目的:分析小丑疗法在小面积Ⅱ度烧伤患儿换药中的应用效果.方法:选择2021年10月-2022年5月笔者医院收治的100例烧伤患儿为研究对象,按随机数字表法分为小丑组和对照组各50例,每名患儿由一名固定家属陪同入组.对照组采用常规换药法换药;小丑组采用小丑疗法换药.比较两组换药时患儿疼痛程度[面部表情疼痛评定法(Face pain scale,FPS)]、换药过程中患儿的依从性及第三次换药结束后家属对护理服务的满意度.结果:三次换药时,小丑组的FPS疼痛评分均低于对照组(P＜0.05),换药依从率均高于对照组(P＜0.05);第3次换药结束后,小丑组家属对护理服务的满意度评分高于对照组(P＜0.05).结论:小丑疗法可以有效提高患儿换药的依从性,减轻烧伤患儿换药疼痛程度,缩短患儿哭闹时间,提高患儿家属对护理服务的满意度.

目的 探讨神经外科患者术后痰培养细菌耐药情况以及肺炎克雷伯菌耐药基因,为神经外科肺部感染患者经验性用药提供依据.方法 选取2016年1月-2020年12月空军军医大学第一附属医院1 331例神经外科下呼吸道感染患者送检的5 362份痰标本,使用全自动细菌鉴定仪对术后痰液进行分离病原菌和鉴定,采用纸片扩散法分析其耐药性,并检测肺炎克雷伯菌耐药基因.结果 5 362份痰标本,共分离出病原菌4 809株.其中革兰阳性菌1 130株(23.50％),主要以金黄色葡萄球菌、纹带棒状杆菌、肺炎链球菌为主;革兰阴性菌3 560株(74.03％),主要以鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌为主;真菌119株(2.47％).革兰阳性菌对青霉素、克林霉素的耐药率较高,多数对万古霉素、利奈唑胺较敏感;革兰阴性菌对头孢唑林、头孢曲松、氨苄西林/舒巴坦、四环素的耐药率较高,多数对替加环素、黏菌素较敏感;碳青霉烯耐药肺炎克雷伯菌blaKPC、blaTEM、blaSHV、blaNDM、armA、rmtB 耐药基因的检出率为 83.58％、96.72％、90.45％、6.57％、11.04％、64.48％.结论 神经外科患者术后下呼吸道感染的病原菌以革兰阴性菌为主,且整体耐药水平较高,尤其是部分肺炎克雷伯菌携带金属酶基因等,临床应根据药敏、耐药表型与基因检测及时调整用药.

目的 分析我国失能老人照护研究热点及进展,为更好地照护失能老人和今后的研究提供参考和依据.方法 检索中国知网中发表的关于失能老人照护的文献,利用CiteSpace 5.8.R3从作者、研究机构及关键词三方面进行知识图谱的可视化分析.结果 共筛选出758篇文献,失能老人照护的发文量整体呈上升趋势,少数作者发挥核心作用,机构间缺乏学术交流与合作;政策因素是推动失能老人照护研究的重要因素;热点主题可以归纳为长期照护、照护方式、照顾者;"照护需求""居家护理""医养结合"是我国学者未来持续关注的热点.结论 失能老人照护问题是我国养老事业的重点和难点,也是学者关注的重点,我国关于失能老人照护的各项制度、举措正处于积极探索与试点阶段,在未来的研究中应加强学者之间、机构之间的合作网络建设,鼓励更多社会力量积极参与进来,构建一整套与社会主义制度相适应的照护体系.

Objective To construct an early warning system for postpartum urinary retention to reduce the incidence of post-partum urinary retention,and improve maternal satisfaction.Methods Based on the needs of puerperal women,KJ method,Ka-no model,Quality House and other tools,combined with TRIZ theory and HFMEA,were used to establish a standardized postpar-tum urine retention early warning score system.Three-level early warning and grading care for puerperal urine retention,and post-partum continuous care services were provided.Results The incidence of postpartum urinary retention decreased from 4.5%to 2.3%,the duration of first urination decreased from 4.8h to 3.1h,the incidence of negative emotion decreased from 43%to 15%,and the hospitalization satisfaction increased from 90%to 98%.Conclusion Combining quality function development with quality control circle can effectively identify the postpartum needs,reduce the incidence of maternal urinary retention,improve maternal sat-isfaction.

目的 明确影响糖尿病患者再入院的相关因素,为护理人员评估和识别高危人群提供理论依据.方法 计算机检索中国知网、万方数据库、维普数据库、PsycINFO文献数据库、PubMed、Medline、Cochrane Library、Web of Science、SinoMed等中英文数据库,检索时限为建库至2022年6月,对纳入文献进行数据提取和质量评价,采用RevMan 5.3统计软件进行Meta分析.结果 共纳入17篇文献,包括52项危险因素.Meta分析结果显示,女性(OR=0.95,95％CI0.93～0.96,P＜0.000 01)、血糖(OR=1.41,95％CI1.16～1.70,P=0.000 4)、住院时间(OR=1.04,95％CI1.00～1.08,P=0.04)、残疾(OR=1.58,95％CI 1.30～1.92,P＜0.000 01)、退 休(OR=1.45,95％CI 1.31～1.61,P＜0.000 01)、失 业(OR=1.35,95％CI 1.26～1.45,P＜0.000 01)、使用胰岛素(OR=1.19,95％CI 1.14～1.24,P＜0.000 01)、血钠低(OR=1.19,95％CI 1.08～1.30,P=0.000 3)、红细胞压积(OR=0.90,95％CI 0.89～0.92,P＜0.000 01)、不遵医嘱出院(OR=1.63,95％CI1.53～1.72,P＜0.00001)、急诊(OR=1.20,95％CI1.18～1.21,P＜0.00001)、液体和电解质紊乱(OR=1.15,95％CI1.08～1.22,P＜0.00001)、心力衰竭(OR=1.24,95％CI1.15～1.33,P＜0.000 01)、合并症(OR=1.12,95％CI 1.00～1.25,P＜0.05)、肾衰(OR=1.98,95％CI 1.79～2.19,P＜0.000 01)、贫血(OR=1.25,95％CI1.15～1.36,P＜0.00001).结论 女性、血糖、住院时间、残疾、退休、失业、使用胰岛素、血钠低、红细胞压积、不遵医嘱出院、急诊、液体和电解质紊乱、心力衰竭、合并症、肾衰、贫血是影响糖尿病患者再入院的因素.

目的 探讨早期标准化活动方案结合5A护理模式在重症监护室(ICU)机械通气患者中的应用效果.方法 选取2020年1月至2021年3月我院96例ICU机械通气患者作为研究对象,按护理方案不同将其分为对照组和观察组,各48例.对照组给予常规护理,观察组在对照组基础上给予早期标准化活动方案结合5A护理模式.比较两组的护理效果.结果 观察组的机械通气时间、肌力恢复正常时间、ICU住院时间短于对照组,吸痰次数少于对照组(P<0.05).观察组的不良事件总发生率、下肢深静脉血栓发生率低于对照组(P<0.05).护理后,观察组的血栓调节蛋白(TM)、凝血酶-抗凝血酶复合物(TAT)、组织型纤溶酶原激活物-抑制剂复合物(t-PAIC)水平低于对照组(P<0.05).结论 早期标准化活动方案结合5A护理模式可有效改善ICU机械通气患者通气状态,缩短ICU住院时间,降低下肢深静脉血栓发生率,值得推广.

目的:了解 2011 年―2021 年国内外机器学习在护理领域的研究现状、热点及前沿动态,旨在为该领域深入开展机器学习相关研究提供借鉴和参考.方法:检索Web of Science核心数据库中的相关文献,采用CiteSpace软件对纳入文献进行可视化分析.结果:共纳入 5 992 篇有效文献,发文量呈不断上涨趋势,文献最高被引频次为58次,高频关键词有"nurse"(护士)、"prevalence"(患病率)、"risk factor"(危险因素)等;突现关键词有"satisfaction"(满意度)、"cost"(成本)、"readmission"(再入院)等.结论:机器学习作为一种强大的统计工具,为护理的信息化发展提供新模式和新经验,我国科研人员在保证科研产出的同时,应注意加强跨地区合作,加大科研投入,同时注重跨学科协同创新护理人才的培养,切实推进我国护理信息化、智能化的发展.

目的 探讨固摄补肾针刺法配合经颅直流电刺激治疗脑卒中尿失禁的效果.方法 选择2020 年12 月—2021 年12 月空军军医大学第一附属医院收治的脑卒中尿失禁患者84 例,随机分成对照组和观察组各42 例.2 组患者均予内科常规治疗和排尿反射训练,对照组联合经颅直流电刺激治疗,观察组联合经颅直流电刺激及固摄补肾针刺法治疗,2 组均连续治疗8 周.观察比较2 组患者治疗前及治疗8 周后国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-UI SF)评分、尿失禁生活质量问卷量表(I-QOL)评分、72 h排尿日记、膀胱最大容量、残余尿量变化,评估 2 组临床疗效及治疗安全性.结果 与治疗前比较,治疗8 周后2 组患者ICIQ-UI SF评分明显降低,夜尿次数、白天排尿次数、总排尿次数、尿失禁次数、残余尿量均明显减少,I-QOL评分明显升高,平均每次尿量、膀胱最大容量均明显增加,且观察组上述指标较对照组改善更明显,差异均有统计学意义(P均<0.05);观察组总有效率为92.9％(39/42),明显高于对照组的69.0％(32/42),差异有统计学意义(P<0.05);2 组治疗期间均未发生与经颅直流电刺激和针刺治疗相关的不良事件.结论 固摄补肾针刺法配合经颅直流电刺激治疗脑卒中尿失禁疗效十分显著,能够减少尿失禁次数,减轻尿失禁程度,增大膀胱容量,改善患者生活质量,有助于促进患者机体功能康复.

目的 构建野战医疗所战创伤护理技术体系.方法 在文献回顾和小组讨论的基础上拟定野战医疗所战创伤护理技术体系初稿,编制成咨询问卷,选择16名相关领域专家进行德尔菲专家咨询.结果 构建的野战医疗所战创伤护理技术体系共包含4个一级指标、17个二级指标、48个三级指标,共发放两轮专家咨询问卷,回收率均为100％,两轮专家权威系数为0.832,变异系数分别为0.107～0.115、0.106～0.111,协调系数分别为0.190～0.317、0.346～0.458,差异均具有统计学意义(P<0.05).结论 构建的野战医疗所战创伤护理技术体系具有科学性和可操作性,可以为野战医疗所战创伤护理技术培训与考核提供理论依据,具有理论和实际意义.

目的 探讨磁性管理理念在综合医院外勤中心管理中的应用效果.方法 以综合医院外勤中心人员为研究对象,2020 年 1 月至 12 月实施外勤中心常规管理,2021 年 1 月至 12 月实施磁性管理理念.比较磁性管理理念实施前、后外勤人员离职率和临床科室对外勤人员的满意度.结果 磁性管理理念实施后,外勤人员离职率降低至 2.04%;磁性管理理念实施后,临床科室对外勤人员的满意度评分为(96.78±3.12)分,高于实施前的(92.16±2.08)分(P＜0.05).结论 磁性管理理念应用于综合医院外勤中心管理中,可明显降低人员的离职率,提高临床科室对外勤人员的满意度,有利于提升护理质量.

Objective: To construct the minimum data set of quality control in the key links of nursing, with a view to the application of quality control effects in the process of nursing quality control informatization. Methods: By consulting literature and national standards, expert correspondence and based on the third normal form theory of database, the minimum data set of quality control in key links of nursing was developed and applied to the practice of nursing quality control informatization. The changes of nursing quality control time and nursing quality indexes before and after application were compared. Results: The minimum data set of quality control for key links of nursing included 38 items in 6 categories,namely 2 items of personnel management, 2 items of medication management, 12 items of clinical nursing and safety management, 9 items of nursing document management, 8 items of health education management and 5 items of quality management data. After application, the cumulative time of quality control information input, feedback and statistics was significantly shortened（P＜0.001）, the effective rate of patient identification, the qualified rate of nursing document writing,the qualified rate of overall nursing of responsibility system, the awareness rate of patient health education, and the follow-up rate of discharged patients have increased（P＜0.05）, and the incidence of falls in hospitalized patients decreased significantly（P＜0.05）. Conclusion: The application of the minimum data set of quality control in the key links of nursing effectively promoted the informatization, standard processing and rapid feedback of quality control data, and improved the evaluation efficiency of nursing quality control and clinical nursing quality.

Schizophrenia patients with auditory verbal hallucinations (AVHs) are diseased groups of serious psychosis with still unknown etiology. The aim of this research was to identify the neurophysiological correlates of auditory verbal hallucinations. Revealing the neural correlates of auditory hallucination is not merely of great clinical significance, but it is also quite essential to study the pathophysiological correlates of schizophrenia. In this study, 25 Schizophrenia patients with AVHs (AVHs group, 23.2 ± 5.35 years), 52 Schizophrenia patients without AVHs (non-AVHs group, 25.79 ± 5.63 years) and 28 healthy subjects (NC group, 26.14 ± 5.45 years) were enrolled. Dynamic functional connectivity was studied with a sliding-window method and functional connectivity states were then obtained with the k-means clustering algorithm in the three groups. We found that schizophrenia patients with AVHs were characterized by significant decreased static functional connectivity and enhanced variability of dynamic functional connectivity (non-parametric permutation test, Bonferroni correction, p < 0.05). In addition, the AVHs group also demonstrated increased number of brain states, suggesting brain dynamics enhanced in these patients compared with the non-AVHs group. Our findings suggested that there were abnormalities in the connection of brain language regions in auditory verbal hallucinations. It appears that the interruption of connectivity from the language region might be critical to the pathological basis of AVHs.

目的 降低宫颈癌根治术患者术后尿管重置率.方法 成立品管圈圈组,对宫颈癌根治术患者术后14 d尿管重置情况进行解析,针对问题真因制定措施加以改进,包括优化术式,规范流程与制度,构建多学科康复团队,建立盆底治疗中心等.结果 宫颈癌根治术患者术后尿管重置率从36.07％降低至15.00％.结论 品管圈活动降低了宫颈癌根治术患者术后尿管重置率,减少了泌尿系统感染风险,提高了患者生活质量,在使患者受益的同时优化了医疗资源配置.

目的 评价野战医疗所环境消毒方案和手卫生效果.方法 通过现场采样和细菌分离鉴定方法,对所建立的野战医院环境消毒方案和手卫生效果进行评价.结果 经过紫外线照射消毒法和化学消毒剂消毒方法,使野战医院环境室内空气和物体表面卫生质量得到提高.室内空气合格率由消毒前的4.76％提高到消毒后的79.36％;物体表面合格率由26.31％提高到52.63％.医务人员手卫生合格率为83.33％.野战医院环境标本分离出枯草杆菌、表皮葡萄球菌、鲍曼不动杆菌、大肠埃希菌等致病菌.结论 本研究野战医院的消毒方案适应野战环境医院感染管理的需要,便于组织实施,可以保障野战条件卫生质量.

目的 拟构建护理岗位文职人员初级晋中级培养指标体系.方法 运用文献阅读法及德尔菲专家咨询法初步构建护理岗位文职人员初级晋中级培养指标体系.结果 专家积极系数分别为95％和100％;专家权威程度为0.907;Ⅰ、Ⅱ级指标的Kendall's W协调系数分别为0.45和0.42(P＜0.001).初步确立了护理岗位文职人员初级晋中级培养指标体系,包含I级指标4个、Ⅱ级指标24个.结论 参与专家的积极性、权威性较好,其代表性和意见协调性较高,该指标体系的构建可为各级医院制定护理岗位文职人员初级晋中级综合能力培养方案提供参考.

目的:调查消化内镜护士专科培训及职业发展需求,为明确消化内镜专科护士规范化培训方案、推进护士职业持续发展提供参考依据.方法:采用自行设计的消化内镜护理工作问卷对全国28个省、自治区、直辖市的消化内镜护士进行调查.结果:调查对象4509人,33.40％的调查对象认为学校所学知识和技能不能满足目前岗位需要;团队协作能力(76.98％)、临床动手能力(76.56％)、沟通交际能力(74.01％)等相关素质及能力非常重要;80.53％的调查对象认为建立消化内镜专科护士培训基地是目前最亟待解决的问题.结论:应尽快完善消化内镜专科护士的标准化培训体系,实施消化内镜专科护士全国性的资格认证,多途径满足各级护理人员对消化内镜护理专业知识的学习和考核.

Background: As one of the main participants in health care, nurses are esteemed an important driving force for the vigorous health care development. Studies report that nurses’ proactive personality has positive effects on their job performance; however, this relationship acquires further understanding. Objective: A cross-sectional study was performed to explore the relationship between nurses’ proactive personality and job performance; the mediating role of nurses’ competency and work engagement in this relationship was also evaluated. Methods: The study was performed in a large third-degree general hospital in October 2019, Xi’an, PR, China. A sample of 246 nurses participated in this cross-sectional study. Proactive personality was assessed with the Proactive Personality Questionnaire (PPS), job performance was assessed by Heilman three-item measurements, nurse competence was estimated with Nurse Competency Scale (NCS), and work engagement was assessed with the Utrecht Work Engagement Scale (UWES). The structural equation model was used to test the main hypotheses. Results: Structural equation model analysis revealed that work engagement partially mediated the association between proactive personality and job performance. The serial two-mediator model which was used to explore the association between proactive personality and job performance through competency and work engagement, in sequence, was demonstrated. Conclusion: This study demonstrates that work engagement partially mediated the association between nurses’ proactive personality and their job performance. The serial two-mediator model demonstrated that proactive personality was associated with job performance via competency and work engagement. This study also revealed the critical role of nursing managers in understanding the nurses’ proactive personality, which would facilitate them to enhance the latter’s competency and promote their work engagement. All these will in turn constantly improve the overall quality of nursing and advance professional development of nursing and benefits for patients.

目的 探讨脊髓损伤患者的感恩水平及其影响因素.方法 2018年11月-2019年6月,采用自行设计的一般资料调查问卷、感恩量表、积极心理资本量表、社会支持量表,便利抽取3所三甲医院的385例脊髓损伤患者为研究对象进行问卷调查,并分析感恩水平的影响因素.结果 本研究患者感恩得分为(28.03±4.74)分,46.5％患者感恩得分低于平均值,心理资本总分为(117.63±16.27)分,社会支持总分为(61.59±9.23)分.多因素分析结果显示,心理资本、社会支持、损伤程度、年龄、有无并发症及文化程度对患者感恩水平具有显著预测作用(P<0.05).结论 脊髓损伤患者感恩得分处于中等偏低水平,心理资本、社会支持、损伤程度、年龄、有无并发症及文化程度是脊髓损伤患者感恩水平的主要影响因素.

目的 探讨俯卧位通气是否对主动脉夹层手术后严重低氧血症的患者有效.方法 选择2015年12月至2017年11月在本科行主动脉夹层动脉瘤手术治疗336例,将术后动脉血氧合指数(OI)≤100的59例患者随机分为两组,一组继续应用呼吸机治疗,29例;另一组实施呼吸机治疗+俯卧位通气治疗,30例.结果 在开始治疗后第2h、6h、12 h分别做血气分析,俯卧位组动脉气分压(PaO2)、OI较治疗前显著上升(P＜0.05),且高于仰卧位组(P＜0.05).两组间治疗前后动脉二氧化碳分压(PaCO2)改变无统计学差异(P＞0.05).俯卧位比仰卧位组的呼吸机时间和ICU停留时间均显著缩短.结论 俯卧位通气可有效改善主动脉夹层手术后低氧血症.