调查某三级综合医院新毕业护士的培训需求,为制定培训方案提供依据.调查显示,新毕业护士培训应以学员需求为导向,采用多途径、多元化方式进行进阶化、阶梯式的培训,以建立适宜本地的、可有效推广的培训模式和体系.

从"新工科"建设的角度系统研究了西南地区某高校2017年以来的科研项目发展现状,包括项目类型、经费结构、负责人年龄结构等,并分析总结规律,为学校抓住"新工科"建设的发展机遇,创造科研实力再提升的良好局面提供数据支撑.

发展促进新入职护士从学校毕业过渡至临床实践的培训项目有助于促进其职业角色顺利转变.本文对国外新入职护士胜任力培训项目进行介绍,以期为我国建立标准、规范的新入职护士胜任力培训体系,促进培训同质化、标准化、规范化提供参考.

目的 探讨显微手术联合术中脊髓血管造影检查治疗脊髓硬脊膜动静脉瘘的疗效和应用价值.方法 回顾性分析四川大学华西医院神经外科2013年5月—2017年9月,采用显微手术闭塞瘘口同时行术中脊髓血管造影检查治疗的52例脊髓硬脊膜动静脉瘘患者的临床资料.结果 在术中脊髓血管造影辅助下,52例患者术中达到100％的解剖治愈率.术后第7 d 43例患者(82.7％)的脊髓功能评分改善.术后50例患者(96.2％)随访6个月,Aminoff评分显示28例患者(56％)治愈,18例患者(36％)脊髓功能改善,4例患者(8％)脊髓功能无变化;无症状加重者.结论 显微手术闭塞瘘口能有效治疗脊髓硬脊膜动静脉瘘,术中脊髓血管造影对准确判断是否完全闭塞瘘口和多个瘘口的存在有着极大地帮助.

新型冠状病毒肺炎(novel coronavirus pneumonia,NCP)为新发现的2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)所致,最初发生在湖北武汉,初步考虑与野生动物感染相关,目前已明确可以人传人,并在武汉以外扩散出现输入型病例[1].2019-nCoV传播途径复杂,故NCP容易误诊或漏诊,并可能导致在医院内部分防控薄弱部门和社会人群中传播.2020年1月20日,NCP已被纳入《中华人民共和国传染病防治法》规定的乙类传染病,并采取甲类传染病的预防、控制措施[2].本文总结一例输入型难辨性NCP (indistinguishableNCP,INCP)患者的临床特点并对其防控环节进行分析,以助疫情防控中首诊医生注意识别、减少漏诊,以及科学排查和追踪密切接触者.

目的 探讨颅内多发动脉瘤(MIA)的临床、影像学特点及显微外科手术治疗策略.方法 回顾性分析2015年1月—2018年1月宜宾市第一人民医院神经外科收治的,并经显微手术治疗的30例颅内多发动脉瘤患者的临床资料;包括影像学特点、诊断、手术入路、手术时机和预后等.结果 本组患者中男性18例,女性12例,年龄42～78岁,平均58.2岁;共67个动脉瘤,其中25例患者(83.3％)有2个动脉瘤,3例患者(10％)有3个动脉瘤,2例患者(6.7％)有4个动脉瘤.动脉瘤的部位:65个动脉瘤位于前循环,其中后交通动脉+前交通动脉7例(23.3％),后交通动脉+大脑中动脉7例(23.3％),双侧后交通动脉5例(16.7％);2个动脉瘤位于大脑中动脉+床突旁动脉.所有患者均行开颅显微手术动脉瘤夹闭术.根据动脉瘤不同的部位及数量设计入路,以尽可能一个入路一次夹闭所有动脉瘤为目标进行选择,共进行37例次手术.其中翼点或扩大翼点入路31例次(83.8％),额部纵裂入路4例次,枕下和颞下入路各1例次.一期手术治疗22例(73.3％),二期手术治疗8例(26.7％);手术时机均选择早期或超早期进行.出院时患者的格拉斯哥预后量表(Glasgow outcome scale,GOS)评分:5分者20例(66.7％)、4分5例(16.7％)、3分3例(10％)、1分(死亡)2例(6.7％).术后随访18～60个月,动脉瘤复发1例,对侧新发1例,无再出血者.结论 早期手术治疗,在确定并首先处理责任动脉瘤的前提下,争取一期或分期手术处理所有动脉瘤,减少再出血的风险,将有助于改善患者的预后.

Objective:To explore the status quo of knowledge, attitude and practice (KAP) of pediatric cryptorchidism in community pediatric medical staff and analyze its influencing factors.Methods:From October 2018 to December 2019, the medical staff from 10 community health service centers in Chengdu were selected by convenient sampling and investigated with the self-designed Pedicatric Cryptorchidism KAP Questionnaire. Totally 113 questionnaires were distributed and collected in this study, with 108 valid questionnaires, accounting for a recovery rate of 95.6%.Results:The total Pediatric Cryptorchidism KAP Score of the 108 pediatric medical staff was (127.39±18.34) , including (90.51±14.37) for knowledge, (22.02±2.10) for attitude, and (14.81±10.05) for practice. Multivariate analysis showed that the experience of receiving or nursing children with cryptorchidism, years of work in community health service centers, total years of work, job titles, and occupations entered the regression model of the knowledge of pediatric cryptorchidism in community pediatric medical staff ( R2=0.773, P<0.01) ; work years and occupations entered the regression model of the belief ( R2=0.261, P<0.01) ; pediatric work years, total work years, years of community health service, experience of receiving or nursing children with cryptorchidism, job titles, and occupations entered the regression model of the practice ( R2=0.591, P<0.01) . Conclusions:Community pediatric medical staff have a low overall knowledge of pediatric cryptorchidism. Relevant knowledge and skill training as well as individualized guidance about pediatric cryptorchidism should be provided to community pediatric medical staff according to the characteristics of job titles, occupations, experience of receiving or nursing children with cryptorchidism, and working years.

目的 探讨荧光造影技术在脊髓硬脊膜动静脉瘘(DAVF)显微手术中的应用价值.方法 回顾性分析四川大学华西医院神经外科2012年1月—2018年1月收治的28例脊髓硬脊膜动静脉瘘患者的资料.患者均行脊髓血管造影确诊.手术采用全椎或半椎板入路,术中用吲哚菁绿荧光造影明确瘘口的位置、引流静脉及供血动脉,行瘘口切除后再次造影检查.采用改良Aminoff-Logue量表(ALS)评估患者手术前后的脊髓功能.结果 本组患者中瘘口位于颅颈交界、胸髓上段、胸髓下段、脊髓腰段的患者,分别为2例、8例、10例、8例.患者手术均成功,瘘口均完全切除,术后影像学复查无复发者.随访时间6～72个月,结果显示治愈为18例、改善8例、无变化2例,好转率为92.85％.患者术后的改良ALS评分(2.1±1.4)比术前(4.6±1.9)明显好转(P<0.05).结论 显微外科手术是治疗脊髓硬脊膜动静脉瘘最有效的方法.术中采用荧光造影,能准确定位瘘口位置,同时对瘘口切除进行评估,极大地提高了手术的精准度.

目的 在新型冠状病毒肺炎发生的背景下,强化规范化培训护士的培训和关键环节管理,保证疫情救治、培训工作和人员安全的多重需求.方法 通过依托医院信息化平台,强化管理、培训、防控3大环节,进行合理纵深分工,协同网格管理;科学评估疫情,动态人力调整;专项在线培训,保证全员覆盖;及时评价考核,注重实战演练;实时动向管理,有效隔离管理;充分重视人文,做好心理调适.结果 疫情防控期间完成46名规范化培训护士的科室调配;完成专项在线培训4场,平均培训参与率≥90％,课程满意度≥95％,指导完成19名规范化培训护士的有效隔离,做到规范化培训护士院内零感染.结论 疫情期间采取针对性的培训和管理策略,可切实保障规范化培训护士工作安全,保证护士规范化培训工作有序、高效、安全进行.

Objective:To investigate the current situation of Kinesiophobia in school-age children after fracture surgery, and to explore the influencing factors, in order to provide reference for the prevention and intervention of Kinesiophobia in school-age children.Methods:February 2018-March 1919, Using convenient sampling method, Investigation and analysis of Sixty-five school-age children one day after surgery in a pediatric surgery inpatient department using a general data questionnaire and Tampa Scale of Kinesiophobia (TSK).Results:Age of children was (9.55±2.15) years old, the score of TSK was (45.12±5.33) points, one-way analysis of variance showed that there were statistically difference in the total score of TSK between patients with different causes of injury, injured parts, degrees of pain and whether to accept pain-related guidance or not ( F values were 3.913-33.333, P<0.05) . Multiple linear regression analysis showed pain-related guidance and pain levels entered into the regression model. Conclusions:The incidence of Kinesiophobia in school-age children after fracture surgery was high, it is recommended to use pain control and pain-related guidance to prevent and intervene the Kinesiophobia.

During the epidemic of the COVID-19, anxiety and stress-related disorders are common negative emotions experienced by medical staff. Based on the integration of psychological intervention and the model of West China Sunshine hospital, we helped a medical staff who suffered from panic disorder by providing her with supportive psychotherapy, cognitive behavior therapy, muscle and breath relaxation therapy as well as psychological training. According to follow-up assessments, her anxiety symptoms improved significantly.

目的 介绍1例交通性支气管肺前肠畸形、脓毒症、右旋心、动脉导管未闭、肺动脉吊带患儿的围手术期护理方法.方法 术前以循环系统、呼吸系统及消化系统为主进行病情监测,适时调整饮食,加强以斜坡卧位、坐位及左侧卧位为主的体位管理,术后进行出血的预防及管理,加强营养支持,进行限制性液体管理,间断夹闭胸腔闭式引流管,进行呼吸功能训练及气道管理.结果 经过多学科的综合治疗与护理,患儿未出现并发症,体重逐步增加,术后第10天病情平稳出院.结论 严密的病情监测、适时调整饮食、呼吸功能训练及术后限制性液体管理等护理措施对交通性支气管肺前肠畸形伴先天性心脏病患儿的康复尤为重要.

乳腺癌是全球女性发病率及病死率最高的癌症,也是我国女性发病率最高、且病死率非常高的癌症[1-2],且近年来我国乳腺癌发病率不断增长[3-4].乳腺癌患者在患病及治疗过程中,常会呈现一系列的负性情绪变化,如焦虑、抑郁、不安、急躁易怒、心烦意乱等[5-6],这些情绪将对患者的日常生活、生活质量、护理满意度、是否接受疾病诊断及治疗效果等造成影响,且负性情绪越重、持续时间越长,患者的生活质量、护理满意度等越低[7-10].

目的 探讨未破裂颅内动脉瘤(UIAs)患者动脉瘤夹闭术后慢性硬膜下血肿(CSDH)的发生率及相关危险因素.方法 采用回顾性队列研究设计,连续收集2007年1月至2016年12月笔者单位神经外科收治的615例行动脉瘤手术夹闭的UIAs患者作为研究对象,收集患者临床资料、影像学检查及术后随访结果,计算术后CSDH的发生率,采用多因素Logistic回归模型分析UIAs患者术后发生CSDH的相关危险因素.结果 615例UIAs患者行动脉瘤夹闭术后,有71例患者发生了CSDH,术后CSDH的发生率为11.5％.发生CSDH组患者的平均年龄明显高于未发生CSDH患者(62.2±9.7)岁vs(58.9±9.2)岁,差异有统计学意义(t=2.825,P=0.005).年龄≥60岁、最大动脉瘤直径≥25 mm、脑萎缩分级3～4级、CT值≥40、硬膜下积液分级为IB与UIAs患者动脉瘤夹闭手术后发生CSDH相关;多因素Logistic回归分析发现,脑萎缩分级3～4级(OR =1.979,95％CI:1.940～2.031)、CT值≥40(OR =3.401,95％CI:2.922 ～3.868)、硬膜下积液分级IB(OR=2.866,95％ CI:2.644 ～3.012)是UIAs患者动脉夹闭术后发生CSDH的独立危险因素.结论 脑萎缩分级3～4级、CT值≥40、硬膜下积液分级IB是UIAs患者动脉夹闭术后发生CSDH的独立危险因素.

目的 将课题计划书引入《护理研究》课程教学,以期提高护理本科生的科研能力.方法 在2014～2016学年的《护理研究》课程教学中引入课题计划书,在常规理论教学基础上,引入课题计划书研讨课,由受过培训的课题辅导老师负责指导,同时制订课题计划书考核评价标准并于期末由教师使用此评价标准为护生的研究计划书评分,调查护生对护理研究课程教学中引入课题计划书的评价,并统计课题计划书入选课题立项项目情况.结果 2014～2016学年护生的课题计划书考评得分分别为84.50±3.62、91.00±2.17、87.08±3.59;护生对护理研究课程教学中引入课题计划书总体评价均分3.89分;2014～2016学年有5项研究计划书入选“大学生创新创业训练计划”省级立项项目,10项入选为校级项目.结论 《护理研究》课程教学引入课题计划书使护生具备一定的科研素养,提高了护生的科研能力,获得了护生的高度评价.

[目的]了解乳腺癌病人患病过程的职业情况,探讨影响病人职业改变的因素.[方法]采用配额抽样法,选取2016年8月-11月在四川省某三级甲等医院就诊的216例乳腺癌病人,根据化疗周期配额抽样,采用社会人口学资料调查表、疾病及治疗相关资料调查表以及修订的症状经历指数量表于化疗周期内进行调查.[结果] 216例乳腺癌病人中,73例(33.80％)患病前后职业发生了变化,64例(87.67％)由在职转为无业,9例(12.33％)由在职转为病退.多元线性回归分析显示:病人的年龄、病前职业情况、文化程度以及居住地是影响乳腺癌病人患病前后发生职业变化的主要因素,共同可解释病人患病前后职业变化变异度的48.1％.[结论]乳腺癌病人患病前后职业变化情况显著,临床医务人员应重视病人职业变化,针对不同的病人提供适当的干预方式,促进其早日回归社会,提高生存质量.

Objective To investigate the oxygen concentration and inspired oxygen concentration of noninvasive positive pressure ventilation (NPPV) in treatment of patients with AECOPD accompanied with type II respiratory failure. Methods A cross-sectional design survey was carried out in department of respiratory medicine wards of 30 comprehensive hospitals of Sichuan province to measure oxygen concentration, oxygen concentration of the ventilator exit, and actual oxygen concentration through nasal mask or mask. Results Central oxygen supply was utilized in all 30 hospitals with 3 oxygen delivering methods: molecular sieve oxygen generator (5, 16.7%), liquid oxygen tank (7, 23.3%), and combination of oxygen generator and liquid oxygen tank (18, 60.0%). The average oxygen concentration was (85.60 ± 5.65) % which is lower than anticipated. Actual oxygen concentration is (33.36 ± 1.29) % when 40% of FiO2was provided, which declined with the increase of IPAP. Conclusion More work should be done to monitor the oxygen concentration of central oxygen supply, ventilator exit and actual oxygen concentration when using nasal mask or mask. Upregulation of oxygen concentration should be provided when providing oxygen for the patients with AECOPD and type II respiratory failure.

Objective To investigate the risk factors of neurological deficits in patients with cerebral arteriovenous malformation (CAVM) after microsurgical resection.Methods 213 patients with CAVM treated with microsurgical resection in our hospital from January 2007 to January 2017 were enrolled. Before and 7 days after surgery, their neurological function was classified by modified Rankin scale (mRS), recurrent neurological dysfunction was defined as that the postoperative mRS score was more than preoperative. Their general information, laboratory and pathological detection indexes were observed, and the risk factors of recurrent neurological dysfunction were analyzed with single factor andLogistic regression analysis.Results 43 patients developed recurrent neurological dysfunction. Single factor analysis and multivariateLogistic regression analysis showed that preoperative intracranial hemorrhage, high expression of Angiogenin-1(Ang-1) were protective factor for recurrent neurological dysfunction (P<0.05). drainage through deep venous, lesion located in functional areas, larger size, Spetzler-Martin(Ⅲ-Ⅴgrade), aneurysm accompanying AVM, lower resistance index of feeding artery, higher expression of vascular endothelial growth factor (VEGF) and Ang-2 were risk factors (P<0.05).Conclusion Neurological dysfunction is easy to reoccur in patients with CAVM after microsurgical CAVM resection. Preoperative intracranial hemorrhage and high expression of Ang-1 were protective factor. Drainage through deep venous, lesion located in functional area, larger size, Spetzler-Martin(Ⅲ-Ⅴgrade), aneurysm accompanying CAVM, lower resistance index of feeding artery, higher expression of vascular endothelial growth factor (VEGF) and Ang-2 were risk factors.

目的 探讨Capfini血栓风险评估模型在神经外科卧床患者静脉血栓栓塞(venous thromboembolism,VTE)筛选中的有效性.方法 对2010年1月至2017年8月期间在我院进行过VTE筛查的神经外科卧床患者进行回顾性Caprini风险评估模型评分及VTE风险等级分级,比较是否发生VTE患者的Caprini评分和不同VTE风险等级患者VTE的发生率,采用多因素Logistic回归模型分析VTE风险等级分级与VTE发生风险的关系.结果 VTE发生率为5.4％,低危、中危、高危、极高危组VTE的发生率分别为:0.9％、1.9％、4.8％、10.6％.VTE患者Caprini评分明显高于非VTE患者[6(3～7) v..s.s.3(2～5);Z=13.679,P＜0.001].Caprini风险评估模型评定VTE风险等级为高危和极高危卧床患者发生VTE的风险分别是低危患者3.228倍和12.705倍.结论 Caprini风险评估模型能对神经外科卧床患者术后住院期间VTE的发病风险进行预测,尤其是针对VIE发生风险等级为高危和极高危患者,值得临床推广应用.