慢性肾脏病患者由于肾脏排泄功能严重受损,导致其高尿酸血症的发病率高于正常人群,单纯应用中药治疗效果并不理想.目前临床对高尿酸血症的治疗一般从两个方面进行.减少摄入嘌呤可以减少尿酸的来源,还要注意诱发高尿酸血症的药物;其次是降尿酸治疗.

目的 构建我国急诊护士灾害护理能力评价指标体系.方法 通过理论材料及相关文献选定评价指标体系框架,结合专家访谈了解急诊护士灾害护理能力的相关概念、职责和评价指标.运用Delphi法对30名专家进行两轮函询,构建急诊护士灾害护理能力评价指标.结果 两轮函询问卷有效回收率均为100.00％,专家的权威系数为0.883,判断系数为0.886,熟悉程度为0.880.两轮函询协调系数重要性W值为0.507与0.481,可行性W值为0.437与0.441,均具有统计学意义(P<0.01).最终确立了包含4个一级条目、10个二级条目、54个三级条目的急诊护士灾害护理能力评价指标.结论 根据函询专家的权威意见修订形成的急诊护士灾害护理能力评价指标内容具有科学性、可靠性及实用性,结合心理护理能力,细化急诊护士灾害护理能力,为未来进一步研究奠定科学依据及基础,可以在临床推广应用.

目的:构建急诊预检分诊护士岗位培训方案,为临床工作提供参考.方法:通过两轮专家咨询,对条目进行修改、整理,并测量条目的权重值.结果:遴选专家对本研究有较高兴趣,函询意见较为集中,两轮函询后形成的急诊预检分诊护士岗位培训方案包括一级条目3个、二级条目21个、三级条目69个.结论:构建的急诊预检分诊护士岗位培训方案具有科学性和可靠性.覆盖面广且充分结合预检分诊实际工作情况,能为下一步研究提供借鉴.

目的 通过质性访谈了解医技人员实施急救措施的促进与障碍因素,深层次挖掘影响其实施急救措施的根本原因和动力.方法 采用目的抽样法选取我院医务人员进行访谈,以访谈内容饱和为止,共获得25份访谈资料,包括10名急救护士、4名急救医生、6名医技人员及5名后勤工人,应用Colaizzi 7步分析法分析资料.结果 障碍因素共析出4个主题,分别为环境因素、职能因素、工作性质及心理因素;促进因素析出3个主题:急诊轮转经验、专业领域相关性及职业素养.形成障碍因素的根本原因是急救培训少、经验不丰富、实际操作少,而实施急救措施的动力是其职业道德、职业责任感及职业信仰.结论 管理者应培养医技人员的急救意识及技能,改变培训模式,定时演练实践,通过医、技、护人员的配合协调,提高整体应急水平.

目的 调查社区居民进行院外心肺复苏的意愿,挖掘影响其实施心肺复苏术(cardiopulmonary resuscitation,CPR)的原因,为未来促进"第一目击者"实施CPR提出建议及对策.方法 于2019年5月—9月,组织来自上海地区不同事业单位、企业、学校等的社区居民进行13场心肺复苏培训,并对社区居民采用方便抽样方法进行问卷调查.结果 共收集有效问卷822例,居民年龄(36.42±11.43)岁(17～76岁),调查显示社区居民对CPR知晓率较高,为93.2％;95.99％的居民对学习CPR有较大的兴趣;59.00％的居民愿意参与相关CPR技能的培训课程;实施CPR阻碍因素较为明显,分别为"担心技能不够""担心被误解"和"担心得传染病".结论 提高居民实施CPR的意愿度需要建立统一的培训体系、完善相关法律法规、加强CPR宣传及培训力度.

Objective:To study the influence of communication adequacy of critical patients on their willingness to participate in their own medical safety.Methods:From August 2019 to October 2019, a questionnaire survey was conducted on 209 critical patients.Results:The willingness to participate in the medical safety of critical patients was 3.92 ± 0.57, the willingness to participate was higher, the communication between doctors and patients was more sufficient, and the willingness to participate in the medical safety of patients was increased.Conclusions:Understanding the psychology of critical patients and paying attention to the sufficiency of communication between doctors and patients can increase the flexibility of patients' participation in medical safety and improve their willingness to participate in their own medical safety.

Objective:To explore the knowledge and attitude of cardiopulmonary resuscitation (CPR) in community residents in Shanghai and analyze the influencing factors.Methods:The residents in 16 communities in Shanghai were selected by convenient sampling and investigated from November 2018 to June 2019, and a total of 714 valid questionnaires were recovered. The residents' CPR knowledge and attitude were analyzed descriptively, and multiple linear regression was used to analyze the influencing factors.Results:The total score of CPR knowledge among the 714 community residents in Shanghai was (24.58±7.80) , with a passing rate of 36.13% (258/714) , and the passing rate of "artificial respiration knowledge" was the lowest, which was 38.66% (276/714) . The total score of the residents' CPR attitude was (40.95±5.18) , and the average scores of "attitude to learning CPR" and "attitude to implementing CPR" were (3.60±0.45) and (3.22±0.50) , respectively. Analysis of the influencing factors showed that gender, age, education level, conscious health status, whether they have heard of CPR, whether they have received CPR training, and whether they have encountered emergency rescue communities were the influencing factors to the community residents' CPR knowledge and attitude ( P < 0.05) . Conclusions:The overall CPR knowledge level of the community residents in Shanghai is relatively low, and the residents prefer to learn CPR and implement CPR for their relatives and friends, rather than strangers. Younger, better conscious health status, and having heard of CPR can help the residents improve their CPR knowledge and attitude, while women, higher education level, and residents who have encountered emergency rescue communities have better CPR knowledge. The CPR training has a positive effect on the residents' attitude to learning and implementing CPR. Future CPR training needs to increase the training intensity and duration, and help the residents to improve the level of CPR knowledge and attitude.

[目的]基于人工神经网络(ANN)模型构建方法,构建急诊预检分诊预测模型.[方法]收集2018年11月1日—2018年11月30日就诊的急诊病人分诊情况,应用ANN模型,模拟预检护士预检分诊头晕/眩晕病人的思维过程,将分诊依据作为输入层,包括生命体征(体温、脉搏、呼吸、血压)、意识、格拉斯哥评分(GCS)、疼痛评分、血糖,输出层为分诊结果,预测分诊准确率.[结果]基于传统人工预检分诊预检结果(准确率为80.2％,AUC=0.509)进行逻辑演练及专家分级后进行ANN模型构建,测得预测准确率为99.4％,AUC=1.000,血压是判断头晕/眩晕病人重要依据.[结论]构建的急诊预检分诊预测模型可以有效提高护士分诊正确率,使急诊病人的评估同质化.

Objective To explore the application effect of triage-registration information systems in emergency patients. Methods A total of 18 964 emergency patients from 1 December 2016 to 31 December 2016 in Zhongshan Hospital of Fudan University Emergency Department were selected as control group and 18798 emergency patients as experimental group from March 1, 2017 to March 31, 2017. In the control group, the patients were used traditional mode of triage-registration and registration office respectively line. In the experimental group, the patients were used triage-registration information systems in line once. The emergency waiting time, patient satisfaction and medical staff satisfaction were compared between the two groups before and after the application of triage-registration information systems. Results The waiting time in the experimental group was significantly shorter than that in the control group, median(P25, P75):11(6-28)min vs. 10(4, 27)min, The difference between both groups was statistically significant(Z=-14.5433, P=0.000). The patient satisfaction in the experimental group were better than those in the control group, (2.89 ± 0.41 vs. 2.98 ± 0.13), and with statistical difference (Z=-10.317, P＜0.05). And the acceptance of the medical staff in the experimental group were better than those in the control group, (2.90±0.35 VS 2.97±0.16), and with statistical difference (Z=-5.527, P<0.05). Conclusions The development and application of the triage- registration information system can effectively shorten the waiting time of patients, improve the experience of emergency patients, improve the satisfaction of medical staff, and realize the optimization of the process of seeking medical treatment.

目的 探讨翻转课堂教学模式在急诊临床护理教学中的应用效果.方法 将2016年6月-2017年5月在我院急诊科实习的急诊实习168名护生随机分为实验组和对照组.其中实验组87人,采用翻转课堂教学模式开展教学活动;对照组81人,采用传统教学法进行教学.实习结束前进行理论与技能操作的考核,并以网络问卷星形式开展护生对教学效果的问卷调查.结果 实验组的理论成绩和技能操作成绩均高于对照组,且差异有统计学意义(P＜0.01);翻转课堂教学模式在提高护生学习积极性、自学能力、适应性和应急能力等方面优于传统教学方法(P＜0.01).结论 翻转课堂教学模式不仅可提高护生学习成绩,还能培养护生学习的积极性和主动性、团队协作、应急处理等综合能力,是一种值得推广的临床护理教学方法.

Objective:To study the role of modified oxygen nebulizer of tracheotomy mask in tracheotomy patients without ventilator support.Methods:From January 2013 to June 2015,56 tracheotomy patients from emergency intensive care unit (EICU),without ventilator support,were randomly divided into control group and observation group,with 28 cases in each group.In control group,the tracheotomy was covered with sterile gauze and traditional intermittent airway humidification was applied.In observation group,modified oxygen nebulizer was used.The wet effect and complications were compared between the two groups.Results:There was no significant difference in heart rate and respiratory rate between the two groups.The oxyhemoglobin saturation in observation group was higher than which in control group (P<0.05),and higher than the oxyhemoglobin saturation before humidification ([95.5±1.6]%,P<0.05).The statistical significances of wet effect and complications were found between two groups (P<0.05).Conclusions:The modifying oxygen of nebulizer of tracheotomy mask,without electric power,driven by oxygen can effectively humidify the airway in the tracheotomy patients without ventilator support.

目的 探讨RPR滴度检测对梅毒患者治疗疗效的情况.方法 跟踪梅毒确诊病人55例,治疗前后均抽采患者血液,按1:2、1:4、1:8、1:16、1:32、1:64检测出患者达到的滴度,判断其血清滴度转阴情况.结果 50例患者转阴性,5例治疗无效.结论 血清学检测,是诊断梅毒的重要依据之一,对于判断治疗后梅毒患者是否达到血清治愈、是否复发或是否中枢神经系统受梅毒感染,其滴度检测就显得十分重要.

对微量泵输注高浓度氯化钾纠正严重低钾血症的可行性、安全性、方法、不良反应、观察和护理等方面进行综述,认为在临床应用中应重视持续心电监护,加强尿量、生化和血气的监测,做好微量泵的管理和补钾通道的监护等,以提高高浓度氯化钾微量泵的应用效果。