Resumo Objetivo Avaliar os efeitos da intervenção terapêutica de enfermagem baseada no modelo de trajetória da doença crônica na ansiedade e na qualidade de vida de pacientes com doença cardíaca coronária (DCC). Métodos Um total de 118 pacientes com DCC admitidos entre fevereiro de 2019 e fevereiro de 2021 foram distribuídos aleatoriamente em grupos controle e observação (n = 59). O grupo controle recebeu intervenção de enfermagem de rotina, enquanto o grupo observação recebeu intervenção com base no modelo de [...]

Objective: We aimed to assess the effects of nursing intervention therapy based on chronic disease trajectory model on anxiety and quality of life (QOL) of patients with coronary heart disease (CHD). Methods: A total of 118 CHD patients admitted from February 2019 to February 2021 were randomly assigned into control and observation groups (n=59). Control group was given routine nursing intervention, while observation group was given intervention based on chronic disease trajectory model. Clinical symptom, self-rating anxiety scale (SAS), QOL and self-efficacy scores were compared. Incidence rates of complications were compared. Multivariate linear regression analysis was performed for the mediating effect of self-efficacy on relationship between anxiety and QOL. A structural equation model was constructed and verified. Results: After intervention, clinical symptom and SAS scores significantly declined in both groups, especially in observation group (P<0.05). QOL and self-efficacy scores rose significantly in both groups, particularly in observation group (P<0.05). Self-efficacy score was negatively correlated with SAS score and positively correlated with QOL score, and there was a negative correlation between SAS score and QOL score (P<0.05). The model of self-efficacy, anxiety and QOL had good fitness, and the mediating effect of self-efficacy on relationship between anxiety and QOL was 0.896. The incidence rate of complications was significantly lower in observation group than in control group (P<0.05). Conclusion: Nursing intervention based on chronic disease trajectory model significantly relieves the anxiety, improves QOL, and increases the self-efficacy score of CHD patients. Self-efficacy is a mediator for the relationship between anxiety and QOL.

目的 探讨主动循环呼吸技术对老年心血管疾病合并肺部感染的干预效果.方法 选取2019年11月至2020年9月浙江医院收治的老年心血管疾病合并肺部感染患者76例,其中38例(对照组)予以常规护理干预,余38例(观察组)在对照组的基础上予以主动循环呼吸技术护理干预.比较两组患者咳嗽排痰能力(1 h排痰量及24 h排痰量),并观察肺部体征(包括肺部啰音、痰鸣音、胸部CT检查)和血氧饱和度的改善情况.组间计量资料的比较采用t检验,计数资料的比较采用χ2检验.结果 与对照组比较,观察组患者1 h和24 h排痰量均显著增加,血氧饱和度显著升高,肺部啰音、痰鸣音及胸部CT检查得到改善的患者更多,差异均有统计学意义(t=5.000、3.700、4.380,χ2=26.316、34.211、27.390;P<0.01).结论 主动循环呼吸技术能增强老年心血管疾病合并肺部感染患者的咳嗽排痰能力,改善氧合状况和肺部体征.

OBJECTIVE To discuss the clinical significance and related factors of objective monitoring in catheter-related hospital infections in ICU.METHODS A total of 600 patients with catheter therapy in ICU from Jan.2015 to Dec.2016 were included in the study,the objective monitoring of catheter-related hospital infections was performed from January 2016.The 300 patients treated in 2015 were set as control group,and 300 patients treated in 2016 were set as experimental group.The catheter-related hospital infection rate was compared between the two groups,and the pathogens of the catheter-related hospital infection were analyzed.RESULTS The patients in experimental group had 26 cases of catheter-related hospital infections with the infection rate of 8.67 ％,which were significantly lower than 42 cases and 14.0.％ in 2015(P＜0.05).The two groups were infected mainly by pulmonary and urinary tract infection.The infections of experimental group were 56 cases,which were less than 97 cases of control group (P＜0.05).There were no significantly differences in the incidence of VAP,CAUTI,and CLABSI between the two groups.Totally 256 strains of pathogenic bacteria were detected in 70 cases of catheter-related hospital infections,including 146 strains of gram-negative bacteria accounting for 57.03％,mainly Acinetobacter baumannii and Klebsiella pneumonia,86 strains of gram-positive bacteria accounting for 33.59 ％,mainly Staphylococcus epidermidis and Staphylococcus aureus,and 24 strains of fungi.CONCLUSION Objective monitoring can regulate the intubation operation and daily use of various catheters,thus effectively reduce the incidence of catheter-related hospital infections.

目的 探讨综合康复护理干预对老年吞咽障碍患者并发症的影响及康复评价.方法 选择2011年5月～2012年3月浙江医院康复科住院老年吞咽障碍患者64例,随机分为对照组(32例)和观察组(32例).对照组给予常规护理干预,观察组给予综合康复护理干预,3个月后比较两组患者误吸、吸人性肺炎、营养不良的发生情况;采用标准吞咽功能评价量表(SSA)评价存在吞咽功能障碍,采用吞咽障碍生活质量量表(SWAL-QOL)评价患者生存质量.结果 ①3个月后观察组患者误吸及吸人性肺炎、营养不良的发生率显著降低,与对照组比较差异有统计学意义(P＜0.05).②治疗前及治疗后1周两组患者SSA评分差异无统计学意义(P＞0.05),治疗后2、3、4周观察组SSA评分显著高于对照组(P＜ 0.05),两组治疗后2、3、4周与同组治疗前比较,差异均有统计学意义(P＜ 0.05或P＜ 0.01).③两组治疗后4周SWAL-QOL评分高于治疗前,差异均有高度统计学意义(均P＜0.01);两组治疗后4周SWAL-QOL评分比较,差异有统计学意义(P＜0.05).结论 综合康复护理干预能有效降低误吸、吸人性肺炎、营养不良的发生率,改善患者生活质量.

目的 探讨老年住院患者在肾素血管紧张素醛固酮血浆检验中预防跌倒的相关措施.方法 选择浙江医院2012年5月～2013年5月行肾素血管紧张素醛固酮血浆检验的住院患者177例,随机将患者分为观察组89例,对照组88例,对照组给予常规护理措施,观察组给予患者防跌倒综合干预措施.采用独立性功能测量(FIM)量表进行日常生活能力评定,采用自我护理能力实施量表(ESCA)调查患者的适应与自我护理能力.结果 ①观察组患者行高血压三项检验时未发生跌倒;对照组患者发生6例次的跌倒,但未有骨折等严重并发症.②两组患者出院时FIM量表评分差异无统计学意义(P＞0.05).出院后3、6个月观察组FIM量表评分均高于对照组,差异有统计学意义(P＜0.05).③观察组患者出院后3、6个月在ESCA总分、自我护理责任感、自我护理技能、健康知识水平、自我概念等项均明显优于对照组同时期,差异均有统计学意义(均P＜ 0.05).结论 对住院患者行高血压三项检验中实施针对性的跌倒干预措施,能有效避免跌倒的发生.

目的探讨以提高自我效能感为原则的健康教育对老年冠状动脉性心脏病患者生活质量的影响,为提高老年冠状动脉性心脏病患者的生活质量提供新思路。方法便利抽样法选取2008年8月至2009年12月在浙江医院心脏康复科进行治疗的120例老年冠状动脉性心脏病患者,按住院号末尾数单双号将其分成观察组和对照组,每组60例。对照组患者实施常规护理及常规健康教育,观察组患者在常规护理的基础上实施以提高自我效能感为原则的健康教育,重点为针对冠状动脉性心脏病危险因素的教育。采用一般自我效能感量表及冠状动脉性心脏病生活质量量表对两组老年冠状动脉性心脏病患者进行教育前、教育6个月后比较。结果健康教育前两组老年冠状动脉性心脏病患者的自我效能感明显低于全国常模,差异均有统计学意义(均P<0.05),健康教育前两组患者的生活质量总分值、生活质量各分值、自我效能分值的差异无统计学意义(均P>0.05)。健康教育6个月后,两组患者在生活质量总分及自我效能分值上均较健康教育前有所提高,差异均有统计学意义(均P<0.05)。且观察组患者的生活质量总分、生活质量各分值及一般自我效能分值均高于对照组患者(均P<0.05)。结论提高患者的自我效能感有利于老年冠状动脉性心脏病患者生活质量的提高。