Objective:To establish a nursing intervention process for Intensive Care Unit (ICU) patients with thirst after cardiac surgery to guide clinical practice, so as to provide a basis for the scientific management of thirst in patients after cardiac surgery.Methods:We searched domestic and foreign databases to obtain and evaluate relevant literature on thirst in critically ill patients. After discussion by the research group, the first draft of the thirst intervention process was formulated. The Delphi method was used to conduct two rounds of expert consultation, and finally the nursing intervention process for ICU patients with thirst after cardiac surgery was determined.Results:Through two rounds of expert consultation, 4 first-level indicators (pre-intervention evaluation, graded intervention, post-intervention evaluation, health education) , 11 second-level indicators, and 29 third-level indicators were formed. The authority coefficients of the two rounds of expert consultation were 0.83 and 0.85 respectively, and Kendall's W were 0.259 and 0.214 respectively. Conclusions:Expert advice tends to be consistent, highly authoritative, and good coordination, which can provide a scientific management basis for the construction of nursing intervention process for ICU patients with thirst after cardiac surgery.

新型冠状病毒肺炎(coronavirus disease 2019,简称"COVID-19")是近年来发生的影响范围最广、危害性最大的全球性传染病.当前海外疫情仍处在大流行阶段,欧美国家大幅反弹,印度疫情愈加严重,截至2020年11月26日,累计海外确诊人数达6072万.我国疫情防控成效显著,仅用3个月时间就取得武汉、湖北保卫战胜利.2020年4月全国进入了疫情常态化防控阶段.目前累计确诊病例9.3万,作为人口占全球18.4％,确诊仅为全球的0.15％,见证了我国防疫措施的科学性.虽然中国进入了后疫情时代,但疫情局部暴发风险仍然存在.2020年10月11日,青岛市发生的新冠疫情与青岛市胸科医院高度关联.随着我国经济活动的全面恢复,医院门诊量大幅回升,医院新冠疫情防控仍需高度重视.东部战区总医院承担支援武汉抗疫,参加火神山医院医疗救治任务,在新冠疫情防控上具有一线实战经验[11,新冠疫情发生以来,各项防控工作有条不紊,现将防控措施经验梳理总结,供医疗卫生机构参考借鉴.

发生在武汉的新型冠状病毒（COVID-19）感染的肺炎疫情进入关键时期。医院作为疫情防控的重要机构,控制院内感染,保护医务人员健康对于疫情防控具有重大意义。结合此次疫情特点,综合《医疗机构内新型冠状病毒感染预防与控制技术指南》和专家共识,梳理出医院在加强新型冠状病毒感染控制中的7项措施建议,供医疗机构参考。

文章主要探讨新型冠状病毒肺炎(简称新冠肺炎)疫情期间手术筛查及肺炎前置病房的组建与管理的重要性.从手术筛查、肺炎前置病房设置、遵循隔离及收容要求做好人员的抽组和调配、结合防控特点建立标准化的工作流程、重点环节重点人员重点流程、对抽组人员新冠肺炎防控相关知识及技能培训、消毒隔离制度的落实及科室发生疑似、确诊患者处置等方面实施.期间所有收治患者无交叉感染发生,确保了医院重要医疗环节的安全.手术筛查及肺炎前置病房的组建与管理在新型冠状病毒感染疫情期间的防控和医疗诊治工作的有序开展起到非常必要的作用.

面对陆续发生的新型冠状病毒感染的肺炎疫情,因其存在核酸阳性率表达率较低,且存在假阴性问题,东部战区总医院组建了肺炎前置病房以收治病毒核酸筛查阴性、影像学存在肺炎表现的发热患者.目前肺炎前置病房共收治22例新冠病毒核酸检测阴性的肺炎患者,其中6例尚在院治疗中,16例治愈出院,医护人员零感染.文章将从病房设置与管理、工作流程、收治情况、诊疗经验等方面阐述肺炎前置病房在应对疫情爆发时的应用与探索.

目的 失禁相关性皮炎是临床常见的皮肤损伤,但何种皮肤保护剂能够有效预防和降低成本尚缺乏证据,文章旨在探讨两种皮肤保护剂护理失禁患者的临床效果和成本效益,为有效预防失禁相关性皮炎提供依据.方法 便利抽样选取124例失禁患者,随机分为观察组与对照组,每组62例,在以管理失禁、清洁和保护为主的结构化皮肤护理方案基础上,观察组患者涂抹复合氧化锌软膏保护皮肤,对照组患者涂抹造口粉联合皮肤保护膜保护皮肤,连续干预7 d,主要观察指标为失禁相关性皮炎发生率和护理材料成本.结果 观察组62例患者完成研究,对照组因死亡和出院脱落2例,60例患者完成研究.对照组和观察组IAD发生率方案数据分析集显示分别为20.00％和6.45％,意向性分析集显示分别为22.58％和6.45％,差异均有统计学意义(P<0.05).观察组护理材料平均每例成本[(239.71±48.55)元]低于对照组[(264.35±61.55)元],差异有统计学意义(P<0.05).结论 在结构化皮肤护理方案基础上采用复合氧化锌软膏能够提高失禁相关性皮炎的预防效果,同时降低材料成本.

目的 探讨品管圈活动在降低食管癌患者术后肠内营养腹胀发生率中的方法及效果.方法 选取2017年3月至2018年7月胸外科食管癌术后行肠内营养支持的患者120例,随机分成品管圈组和对照组(每组60例).品管圈组成立QCC小组,应用品管圈对腹胀发生率进行调查,对发生原因进行分析,制定对策,建立相关专科知识资料库,制作功能锻炼教育手册,制定个性化运动方案及肠内营养耐受性处理流程.对照组使用常规护理流程.比较两组患者肠内营养所致腹胀的发生率及满意度.结果 品管圈组腹胀发生率为8.3％ (5/60),对照组发生率为35.0％ (21/60),品管圈组腹胀发生率显著低于对照组,差异有统计学意义(x2=12.570,P=0.000).品管圈组满意度优于对照组,差异有统计学意义(93.3％ vs 75.0％,x2 =7.566,P=0.006).结论 开展品管圈活动可有效降低食管癌患者术后因肠内营养而发生腹胀的概率,改善患者的体验,提高患者的满意度.

贲门失弛缓症(achalasia of cardia,AC)是一种原发性食管神经肌肉病变所致的食管运动功能障碍性疾病,以吞咽时食管体部缺乏蠕动以及食管下段括约肌松弛不良或完全不松弛为特征,伴有食管体部的扩张.发病率为0.5～1.2/10万,常见于30～60岁.临床主要表现为吞咽困难、胸骨后疼痛、呕吐、食物反流;吞咽困难多呈间歇多发性,常因情绪波动,发怒,忧郁或进食过冷和辛辣的食物而诱发.长期吞咽困难可造成营养不良和消瘦[2].有学者报道食管贲门失弛缓症致食管癌的发生率为4.6％,明显高于一般人群,可能与食管腔内长期有食物潴留致食管黏膜病变有关,目前手术切除是最常见的治疗方法.此类患者术前就存在不同程度的营养不良和心理问题,增加患者的手术风险和术后并发症的发生率,因此,充分的术前准备和有效的营养支持对此类患者尤为重要.

Objective To explore the effect of preventing skin tears with prevention protocol based on guideline. Methods According to International Guideline of Prevention Skin Tears to discuss and make prevention protocol, including prediction risk people, prevention fall and fall from bed with auxiliary means, wearing long sleeves clothes, using emollient on skin twice a day, providing nutrients and water, prevention friction and shear force with movement skills, totally six comprehensive measures. Wound care team trained backbone nurses the measures and backbone nurses trained clinical nurses. Before and after intervention 5 month and 17 month, every patient with age more than 18 years and hospitalized more than 24 hours was checked skin from head to toes in order to observe and compare skin tears incidence and practicable rate of prevention measures by cross-sectional survey.Results Before intervention, skin tears incidence was 0.77%(12/1 558), and skin tears incidence after intervention 5 month and 17 month was 0.16%(3/1 777) and 0.22%(4/1 825) ( P<0.05) . Practicable rate of 6 measures in patients with risk and with skin tears after intervention 5 month and 17 month was increased than that before intervention which was unsatisfactory (P>0.05).Conclusions Preven-tion skin tears protocol can reduce skin tears incidence, but practicable rate need be improved. In future nurses training, guidance and management bedside should be strengthened in order to enhance practicable rate of prevention measures.

肠功能障碍是肠实质与(或)功能的损害,导致消化、吸收营养与(或)黏膜屏障功能产生障碍[1].它会对机体造成多方面的影响,其中就包括运动功能的减弱,临床表现为腹胀、肠梗阻以及肠道的菌群失调.2015年5月25日我院收治了1例溃疡性结肠炎术后并发肠功能障碍病人,该病人在促肠动力基础上行粪菌移植技术,结合有效的康复锻炼、饮食指导及心理支持,病情好转并出院.现将护理总结如下.

Objective Because of the major trauma from thoracotomy , postoperative pain may arouse patients'psychological and physiological stress response and hence affected the treatment outcome and functional recovery seriously .We retrospectively studied the correlation between the staging of pain and nursing interference to investigate the effect of nursing interference on the pain intensity after thoracic surgery . Methods Five hundred and eighty cases of patients surviving thoracotomy between December 2013 and March 2014 in Nanjing Jingling Hospital were reviewed .Correlations between comfortable nursing measures such as effective analgesia , postural care , catheter care , environmental interventions , psychological intervention and the standard assessment of pain were analysed according to postoperative pain stage . Results With comprehensive nursing interference , the highest pain score occurred in the first 24 hour (2.89 ±0.39).The score was reduced gradually to 2.25 ±0.90 in stage Ⅱ, 1.58 ±0.57 in stage Ⅲ and 1.06 ±0.24 in stage Ⅳrespectively . Conclusion Comprehensive nursing interference according to pain staging may relieve pain effectively after thoracotomy .

目的：探讨漏斗胸患者行改良漏斗胸矫形术的（改良Nuss术）围术期呼吸道管理措施。方法对漏斗胸53例围术期的排痰功能训练、联合雾化吸入、术后正确评估疼痛并有效镇痛、严密观察有无血气胸的发生、鼓励患者少量多次饮水湿化呼吸道，并做好积极的心理支持等一系列护理措施。结果53例均顺利完成手术，未出现肺部护理并发症，达到预期效果满意出院，所有患者均获随访，未出现钢板移位。结论漏斗胸患者行围术期呼吸道管理，减少了并发症的发生，更有利于患者康复。

Objective Aortic dissection is accute in occurrence along with fast change , which is inclined to to induce psy-chotic symptoms and affect the lives of patients .The study was to investigate the effects of healthcare cooperative intervention on pa-tients with psychiatric symptoms secondary to aortic dissection . Methods We established medical cooperation organization structure to clarify the division of responsibility along with a quick assessment form , a process chart and a green channel for emergencey treat-ment.The above method was applied to intervene 32 patients with psychiatric symptoms secondary to aortic dissection and observe the diagnosis time , the time from diagnosis to surgery , the remission time of psychiatric symptoms , the incidence of adverse events and the length of stay. Results 32 patients were diagnosed within 30min followed by emergency surgery within 30min after diagnosis, which was 1-2 hours shorter than the previous diagnosis and surgery preparation time .5-21 d after surgery , psychiatric symptoms have been effectively controlled.Extubation, falling out of bed, self-injury or injury and other adverse events did not occur .No patient died, and the average length of stay was 13.5d, which was 1.75d shorter than the length of stay of previous similar patients . Conclusion The healthcare cooperation method can quickly identify patients with psychiatric symptoms secondary to aortic dissection , prevent adverse events and shorten the length of stay .

外科手术治疗肺癌的原则是最大限度地切除肿瘤组织和最大限度地保留健康组织.对于肿瘤已侵犯支气管开口、主支气管的中心型肺癌,支气管袖状肺叶切除术不仅可以完整切除肿瘤,同时较之全肺切除术保留更多的健康肺组织,改善了患者的生活质量[1].达芬奇-S外科手术系统是目前世界上最为成熟且应用最为广泛的机器人外科手术系统,带来了外科手术微创的革命,被誉为第3代外科手术[2].它在心胸外科领域的技术越来越成熟,但因肺叶袖状切除手术难度较大,国内少见相关报道.我科于2014年1 1月收治了1例右侧中央型肺癌的患者,并在达芬奇机器人辅助下,对其进行了右上肺袖状切除+淋巴结清扫术,经过个体化的围术期护理,患者顺利康复出院.现将护理体会报告如下.

外科手术是食管癌患者治疗的首选方式,近些年管状胃成形及全胃代食管[1]手术因接近正常食管生理解剖结构、可有效减少或预防食管癌手术后反流等并发症和改善患者术后生活质量[2]而得到广泛应用,但手术后消化道制酸能力下降、使用抗生素后容易导致菌群失调而出现腹泻,如何观察和有效护理成为手术后护理的要点. 2013年4月和2014年5月南京军区南京总医院心胸外科发生两批次共15例手术后群发腹泻并发失禁相关性皮炎患者,经检查诊断原因可能与此有关,采用医护合作方式在1周内控制了腹泻,治愈了相关性皮炎,现报道如下.

目的：总结杂交手术室中胸腔镜下切除肺部微小病灶的手术护理经验。方法在杂交手术室中16例胸腔镜下行肺部微小病灶切除的手术护理，重点包括术前准备、术中巡回护士、器械护士、腔镜护士的无缝隙配合及术后访视。结果16例均手术顺利，术后回访无并发症发生。结论精心的护理配合及腔镜护士的专职负责是保证手术成功的关键之一。

[目的]分析12所综合性医院护士识别压疮分期的准确率及存在问题,并提出对策.[方法]对462名来自12所综合性医院的压疮护理小组护士采用培训包集中讲解和讨论2h,发放20张共23处压疮不同分期的照片,看照片答题,在1h内完成考核,使用统一的评分标准评卷并复核,分析压疮分期判断准确率和存在问题.[结果]462名护士在规定时间内完成答题,护士判断压疮分期的总准确率为92.89％(87.45％～97.62％);存在的主要问题:不能准确识别Ⅲ期和难以分期压疮,误判率较高,分别为12.34％和12.55％.得分64分～100分(94.85分±3.81分),≥90分者457人,占98.92％.三级医院护士得分(95.15分±4.07分)高于二级医院护士(94.00分±2.24分).不同护龄、学历和职称护士得分比较差异有统计学意义(P＞0.05).[结论]使用培训包集中讲解和讨论及采用压疮照片识别分期形式的考核有助于提高护士识别压疮的准确率,但对Ⅲ期压疮和难以分期压疮误判率较高,需要进一步加强岗位培训和指导.

<正>肾移植术后需用免疫抑制剂进行抗排异治疗,导致患者免疫力低,感染发生率高,而移植肾失功后在进行再次肾移植之前必须血液透析治疗。感染性心内膜炎是血液透析患者致命的合并症,一旦发生,病死率高达50%[1]。2012年8月,本科收治一例肾移植术后14年,移植肾失功后血液透析并发感染性心内膜炎患者,通过加强对患者有针对性地实施围手术期护理,取得了较满意的效果,现报告如下。

Objective: To explore the effect of training assessment for wound care group using disposable consumables safely through specialized disposable consumables in wound care.Methods: Consumables suppliers and experts of wound care group co-formulated and co-implemented the training plan.The wound care effect with the methods of combination of theory examination,practice,and safety management was statistically evaluated.Results: After training,the effect of wound care of 35 nurses training was significant,in which the nurses with less than 5 years in working experience had more progress in theoretical basis and practical capability.Conclusion: Implementing wound care training had enhanced the nurses’ knowledge and ability of disposable use and safety management of medical consumables.It will help the hospital to promote itself..

[目的]以探究学习方式培养护理骨干护理质量管理的意识和能力.[方法]以医院管理年、医院文化建设年、病人安全年为契机,以人文精神为指导,通过营造护理文化,提升个体素质;构建学习平台,优化教与学环境;明确质量控制的主体身份,实行系统化目标管理,并注重引导护理骨干以质疑、比较和读写结合的探究学习方式参与护理质量管理过程.[结果]有效提高了病人对护理工作的满意度,护理骨干对自身工作理念和精神状态的评价也有积极改观.[结论]临床护理骨干以探究学习方式参与护理质量管理的模式能有效发挥护理骨干在护理质量管理中的作用,丰富护理管理的内涵,有效提高护理质量.