目的 调查首次经皮冠脉介入(PCI)术后患者的电子健康素养现状,并分析其影响因素.方法 2021年10月-2022年2月,便利抽取河南省某三级甲等医院心内科住院的272例首次PCI术后患者作为研究对象,采用一般资料调查表、电子健康素养量表进行调查,并采用单因素分析和多重线性回归分析首次PCI术后患者电子健康素养的影响因素.结果 首次PCI术后患者的电子健康素养得分为(24.06±3.67)分.多重线性回归分析结果显示,年龄、是否愿意使用网络查找相关健康信息、获取健康信息的途径、网络健康信息自我感知可信度、获取网络健康信息的重要性是电子健康素养的影响因素(P＜0.05),共解释变异率的38.6％.结论 首次PCI术后患者的电子健康素养水平有待提高,医护人员应采取电子健康素养技能培训及专业健康网站使用培训等针对性干预措施,以提高首次PCI术后患者的电子健康素养水平.

目的 构建基于案例库的新入职护士危急症护理培训方案,为临床新入职护士的危急症护理核心能力培养提供参考.方法 通过案例收集与编写、案例审核与修订、案例编码入库形成包括8个病种、38个危急症案例的案例库.在文献分析和访谈的基础上设计基于案例库的危急症护理培训方案初稿,采用专家小组会议法对8名专家进行2轮修改论证,形成新入职护士危急症护理培训方案.结果 最终确定包括培训目标、培训活动实施策略、培训内容及考核评价4个方面的新入职护士危急症护理培训方案,专家权威系数为0.938.结论 基于案例库的新入职护士危急症护理培训方案具有较好的科学性与可靠性,可用于三级甲等医院新入职护士的危急症护理培训,但有待通过实践进行完善.

The evaluation of acute alcohol impairment is an important basis for evaluating the physiological and psychological status of patients and judging their treatment and nursing measures.There is a large number of research on acute alcohol impairment by foreign researchers,but there are few relevant research reports in China.This article reviews the origin,development and the evaluation tools of acute alcohol impairment in the context of emergency treatment,and summarizing its advantages and disadvantages by comparing the content,evaluation methods,applicable population,reliability and validity of each evaluation tool,in order to provide scientific references for the evaluation,treatment and nursing care of acute alcohol impairment for emergency departments in China.

Objective:To investigate the occurrence and influencing factors of cerebral microbleeds in patients with acute cerebral infarction.Methods:This study was a prospective cohort trail. A total of 114 patients with acute cerebral infarction treated in Henan Provincial People’s Hospital from January 2020 to January 2023 were selected. According to occurrence of cerebral microbleeds during the visit, the selected patients were divided into occurrence group and non-occurrence group. The baseline data of the two groups were counted and compared. Univariate and multivariate logistic regression analysis was used to test the influencing factors of cerebral microbleeds in patients with acute cerebral infarction.Results:Forty-two of 114 patients developed cerebral microbleeds, with an incidence of 36.84% (42/114). There were statistical significant differences in hypertension, 24-hour systolic blood pressure coefficient of variation (SBP-CV), 24-hour diastolic blood pressure coefficient of variation (DBP-CV), glomerular filtration rate, platelet distribution width and serum 25-hydroxyvitamin D between the two groups ( P<0.05). Results of logistic regression analysis showed that elevated 24 h SBP-CV, elevated 24 h DBP-CV, decreased glomerular filtration rate, decreased serum 25-hydroxyvitamin D, and increased platelet distribution width were related factors affecting the occurrence of cerebral microbleeds in patients with acute cerebral infarction ( P<0.05). Conclusions:The incidence of cerebral microbleeds in patients with acute cerebral infarction is relatively high, which is mainly influenced by 24 h SBP-CV, 24 h DBP-CV, glomerular filtration rate, serum 25-hydroxyvitamin D and platelet distribution width.

目的:调查急诊科护士的职业悲伤现状并分析其影响因素.方法:采用便利抽样法2022年8月—2022年10月选取河南省6所三级甲等医院的366名急诊科护士为研究对象,采用一般资料调查表、修订版悲伤体验量表、中文修订版死亡态度描述量表、临终关怀态度量表、心理脱离量表、社会支持评定量表进行调查.结果:急诊科护士职业悲伤总分为(44.60±5.05)分;多元线性回归分析结果显示,宗教信仰、接触死亡形式、接受死亡教育培训情况、接受临终关怀教育情况、接触死亡频率、自然接受、死亡逃避、临终关怀态度、心理脱离、社会支持是急诊科护士职业悲伤的影响因素(P<0.05),共解释总变异的40.7％.结论:急诊科护士职业悲伤处于轻度水平,提示护理管理者应及时关注急诊科护士的心理健康,采取针对性措施,帮助其降低职业悲伤水平,以促进其悲伤成长.

Objective To analyze the value of psychological nursing combined with health education in the nursing of patients with acute myocardial infarction. Methods 160 patients with acute myocardial infarction treated in our hospital from January 2021 to June 2021 were selected as the research object,and divided into two groups according to the “Random number table method”（80 cases in each group）. The control group received routine nursing,and the observation group carried out psychological nursing combined with health education on the basis of the control group. The psychological emotional state,nursing effect and self-efficacy of the two groups were compared. Results The scores of SDS,SAS and SSS in the observation group were lower than those in the control group（T values were 9.823,8.202and 3.631,P＜0.05）. The scores of treatment compliance（96.42±4.24）,nursing satisfaction（95.14±6.92）and mastery of health-related knowledge（96.24±3.46）in the observation group were higher than those in the control group（T values were 11.160,11.197 and 23.451,P＜0.05）. The self-efficacy score of the observation group（31.42±4.61）was higher than that of the control group（27.25±5.05）（t value was 5.449,P＜0.05）. Conclusion Choosing psychological nursing combined with health education in the nursing of patients with acute myocardial infarction can improve their psychological state and self-efficacy,and then improve their treatment compliance.

目的:基于ABC-X模型探究急诊科护士工作投入现状并分析其影响因素及内在作用机制.方法:便利抽取河南省二级及以上医院的392名急诊科护士为研究对象,采用一般资料调查表、工作投入量表、工作场所暴力测定频度量表、医护人员抗逆力量表、工作-家庭支持量表、共情疲劳量表对其进行调查.结果:急诊科护士工作投入总分为(51.29±10.36)分;抗逆力、工作-家庭支持与工作投入呈正相关,遭受暴力频度、共情疲劳与工作投入呈负相关(均P＜0.01).暴力频度、工作-家庭支持与共情疲劳能直接影响工作投入,且暴力频度、工作-家庭支持均通过共情疲劳间接影响工作投入.结论:急诊科护士工作投入处于较低水平,暴力频度、工作-家庭支持与共情疲劳是工作投入的主要影响因素,且存在相互作用.建议护理管理者采取针对性措施,营造安全的科室环境,减少工作场所暴力发生频度,减轻其共情疲劳,进而提高工作投入水平.

Objective: To investigate the humanistic care consciousness and ability of outpatient and emergency nurses in tertiary Grade A hospitals in Zhengzhou City. Methods: In June 2021, a total of 345 outpatient and emergency nurses from 6 tertiary Grade A hospitals in Zhengzhou City were selected as the survey objects by random number table method. The humanistic care ability of outpatient and emergency nurses was investigated. Multiple linear regression analysis was used to analyze the related factors influencing the humanistic care ability of outpatient and emergency nurses. Results: The total score of humanistic care ability of outpatient and emergency nurses in Zhengzhou tertiary Grade A hospital was (194.18±30.53). The scores of humanistic care ability of outpatient and emergency nurses with different gender, age, educational background, professional title, length of service, night shift frequency, marital status, children's status, employment patterns and average monthly household income were significantly different (P<0.05). Regression analysis showed that education background, length of service, professional title and night shift frequency were independent influencing factors for outpatient and emergency nurses' humanistic care ability (β=0.243, 0.139, 0.163, -0.126, P<0.05) . Conclusion: At present, the humanistic care ability of outpatient and emergency nurses in tertiary Grade A hospitals in Zhengzhou City is still low. Education, length of service, professional title and night shift frequency are independent influencing factors affecting the humanistic care ability of nurses.

随着经济社会的发展,心血管疾病已经成为全球的主要死亡因素,严重危害人类健康[1].主动脉内球囊反搏(IABP)作为目前应用最广泛的机械循环辅助装置,已经成为心血管疾病患者治疗不可或缺的手段[2].心脏康复(cardiac rehabilitation,CR)是指为心脏病患者提供生理、心理、社会环境的支持,最大限度地恢复患者的生理功能和社会功能[3].大量研究已证实,对心肌梗死、心力衰竭、心脏外科围手术期等心血管病患者进行早期心脏康复能够有效改善患者心肺功能、提高患者的运动能力和生活质量[4-6],最新欧美指南也均强调早期心脏康复在心血管疾病临床治疗中的作用[7,8].但是,目前临床上为防止IABP术后导管移位等并发症,常规对置管侧下肢进行制动,但是肢体制动又进一步增加了患者下肢静脉血栓和运动功能减弱的风险.ICU护士作为IABP患者的主要照护者,其对早期心脏康复的认知可能会影响到早期心脏康复的实施,为了了解ICU护士对IABP患者早期心脏康复的认知现状及影响因素,本研究针对我院ICU护士开展了相关调查,现报告如下.

目的 探讨颅脑损伤患者MSCT征象特点及检查时有效的护理措施.方法 选取104例颅脑损伤患者,均行MSCT检查并对图像进行评分,利用格拉斯哥预后(GOS)评分对患者的预后情况进行评价,分析影像学评分与GOS评分之间的相关性.结果 MSCT检查显示104例患者中29.81％为硬膜下血肿、25％为脑挫伤、21.15％为颅脑损伤、18.27％为硬膜外血肿、5.77％为弥漫性轴索损伤.经相关治疗干预6个月后预后情况良好者61例,预后情况不佳者43例,前者鹿特丹CT评分明显低于后者(P＜0.05);经Pearson相关性分析显示,预后结局与MSCT影像学评分之间呈负相关性(r=-0.869,P＜0.05).104例患者MSCT平均检查耗时(17.64±3.58)min;检查期间意外事件总发生率5.77％、护理总满意度90.38％.结论 MSCT检查可以辅助预测患者预后情况;而在分阶段给予相应的护理干预可以减少意外事件的发生,提高患者家属的满意度.

目的 探讨基于循证医学编制的体外膜肺氧合(ECMO)危重症患者院内转运单的实施效果.方法 选取医院急诊重症监护室2018年10月—2019年9月收治的20例危重症患者为对照组(实施前),选取医院急诊重症监护室2019年10月—2020年9月收治的20例危重症患者为观察组(实施后).成立危重症患者院内转运调研编制小组,通过循证医学,制定ECMO危重症患者转运核查单,在2轮的循环下发现临床实践过程中的问题,修正与完善核查单项目,对比两组患者转运过程中不良事件发生率、转运所需时间与转运前评估时间.结果 与对照组对比,观察组患者不良事件总发生率大幅下降,转运前评估时间与转运所需时间大幅缩短,组间比较差异有统计学意义(P<0.05).结论 基于循证医学编制的ECMO危重症患者院内转运单,可完善转运前所需的物资,避免转运途中紧急情况急救,避免单纯经验性记忆造成的准备不完善和大量耗时等问题,降低转运途中风险,保证临床护理服务质量.

目的 探讨外周血胱抑素C(sCysC)联合尿N-乙酰-β-D-氨基葡萄糖苷酶(uNAG)对重症感染患者急性肾损伤(AKI)的预测价值.方法 回顾性分析2019年1月-2020年3月河南省人民医院重症医学科(ICU)收治的300例重症感染患者的临床资料,患者依据KDIGO标准分为AKI组80例和非AKI组220例,对比其临床资料和sCysC、uNAG水平,并根据AKI严重程度将AKI组患者分为轻症AKI患者50例和重症AKI患者30例,对比两组sCysC、uNAG水平,采用受试者工作曲线(ROC)及曲线下面积(AUC)分析sCysC、uNAG对重症感染患者AKI及重症AKI的预测价值.结果 AKI组sCysC、uNAG分别为(0.91±0.18)mg/L、(3.85±0.92)Um-mol/L高于非AKI组(P<0.001);重症AKI患者sCysC、uNAG分别为(1.06±0.14)mg/L、(5.32±0.79)Um-mol/L高于轻症AKI组(P<0.001).sCysC、uNAG单独及联合检测预测重症感染患者AKI的AUC分别为0.858、0.886、0.924,联合检测预测重症感染患者AKI的AUC大于单独检测(P<0.001).sCysC、uNAG单独及联合检测预测重症感染患者重症AKI的AUC分别为0.727、0.833、0.886,联合检测预测重症感染患者重症AKI的AUC大于单独检测(P<0.001).结论 sCysC、uNAG对重症感染患者AKI及重症AKI均有一定预测价值,且其联合检测对AKI及重症AKI的预测效能更高.

目的 探究血清中性粒细胞弹性蛋白酶(NE)、可溶性尿激酶型纤溶酶原激活物受体(su-PAR)、白细胞介素-35(IL-35)对机械通气合并呼吸机相关性肺炎(VAP)患者临床预后的预测.方法 选取河南省人民医院2017年1月-2019年8月收治的机械通气合并VAP患者114例作为研究对象,随访30 d,根据预后情况分为生存组80例、死亡组34例.比较两组确诊VAP时、治疗1 d、3 d、5 d、7 d时血清NE、su-PAR、IL-35水平,采用Logistic回归分析血清各指标与预后的关系,采用受试者工作特征(ROC)曲线及ROC曲线下面积(AUC)分析血清NE、su-PAR、IL-35对预后的预测价值,采用卡普兰-迈耶曲线(K-M)分析血清NE、su-PAR、IL-35高危者、低危者的生存曲线.结果 死亡组确诊VAP时血清NE、su-PAR、IL-35分别为(177.20±36.52)μg/L、(9.82±1.39)ng/ml、(35.10±4.03)pg/ml,高于生存组的(142.29±30.04)μg/L、(7.46±1.15)ng/ml、(31.27±3.47)pg/ml(P<0.001);血清NE、su-PAR、IL-35与预后显著相关(P<0.05);死亡组血清NE、su-PAR、IL-35治疗1 d、3 d、5 d、7 d呈升高趋势,生存组血清NE、su-PAR、IL-35水平在治疗5 d时达到高峰,治疗7 d时显著下降,且生存组治疗1 d、3 d、5 d、7 d血清NE、su-PAR、IL-35水平低于死亡组(P<0.05);预测预后的AUC:NE为0.741,su-PAR为0.720,IL-35为0.804,三者联合为0.873,联合检测优于单独检测(P<0.05);血清NE、su-PAR、IL-35高危者死亡率高于低危者(P<0.05).结论 血清NE、su-PAR、IL-35在机械通气合并VAP病死患者中呈高表达,与预后显著相关,并具有较高的预后预测价值.

目的 探讨急诊一体化管理信息系统在ST段急性心肌梗死(STEMI)患者救治中的应用.方法 选取2018年1月—2019年12月医院急诊收治的STEMI患者92例,根据患者入院时间分为对照组(2018年1—12月)及观察组(2019年1—12月),每组46例.对照组实施急诊常规性管理,观察组采用急诊一体化管理信息系统,比较两组患者救治效率、救治效果及护理满意度.结果 观察组接诊时间、分诊时间、辅助检查时间、入门至球囊扩张时间(D-to-B)、急诊停留时间均短于对照组(P<0.05).观察组患者救治成功率高于对照组(P<0.05),而绕行ICU率、急诊留观室滞留率、心脏不良事件发生率低于对照组(P<0.05).观察组对急诊预检工作人员态度、对挂号就诊流程管理、对就诊顺序安排、对排队预检等候时间、对就诊等候时间、对收费排队等候时间、对候诊室环境管理及满意度总评分均高于对照组(P<0.05).结论 急诊一体化管理信息系统能有效提高STEMI患者救治效率,降低心脏不良事件发生率,提高患者救治效果及护理满意度.

目的 探讨急诊就诊晚期肺癌的临床特征及患者死亡的影响因素.方法 选取急诊就诊晚期肺癌患者83例,收集患者年龄、性别、病理类型、急诊原因、预后情况和D-聚体(D-D)、白细胞介素-6(IL-6)、血乳酸等信息,分析急诊就诊晚期肺癌患者的临床特征和急诊后3个月内死亡的危险因素.结果 急诊就诊的晚期肺癌患者中,男性占比67.47％,女性占比32.53％;年龄<60岁占比37.35％,≥60岁占比62.65％;腺癌占比59.04％,鳞癌占比21.69％,小细胞癌占比19.28％;急诊原因以肺部感染(62.65％)、呼吸衰竭(55.42％)、意识障碍(22.89％)为主;急诊后3个月内死亡率为63.86％.白细胞、白蛋白、D-D、IL-6、血乳酸水平和是否合并呼吸衰竭、肺部感染、贫血、电解质紊乱为晚期肺癌患者急诊后3个月内死亡的影响因素(P<0.05);logistic回归分析显示,白细胞升高、白蛋白降低、D-D升高、IL-6升高、血乳酸升高、呼吸衰竭、肺部感染、贫血、电解质紊乱是晚期肺癌患者急诊后3个月内死亡的危险因素(P<0.05).结论 急诊就诊晚期肺癌患者预后差,急诊后3个月内死亡率高,临床可结合患者死亡的危险因素,实施针对性干预措施,以延长患者生存期,提高预后效果.

目的:分析连续脑电图检测脑出血患者脑功能异常与预后的相关性.方法:回顾性分析2017-02～2019-12期间100例脑出血患者的临床资料,所有入选者均接受连续脑电图检测,并依据CEEG分评估患者脑功能情况,记录所有入选者预后情况.分析脑功能异常与预后的相关性.结果:本研究100例患者中均表现为脑功能异常,异常率为100％.32例患者表现为弥散性活动,其中7例患者病死;20例患者表现为癫痫样活动,其中7例患者病死;8例患者表现为间歇性δ节律,无病死患者;8例患者表现为单节律活动,全部病死;15例患者表现为低波幅活动,全部病死;6例表现为三相波,其中3例患者病死;10例患者表现为局灶性异常,无病死;1例表现为爆发-抑制性交替,全部病死;CEEGⅣ～Ⅴ级病死率较CEEG Ⅰ～Ⅱ级与Ⅲ级均较高,且CEEGⅢ级与CEEG Ⅰ～Ⅱ级相比更高,差异有统计学意义(P＜0.05);经Spearman等级相关性分析结果显示,CEEG分级与预后表现为正相关(r=0.457,P=0.000).结论:CEEG检测脑出血患者脑功能有助于客观、准确评估患者并预测疾病预后情况,且两者之间呈正相关,即脑功能损伤程度越高、预后情况越差.

[目的]调查急诊重症监护室(EICU)护士对重症病人开展早期康复活动的认可程度,并分析其影响因素.[方法]采用整群抽样的方法选择某院EICU的46名护士为研究对象,采用自行设计的一般资料问卷和护士对重症病人开展早期康复活动认可程度问卷进行问卷调查,采用t检验和方差分析了解EICU护士对重症病人开展早期康复活动的认可程度的影响因素,采用相关分析和回归分析探讨其相关和预测因素;同时选择不同职称护士进行质性访谈,进行深层次的了解.[结果]影响EICU护士对重症病人开展早期康复活动认可的主要因素为年龄、职称、工作年限、是否是专科护士和常上班次.相关分析和回归分析结果显示:年龄、职称、工作年限、是否是专科护士和常上班次与EICU护士对重症病人开展早期康复活动的认可程度得分具有相关性,且工作年限因素可作为认可程度得分的预测因素.[结论]EICU护士对重症病人开展早期康复活动的认可程度相对较高,同时其影响因素较多,需要护理管理者结合影响因素制订相关策略,以提高EICU护士对重症病人开展早期康复活动的认可程度,促进早期康复活动的开展.

Objective:To investigate the relationship of glycated hemoglobin(HbA1c)and brain natriuretic peptide(BNP)levels with clinical prognosis of acute myocardial infarction.Methods:A total of 108 patients with acute myocardial infarction combined with diabetes mellitus, who underwent percutaneous coronary intervention(PCI)from March 2016 to June 2017 in our hospital, were enrolled.According to the HbA1c level, patients were divided into three groups: Group A(HbA1c≤6.9%, n=36), Group B(7%≤HbA1c≤7.9%, n=31)and Group C(HbA1c≥8%, n=41). HbA1c and NT-proBNP levels, cardiac function classification at admission and discharge, the incidence of adverse cardiac events during hospitalization and left ventricular ejection fraction(LVEF)at admission, discharge and 3 months after discharge were analyzed.Results:Among the three groups, plasma NT-proBNP levels were higher in Group C than in Group B and Group A( P<0.05), and there was no significant difference between Group B and Group C( P<0.05). Furthermore, HbA1c levels were positively correlated with NT-proBNP levels in Group C( P<0.05). Cardiac function grading was better in Group A and Group B than in Group C at discharge.During hospitalization, the incidence of adverse cardiac events in Group C was 29.3%, which was higher than in Group A(8.3%)and Group B(9.7%)( P<0.05). LVEF levels were significantly improved in Group A and Group B at discharge and 3 months after discharge, compared with those at admission, while Group C had no significant improvement in LVEF levels and had lower LVEF than Group A and Group B( P<0.05). Conclusions:HbA1c and NT proBNP levels can be used as a joint monitoring indicator in patients with acute myocardial infarctions after PCI, to help prevent and reduce the incidence of complications and mortality in patients with acute myocardial infarction after PCI and improve clinical prognosis.

[目的]及时发现新型冠状病毒防控期间一线医务人员的心理问题并进行有针对性的干预,保障一线医务人员的身心健康,促进抗疫工作的顺利进行.[方法]对河南省某新型冠状病毒感染病人定点收治医院的急诊重症监护室(EICU)医务人员进行心理干预,然后采用症状自评量表(SCL-90)进行干预前后的测评.[结果]新型冠状病毒感染定点收治医院急诊重症监护室医务人员普遍存在心理问题,给予心理干预后,SCL-90得分有所下降,差异有统计学意义(P<0.05).[结论]心理干预可有效改善定点收治医院急诊重症监护室医务人员的心理健康状态,保障一线医务人员的身心健康,促进新型冠状病毒的防治工作顺利进行.

目的 分析中青年脑梗死患者创伤后成长及影响因素.方法 回顾性分析2017年1月至2018年1月河南省人民医院100例中青年脑梗死患者的临床资料,依据入选者创伤后成长情况分为对照组(恢复较差,40例)与观察组(恢复较好,60例),经Logistic多因素回归分析模型分析创伤后成长的影响因素.结果 两组性别、婚姻状况、居住环境对比,差异无统计学意义(均P>0.05).观察组文化水平在大专以上、月收入>5000元、疾病了解程度为完全了解者占比均高于对照组,病程>5 a、后遗症数量≥3个者占比均低于对照组,差异有统计学意义(均P<0.05).文化水平、月收入、病程、后遗症数量、疾病了解程度为创伤后成长的独立危险因素(均P<0.05).结论 文化水平、月收入、病程、后遗症数量、疾病了解程度为创伤后成长的影响因素,应及时采取相应措施促进患者创伤后成长.