目的 研究基于纤维内镜吞咽功能评估(FEES)指导下的摄食训练对改善脑卒中患者吞咽功能的康复效果.方法 选择60例入住南京医科大学附属无锡市同仁康复医院神经康复科因吞咽障碍留置胃管的脑卒中患者,分别纳入观察组和对照组进行回顾性病例对照研究.给予两组患者常规的神经康复训练和吞咽功能训练.根据改良容积-黏度测试结果,选择能够安全吞咽时液体的体积和稠度带管对对照组患者进行摄食训练;在FEES指导下通过选择安全进食的食物性状和一口量、指导吞咽技巧和代偿方法等对观察组患者进行直接摄食训练.分别于干预前和干预4周后评价两组患者的洼田饮水试验分级和功能性经口摄食量表评分,记录两组拔除胃管时间和胃管拔除率、肺炎发生率等指标变化.结果 与对照组比较,干预后,观察组患者功能性经口摄食量表评分均值显著改善〔(5.33±0.48)分vs.(3.67±0.51)分,P<0.001)〕,干预期间肺炎发生率显著降低(6.7％vs.36.7％,P=0.005),拔除胃管时间减少〔(15.24±3.21)天vs.(19.36±3.58)天,P=0.019)〕,差异均有统计学意义.洼田饮水试验评级治愈率和显效率总和较对照组提高(66.7％vs.53.33％,P=0.329)、胃管拔除率升高(86.7％vs.73.3％,P=0.197),但差异无统计学意义.结论 FEES指导下的直接摄食训练可有效保证患者进食安全,并改善其吞咽功能.

目的 观察改良容积粘度测试在神经康复科吞咽障碍患者吞咽功能评估中的应用效果.方法 选取神经康复科的80例吞咽障碍患者,按随机数字表分为观察组和对照组各40例.对照组采用进食评估问卷调查工具-10和洼田饮水试验进行吞咽评估,并给予常规饮食护理和指导.观察组在对照组的基础上采用改良容积粘度测试进行评估,并根据测试结果给予饮食训练和指导.结果 观察组吸入性肺炎发生率、留置胃管率均低于对照组(P=0.028;P=0.022),差异有统计学意义.结论 采用改良容积粘度测试能降低吞咽障碍患者吸入性肺炎的发生率,降低留置胃管率.

目的 观察手功能位保持枕对脑卒中早期偏瘫患者手功能的影响.方法 选取2019年5月至2020年3月无锡市同仁康复医院符合入组标准的脑卒中患者共60例,随机分为观察组(30例)和对照组(30例)两组.对照组采用腕手矫形器,观察组采用手功能位保持枕,比较两组在入组时、入组后4周及入组后8周的偏瘫手握力、腕关节掌曲肌和背伸肌肌力、改良版Ashworth量表评分(MAS)、Fugl-Meyer量表(FMA)手指部分及对康复辅助支具的满意度情况.结果 入组时及入组后4周,两组患者握力、腕屈肌力、腕背伸肌力、MAS评分、FMA评分比较差异均无统计学意义(P>0.05);入组后8周,除腕屈肌力比较差异无统计学意义(P>0.05)外,观察组患者握力、腕背伸肌力、FMA评分均显著高于对照组,MAS评分等级优于对照组(均P<0.05).除耐用性外,观察组患者对辅助支具的美观性、重量、使用的简易度、舒适度、性价比和向别人推荐的可能性评分均明显高于对照组(P<0.05).结论 手功能位保持枕能有效改善脑卒中患者偏瘫手的握力、肌力及运动功能,降低肌张力,患者满意度高,值得推广.

目的 根据专业、层次、学制等特点,立足专业需求,对医学本科不同专业设置不同的教学计划和培养目标,针对性的开展实验教学,并评价其效果.方法 将我校本科临床医学、医学影像学和医学检验及生物医学分为3种不同专业组,每组130人,随机分为教改及传统班(每班65人).结合不同专业特点采取针对性的教学方法,通过调查问卷和实验课考核对教学结果 进行评价分析.结果 调查问卷显示教改班满意度显著高于传统班,实验课考核成绩显示三个专业的教改班学生成绩均显著高于传统班(P<0.05).结论 专业导向性教学方式能体现出不同专业的需求差异,更能激发学生兴趣,增加了与本专业的紧密性,为专业方向不同的应用型医学人才的教学培养方法提供了示范作用.

目的 探讨案例教学结合视频操作教学方法在康复专科医院新入职护士规范化培训中的应用效果.方法 选择无锡市同仁康复医院2017年新入职的23名护士设为对照组,采用传统的课堂讲授、操作示教进行规范化培训;2018年新入职的22名护士为试验组,通过制定适合康复医院的专科培训内容,采用案例教学结合视频操作教学的培训方法进行规范化培训.比较两组新入职护士规范化培训3个月后康复护理理论与专科操作考核成绩、综合能力评价及护士对教学质量的评价.结果 试验组新入职护士康复理论成绩[(82.18±3.40)分]、专科操作考核成绩[(86.86±3.04)分]、综合能力评价[(90.14±2??61)分]均显著高于对照组[(77.26±4.01)分、(83.22±2.33)分、(85.87±2.97)分],差异均有统计学意义(均P<0.01);试验组新入职护士对教学质量评价总分为(3.53±0.17)分,显著高于对照组的(3.30±1.14)分(P<0.01).结论 采用案例教学法能提升新入职护士专业技术水平和临床护理综合能力,提高新入职护士规范化培训的整体成效,值得推广.

目的 探讨体外膈肌起搏在慢性阻塞性肺疾病患者康复护理中的应用效果.方法 将60例慢性阻塞性肺疾病患者随机分为观察组30例和对照组30例.对照组进行传统呼吸肌训练,观察组在传统呼吸肌训练基础上辅以体外膈肌起搏治疗,均干预20d.干预前后采用慢性阻塞性肺疾病评估测试(CAT)评分、改良Barthel指数、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)评价干预效果.结果 干预后两组CAT评分、改良Barthel指数评分、FVC和FEV1比较,差异有统计学意义(均P＜0.01).结论 体外膈肌起搏能有效改善慢性阻塞性肺疾病患者肺功能,提高患者日常生活活动能力和生活质量.

目的 观察神经肌肉电刺激结合吞咽康复训练对脑卒中患者吞咽障碍的治疗效果.方法 采用随机数字表将60例患者分为观察组和对照组各30例.对照组接受为期4周吞咽康复训练,观察组在对照组基础上行吞咽神经肌肉电刺激治疗.入院3 d内及康复治疗4周后采用Gugging吞咽功能评估量表判定患者吞咽障碍状况,康复训练4周后判定患者吸入性肺炎发生率.结果 康复治疗4周后吞咽障碍治疗总有效率观察组93.33％ 、对照组73.33％,比较差异有统计学意义(P<0.05);吸入性肺炎发生率观察组10.00％ 、对照组33.33％,比较差异有统计学意义(P<0.05).结论 神经肌肉电刺激疗法可以提高脑卒中吞咽障碍患者康复治疗效果.

目的 观察Gugging吞咽功能评估联合营养风险筛查工具在亚急性脑卒中吞咽障碍患者营养干预中的作用.方法 将144例亚急性脑卒中吞咽障碍患者按随机数字表分为观察组和对照组各72例.对照组应用Gugging吞咽功能评估量表评估吞咽功能并予常规营养干预措施,观察组应用Gugging吞咽功能评估量表联合营养风险筛查进行吞咽功能及营养状态评定,根据筛查结果 给予针对性的营养干预.在干预后1个月、3个月分别比较两组患者饮食依从性及营养不良发生率.结果观察组患者在干预1个月、3个月后饮食依从性高于对照组,比较差异有统计学意义(P<0.05),营养不良发生率低于对照组.结论 亚急性脑卒中吞咽障碍患者采用Gugging吞咽功能评估量表联合营养风险筛查进行营养干预,可有效提高饮食依从性,减少营养不良的发生.

Objective To explore the application effect of Gugging swallowing screen(GUSS) in patients with subacute stroke.Methods A total of 128 patients with subacute stroke in our hospital from October 2014 to December 2015 were recruited.GUSS and Watian water drinking test were evaluated before and 1 month after treatment.The responsiveness of GUSS was assessed by effect size and standardized response mean.Results A total of 63 patients (49.22%) with swallowing disorder were detected by GUSS, while 48 patients (37.50%) were detected by Watian water drinking test.The effect size was 2.43 for GUSS and 1.72 for Watian water drinking test.The standardized response mean was 2.15 for GUSS and 1.95 for Watian water drinking test.There was significant difference before and after treatment in the score of two scales (P<0.001).Conclusions GUSS has higher screening rate and responsiveness in patients with subacute stroke than Watian water drinking test.

康复医学是指综合应用各种有效措施,减轻并代偿伤病残者的心身功能障碍,使残存功能得到最大限度改善和发挥,以最佳状态回归家庭、参与社会[1].2012年5月至6月,笔者赴德国柏林医院、勃兰登堡医院和Medical Park等多家医院考察学习,了解德国康复医疗模式,以期对我国康复医疗发展有所启示.现介绍如下.

Objective To explore the rehabilitation efficacy of Orem self -care mode on the psychological and behavioral symptoms of patients with vascular dementia (VD).Methods 63 patients with VD who met the inclusion criteria ,were divided into the control group and the observation group ,30 cases each in random order .The two groups of patients were treated with donepezil to improve cogni-tion,while the observation group used Orem self -care mode on the basis of that .Two groups respectively used the clinical global impres-sions scale(CGI)to assess the effect before the intervention and 6 weeks after the intervention,also adopting the BEHAVE -AD to assess the psychological and behavior symptoms of dementia .Results CGI-SI scores of the observation group after the intervention was differ-ent from that of the control group,and the difference was statistically significant (t=5.751,P<0.01).BEHAVE-AD total scores and behavioral disorders ,aggressive behavior ,emotional symptoms factor scores of the observation group after the intervention were all differ -ent from those of the control group,and the differences were respectively statistically significant (t=5.022~7.157,P<0.01).Conclu-sion Application of Orem self -care mode shows a significant role in the improvement of psychological and behavioral symptoms of pa -tients with VD.

Objective To explore the effect of Orem self-care mode on the self-care ability and psychological status in patients with stroke rehabilitation .Methods Sixty stroke patients who met the inclusion criteria were randomly divided into the observation group and the control group in random order , each with 30 cases.The control group received traditional conventional nursing , while the observation group received Orem self-care mode on the basis of conventional nursing .The nurses observation scale for inpatient evaluation ( NOSIE) was used to assess the clinical effect before the intervention and two months after the intervention , and the psychological status was evaluated by Symptom Checklist-90 ( SCL-90 ) .Results No significant differences were found in the scores of NOSIE and SCL-90 between two groups before intervention (P>0.05).The scores of total NOSIE, social function, social interest, personal hygiene were respectively ( 123.49 ±13.24 ), (32.76 ±5.29), (33.59 ±7.28), (26.34 ±3.52) in the observation group two months after intervention , and were significantly higher than (107.57 ±11.23), (26.32 ±4.09), (23.29 ±4.28), (19.29 ±3.19) in the control group;the scores of withdrawal and depression were respectively (4.02 ±2.12), (2.03 ±1.24) in the observation group two months after intervention , and were significantly lower than (6.87 ±1.05), (3.78 ± 1.09) in the control group, and the differences were statistically significant (t=5.023, 5.275, 6.680, 8.129, 6.598, 5.805, respectively;P<0.01).The total score of SCL-90 and the factor scores of depression , anxiety, somatization, interpersonal were respectively (109.59 ±21.37), (1.81 ±0.45), (1.23 ±0.42), (1.09 ± 0.47), (1.32 ±0.43) in the observation group, and were significantly lower than (130.42 ±29.47), (2.45 ±0.73), (2.13 ±0.29), (3.41 ±0.92), (2.32 ±0.47) in the control group, and the differences were statistically significant ( t =3.134, 4.088, 9.658, 8.311, 8.598, respectively; P <0.01 ). Conclusions Application of Orem self-care mode plays a significant role in the improvement of self-careability and psychological status of patients with stroke rehabilitation , especially in depression and anxiety .

目的:探讨患者"三要素"调查与心理护理相结合改善抑郁症患者护理效果。方法:将符合入组标准的抑郁症患者随机分为干预组77例和对照组60例,全部进行患者"三要素"调查。在应用抗抑郁药物治疗的同时,对照组实施常规心理护理,干预组患者实施在患者"三要素"调查基础上调整过的有针对性的心理护理。在患者干预8周后各进行一次护士用住院患者观察量表(NOSIE)评定,以判断疗效。结果:干预组患者8周后,其NOSIE的病情总估计分、总积极因子分等9项因子分的改善均显著优于对照组(P<0.01),而精神病表现因子分的改善与对照组无显著差异(P>0.05)。结论:通过患者"三要素"调查可以更清晰的把握住院抑郁症患者心理问题的脉络,更有利于抑郁症患者的病情康复。

老年患者精神症状和躯体疾病的相互影响使得护理工作者在及时识别老年人常见的精神障碍中变得至关重要.而现今国内尚没有相应的调查手段来测验护理工作者的老年精神卫生护理知识水平,仅有的三基考试并不能取得良好的效果。

Objective To investigate the influence of the independent living-skill training in community on the social function in patients with chronic schizophrenia.Methods A total of 120 patients with schizophrenia who were discharged after rehabilitation from January to June,2008 were randomly divided into the observational group(n=60)and the control group(n=60).Of the patients in the control group who undergone conventional rehabilitation training,8 quit the training and 52 actually completed the training;Of the patients in the observational group who undergone independent living skill training,4 quit the training and 56 actually completed the training.Scale for the assessment of positive symptoms(SAPS),scale for the assessment of negative symptoms(SANS)and social dysfunction scale(SDSS)were used in the patients of the two groups to assess levels of rehabilitation before treatment,at the end of 8,and 26 weeks,and 1 year after treatment.And nurses' observation scale for inpatient evaluation(NOSIE)was also used before treatment and 1 year after treatment.Results The scores of SAPS,SANS,SDSS before the treatment,at the end of 8 and 26 weeks,and 1 year after treatment in the observational group were significantly higher than those in the control group(P0.05 or P0.01).And the scores of NOSIE in the observational group on 1 year after treatment were superior to those before the treatment(P0.01).Conclusion The independent living skill training in community can effectively improve the social function and the life quality of patient with chronic schizophrenia.

Objective:To explore the effect of program training in rehabilitation of schizophrenic patient in community care. Methods:The schizophrenic patients in community were divided into training group and control group (each group has 50 patients). Meanwhile the drug treatment, experimental group was given specific program training to rehabilitate, and control group was taken the traditional intervention methods. After the follow up visit of whole year, the pathogenetic condition by BPRS, the social disability by SDSS the compliance, the relapse and reemployment of two groups were compared.Results: The BPRS scores, the relapse rate and reemployment rate of training group after 6 or 12 months in patient therapy were significant low than control group. The SDS$ scores and compliance situation of training group was significant better than control group.Conclusions: The application of program training in the community care of schizophrenic patient can improve the pathogenetic condition, reduce the relapse rate, postpone the social disability, and promote them to retune society finally.

[目的]探讨参与型护理模式对抑郁症病人生存质量和自杀态度的影响。[方法]将符合入组标准的160例抑郁症病人随机分为实验组和对照组各80例,在应用抗抑郁药物治疗的同时,实验组病人实施参与型护理模式,对照组实施精神科常规护理。于病人入组时和干预8周后采用世界卫生组织生存质量测定量表(WHOQOL-BREF)和自杀态度问卷(QSA)进行评定。[结果]两组病人8周后在生理领域、心理领域和社会关系领域生活质量评分比较差异有统计学意义(P<0.05或P<0.01),且实验组对自杀行为性质的认识和对自杀者、自杀者家属及安乐死的态度评分高于对照组病人(P<0.01)。[结论]参与型护理模式可以改善抑郁症病人生活质量,影响其自杀态度,预防自杀。

抑郁症是一组以心境持续低落为主要特征的精神障碍,给患者本人、家庭和社会带来沉重的负担.现在的研究[1]一般认为,抑郁症康复的重点在于患者生活质量的改善,更好地回归社会和预防复发.参与型护理模式是通过调动患者自身的积极性,使其参与到自己的健康决策和自我护理中来[2],从而实现疾病康复.我院自2007年1月起对住院抑郁症患者采用参与型护理模式,在改善其自我护理能力和生活质量方面取得了良好的效果,现报道如下。

现在的研究一般认为抑郁症治疗的重点在于患者生存质量的改善,更好地回归社会和预防复发[1].为探讨通过健康教育改善非住院康复期抑郁症患者的生存质量,促进回归社会的可行性,我院2004年9月-2006年3月对198例康复期抑郁症患者,利用灵活多变的形式对康复期抑郁症患者实施为期6个月的社区健康教育并进行对照研究,现报道如下.