structural empowerment and psychological resilience (r=0.637, 0.670, P<0.01). The results of structural equation model showed that psychological resilience had a partial mediating effect between structural empowerment and job engagement. The mediating effect value was 0.321, accounting for 48.86% of the total effect. Conclusions In this study, the structural empowerment, psychological resilience and job engagement of clinical nurses are above the medium level, and psychological resilience has a partial mediating effect between structural empowerment and job engagement. Nursing managers should fully empower nurses at the organizational level, take targeted measures to improve their psychological resilience and enhance their level of work engagement.

    护士心理韧性结构授权工作投入中介效应

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    护士隐性知识共享现状及影响因素分析

    刘婷潘晓彦邓婷婷皮海燕...
    931-936页
    查看更多>>摘要：目的 了解护士隐性知识共享的现状，并分析影响因素。 方法 采用便利抽样法，于2023年3—6月选取长沙市3所三级甲等医院的437名护士为研究对象，采用一般资料调查表、隐性知识共享量表、护士个人—组织契合量表和职业倦怠量表进行调查。采用R软件randomForest程序包构建随机森林模型，对隐性知识共享影响因素的重要性进行排序；采用LASSO分析进行变量选择，将筛选出的变量采用多重线性回归分析进行影响因素分析。 结果 共发放问卷437份，回收有效问卷434份，问卷有效回收率为99.31%（434/437）。434名护士的隐性知识共享量表得分为（13.09±3.03）分。随机森林算法结果显示，重要性排序前4位的自变量分别为职业倦怠、职称、工作年限和个人—组织契合度。多重线性回归分析结果显示，职业倦怠、职称、个人—组织契合度是护士隐性知识共享的主要影响因素（P<0.01）。 结论 护士的隐性知识共享水平有待提高，护理管理者可通过降低护士职业倦怠程度、完善职称晋升制度和提高个人—组织契合度的途径提升护士的隐性知识共享水平。 Objective To explore the current situation of tacit knowledge sharing among nurses and analyze its influencing factors. Methods From March to June 2023, convenience sampling was used to select 437 nurses from three ClassⅢ Grade A hospitals in Changsha as the research subject. The survey was conducted using the General Information Questionnaire, Tacit Knowledge Sharing Scale, Person-Organization Fit Assessment Scale for Nurses, and Maslach Burnout Inventory. The R software randomForest package was used to construct a random forest model and rank the importance of factors influencing tacit knowledge sharing LASSO analysis was used for variable selection, and the selected variables were analyzed for influencing factors using multiple linear regression. Results A total of 437 questionnaires were distributed, and 434 valid questionnaires were collected, with an effective response rate of 99.31% (434/437). The Tacit Knowledge Sharing Scale score of 434 nurses was (13.09±3.03). The random forest algorithm showed that the top four independent variables in importance ranking were occupational burnout, professional title, working years, and person-organization fit. Multiple linear regression analysis indicated that occupational burnout, professional title, and person-organization fit were the main influencing factors of tacit knowledge sharing among nurses (P<0.01) . Conclusions The tacit knowledge sharing among nurses needs to be improved. Nursing managers can enhance the tacit knowledge sharing among nurses by reducing their professional burnout, improving the system of professional title promotion, and enhancing the fit between persons and organizations.

    护士隐性知识共享随机森林模型现状影响因素

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    加速康复外科在全髋关节置换患者围手术期管理中实施的现状调查及影响因素分析

    王佳音侯晨昕杨聪颖金晓燕...
    937-943页
    查看更多>>摘要：目的 了解加速康复外科（ERAS）在全髋关节置换患者围手术期管理中的实施现状及其影响因素。 方法 本研究采用横断面调查的方式，采用目的抽样法，于2022年5—12月选取北京市9家ERAS试点医院的186名骨科护士为研究对象。采用自行设计的问卷对ERAS实施现状进行调查。采用Pearson相关分析护士ERAS实施现状自评问卷得分与ERAS行为意向问卷得分的相关性，采用多重线性回归分析ERAS在全髋关节置换患者围手术期实施的影响因素。 结果 本研究共发放问卷186份，回收有效问卷186份，问卷有效回收率为100.00%（186/186）。ERAS实施现状问卷总得分为（116.49±20.71）分，各维度的标化得分由高至低分别是随访管理[（80.22±20.44）分]、术中[（78.98±15.17）分]、术前[（74.72±14.09）分]和术后[（69.77±15.94）分]；ERAS行为意向问卷总得分为（77.39±15.08）分，各维度的标化得分由高至低依次为主观规范[（79.93±19.01）分]、行为意向[（77.69±19.61）分]、行为态度[（74.19±15.77）分]和知觉行为控制[（64.41±14.69）分]。护士职称、对ERAS的熟悉程度、是否接受过ERAS培训以及主观规范是ERAS实施现状得分的影响因素（P<0.05），共解释总变异的40.9%。 结论 应该加强护士ERAS相关的培训，增加相关知识的熟悉程度，采用多种激励措施进一步提升ERAS方案在临床中的应用。 Objective To explore the implementation status and influencing factors of enhanced recovery after surgery (ERAS) in perioperative management of patients undergoing total hip arthroplasty. Methods This study was a cross-sectional study. From May to December 2022, purposive sampling was used to select 186 orthopedic nurses from 9 ERAS pilot hospitals in Beijing as the research subject. A self-designed questionnaire was used to investigate the implementation status of ERAS. Pearson correlation was used to analyze the correlation between Nurse ERAS Implementation Status Questionnaire scores and ERAS Behavioral Intention Questionnaire scores. Multiple linear regression was used to analyze the influencing factors of ERAS in perioperative nursing of patients undergoing total hip arthroplasty. Results A total of 186 questionnaires were distributed and 186 valid questionnaires were collected, with an effective response rate of 100.00% (186/186). The total score of the Nurse ERAS Implementation Status Questionnaire was (116.49±20.71), and the standardized scores for each dimension from high to low were follow-up management (80.22±20.44), intraoperative period (78.98±15.17), preoperative period (74.72±14.09), and postoperative period (69.77±15.94). The total score of the ERAS Behavioral Intention Questionnaire was (77.39±15.08), and the standardized scores of each dimension from high to low were subjective norm (79.93±19.01), behavioral intention (77.69±19.61), behavioral attitude (74.19±15.77), and perceived behavioral control (64.41±14.69). The nurse's professional title, familiarity with ERAS, ERAS training, and subjective norm were the influencing factors of the specific implementation status score of ERAS (P<0.05), explaining 40.9% of the total variance. Conclusions Nurses should strengthen training on ERAS, increase their familiarity with knowledge, and adopt various incentive measures to further enhance the implementation of ERAS programs in clinical practice.

    横断面调查加速康复外科髋关节置换术实施现状影响因素

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    基于CiteSpace的我国脑瘫儿童康复护理的可视化分析

    邓一宋珊珊董丽何月...
    943-949页
    查看更多>>摘要：目的 基于CiteSpace软件的可视化功能，分析国内脑瘫儿童康复护理领域的研究现状、热点及趋势，为我国进一步开展脑瘫儿童康复护理研究提供参考和借鉴。 方法 检索中国知网、万方数据库、维普网中脑瘫儿童康复护理的相关文献，检索时限为建库至2023年6月18日。本研究采用CiteSpace.5.8.R3对文献进行可视化分析。 结果 共纳入1 092篇文献，发文时间为1991—2023年，发文量总体呈上升趋势；文献地区和机构分布不均，彼此合作度较低；研究前沿为运动功能、沟通技巧生活质量。 结论 我国脑瘫儿童康复护理研究处于发展时期，关注度和重视度有待提高。 Objective To analyze the research status, hot spots and trends in the field of rehabilitation nursing for children with cerebral palsy in China based on the visualization function of CiteSpace software, so as to provide reference for further research on rehabilitation nursing of children with cerebral palsy in China. Methods Literature related to rehabilitation nursing of children with cerebral palsy was searched from CNKI, Wanfang Database and VIP, and the search period was from the establishment of the databases until June 18, 2023. In this study, CiteSpace 5.8.R3 was used for visual analysis of the literature. Results A total of 1 092 articles were included, published from 1991 to 2023, and the number of published papers showed an overall upward trend. The distribution of literature among regions and institutions was uneven, and the degree of cooperation was low. Research frontiers included motor function, communication skills and quality of life. Conclusions The research on rehabilitation nursing of children with cerebral palsy in China is in the development period, and the degree of attention and importance needs to be improved.

    脑瘫儿童康复护理文献计量学CiteSpace可视化

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    智能型多功能下肢疾患康复治疗仪预防脑卒中偏瘫患者下肢深静脉血栓的效果

    李冰贾汝福王芝静李海月...
    950-953页
    查看更多>>摘要：目的 探讨智能型多功能下肢疾患康复治疗仪对预防脑卒中偏瘫患者下肢深静脉血栓的效果。 方法 采用便利抽样法，于2022年9月—2023年9月选取沧州市中心医院神经内科、神经外科及康复科收治的121例脑卒中偏瘫患者为研究对象，采用随机数字表法将研究对象分为对照组（n=58）和观察组（n=63）。对照组给予标准药物治疗和常规康复护理，观察组在对照组基础上采用智能型多功能下肢疾患康复治疗仪治疗，干预时间均为4周。比较干预后两组患者的下肢临床症状（肿胀、疼痛、皮温、腓肠肌试验结果）、下肢深静脉血栓的发生情况。比较干预前后两组患者的血浆D-二聚体水平、股静脉血流速度及血流量。 结果 干预后，观察组患者的下肢临床症状（肿胀、疼痛、皮温升高、腓肠肌试验阳性结果）、下肢深静脉血栓的发生例数低于对照组（P<0.05）；观察组患者的血浆D-二聚体水平低于对照组（P<0.05），股静脉血流速度、血流量高于对照组（P<0.05）。 结论 智能型多功能下肢疾患康复治疗仪可有效预防脑卒中偏瘫患者下肢深静脉血栓的发生。 Objective To explore the effectiveness of intelligent multifunctional rehabilitation instrument for lower limb diseases in preventing deep vein thrombosis in stroke patients with hemiplegia. Methods From September 2022 to September 2023, convenience sampling was used to select 121 stroke patients with hemiplegia admitted to the Department of Neurology, Neurosurgery, and Rehabilitation of Cangzhou Central Hospital as the study subject. The study subjects were divided into a control group (n=58) and an observation group (n=63) using the random number table method. The control group was treated with standard medication and routine rehabilitation nursing, while the observation group was treated with the intelligent multifunctional rehabilitation instrument for lower limb diseases on the basis of the control group. The intervention time was four weeks for both groups. This study compared the incidence of clinical symptoms of lower limbs (swelling, pain, skin temperature, gastrocnemius test results) and deep vein thrombosis in the lower limbs between two groups of patients after intervention. The plasma D-dimer levels, femoral vein blood flow velocity, and blood flow of the two groups of patients before and after intervention were also compared. Results After intervention, the number of cases of lower limb clinical symptoms (swelling, pain, elevated skin temperature, positive results of gastrocnemius muscle test) and deep vein thrombosis in the observation group was lower than that in the control group (P<0.05). In the observation group, the plasma D-dimer levels of patients were lower than those of the control group (P<0.05), and the femoral vein blood flow velocity and blood flow were higher than those of the control group (P<0.05) . Conclusions The intelligent multifunctional rehabilitation instrument for lower limb diseases can effectively prevent the occurrence of deep vein thrombosis in stroke patients with hemiplegia.

    卒中智能型多功能下肢疾患康复治疗仪偏瘫深静脉血栓

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