目的:了解妊娠期糖尿病(GDM)孕妇产后2年转归情况、保健现状和产后保健需求,为完善GDM孕妇产后保健、减少不良转归提供参考.方法:通过便利抽样对2年内在天津市某三级甲等医院产科分娩的妊娠期糖尿病孕妇产后转归现状及保健需求进行问卷调查.结果:13.6％GDM孕妇出现产后体质量滞留;56.5％GDM孕妇产后从未监测过血糖,4.2％GDM孕妇在产后不同时间出现了糖耐量受损,1例GDM孕妇产后2年内已确诊2型糖尿病;59.7％GDM孕妇在产后42天内进行了产后保健,34.6％GDM孕妇从未进行过产后保健,36.1％GDM孕妇没有得到任何相关专业人士的指导;GDM孕妇更希望由妇产科医生、助产士、社区保健医生通过孕妇学校课程、宣传手册、微信公众号等线上形式提供新生儿保健指导、膳食指导、运动指导、主要照护者健康教育等保健内容.结论:目前GDM孕妇对血糖变化重视程度较低,自我监测意识较差;产后保健不够系统、规范,未来应进一步加强筛查与管理,以减少GDM产后不良转归的发生.

目的:汉化机械通气患者拔管后吞咽障碍筛查工具(postextubation dysphagia screening,PEDS),并检验其信效度及诊断价值.方法:严格遵循Brislin翻译模型对PEDS工具进行汉化,并经专家函询、ICU护士认知性访谈及预试验调适问卷条目,将其应用于100例经口气管插管机械通气患者.问卷内部一致性采用Cronbach's α系数评估、评定者间信度采用组内相关系数评估;内容效度指数以及探索性因子分析验证效度检验结果;以吞咽障碍评估金标准——纤维内镜吞咽功能检查为参考标准,通过灵敏度、特异度进行诊断价值评价.结果:中文版PEDS工具总的Cronbach's α系数为0.904;评估者内部信度系数为0.930;各条目内容效度指数为0.84～1.00,总的内容效度指数为0.96;机械通气患者拔管后吞咽障碍的发生率为56％,灵敏度为82.1％,特异度为70.5％.结论:中文版PEDS工具具有良好的信效度,灵敏度高,适用于经口气管插管机械通气患者吞咽障碍的筛查.

目的:比较衰弱表型(Frailty Phenotype,FP)、衰弱量表(Frail scale,FS)、埃德蒙特衰弱量表(The Edmonton Frail Scale,EFS)3种衰弱评估工具对老年腹部手术患者术后并发症的预测效能,以期为衰弱评估工具的选择提供参考.方法:便利选取某三级甲等医院年龄≥60岁的老年腹部手术患者184例,采用FP、FS、EFS评估患者的衰弱状态,收集患者的一般资料、手术类型、手术方式以及术后并发症的资料.应用X2检验,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析FP、FS和EFS对老年腹部手术患者术后并发症的预测作用.结果:184例老年腹部手术患者FP、FS、EFS衰弱的检出率分别为22.3％、16.8％、22.2％,3种评估工具的衰弱检出率比较差异无统计学意义(P＞0.05).FP预测老年腹部手术患者术后并发症发生的ROC面积为0.798,高于FS、EFS的0.681和0.670(P＜0.05)o结论:3种衰弱评估工具对老年腹部手术患者的衰弱检出率具有一致性.与FS、EFS相比较,FP更能够有效预测老年腹部手术患者术后并发症的发生.

ObjectiveTo explore the intervention effect of the nurse⁃led frailty full⁃process management model on elderly patients undergoing abdominal surgery.MethodsA total of 60 elderly frail patients who underwent elective abdominal surgery in a tertiary grade A general hospital，were randomly divided into an observation group and a control group，30 cases in each.The control group received routine nursing care，and the observation group adopted the nurse⁃led fraility full⁃process management model.The grip strength，pace，weakness，length of postoperative hospital stay，and complications occurance between two groups were compared.The patients' quality of life at 1 month，3 months，and 6 months after discharge was followed up.ResultsAt the time of discharge，the scores of grip strength，pace，and weakness of the patients in the observation group were 23.98±6.45 kg，0.55±0.13 m/s，and 2.83±0.79，respectively，while those of the control group were 20.49±6.54 kg，0.48±0.10 m/s，3.40±1.13，respectively.The differences between the two groups were statistically significant （P<0.05）.The observation group's length of postoperative hospital stay and complication rate were shorter and lower than those of the control group （P<0.05）.With the extension of follow⁃up time，the physical health status （PCS） and role⁃emotional （RE） scores of the observation group gradually increased.ConclusionsThe nurse⁃led frailty whole⁃process management model could help delay the patient's decline degree of grip strength，pace，and frailty.It could also shorten the length of postoperative hospital stay，reduce postoperative complications，and improve the quality of life of the elderly patients with frailty after abdominal surgery.

目的:调查天津市新型冠状病毒肺炎患者的心理健康水平与特质应对方式现状,并探讨两者之间的关系,为临床一线护理人员开展心理干预提供科学依据.方法:对天津市某三级医院收治的72例新型冠状病毒肺炎患者采用一般资料调查问卷、广泛性焦虑量表(Generalized Anxiety Disorder,GAD-7)、患者健康问卷抑郁量表(Patient Health Questionnaire-9,PHQ-9)及特质应对方式量表(Trait Coping Style Questionnaire,TCSQ)进行调查.结果:新型冠状病毒肺炎患者GAD-7得分为(7.23±2.17)分,焦虑发生率为72.22％ (52/72);PHQ-9得分为(8.20±2.01)分,抑郁发生率为70.83％ (51/72).新型冠状病毒肺炎患者GAD-7和PHQ-9总分与积极应对(PC)得分呈负相关(P＜0.05),与消极应对(NC)得分呈正相关(P＜0.05).结论:新型冠状病毒肺炎患者普遍存在不同程度的心理健康问题,且与面对疾病的应对方式密切相关,医务人员应在给予患者治疗的同时,采取针对性措施,维护其心理健康,促进疾病康复.

对远程监护在慢性阻塞性肺疾病患者中应用的相关概念、应用优势、国内外现状、应用建议等进行分析和总结,旨在为远程监护在慢性阻塞性肺疾病中的应用提供依据和参考.

目的 了解2型糖尿病住院患者积极度和心理弹性的现状,探讨两者之间的相关性,为糖尿病患者护理干预提供理论依据.方法 于2019年10月至2020年1月,采取便利抽样的方法选取天津市2所三级甲等医院内分泌科住院治疗的413例2型糖尿病患者作为研究对象.采用一般资料调查表、患者积极度量表(PAM)、心理弹性量表(CD-RISC)对患者进行调查.采用SPSS 24.0统计软件进行方差分析、x2检验、Brown-Forsythe检验,采用多元有序logistic回归分析患者积极度和心理弹性的相关性.结果 413例2型糖尿病住院患者PAM的中位数为53.2 分(P25～P75:48.9～60.6分),处于第2水平;患者心理弹性平均分为(63.41±11.03)分,为中等水平.多元有序logistic回归分析结果显示,病程(OR=0.437,95％CI:0.259～0.738)、文化程度(OR=0.314,95％CI:0.141～0.703)、坚韧(OR=1.080,95％CI:1.025～1.138)、力量(OR=1.103,95％CI:1.019～1.193)及乐观(OR=1.200,95％CI:1.050～1.373)与患者积极度呈正相关;体质指数(OR=0.930,95％CI:0.879～0.983)、收缩压(OR=0.985,95％CI:0.971～0.998)、糖化血红蛋白(OR=0.881,95％CI:0.785～0.988)与患者积极度呈负相关,均有统计学意义(P＜0.05).结论 医护人员应注重患者积极情绪的调动与培养,并针对性地对患者进行疾病管理,提高患者积极度及疾病的自我管理能力.

Frailty is a common physiological dysfunction syndrome in the elderly. Aging requires active prevention and treatment of the aging problem. Based on the background of aging problem, this paper introduces the classic and personalized methods for identifying senile frailty and analyzes their applicability. This paper discusses the evolution of the intervention center of senile frailty from the horizontal expansion of the intervention object and the vertical extension of the intervention path, discusses the significance of the comprehensive care model based on the comprehensive assessment of the elderly and the multidisciplinary cooperation in the frailty management, and expounds the bottleneck problems in the frailty management of the elderly.

ObjectiveTo systematically evaluate the effect of psychological intervention on negative emotion and quality of life of elderly patients with chronic obstructive pulmonary disease（COPD）.MethodsRandomized controlled trials about the effect of psychological intervention on negative emotion and quality of life of elderly patients with COPD，were retrieved from The Cochrane Library，PubMed，EMbase，VIP，CNKI，Wanfang Data and CBM.The retrieval time was from inception to 23 February，2020.Literature screening，data extraction and quality evaluation were carried out independently by two researchers.Then，RevMan 5.3 software was used for Meta analysis.ResultsA total of 15 researches were included，involving 1 455 patients.Meta⁃analysis showed that compared with routine nursing group，the degree of anxiety in psychological intervention group reduced［MD=-8.04，95%CI（-9.27，-6.81），P<0.000 01］，the degree of depression decreased［MD=-8.94，95%CI（-10.41，-7.46），P<0.000 01］，the forced expiratory volume in the first second（FEV1） increased［MD=0.43，95%CI（0.30，0.55），P<0.000 01］，and the ratio of forced expiratory volume to forced lung capacity in the first second（FEV1/FVC） raised［MD=14.33，95%CI（10.66，18.01），P<0.000 01］.The quality of life was better［MD=13.60，95%CI（7.15，20.04），P<0.000 1］.And the sensitivity analysis showed that results in above were stable and reliable.However，two sides of funnel chart of anxiety and depression were asymmetrical.ConclusionsCurrent evidence showed that compared with routine nursing，psychological intervention was more conducive to improving negative emotion and lung function of elderly patients with COPD，and promoting quality of life of patients.However，limited by quality of included researches and follow⁃up time，above conclusions need to be verified by conducting more high⁃quality studies.

目的 构建适合孕产妇的盆底功能障碍风险预测评估量表,为孕产妇盆底功能障碍性疾病(PFD)高危人群筛查提供参考依据.方法 在文献研究和小组讨论的基础上编制专家咨询问卷,应用德尔菲法确定量表条目,对302例孕产妇进行盆底功能障碍风险评估,验证量表信效度.结果 孕产妇盆底功能障碍风险评估量表共包括4个维度,16项条目,总量表的Cronbach's α系数为0.872,重测信度为0.841.量表水平的内容效度指数为0.90,通过探索因子分析共提取2个公因子,累计方差贡献率为72.38％,效标关联效度中量表的评估值与标准值的相关系数r值为0.647.受试者工作特征(ROC)曲线结果显示曲线下面积(AUC)为0.771,最佳高危临界值为20.5,此时对应的灵敏度为79.4％,特异度为78.8％.结论 该研究构建的孕产妇PFD风险评估量表具有良好的信效度,可以作为孕产妇盆底功能障碍的评估工具应用.

Objective:To investigate the changes of cognitive function and self-care ability in patients with mild cognitive impairment after stroke after sensory integration therapy.Methods:One hundred patients with mild cognitive impairment after stroke were divided into control group and intervention group according to the random number table method. The control group was given the routine health education path and rehabilitation training, and the intervention group was given the cognitive rehabilitation through sensory integration therapy on the basis of the control group. The cognitive function and self-care ability of the patients were evaluated by the Montreal cognitive assessment(MoCA) and daily self-care ability scale(ADL) before and after intervention.Results:After intervention, the total MoCA score, visual space, nominalization, language, abstraction and memory scores of the intervention group were 26.02±1.15, 3.50±0.76, 2.98±0.14, 2.90±0.30, 2.84±0.37 and 3.18±0.69, respectively, while those of the control group were 23.32±1.90, 2.86±1.20, 2.78±0.42, 2.82±0.39, 1.58±0.54 and 2.82±0.94, respectively. The difference between the two groups was statistically significant ( t value was -18.296--2.064, all P<0.05). The scores of attention and directional force in the intervention group were 5.44±0.67 and 5.18±0.85, respectively, while those in the control group were 5.32±0.84 and 5.14±0.78, respectively. There was no statistically significant difference between the two groups ( t value was -1.288, -0.704, P>0.05).After intervention, the total ADL score, stool, urine, toilet, eating, dressing and bathing scores of the intervention group were 65.00±5.98, 5.90±2.19, 6.40±2.27, 7.40±2.72, 7.80±2.70, 7.50±2.53 and 5.50±1.52, respectively, The control group was 53.60±10.20, 3.50±3.23, 5.00±3.50, 5.50±3.23, 5.40±3.76, 5.90±3.45, and 4.40±2.79, respectively. The difference between the two groups was statistically significant ( t value was -7.573~-2.615, all P<0.05). Conclusions:Sensory integration therapy can improve the cognitive function and self-care ability of patients with mild cognitive impairment after stroke.

[目的]探讨新护士公平敏感性与工作幸福感的相关性。[方法]采用一般资料调查表、公平偏好问卷、护士工作幸福感量表对天津市某肿瘤专科医院234名新护士进行问卷调查。[结果]新护士公平敏感性总均分为（3.40±0.45）分,奉献维度均分[（3.52±0.50）分]高于酬赏维度均分[（3.27±0.58）分];新护士工作幸福感总分为（88.44±15.60）分,以工作价值维度均分[（4.69±0.81）分]和人际间维度均分[（4.92±0.84）分]较高。相关性分析中两者总分及各维度得分均呈正相关,相关系数为0.234～0.476（P＜0.01）。回归分析表明,公平敏感性中的奉献和酬赏对工作幸福感具有预测作用（P＜0.05）。[结论]新护士公平敏感性与工作幸福感具有相关性,公平敏感性中的奉献和酬赏均为工作幸福感的影响因素。

Extracorporeal membrane oxygenation (ECMO) hit a great milestone in critical care medicine since it has brought more hope for the diagnosis and treatments of critically ill patients. However, benefits to patients are alongside with nursing challenges as the technique develops. This paper discusses the challenges and dilemma concerning critical care of patients with ECMO, proposing to improve the quality of critical care management of ECMO patient by standardized nursing process of ECMO patients, specialized nursing training and in-depth regional cooperation.

2019 年 12 月以来,我国尤其是湖北省武汉市等地区暴发了新型冠状病毒肺炎(简称:新冠肺炎)疫情,至今国内已有超 8 万人发病,死亡病例 3 千余人,现世界各地均有疫情报告.该疾病传播速度之快,传播方式之诡异,以及临床进程迅速,均是对全人类的挑战.全国的医务工作者紧急出动,数以万计的医护人员在全国各地同疫情展开了斗争.天津也不例外,在天津市救治新冠肺炎定点医院,数支医疗队紧急集结,救治新冠肺炎患者.天津市新冠肺炎发病特点多为家庭聚集发病,老年患者居多,多合并高血压、冠心病、糖尿病、脑血管疾病等多种基础疾病,由于疾病进展迅速,合并症较多[1],初期临床救治效率存在一定欠缺,治疗初期出现一定的困难、挫折.

目的 了解膀胱癌术后患者配偶恐惧疾病进展和创伤后应激障碍水平的现状,并分析两者的相关性.方法 采用便利抽样法对120例膀胱癌术后患者配偶应用一般资料调查问卷、配偶恐惧疾病进展量表(FoP-Q-SF/P)和事件影响量表修订版(IER-S)进行调查.结果 膀胱癌术后患者配偶恐惧疾病进展的得分为(35.75±9.86)分,IER-S得分为(29.92±17.06)分,膀胱癌术后患者配偶的恐惧疾病进展总分及各维度得分与创伤后应激得分及各维度得分均呈显著正相关(P<0.01).结论 膀胱癌术后患者配偶恐惧疾病进展水平较严重,且与创伤后应激障碍水平有显著相关性,可以通过减少配偶的创伤后应激性来可改善其恐惧疾病进展水平.

目的:探索心肺运动试验在指导2型糖尿病患者精准化运动中的效果.方法:选择接受心肺运动试验的2型糖尿病患者60例,随机分为对照组和干预组,每组30例.对照组给予患者常规运动指导,干预组根据患者心肺运动试验结果给予精准化指导.运动3个月后,比较两组患者试验前后的糖化血红蛋白(HbA1c)、BMI、峰值摄氧量(VO2peak)、峰值氧脉搏(O2Pulsepeak)、无氧阈(AT)、峰值潮气量(VTpeak)结果,统计患者运动过程中不良事件发生情况.结果:3个月后与基线比较,对照组患者HbA1c、BMI、O2Pulsepeak、VTpeak的变化有显著差异(P＜0.05),VO2peakk、AT的变化无差异(均P＞0.05),干预组所有数值变化显著(均P＜0.05);干预组除HbA1c(P＞0.05)外,其余数值较对照组改善程度明显(P＜0.05);不良事件中,两组患者低血糖的发生无差异(P＞0.05),对照组心脏危险事件明显高于干预组(均P＜0.05).结论:两种运动方式均能降低患者血糖水平,但是根据心肺运动试验结果指导2型糖尿病患者的精准化运动,更能有效提高患者心肺功能,减少运动过程中不良事件发生率.

Objective To explore the key initiatives and effective methods for preparing the constructions of emergency-oriented hospitals under COVID-19 pandemic. Methods The wartime mechanism was strengthened by adhering to unified leadership, trengthening the top-level design and clarifying the division of responsibilities. Objective management was used as a means to take into account the key of personnel allocation and training, prevention and control of hospital infection, transformation of contagious ward, logistic support, equipment and material supply and construction of system and process. Results The preparations and constructions of the emergency-oriented hospitals were completed in 72 hours，which passed the acceptance and inspections from infection control experts，who appraised our work to be “the highest in difficulty, the fastest in project progress and the highest in quality". Totally, upon to the preparations，14 medical teams were set up and the layout process reestablishment of 14 wards was completed, the installation and preparation of nearly 10000 sets/pieces of medical equipment and medical materials were completed as well and more than 80 work systems and process systems for 9 major modules were established. Conclusion The preparations and constructions of emergency-oriented hospitals should be performed upon the thorough implementation of the decisions and arrangements by the municipal Party committee and the municipal government, insisting on the wartime thinking and establishment of high-quality management team and effective goal management focusing on details and actual needs of medical staff.

Anti-contactin-1(CNTN1) IgG4 antibody is a reliable biomarker of a specific subset of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients with distinct clinical features, including advanced age, aggressive symptom, predominantly motor involvement, sensory ataxia, and poor response to intravenous immunoglobulin. Nerve conduction study showed decrease of nerve conduction velocity, reduction of compound motor active potential amplitude without temporal dispersion at early stage of the disease. The article reported an anti-CNTN1 IgG4 antibody positive case, reviewed the current relevant literature, and then summarized the clinical characteristics of anti-CNTN1 IgG4 antibody associated CIDP.

目的 探讨灵性健康在晚期癌症患者的症状负担与生活质量间的中介作用.方法 选取天津医科大学肿瘤医院晚期癌症患者作为研究对象,应用一般资料调查量表、症状负担量表、慢性疾病治疗功能评估-灵性量表-12及癌症患者生命质量测定量表分别对患者的一般资料、症状负担、灵性健康及生活质量进行调查,并采用中介效应检验方法分析灵性健康在症状负担和生活质量之间的中介作用.结果 共发放问卷230份,回收有效问卷212份,有效回收率为92.2％.灵性健康与总体生活质量呈正相关(r =0.619,P＜0.01),与症状负担呈负相关(r=-0.505,P＜0.01),症状负担与总体生活质量呈负相关(r=-0.590,P＜0.01).灵性健康在症状负担与总体生活质量、躯体、角色、情绪、社会功能之间存在中介作用,在认知功能方面无中介作用.结论 症状负担通过灵性健康影响晚期癌症患者的生活质量,临床护士应采取有效措施关注并提升患者的灵性健康,从而提高晚期癌症患者的生活质量.