血液检查是临床诊断和治疗的一项重要依据[1].因此,血液化验结果的准确性十分重要.正确的血液采集方式、标本及时送检以及良好的保存条件是提高检测结果的准确性和可靠性的关键环节.室温下血液标本保存时间不宜超过8 h,当保存温度高于30℃时,对检测结果影响较大[2].且临床上检测儿茶酚胺、胃泌素、甲旁素等,由于其代谢较快,需及时冷藏以保证标本检测结果准确性[3].但是传统的血液标本送检装置无冷藏功能,运送过程中温度得不到保障,容易影响标本质量.针对上述问题,我们设计了冷藏血标本盒并将其应用于临床,取得了良好的效果,现介绍如下.

BACKGROUND Nurses' level of knowledge about pain management directly determines the steps of implementation of clinical pain policies. METHOD This study surveyed 2,882 pediatric nurse practitioners from six children's hospitals using demographics and pain management questionnaires, as well as the Chinese version questionnaire of the Pediatric Nurse Practitioners' Knowledge and Attitudes Survey Regarding Pain (PNKAS) via the WeChat application. RESULTS The total score on the PNKAS was 14.88 ± 3.58 for the pediatric nurse practitioners. Multiple regression results showed the main factors influencing the PNKAS score related to position, the frequency of receiving training pain-related knowledge, and working department, which could account for 35.1% of the total variance. CONCLUSION Pediatric nurse practitioners from pediatric hospitals were not found to have sufficient knowledge or an appropriate attitude regarding pain management. A new standardized training project of pain management that is closely related to clinical practice for children should be conducted in the future. [J Contin Educ Nurs. 2019;50(6):275-281.].

Objective To learn the cognitive status for newborns medical pain in medical workers of neonatal intensive care unit of children′s hospitals and provide clinical basis for optimizing neonatal pain management. Methods Totally 320 medical staff in neonatal intensive care units of six children′s hospital in Wuhan, Shenzhen, Shanghai, Nanjing, Zhejiang, Chongqing were investigated using medical pain management survey questionnaires by means of convenience sampling method. Results The knowledge on neonatal pain were at quite high level, accuracy rate was (80.5 ± 18.1)%;but on pain feel, pain relief rate and anodyne-use, the accuracy rate was relatively low; chest drainage, lumbar puncture and PICC placement were generally considered to cause severe pain with scores of 8.03±2.20, 7.17±2.17, 7.09 ± 2.00, respectively. Medical staff with different degrees, having children or not, different titles and with different years of working at NICU had impact on neonatal pain assessment on heel prick and venipuncture among full-term newborns. The difference was statistically significant (χ2=6.208-23.314, P<0.05). Conclusions Neonatal pain management is gradually emphasized by clinical medical staff, but there exist a certain bias on the perception and assessment of pain. So, it needs to strengthen pain-related knowledge training on health care for newborns to prevent and reduce neonatal pain, improving neonatal pain management.

目的：探讨小儿外科新护士实施全程导师制培训的实践效果。方法选拔并聘任岗位导师，拟订其岗位职责、阶段教学目标和培训内容，对26名新护士进行全程多导师教学培训，完成各阶段教学目标后，通过对新护士实施理论及技能终末考核、医护团队对新护士工作能力评价及家属满意度评价，检验教学实践活动效果。结果26名新护士均按期取得独立值班资格。培训时间最短16周，最长24周，平均为20周。护理部考核理论平均成绩（92.5±1.78），技能平均成绩（91.1±1.04）。医护同行评价新护士责任心满意度为100%；工作质量、理论水平、操作技能、应急协作能力和沟通能力满意度＞91.1%；病人对新护士各项工作满意度均＞91.5%。结论实施全程多导师教学，可发挥团队的教学优势，促进新护士提高工作能力，快速融入医护团队，实现角色转变，使儿科新护士规范化培训体系更加规范。

Objective To compare the status of nurses′cognition on children′s pain between the pediatric intensive care units (PICUs) and common wards .Methods Surveys were completed by the pediatric nurses through the WeChat platform ,3 283 quali‐fied surveys from department of nursing of 11 three level of first‐class hospital in central China ,were sent back and analyzed . Results There was no statistical difference in the age ,marital status ,professional title ,highest academic qualifications ,and the dis‐tribution of professional nursing service life between PICU nurses and common ward nurses(P>0 .05) .Statistical differences were found among the sex ,the positions ,the experiences of nursing and the pediatric nursing (P< 0 .05) .Significant differences were found between the total score of the PNKAS of the PICU nurses and that of common ward nurses(P<0 .05) .Among the four di‐mensionalities ,statistical difference was only found in the item of pharmacological analgesia between PICU nurses and common ward nurses (P<0 .05) .There were no statistical difference on the correct ratio of the top three correct answers and the top three wrong answers between PICU nurses and common ward nurses(P>0 .05) .Conclusion The knowledge of the PICU nurses and common ward nurses were both not optimistic .Specific training should be provided according to the different status of the PICU nurses and common ward nurses ,so that better pain management would be provided to the pediatric children .

There is a large number of herbal drug custom about epidemic prevention ,health care ,disease prevention and cure in Chinese folk .The herbal drug folklore about epidemic prevention ,health care and cure of disease was formulated by ancient Chinese through herbal drugs related practices of production and living . The herbal drugs of folklore were reported by herbal books and became an important part of Chinese medicine due to their reliable effect about epidemic prevention ,health care and cure of disease .The process of herbal folklore initiation ,formation ,propagation ,inheritance , specification and entering into the herbal books could be used as folklore illustration on Chinese medicine theory of origin diversification including animal instinct theory ,labor creating theory ,oracle creationism ,and witch source theory ,etc .

Objective To explore the emergent nursing care of peritonsillar abscess in an infant. Methods The process of observation, treatment and nursing care of an infant with peritonsillar abscess were reviewed, and the nursing experiences were summarized. Results Through close observation of the rate, rhythm and depth of the respiration, the early signs of airway obstruction, guide parents with children right, keep the children quiet, open the airway, at the same time to prepare relevant emergency use objects to be prepared for emergency surgery, we saved time for the operation. Postoperative management of the airway and observation for the signs of bleeding in the area of incision were provided. The infant recovered well and was discharged after the treatment and nursing. Conclusions This case reminds nurses to pay attention to the airway obstruction while caring for the infants with peritonsillar abscess. The key points of nursing are observation and management of the airway obstruction, emergent preoperative preparation, postoperative monitoring, management of the airway and observation for the bleeding of the incision area.

It has been demonstrated that patients with chronic wounds experience the most pain during dressing changes. Currently, researchers focus mostly on analgesics and appropriate dressing materials to relieve pain during dressing changes of chronic wounds. However, the effect of nonpharmacologic interventions, such as virtual reality distraction, on pain management during dressing changes of pediatric chronic wounds remains poorly understood. To investigate the effect of virtual reality distraction on alleviating pain during dressing changes in children with chronic wounds on their lower limbs. A prospective randomized study. A pediatric center in a tertiary hospital. Sixty-five children, aged from 4 to 16 years, with chronic wounds on their lower limbs. Pain and anxiety scores during dressing changes were recorded by using the Wong-Baker Faces picture scale, visual analogue scale, and pain behavior scale, as well as physiological measurements including pulse rate and oxygen saturation. Time length of dressing change was recorded. Virtual reality distraction significantly relieved pain and anxiety scores during dressing changes and reduced the time length for dressing changes as compared to standard distraction methods. The use of virtual reality as a distraction tool in a pediatric ward offered superior pain reduction to children as compared to standard distractions. This device can potentially improve clinical efficiency by reducing length time for dressing changes.

总结了6例腹股沟Littre疝患儿行Meckel憩室楔形切除或肠管切除+肠吻合术+疝囊高位结扎术的术后护理.护理重点包括:重视腹股沟切口和阴囊处的管理,加强管路维护,严密观察切口及排便的情况,注意腹部体征的变化,有针对性地处理发热,实施全肠外营养的护理,积极防范并发症.本组6例术后患儿随访7个月至3年,均无疝复发及肠粘连等并发症发生.

护理是一个需要各班协作、医护协作的工作,上一班工作没做好,可能直接影响下一班的工作[1].由于新护士临床经验不足,理论与实践不能很好地结合起来,易出现对患者病情观察不到位、忽视特殊患者的安全管理、护患沟通障碍、遇到抢救等应急事件时感到束手无策等情况[2].存在相当大的安全隐患的同时也严重影响了医患、医护和护护之间的关系.尤其是儿科,患儿病情变化快,对护士的要求更高,规范化培训可以使新毕业护士更好、更快适应护士角色,提高工作及学习能力,降低职业风险,加强医护患之间的密切配合,提高护理质量和满意度[3-4].我院运用自制《儿科新护士培训手册》对新护士开展规范培训,效果显著,现报道如下.

This paper summarizes the perioperative nursing of Billroth II operation in 4 children with hemorrhage induced by duodenum ulceration.The key points in preoperative care were close observation of the children ’s response and vital signs,fluid infusion to correct fluid and electrolyte imbalance,as well as preoperative preparations.After the surgery,nursing care focused on monitoring of postoperative complications,total parenteral nutrition support,diet guidance and effective psychological support.The children were all discharged with recovery.

Objective:To explore the effect of the raining handbook for new pediatric nurses in the standard training and the significance in facilitating the roles transform for new nurses. Methods: A total of 50 new nurses were randomly divided into the intervention group and the control group. According to the training handbook for new pediatric nurses, multi mentors tutoring, stage training, flexible teaching and periodical examination were performed in the intervention group. The traditional training was performed in the control group. The results of examinations and satisfaction rates at pre-training and post-training were compared. Results: Scores of the assessment, patients' satisfaction, medical and nursing team satisfaction and new nurses' self-satisfaction were higher in the intervention group compared with the control group (P0.05). Conclusion: The application of the training handbook in standard training can improve the capability of the new nurse, enhance the roles transform and enable the new nurse to be competent for pediatric nursing.

OBJECTIVE To explore the current situation of multidrug-resistant bacteria infections in pediatric intensive care unit(PICU)so as to provide effective interventions for the control of infections.METHODS The results of pathogen cultures and drug susceptibility testings in Wuhan Children's Hospital from Jan to Dec in 2011 were analyzed retrospectively.RESULTS There were 1408cases in PICU in 2011.8534case-times of clinical specimen were tested.769cases were tested positive with the positive rate of 9.01%,including 126(16.38%) cases of multi-drug resistant bacteria.Of all the isolated muldrug-resistant bacteria,the detection rate of the Acinetobacter baumannii was the highest(63.0%),followed by the Klebsiella pneumoniae(20.0%),Escherichia coli(12.0%),methicillin-resistant Staphylococcus aureus(4.0%),and Pseudomonas aeruginosa(1.0%)respectively.Analysis of infection sources revealed that 40.0% of the infections occurred in communities,the bacterial colonization accounted for 34.0%,and hospital acquired infections accounted for 26.0%.CONCLUSION Multidrugresistant bacteria infections are increasingly serious in PICU.The cases with hospital-acquired infections caused by multidrug-resistant bacteria are increased,the medical staff should strengthen the monitoring of the mutidrugresistant bacteria in PICU,strictly implement the hand hygiene and disinfection and isolation measures,and reasonably use antibiotics so as to effectively prevent the prevalence and spread of the drug resistant strains.

Objective To summarize the surgical treatment approach for young children with congenital heart disease who required mechanical ventilation before cardiac surgery. Methods A retrospective review of a cohort of patients in our department from Sep.2011 to Apr.2012 was performed.The subjects study included 16(10 male and 6 female) cases of congenital heart diseases supported with mechanical ventilation before cardiac surgery.Their ages ranged from 21 days to 7 months post-delivery.Among them 10 cases were less than 2 months old.Before the operations,all patients required tracheal intubation for mechanical ventilation(6 cases due to hypoxic seizures,10 cases due to respiratory failure).The duration of preoperative mechanical ventilation was from 1 to 20 days.Different types of surgical procedures and cardiopulmonary by passes(CPB) were performed according to the types of diseases.Anatomy correction was performed in 14 cases,while sta-geing operations were needed in 2 cases. Results The mean aortic cross clamp time was(34.34±30.24) min(ranging 24-93 min),the mean CPB time was(54.28±60.43) min(ranging 34-196 min),the mean duration of postoperative ventilation was(98.21±100.36) hours(ranging 40-391 hours),and the mean ICU was(7.25±12.94) days(ranging 4-19 days).One case died during the operation,and 2 cases died post-surgery,they all died of pneumorrhagia.The other 13 survivors were discharged with recovery.Two cases of them required delayed sternal closure because of unfavorable postbypass hemodynamics.Other morbidities in the immediate postoperative period included low cardiac output state(n=3),peritoneal dialysis(n=3),chylothorax(n=1),which were cured with thoracic duct ligation 1 week later.Eight patients had positive postoperative sputum bacterial cultures with the same organisms that were cultured preoperatively in 5 cases of them.There were no instances of wound infection or mediastinitis. Conclusions High risks existed in congenital heart surgeries with preoperative mechanical ventilation.More complications and longer postoperative recovery time were noted.Corrective cardiac surgery should be consi-dered before the emergence of critical symptoms.

Objective:To investigate the applications of multimedia health education in rehabilitation of gluteal muscle contracture in children.Metheds: 60 patients with gluteal muscle contracture were randomly divided into experimental group and control group,the control group use routine methods of health education,the experimental group applies multimedia health education,compared with two groups by the effect of rehabilitation,the time for health education and satisfaction with the results of health education.Results:The effect of rehabilitation and satisfaction of experimental group are better than the control group;the time for health education in the experimental spend less than the control group.Conclusion: Multimedia health education is more intuitive and stimulate the initiative of rehabilitation of the gluteal muscle contracture in children.lt could be widely applied.

目的 探讨一种新的婴儿静脉留置针穿刺和送管方法,提高静脉穿刺成功率,减少患儿痛苦.方法将2011年1～3月住院的200例患儿随机分为对照组(常规方法)和实验组(单手进针法)各100例进行留置针穿刺.结果实验组的静脉穿刺成功率为97%,对照组的穿刺成功率为85%,实验组静脉穿刺成功率明显高于对照组(χ2=8.791,P<0.01).结论改进后的婴儿静脉留置针单手穿刺和送管方法优于常规的婴儿静脉留置针穿刺和送管方法.

Objective This study aimed to summarize the method of diagnosis and surgical treatment for congenital vascular ring in infants.Methods A retrospective analysis of clinical data of 16 cases (male =11; female =5) with congenital vascular rings from March 2008 to July 2011were conducted.Patients’ agesranged from 4 months to 3.2 years old (mean 2.2 years 1.7).Preoperative 64 slice CT chest with three-dimensional reconstruction of the great vessels and trachea were performed,The diagnosis included double aortic arch in 3 cases; right aortic arch with left ligament and aberrant left subclavian artery in 7 cases; right aortic arch with aberrant left innominate artery in 1 case,left aortic arch with aberrant right subclavian artery in 2 cases; pulmonary artery sling in 3 cases.Clinical manifestations of childrenincluded recurrent respiratory tract infection,chronic cough,wheezing,respiratory distress,dysphagia,and vomiting.13 patients underwent surgical repair; 3 cases of pulmonary artery sling had surgery under cardiopulmonary bypass; while the others had off-pump surgery,including l case of aortopexy surgery.Results No operative mortality was seen in any patient.Postoperative complication included 1 case of chylothorax and 1 case of left vocal cord palsy.The mean follow-up period was 6 months.Gastrointestinal symptoms disappeared 2 weeks after the operation.6 patients still had wheezing,recurrent respiratory tract infection 3 months after the operation.By 6 months,2 patients had wheezing,and chronic cough.Only 1 patient still had wheezel year after operation.Significant reduction of seizure frequency was obtained comparing with the previous status and normal growth and development were achieved.Conclusions In infants and young children with recurrent pneumonia,breathing difficulties unexplained wheezing,dysphagia,the possibility of vascular ring should be borne in mind.Early detection,and surgical treatment should be offered.

目的 探讨葡萄糖喂服方式对足跟采血所致新生儿疼痛的影响,为临床干预减轻新生儿操作性疼痛提供一种方便可行的葡萄糖喂服途径。方法 将70例健康足月新生儿随机分为观察组和对照组各35例,脱落6例,最终入组各32例。观察组在足跟采血前用婴儿奶嘴喂服25％葡萄糖,对照组用注射器滴注葡萄糖于婴儿口中。观察足跟采血时和采血结束后2min各组新生儿疼痛量表(NIPS)得分、心率和氧饱和度变化。结果 足跟采血过程中和结束后2min,两组NIPS评分、心率及氧饱和度差异均无统计学意义(P＞0.05)。结论 用奶嘴喂服葡萄糖与传统的注射器喂服方法对减轻新生儿足跟采血所致疼痛反应的效果无差异,但前者更接近自然吸吮行为,且方便易行。

Objective To formulate and apply guideline for training novice nurses working in orthopedic department,and to make the training scientific and normative.Methods By reviewing related references and hospital′s regulations,and combining with practice in orthopedic department and the survey results indicating competencies that nurses wroking in orthopedic department should master,developed the guideline for training novice nurses in orthopedics,and revision was made after scrutinization.Eighteen novice nurses were trained with strategies of multi-teacher mentoring,stage-based training,and various teaching methods.Results After 7 to 24 weeks′training,all of the 18 nurses obtained ≥85 points in the examination;all of them worked independently on schedule,and no nursing errors and nurse-patient disputes occurred within 5 to 30 months after they worked imdependently.The average score of the training method evaluated by novice nurses reached 90.5 points.Conclusion The composition and implementation of the guideline for training novice nurses in orthopedics makes the training normative,orderly and effective,which is of benefit to promotion of nursing management.

Objective To explore the application mode and effects of "Orthopedic Training Guideline on New Nurses".Methods 16 new nurses in orthopedic ward were trained with variable forms and assessments of the multiple-mentoring system to stimulate their learning interests and initiatives.Results 16 new nurses had succeeded in the assessments.No one made an error,or received a complaint when they worked independently.Conclusions The guideline made standardsand procedures for the training.