Objective To explore the application effects of Donabedian's structure-process-outcome three-dimension quality assessment model on perioperative blood glucose management among elderly patients with hip fracture. Methods From September 2016 to April 2017, a total of 129 elderly patients with hip fracture of the Third Hospital of Hebei Medical University were numbered according to admission order. From September to December 2016, a total of 62 cases were in control group receiving routine blood glucose management. From January to April 2017, 67 cases were in observation group treated with blood glucose management based on Donabedian's three-dimension quality assessment model. And then, we compared the blood glucose on admission and before discharge, waiting time before surgery, healing time of wound and cases of hypoglycemia. At the same time, we investigated the demands of training content of medical staff (n=133). Results There was no statistical difference in the first blood glucose 24 hours after admission and 2 hours after meal of patients between two groups (P＞0.05). After intervention, the waiting time before surgery, healing time of wound and incidence rate of hypoglycemia in observation group [(3.34±0.88) d, (4.43±1.38) d and (3/67, 4.5%)]were less than those in control group [(4.63±1.41) d, (6.47±2.24) d and (10/62, 16.1%)];the fasting blood glucose and blood glucose 2 hours after meal in observation group [(5.96±1.21), (7.60±0.96) mmol/L] were lower than those in control group [(10.80±1.14), (9.94±1.98) mmol/L]one day before discharge all with significant differences (P＜ 0.05). There was also significant difference in blood glucose 2 hours after meal in observation group before and after intervention (P＜0.05). The demands of training content of medical staff (n=133) included diet management, correct usage of insulin, oral hypoglycemic agents instruction, blood glucose monitoring management;the influencing factors on implementing blood glucose management involved busy work, inconsistent dinner time, insufficient knowledge, and so forth. Conclusions Blood glucose management process based on Donabedian's three-dimension quality assessment model can effectively control perioperative blood glucose among elderly patients with hip fracture, shorten waiting time before surgery as well as healing time of wound and reduce cases of hypoglycemia which makes for overall rehabilitation of patients.

Objective To investigate feasibility and effectiveness of combined level-one quality control and management mode. Methods Contents of combined level-one quality control and management mode were introduced, including determining departments combination, establishment and work procedure of the combined quality control group, frequency of combined quality control, and approaches of continuous quality improvement. Quality control data of the Nursing Department from January 2013 to December 2014 were taken to statistically analyze compliance rate of 6 nursing quality standards, satisfaction of hospitalized patients, and incidence of nursing defects, before and after implement of combined quality control&management mode. Results Compared with before, after implementation of combined level-one quality control and management mode, compliance rates of nursing documentation, basic nursing, treatment safety, head nurse management, and ward management, as well as satisfaction of hospitalized patients, and incidence of nursing defects were statistically significant (χ2 =4. 182, 8. 177, 6. 157, 5. 148, 5. 135, 7. 875, 7. 754; P <0. 05). Compliance rates of health education quality before and after the implementation were not statisticallysignificant (χ2 = 4. 182, P > 0. 05 ). Conclusions Implementation of combined level-one quality control and management mode can improve compliance rate of nursing quality standards and satisfaction of hospitalized patients, and decrease incidence of nursing defects, which is a new feasible and effective management mode in clinical work.

目的：探究强化精氨酸的肠内营养对颈髓损伤患者术后代谢及预后的影响。方法选择颈髓损伤术后患者53例，随机分为2组，对照组（ n =28）未服用精氨酸，研究组（ n =25）精氨酸30 g/ d 口服，2组患者均采用等热量等氮（105 kj·kg -1·d -1，1.2 g·kg -1·d -1）肠内营养支持14 d，于第1天、第7天和第14天测定空腹血糖、血脂、白蛋白、前白蛋白和转铁蛋白，记录感染情况和经济指标。结果第7天和1天比较，对照组的胆固醇和前白蛋白；研究组的血糖和前白蛋白差异均有统计学意义（ P <0.01）。第14天和第7天比较，对照组的血糖。2组的胆固醇、三酰甘油、白蛋白、前白蛋白和转铁蛋白差异均有统计学意义（ P <0.01）。2组比较，第7天的血糖和前白蛋白；第14天的白蛋白和转铁蛋白差异均有统计学意义（ P <0.01）；感染率和药品费用比较差异均有统计学意义（ P =0.048；P <0.01）。结论颈髓损伤患者术后应用精氨酸有利于改善糖、蛋白质代谢，减少感染并发症及节约药品费用。

This study aims to assess the outcomes of displaced femoral shaft fractures (DFSFs) treated by antegrade nailing with the assistance of a newly invented intramedullary (IM) reduction device.

Objective To evaluate the impact of different ages, different gender, with or without exercise and different fracture sites on the nutritional status using mini nutritional assessment (MNA-SF) in hospitalized elderly fracture patients. Methods A total of 1 353 hospitalized elderly patients with fracture were included. The MNA-SF investigations were completed within 3 days after admission. The diet, body weight, physical activity, psychological trauma or stress, psychological problems, body mass index (BMI), calf circumference (CC), history of aerobic exercise and the fracture sites were recorded three days after admission. The nutritional status were evaluated including normal nutrition, risk of malnutrition and malnutritional status. The relationships of nutritional status were analyzed between different ages, different gender, with or without exercise, different fracture sites. Results There were significant differences in the incidence of normal nutrition, risk of malnutrition malnutrition and non-normal nutritional status between different ages, different gender, with or without exercise, femoral intertrochanteric fracture and upper limb fracture. There were also significant differences in the incidence of normal nutrition, risk of malnutrition and malnutrition between femoral neck fracture and upper limb fracture. Conclusion There is a higher incidence of non-normal nutritional status in patients older than 80 years, female, with no regular exercise and with femoral intertrochanteric fracture.

Objective To study the status of the usage and the awareness of drip chamber in the application in administration of medicine .Methods The self-designed questionnaire about drip chamber used for administration of medicine was used to survey 310 nurses.Results There were different kinds of appellations for the drip chamber , among with the “Murphy's Dropper” was used the most , and it was not in line with the national and the international standards .298 nurses ( 96.13%) in the survey accepted and used the drip chamber for administration of medicine .246 nurses (82.55%) replaced the intravenous injection by the drip chamber for administration of medicine .Only 12 nurses were opposed to the drip chamber for administration of medicine.All the respondents failed to give the exact answer of drug concentration changes and the amount of electrolyte solution used for rinsing drip set .Conclusions The application of drip chamber should be standardized by national and international standards .Nurses fail to fully recognize the way of using drip chamber for medicine, so it cannot be replaced completely by the intravenous injection .

OBJECTIVE To investigate the effects of different intake of protein on nutritional indicators in severe stroke patients. METHODS 89 patients with severe stroke and NRS-2002 scores not less than 3 were enrolled. The patients were divided into group A, group B and group C by random, and 28 cases were in group A with protein intake at 0.9 g/kg, 30 cases were in group B with protein intake at 1.2 g/kg and 31 cases were in group C with protein intake at 1.6 g/kg, all patients were given the same calories support (25 kcal/kg). On the day of pre-intervention, the 7th and 14th day of post-intervention, fasting blood samples were collected from every subjects. The total protein (TP), albumin (ALB), hemoglobin (Hb), creatinine (Cr), blood urea nitrogen (BUN), midarm circumference (MAC) and calf circumference (CC) were recorded. RESULTS (1) The MAC and CC of health side body decreased on the 14th day post-intervention in group A and group B, the differences were significant compared with pre-intervention and on the 7th day post-intervention (P < 0.05), but there were no statistical differences between group A and group B. The index of group C had no significant changes from pre-intervention to the 14th day post-intervention. The differences among the three groups were statistically significant on the 14th day post-intervention (P < 0.05). (2) TP, ALB and Hb in group A were decreased from pre-intervention to the 14th day post-intervention, the differences were statistically significant. The levels of TP and Hb decreased in group B during the observation period, the differences were statistically significant. ALB in group B was decreased on the 7th day post-intervention, but it was increased on the 14th day post-intervention, there was no statistical difference compared with pre-intervention. The levels of TP, ALB and Hb in group C had no significant differences on the 7th day post-intervention, but they all increased on the 14th day post-intervention. The differences of ALB and Hb in group C were statistically significant on the 14th day post-intervention compared with pre-intervention and on the 7th day post-intervention. The differences of TP, ALB and Hb among the three groups were statistically significant on the 14th day post-intervention. (3) Cr in the three groups did not have significant differences during the observation period. BUN of group A and group B were both increased post-interventinon, the differences were statistically significant compared with pre-intervention and there were statistically significant differences between group A and group B (P < 0.05). BUN in group C did not have significant changes during the observation period. On the 14th day post-intervention, the differences of BUN were statistically significant among the three groups (P < 0.05). CONCLUSION The nutritional effect of protein intake at 1.6 g/kg is better than 0.9 g/kg and 1.2 g/kg on improving the nutritional status in severe stroke patients.

Objective To detect the osteopontin (OPN) autocrine function of the osteoclasts in neurofibromatosis type 1 heterozygote (Nfl+/-) and wild type (Nfl+/+) mice.Test the osteoclasts function of neurofibromatosis type 1 heterozygote (Nfl+/-) and wild type (Nil+/+) mice with exogenous neutralizing OPN antibody,analysis the role of autocrine OPN in the hyperfunction of osteoclast in neurofibromatosis type 1.Methods Culture the low density bone marrow cells from Nfl heterozygote (Nfl+/-) and wild type (Nfl+/+) mice (4-6 weeks old) with macrophage colony-stimulating factor (M-CSF) and receptor activator of NF-κB ligand(RANKL),Measure.the OPN concentration in osteoclast culture superenant with ELISA.Culture the low density bone marrow cells from Nf1+/-and Nf1+/+ mice with or without exogenous neutralizing antibody for OPN.The function of osteoclasts and osteoclast progenitors in formation,migration,adhesion,and bone absorption were tested.Results A significantly higher concentration of OPN was detected in the Nf1+/-osteoclast culture media as compared to that of wild type.In control,Osteoclast functions,including migration,adhesion,and bone resorption of Nf1 +/-were higher than that of wild type.Addition OPN neutralizing antibody to the Nf1+/-OCL significantly reduced OCL formation.Neutralizing OPN antibody diminished both wild type and Nf1+/-OCL adhensiontion,Anti-OPN minimized OCL migration in both wild type and Nf1 +/-OCL cultures as measured by the transwell assays.Neutralizing OPN antibody diminished both wild type and Nf1+/-OCL pit formation,P＞0.05 for comparing Nfl+/-vs.wild type OCLs with anti-OPN antibody.Conclusion The hyperfunction of osteoclast in Nf1 heterozygote is related with autocrine osteopontin,inhibition of OPN may be an effective treatment for bone destruction of neurofibromatosis type 1.

目的讨论实施肠内营养(EN)及全肠外营养(TPN)两种不同的营养方式对肝移植术后患者进行营养支持治疗对术后各器官恢复的影响。方法将98例接受肝移植手术患者随机分为肠内营养组(EN组,n=42例)和全肠外营养组(TPN组,n=56例),EN组及TPN组分别检测3组患者术前1d、术后第5天和第10天时的营养状况及肝功能的变化,观察不同营养方式对患者术后各器官恢复的影响。结果 EN组和TPN组患者术后都无明显肝功能损害加重;EN组患者术后较早达到正氮平衡,体重减轻较少,感染率较低与TPN组比较差异均有统计学意义(P<0.01)。结论肝移植术后应用EN进行营养治疗是一种方便、安全、有效的临床营养支持方法。

肝移植手术是治疗终末期肝病的重要手段,肝移植的最终目的是延长终末期肝病患者的生命和改善患者的生活质量[1]。由于移植受体术前营养不良、移植手术时间长、术后免疫抑制剂和广谱抗生素的应用[2],使口腔内正常菌群失调,微生物迅速繁殖,口咽部的条件致病菌极易定植,并发生移行和易位,从而引起口腔及呼吸道甚至全身感染。去除口腔定植的病原菌对预防肝移植术后感染起着非常重要的作用。2002年1月—2011年12月我科对接受肝移植手术患者术前采用含三氯羟基二苯醚漱口液进行口腔护理,预防肝移植术后口腔并发症及肺部感染,效果良好,现报告如下。

目的 探讨呼吸护理专业组对预防住院患者呼吸系统并发症和提高护理人员专业水平的效果.方法 择优选拔小组护理骨干,明确小组成员职责；对呼吸系统基础理论、疾病知识和护理常规、操作技能进行系统培训；对并发症的高危人群制定呼吸管理标准护理计划执行单；建立护理部、小组二级质量控制体系；定期开展小组活动,组织进行疑难病例讨论.结果 规范了护士的专业行为,提高了护理质量,提升了护理小组的专业成就感.结论 呼吸道专业护理小组的建立能保证护士对患者实施规范的呼吸道护理措施,减少呼吸系统并发症,提高患者生命质量,推进护理学科向专业化发展.

Objective To study the effect of in-hospital emergency mode of mobile ICU to rescue respiratory and cardiac arrest patients.Methods Mobile ICU infrastructure including necessary rescue equipment,sufficient amount of rescue medication and medical staff proficient in first aid techniques was established.Mobile ICU was used to rescue 22 cases of respiratory and cardiac arrest patients from January 2009to July 2011 in our hospital clinical departments,and the effects were analyzed.Results Mobile ICU arrived at the scene and set up its emergency rescue team in (2.5 ± 0.5 ) min.Out of the 22 cases,4 cases died (18.18％),12 cases were successfully rescued ( 54.55％ ),6 cases were transferred to ICU for further treatment (27.27％).No medical dispute happened.Conclusions The establishment of in-hospital emergency mode of mobile ICU can elevate the level of treatment of respiratory and cardiac arrest patients,improve the successful rate,and save patients lives to the maximum extend.

目的探讨骨科外来器械管理中存在的问题,制定有针对性的管理措施,杜绝安全隐患。方法对器械清洗、灭菌、发放、保管至使用环节实施全程无缝隙管理:即细化外来器械清洗、灭菌及保管环节管理,引入目视管理方法识别外来器械,建立骨科内植入物器材网络确认系统,科学调配器械保证手术供应,规范培训厂商跟台技术人员。结果两年来骨科手术年均20 000例,使用外来器械年均14 000次,未出现因外来器械原因导致的手术推迟、失败或感染。结论实施全程无缝隙管理,提高了骨科外来器械质量,保证了患者安全。

This paper introduces the design and application of the risk assessment and nursing plan sheet for respiratory system complications in older patients with hip fracture.The items of risk assessment included patients' age,primary diseases,duration of bed rest,pain,ability of independent expectoration,duration of operation and anesthesia method.Based on the results of risk assessment,the patients were classified into low risk group,moderate risk group and high risk group.We quantified the danger-evaluation and divided it into 3 grades,mild-,moderate-and height danger.Then,standardized nursing plans were formulated in the aspects of observation of breath,oral care,prevention of aspiration,breathing exercises and rehabilitation gymnastics,guidance of effective expectoration,position and pain management.The application of this sheet effectively reduced the incidence of respiratory system complications in older patients with hip fractures and improved the outcomes of nursing care.

Objective To discuss the function of nursing sign in blood transfusion of RhD negative patients.Methods From May 2010 to September 2011,nursing signs were used in RhD negative patients.The blood transfusion department distributed the report of blood type test and an "RhD(-)" sign to the nurse.After double check,the sign was hang on the patient' s bed.In the event of transfer or operation,the sign was delivered to the next department.When the patient was discharged,the sign was returned to the blood transfusion department.A questionnaire survey was conducted to investigate blood transfusion safety knowledge of RhD negative patient of the nurses and corresponding training was carried out.Results After the use of "RhD(-)" sign,76 RhD negative blood patients received blood transfusion and no blood transfusion dispute or mistake was reported.Awareness of relative knowledge of the nurses was 100％ after the training.Conclusions The use of "RhD(-)" sign protects the patients' right of informed consent and can caution medical personnel and patients,prevent blood transfusion mistakes and ensure the transfusion safety.

Objectives: To investigate the incidence of complications in patients with different degrees of cervical spinal cord injury(CSCI),and to explore the correlation of severity and complications.Methods: 325 CSCI patients suffering from acute spinal cord injury in our hospital from January 2005 to May 2009 were reviewed retrospectively.A total of 305 patients were selected,while 20 patients of hospital stay 7d were excluded in this study.There were 249 males and 56 females,with a mean age at injury of 45 years old(range,14-83 years old),the interval between treatment and injury was 0.5h to 20d,and hospital stay was 7-45d(average,23d).The pathology included high fall injury in 111 cases,traffic accident in 85 cases,fall injury in 75 cases,heavy weight injury in 15 cases and unknown injury in 19 cases.According to the ASIA classification: there were 132 cases of grade A,26 grade B,89 grade C and 58 grade D.The patients were divided into A(grade A),B(grade B),C(grade C),D(grade D) groups according to injury severity,and the incidences of complications in four groups were statistically analyzed.Results: A total of 13 complications occurred in 305 patients,which included 229 cases(75.08%) with constipation,144 cases(47.21%) with heart rate decline,137 cases(44.92%) with hyponatremia,124 cases(40.46%) with high fever,104 cases(34.10%) with respiratory dysfunction,94 cases(30.82%) with blood pressure decreasing,83 cases(27.21%) with hypoproteinemia,72 cases(23.61%) with anemia,70 cases(22.95%) with digestive dysfunction,45 cases(14.75%) with hypokalemia,38 cases(12.46%) with pressure ulcers,28 cases(9.18%) with urinary tract infection and 9 cases(2.95%) with deep vein thrombosis.The incidences of constipation and deep venous thrombosis among the four groups showed no significant difference(P0.05);while the incidences of remaining complications were different among the four groups(P0.05).Except constipation,pressure sores,urinary tract infection and DVT,the incidence of other complications in group A was group B,group C and group D.Conclusions: The incidence of complications is high for CSCI patients,which is positively correlated with the degree of injury except constipation,pressure sores,urinary tract infection and DVT,and the incidence of complications in grade A and B is significantly higher than grade C and D.

目的:探讨创伤骨折患者体位护理的方法及注意事项。方法:对1358例创伤骨折患者进行体位护理并对其进行分析,强化护理人员体位护理管理,加强安全管理、动态评估、健康教育及康复指导。结果:本组无1例患者发生与体位护理不当引起的并发症。结论:重视创伤骨折患者的体位护理不仅可以减轻患者疼痛,密切医、护、患关系,而且对患者康复具有重要的临床意义。

[目的]探讨冷敷疗法对关节功能障碍恢复期康复训练效果的影响。[方法]选取我科2009年6月—12月膝关节功能障碍康复期病人90例,随机分为两组,每组45例。两组病人在关节松动术、肌力训练及关节牵伸等各种功能锻炼后立即给予冰袋冷敷10min~15 min。观察组采用10%盐水冰袋外敷,对照组采用普通清水冰袋外敷。观察两组关节疼痛、肿胀程度、异位骨化肌炎发生率。[结果]两组冰袋冷敷后10 min1、5 min关节疼痛比较有统计学意义,两组冰袋冷敷后5 min、10 min肿胀评分比较有统计学意义,观察组效果好于对照组;两组均未发生异位骨化肌炎。[结论]10%盐水冰袋冷敷减轻关节肿胀、疼痛效果较清水冰袋外敷好。

目的 探讨颈椎损伤患者的流行病学特点,并对其相关因素进行分析.方法 对我院2005年5月～2009年12月收治的362例颈椎损伤患者进行回顾性分析,查阅原始住院记录,对其性别分布、年龄分布、受伤原因、损伤类型、合并症、并发症和病化率等进行统计分析.结果 颈椎损伤患者的病死率为5.80％；颈椎损伤高发的年龄段为40～49岁(30.66％)；高处坠落(35.36％)和交通事故(27.08％)是主要的受伤原因:好发部化为C5(21.27％)和C6( 28.45％)；并发症排在前三位的依次为便秘(70.17％)、心率下降(42.27％)和低钠血症(39.50％).结论 了解颈椎损伤患者的流行病学特点,对促进患者康复、提高生活质量及生存寿命具有重要意义.

目的探讨最大限度使四肢骨折患者术后关节功能恢复,减少功能障碍的发生。方法将336例四肢骨折术后患者随机分为实验组和对照组。对照组166例,采用常规护理,按传统的方式进行健康教育;实验组170例,除了采用常规护理外,根据骨折患者的具体情况制定出个体化、有针对性的健康教育计划,要求护士按计划反复对患者进行指导和教育。结果实验组在提高健康教育的认知度、参加康复训练的主动性、预防关节功能障碍等方面优于对照组,两组资料经统计学处理差异有显著性(P<0.01)。结论个体化健康教育对骨折患者术后的功能康复起着重要的促进作用。