目的:调查儿科护士对 2020 年发布的《儿童动脉血气分析临床操作实践标准》的临床实践现状,为提升儿童动脉血气标本采集护理质量提供依据.方法:于2022 年 8月—9月,采用便利抽样法,抽取全国范围内32所医疗机构的 838 名儿科护士为研究对象,采用自行编制的调查问卷进行儿童动脉血气分析临床操作实践现况调查.结果:调查中仅有 28.64%的护士知晓患儿体温对于血气分析结果的影响;67.78%的护士知晓应在动脉血气操作前安抚患儿情绪,68.97%的护士知晓在桡动脉采血前应进行Allen试验/改良版Allen试验结果判定方法,80.31%的护士选择专业动脉采血器,90.69%的护士首选桡动脉进行动脉采血,6.44%的护士因动脉采血操作而发生至少1次针刺伤,80.67%的护士表示科室针对动脉采血操作进行培训或考核.结论:儿科护士对《儿童动脉血气分析临床操作实践标准》的整体掌握较好,大多数儿科护士对动脉血气分析相关知识掌握和临床实践水平有待提升,需要进一步培训与临床实践督导.

目的 调查儿童综合医院重症医学科护理工作量及护理人力资源配置现状.方法 采用护理活动评分量表,于2019年3月1日至31日连续31 d,每天3个时间点,即每班次下班时的16:00、00:00、8:00,共93个时点对当班所有患儿进行数据采集,评估住院所有患儿所有班次的护理工作量及护理人力资源配置情况.结果 共采集了2703份护理工作量及护理人力资源配置相关数据.儿童综合医院重症医学科患儿护理活动评分量表得分平均为(58.63±10.81)分;儿童综合医院重症医学科护士总体配置上,每例患儿每班次实际配置的护士数小于理论应配置护士数,两者比较差异具有统计学意义(P<0.01).各班次每例患儿实际配置的护士数与理论应配置护士数相比,差异具有统计学意义(P<0.01).结论 儿童综合医院重症医学科护理人力资源配置应该与成人ICU持平或高于成人ICU.儿童综合医院重症医学科护理人力资源总体配置和各班次配置均不足,夜班护士工作负荷尤其过重.护理管理者应努力提高护理人力资源的总体配置水平和各班次配置水平,并根据白夜班护理工作量的差异,进行护理人力资源的精确配置.

总结4例重度婴儿肉毒杆菌毒素中毒患儿的救治与护理经验.包括婴儿肉毒杆菌毒素中毒的筛查及标本采集和运输,及早给予肉毒抗毒素治疗,保持肠道通畅、促进毒物排除,ECMO的护理,血气胸的护理,粪菌移植的护理等,通过专业化的护理措施保证了重度婴儿肉毒杆菌毒素中毒患儿的治疗效果.3例重度患儿治愈出院、1例极重度患儿好转出院.

目的 探讨婴幼儿时期行人工耳蜗植入手术患儿围手术期有效护理方法.方法 对首都医科大学附属北京儿童医院耳鼻咽喉头颈外科病房自2018年1月——2020年1月收治122例3岁以下婴幼儿极重度感音神经性耳聋患儿术前、术后护理,密切观察病情变化,提高护理质量,预防并发症的发生.结果 通过对我科室自2018年1月——2020年1月收治感音神经性耳聋3岁以下(含三岁)婴幼儿共122例,其中男孩72例,女孩50例,单侧78例,双侧44例,其中15例有大前庭导水管畸形,2例诊断瓦登伯格综合征.术后出现一过性声音嘶哑16例

Objective:To investigate the knowledge, attitude and practice of ICU medical staff in in ICU children with delirium in children's hospitals and analyze its influencing factors.Methods:Using the convenient sampling method, ICU medical staff from 26 children's hospitals in China were selected as the research objects from April 20, 2020 to May 10, 2020. A self-designed ICU pediatric delirium knowledge-attitude-practice questionnaire was used to investigate knowledge, attitude and practice scores of ICU medical staff in children's hospitals. Multiple linear regression analysis was used to analyze the influencing factors. A total of 740 questionnaires were collected, of which 734 were effective, with the effective recovery of 99.2%.Results:Among 734 ICU staff in children's Hospital, 78 (10.6%, 78/734) had a good knowledge of delirium and only 236 (32.2%, 236/734) had received training on ICU delirium. 395 (53.8%, 395/734) medical staff carried out clinical delirium management in ICU. And the assessment implementers were mainly doctors, accounting for 63.5% (251/395) , and nurse evaluators accounted for 36.5% (144/395) . The item with the highest score of attitude of 734 pediatric ICU medical staff towards delirium was "the need to understand the relevant knowledge of ICU delirium in clinical nursing work", with a score of (4.22±0.83) . Multiple linear regression analysis showed that the identity of medical staff, department and whether to receive training were the influential factors for the level of knowledge, attitude and practice of delirium among ICU medical staff in children's hospital ( P<0.05) . Conclusions:Pediatric ICU medical staff have insufficient knowledge of delirium and positive attitude towards ICU delirium. They have insufficient initiative in nursing behavior and the clinical development of ICU pediatric delirium management is insufficient and lacks standardization. It is recommended to carry out a diversified training program on ICU delirium related knowledge for pediatric ICU medical staff, formulate an ICU pediatric delirium assessment process and normalize the delirium assessment into clinical practice, so as to identify early delirium in ICU children and take preventive measures to reduce occurrence of delirium.

This article summarizes the necessity of professional team cooperation in the field of pediatric critical care, the status of domestic and foreign child critical care team cooperation, the role of nurses in team cooperation, team cooperation evaluation tools and so on. This article aims to provide new methods and ideas for the development and cooperation of nursing team building and cooperation in the field of critically ill children in our country, and to improve the team's ability to treat critically ill children.

目的 评价改良工型腕部束缚带在先天性心脏病(CHD)患儿术后的应用效果.方法 选取2018年3月至2019年11月CICU收治的258例CHD术后患儿作为研究对象,将其按随机数字表法分为观察组与对照组,每组129例.观察组和对照组分别予自行设计的改良工型腕部束缚带和传统腕部束缚带进行固定约束.记录保护性约束期间2组被约束患儿腕部挣脱情况、约束部位的皮肤损伤、护士对患儿进行桡动脉导管操作时松解和重新约束总时长.采用自制满意度量表收集患儿家属、护士对保护性约束方式的满意度.结果 观察组腕部挣脱率低于对照组[0％(0/129)比62.02％(80/129),P<0.01];观察组约束部位皮肤损伤率低于对照组[1.60％(2/129)比44.19％(57/129),P<0.01];护士对患儿进行桡动脉导管操作时松解和重新约束完成总时长,观察组为(9.21±1.41)s,低于对照组的(46.46±3.74)s(P<0.05);观察组患儿家属对保护性约束方式的满意度高于对照组(94.57％比62.01％,P<0.05);护士对观察组患儿约束方式的满意度高于对照组(96.89％比36.43％,P<0.05).结论 改良工型腕部束缚带约束效果好、舒适度高,可减少束缚带接触部位皮肤神经损伤和压力性损伤,便于护士对患儿手部进行操作,有助于患儿家属和护士满意度的提高.

目的 ：总结儿童甲状腺肿瘤围手术期护理经验，探讨儿童甲状腺肿瘤围手术期临床护理方法。方法 ：通过回顾性分析我科自 2016 年 5 月至 2019 年 5 月收治的50 例儿童甲状腺肿瘤患者的临床资料，总结甲状腺肿瘤患儿围手术期的护理方法及注意事项。结果 ：入组甲状腺肿瘤患儿共 50 例，男性患儿 16 例，女性患儿 34 例。术后病理回报甲状腺乳头状癌 49 例，甲状腺腺瘤 1 例。术后所有患儿伤口均一期愈合术后临时性声音嘶哑患儿 17 例，经雾化吸入及静脉使用激素后痊愈；短暂性手足麻木 7 例，经静脉补钙或口服钙剂治疗后症状缓解。结论 ：对儿童甲状腺手术及并发症的充分认识是做好围手术期护理工作的关键 ；做好围手术期护理，能有效地预防和减少并发症的发生，可提高甲状腺手术的疗效，缩短手术康复时间。

Objective:To investigate the occurrence of complications in domestic children's arterial blood specimen collection, analyze its influencing factors, so as to provide an improved basis for improving the quality of arterial blood specimen collection.Methods:This study adopted the cross-sectional research method. From July to September 2019, convenience sampling was used to select 2 235 children admitted to the Department of Pediatrics of 17 children's specialized hospitals and ClassⅢ Grade A hospitals across the country as the research object. The self-designed Childhood Arterial Blood Specimen Collection Complications Questionnaire was used to investigate the status of children's arterial blood specimen collection and the occurrence of complications, and its influencing factors were analyzed. Single factor analysis and binomial Logistic regression were used to analyze the influencing factors of complications in children's arterial blood specimen collection. A total of 2 235 questionnaires were issued, and 2 205 valid questionnaires were returned with the valid response rate of 98.7%.Results:The incidence of complications in the collection of arterial blood specimens in children was 73.2% (1 614/2 205) , mainly subcutaneous hemorrhage, accounting for 71.7% (1 581/2 205) . The incidence of single complications was 57.6% (1 269/2 205) . Binomial Logistic regression analysis showed that the angle of needle insertion, pressing time and the operator's working years were the influencing factors for the complications of arterial blood specimen collection in children, and the differences were statistically significant ( P<0.05) . Conclusions:The incidence of complications in the collection of arterial blood specimens in children is relatively high, which is related to the angle of needle insertion, pressing time, and the working years of the operator. It is necessary to establish standardized operating procedures and homogenized management to further improve the operating level and reduce the incidence of complications in the collection of arterial blood specimens in children.

总结6例集体重度氯气中毒患儿的多学科救治与护理经验.包括成立多学科救护小组,实施肺通气保护策略,做好气道管理、眼部护理及有针对性的心理护理.通过专业的护理措施保证了重度氯气中毒患儿的治疗效果,6例患儿均痊愈出院.

目的:探讨不同更换方式对使用微量泵持续泵入多巴胺联合肾上腺素的心脏病术后患儿血压的影响,为临床实际护理工作提供依据.方法:随机选取行心脏手术后需持续微量泵泵入多巴胺联合肾上腺素的患儿90例作为研究对象,采用随机数字表法分为A组(直接更换组)、B组(双泵直接更换组)、C组(双泵并行更换组),各30例.观察更换药液10 min内3组患儿血压变化情况.结果:组内比较显示,A组和B组患儿不同时点SBP、DBP和MAP间差异均有统计学意义(P<0.05～P<0.01),其中更换药液1 min时三指标均较更换前降低(P<0.05～P<0.01),更换5 min和10 min时均较更换1 min升高(P<0.05～P<0.01);而C组患儿不同时点SBP、DBP和MAP间差异均无统计学意义(P>0.05).组间比较显示,更换药液前和更换10 min,3组患儿SBP、DBP和MAP差异均无统计学意义(P>0.05);更换药液1 min,C组患儿SBP、DBP和MAP均明显高于A组和B组(P<0.01);更换5 min,C组SBP明显高于A组(P<0.01).C组患儿血压波动幅度和血压波动时间均低于A组和B组(P<0.05～P<0.01),B组血压波动幅度和血压波动时间亦均低于C组(P<0.05和P<0.01).结论:双泵并行更换多巴胺与肾上腺素持续静点微量泵效果良好,较好解决了药物中断对患儿损害,避免药液中断,同时也降低患儿血压骤变风险,有助于保障药液更换的安全性.

总结国内首例胸腔镜手术治疗左室心外膜囊肿患儿围术期的护理.经过严密的病情监测,术前预防心律失常、心力衰竭的发生,术后以循环系统为主进行病情监测,维护心功能,预防肺不张、心包填塞等护理措施,患儿痊愈出院.

目的:调查护士儿童动脉血气分析临床操作实践现状,为开展规范化临床操作实践提供参考.方法:采用便利抽样方法,于2019年7月2日至8月31日,采用自行设计的调查问卷对全国范围内17家三级甲等医疗机构内的儿科护士进行动脉血气分析操作实践现况调查.结果:共回收有效问卷1518份,其中67.7％的护士使用专业采血器进行采血;桡动脉为首选穿刺部位,占74.4％.不同科室动脉血气分析采血工具选择、采血工具使用方法不同.近一年在动脉血气分析操作中发生针刺伤的护士为127名,发生率为8.4％.结论:儿童动脉血气分析采血流程规范化、管理标准化十分必要,尚须加强动脉血气分析操作知识和技能培训,以提高动脉采血的成功率,保证检测结果的准确性.

Objective:To improve accuracy of prediction amount of length of gastric tube placed through nose and reduce occurrence of adverse events thorough clinical observation of measurement of length of nasogastric tube placement in critically ill children.Methods:Using the convenient sampling method, critically ill children who were hospitalized and needed a nasogastric tube in Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital Affiliated to Capital Medical University were selected from April to September 2019. The prediction method of "nos-ear-xiphoid (NEX) increased by 5 cm" (NEX+5 cm) was adopted. The values of placed length in this study were collected and compared with those predicted by traditional measurement method (namely NEX) , improved "nose-ear-mid-umbilicus" (NEMU) and formula method.Results:A total of 52 critically ill children were enrolled in this study. The length of placed nasogastric tube was 31.5 (28.3, 35.8) cm, and 43 cases (82.7%) were determined to be qualified by X-ray. The length of gastric tube required to be placed in children was 27.0 (24.1, 31.0) cm according to the NEX method, and the length of gastric tube required to be placed in children was 26.1 (22.5, 29.0) cm measured by the formula method. Both were shorter than that measured by NEX+5 cm, and the differences were statistically significant ( P<0.01) . The NEMU method measured the length of gastric tube to be inserted into the child to be 31.0 (28.3, 36.0) cm. Compared with the length measured by NEX+5 cm, and the difference was not statistically significant ( P>0.05) . Conclusions:This study uses NEX+5 cm to predict the actual length of the gastric tube inserted through the nose. The accuracy is relatively high and the operation method is simple. It is necessary to consider individual differences in clinical applications, especially the large variability in infants and young children. After catheterization, abdominal ultrasound, X-ray and other auxiliary examination methods should be used to determine the location of catheterization, and individualized catheterization programs should be given to children according to different therapeutic objective.

Objective:To investigate the clinical practice status of neonatal arterial blood gas collection in Class Ⅲ Grade A children's hospitals in China, so as to provide a reference for further standardizing neonatal arterial blood gas collection operating standards.Methods:From July to September 2020, convenience sampling and self-designed Neonatal Arterial Blood Gas Collection Technology Practice Questionnaire were adopted to conduct a cross-sectional survey on the technical operation of 824 nurses of Neonatology Department in 15 ClassⅢ children's hospitals, general hospitals, and maternal and child health hospitals across the country. A total of 824 questionnaires were distributed, 791 were retrieved, and 747 valid questionnaires were collected.Results:The most common site for neonatal arterial blood gas collection was the radial artery, accounting for 98.80% (738/747) , followed by the brachial artery 47.79% (357/747) . The radial artery was often selected below the place where the pulsation was strongest (46.86%, 350/747) , and the most needles were inserted at an angle of 15° to 30°. The brachial artery was often selected below the place where the pulsation was strongest (58.77%, 439/747) , and the most needles were inserted at an angle of 30° to 45°. The more common complications after arterial blood gas collection were bruising, bleeding, and hematoma. A total of 390 (52.21%) nurses received uniform training in arterial blood gas collection in the past year. There was a statistically significant difference in the incidence of needle stick injuries in the collection of nurses of Neonatology Department who received uniform training or not ( P<0.05) . Conclusions:The operating standards for neonatal arterial blood gas collection are not uniform, and it is necessary to standardize the collection process and management. Although the training for nurses has been carried out in clinical practice, the incidence of needle stick injuries among nurses still needs to be further reduced, especially the targeted training of arterial blood gas collection and operation skills. The collection tools should be improved to increase the success rate of arterial blood collection, reduce the occurrence of complications, and ensure the safety of nurses.

目的 了解护理持续改进管理举措的实施结果及儿童医院患者的特殊需求.方法 采用方便抽样的方法,选择我院2018年7月-2019年1月间360名住院患儿及家长作为对照组,2019年2月-2019年9月间收治的360名患儿及家长作为实验组,采用满意度问卷进行调查.结果 住院患者的满意度在逐渐提高,护理持续改进后护士工作主动性较强,在护理操作技术、护患沟通、健康教育3个维度的满意度高于改进前.结论 护理持续改进管理实施效果较好,患者满意度提高.

先天性心脏病(简称先心病)是儿童最常见的心脏病,多数患儿临床表现为重症状态,肺炎反复发生[1].并且随着小儿心脏外科技术的不断成熟与进步,手术越来越向低龄、低体重患儿方向发展.手术全身麻醉的影响加之小儿自主排痰能力差,术后常会因分泌物多而致肺炎、肺不张等,直接影响手术的成功及患儿的预后,已被日益引起重视.为保证快速、及时、有效的清理患儿呼吸道,同时节约成本,本文将经鼻行气管内吸痰法与传统吸痰方法(传统的经口鼻吸痰法、纤维支气管镜)进行比较,观察其临床效果,报告如下.

Objective:To explore the effect of three-level delirium nursing management process on the treatment outcome and quality of care in the pediatric intensive care unit (PICU).Methods:Since January 2019, three-level delirium management process for PICU were developed. 75 children were randomly selected as the experimental group for 6 months, and 75 patients who received routine care between July and December 2018 were selected as the experimental group. The control group received routine nursing care, and compared the differences in the incidence, duration, and length of PICU stay in the intensive care unit (DICU) between the two groups of children. The family members' satisfaction with the quality of care and the evidence-based knowledge of PICU nurses were compared before and after implementation.Results:The incidence of DICU in the experimental group was 21.33% (16/75), the incidence of unsafe events related to DICU was 2.67% (2/75), and the control group was 40.00% (30/75), 12.00% (9/75). The difference was statistically significant ( χ2 values were 6.145, 4.807, P<0.05); the duration of the DICU in the test group (14.16±4.25) hours, and the length of ICU hospitalization (48.62 ± 8.85) hours were less than (17.37±5.36) hours and (52.03±8.10) hours in the control group, the difference was statistically significant ( t values were 2.070, 2.462, P<0.05); The score of Nursing Delirium Screening Scale (Nu-DESC) for nursing care of DICU patients in the two groups was not statistically significant ( P>0.05). The score of the test group after nursing was (1.72 ± 0.75) points, which was lower than (2.17±0.63) points of the control group. The difference was statistically significant ( t value was 2.159, P<0.05); The results of the nursing quality evaluation questionnaire showed that the satisfaction of family members in the test group with respect to nursing services was 93.33% (60/75), which was higher than 82.67% (52/75) in the control group, with a significant difference ( χ2 value was 4.040, P<0.05). After the implementation, the correct answer rate of the "risk factors for delirium" questionnaire in the deliberate evidence-based knowledge questionnaire was significantly higher than before the implementation ( P < 0.05). After 6 months of implementation, the score of evidence-based knowledge of delirium was (6.82 ± 1.74) points higher than (4.26 ± 0.85) points before implementation, the difference was statistically significant ( t value was 3.739, P<0.01). Conclusions:The three-level nursing management process in the PICU ward can better prevent the occurrence of paralysis, strengthen the quality of nursing services, and exercise the comprehensive quality of nursing staff.

目的 总结体外膜肺氧合技术(extracorporeal membrane oxygenation,ECMO)联合连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)救治儿童暴发性心肌炎的护理体会.方法 选择2017年7月至2019年7月首都医科大学附属北京儿童医院收治的4例暴发性心肌炎患儿,护理重点在于维持并监测ECMO及CRRT的运转情况,准确评估,促进心、肺、肾功能的恢复情况;做好体位及镇静镇痛管理及管路安全维护;监测并及时处理出血、血栓及感染等并发症等.结果 4例患儿病情均恢复稳定,成功撤离ECMO、CRRT和人工呼吸机,经治疗后痊愈出院.结论 暴发性心肌炎病情凶险,急性期病死率高,经过积极治疗,早期ECMO联合CRRT治疗可以提高患儿生存率,改善预后.

化疗为儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)首选的有效治疗方法.随着诊疗技术的改进,儿童ALL的长期无事件生存率已达80％～90％,但在疾病治疗过程中会发生各种并发症而影响疾病的预后.急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是指由各种非心源性肺内因素导致的急性进行性缺氧性呼吸衰竭,死亡率高达50％以上.ALL并发ARDS病情凶险,预后差,护理难度大.我科收治的一位2岁ALL并发ARDS患儿,经过积极治疗护理取得较好效果,报告如下: