AIM:To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice. DESIGN:This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. METHODS:Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies. DATA SOURCES:UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023. RESULTS:We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were 'strong' and 5 were 'weak', 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two. CONCLUSION:The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE:The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients. IMPACT:The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients. REPORTING METHOD:This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is 'Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients', the registration number is 'ES20231823'.

从治疗负担的概念、主要内容、理论模型、影响因素、评估工具及缓解慢性心力衰竭病人治疗负担的干预策略等方面进行综述,以期为我国开展相关研究提供参考.

This article reviewed the concept，main content，theoretical models，influencing factors，assessment tools of treatment burden，and intervention strategies to alleviate treatment burden of patients with chronic heart failure.its aimed at providing reference for relevant research in China.

目的 探讨维持性血液透析(MHD)患者衰弱发生现状与影响因素,以便为构建护理干预措施提供依据.方法 于2021年12月—2022年3月,采用一般资料调查表、综合医院焦虑抑郁量表(HADS)、埃德蒙顿衰弱量表(EFS)对衡阳市某三级甲等医院血液净化中心的216例MHD患者进行调查,采用单因素分析、多因素Logistic回归分析,确定血透患者衰弱发生的影响因素.结果 MHD患者衰弱发生率为46.76％;多因素Logistic回归分析显示,年龄、服药种类、透析充分性、跌倒史为促成MHD患者衰弱发生的影响因素,白蛋白水平高、握力大为减少衰弱发生的因素,差异有统计学意义(P<0.05).结论 MHD患者衰弱发生率较高,且与年龄、白蛋白水平、服药种类、跌倒史、握力、透析充分性密切相关,针对上述影响因素尽早实施相应的护理干预措施,以降低MHD患者衰弱发生率.

目的:了解骨质疏松性椎体压缩性骨折患者骨质疏松知识和健康行为水平的现状,并分析两者之间的相关性.方法:采用便利抽样法选取2021年1-6月衡阳市某4家三级医院收治的300例骨质疏松性椎体压缩性骨折患者作为研究对象.采用骨质疏松知识问卷(OKT)及骨质疏松健康行为量表进行调查,并探讨两者之间的关系.结果:OKT总分平均(8.38±4.57)分;健康行为总分平均(52.93±7.52)分,两者总分均未达标;Pearson相关性分析显示,骨质疏松(OP)知识与健康行为总分呈正相关(r=0.678,P<0.01)

Purpose The purpose of this study was to translate and evaluate the psychometric properties of the Chinese version of the Upper Limb Lymphedema Quality of Life Questionnaire (C-ULLQoL). Methods Eighty-five participants completed the C-ULLQoL and the Functional Assessment of Cancer Therapy-Breast (C-FACT-B). The Cronbach's alpha (alpha) was used to determine the internal consistency, and intraclass correlation coefficients (ICCs) - to evaluate the test-retest reliability. The content validity index (CVI) was assessed by a group of experts. Construct validity was examined by performing factor analysis and criterion validity by observing the correlations between C-ULLQoL with C-FACT-B. Results Cronbach's alpha of the total scale was 0.930. ICC scores ranged from 0.874 to 0.938. The content validity of C-ULLQoL was acceptable. Two factors (65.488% of the variance) were extracted by exploratory factor analysis. A significant correlation was observed between C-ULLQoL and C-FACT-B (r = -0.611, p < 0.01). Conclusion The C-ULLQoL is a reliable and valid questionnaire that can be used in clinic and scientific practice for evaluating health-related quality of life in Chinese patients with breast cancer-related lymphedema.

目的 通过Meta分析系统评价维持性血液透析(maintenance hemodialysis,MHD)患者跌倒的发生率及影响因素.方法 计算机检索Web of Science、the Cochrane Library、EMbase、PubMed、中国生物医学数据库(CBM)、中国知网(CNKI)、维普数据库和万方数据库关于维持性血液透析跌倒发生率及影响因素的研究.检索时间为建库至2021年4月,利用Stata 12.0和Revman 5.3软件对符合纳排标准的文献进行系统评价.结果 纳入6项横断面研究,5项队列研究和1项病例对照研究,共2656位患者.Meta分析结果显示,维持性血液透析患者跌倒的总体发生率及95％CI为25％(0.19,0.30).各危险因素的OR或SMD及95％CI为:高血压1.50(0.84,2.67)、透析中低血压2.12(1.65,2.72)、糖尿病2.49(1.96,3.16)、衰弱3.15(2.01,4.92)、抑郁4.07(2.29,7.23)、外周血管疾病7.49(1.57,35.67)、使用辅助器械3.34(2.10,5.33)、年龄0.39(0.16,0.61)、透析龄0.25(0.05,0.45)、保护因素为血红蛋白-0.43(-0.61,-0.26).结论 维持性血液透析患者跌倒的危险因素众多,应尽早进行MHD患者跌倒风险评估并行早期预防和干预.

目的 探讨2型糖尿病患者(T2DM)并发糖尿病肾病(DKD)微量白蛋白尿的影响因素.方法 选取2020年8月至2021年4月衡阳市某两所三甲医院收治的308例T2DM患者作为研究对象,根据患者是否出现微量白蛋白尿进行分组,即尿白蛋白排泄率(UAER)为30～300 mg/24 h纳入DKD组,UAER＜30 mg/24 h纳入非DKD组.采用二元logistic回归分析T2DM患者发生DKD的影响因素.结果 本研究的308例T2DM患者中,DKD微量白蛋白尿患者有136例(44.16％),非DKD微量白蛋白尿患者有172例(55.84％).单因素分析结果显示,DKD组的年龄、糖尿病病程、收缩压、舒张压、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、高血压史人数占比、腹型肥胖人数占比高于非DKD组,自我效能评分、健康促进生活方式评分低于非DKD组,差异有统计学意义(P＜0.05);二元logistic回归分析结果显示,糖尿病病程(β=0.055,OR=1.057,95％CI=1.007～1.109)、收缩压(β =0.039,OR=1.040,95％ CI=1.016～1.064)、LDL-C (β=0.333,OR=1.395,95％CI=1.017～1.914)、腹型肥胖(β=0.596,OR=1.815,95％ CI=1.039～3.171)、HbA1c (β=0.182,OR=1.199,95％CI=1.071～1.344)是T2DM患者发生DKD微量白蛋白尿的危险因素(P＜0.05),健康促进生活方式评分(β=-0.018,OR =0.983,95％CI=0.967～0.998)、自我效能评分(β=-0.029,OR=0.972,95％CI=0.948～0.996)是T2DM患者发生DKD微量白蛋白尿的保护因素(P＜0.05).结论 随着糖尿病病程延长、血糖控制不佳,T2DM患者极易并发肾脏疾病,护理人员需注重提高患者的自我效能,倡导健康促进生活方式,从而预防或延缓DKD微量白蛋白尿的发生.

To explore the adoption effect of nano-silver medical antibacterial dressing in the perioperative treatment of patients with laryngeal cancer, 120 patients with early laryngeal cancer were selected as the research objects. According to the different treatments, they were averagely divided into the test group (laser vocal cord surgery under a laryngeal microscope and nano-silver medical antibacterial dressing) and the control group (laser vocal cord surgery under a laryngeal microscope and sterilized vaseline gauze). The results showed that there were considerable differences in dressing-change times, dressing-change cost, hospital stay, and recovery time between both groups (P<0.05). The number of mild pain cases in the test group was more than that in the control group at 1, 3, and 5 days after surgery, with statistically considerable differences (P<0.05). There were substantial differences in wound area between the two groups at 3 and 5 days after surgery, and the test group was larger than the control group (P<0.05). In the test group, 0 patients had postoperative reinfection, wound dehiscence, and wound hernia. In the control group, 3 patients had postoperative reinfection, 1 had wound dehiscence, and 1 had wound hernia. In summary, compared with traditional sterilized vaseline gauze, the nano-silver medical antibacterial dressing could reduce postoperative dressing pain and promote the recovery of wounds, thus shortening the hospital stay and improving the quality of life of patients after surgery.

目的 探讨本科内科护理学线上一流课程资源建设方法及在教学中的应用效果.方法 以湖南省线上一流课程内科护理学立项为契机,从建设目标、师资队伍、框架设计、内容遴选和微视频设计5个方面进行了课程资源建设.以南华大学船山学院2018级88名护理本科生为研究对象,基于线上内科护理学课程开展混合式教学,采用学习成绩、学生参与度和教学满意度评价其应用效果.结果 内科护理学课程线上资源共有微视频116个,总时长1122 min,涵盖9个章节;测验和作业的习题总数2315道,考试题库总数1346道,课外学习资料中,非视频资源(课件、教案、电子版教材、知识拓展等)411个.学生过程成绩为(88.28±7.42)分、期末成绩为(76.42±10.82)分,课程总评成绩为(82.44±8.84)分.任务点完成率、课程视频进度、章节测验进度均为100％,视频观看时长468～785(626.10±60.07)min,章节学习次数为111～535(253.91±98.92)次,学生在线参与讨论次数为15～91(51.49±12.42)次.学生对教学资源、教学平台、教学方式满意度分别为90.9％(80/88)、94.3％(83/88)和95.5％(84/88).结论 内科护理学线上一流课程资源丰富,基于线上课程的混合式教学应用良好.教师应该不断学习和应用教育新技术,着力建设有特色的线上一流课程和高效应用线上一流课程,充分发挥线上线下混合教学的优势,实现信息化环境下的教学创新.

Rehabilitation intervention which refers to the functional training by caregivers with the aid of specialized nursing techniques and the progressive promotion of patients' training initiative, with the purpose of improving mobility and quality of life, is of great significance. The purpose of the study was to investigate the effect of the rehabilitation intervention-centered targeted nursing model on the cardiac function recovery and negative emotions in patients with acute myocardial infarction (AMI). A total of 120 AMI patients admitted to our hospital between January 2019 and January 2020 were selected as the study subjects and randomly divided into group A (n = 60) and group B (n = 60), in which the group B patients received routine nursing combined with rehabilitation intervention, while based on the treatment in group B, the patients in group A underwent rehabilitation intervention-centered targeted nursing model. Then, the cardiac function indexes, negative emotion score, levels of risk factors for heart failure, complication rate (CR), and the quality of life (QOL) of the patients were compared between the two groups. The cardiac function indexes of the patients after nursing in group A were significantly better than those in group B (P < 0.001); the negative emotion scores of the patients after nursing in group A were significantly lower than those in group B (P < 0.001); the levels of risk factors for heart failure of the patients after nursing in group A were significantly lower than those in group B (P < 0.001); the CR of the patients in group A at 15 d and 30 d after admission was significantly lower than that in group B (P < 0.05); the QOL scores of the patients after nursing in group A were significantly higher than those in group B (P < 0.001). Rehabilitation intervention-centered targeted nursing model can optimize cardiac function, weaken the levels of risk factors for heart failure, reduce the incidence of complications, improve psychological conditions, and enhance the quality of life in AMI patients, which is worthy of application and promotion in clinical practice.

目的:研究快速康复外科护理在骨质疏松性椎体压缩性骨折患者围手术期中的效果.方法:将本次研究的时间选择在2021年7月-2021年12月,并将本研究时间内我院进行经皮椎体成形术(PVP)治疗的骨质疏松性椎体压缩性骨折患者80例设定为本次研究对象,将患者按照随机数字表法分为对照组和实验组,对照组患者在其围手术期接受常规护理干预,而实验组患者在其围手术期接受快速康复外科护理,并对两种护理方式所带来的临床效果进行对比分析.结果:实验组腰椎活动度、心理状态以及生活质量改善均优于对照组,护理满意度高于对照组,P ＜

目的 探讨老年心衰患者主要照护者照护能力与照护负荷的相关性,分析其影响因素,提高照护者照护能力,保证患者身心健康.方法 随机选取2018年12月至2020年12月郴州市某医院心脏重症监护室的老年心衰患者100例,采用照护者照护能力问卷和照护负荷问卷调查分析两者的相关性.结果 老年心衰患者主要照护者照护能力问卷总分为(52.12±7.27)分,照护负荷问卷总分为(37.35±11.62)分.Pearson相关分析显示,照护能力和照护负荷呈负相关关系(r=-0.33,P<0.01).文化程度、照护经验、患者疾病严重程度为照护者照护能力和照护负荷的影响因素(P<0.05).结论 本研究所选老年心衰患者主要照护者照护能力和照护负荷处于中等水平,应关注文化程度低、患者病情严重、无照护经验、照护负荷较重的照护者,提高老年心衰患者及其主要照护者的生活质量.

目的:分析生态瞬时评估法在疲乏纵向研究中的研究现状、趋势和发展前沿,为生态瞬时评估法在我国的进一步发展与应用提供参考和方向.方法:Web of Science核心合集数据库为数据来源,运用CiteSpace软件从文献年度发文量、国家和机构、学科领域分布、高频关键词及文献共被引5个方面进行可视化分析.结果:纳入444篇文献,发文量呈逐年上升趋势;美国发文量居首位;高强度突现学科为"ONCOLOGY""NURSING""PUBLIC,ENVIRONMENTAL&OCCUPATIONAL HEALTH"等;高频关键词为疲乏、生活质量、抑郁、症状、疼痛等;形成10个聚类群,分别为研究的疾病、内容与方法3个方面;被引文献的被引频次与中心性均较低.结论:目前生态瞬时评估法在国外疲乏纵向研究的领域与范围较小,多集中在临床医学护理领域,未来研究的热点会是抑郁、疼痛、失眠以及症状群等与生活质量相关的内容,提示研究者今后不仅要注重研究方向与研究内容的深层次开展,更要关注新方向、新主题的研究.

目的 调查不同射血分数类型慢性心衰患者存在营养不良风险的情况,并分析相关影响因素.方法 以2020年8-12月收治于衡阳市某三级甲等医院心内科的慢性心衰患者作为调查对象,采用一般资料调查问卷、营养风险筛查量表(NRS-2002)进行调查及评估.结果 共调查患者329例,存在营养不良风险者155例,占47.11％.其中,射血分数降低组患者中存在营养不良风险者占57.71％,高于射血分数中间值组(37.50％)和射血分数保留组(32.93％).logistic回归分析显示,年龄≥70岁、N末端B型利钠肽前体(NT-proBNP)及射血分数<40％均是慢性心衰营养不良风险的影响因素(P<0.05),淋巴细胞数值是其保护性因素(P<0.05).结论 慢性心衰患者存在较高的营养不良风险,其中射血分数降低的患者营养不良风险更高.临床护理工作中,应对年龄≥70岁、射血分数<40％及NT-proBNP升高的慢性心衰患者实施有针对性的营养评估,以及时发现患者的营养问题并进行干预,促进患者预后改善和生活质量提升.

Aim. The aim of this study is to evaluate the impact of Chinese native culture education based on Chinese native culture on the intercultural competence of undergraduate nursing students. Method. A quasi-experimental design with pretest and posttest was used. We recruited nursing students from 4 classes of the School of Nursing in our hospital in 2016 as research subjects. Undergraduate nursing students (n = 79) who completed one semester of education in indigenous Chinese culture completed a demographic questionnaire and the transcultural self-efficacy tool (TSET). Chinese native culture education is the topics related to nursing, consistent with the culture of Chinese patients under the background of Chinese native culture, including the dietary habits, taboos, religions, values, particularly Chinese medicine, and specific diseases. The control group (n = 91) was students who did not participate in Chinese native culture education and completed the instrument during the same time frame. Result. Students who participated in Chinese native cultural education significantly improved their transcultural selfefficacy in three dimensions: cognition, emotion, and practice. Compared with the control group, the students in the cultural education group had higher change scores in three sizes of transcultural self-efficacy. Conclusion. When strengthening cultural education for undergraduate nursing students, adding content related to Chinese native culture can improve their transcultural self-efficacy and meet the growing cultural needs of patients.

为探讨基于微课的线上线下教学在外科护理学总论实验教学中的应用效果,本文将2017级护理学本科8个班的239名学生以班为单位随机分为试验组(122名)与对照组(117名).试验组应用基于微课的线上线下教学模式,对照组采用传统的实验室教学.比较两组的操作成绩、课程总评成绩、学生对教学的评价.结果显示,试验组学生的操作平均成绩、课程总评成绩好于对照组,差异有统计学意义(P<0.05);试验组学生对教学的评价高于对照组(P=0.000,0.021).因此,基于微课的线上线下混合式教学能提高学生的学习兴趣,提高学习成绩,培养评判性思维能力.

目的:调查新冠肺炎患者的焦虑症状并分析相关因素.方法:新冠肺炎患者108例,采用自编一般资料调查表、广泛性焦虑量表(GAD-7)、简易应对方式量表(SCSQ)进行调查.结果:GAD-7总分(10.3±4.5)分.对GAD-7各条目进行秩和检验发现,有焦虑症状患者的GAD-7得分大于无焦虑症状患者(P＜0.05).GAD-7总分与积极应对得分呈负相关(r=-0.44,P＜0.001),与消极应对得分呈正相关(r=0.31,P＜0.01).二分类logistic回归分析显示,有发热症状、有接触史是焦虑症状的危险因素(OR =33.40、18.13),男性、积极应对是焦虑症状的保护因素(OR=0.02、0.03).结论:新冠肺炎患者为女性、出现发热、有接触史时其焦虑症状越严重.

目的 了解老年维持性血液透析患者认知衰弱现状,探讨其发生的主要影响因素.方法 于2020年5月～7月,通过便利抽样法,采用Fried衰弱表型量表、蒙特利尔量表(长沙版)、临床痴呆评定量表、Zung氏抑郁自评量表,对衡阳市三所三级甲等医院的204例老年血透患者进行现况调查.结果 老年维持性血液透析患者发生认知衰弱42例,发生率为20.58％.单因素分析结果提示,两组性别、受教育程度、婚姻状况、居住状态、付费方式、血透期、乙肝(丙肝)病史、饮酒、吸烟占比比较,差异无统计学意义(>0.05);不同年龄、脑卒中病史、合并症数量及抑郁程度的老年MHD患者认知衰弱比较,差异具有统计学意义(<0.05).Logistic回归模型结果显示,高龄、合并3种及3种以上并发症、有脑卒中病史和中、重度抑郁是老年维持性血液透析患者认知衰弱发生的危险因素.结论 老年维持性血液透析患者认知衰弱患病率较高,高龄、合并3种及3种以上并发症、有脑卒中病史和中、重度抑郁患者易发生认知衰弱.应加强早期认知衰弱筛查,促进患者的自我管理从而减少合并症及脑卒中的发生,帮助患者减轻心理负担情绪可有效预防认知衰弱发生的风险.

目的 探讨喉癌术后患者自我效能感和创伤后成长水平的相关性.方法 2019年1月～2020年9月采用一般资料调查表、中文版癌症自我管理效能感量表(C-SUPPH)和简体中文版创伤后成长评定量表(C-PTGI)对襄阳市三级甲等医院首发喉癌确诊的162例患者进行调查.结果 喉癌术后患者自我效能感得分为(77.46±20.25)分、创伤后成长得分(55.68±8.90)分;自我效能感总分与创伤后成长总分及其各维度的得分均呈正相关(P<0.05);自我效能、并发症、手术方式、受教育程度是创伤后成长状况的影响因素,共解释了创伤后成长水平47.20％的变异量.结论 喉癌术后患者的创伤后成长状况与自我效能感密切相关.应采取个性化、可操作的干预措施,提高喉癌术后患者的自我效能感,进而有效促进创伤后成长,加速康复.