Objective:To explore the demand and mode of palliative care for emergency dying patients by analyzing the case data of emergency death and cardiopulmonary resuscitation.Methods:The data of 776 cases of emergency clinical death and cardiopulmonary resuscitation in the Second Affiliated Hospital of Soochow University from 2017 to 2020 were retrospectively analyzed.Results:A total of 687 patients were included with (70.38 ± 16.57) years old, and 49.8% (342/687) of them were 75 years old and above; among them, 36.0% (247/687) patients or their families chose not to give cardiopulmonary resuscitation (DNR) in the last stage of their lives,and 63.2%(156/247) of DNR patients were 75 years old and above. The top four etiology of DNR were cerebral hemorrhage, respiratory failure, multiple organ dysfunction syndrome and out of hospital cardiac and respiratory arrest.After successful cardiopulmonary resuscitation, 37.5% (45/120) of the patients' family members chose to give up treatment again. The median stay time of DNR patients in the emergency room was 738.7 minutes.Conclusions:The patients who choosed DNR were mainly 75 years old and above, with cerebral hemorrhage, respiratory failure, multiple organ failure and cardiac and respiratory arrest. The detention of these patients in the emergency room increases the congestion of the emergency room, and at the same time, they can not get a peaceful palliative care environment. It is suggested that emergency medical staff should strengthen the awareness and improve the ability of palliative care. A relative independent area and corresponding soothing palliative treatment and nursing should be given to the DNR patients.

目的:了解重症监护室(ICU)病人住院期间的睡眠状况及不同阶段的特点.方法:采用方便抽样法选择85例成人ICU病人进行睡眠状况的评估与记录,选择首次(T1)、住院中期(T2)、出院前1 d(T3)数据进行分析.结果:共收集430份睡眠质量评分,单因素重复测量方差分析结果显示,ICU住院病人在T1～T3阶段理查兹-坎贝尔睡眠量表得分分别为(58.33±18.27)分,(61.45±12.71)分及(58.67±15.51)分,差异无统计学意义(P>0.05).但两两比较发现,T2阶段比T3阶段睡眠得分高(2.78±1.23)分,差异有统计学意义(P<0.05).各阶段护士评估时长均高于病人自评时长,差异均具有统计学意义(P<0.05).病人认为影响夜间睡眠状况的主要为环境、心理、生理病理、医源性刺激等因素.结论:ICU病人在住院期间睡眠质量处于中等水平,住院中期睡眠质量最好.在不同阶段影响病人睡眠的主要因素不同,应加强对医护人员的睡眠相关知识及管理能力的培训,促进行为修正,采取相应干预措施,制定睡眠管理方案.

目的 分析血清尿酸、嗜酸性粒细胞趋化因子(Eotaxin)及骨膜蛋白(Periostin)在支气管哮喘急性发病过程中的作用及相互关系.方法 随机抽取2017年1月至2018年7月该院就诊且确诊的106例支气管哮喘患儿(哮喘组)和110例门诊体检的健康儿童(对照组)作为研究对象,用酶联免疫吸附测定法检测血清尿酸、Eotaxin、Periostin水平,各组间进行比较,同时测量哮喘组患儿肺功能,并进行比较.结果 对照组儿童血清尿酸、Eotaxin及Periostin水平均低于哮喘组急性发作期和慢性持续期,且慢性持续期低于急性发作期,差异均有统计学意义(P<0.05).哮喘组患儿急性发作期血清Eotaxin水平与血清尿酸、Periostin水平呈正相关(均P<0.05),慢性持续期血清Eotaxin水平与血清尿酸、Periostin水平呈正相关(均P<0.05).急性发作期血清中尿酸、Eotaxin、Periostin水平与第1 s用力呼气量(PEV1)、呼气流量峰值(PEF)呈负相关(均P<0.05);慢性持续期血清中尿酸、Eotaxin、Periostin水平与PEV1呈负相关(均P<0.05);慢性持续期血清中尿酸、Periostin水平与PEF呈负相关(P<0.05).结论 哮喘患儿血清中尿酸、Eotaxin、Periostin水平增高,且急性发作期高于慢性持续期,尿酸、Eotaxin、Periostin水平与肺功能水平呈负相关,可为评价支气管哮喘病情变化及治疗效果提供参考依据.

[目的]探讨基于要因分析的睡眠管理干预对重症监护室(ICU)清醒患者睡眠质量的影响.[方法]选择2018年5月11日至2018年8月31日本院收治的301例ICU清醒患者,根据干预时间分为干预前(2018年5月11日至6月30日)130例、干预后(2018年7月1日至8月31日)171例.分析干预前患者睡眠障碍发生主要因素,给予针对性的睡眠质量管理干预,比较干预前后睡眠质量、睡眠障碍、患者满意度等指标.[结果]干预后,ICU清醒患者睡眠深度、睡眠潜伏期、夜间睡眠、睡眠质量评分明显高于干预前,差异有统计学意义(P＜0.05).干预后,ICU清醒患者睡眠障碍发生率为19.88％(34/171)明显低于干预前的81.54％(106/130),其中环境因素、心理因素、疾病因素、护理因素、药物因素所致睡眠发生率明显低于干预前(P＜0.05).干预后,ICU清醒患者满意度为93.57％(160/171)明显高于干预前的82.31％(107/130),差异有统计学意义(x2=9.345,P ＜0.05).[结论]基于要因分析法的睡眠管理干预有助于改善ICU清醒患者睡眠质量,减少睡眠障碍发生率,提高患者满意度.

In China's 13th Five-Year Plan, it points out that it is necessary to establish a family-based and community-based old-age service model. As a result, there is a growing demand for community old-age service. As the core technology of geriatric medicine, comprehensive geriatric assessment (CGA) has been widely applied in various clinical fields. This paper mainly summarizes the basic concept of CGA and the research progress and application of CGA in community old-age service.

目的 探讨早期心电图筛查的质量管理在急诊非创伤性胸痛患者预检分诊中的应用效果.方法 收集2017年1月-2018年12月于我院急诊就诊的急性非创伤性胸痛患者临床资料,按入院时间顺序将其分为两组,2017年入院患者2803例为对照组,采用常规预检分诊组;2018年入院患者3028例为观察组,采用早期心电图筛查质控组.比较两组非创伤性胸痛患者高危胸痛检出率、高危胸痛漏检率、胸痛患者分诊过度率、首份心电图时间、患者入院至球囊扩张时间(D2 B时间)、胸痛患者死亡率的变化.结果 与对照组相比,观察组高危胸痛患者检出率增加(P<0.05)、高危胸痛患者漏检率较对照组明显减少(P<0.01),分诊过度率增加(P<0.001);观察组首份心电图完成时间较对照组明显缩短(P<0.01);心肌梗死患者D2B时间、胸痛患者死亡率在相比较后差异均无统计学意义(P>0.05).结论 对早期心电图筛查进行系统的质量管理能提高高危胸痛患者检出率、降低高危胸痛患者漏检率、缩短胸痛患者首份心电图时间,但对心肌梗死患者D2 B时间、胸痛患者死亡率无影响,在一定程度上增加了低危胸痛患者分诊过度率.

目的 构建ICU患者谵妄评估约束分级方案并探讨其临床应用效果.方法 运用德尔菲专家函询法构建ICU患者谵妄评估约束分级方案.采用方便抽样法,选择416例ICU住院患者为研究对象,按护理单元将其分为试验组214例、对照组202例.试验组采用ICU患者谵妄评估约束分级方案进行谵妄评估及约束;对照组采用加拿大ICU约束决策轮及等级工具进行约束指导.结果 比较两组总约束时间、各级约束时间、疾病转归等,差异具有统计学意义(P＜0.05).在患者满意度、非计划性拔管率、坠床/跌倒方面,差异无统计学意义(P＞0.05).结论 基于德尔菲专家函询法构建的ICU患者谵妄评估约束分级方案,可减少ICU患者的约束时间,降低患者身体约束率及约束强度,改善患者的预后,保障了患者的安全.

直升机医学救援是借助直升机,将救援力量、药品器材等快速运送至现场,对个体或群体实施及时有效救援;或在医疗监护下,将危重伤员快速运至后方医院,接受进一步全面救治,旨在排除交通、地形等影响,缩短抢救转运时间,建立无缝式救援链 [1].直升机救助的危重伤员往往需要建立人工气道,人工气道是将气管导管经鼻或口插入气管,或者通过气管切开建立的人工气体通道 [2,3].我国对人工气道进行管理的主体是护士,所以人工气道的管理是指插管成功后的护理,护士主要观察的是插管成功后发生的不良事件.中欧地区入院前气道管理是由医师来完成,在北美地区是由非医师的辅助医务人员完成 [4,5],其人工气道管理重点是插管,其次是维护.因此气管插管通常被认为是气道管理的黄金标准 [6].有报道称直升机救援中人工气道不良事件的发生率高达18.6％～22.4％[7-9].其中低氧血症的发生率为10.8％～15.4％[10,11],气道损伤为0.5％～1.6％[12,13],意外拔管为2.0％[14,15],高血压为0.7％～15.1％[16,17].所以在整个直升机转运危重伤员期间实施严格、有效、细致的气道管理,才能尽量避免或减少不良事件的发生.

Objective To develop a competency evaluation index system for flood disaster relief of nurses. Methods The preliminary system was designed by combining methods of literature review, competency theory and semi-structured interview. The indicators and weights were determined by two rounds of Delphi consultation. Results The competency index system of flood disaster nurses comprised of 3 first-level indicators, 12 second-level indicators and 77 tertiary indicators. The expert authority coefficient was 0.84, and the variation coefficients were 9.20％-21.60％ and 0.00％-19.37％, and the coefficients of coordination were 0.200-0.317 and 0.221-0.361, respectively. The differences had statistical significance (P＜0.05). Conclusion The competency evaluation index system for flood disaster relief of nurses developed in the current study highlights the characteristics of flood disaster relief in China.It provides reference basis for selecting, training and evaluating disaster relief nurses.

严重创伤救治的效果不仅与救治技术相关,而且与救治体系的建设和有效运行密切相关,即完善的区域性创伤救治体系对创伤救治起到十分重要的作用 [1].1976年美国创伤外科医师学会(ACSCOT)提出了创伤中心分级及指南,根据创伤中心具备的条件分为Ⅰ~Ⅳ级 [2];1992年美国创伤急救系统计划提出"广义创伤体系"的概念 [3],包含了一个区域所有的医疗急救体系,其涵盖的内容包括院前急救、院内创伤救治中心、康复治疗、人员培训和体系动态评估等 [4].

目的 探索妇幼保健系统协同发展的影响因素,并据此提出针对性政策建议.方法 对妇幼保健机构的协同发展情况进行现场问卷调查,利用PEST分析法提出可能的影响因素,并进行统计学分析.结果 对妇幼保健系统协同发展有影响的外部因素为:人均GDP及育龄妇女和7岁以下儿童数占总人口百分比;内部因素为:机构评审级别、总资产、1万元以上设备数、年诊疗人次,妇幼保健项目开展数、编制床位数、机构总收入、机构总盈利、机构继续教育费用.结论 应坚持政府为主的投入保障机制,并增强机构盈利能力;完善各级妇幼保健机构之间的分工、协调与双向转诊制度;加强培训与继续教育.

阐述正念认知疗法在老年糖尿病患者治疗中取得的成就及不足.通过陈述正念和正念认知的概念,讲解正念认知疗法的作用机制,以及目前在糖尿病治疗中如何引用正念认知疗法及其实施现状.正念认知疗法对老年糖尿病患者有一定的治疗作用.正念训练可以提升老年糖尿病患者的信心,减轻患者的心理压力,使老年患者能积极配合医生的治疗.正念的核心在于培养一种“以不评价、接受和觉知当下的态度,来应对令人厌恶的认知、感受和情感”的能力;其核心技能是:通过正念训练,参与者意识到“思维的行动模式”普遍存在,并且能够从这种心理状态中解脱出来.正念认知疗法对老年糖尿病治疗行之有效,同时还需要笔者继续深入研究补充不足之处,从而进行大面积的推广.

静脉治疗是直升机医学救援重要的组成部分,是决定伤病员得到及时、有效救治的关键.近年来,直升机医学救援发展较快,有关直升机医学救援的报道屡见不鲜,但对于静脉治疗管理的研究鲜有提及.笔者查阅相关文献并咨询专家,根据临床静脉治疗管理经验,对直升机医学救援静脉治疗管理可能出现的不良事件及危险因素进行分析,探讨相应的应急处置方法,旨在为直升机救援静脉治疗管理规范化提供研究依据.

目的 了解武警部队官兵的健康状况,为有针对性地开展健康教育提供理论依据.方法 分别选取南方、北方地区武警某部官兵255名和138名,共393名.采用自测健康评定量表,了解官兵的生理健康、社会健康及精神健康状况.结果 不同地区、不同年龄及不同入伍时间的武警官兵自测健康情况存在统计学差异(P<0.05).南方地区组的总体健康评分(360.01±52.16)高于北方地区评分(335.35±46.56),差异有统计学意义(P<0.05);18～25岁年龄组的总体健康评分(356.05±51.16)高于26～34岁年龄组评分(334.07±49.68),差异有统计学意义(P<0.05);入伍时间在2001—2011年的健康评分(337.66±44.13)高于入伍时间在2012—2017年组的评分(357.15±53.43),差异有统计学意义(P<0.05).结论 武警官兵的总体健康良好,但不同地区、不同年龄及不同入伍时间的武警官兵健康状况不同.

Objective To explore the effect of dexamethasone on body composition of mice of two different ages in order to select an ideal sarcopenia model.Methods C57BL/6 mice aged 8-10 weeks were randomly divided into the experimental group (DA) and control (NA),while another sixteen C57BL/6 mice aged 6-7 months were randomly assgined to the experimental group(DM) and control (NM).There were eight mice in each group.The control group received 0.9％ saline injection,while the experimental group was subcutaneously injected with 5 mg/kg dexamethasone for 19 days.The body composition of all the mice was measured every three days.24h after the final administration,the body composition was measured with EchoMRITM.Results After dexamethasone intervention,compared with NA group,weight in DA group was reduced by 5.97％ (P ＜ 0.05),muscle mass by 14.33％ (P ＜ 0.01)but fat mass increased by 32.94％ (P ＜ 0.05).Compared with NM group,weight in DM group increased by 13.67％ (P ＜ 0.05),muscle mass reduced by6.06％ (P ＜ 0.05) and fat mass increasedby 43.77％ (P ＜ 0.01).There was no significant difference in the intervention effect of dexamethasone on muscle between mice of 6-7 months old and those of 8-10 weeks old(P ＞ 0.05),but the intervention effect of dexamethasone on fat was significantly different (P ＜ 0.05).Fat of mice of 6-7 months old was increased more significantly than that of 8-10-week-old mice.Conclusions Under the conditions of this experiment,mice of 6-7 months old are more suitable for a long-term study of a sarcopenia model than mice of 8-10 weeks old.

Objective To discuss the risk factors of incontinence-associated dermatitis in elderly patients,the study was initiated.Methods Totally 170 elderly patients from a Level 3 grade comprehensive hospital of Beijing were collected.age,gender and other 10 data.The study allocated patients into case group and control group based on the end whether get incontinent dermatitis.Univariate and multivariate Logistic regression analysis were conducted to compare the 11 indicators mentioned above between the two groups to find out the risk factors.Multiple linear regression analysis of elderly patients with IADS score.To explore the elderly patients Incontinence associated dermatitis severity correlation factors.Results The types of incontinence,diarrhea,damp frequency,the types of incontinence,diarrhea,damp frequency,and Antimicrobials species were significantly different between the two groups (P ＜ 0.05);The multivariate Logistic regression analysis showed that fecal incontinence,diarrhea and diabetes were risk factors (P ＜ 0.05).Multiple linear regression analysis showed that fecal incontiuence and damp frequency were positive associated with the scores of elderly patients Incontinence associated dermatitis severity.Conclusion Elderly patients with fecal incontinence,diarrhea and diabetes are at high risk of Incontinence associated dermatitis.In clinical nursing,these patients should be identified and receive precaution in order to curb Incontinence associated dermatitis from happening.Elderly patients with Incontinence associated dermatitis risk factors identification and risk assessment tools in nursing work,also need care managers and decision makers to make further specification and research.

目的 调查我国大陆三级甲等医院护理员配置及职业知识技能现状,为规范管理护理员提供参考.方法 随机抽取全国5省/直辖市25所三级甲等综合性医院的964名护理员,采用专题小组自制的一般资料问卷及护理员职业知识技能问卷进行调查.结果 护理员以女性、农村进城务工人员为主,年龄≥40岁者占86.31％、小学及以下文化水平者占48.65％,多与第三方中介组织签约、以无用工合同者为主.护理员日均工作时间为(18.30±7.06)h,同期照顾患者可达(6.11±11.18)人;88.17％税后月收入≤4 000元.职业知识技能自评得分为(58.20±7.43)分,护理员对所在医院病区环境的了解程度最高,其次为对日常生活照料技术(如帮患者翻身、叩背、擦浴、晨晚间护理等)及对患者搬运、转移过程中(如使用轮椅、平车等)的安全保护等.结论 中国大陆医疗机构现有护理员工作负荷重,福利待遇偏低,整体素质有待提高,人力资源结构有待调整,职业培训有待进一步规范.

Objective Study the recovery of the meropenem micro dialysis probe in normal rats and in rats of sepsis in vivo.Method Rats randomly divided into two groups: control group(1case)and sepsis group (3 cases).firstly, to probe into the rat skin, muscle, blood vessels and lungs, respectively, then, collect samples, and then, determination of different parts of the recovery.Result The recovery of all research target parts (lungs, blood vessels, skin and muscles), the normal rats were 30.14％±7.62％, 26.20％±0.14％, 25.90％±1.28％, 13.95％±0.32％.And the sepsis group were 46.43％±1.50％, 45.96％±1.78％, 33.93％±0.39％, 39.48％±2.38％.The recovery in control group were lower than target parts of the rats of sepsis group, the recovery both in control group and sepsis group at the target of the study area are highest in lung.Conclusion Meropenem was a high protein binding rate of drug, the lung protein content was low, but the pulmonary absorption of meropenem was the least, so meropenem in the lung had the highest recovery rate.By micro dialysis technology research normal and sepsis in rats of different target parts of a recovery, and then calculate different drug concentration of the target area.

Objective To analyses the effects on broncho-alveolar lavage (BAL) in patients with pneumonia complicated structural lung disease. Methods 82 patients who suffering from pneumonia complicated structural lung disease in our hospital from June 2012 to June 2014 were selected and divided into the control group (55 cases) and the experimental group (27 cases),which according to accepting or not accepting BAL. Control group were given routine treatment,such as antibiotics,sputum suction,while the experimental group accepted BAL on the basis of routine treatment. The white blood cell (WBC),neutrophil number (N) in peripheral blood and the arterial blood PO2/ FiO2 were test at the third day after treatment, and the chest radiography was done at the seventh day. The time of their body temperature reaching normal,inpatient time and mortality were also recorded. Results After three days treatment,the total number of WBC and N in peripheral blood of the experimental group was decreased significantly than that of the control group (P < 0.05),and PO2 / FiO2 of the experimental group was increased significantly than that of the control group (P < 0.05);The time of body temperature reaching normal and inpatient time were were significantly shorter in the experimental group than in the control group (P < 0.05). The results of chest radiography showed a faster absorption of the inflammation in lung in the experimental group than the control group(P<0.05). There was no significant difference of mortality rate between both groups (P > 0.05). Conclusion Broncho-alveolar lavage (BAL) is a high effective and safe therapeutic method for patients with pneumonia complicated structural lung disease.

Objective To investigate the potentiality of D3-creatine dilution method to be used in detection of skeletal muscle mass, so as to provide a new method for skeletal muscle mass detection in mice. Methods Four weeks, 10 weeks and 13 months old male C57BL/6 mice (10 each) were used in the present study. All mice were fed with a single dose of D3-creatine (2mg/kg) after testing body composition by EchoMRITM. Urine was collected at 24h, 48h and 72h after creatine administration, and analyzed by liquid chromatography-tandem mass spectrometry mass spectrometry (LC-MS/MS) that was used to determine the creatine pool size. The relationship between creatine pool size and the skeletal muscle mass determined by EchoMRITM was analyzed. Results Both lean body mass and total creatine pool size were aged mice > adult mice > juvenile mice. There was a significant correlation (r=0.687, P=0.000) between the lean body mass measured by EchoMRITM and the total creatine pool size calculated by D3-creatine dilution method. Conclusion The D3-creatine dilution method may be used to determine the skeletal muscle mass of mice. DOI: 10.11855/j.issn.0577-7402.2017.07.10