Objective To make an artificial anal bag and explore its application effect. Methods The artificial anal bag was composed of a chassis and a bag body which was equipped with a one-way exhaust valve. A total of84 patients with artificial stoma after radical resection of colorectal cancer in a tertiary Grade-A hospital from December 2021 to May 2022 were selected as the application objects. The patients were divided into the experimental group（42 cases） and the control group（42 cases） by random number table method. The experimental group received self-made ventable artificial anal bags,and the control group received conventional artificial anal bag. The differences of postoperative defecation time,feeding time and length of hospital stay between the two groups were compared,as well as the satisfaction of medical staff and patients,the incidence of postoperative ileus between the two groups. Results The postoperative defecation time,feeding time and hospitalization days of experimental group were less than those of control group,the differences were statistically significant（P＜0.05）. The satisfaction of experi mental group was higher than control group,the difference was statistically significant（P＜0.001）. The incidence of postoperative ileus in experimental group was significantly lower than that in control group （ χ2=6.098,P＜0.05 ）.Conclusion The ventable artificial anal bag is convenient to operate,time and labor saving,improve the comfort and satisfaction of patients,reduce the incidence of intestinal obstruction,shorten the average length of hospital stay,and better implement the concept of enhanced rehabilitation.

AIM:To analyse the risk factors and incidence of falls in geriatric outpatients in a university hospital ward in Hangzhou, China. METHODS:From May 2020 to August 2022, 1712 geriatric outpatients in a university hospital ward in Hangzhou, China, were screened using a socio-demographic questionnaire (e.g. gender, age, living arrangement, etc.) and assessment scales. The correlation between each factor and falls was preliminarily analysed by chi-squared tests. Finally, binary logistic regression analysis was conducted to further analyse the risk factors of falls. The STROBE checklist was used in reporting this study. RESULTS:Of the 1712 geriatric outpatients recruited, 1626 participants (60-79 and ≥ 80 years old) with complete questionnaire and assessment data were included. The occurrence of falls for those in the 60-79 age group was 8.4%, and for those in the ≥80 age group it was 13.4%. Age (p = .007), use of a walking assistance device (p < .001), the Stay Independent Brochure Questionnaire (SIB) (OR = 7.751, 95% CI = 5.089-11.806, p < .001), living arrangement (p = .004), timed up and go test (TUGT) (p = .007) and three diseases or above (OR = 2.496, 95% CI = 1.358-11.4.586, p = .003) reached statistical significance. CONCLUSIONS:Older people have a high incidence of falls. In this study, age, disease history, SIB scores (≥4 points), living arrangement, TUGT and walking assistance device increased the probability of falls in older Chinese adults. Personalised interventions should be carried out according to the specific situation of older people to effectively reduce their incidence of falls and improve their quality of life. RELEVANCE TO CLINICAL PRACTICE:The basic characteristics and fall risk factors of the older can help nurses identify fall risk, and early intervention by caregivers can reduce fall-related injuries, which has practical significance for promoting healthy aging. PATIENT OR PUBLIC CONTRIBUTION:The subjects of this study were older patients ≥60 years old, and the demographic characteristics and fall-related information of patients were obtained by questionnaire. The team worked closely with a team of experts in the field of health care. Some researchers collect data and rewrite them, while other researchers analyse the information and write a paper. All authors read and approved the final manuscript.

肌少症的发生与年龄密切相关，多见于老年人群，临床以骨骼肌肌量下降、肌力减退等特征性改变为主，可出现躯体活动障碍、认知功能障碍等常见表现，从而导致跌倒、生活质量下降等诸多不良结局[1]。研究已证实，肌少症和认知功能障碍存在密切相关性，且两者的危险因素存在一定共性，如老年、不良生活方式、代谢紊乱、机体持续炎症反应等[2,3]。肌少症患者一旦合并认知功能障碍，则可能进一步增加痴呆、跌倒甚至死亡的风险，给家庭和社会带来沉重的照护负担和精神负担。既往对于肌少症患者的护理干预多以肢体功能恢复为主导，未能对认知功能的干预给予足够重视，大多采用程式化干预，个体强化干预措施的实施力度不足，亦未能形成完整的护理干预方案，这可能导致患者认知功能的改善无法达到预期效果。鉴于此，浙江大学医学院附属第一医院在既往护理干预的基础上，制定护士主导的个体强化干预方案，以期为老年肌少症合并认知功能障碍患者生活质量的改善提供参考，现报告如下。

对国内外开发的慢性阻塞性肺疾病病人出院准备度评估工具进行综述,包括评估工具的主要内容、特点、应用现状及局限性,以期为建立和应用本土化测评工具提供借鉴,并为开展相关研究提供参考.

随着人口老龄化和高龄化,口腔衰弱这一综合征被逐渐认识和重视.通过国内外文献回顾,阐述了口腔衰弱的概念及流行情况、影响因素、评估工具,以期为我国口腔衰弱的研究发展提供参考依据.

在世界范围内,跌倒是老年人伤残、失能和死亡的重要原因,65岁及以上的社区老年人每年有1/3会发生摔倒,80岁及以上则达1/2[1].计算机决策支持系统UpToDate数据库提出当老年人发生任何新情况时,应始终牢记可能出现的药物不良事件,考虑其是否与药物有关,直到证明为其他原因引起[2].药物是跌倒的关键且可调节的因素之一,可引起老年人意识、精神、视觉、步态、平衡等方面出现异常而导致跌倒,且药物的种类、剂量、多重用药皆可增加老年人的跌倒风险[1].老年人由于机体生理功能老化、免疫力下降,易患多种慢性疾病,是服用药物种类和数量最多的群体,在美国和欧洲国家,85％的老年人至少服用1种药物,48％的老年人服用3种或更多药物[3].集束化是美国卫生保健研究所为改善护理过程和患者结局而制订的一系列有循证实践和基础的可操作结构化方法,通常有3～5种,从而为患者提供更可靠的最佳护理[4].患者教育是护理中必不可少的工作之一,有助于提高患者的自我管理、依从性和满意度.基于患者教育和认知之间、患者认知和跌倒之间的直接因果关系[5-6],本研究对浙江大学医学院附属第一医院的老年群体引入集束化的患者教育模式,有效提高了住院的老年患者对跌倒相关性药物的认知,说明其对减少老年住院患者跌倒具有重要的意义.

目的 观察两种不同手术方式治疗剖宫产后子宫瘢痕憩室(PCSD)的疗效.方法 收集46例伴异常子宫出血症状有手术指征的PCSD患者,分别采用宫腔镜PCSD电切“开渠”术和宫腹腔镜联合PCSD修补术,并比较两种术式术后疗效及月经经期状况.结果 宫腔镜组术后6个月临床有效率达70％,Ⅱ型PCSD患者术后6个月均治愈;宫腹腔镜组术后6个月的临床有效率高达94.74％,治愈率达84.21％.两组术后平均经期均较术前明显缩短(P＜0.05).结论 宫腔镜PCSD电切“开渠”术及宫腹腔镜联合PCSD修补术均为有效治疗PCSD所致异常子宫出血的途径,但前者更为适合Ⅱ型或以下无生育要求的PCSD患者;后者疗效优于前者,适用于所有类型的PCSD患者,推荐用于治疗Ⅲ型PCSD患者.

子宫肌瘤是女性生殖系统中最常见的良性肿瘤,随着年龄的增长,子宫肌瘤发病率增加,50岁女性发病率高达70％～ 80％;根据肌瘤与子宫壁的关系,子宫肌瘤可分为4类:肌壁间肌瘤、黏膜下肌瘤、浆膜下肌瘤及阔韧带肌瘤.目前临床多采用国际妇产科联盟(FIGO)子宫肌瘤9型分类法(图1).子宫肌瘤临床表现多为月经量增多、白带增多、腹部包块、慢性盆腔疼痛、不孕、流产、盆腔周围器官压迫及出血等.

Objective: To explore the effect of combined enteral and parenteral nutrition support improvement on the intestinal microecology of elderly pa -tients with severe stroke.Methods: A retrospective analysis was made for a total of 100 stroke patients aged ≥75 and with 3 -8 in Glasgow coma score ( GCS) admitted to the ICU in the Department of Geriatrics of our hospital from May 2015 to May 2017.With random number method, the patients were di-vided into observation group and control group.According to the actual situation of patients in the control group , it was decided to adopt simple enteral nu-trition or simple parenteral nutrition support.The modified combined enteral and parenteral nutritional support was adopted for the observation group.The nutritional status, immune function and the incidence of various complications were compared between the two groups.Results: After 21 days, it was ob-served that the level of serum albumin and hemoglobin, the level of immunoglobulin IgA, IgG and IgM and the ratio of T cell subgroup CD4 and CD4 /CD8 in the observation group were significantly higher than those in the control group, and the differences was statistically significant ( P <0.05).It was ob-served that the incidence of various infections and gastrointestinal complications in the observation group was lower than that in the control group , and the differences were statistically significant(P <0.05).Conclusion: The modified combined enteral and parenteral nutrition support has a good regulatory effect on the intestinal microecology of elderly patients with severe stroke, which can significantly improve the nutritional status and immune function of patients , reduce the incidence of complications, and is worthy of clinical promotion.

Objective:To explore the effect of resistive exercise intervention in patients with type 2 diabetes mellitus complicated with sarcopenia.Methods:A total of 104 patients with type 2 diabetes mellitus complicated with sarcopenia receiving treatment in our hospital from January to December 2016 were selected and randomly divided into control group and observation group.Both groups received conventional treatment of diabetes.The control group maintained the state of daily life,and elastic band resistive exercise was adopted for the observation group.Blood glucose index,index of sarcopenia and quality of life were compared between the two groups before and after intervention.Results:Before intervention,the differences in blood glucose index,sarcopenia index and SF-36 scale score were not significant between the two groups(P ＞ 0.05);after intervention,the blood glucose index and sarcopenia index in the two groups were significantly improved than before,and the improvement in the observation group was better than that in the control group(P ＜0.05);after intervention,the SF-36 scale score in the observation group was significantly improved than before,and was higher than that in the control group(P ＜ 0.05).Conclusion:Resistive exercise in patients with type 2 diabetes mellitus complicated with sarcopenia can improve blood glucose control effect and sarcopenia index,and improve the quality of life of patients.

目的:降低老年患者住院期间坠床/跌倒的发生率.方法:对住院的老年患者进行及时准确的评估,对坠床/跌倒高风险患者进行告知、高危标识、环境护理风险管理、应急预案、个性化干预措施等进行干预.结果:经过对老年患者坠床/跌倒预防,有效的降低住院患者不良事件的发生.结论:对老年患者坠床/跌倒的预防措施可有效的减少其坠床及跌倒的发生.

目的探讨肾移植术后带状疱疹的治疗与护理。方法对24例肾移植术后带状疱疹患者进行基础、心理、疼痛护理,以及对局部皮损的积极湿敷、特定电磁波治疗仪(TDP)照射等全方位护理。结果 24例患者均痊愈,顺利出院。结论在肾移植术后带状疱疹的护理过程中密切观察患者病情变化,多与患者交流、沟通,预防继发感染和后遗神经痛的发生,做到全方位的护理干预,以减轻患者痛苦,提高患者生活质量。

<正>组织细胞坏死性淋巴结炎(histiocytic necrotizing lymphadenitis,HNL)又称菊池-藤本病(Kikuchi-Fujimoto disease),由日本学者Kikuchi和Fujimoto于1972年首先分别报道,多见于东方女性,主要临床表现为持续发热、乏力、浅表淋巴结肿大伴疼痛、白细胞减少且抗生素治疗无效,是一种自限性的免疫性疾病[1-2]。现将本院收治的1例HNL患者的护理体会报道如下。

目的观察老年患者鼻饲胃管固定方法改进后的效果。方法对100例老年患者长期留置胃管的固定方法进行比较,随机分为A、B两组各50例,A组采取常规方法固定,B组采取改进方法固定。结果 A组患者脱管率明显较B组低,差异有统计学意义(P<0.01)。结论与常规方法比较,改进方法能降低老年患者的脱管率,减少护士工作量,经济适用、取材方便、制作简单、使用安全,有广阔的应用前景。

Distance relay is widely used in HV and EHV transmission lines.Along with the development of power system,the transmission lines become shorter and shorter,especially in urban network.Because the voltage measuring error increases when phase to phase short circuit occurs, distance relay protection will act improperly.A formula of voltage measuring error calculation is derived form phase to short circuit,and its influence on distance relay protection is analyzed.