目的 探寻本科护生对儿科实习带教方式的需求.方法 运用深度访谈法对2019年8月至12月在重大医科大学附属儿童医院实习的本科护生的需求进行质性研究;运用Claizzi现象学资料7步分析法进行资料分析和整理.结果 共提炼出7个主题,包括:儿科实习感受较差,护生期望理论带教形式多样,提升儿科操作确定感,人文关怀带教多元化,沟通带教采用榜样的形式,增加护理文书及法律的带教内容,增加临床实践带教.结论 护生认为儿科实习与其他科室实习差异大,希望儿科带教方式多样且注重实践.

背景现普遍认为支气管哮喘(简称哮喘)是基因和环境交互作用的结果,由于基因改变的缓慢性,越来越多的证据表明哮喘的发病率和病死率是暴露于现代室内环境中的过敏原和刺激物所致,WHO报道,44％的哮喘疾病由室内燃料、二手烟等环境因素引起.目前研究表明家族哮喘史、过敏原等是哮喘众所周知的危险因素.除此之外,诱发哮喘发病的因素还有很多:如室内环境潮湿、室内空气污染、被褥、枕芯材质及清洁程度、吸油烟机及防尘罩等的使用情况却少有研究.目的 探讨重庆市室内环境与儿童哮喘发病的相关性,为哮喘儿童家庭护理的干预措施提供依据.方法 选取2017年5—7月重庆医科大学附属儿童医院呼吸中心诊治的哮喘患儿作为病例组,根据性别、年龄按1:1匹配选取2017年8—9月于本院呼吸中心诊治的非哮喘儿童作为对照组.在瑞典Dampness in Buildings and Health(DBH)问卷的基础上结合实际住宅特征进行调整补充,拟定"儿童支气管哮喘相关因素调查问卷",问卷内容包含一般资料、室内环境(枕芯、被褥材质,枕芯、床单清洗频率,防尘罩清洗,鲜花接触频率,霉菌生长、漏水、冷凝水,加湿器使用频率,母孕期或儿童被动吸烟,地面材料,墙壁类型,开窗通风频率,厨房燃料、吸油烟机、空调过滤器清洗,宠物饲养,毛绒玩具接触频率,蟑螂/老鼠接触频率).采用Logistic回归分析分析室内环境与儿童哮喘的相关性.结果 共发放问卷750份,收回730份,剔除不合格问卷18份,有效问卷712份,有效回收率为94.9％.最终病例组入选356例,对照组入选356例.多因素Logistic回归分析结果显示,枕芯材质、被褥材质、枕芯清洗频率、床单清洗频率、鲜花接触频率、霉菌生长、漏水、冷凝水,母孕期被动吸烟、儿童被动吸烟、蟑螂/老鼠接触频率与儿童哮喘有相关性(P<0.05).结论 不良室内环境对儿童哮喘有一定的影响,枕芯材质、被褥材质、枕芯清洗频率、床单清洗频率、鲜花接触频率、霉菌生长、漏水、冷凝水、母孕期被动吸烟、儿童被动吸烟、蟑螂/老鼠接触与儿童哮喘相关,积极采取干预措施改善存在的危险因素,减少室内环境污染,可降低儿童哮喘的发病率.

目的 探讨重庆地区儿童哮喘的危险因素并提出护理对策.方法 2017年9月至2018年9月向重庆市万盛区的幼儿园和初中以下学校学生家长发放调查问卷2800份,回收2613份,有效2503份,筛选疑似哮喘的儿童到我院进一步检查,最终确诊87例,患病率3.48％,将87例哮喘患儿作为观察组,随机抽取同期来院体检、就诊的无哮喘儿童91例作为对照组,回顾分析患儿的个人病史、家族病史、喂养史及家庭环境等信息,分析重庆地区儿童哮喘患病现状和危险因素.结果 经多因素logistic回归分析发现,过敏性鼻炎史、频繁呼吸道感染史、尘螨过敏史、大量应用抗生素、家中墙面壁纸、1级家长哮喘史为发生哮喘的独立危险因素.结论 重庆地区儿童哮喘的危险因素主要涉及遗传、免疫、环境几个方面,应针对以上因素,结合地区特点给予干预措施,保持儿童活动室内通气,选择环保材料装修,清除尘螨,重视家长的相关知识宣教工作.

Objective To compare the different methods of administration of diacetyl (DA)-established bronchiolitis obliterans (BO)murine model so as to establish a simple,easy-to-operate and stable BO murine model. Methods SPF grade C57BL/6 male mice (6 to 8 weeks)were randomly divided into four groups with 10 mice in each group:oropharyngeal aspiration group (OPR),intratracheal instillation group (ITI),and control groups (OPR-CON and ITI-CON).OPR group was treated with DA (400 mg/kg,327 mg/kg)by oropharyngeal aspiration;ITI group received DA (400 mg/kg,327 mg/mL)through intratracheal instillation;OPR-CON group and ITI-CON group were treated with sterilized distilled water instead of DA,while the other experimental conditions were the same as those in OPR and ITI groups.The mice were kept in SPF-class animal center for 7 d to collect specimens. Collected bronchoalveolar lavage fluid (BALF)and the left lung were examined pathologically.Results Male C57 BL/6 mice were treated with a single dose of DA (400 mg/kg,327 mg/kg)by OPR or ITI,which could establish BO model.The successful model was evaluated by pulmonary function,BALF counts and pathological examination. Airway hyperresponsiveness occurred with the two-method resulted BO.And two methods of instilling DA resulted in airway injury,lumen occlusion,infiltration of inflammatory cells in the airway and around the vessels.The mortality rate of mice was up to 60% and the success of model construction was only 20% in BO model by oropharyngeal aspiration of DA,while that in ITI group mortality was only 30%,the success of model construction was up to 60%.There was no death in control groups.Conclusion BO murine model could be successfully established by OPR or ITI of DA (400 mg/kg,327 mg/mL).However,the BO model was established well by ITI of DA with lower mortality rate.Therefore,ITI of DA-established BO murine model is recommended for use.

[目的]探讨PDCA循环管理法在提高儿科医务人员手卫生依从性中的应用效果.[方法]运用计划-执行-检查-处理(PDCA)分析影响手卫生依从性的因素,通过制定目标、改变培训方式,加强考核力度,每月不定期的手卫生依从性调查,观察实施前后的效果.[结果]实施前后儿科医务人员手卫生依从率比较,差异有统计学意义(P＜0.05).[结论]PDCA管理模式可提高医务人员手卫生依从率.

[目的]探讨PDCA管理模式在鼻塞式持续正压通气(CPAP)治疗重症肺炎患儿临床护理中的应用.[方法]选取本病区收治的120例行鼻塞式CPAP治疗的重症肺炎患儿,根据入院时间分为对照组及观察组各60例,比较两组惠儿治疗前后血气指标改善情况,记录两组患儿治疗依从性、有效率、并发症发生率、家属满意率情况.[结果]观察组患儿干预后pH值、动脉血氧分压(PaO2)、血氧饱和度(SaO2)水平明显高于对照组(P＜0.05),而二氧化碳分压(PaCO2)水平低于对照组(P＜0.05).观察组患儿治疗依从性、有效率、家属满意率均高于对照组(P＜0.05),而患儿并发症发生率、风险事件发生率低于对照组(P＜0.05).[结论]PDCA管理模式能有效提高肺炎鼻塞式CPAP患儿治疗依从性及治疗效果,改善患儿气血指标,有利于患儿预后,提高患儿家属满意率.

目的:探讨胸部物理治疗对儿童毛细支气管炎的疗效及安全性.方法:检索Cochrane图书馆、EMBASE、PubMed、Ovid、PEDro、CNKI及万方数据库,搜集关于毛细支气管炎胸部物理治疗的随机对照试验.两位研究者独立对纳入研究进行质量评价和资料提取.应用RevMan 5.3软件进行Meta分析,根据异质性结果选择相应效应模型分析.结果:13篇文献纳入研究,共1575患者.本文将治疗方法分为三组进行亚组分析:CPT vs无CPT(PET vs无PET;CCPT与无CCPT)、PET与CCPT治疗、PET与吸痰.Meta结果显示:在患者住院时间,治疗有效率,碳酸氢盐浓度,肺部症状及体征方面CPT治疗有明显疗效.而CPT治疗对患者基础生命体征、临床评分、需氧情况、血液pH值、二氧化碳分压方面无明显疗效.PET治疗对患者呕吐,呼吸不规则发生率,血氧饱和度的稳定作用优于吸痰疗法,但不能降低患者ICU入院率、人工辅助通气率及抗生素使用率,心动过缓伴低氧血症的发生率,肌张力低下的发生率,PET比较于CCPT不能降低呼吸窘迫率的发生.结论:据现有研究表明,胸部物理治疗对儿童毛细支气管炎患者的症状改善有较好的疗效及安全性,值得临床推广使用.

Objective: To summarize the method of transitional care service dominated by nurses for children with asthma and evaluate its effect. Methods: In order to control and manage asthma, we launched transitional care service for children with asthma which asthma management capability assessment, implementation of asthma transitional care (asthma related education, improvement of the asthma self-management ability, and the psychological support for asthmatic children and their parents), and evaluation the asthma management were included. Results: Before and after continuing care service, children’s C-ACT score were (19.54±3.87) vs. (22.40±3.42) (P<0.01), MARS-A score (3.90±1.02) vs. (4.66±0.47) (P<0.01), SAS score (29.47±8.40) vs. (25.61±5.83) (P<0.01), FEV1% (69.35±9.97) vs. (90.47±9.68) (P<0.01), PEF% (63.74±12.40) vs. (89.44±7.55) (P<0.01). Conclusion: The effect of transitional care for children with asthma is remarkable. However there were some problems such as shortages of nursing manpower, lack of family visit, and patients demand increase. Therefore, in order to improve efifciency and optimized nursing outcomes, more specialized nurses, part-time nurses, and community nurses should be involved in the asthma transitional care, and the application of emerging extended care model such as WeChat group, QQ group, asthma management ,et al., should be promoted at the same time.

目的：探讨小儿静脉留置针留置失败的原因。方法选取2012年12月至2013年10月行留置针静脉滴注住院患儿423例，对患儿年龄、穿刺部位、留置针留置时间及滑脱原因进行分析。结果423例患儿中留置失败75例，失败率为17.73%；而头、足部留置失败率明显高于手部；年龄大于6个月患儿失败率明显高于6个月以内患儿；留置失败最常见的原因为留置针脱落、局部渗血、皮肤发红等。结论留置针留置失败与固定方法、患儿年龄、穿刺部位、家属对留置部位的护理等有关。

阐述教学医院工作现状，分析影响教学医院医护关系的原因，提出改善教学医院医护关系的方法及途径，强调应实施入科教育制度、建立导师负责制、建立良好沟通方式及沟通渠道、营造灵活多变的医护关系、加强低年资医护人员各级培训，以营造和谐的医护关系。

OBJECTIVE To analyze hospital infections in hospitalized children and major pathogens in the respirato‐ry department in order to provide reference for taking effective infection control measures in hospital .METHODS Clinical data of 2 576 hospitalized children in the respiratory department during 2012 to 2013 were investigated to retrospectively summarize the separated and identified pathogens and drug sensitivity test results .The change of pathogenic bacteria ,drug sensitivity ,and infection sites were analyzed .RESULTS Hospital infections occurred in 102 cases ,the incidence rate was 3 .96% .The main infection sites were upper respiratory tract ,accounting for 53 .92% ,followed by gastrointestinal tract ,accounting for 18 .63% .Totally 118 pathogens were found ,including 80 gram‐negative bacteria accounting for 67 .80% ,22 gram‐positive bacteria accounting for 18 .64% ,16 fungi ac‐counting for 13 .56% .The detection rate of K lebsiella pneumoniae was increased from 9 .43% in 2012 to 24 .62%in 2013 ,the differences were significant (P< 0 .05) .The drug sensitivity test results showed the main gram‐nega‐tive bacteria were multi‐drug resistant .CONCLUSION Clinicians should timely monitor the bacterial change and the sensitivity to drugs for hospitalized children in the respiratory department and take comprehensive measures combi‐ning with the results of drug sensitive test to rationally select antimicrobial agents .

目的：调查了解儿科腕带信息核对中的问题，并进行原因分析，提出相应对策。方法调查员在22名护士不知情的情况下跟随其做治疗的过程，以了解护士核对腕带信息情况。将120例患儿佩戴腕带的部位进行分组，其中腕带佩戴在手腕处40例，佩戴在足处40例，佩戴在外衣处40例；观察120例患儿在900次治疗过程中护士核对腕带信息的次数，其中白天观察600次，夜间观察300次；研究者与被观察者进行访谈，了解其未核对腕带信息的原因。结果观察中护士在给患儿行900次治疗过程中未核对患儿腕带信息有54次（6.00%），而是采用提问式的方法只核对了患儿的姓名，而未核对患儿的住院号；从腕带佩戴的部位看，其核对腕带信息率从高到低依次为：外衣处、手部、足部；夜间核对腕带信息的次数比白天低；低年资护士核对腕带的次数比高年资护士低。通过观察者观察及与护士交谈了解到护士未核对腕带信息的原因有以下几方面：（1）认为工作“忙”；（2）查看腕带信息不方便；（3）家属不配合；（4）患儿不配合。结论由于儿科患儿的特殊性，为了提高腕带信息的核对率，应进行多方面的干预，除提高护理人员的核对意识外，还应根据患儿的年龄、患儿及家属的配合度，将腕带佩戴到合适的部位，以便护士能及时查对。

To determine the response of nebulized magnesium sulfate on the lung function of children with bronchial hyperresponsiveness.

目的 观察硫酸镁雾化能否改善哮喘患儿吸入乙酰胆碱激发后的肺功能,并与雾化吸入沙丁胺醇和硫酸镁+沙丁胺醇进行比较.方法 330例乙酰胆碱激发试验阳性的哮喘息儿随机分为3组,3组分别给予雾化吸入硫酸镁,沙丁胺醇,硫酸镁+沙丁胺醇,观察用药后2个时点(10和20 min)第1秒用力呼气量(FEV1)、最大呼气流速(PEF)的肺功能指标.结果 ①3组患儿用药后2个时点的FEV1、PEF值均较激发值显著上升(P＜0.05),但3组2个时点的FEV1、PEF值两两比较差异无统计学意义(P＞0.05);②沙丁胺醇组及硫酸镁+沙丁胺醇组2个时点的FEV1、PEF值占预计值的百分比高于硫酸镁组(P＜0.05);③硫酸镁组和硫酸镁+沙丁胺醇组用药后20 min时点的FEV1及PEF值占预计值的百分比高于用药后10 min时点的百分比(P＜0.05).结论 硫酸镁雾化吸入能改善哮喘患儿吸入乙酰胆碱激发后的肺功能,但其效果不如单用沙丁胺醇;硫酸镁+沙丁胺醇联合应用不具有协同效应.

腺病毒肺炎为腺病毒(adenovirus,ADV)感染引起的急性下呼吸道疾病,多见于6个月至2岁小儿[1].6个月至2岁小儿的ADV特异性抗体降至最低,易重症感染,病情重、并发症多,是引起儿童死亡的首要原因,目前缺乏特异性治疗.近年来,我院采用纤维支气管镜肺泡灌洗术辅助治疗婴幼儿重症腺病毒肺炎,疗效理想,现报告如下.

目的 观察硫酸镁雾化是否能改善乙酰胆碱激发后的哮喘患儿肺功能,并与单用沙丁胺醇雾化及二者联合雾化进行比较.方法 收集2011年11月至2012年3月重庆医科大学附属儿童医院复诊的哮喘患儿84例,随机分为3组,均进行肺功能激发,然后用不同药物行支气管舒张试验.(1)硫酸镁组:雾化吸入等渗硫酸镁溶液(7.5％,含硫酸镁150 mg)2 mL; (2)沙丁胺醇组:雾化吸入沙丁胺醇溶液(含沙丁胺醇2.5 mg)2 mL; (3)硫酸镁+沙丁胺醇组:雾化吸入硫酸镁+沙丁胺醇混合溶液(含硫酸镁150 mg+沙丁胺醇2.5 mg)2.5 mL.观察各组药物雾化吸入后10、20 min肺功能改变情况.结果 各组雾化吸入不同舒张药物后肺功能均有显著上升,比较各组舒张后的肺功能值差异无统计学意义(P＞0.05),但沙丁胺醇组分别与硫酸镁组、硫酸镁+沙丁胺醇组舒张试验后10 min第1秒用力呼气量(FEV1)及最大呼气峰流量(PEF)上升的百分比差异有统计学意义(P＜0.05);各组内不同时间段比较,硫酸镁组与沙丁胺醇组舒张试验后的肺功能较激发后的肺功能差异有统计学意义(P＜ 0.05),但与硫酸镁+沙丁胺醇组差异无统计学意义(P＞0.05).结论 单用硫酸镁雾化吸入有支气管扩张作用,雾化吸入后10 min内对肺功能改善效果不如单用沙丁胺醇好,但总体两者无明显差别.硫酸镁+沙丁胺醇联合雾化吸入虽有支气管扩张效应,但不能明确说明二者联合是否具有协同效应.

<正>婴幼儿出现反复或持续吼喘的病因非常复杂,先天性气道或肺发育异常是导致小婴儿尤其是6个月以内婴儿持续吼喘的原因之一,常被误诊或漏诊。现将我院近期1例无名动脉压迫综合征患儿报道如下。1病例介绍患儿,男,5个月6天,因"不明原因反复吼喘5个月"入院。生后数天即出现反复吼喘,尤以活动及哭吵后

Objective To research the nursing care method of severe children adenovirus pneumonia.Methods The clinical data in 231 cases of children adenovirus pneumonia and nursing care measures were analyzed.Results Among 213 cases of severe children adenovirus pneumonia,128 cases were cured completely and discharged from hospital,59 cases turned better,16 cases were unhealed and 10 cases died.Conclusion Severe adenovirus pneumonia occurs abruptly with long disease course and fast change,and threatens children' s life.So the fever duration should be paid much attention during the nursing process,performing better care of high fever and respiratory tract management.The manifestations of systemic poisoning symptoms and complications caused by infection should be clolsely observed and the corresponding treatment measures should be taken,at the same time,the parents and patients should be given better nursing care for promoting the recovery of the children patients.

Objective To investigate the asthmatic children with anxiety disorder and its influencing factors,in order to provide a reference for active intervention.Methods Totally 408 8-16 year-old urban children with asthma,who were obtained a treatment in Asthma Center of Children′s Hospital of Chongqing Medical University from September 2011 to November 2011,were investigated by using the basic situation questionnaire and the screen for child anxiety related emotional disorders(SCARED).Results The prevalence of asthmatic children with anxiety disorder was 38.0%.Somatization / panic,generalized anxiety and social anxiety score in 13-16 years old group was significantly higher than that of the 8-<13 years old group.Separation anxiety score was highest in the 8-<13 years old girl′s group,and the total score of Anxiety Disorder Scale was lowest in the 8-<13 years old boy′s group(P<0.01).Multiple linear regression analysis showed that those factors,such as the parental recognition degree,lung function and marital of parents were the main influential factors of asthmatic children with anxiety disorder.Conclusion Anxiety of asthma children is universal.Clinical staff should practice directive health education combined with the influential factors,in order to improve the quality of asthma children′s life.

Objective To explore the role of group play therapy in the improvement of mental coping ability in children with asthma. Methods Forty-four asthmatic children with behavior problems were randomly divided into experimental group (n=25) and control group (n=19). All children received two tests. The tools in this research were Achenbach Child Behavior Checklist (CBCL) and Coping with a Disease Questionnaire (CODI). Before intervention, both groups received pretest. Members from the experimental group were provided with counseling for 3 months, once every two weeks for a total of 6 times, while during this period the members of the control group had not any experimental intervention．After intervention, the two groups received posttest. Five patients dropped out, and 39 went through this research (20 in experimental group and 19 in control group). The effects of group play therapy on behavior problems and coping strategy of children with asthma were evaluated. Results There was no statistically significant differences in the general information (age, sex, education, parents' marriage status and family structure) and basic score of CBCL and CODI between the two groups (P > 0.05). After intervention, the scores of social problems, social withdrawal, depression, compulsive behavior, aggressive behavior and immature and total behavior problem score dropped significantly in experimental group (P < 0.05) while there were no significant changes in control group. And the scores of acceptance, avoidance and emotional reaction increased significantly in experimental group (P < 0.05) while there were no significant changes in control group. Conclusions Group play therapy can improve the children's confidence and interpersonal adaptability and emotion management capacity, thus correcting deviant behavior, ameliorate coping strategy, improving mental coping capability, and promote the development of mental health in children with asthma.