Objective:To construct an evaluation index system for nursing quality of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in emergency department based on the Donabedian's structure-process-outcome model to evaluate the nursing quality.Methods:On the basis of literature review and semi-structured interviews, the Delphi method and the analytic hierarchy process are combined to determine the evaluation index system for nursing quality of AECOPD in emergency department and the weight of each index.Results:In two rounds of expert consultation questionnaires, the valid recovery rates were 92.31% and 100.00%, and the expert authority coefficients were 0.843 and 0.887, and the Kendall's coordination coefficients were from 0.220 to 0.420 (all P<0.001) . The final evaluation index system for nursing quality of AECOPD in emergency department included 3 first-level indicators, 12 second-level indicators and 37 third-level indicators. Conclusions:The constructed evaluation index system for nursing quality of AECOPD in emergency department is scientific, reliable and practical, which provides a reference for clinical evaluation of AECOPD nursing quality.

目的 构建急性冠脉综合征(acute coronary syndrome,ACS)护理质量评价指标体系,为科学评价ACS护理质量提供参考标准.方法 以Donabedian“结构—过程—结果”三维质量模型为理论框架,结合文献分析、半结构式访谈,拟订ACS护理质量评价指标体系初稿,采用德尔菲专家函询法确定ACS护理质量评价指标体系,同时结合层次分析法确定各层级指标的权重.结果 2轮专家函询问卷的有效回收率均为100％,专家权威系数分别为0.822和0.838.专家函询的肯德尔协调系数为0.318～0.343 (P＜0.001).最终形成的ACS护理质量评价指标体系内容包括3项一级指标,12项二级指标和29项三级指标.结论 本研究构建的ACS护理质量评价指标体系较为全面,为临床评价ACS护理质量提供参考标准.

Objective To explore the effects of checklist for nursing handover in emergency department. Methods A total of 48 emergency department nurses were recruited by convenient sampling method. We implemented nursing bedside handover checklist four months, the quality of the nursing handover and nurses′ mastery of the patients′ condition and the patients′ satisfaction were compared before and after the implementation. Results After four-month intervention, the score of the nursing handover quality increased from 60.39 ± 3.22 to 67.73 ± 3.09, the difference was statistically significant (t=-14.377, P＜0.01). The score of the nurses′mastery of the patients′condition increased from 23.89 ± 2.34 to 27.08 ± 1.82, and there was significant difference(t=-7.287, P＜0.01). Patients′ satisfaction improved from 91.163% (111/121) to 96.67% (116/120), the difference was statistically significant (χ2=10.66, P＜0.05). Conclusions Implementation of nursing bedside-handover checklist in emergency department can reduce individual cognitive defects, decrease the information missing of the nursing handover,improve the quality of nursing work and ensure the safety of patients.

目的 分析预见性护理应用于脑出血急性期护理中的临床效果.方法 将在我院进行治疗的80例脑出血急性期患者作为本次研究的观察对象.将其按照门诊收治的时间平均分为两组,研究组与对照组.对照组患者给予常规护理,研究组患者给予预见性护理.对比两组护理效果.结果 研究组护理后并发症及住院时间明显少于研究组,差异有统计学意义(P＜0.05);且研究组护理满意度明显优于对照组,差异有统计学意义(P＜0.05).结论 针对脑出血急性期患者可给予预见性护理,临床效果优异,值得推广应用.

PurposeObstructive sleep apnea (OSA) can lead to structure and function damages of multiple organs. OSA is closely related to cardiovascular diseases. This study aims to evaluate left ventricular function in OSA patients with normal left ventricular ejection fraction.Materials and MethodsSixty OSA patients were divided into mild, moderate and severe group according to the clinical diagnosis, with 20 patients in each group. Another 20 healthy volunteers were recruited as normal control group. Strain (S), systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA) values in longitudinal, circumferential and radial directions of all the subjects were measured by using speckle tracking imaging. The SRE/SRA rates in three directions were calculated.ResultsLeft ventricular longitudinal systolic function showed significant lower in moderate and severe groups than in the control and mild groups (P<0.05). Circumferential and radial contraction reduced in the severe group, and the difference was statistically significant (P<0.05). The longitudinal, circumferential, and radial diastolic functions of the myocardial fibers in the left ventricle decreased in moderate and severe OSA patients when compared with that of the mild OSA patients and healthy individuals (P<0.05).ConclusionThe speckle tracking imaging has the potential to detect the subclinical left ventricular dysfunction in OSA patients with normal left ventricular ejection fraction and might provide useful information for risk stratification.

Objective:Obstructive sleep apnea (OSA) may predispose patients to and heart failure.The aim of this study was to determine the index of myocardial performance ( IMP) reflecting left ventricular global function in uncomplicated OSA pa-tients.Methods:Fifty-eight subjects without hypertension,diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment.According to the apnea hy-popnea index ( AHI) , subjects were divided into three groups: group 1, control subjects with nonapneic snorers ( AHI<5,n=16) ;group 2, patients with mild to moderate OSA (AHI:5–30,n=23) ;and group 3, severe OSA (AHI>30, n=19) . Basic echocardiographic measurements LVM index were measured. Left ventricular IMP was calculated as ( isovolumic contraction time+isovolumic relaxation time) /aortic ejection time by Doppler echocardiography. Results:There were no significant differ-ences in age, sex, body mass index, heart rate, and systolic and diastolic blood pressure among the three groups. Left ventricular IMP was significantly higher in severe OSA patients than in controls ( P<0.01) . There was no significant difference between controls and mild to moderate OSAHS and between mild to moderate OSA and severe OSA. Conclusion:The present study demonstrates that patients with severe OSA have global left ventricular dysfunction.

Objective:To compare the clinical effect of maxillary sinus floor elevation by the Disk-up Sinus Reamer(DSR) and bone condensers with simultaneous placement of implants.Methods:58 patients underwent maxillary sinus floor elevation.According to the principle of random group which is divided into two groups,the Disk-up Sinus Reamer(DSR)for group A with 47 implants were inserted,the bone condensers for group B with 51 implants were inserted.The safety of the technique and the pain index during the operation was evaluated.The final prostheses were restored in 3-6 months postoperatively.The follow-up period was 3 to 24 months.The stability and osseointegration of the implants were clinically evaluated,and the endo-sinus bone gain around the implants were measured.Results:Group A of the elevation height ranged from 3 to 8 mm,with an average of(4.87±1.38)mm,no serious suffering or uncomfortable subjective sensation in any patients during operation with a pain index of(1.86±0.88).group B of the elevation height ranged from 3 to 7 mm,with an average of(4.63±1.17)mm,serious suffering or uncomfortable subjective sensation in some patients during operation with a pain index of(3.97±1.57).the height of bone loss was different between the group of A and B.During the follow-up period,no sinus complication was observed.X-ray showed good osseointegration.There were no implants or prostheses which were loose or lost.Conclusion:With DSR and bone condensers,maxillary sinus floor elevation with simultaneous placement of implants show satisfactory clinical results in short term,the technique by the DSR with higher elevation height,fewer clinical complications and less pain.

持续性抗炎是预防哮喘反复发作的关键,而吸入糖皮质激素则是当今最有效的治疗手段.目前也证实小剂量的茶碱具有对气道抗炎、免疫调节作用,被推为与皮质激素联用的二线控制哮喘药物.我们自1997年8月起应用二丙酸倍氯米松(必可酮,葛兰素威康中国有限公司)吸入合并口服小剂量无水茶碱控释片(商品名:优喘平)治疗支气管哮喘患者46例,现报告如下.