目的 从文献计量的角度分析我国护士胜任力模型的应用研究和发展状态,为护理领域胜任力模型研究提供参考.方法 检索中国知网(CNKI)、万方数据知识服务平台和大医医学搜索三大数据库自建库至2018年8月31日护士胜任力模型文献,分别从年度分布、期刊分布、地域分布、作者分布、机构分布、主题分布、基金支持和研究对象等方面对128篇文献进行统计分析.结果 胜任力模型文献数量近年来呈快速增长趋势,文献期刊分布在45种期刊、23个省市地区,46篇文章获得基金支持.结论 我国护理领域胜任力模型相关概念尚有待于统一,构建方法尚有待于规范,建立指标尚有待于完善,研究对象尚有待于细化,模型尚有待于验证.

目的:探讨构建老年护理方向护士胜任力模型,为老年护理学二级学科的建立、老年护理学课程设置、培养目标体系的建立、对老年护理方向护生的考核提供参考依据.方法:采用文献回顾法,构建老年护理方向护士岗位胜任力初级模型;运用Delphi法对15名专家进行2轮函询,对模型各指标进行修改与完善,并运用层次分析法确定各级指标权重.结果:2轮函询问卷的有效回收率分别为83％和100％;专家权威系数分别为0.94、0.91.最终确立老年护理方向护士胜任力模型包含6个一级指标、44个二级指标.结论:初步构建老年护理方向护士胜任力模型,可为老年护理学课程设置、培养目标体系的建立、对老年护理方向护生的考核提供参考依据.

Objective:To investigate the effect of repeated transcranial stimulation ( rTMS) on the improvement of depression in patients with cerebral infarction and the change of FTHUE-HK ( FTHUE-HK) rat-ing in patients with hemiplegia. Methods:96 patients with cerebral infarction who were treated in our hospital from September 2015 to August 2016 were selected and divided into three groups:0. 5Hz group, 1Hz group and 2Hz group , Each group of 32 cases. Three groups were using the basic drug therapy and rehabilitation training, on the basis of this group with the corresponding frequency rTMS for treatment. The improvement of depression in the three groups before and after treatment was evaluated by the Depression Self-Rating Scale ( SDS) . The changes of FTHUE-HK were observed before and after treatment. Results:There was no signifi-cant difference in SDS scores between the two groups before treatment ( P> 0.05) . However, after treatment, the scores of SDS in the three groups were significantly decreased, but the 0.5Hz group and the 2Hz group all dropped below the cut- (P <0.05), but there was no significant difference between the two groups (P <0. 05), but there was no significant difference between the two groups (P <0.05). There was no significant difference in FTHUE-HK between the two groups before treatment, and there was no significant difference be-tween the two groups and the 2Hz group ( P <0.05) . Conclusion:The use of different frequencies of rTMS in the treatment of cerebral infarction patients can improve the patient's depressive symptoms and hemiplegia up-per limb function, but in contrast, high frequency and low frequency rTMS treatment of cerebral infarction is more significant.

Objective To investigate the clinical effect of low frequency repetitive transcranial magnetic stimu-lation(rTMS)in the treatment of anxiety and depression of elderly patients with acute cerebral infarction.Methods 80 cases of elderly patients with anxiety and depression after acute cerebral infarction were selected and randomly divided into rTMS group and the conventional group.The two groups were both given conventional drug therapy and rTMS group was added with rTMS treatment at the same time.After 8 weeks of treatment,the treatment effects of the two groups of patients were compared.Results After treatment,Hamilton Depression Scale[[(9.86 ±2.04)points],Hamilton Anxiety Scale[(10.24 ±1.75)points]and Chinese brain stroke scale[16.39 ±2.27)points]in rTMS group were lower than those in the conventional group[(11.18 ±2.23)points,(12.05 ±2.11)points and(19.15 ±2.50) points,respectively],P<0.05.The serum level of brain-derived neurotrophic factor[(28.14 ± 4.42)μg· L-1· mL-1)]in rTMS group was higher than that in the conventional group[(25.26 ±4.25)μg· L-1· mL-1],P<0.05.Conclusion RTMS assisted drug in the treatment of anxiety and depression in elderly patients with acute cerebral infarction has better effect than the single drug treatment.

Objective To analyze the effect of high flow humidification oxygen therapy on pulmonary infection in elderly patients with cerebral infarction and the effect on oxygen saturation and pneumonia in patients with cerebral infarction. Methods A retrospective study was conducted on 70 elderly patients with pulmonary infarction who were hospitalized in geriatrics department of Affiliated Hospital of Chengde Medical College from May 2015 to January 2017. The patients were divided into control group and experimental group according to different oxygen feeding methods.The control group was treated with traditional nasal catheter oxygen mask,the experimental group were treated with high respiratory flow humidified oxygen. The heart rate,respiratory frequency,blood pressure,blood gas index change,change the expectoration ability of patients,the hospital infection rate and patients,the incidence of drug-resistant bacteria,antibiotic use time were observed in the two groups. Results There was no difference of blood pressure before and after treatment in two groups(P> 0.05). 1H,4H two groups,24h heart rate,respiratory rate,PaO2,PaCO2,SaO2,PH and oxygen index levels were improved dramatically after treatment than before treatment in two groups(P< 0.05),and these treatment index were better in experimental group than in control group after treatment(P < 0.05). Two groups of patients after treatment of sputum viscosity grade was improved too after treatment in the two groups(P < 0.05),and the sputum characters was better in experimental group than control group after treatment(P< 0.05). The rate of internal infection and the incidence of drug-resistant bacteria in experimental group were lower than those of the control group,and the time of antibiotics use was shorter in experimental group than that in control group(P<0.05).Conclusion High flow humidification oxygen therapy can improve the blood gas index and respiratory function of pulmonary infection in elderly patients with bedridden cerebral infarction,and improve the comfort of patients,and reduce the incidence of nosocomial infection and the incidence of drug-resistant bacteria.

目的 探究老年高血压患者的血管弹性状态、内皮功能、虚弱指数的研究.方法 选取承德医学院附属医院2017年2月 ～2018年2月收治并进行血管相关功能检测的老年高血压患者50例(高血压组),同期住院进行健康体检者50例作为健康对照组,通过肱动脉二维超声显像,并测定肱动脉内径及反应性充血变化.结果 反应性充血引起肱动脉内径的变化在高血压组减弱,高血压组的反应性充血舒张百分比较对照组低,比较差异有显著统计学意义(P<0.01).老年高血压患者的非内皮依赖性血管扩张能指标与健康对照组比较差异无统计学意义(P>0.05);内皮依赖性血管扩张功能指标明显低于健康对照组,差异有统计学意义(P<0.01).高血压组患者由于高血压、饮食、服药及年龄的原因造成了身体不健康指数的增高,其虚弱指数显著高于健康对照组,差异有统计学意义(P<0.01).结论 老年高血压患者的血管弹性状态和内皮功能受高血压影响,由于疾病相关因素导致虚弱指数上升,应在临床诊断治疗中予以关注.

Objective It is to observe the clinical curative effect of ginkgo leaf tablet combined with low frequency repetitive transcranial magnetic stimulation on anxiety and depression after lacunar infarction and effect on blood rheology.Methods 121 cases of patients with anxiety and depression after lacunar infarction were randomly divided into observation group (n =61) and control group (n =60),the control group was treated with low-frequency repetitive transcranial magnetic stimulation,the observation group was given ginkgo leaf tablet orally on the basis of treatment in control group,one tablet per day,3 times/d,the treatment course was 12 weeks.The changes of scores of Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD),the United States national institutes of health stroke scale (NIHSS) and the Barthel index (BI) score,36 items concise health scale (SF-36) score and indexes of hemorheology before and after treatment were observed in both groups.Results After treatment,the scores of HAMA,HAMD,NIHSS and BI were significantly improved (P ＜ 0.05) in both groups (P ＜ 0.05),and the improvements of these indexes in observation group were better than that in control group (P ＜0.05);the scores of SF-36 scale such as physiological function (PF),vitality (VT),general health (GH),body pain (BP),physiological functions (RP),social function (SF),mental health (MH),emotional functions (RE) were increased significantly (P ＜ 0.05),and the improvements of these indexes in observation group were better than that of control group (P ＜ 0.05);whole blood hyposhear viscosity,whole blood middle shear viscosity,whole high blood viscosity,plasma viscosity,erythrocyte aggregation index were significantly decreased,the levels of the above indexes in observation group were lower than that in the control group (P ＜ 0.05).Conclusion Ginkgo leaf tablet combined with low frequency repetitive transcranial magnetic stimulation can significantly improve blood rheology and anxiety depression,promote the recovery of nerve function,independent life ability and quality of life in the patients with anxiety and depression after lacunar infarction.

Objective To investigate the effect of high flow oxygen therapy system on the incidence of hospital acquired pneumonia in patients with tracheotomy.Methods 70 patients who separated from the ventilator of tracheoto-my were randomly divided into treatment group (humidified oxygen humidified high flow)and conventional group (tra-ditional artificial humidification oxygen mask)35 cases,arterial oxygen partial pressure (PaO2 ),arterial partial pressure of carbon dioxide (PaCO2 ),oxygen saturation (SaO2 ),the incidence of airway humidification effect of pH value,satis-faction rate and complication were compared between two groups.Results Before the treatment,humidified oxygen ther-apy group and normal group of PaO2 ,PaCO2 ,SaO2 ,pH value of the difference was not statistically significant (P >0.05);4 h treatment,after the treatment of 24h,PaO2 ,SaO2 humidification oxygen therapy group were higher than that in control group (P <0.05 ),there was no significant difference between PaCO2 and the conventional group (P >0.05);after 1 2 h treatment,the two groups of patients with airway humidification was evaluated,humidification oxygen therapy group airway humidification satisfaction was 80% higher than the conventional group 54.29% (P <0.05);hu-midification oxygen therapy group excessive airway humidification of 0% lower than the conventional group 1 1 .43%(P <0.05);the treatment process,oxygen humidification treatment group,the complication rate was 1 1 .43% lower than the conventional group 40 (P <0.05),humidification oxygen therapy group occurs in hospital acquired pneumonia in 6 cases (1 7.1 4%)of 1 4 cases lower than the conventional group (40%),the difference was statistically significant (P <0.05).Conclusion High flow humidification oxygen therapy system can effectively reduce the incidence of hospital ac-quired pneumonia in patients with tracheotomy and maintain stable blood gas levels.

Objective:To investigate the usefulness of the inflammation based index ( IBI) as prognos-tic factors in patients with hepatocellular carcinoma ( HCC) . Methods:A total of 119 HCC patients admitted in our hospital from July 2011 to July 2014 were enrolled in the study. The HCC patients were assigned accord-ing to the grade (0, 1, 2) of IBI. The correlations between IBI and clinic-pathologic features were detected in the study. The prognostic significance of IBC and barcelona clinic liver cancer ( BCLC) were analyzed by uni-variate survival analysis. Results:The AFP level in human serum ( P<0.05) and inntrahepatic metastasis ( P<0.01) significantly increased in the HCC patients of the high IBI group compared with 0 grade IBI group. Child-Pugh class and BCLC had a significant difference between 0, 1, 2 IBI groups ( P<0.01) . The IBI grade negatively correlated with tumor-free survival time. Conclusion:The IBI score is consistent with the clinico-pathological features and BCLC staging of HCC, which could be used as an effective indicator for the prognosis of HCC patients.

Objective To analyze the risk factors for prognosis of surgical treatment of primary hepatocellular carcinoma (PHC).Methods The clinical data of 109 patients who underwent hepatectomy for PHC in our hospital were retrospectively analyzed.The 5-year survival rate was used as the observation index to observe the risk factors of the prognosis of PHC.Results Tumor diameter>5 cm, AFP>400 μg/ L, changes of preoperative and postoperative AFP, combined with cirrhosis, tumor invasion of blood vessels, postoperative adjuvant therapy with TACE were the independent factors which affected the survival rate of hepatocellular carcinoma (P<0.05).Conclusion There are many factors which will affect the prognosis of primary hepatocellular carcinoma (PHC).Patients with large tumor, combined with cirrhosis, tumor invasion of blood vessels, changes of preoperative and postoperative AFP, AFP>400 μg/L can predict the poor prognosis of patients after surgery, prophylactic postoperative TACE can improve the prognosis of patients.

Objective To evaluate the effect of low frequency repeated transcranial magnetic stimulation (rTMS) on patients with acute cerebral infarction (ACI),and to provide a basis for the treatment of ACI.Methods A total of 200 ACI patients complicated with hemiplegia were recruited in Affiliated Hospital of Chengde Medical College from January through November 2016 and then randomly divided into a rTMS group and a routine treatment group (100 patients in each group).All the patients received routine rehabilitation treatment while the patients of rTMS group accepted rTMS at the same time.We analyzed differences in scores of National Institutes of Health Stroke Scale (NIHSS) and Fugl-Meyer,Barthel Index (BI),latency and amplitude of motor evoked potential (MEP),central motor conduction time (CMCT),and score of Hamilton Anxiety Scale (HAMA)between the two groups after 2 and 4 weeks' treatments.Resuits There were no statistically significant differences between the two groups in NIHSS score,BI index,Fugl-Meyer score,MEP latency,MEP amplitude,CMCT,and HAMA score before the treatments (P ＞ 0.05 for all).Compared to those of the routine treatment group,significantly higher BI index (69.43 ± 7.85％ vs.63.18 ± 8.40％),Fugl-Meyer score (65.20 ±6.84 vs.60.88 ±7.47),and MEP amplitude (1.04 ± 0.19 mv vs.0.91 ± 0.15 mv) and lower NIHSS score (5.13 ± 1.96 vs.5.72 ± 1.88),MEP latency (23.72 ±0.43 ms vs.24.10 ±0.38 ms),and CMCT (10.11 ±0.49 ms vs.10.67 ±0.43 ms)were observed in the rTMS group (all P ＜ 0.05) after 2 weeks' treatments;by the end of 4 weeks' treatments,the rTMS group showed significantly higher BI index (83.20 ± 8.17％ vs.76.94 ± 9.35％),FuglMeyer score (74.12 ±6.65 vs.69.36 ± 7.17),and the MEP amplitude (1.15 ± 0.16 mv vs.0.96 ± 0.18 mv) and lower NIHSS score (3.27 ± 1.05 vs.4.06 ± 1.13),MEP latency (23.12 ± 0.36 ms vs.23.70 ± 0.47 ms),CMCT (9.62 ±0.51 ms vs.10.01 ±0.64 ms),and HAMA score (7.53 ± 1.86 vs.8.96 ± 1.97) compared to the routine treatment group (all P ＜ 0.05).Conclusion rTMS could significantly improve motor function and anxiety in patients with acute cerebral infarction.

目的 探讨IBI评分系统评估肝癌切除术后患者预后的临床价值.方法 选取165例肝癌切除术后患者为研究对象,按照IBI评分系统(分为0,1,2级)分为3组:Ⅰ组35例,Ⅱ组62例,Ⅲ组68例,比较3组一般临床资料,记录术后随访1年、3年及5年生存率,采用Logistic回归分析方法分析IBI评分系统与肝癌术后患者预后的关系,并利用ROC曲线评价IBI评分系统预测肝癌切除术后患者预后价值.结果 3组间肝功能Child-Pugh分级、TNM分期、BCLC 分期、血清AFP 水平、手术切缘、肿瘤类型、血管癌栓、手术类型比较差异均有统计学意义(P均<0.05);3组术后随访1年、3年及5年的生存率及中位生存期差异有统计学意义(P均<0.05),且从Ⅰ组到Ⅲ组生存率逐渐降低(P均<0.05);不同TNM分期及BCLC分期患者术后随访1年、3年及5年生存期亦存在类似的现象.Logistic回归分析显示,IBI评分是术后患者死亡的独立预测因素[OR=2.465,95%CI(1.621,3.671),P<0.05)],ROC 曲线分析显示IBI评分系统预测肝癌术后患者死亡的曲线下面积(ROCAUC)为0.785,敏感性和特异性分别为76.5%和78.3%.结论 随着IBI评分的增加,肝癌切除术后患者生存率显著降低,该评分可能是术后患者预后不良的独立预测因素,且能做出有效判断,简单易行,值得临床推荐.

Objective To investigate the characteristics and quality of life of patients with pulmonary infections after tracheotomy.Methods Betweem November 2012 and November 2016,200 ICU cases of patients with tracheal tubes after tracheotomy were studied and divided into the infection group (126 cases) and non-infection group (74 cases) according to the occurrence of pulmonary infections.The characteristics of patients with urinary tract infections were statistically analyzed,and the quality of life was compared between the two groups.Results Among the 200 cases with tracheal tubes,126 suffered from pulmonary infections.From respiratory secretions were detected 268 strains of pathogens,including 170 strains of gram-negative bacilli (63.43％),59 strains of gram positive cocci (22.01％),and 39 strains of fungi (14.55％).The scores of mental function,physical function,social functioning and quality of life in the infection group were lower than in the non-infection group,and the difference was statistically significant (P＜0.05).Conclusion The incidence of pulmonary infections in patients with tracheal incision is high,which is mainly caused by gram-negative bacilli,and pulmonary infections can seriously affect the quality of life of patients.

目的 探讨基于炎症反应指数(IBI)评分系统在肝癌患者预后评估中的价值.方法 选取行根治性肝癌切除术133例患者,按照患者IBI评分系统(分为0、1、2三级)进行分组,依次分为A组(0级,n=24)、B组(1级,n=49)及C组(2级,n=60),比较三组之间相关临床资料的差异,并采用Logistic回归分析IBI评分系统与肝癌预后(复发及死亡)的关系,C-index评估IBI 评分系统预后分析的等级效价.结果 A组、B组、C组三组在血清AFP 水平、肝功能Child-Pugh 分级、巴塞罗那临床肝癌(BCLC)分期、复发例数及时间、死亡例数及时间方面差异有统计学意义(均P<0.05),A组复发及死亡情况差于B组、C组,B组差于C组,差异均有统计学意义(均 P<0.05);Logistic回归分析显示,IBI评分是患者复发(OR=2.241,95％CI:1.121～3.289,P<0.05)及死亡(OR=1.789,95％CI:1.309～3.501,P<0.05)的独立预测因素,且C-index分析显示IBI 评分系统对于复发及死亡的预测具有较高的准确性,且高于BCLC分期.结论 IBI评分是肝癌术后复发及预后的独立预测因素,且能够对患者预后作出有效判断,简单易行.

目的 应用终末期肝病评分系统(MELD)评估不同预后的腹腔镜胆囊切除术(LC)患者,探讨该评分系统在LC中的临床应用价值.方法 回顾性分析2014年1-12月于该院肝胆外科行LC的162例患者的临床资料,分析术前、术后MELD分值差异与LC术后患者预后的关系.结果 LC治疗后并发症组MELD评分分值明显高于无并发症组(P＜0.05),MELD评分分值与并发症发生率呈正相关,MELD分值＞30分者,3个月内并发症发生率为75.00％.结论 MELD评分分值与LC治疗预后的并发症发生率关系密切,呈正相关.MELD在评估LC治疗的预后中有较大临床价值.

目的 拟用成年犬全肋骨肋间肌制成的胸膜肌瓣环替代胸内部分气管,观察实验犬术后生存情况并评估实验可行性,为今后临床气管肿瘤的外科手术治疗提供理论与实践的依据.方法 将成年犬第3肋骨肋间肌折曲成五边形,游离缘与根部卷曲缝合成一个带血管蒂的全肋骨胸膜肌瓣环替代胸腔内部分气管.观察实验犬术后生存情况进行观察并根据实验结果对实验的可行性进行评估.结果 大多数实验犬在术后3个月内呼吸平稳,进食正常,活动自如.少数实验犬出现轻度喘憋,直至平静状态下出现呼吸困难,最终死于呼吸衰竭.结论 犬全肋骨胸膜肌瓣环再造气管达到了气管的管道形态,短期内再造气管的组织能够存活.带蒂全肋骨胸膜肌瓣环可以替代胸腔内部分气管,实验具有可行性.