目的 构建脑卒中照顾者对卒中复发应急能力测评量表,并检验其信度效度.方法 以应急准备能力模型为理论依据,通过文献回顾、半结构化访谈、德尔菲专家函询法、预调查构建测试版量表.选取 556名脑卒中照顾者进行调查,并进行信效度检验,形成正式版量表.结果 最终形成的脑卒中照顾者对卒中复发应急能力测评量表包含 5个维度,35个条目.经探索性因子分析,提取的公因子与理论框架构建的条目归属相符,累积方差贡献率为 63.792%.验证性因子分析显示χ2/df=1.542,拟合优度指数(GFI)=0.873,近似误差均方根(RMSEA)=0.041,调整拟合优度指数(AGFI)=0.848,比较拟合指数(CFI)=0.920,提示模型拟和良好.总量表内容效度指数为 0.935,各条目内容效度指数为 0.780～1.000.总量表Cronbach 系数为 0.882.结论 脑卒中照顾者对卒中复发应急能力评估量表具有良好的效度和信度,可作为医护人员评价脑卒中照顾者对卒中复发应急能力水平的测评工具.

目的:构建分级肺康复护理方案,预防ICU患者卒中相关性肺炎的发生.方法:在文献研究和半结构访谈的基础上,构建预防ICU患者卒中相关性肺炎的分级肺康复护理草案.采用德尔菲法进行2轮专家函询,按照专家意见对条目进行修改.结果:最终形成预防ICU患者卒中相关性肺炎的分级肺康复护理方案包括基础肺康复策略、一级肺康复策略、二级肺康复策略3项一级指标、15项二级指标、39项三级指标.结论:构建的预防ICU患者卒中相关性肺炎分级肺康复护理方案科学可靠,可以为开展神经科ICU康复护理研究及实践提供借鉴.

目的:探讨分级肺康复护理方案在预防脑卒中相关性肺炎中的应用效果。方法:方便抽取2022年8月—10月陕西省某三级甲等医院神经内科重症监护室（ICU）的80例病人作为研究对象，随机分为对照组和干预组各40例，对照组实施神经内科ICU常规护理，试验组在常规护理的基础上实施分级肺康复护理方案，干预2周后比较两组病人脑卒中相关性肺炎发生率、临床肺部感染评分、标准吞咽功能评估量表评分、上肢运动功能量表（Fugl-Meyer）评分、氧分压（PaO2）、二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）和ICU住院时间。结果:干预组脑卒中相关性肺炎发生率、临床肺部感染评分、标准吞咽功能评分、PaCO2值及ICU住院时间均显著低于对照组，PaO2值、PaO2/FiO2值、Fugl-Meyer评分均显著高于对照组，差异均有统计学意义（P<0.05）。结论:分级肺康复护理方案可有效降低神经内科ICU病人脑卒中相关性肺炎的发生率，减轻肺部感染的严重程度，改善病人呼吸功能、吞咽功能、上肢运动情况，缩短ICU住院时间。

目的 比较经皮椎弓根螺钉与Wiltse入路复位内固定术治疗中青年无神经症状胸腰椎骨折的临床疗效.方法 对2015年3月至2018年3月间在西安交通大学第一附属医院骨科诊治的108例无神经症状的胸腰椎骨折患者进行前瞻性研究,依从随机化原则,将54例分为经皮椎弓根螺钉复位内固定组(A组),另54例分为Wiltse入路复位内固定组(B组).比较A组和B组患者的手术时间、术中出血量、切口长度、术中透视次数和术后住院时间,比较两组术前、术后3 d及每次复查时的视觉模拟评分法(visual and logue scale,VAS)评分,以及术前及术后即刻、术后3个月、术后1年、术后3年椎体的前缘高度压缩率、Cobb角,术前及术后3个月、术后1年、术后3年的Oswestry功能障碍指数(oswestry disability index,ODI).结果 108例患者均获得随访.两组的手术时间、术中出血量和术后住院时间均无统计学差异(P>0.05).B组术中透视次数明显少于A组(P<0.05),而切口长度相较于A组则更短(P<0.05).两组术前、术后及随访时的VAS评分和ODI值无显著差异(P>0.05),而B组术后和随访时的椎体前缘高度压缩率、Cobb角均明显低于A组(P<0.0125).结论 经皮椎弓根螺钉内固定术与Wiltse入路复位内固定术治疗无神经症状胸腰椎骨折均安全有效.但Wiltse入路的术中透视次数明显减少,且切口长度小于经皮椎弓根螺钉复位内固定组,术后的椎体前缘压缩率以及Cobb角均低于经皮椎弓根螺钉复位内固定组,临床疗效更好.

目的 了解护士情绪劳动、离职意愿、工作压力及工作场所暴力的现状并探讨其相关关系和影响因素.方法 采用护士情绪劳动量表、离职意愿量表、护士工作压力源量表和工作场所暴力频度测定量表对720名护士进行问卷调查.结果 护士情绪劳动总分为(48.22±8.58)分,年龄、工作年限、聘用形式、职称和夜班频率影响护士的情绪劳动得分(P<0.05);离职意愿总分为(17.98±4.54)分;工作压力和工作场所暴力得分为(93.41±15.39)分和(7.98±3.37)分.情绪劳动、离职意愿、工作压力和工作场所暴力具有直线相关关系(P<0.01).结论 护士情绪劳动、离职意愿、工作压力和工作场所暴力的得分均处于中等水平.遭受工作场所暴力和高强度工作压力会增加护士情绪劳动,导致工作满意度下降和离职意愿上升;过高的情绪劳动又会使护士处于情感压抑状态,影响护患沟通,成为工作场所暴力发生的潜在危险因素.

目的:评价基于改良早期预警评分的脑卒中病人病情评价方法,并与传统护理评价方法进行比较.方法:选取神经内科病房转入ICU的脑卒中病人67例作为观察组,建立基于改良早期预警评分的病情评价方法对病人进行病情观察和护理;将普通病房转入ICU的脑卒中病人53例作为对照组,采用传统生命体征测量方法实施护理.比较2组病人转入ICU前24 h护士测量生命体征次数、转入ICU后24 h的APACHEⅡ评分和住院时间.结果:观察组病人转入ICU前24 h护士测量生命体征次数明显多于对照组(P<0.01),转入ICU后24 h的APACHEⅡ评分明显低于对照组(P<0.01),住院时间短于对照组(P<0.05).结论:对普通病房脑卒中病人采用基于改良早期预警评分的病情评价可提高护士观察病人频率,及时预测病人病情严重程度并予以干预,缩短病人住院时间,有利于提升护理质量.

目的 探讨脑卒中患者家属对卒中发作的应急救援能力,为后期开展家庭急救健康教育提供参考依据.方法 本研究采用质性研究的现象学研究方法对19名脑卒中患者家属进行半结构式访谈,运用Colaizzi 7步分析法对资料进行归纳分析.结果 访谈共提炼出6个主题:对脑卒中疾病认知度低,风险感知与预测能力不足,应急反应能力阙如,院前家庭急救存在误区,应对紧急情况的无助感,就医决策过程中的挣扎.结论 脑卒中急性期患者家属存在应急救援能力不足的现象,医护人员应全面了解急性期患者家属的应急能力,针对患者家属对卒中发作的应对方式,识别影响家属应急能力的不利因素,评估现有的应对资源,从而进行个体化应对技能干预和应对行为指导,提高家属应急能力.

采用一般资料调查问卷和网络环境下医学生自主学习能力测评量表对309名研一医学生进行调查研究,分析了研一医学生网络自主学习能力现状及其影响因素.结果表明,研一医学生网络自主学习能力处于高等水平,总分为(110.99±21.77)分,学习积极性较高.其中,是否担任学生干部、日均线上学习时长、焦虑水平、周内线上查阅资料天数和网络资料加载速率是影响研一医学生网络自主学习能力总分的主要因素(P<0.05).说明研一医学生线上自主学习能力处于高等水平,但需要针对其影响因素进一步采取相应的改进和提升措施,为学校和教学医院提升研究生自主学习能力提供了理论依据.

目的 分析西安地区急性呼吸道病毒感染患者病毒病原学特征,为预防控制病毒性急性呼吸道感染提供参考.方法 通过回顾性收集西安交通大学第一附属医院2016年1月至2020年12月急性呼吸道感染患者的病例资料,采集咽拭子样本,采用逆转录聚合酶链反应(RT-PCR)检测流感病毒A(FluA)、流感病毒B(FluB)、副流感病毒1-3型(PIV-1-3)、腺病毒(AdV)、呼吸道合胞病毒(RSV).结果 2752份合格样本中检出阳性704份,阳性率为25.58％.其中Flu A阳性率最高(7.05％),RSV次之(4.51％),混合感染阳性率为2.33％,主要以Flu A+RSV及RSV+AdV居多.2016-2020年各年ARTI患者呼吸道病毒阳性检出率分别为36.83％、29.16％、24.09％、22.44％、13.54％,不同年份病毒总体阳性检出率差异有统计学意义(P＜0.01).各年龄段ARTI患者呼吸道病毒阳性检出率差异有统计学意义(P＜0.01),其中1～4岁组病毒阳性检出率最高(43.35％),＜1岁组及5～13岁组病毒阳性检出率分别为36.50％、32.73％.呼吸道病毒阳性检出率在春季(3-5月)、夏季(6-8月)、秋季(9-11月)和冬季(12-2月)差异有统计学意义(P＜ 0.01),其中冬季病毒检出阳性率最高(38.35％).结论 ＜5岁儿童ARTI病毒感染率最高,＜ 14岁为ARTI病毒易感人群,高发于冬季.可制定针对性措施,降低ARTI风险.

重症肺炎是由肺炎发展而成,是内科的重危急症之一,在老年患者中发病率较高,临床表现不典型,并发症较多,常并发休克、呼吸衰竭或多脏器功能衰竭等,需通气支持、循环支持、加强监护和治疗[1].重症肺炎合并重症ARDS 的死亡率高达68.13％[2].经早期积极给予体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗,呼吸支持弥补肺功能的不足,缓解急性呼吸窘迫(acute respiratory distress syndrome,ARDS) [3];同时联合连续性肾脏替代(continuous renal replacement therapy,CRRT)治疗,清除体内的炎症介质、毒素,纠正酸中毒,为患者后续治疗迎来宝贵的时间[4 ];再通过实施精细化的护理和积极有效的康复护理措施,改善危重患者的呼吸功能和预后,提高生存率和生活自理能力.2020年3月本院收治1例重症

目的 在疫情期间调查护理专业学生对新发传染病防治知识和自身能力的认知情况,为新形势下护理人才培养提供理论参考.方法 通过网络问卷调查平台对358名护生进行调查,内容包括一般情况、新发传染病防治知识和自身能力认知情况.结果 护生新发传染病相关知识得分为(77.94±14.25)分,答题正确率为78.0％;对新发传染病的传播途径、含氯消毒剂的浓度、医护人员的防护措施、患者出院标准和机械通气护理的回答正确率低于70％;认为自身最缺乏的是应急知识与能力,得分为(4.56±0.43)分;不同学历、居住地的护生对新发传染病防治知识以及自身能力的认知差异有统计学意义(P<0.05).结论 护生对新发传染病防治知识掌握较好但不全面,相关部门应采取针对性措施,加强对不同特征护生的新发传染病相关知识教育,提高其综合能力.

目的 调查新发传染病期间护理专业学生焦虑、抑郁和专业态度状况,探讨新发传染病对护生焦虑、抑郁与专业态度的影响,为护生全面健康发展提供理论性建议.方法 应用问卷星自行设计调查问卷,采用便利抽样法,在新发传染病期间对336名护生的焦虑、抑郁及专业态度进行调查.结果 新发传染病期间护生焦虑发生率为36.9％,抑郁发生率为23.8％,68.0％的护生开始喜欢上护理专业,79.8％的护生为选择护理专业而自豪.专业态度与焦虑的简单线性回归分析,Pearson相关系数r=-0.108,t=-1.978,P<0.05,显示护生的专业态度与焦虑有负相关关系.结论 新发传染病期间,护生焦虑发生率增高,抑郁发生率未见增高,专业态度较为积极,建议高校坚持对新发传染病相关知识的宣传,给予护生充分的社会支持和心理健康指导,引导护生养成积极的专业态度和心理状态,从而促进护生全面健康发展.

目的 探讨臭氧联合射频治疗腰椎术后疼痛综合征(FBSS)下肢痛的临床疗效.方法 选取2018年4月至2019年2月西安交通大学第一附属医院收治的48例以下肢痛为主的FBSS患者,以随机数字表法分为臭氧组和联合组,每组各24例.臭氧组行单一臭氧注射治疗,联合组行臭氧联合射频治疗.于患者治疗后7d,治疗后1、3个月评估临床疗效,并记录视觉模拟评分(VAS)、Oswestry功能障碍指数评分(ODI)及日本骨科学会评分(JOA),观察治疗期间有无并发症.结果 联合组治疗后3个月的优良率(87.50％)明显高于臭氧组(62.50％)(P＜0.05).治疗时间和治疗方法对患者VAS、ODI评分存在交互作用(P＜0.05),治疗时间对患者VAS、ODI评分的影响差异有统计学意义(P＜0.05),两组患者VAS、ODI评分呈现出不同程度的波动变化(P＜0.05),联合组治疗后1、3个月的VAS、ODI评分明显低于臭氧组(P＜0.05).治疗后,两组患者JOA均明显上升,且联合组治疗后3个月的JOA评分明显高于臭氧组(P＜0.05),各组无明显不良反应发生.结论 臭氧联合射频治疗FBSS下肢痛的临床疗效优于单纯臭氧治疗.

目的:构建脑卒中吞咽障碍患者居家护理模式并评价其效果.方法:选取脑卒中吞咽障碍患者78例为研究对象.采用计算机产生随机序列法将患者随机分为观察组和对照组,每组各39例.对照组给予常规健康教育,观察组在常规健康教育基础上给予居家护理服务计划和干预措施,干预12周后,评价并比较2组患者干预前后的吞咽障碍情况、神经功能缺损程度、营养风险、自理能力、日常活动能力、心理状态及康复依从性.结果:干预12周后,2组吞咽障碍功能较治疗前明显提高(P＜0.05),且观察组更优于对照组(P＜0.05).干预后,观察组患者神经功能缺损、营养风险、抑郁评分明显低于干预前及对照组(均P＜0.05),观察组患者自理能力、日常活动能力、依从性得分均高于干预前及对照组(均P＜0.05);对照组各项指标干预前后比较除营养风险和抑郁评分外,其余各项指标差异有统计学意义(均P＜0.05).结论:脑卒中吞咽障碍患者居家护理模式有较高的实用价值,对改善脑卒中吞咽障碍患者吞咽情况,提高患者生活质量,促进患者康复,实现医院-社区-家庭的无中断长期护理服务有重要作用.

Objectives? To test the reliability and validity of the Chinese version of the Social Impact Scale (SIS) for the stigma of stroke patients in China, and to provide an effective tool for assessing the stigma of stroke patients. Methods? A total of 170 stroke patients who met the inclusion criteria were selected by the Rehabilitation Medicine Department of a tertiary hospital in Xi'an, Shaanxi Province. The Chinese version SIS was used to investigate the stigma. Using the degree of discrimination, coefficient of variation, and correlation analysis to analyze the scale items, Cronbach's alpha, content validity index, and exploratory factor analysis were used to evaluate the reliability, content validity, structural validity of the scale. The criterion-related validity is used to measure the correlation between social impact scale and daily activity ability, self-esteem, and depression. Results? A total of 170 questionnaires were distributed, and 164 valid questionnaires were returned. The response rate was 96.5%. The SIS can identify high and low groups (P＜0.01), the coefficient of variation of each item of the scale is over 15%, and the correlation coefficient between each dimension and total score of the scale is 0.739-0.875 (P＜0.01). The correlation coefficient between the score and the total score of the scale is 0.325-0.738 (P＜0.01). The results of the exploratory factor analysis retain 18 items, and one common factor is extracted for each dimension. The contribution of each common factor to variance is more than 45%. Finally, each dimension contained no less than three items, and the factor load is ＞ 0.60. The content validity index of each item of the scale is 0.875-1.000, and the content validity index of the scale is 0.944. The revised social impact scale consists of 4 dimensions and 18 items. The internal consistency of the total scale Cronbach's α coefficient is 0.908, and the Cronbach's α coefficients of each dimension are 0.711, 0.662, 0.840, 0.777, respectively. The correlation coefficient of each item is 0.457-0.783 (P＜0.01). The correlation coefficient of each dimension is 0.449-0.867 (P＜0.01). The revised SIS score was negatively correlated with daily activity ability and self-esteem score (r=-0.238, -0.309, P＜ 0.01), and positively correlated with depression score (r=0.537, P＜0.01). Conclusions? The revised SIS has ideal reliability and validity and can be used to evaluate the stigma in stroke patients in China.

Objective To investigate the effect of continuous nursing based on transtheoretical model (TTM) on elderly patients with knee osteoarthitis (KOA). Methods A total of 120 elderly patients with KOA from January 2015 to December 2016 were selected and divided into observation group and control group by the random digits table method , with 60 cases in each. The observation group was given continuous nursing based on TTM, while the control group was given continuous nursing. The functions and symptoms of knee joint of the 2 groups were evaluated by Lysholm Knee Scale Scores (LKSS) and Lequesne's Indexes (LI) after 6 months of implementation and compared. The compliance of rehabilitation training, the distribution of different behavior stages and the quality of life were compared after 6 months of implementation. Results The score of LKSS of the observation group was (78.04±8.55) points, and that of the control group was (69.22 ± 7.90) points, and there was significant difference between the 2 groups (t=6.780, P<0.05). The LI of the observation group was (5.37±1.05) points, and the control group was (6.09 ± 1.60) points, and there was significant difference between the 2 groups (t =3.356, P<0.05). There were significant differences in the distributions of the compliance of rehabilitation training and different behavior stages between the 2 groups (Z=5.814, 6.910, P<0.05). The rate of completely compliance, the percentage of action and maintenance stages of the observation group was 85.00%(51/60), 53.33% (32/60), and the control group was 55.00% (33/60), 28.33% (17/60) , and there was a significant difference between the 2 groups (χ2=12.857, 7.761, P<0.05). The physical condition, symptom and other 5 life quality scores and the total score of the observation group was (26.37±3.08), (11.80±2.15), (18.66± 2.27), (14.98±2.52), (6.93±0.94), (78.69±10.36) points, and the control group was (24.22±3.32), (9.44± 1.29), (17.24±3.07), (14.06±2.07), (6.56±1.05), (71.62±12.15) points, and there was significant difference between the 2 groups (t =2.034-7.291, all P<0.05). Conclusions The application of continuous nursing based on TTM on elderly patients with KOA can significantly change the stages of healthy behavior, improve the patients' compliance of rehabilitation training and quality of life, improve the function and symptom of knee joint.

Objective :To analyze therapeutic effect of exercise rehabilitation therapy combined trimetazidine on CHD and its influence on patients'cardiac function .Methods :A total of 116 CHD patients were randomly and equally di-vided into trimetazidine group (received trimetazidine based on routine treatment ) and combined treatment group (received exercise rehabilitation therapy based on trimetazidine group ) ,both groups were treated for three months . Therapeutic effect ,LVEF ,LVEDd ,6min walking distance (6MWD) ,serum levels of hsCRP ,homocysteine (Hcy) and N terminal pro B-type natriuretic peptide (NT-proBNP) ,plasma levels of endothelin (ET)-1 and nitric oxide (NO) before and after treatment ,and incidence rate of adverse reactions were observed and compared between two groups.Results :Total effective rate of combined treatment group was significantly higher than that of trimetazidine group (96.55% vs.82.76%, P＝0.015).Compared with before treatment ,after treatment ,there were significant rise in LVEF ,6MWD and plasma NO level ,and significant reductions in LVEDd ,serum levels of hsCRP ,Hcy and NT-proBNP and plasma ET-1 level in two groups , P＜ 0.05 or ＜ 0.01. Compared with trimetazidine group after treatment ,there were significant rise in LVEF [ (42.31 ± 7.37)% vs.(47.86 ± 7.42)%] ,6MWD [ (290.62 ± 28.36) mvs .(348.63 ± 28.54) m] and plasma NO level [ (61.54 ± 9.67) μmol/L vs.(72.62 ± 10.41) μmol/L] , and significant reductions in LVEDd [ (58.13 ± 5.82) mm vs.(55.36 ± 5.27) mm] ,serum levels of hsCRP [ (3.86 ± 0.85) mg/L vs .(3.49 ± 0.67) mg/L] ,Hcy [ (12.68 ± 2.47) μmol/L vs.(11.34 ± 2.23) μmol/L] and NT-proBNP [ (924.17 ± 175.87) ng/Lvs.(836.35 ± 158.70) ng/L] and plasma ET-1 level [ (55.83 ± 11.64) ng/Lvs. (49.36 ± 10.23) ng/L] in combined treatment group ,P＜0.05 or ＜0.01. There was no significant difference in in-cidence rate of adverse reactions between two groups ,P＝0.431. Conclusion :Exercise rehabilitation combined trim-etazidine can significantly improve therapeutic effect and cardiac function ,reduce inflammatory factor levels ,and enhance vascular endothelial function in CHD patients .Its adverse reactions are few .

目的 研究分析护理干预对脑卒中并发上消化道出血患者止血时间、肢体运动功能改善及心理状态的影响.方法 选取我院2015年1月至2016年12月收治的脑卒中并发上消化道出血患者80例,随机分为观察组与对照组,各40例.观察组给予综合护理干预,对照组仅给予常规护理干预,观察比较两组患者的止血时间、肢体运动功能及心理状态改善情况.结果 两组护理前Barthel指数、Fugl-Meyer评分比较无显著差异(P＞0.05);护理后,观察组Barthel指数、Fugl-Meyer评分明显高于对照组(P＜0.05).两组护理前SDS、SAS评分比较无显著差异(P＞0.05);护理后观察组SDS、SAS评分显著低于对照组(P＜0.05).观察组出血停止时间及住院时间均显著少于对照组(P＜0.05).结论 将综合护理干预应用于脑卒中并发上消化道出血的临床救治中,可提高患者日常生活能力及肢体运动功能,改善患者心理状态,提高止血效果,缩短治疗时间,促进患者早日康复,在脑卒中并发上消化道出血的临床治疗中有着重要意义.

目的 设计一种集加热与加压输液为一体的恒温加压输液装置,可保证液体在输入的同时进行实时加温保温,避免低体温的发生,同时也适用于不需加温加压的普通输液,减少手术人力资源的浪费.方法 设计的恒温加压输液装置由后部储气囊、中部加热袋和前部搁液袋固定膜组成,储气囊下部通过气管与一只带气阀的充气球连接,加热袋内设有通过电源线与外部温控器电性连接的碳纤维发热线,搁液袋固定膜平置位于加热袋前,储气囊上设有用于悬挂液体袋的液体悬挂钩.恒温加压输液装置的加热温度分为36℃、37℃和38℃三档,可满足不同液体温度的需求.结果 本装置结构简单、操作安全方便、使用效果好,该装置在术中液体需要快速输入时实现了同步加热升温保温,可以有效保证给液的温度需求,避免患者围手术期低体温的发生并解决术中快速补液的问题.结论 本装置可实现医务人员在手术现场人工控制加热开关,减少了远距离取用的时间及人力消耗,适宜推广应用.

Objective: To explore the effect of application of standardized communication mode in doctor -nurse communication. Methods:Using stratified cluster sampling method, 96 nurses and 49 doctors from 10 nursing units were invited to participate in this study. The standardized communication mode training was carried out for nurses, which was implemented by communication guide and electronic medical interaction system. The doctors′satisfaction to nurses′job was evaluated before and after the implementation, and the nursing staffs′attitude toward standardized communication mode was investigated. Results:After 1 year, doctors′satisfaction to nurses′job was higher than that of before, the difference was statistically significant. Nursing staffs′acceptance toward standardized communication mode presented a high level. Conclusions:The standardized communication mode is beneficial to improve the doctor′s satisfaction to the nurses′work, especially in understanding of the disease condition, profes-sional knowledge and cooperation with the doctors. This communication mode is worthy popularizing in the clinical situation.