Objective:To analyze the effect of fruit intake during dialysis on a maintenance hemodialysis patient with arrhythmia caused by hypokalemia during dialysis.Methods:A female patient undergoing maintenance hemodialysis in Guangdong Provincial People's Hospital was found to have arrhythmia due to hypokalemia during dialysis, which did not respond well to medication. According to the food composition exchange table, the fruit with potassium content of about 842 mg and sugar content of about 64 g was converted into the total amount, and the total amount was divided into 2/3 and 1/3. The patient was instructed to take 2/3 portions of fruit at the beginning of dialysis and 1/3 portion of fruit at 2 hours of dialysis. The serum potassium and blood glucose levels and electrocardiogram were closely monitored during dialysis and before the next dialysis.Results:After 7 dialysis courses (nearly a month) of follow-up, the patient's serum potassium was stable during dialysis, the arrhythmia and hypoglycemia were improved, and the constipation was relieved.Conclusions:Intake of fruit with potassium content of 842 mg and sugar content of about 64 g during dialysis can improve arrhythmia and constipation during dialysis. However, the efficacy for other dialysis patients should be confirmed by a series of prospective studies.

ObjectiveTo clarify influence of absolute value of ratio of prepump pressure to blood flow rate（|Pa/Qb|） to dysfunction of autogenous arteriovenous fistulas（AVF） and its safety range，and to explore influencing factors of |Pa/Qb|.MethodsClinical information of 490 patients undergoing long⁃term hemodialysis in hemodialysis centers of 3 tertiary grade A hospitals from January 2018 to January 2019 were analyzed retrospectively.Relationship between |Pa/Qb| and AVF dysfunction was evaluated.Influencing factors of |Pa/Qb| were explored.Results85 of 490 patients had AVF dysfunction.Restricted cubic splines revealed U-shaped association between |Pa/Qb| and risk of AVF dysfunction（P<0.001）.When |Pa/Qb| was from 0.30 to 0.52，AVF function was in the safe range.Linear regression analysis showed that |Pa/Qb| was negatively correlated with mean arterial pressure and age，and positively correlated with β2⁃microglobulin concentrations and hemoglobin concentrations（P<0.05）.ConclusionsWhen |Pa/Qb|<0.30 or |Pa/Qb|>0.52，risk of AVF dysfunction is significantly increased，and patient's AVF function should be reassessed.In addition，|Pa/Qb| monitoring can help nurses judge rationality of blood flow rate setting and identify adverse events，prevent further deterioration of AVF function，and prolong life of AVF.

目的 了解我国血液透析护理人力资源配置及影响因素,为血液透析护理人力资源管理提供参考.方法 采用自行设计的调查问卷,对31省/直辖市/自治区1208所医院共4712名血液透析护士进行调查.结果 每10例患者配备护士人数＜1的医院347所(28.7％),每名护士每班次负责机器台数＞5的医院有455所(37.7％).logistic回归分析显示,地区、医院性质、月透析例次、医院等级、每名护士每班次负责机器台数是影响护士配置的主要因素(均P＜0.01);每10例患者配备护士人数、月透析例次是影响每班次护士配置的主要因素(均P＜0.01).结论 我国血液透析护理人力资源配置不足且每班次护理患者数量超标.建议补足护理人力及保证每个治疗班次的护理人力,以减轻护士工作压力,确保患者的透析质量和安全.

目的 探讨老年维持性血液透析患者自体动静脉内瘘(AVF)1年失功率的影响因素.方法 选取2018年7月至2020年5月在广东省人民医院采用前臂AVF做为血管通路的118例维持性透析患者,分为老年组(≥60周岁)和非老年组(<60周岁),运用彩色多普勒超声检查并随访患者AVF失功情况.采用COX比例风险模型进行多因素分析老年患者AVF 1年失功率的影响因素.结果 单因素分析提示AVF 1年失功率与内瘘穿刺部位血流量有关.Kaplan-Meier生存曲线及log-rank检验提示老年组患者AVF 1年通畅率显著低于非老年组,HR(95％CI)=3.612(1.085～12.020),P=0.036.两组分析提示:吻合口直径小于0.35 cm、内瘘穿刺部位血流量小于500 mL/min和桡动脉血流量小于400 mL/min患者AVF 1年通畅率显著降低(P<0.05).COX比例风险模型多因素分析显示内瘘穿刺部位血流量是AVF 1年通畅率的独立影响因素.结论 老年维持性血液透析患者AVF 1年失功率较高,需要密切关注并定期监测其穿刺部位血流量变化.

抗中性粒细胞胞浆抗体(ANCA)相关性血管炎是一组由自身免疫介导的炎症性疾病.本文介绍了1例ANCA相关性血管炎患者接受蛋白A免疫吸附治疗的情况,对其治疗过程及临床疗效进行分析与总结,以期为临床上治疗此病提供参考和借鉴.

目的:明确泵前动脉压与泵控血流速比值的绝对值(|Pa/Qb|)对自体动静脉内瘘(AVF)功能不良的影响及其安全范围,探究|Pa/Qb|的影响因素.方法:回顾性分析2018年1月—2019年1月3所三级甲等医院血液透析中心490例长期血液透析病人临床资料,评估|Pa/Qb|与AVF功能不良的关系,探究|Pa/Qb|的影响因素.结果:490例病人中有85例病人发生AVF功能不良.限制性立方样条显示,|Pa/Qb|与AVF功能不良风险存在U形关联(P<0.001).当|Pa/Qb|为0.30～0.52时,AVF功能处于安全范围.线性回归分析显示,|Pa/Qb|与平均动脉压、年龄呈负相关,与β2微球蛋白浓度、血红蛋白浓度呈正相关(P<0.05).结论:当|Pa/Qb|<0.30或|Pa/Qb|>0.52时,AVF功能不良风险显著增加,应重新评估病人的AVF功能.此外,|Pa/Qb|监测可帮助护士判断泵控血流速设置的合理性以及识别不良事件,防止AVF功能进一步恶化,延长AVF的使用寿命.

Objective: To analyze the effect of washless hand disinfectant absorption on hand hygiene of outpatient nurses. Methods 40 outpatient nurses in our hospital from July 2018 to October 2018 were randomly divided into two groups. The control group (20) and the observation group (20) used mobile water and hand sanitizer to wash their hands respectively, and the hand hygiene conditions of the two groups were compared. Results in terms of colony count, CFU / cm2 in the observation group (3.24 ± 0.06) was less than that in the control group (14.51 ± 0.09) (P ＜ 0.05); The qualified rate of hand hygiene in the observation group (90.00％) was higher than that in the control group (60.00％) (P ＜ 0.05). The compliance rate of hand washing behavior in the control group was 59.69％ and that in the observation group was 91.99％, which was significantly higher than that in the control group (P ＜ 0.05). In terms of nursing intervention satisfaction, the observation group (95.00％) was higher than the control group (70.00％), with significant difference (P ＜ 0.05). Conclusion in the working process of outpatient nurses, the application of wash free hand disinfectant can not only reduce the number of hand colonies, but also promote the qualified rate of hand hygiene, which is worthy of further adoption and promotion in clinic.

目的 探讨超滤率对维持性血液透析(MHD)患者透析中血压变异性(BPV)的影响.方法 选取2020年1-6月在广东省人民医院、深圳市中医院接受MHD患者278例,根据2020年6月患者每次透析实际超滤量、透析治疗时间和干体重,计算每次超滤率(UFR),根据每次UFR的平均值分为高超滤组(UFR>10 mL·h-1·kg-1)196例和低超滤组(UFR≤10 mL·h-1·kg-1)92例,比较2组患者透析中BPV的差异.BPV用多个血压读数的变异系数(CV)来表示.结果 高超滤组和低超滤组患者透析中收缩压变异性系数(SBP CV)分别为10.57(8.59,12.44)和9.20(7.68,10.93),差异有统计学意义(P=0.001);多重线性回归分析显示,UFR是MHD患者透析中SBP CV的独立危险因素.结论 将MHD患者的UFR控制在≤10 mL·h-1·kg-1,可有效降低患者透析中的SBP CV,提高患者透析的耐受性.

目的 探讨尿液中磷脂酶A2受体(phospholipase A2 receptor,PLA2R)的浓度与特发性膜性肾病(idiopathic membranous nephropathy,IMN)临床严重程度的相关性,分析其在IMN病情评估及预后判断中的价值.方法 选取2017年12月至2018年12月广东省人民医院肾内科经肾活检证实的38例IMN患者,利用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测患者尿PLA2R浓度,采用偏相关方法分析尿PLA2R浓度与患者基线临床数据的相关性,通过受试者工作特征曲线和Logistic回归评估尿PLA2R浓度对患者6个月蛋白尿完全缓解的预测价值.结果 ELISA法测得的尿PLA2R浓度中位数是0.061μg/L,偏相关分析示尿PLA2R浓度与IMN患者基线估算肾小球滤过率(rs=-0.507,P=0.002)及血清白蛋白(rs=-0.464,P=0.004)呈负相关,与基线24 h尿蛋白定量呈正相关(rs=0.700,P<0.001).随访6个月,发现蛋白尿完全缓解组患者尿PLA2R浓度明显低于非完全缓解组[0.024(0.012,0.057)μg/L比0.102(0.041,0.326)μg/L,P=0.008].多因素Logistic回归分析示尿液中PLA2R浓度水平是IMN患者6个月蛋白尿完全缓解的独立预测因素[OR=0.053(0.003～0.865),P=0.039].结论 尿PLA2R浓度与IMN患者的病情严重程度呈正相关,且可独立预测IMN患者6个月蛋白尿完全缓解情况.

血栓形成是维持性血液透析( maintenance hemodialysis, MHD)患者自体动静脉内瘘( arterio-venous fistulas,AVF)失功的主要原因,占比65％ ～85％ [1] ,不仅会影响患者透析质量,也会显著增加患者全因死亡率和心血管死亡率[2].目前,AVF血栓形成最常用治疗方法是使用尿激酶溶栓,此法操作简单、费用低、安全性好.然而,由于影响尿激酶溶栓关键因素尚未明确,关于尿激酶溶栓的效果,各研究报道不一致,成功率在30％ ～70％不等[3,4].因此,本研究回顾性收集本中心2011年01月—2020年06月256例AVF血栓形成后行尿激酶溶栓治疗的临床资料,探索影响MHD患者AVF尿激酶溶栓效果的因素,提高AVF尿激酶溶栓的成功率.

Objective:To compare and analyze the levels of innovative behaviors among hemodialysis nurses in public and private hospitals.Methods:A total of 10 570 hemodialysis nurses in 31 provinces/municipalities were surveyed by the convenience sampling method from July 24 to August 30, 2019, including 9 460 cases from public hospitals (8 918 males and 542 females) and 1 110 cases from private hospitals (1 055 males and 55 females). The demographic data and the scores of Nurse Innovative Behavior Scale of hemodialysis nurses were compared.Results:There were statistically significant differences in age, marital status, number of children, monthly income, highest educated level, length of hemodialysis nursing, way of employment, title, and position of hemodialysis nurses in public and private hospitals (all P<0.001). The total score of innovative behaviors and the score of idea generation dimension of hemodialysis nurses in the public hospitals were (3.07±0.66) and (3.56±0.76) points, respectively, which were lower than those in the private hospitals [(3.12±0.68) and (3.61±0.77) points] (both P<0.05); there were no statistically significant differences in the scores of support and idea realization dimensions of hemodialysis nurses in public and private hospitals (both P>0.05). Conclusions:The levels of innovative behaviors among hemodialysis nurses in both public and private hospitals should be improved. Hemodialysis nurses in private hospitals expect to improve their overall innovative behavior ability by obtaining the organizational support. The problem of low level of innovative behaviors among hemodialysis nurses in public hospitals is critical and worrisome. It is suggested that the managers should strengthen the guidance for nurses to avoid solidifying the holistic thinking in the team and hindering the development of hemodialysis nursing.

目的 了解维持性血液透析(maintenance hemodialysis,MHD)患者自体动静脉内瘘(arte-riovenous fistula,AVF)侧肢体功能锻炼现状并探索其影响因素.方法 对2019年8月～9月在广州、深圳、常州各l家血液透析中心的485例MHD患者进行问卷调查.结果 250(51.5％)名患者进行AVF侧肢体功能锻炼.其中,165例(34.0％)以"握球"方式进行锻炼.多因素Logistic回归分析结果显示,与无生活爱好的患者相比,拥有1～3个及3个以上爱好的患者的OR值及95％CI分别为:2.024(1.310～3.127)P=0.001;2.156(1.043～4.457),P=0.038.与自评AVF维护知识一点不懂的患者相比,知道一点、知道大多数、全部知道的患者的OR值及95％CI分别为:2.024 (0.484～8.459),P=0.334;3.160(0.825～12.102),P=0.093;4.261(I.105～16.426),P=0.035.结论 AVF侧肢体功能锻炼现状不容乐观,建议护士加强对患者功能锻炼的健康教育,尤其鼓励兴趣爱好较少的患者,并设法增强患者功能锻炼的依从性.

目的 探讨血液透析护士创新行为与职业倦怠的相关关系,为针对性干预提供参考.方法 采用一般资料调查表、Maslach职业倦怠量表和护士创新行为量表对全国2738所医院的10570名血液透析护士进行调查.结果 血液透析护士职业倦怠的情感衰竭、去人格化、低个人成就感维度得分中位数分别为15、3、28分;创新行为总均分为3.08土0.67,产生想法、取得支持、实现想法维度得分分别为3.56±0.76、2.76±0.73、3.03±0.91.创新行为与情感衰竭和去人格化呈负相关,与低个人成就感呈正相关(均P＜0.01);多元线性回归分析显示,实现想法是职业倦怠3个维度的影响因素(均P＜0.01).结论 增强血液透析护士的创新行为能力,特别是"实现想法"可显著降低其职业倦怠水平.

目的:调查血液透析护士对丙型肝炎感染暴发事件的压力感受及相关影响因素.方法:采用横断面调查方法对全国31个省/直辖市10570名血液透析护士进行问卷调查,包括人口社会学资料调查问卷、Maslach职业倦怠量表、血液透析护士对丙型肝炎感染暴发事件的压力感受等.结果:22.2％的血液透析护士对丙型肝炎感染暴发事件产生压力增大的感受,9.1％血液透析护士产生压力过大考虑离职的念头.无序多分类Logistic回归分析显示,总护龄、月收入、职务、职业倦怠对血液透析护士产生压力增大以及压力过大考虑离职感受具有明显影响(P<0.05);人际关系差的血液透析护士对丙型肝炎暴发事件会产生压力增大(P<0.05);工作氛围、性别、年龄和职业定位对血液透析护士产生"压力过大考虑离职"的感受具有明显影响(P<0.05).结论:丙型肝炎感染暴发事件对血液透析护士会造成不同程度的压力,建议医院管理者关注丙型肝炎感染暴发事件对血液透析护士的心理影响,并合理安排人力,设置激励机制,创造良好的工作氛围,帮助血液透析护士明确个人职业规划,加强心理建设.

Objective:Recently, platelet≥110×10 9/L was taken as the indication of renal needle biopsy in our unit. To identify the risk factors for bleeding complication after percutaneous renal biopsy in patients with normal platelet count and built predictive models. Methods:We conducted a retrospective study in adult patients undergoing percutaneous renal biopsy in Guangdong provincial people's hospital from June 13, 2017 to December 27, 2018. Those requiring clinical intervention was defined as apparent bleeding, while red blood cell infusion, interventional therapy, kidney surgery, or death was defined as major bleeding.Results:Total 1036 patients were enrolled. Among them, 3.76% patients had apparent bleeding and major bleeding occurred in 1.54% patients. Multiple logistic regression mode demonstrated that estimated glomerular filtration rate<60 mL·(min 1.73 m 2) -1, hematocrit<0.4, and kidney length/height<0.066 were risk factors for apparent bleeding, with an odds ratios ( ORs) of 2.16 (95% CI: 1.08-4.34), 4.04 (95% CI: 1.39-11.76) and 2.65 (95% CI: 1.08-6.50), respectively. Hemoglobin <100 g/L and kidney length/height<0.066 were independently associated with major bleeding, with ORs of 10.29 (95% CI: 3.65-28.95) and 7.87 (95% CI: 1.02-60.43). Predictive bleeding models from the logistic analysis were further visualized using nomogram. These models showed good clinical performances, which were evaluated by the receiver operating characteristic curve. The areas under the curve were 0.713 (95% CI: 0.682-0.742) for the apparent bleeding and 0.802 (95% CI: 0.774-0.827) for the major bleeding, respectively. Conclusions:For patients with normal platelets, baseline renal function, anemia, and relative kidney size are independent risk factors for bleeding complication after percutaneous renal biopsy.

Objective:To explore the correlation between eosinophils and the first-use syndrome (FUS) of dialyzer in hemodialysis patients.Methods:The clinical data of the first 3 dialysis sessions during induction period at Blood Purification Center, Guangdong Provincial People's Hospital from March 2017 to March 2019 were retrospectively collected. The patients were divided into a dialyzer allergy and a no dialyzer allergy group according to whether the FUS of dialyzer occurred during the first three sessions during their induction period. The eosinophil counts, white blood cell counts, and incidences of FUS were compared between these two groups.Results:One hundred and twenty-eight patients were collected, including 59 males (46.1%); and they were (54.8±13.9) years old. The white blood cell count and the eosinophil count in the dialyzer allergy group were significantly higher than those in the no dialyzer allergy group [(6.46±1.82)×10 9/L vs. (5.70±1.58)×10 9/L, t=-2.247, P=0.026; 0.29 (0.18-0.80)×10 9/L vs. 0.26 (0.13～0.31)×10 9/L, W=1 550.5, P=0.045]. There were 29 patients (22.66%) with the eosinophil count ≥0.55×10 9/L and 99 patients (77.34%) with the eosinophil count ＜0.55 to 10 9/L. The incidence of FUS was 44.83% (13/29) in the dialyzer allergy group, and was 19.19% (19/99) in the no dialyzer allergy group ( χ2=7.862, P=0.005). Conclusions:Eosinophil count is significantly increased in patients with FUS. Eosinophil count has a good specificity but a poor sensitivity in the diagnosis of FUS. For patients with increased eosinophil count before their first dialysis, it is recommended to select a dialyzer with good biocompatibility and to fully pre-fill the dialyzer to reduce the incidence of FUS.

目的:探讨维持性血液透析（MHD）患者透析中血压变异性的影响因素。方法:采用回顾性病例对照研究设计，选取2020年1月至6月在广东省人民医院、深圳市中医院血液透析中心接受MHD患者278例，男152例（54.7%），女126例（45.3%），中位年龄57岁，中位透析龄67个月，糖尿病患者89例（32.0%）。根据计算收缩压血压变异性（BPV）中位数，将研究对象分为高BPV组（BPV＞10.05）和低BPV组（BPV≤10.05）。采集其2020年6月每次血液透析治疗透析前、透析中每小时及透析后血压数据，计算透析中血压变异性。结果:高BPV组和低BPV组患者的年龄（ Z=3.402， P=0.001）、糖尿病（ χ2=10.629， P=0.001）、超滤率（ Z=-2.112， P=0.036）、血清白蛋白（ t=2.272， P=0.024）、β 2微球蛋白（ Z=-2.166， P=0.030）比较差异均有统计学意义（均 P＜0.05）。多因素logistic回归分析结果显示，年龄（ OR=1.027，95% CI：0.018～1.045， P=0.005）、糖尿病（ OR=1.876，95% CI：11.076～3.272， P=0.027）、超滤率（ OR=2.571，95% CI：1.471～4.491， P=0.001）是透析中高BPV的独立危险因素。 结论:超滤率是影响MHD患者透析中血压变异的主要危险因素，对于年龄越大、有糖尿病的患者尤其应重点关注。

Job burnout is an occupational illness with high prevalence among nurses in China. The job burnout status among hemodialysis nurses should be given more attention because of they handle sophisticated machinery, and there is a high risk of infection in hemodialysis nursing. The level and influencing factors of job burnout among hemodialysis nurses in mainland China were investigated. This was a cross-sectional study conducted in all 31 provinces of mainland China in 2019. Data from nurses responsible for direct care in 2738 hemodialysis units were analyzed. An effective response rate of 99.00% (10570/10677) was achieved. Hemodialysis nurse burnout was measured by the Maslach Burnout Inventory. Working atmosphere and interpersonal relationships with colleagues were each measured by a single question. Multiple linear regression analysis was used to explore the factors related to nurse burnout. Structural equation modeling was used to explore the effect of the working environment, individual factors, and specialist nurse training on the HD nurse burnout and the intention to leave. The total burnout score was 38.69 (SD17.47), indicating that the level of job burnout among hemodialysis nurses in mainland China was relatively low. Hemodialysis nurses experienced low-level burnout on the emotional exhaustion and depersonalization subscale and high-level burnout on the personal accomplishment subscale. Statistically significant differences in burnout levels were associated with working atmosphere, interpersonal relationships with colleagues, specialist nurse training, number of children, night shift, and marital status. The burnout level of HD nurses in mainland China was relatively low. Working atmosphere, interpersonal relationships with colleagues, and training of specialist nurses are the most important influencing factors regarding job burnout in hemodialysis nurses. Therefore, it is suggested that improving the working atmosphere and interpersonal relationship processing ability and providing more training opportunities for nurses can alleviate job burnout in nurses.

目的:探讨不同类型动静脉内瘘血栓形成后使用尿激酶溶栓的效果，为提高溶栓效率提供理论依据。方法:回顾性收集2014年9月至2016年6月在本院进行维持性血液透析且动静脉内瘘血栓形成尿激酶溶栓的47例患者［男性25例，女性22例，年龄（65.0±14.80）岁］临床资料。根据溶栓效果分为溶栓成功组和溶栓失败组，观察内瘘溶栓成功率、首次溶栓成功（首次使用75万尿激酶溶栓成功率）和溶栓过程中并发症，分析不同类型动静脉内瘘血栓形成后使用尿激酶溶栓的成功率。结果:移植物动静脉内瘘尿激酶溶栓成功率显著高于自体动静脉内瘘［88.5%（23/26）比61.9%（13/21）］（ P＝0.033）。年龄和首次溶栓成功有相关（ P＜0.05），而性别、血管通路使用时间、开始溶栓时间、低血压等观察指标均不相关（均 P＞0.05）。 结论:两种动静脉内瘘类型血栓形成使用尿激酶溶栓治疗均达到较好效果，且移植物动静脉内瘘溶栓效果优于自体动静脉内瘘，同时溶栓效果的影响因素较多，如年龄和内瘘堵塞时间等，因此在临床工作中需要加强内瘘术后功能监测及自我护理的健康宣教。

目的:探讨经皮腔内血管成形术、手术取栓和经皮腔内尿激酶溶栓治疗动静脉内瘘(AVF)功能不良后2年次级通畅率.方法:采用回顾性队列研究设计,收集2016年1月1日—2017年6月1日在广东省人民医院血液净化中心行维持性血液透析的所有病人资料.根据病人动静脉内瘘首次出现功能不良(血栓闭塞或血管狭窄伴有内瘘流量不足)时干预方法分为3组:单纯尿激酶溶栓组、经皮腔内血管成形术组和外科手术取栓组.观察不同干预治疗后2年内瘘次级通畅率、干预成功率和动静脉内瘘干预失功影响因素.结果:动静脉内瘘首次出现功能不良病人133例(血栓闭塞99例,血管狭窄伴有内瘘流量不足34例),干预成功112例(84.2％);动静脉内瘘功能不良干预治疗后2年,单纯尿激酶溶栓组内瘘失功31例(45.6％),经皮腔内血管成形术组内瘘失功10例(25.6％),外科手术取栓组内瘘失功6例(23.1％),3组比较差异有统计学意义(P=0.040);经皮腔内血管成形术组内瘘使用中位时间为[1.24(0.50,2.00)]年,单纯尿激酶溶栓组内瘘的使用中位时间为[0.59(0.32,0.96)]年,外科手术取栓组内瘘使用中位时间为[1.18(0.63,2.00)]年,3组比较差异有统计学意义(P=0.008).Kaplan?Meier生存分析(Log?rank检验)显示:3组间动静脉内瘘2年次级通畅率差异无统计学意义.通过Cox比例风险模型并经过动静脉内瘘使用时间、血钙、血磷和钙磷乘积校正后,外科手术取栓组动静脉内瘘2年次级通畅率[HR(95％CI)为0.31(0.11,0.82),P=0.02]、经皮腔内血管成形术组[HR(95％CI)为0.60(0.26,1.38),P=0.23]均高于单纯尿激酶溶栓组.多因素分析显示,内瘘使用时间≥3年和钙磷乘积≥66 mg2/dL2与内瘘干预后2年失功率相关.结论:经皮腔内血管成形术、手术取栓治疗可以改善动静脉内瘘功能不良后2年通畅率,术后需加强钙磷管理,有助于改进干预效果.