目的 观察和分析使用扩皮引导装置及不同扩皮角度对经外周静脉置入中心静脉导管(PICC)置管的影响,为标准化扩皮提供新的实践途径.方法 选取2021年1月至2022年6月需行超声引导下PICC置管术患者120例.根据是否使用扩皮引导装置以及不同扩皮角度将患者分为4组,分别为传统组、15度角组、30度角组和45度角组,每组各30例.记录各组患者插管前一般情况,记录送鞘成功率、穿刺点出血(渗血)量、不良事件及并发症发生率、置管术后患者疼痛度及操作者满意度情况.结果 使用扩皮引导装置后,一次扩皮送鞘成功率显著上升

目的 探讨吴茱萸热奄包联合超声电导仪透皮给药技术对胃肠手术患者肠道功能恢复的影响.方法 选择2022 年5 月至2023 年5 月粤北人民医院拟行胃肠手术的100 例患者为研究对象,采用随机数字表法将其分为对照组和观察组,各50 例.对照组予以常规护理+吴茱萸热奄包治疗,观察组在对照组的基础上,采用吴茱萸热奄包联合超声电导仪透皮给药技术.比较两组患者术后的肠鸣音恢复时间、首次排气时间、首次排便时间以及腹胀发生率、腹痛发生率和患者满意度.结果 观察组患者术后的肠鸣音恢复时间、首次排气时间、首次排便时间均短于对照组,腹胀发生率和腹痛发生率均低于对照组,患者满意度则高于对照组(均P＜0.05).结论 吴茱萸热奄包联合超声电导仪透皮给药技术促进了胃肠手术患者的肠道功能恢复,提高了患者满意度.

目的:探讨医联体内同质化护理模式对压疮护理质量的影响。方法:选择研究对象来自粤北人民医院（牵头单位）和医联体内3家二级医院，研究时间段为2020年1月至2021年12月。两种护理模式实施时间段为2020年1-12月医联体内的3家二级医院采用《基础护理学》的常规护理模式，收集569例压疮患者为研究对象，同时收集568名患者近亲属进行满意度调查；2021年1-12月采用医联体牵头单位组织培训后的同质化护理模式，收集510例压疮患者为研究对象，同时收集512名患者近亲属进行满意度调查。先对医联体成员单位压疮护理存在的问题进行调查，针对问题进行培训，制定医联体内压疮评估流程、会诊规范及双向转诊机制。观察比较两种护理模式下，医联体内下属成员单位护士对压疮护理知识掌握情况、压疮患者及近亲属满意度、压疮愈合数、新发压疮数及向上级医院转诊压疮患者数。结果:2020年压疮患者同质化护理管理模式实施后，下级成员单位护士压疮护理知晓评分、专业知识评分（5.91分、37.4分）明显高于实施前（5.40分、15.15分）（护理知晓评分： t=9.28， P < 0.05；专业知识评分： t=176.77， P < 0.05）。实施同质化护理模式后压疮患者满意度、近亲属满意度明显高于实施前（患者满意度：χ 2=61.08， P < 0.001；近亲属满意度：χ 2=65.28， P < 0.001）。开展同质化护理模式后压疮愈合率和好转率均明显高于实施前（χ 2=41.41， P < 0.001）。同质化护理模式实施后下级医院向上级医院压疮患者转诊数（27例）明显低于实施前（50例）（χ 2=5.79， P < 0.05）。 结论:构建医联体内同质化护理管理模式，可提高下属成员单位护士护理压疮患者的能力，提高患者及其近亲属的满意度，节约医疗成本，使优质医疗资源下沉，符合国家医改要求。

Objective:To explore the effect of Teach-back combined with continuing nursing on the psychological status of patients with high-risk stress injury of gastrointestinal tumors.Methods:A total of 160 patients with high-risk pressure injury of gastrointestinal tumors admitted to the department of gastrointestinal surgery of YueBei People's Hospital from July 2018 to July 2022 were selected for this study. They were randomly divided into observation group and control group, with 80 cases in each group.The control group was given routine discharge telephone follow-up, while the observation group was given Teach-back education combined with discharge continuity nursing.The psychological status score, quality of life score, incidence of pressure ulcer and nursing satisfaction were compared between the two groups.Results:After nursing intervention, the Self-Rating Anxiety Score (SAS) and Self-Rating Depression Score (SDS) of the observation group were lower than those of the control group ( P<0.05). The scores of the short form of quality of life evaluation after nursing intervention in the observation group were higher than those in the control group ( P<0.05). After nursing intervention, the incidence of pressure injury in the observation group was 11.25%, which was lower than that in the control group (23.75%), and the difference was statistically significant( P<0.05). After nursing intervention, the total nursing satisfaction of the observation group was 92.50%, which was higher than that of the control group (81.25%), and the difference was statistically significant ( P<0.05). Conclusions:Teach-back combined with continuous nursing has a significant nursing effect on patients with high risk pressure injury of gastrointestinal tumors, which can improve the patients' bad mental state, reduce the incidence of pressure injury, and improve the quality of life and nursing satisfaction of patients.

目的:不同肠道清洁方法对内镜下肠息肉切除术前清洁疗效、患者配合度及治疗满意度的影响.方法:选取2019年1-12月本院收治的肠息肉患者240例为研究对象,按照随机数字表法分为对照组、试验A组和试验B组,每组80例.息肉切除术前分别采用不同的肠道清洁方法.对照组口服复方聚乙二醇电解质散;试验A组口服复方聚乙二醇电解质散结合常规左侧卧位清洁灌肠;试验B组给予口服复方聚乙二醇电解质散结合旋转体位清洁灌肠法灌肠.比较三组的肠道清洁度、治疗配合度、疾病知识知晓率、满意度.结果:试验A组清洁度高于对照组,试验B组清洁度高于对照组,试验B组清洁度高于试验A组,差异均有统计学意义(P<0.05);三组比较差异有统计学意义(P<0.05).试验A组主动准备、规范用药、体位保持、服从指令的评分均高于对照组,试验组配合度各项评分均高于对照组,试验B组配合度各项评分均高于试验A组,差异均有统计学意义(P<0.05);三组各项比较差异均有统计学意义(P<0.05).试验A组疾病知识、用药常识、护理知识、生活自理各项知晓率均高于对照组,试验B组各项知晓率均高于对照组,试验B组各项知晓率均高于试验A组,差异均有统计学意义(P<0.05);三组比较各项差异均有统计学意义(P<0.05).试验A组总满意高于对照组,试验B组总满意高于对照组,试验B组总满意高于试验A组,差异均有统计学意义(P<0.05);三组比较差异有统计学意义(P<0.05).结论:口服复方聚乙二醇电解质散结合旋转体位清洁灌肠法灌肠治疗能够提高患者的肠道清洁度、配合度和疾病知识知晓率,提升患者满意度,为内镜下肠息肉切除术提供良好的术前准备,有较高的临床应用价值.

目的:探讨自制负压引流联合优拓治疗对腹部感染性切口患者的治疗效果.方法:选取2018年1月1日～2020年7月31日收治的腹部感染性切口患者为研究对象,采用抛硬币法随机分为观察组、对照组1及对照组2各20例;观察组采用自制负压引流联合优拓治疗,对照组1采用普通换药,对照组2采用优拓银SSD敷料换药;比较三组创面愈合时间、换药次数、切口细菌培养转阴时间、换药费用、疼痛评分及满意度.结果:观察组创面愈合时间、切口细菌培养转阴时间均短于对照组1和对照组2(P<0.01),换药次数、换药费用均少于对照组1和对照组2(P<0.01),疼痛评分低于对照组1和对照组2(P<0.05),满意度评分高于对照组1和对照组2(P<0.01).结论:自制负压引流联合优拓治疗用于腹部感染性切口患者中,能促进患者恢复,减少治疗费用,减轻疼痛,提高满意度.

[目的 ]探讨改良清洁灌肠对不完全性肠梗阻病人舒适度的影响.[方法 ]将140例不完全性肠梗阻病人随机分为3组,试验组(51例)用无菌液状石蜡60 mL保留灌肠3 h后,再用开塞露40 mL加入生理盐水500～1000 m L配合旋转体位清洁灌肠;对照1组(43例)用开塞露40 m L加入生理盐水500～1000 m L配合旋转体位清洁灌肠;对照2组(46例)用开塞露40 m L加入生理盐水500～1000 m L配合传统左侧卧位清洁灌肠.干预结束后调查病人干预期间腹胀痛及便意感程度、对灌肠过程的满意度,记录病人每次清洁灌肠的灌肠次数.[结果 ]3组病人腹胀痛及便意感程度比较、灌肠次数比较、灌肠过程满意度比较,差异均有统计学意义(P<0.05).[结论 ]改良清洁灌肠使病人腹胀痛及便意感减轻,灌肠次数减少,病人灌肠过程满意度提高.

目的 探讨运用品管圈对全院发生压力性损伤管理的效果观察.方法 本课题研究小组回顾性分析2016年压力性损伤院内发生数据,品管圈小组对发生数据进行分析及在2017年第1季度进行一次摸底专项检查,通过检查与结合原始数据分析发生院内压力性损伤原因,讨论提出在全院范围内进行培训、整改,进行了多次全员培训,修订上报流程与制度,品管圈小组对重点科室(如ICU、神经外科、手术室)重点督查与培训.品管圈小组根据每季度上报表格数据与专项检查不良条目分析,利用品管圈进行持续质量改进.结果 通过利用品管圈对控制全院压力性损伤发生的管理,我们优化了上报流程与制度,优化了全院统计数据表格.对比2016年与2017年全院发生例数与发生科室数据,P<0.01,说明不同科室在2016年和2017年发生压力性损伤情况有统计学意义,2017年比2016年总体发生压力性损伤发生例数降低;专项检查对比干预前与干预后主要影响压力性损伤发生的不良条目的 监控数据显示P<0.01,表明影响压力性损伤发生的不良条目在干预前后有统计学意义,表明干预后对影响压力性损伤发生的不良条目降低有促进作用.结论 在护理指南明确,且该类技术管理治疗标准相对稳定时,在全院现有资源上建议使用品管圈管理工具,能有效提高慢性伤口、造口专科小组对全院压力性损伤管理水平.

目的 探讨地塞米松注射液联合康惠尔贴在经外周静脉置入中心静脉导管(PICC)致接触性皮炎中应用效果.方法 选取我院收治的90例PICC致接触性皮炎患者为研究对象,按随机数字表法分为观察组和对照组,每组45例.对照组给予地塞米松注射液外涂联合3M透明敷料换药.观察组给予地塞米松注射液外涂联合康惠尔贴换药.比较两组临床疗效、移位率、脱管率、感染率、换药次数及换药费用.结果 观察组治疗有效率显著高于对照组(P<0.05).观察组移位率、脱管率及感染率显著低于对照组(P<0.05).两组换药费用比较差异无统计学意义(P>0.05).观察组换药次数显著低于对照组(P<0.05).结论 采用地塞米松注射液联合康惠尔贴换药,可有效改善PICC致接触性皮炎,降低感染风险,减少护理工作量.

目的 探讨双螺旋法联合工字形法对胃肠营养管固定的效果.方法 选取我院收治的90例留置胃肠营养管患者为研究对象,按随机数字表法分为观察组和对照组,每组45例.对照组采用蝶形交叉固定法进行胃肠营养管固定.观察组采用双螺旋法联合工字形法进行胃肠营养管固定.比较两组管道移位发生率、不良反应发生率及舒适度.结果 观察组管道移位发生率显著低于对照组(P<0.05).观察组过敏、皮疹及咽部刺激发生率显著低于对照组(P<0.05).观察组舒适度评分显著高于对照组(P<0.05).结论 采用双螺旋法联合工字形法进行胃肠营养管固定,可降低管道移位风险,减少不良反应,提高患者舒适度.

Objective To explore the risk factors of colorectal cancer and the relationship between the number of smoking and the number of years of smoking and the risk of colorectal cancer.Methods By using a hospital based 1:2 matched case-control research method,104 cases of colorectal cancer and 208 controls were selected as a case group and control group respectively in match with the gender,age,nationality,and residence in the same period,and they were investigated with a self-designed questionnaire.The x2 test,rank test and conditional logistic regression model were used for statistical analysis.Results The x2 and rank test showed that the education level,exercise,smoking,diet type,often eat fresh vegetables,a history of cancer,chronic intestinal disease,and character type were significantly different between the two groups (P＜0.05);the multivariate conditional logistic regression analysis showed that the education level,smoking,diet type and history of cancer were independent risk factors for colorectal cancer (OR=1.372,1.758,2.506,2.970 respectively).In addition,the average daily amount of smoking and smoking years in the case group were higher than those in the control group,and there were significant differences between the two groups (P＜0.01),and with the increase of the number of years of smoking,the prevalence of colorectal cancer increased significantly.Conclusions The low educational level,smoking,dietary fat and existing history of cancer can increase the risk of colorectal cancer.Therefore,we should strengthen the health education against smoking,etc.

Objective:To investigate and analysis the status quo of maintenance of PICC patients in hospital at the county level.Method:From January 2013 to December 2013,around the town and the outlying mountainous area of 100 cases of tumor in our hospital and below the county level hospital of 100 cases of nursing staff the period were randomly selected as the research objects,through a questionnaire survey understanding tumor patients with PICC to maintain the status quo.Result:The 100 cases of nursing staff were lack of professional knowledge and professional knowledge of PICC management and maintenance.2012 year in our hospital catheterization outpatients and maintenance were 612 and 2287 cases,2013 year,our hospital building self-centered catheter maintenance network, catheter was 633 cases, outpatient amount of maintenance has decreased 25.8%,1697 patients and 2014 year respectively were 840 cases and 2309 cases,2015 year respectively were 893 cases and 2300 cases,2014 and 2015 year outpatient maintenance had been steadily on the rise. Conclusion:Below the county level hospitals PICC with pipe maintenance patients solved the problem.

Objective To investigate the curative effect of new elyster methods for incomplete intestinal obstruction.Methods Patients with incomplete intestinal obstruction were divided into three groups.Experimental group (51 cases) underwent clyster with 500-1000 ml normal saline containing 40 ml glycerine enema in rotation position after retention enema with 60 ml paraffin oil for 3 hours,control group 1 (43 cases) underwent clyster with 500-1000 ml normal saline containing 40 ml glycerine enema in rotation position,control group 2 (46 cases) underwent clyster with 500-1000 ml normal saline containing 40 ml glycerine enema in left lateral position.Observed intestinal cleanliness,enema effect in three groups.Results The intestinal cleanliness in experimental group,control group 1,control group 2 were 88.24％,72.09％,41.30％,with statistically significant difference (P＜0.05).The number of effective enema in experimental group,control group 1,control group 2 were 47,30,17 cases,with statistically significant difference (P＜0.05).Conclusion The enema effect in experimental group is better than that in control group 1,control group 2.

Objective To investigate genetic association betw een N-acetyltransferase-2( NAT2) gene polymorphism and colorectal cancer( CRC). Methods A hospital-based 1: 2 matched case-control study and PCR-based ligase detection reaction( PCR-LDR) w ere applied to tag single nucleotide lengh polymorphism( SNPs) of NAT2 gene among 104 cases w ith colorectal cancer and 208 controls. Results The genotypic frequency of tag SNPs of NAT2 gene did not deviate from Hardy-Weinberg equilibrium in both case and control groups. Rs1799931 w as not associated w ith colorectal cancer( P 0. 05),but rs1799929 and rs1799930 were related to colorectal cancer( P 0. 05). The case group had more T allele of rs1799929 and A allele of rs1799930 w hen compared to the controls; w hile T allele of rs1799929 and A allele of rs1799930 seemed to be the risk factors of colorectal cancer( odds ratio [OR] = 2. 069,P = 0. 004; OR = 1. 431,P = 0. 004). The frequency of NAT2 slow genotype w as 43. 3% in the cases compared w ith 26. 0% in the controls. As compared w ith the NAT2 rapid genotypes,the NAT2 slow genotype significantly increased the risk of developing colorectal cancer,w ith an OR of 1. 667( 95% confidence interval: 1. 213- 2. 291). Conclusion The results suggest that NAT2 genetic polymorphism is associated w ith colorectal cancer susceptibility. People w ith NAT2 slow genotype have a higher risk of colorectal cancer.

Objective To study the correlation between colorectal cancer and the interaction of NAT2 gene polymorphisms with environmental factors. Methods A hospital- based 1 ∶ 2 case- control study on colorectal cancer was conducted. All the colorectal cancer cases( n = 104) were newly diagnosed,and the controls( n = 208) were diagnosed with non- tumor cases with matched sex,age,ethic group and place of residence. NAT2 genotype from blood derived DNA was determined using PCR- based ligase detection reaction. Conditional logistic regression was used to estimate the odds rations( OR) and 95% confidence intervals( CI). Results The genotypic frequency of rs1799929 and rs1799930 were significantly correlated to colorectal cancer( P 0. 05). For rs1799929 genotypes,there was no significant difference in frequency of the CT or TT between patients and controls( P 0. 05). The frequency of rs1799930 A allelic gene was significantly higher in cases than that in controls,and significantly correlated with colorectal cancer( OR = 2. 059,95% CI1. 259 ~ 3. 366). Interaction was found between rs1799929 and rs1799931( OR = 1. 163),as well as between rs1799930 and enteric chronic diseases( OR = 1. 455),eating fresh vegetables frequently( OR = 0. 629),or diet types( OR =0. 859). Conclusion NAT2 rs1799930 A allelic gene might increase the risk of colorectal cancer. Interactions between rs1799929 and rs1799931,and rs1799930 and enteric chronic diseases suggest increased risk of colorectal cancer. On the contrary,interactions between rs1799930 and rs1799930 and eating fresh vegetables,and rs1799930 and diet types reduces the risk of colorectal cancer.

Objective To study the clinical effect of Nano silver antibacterial gel combined with Algoplaque in the treatment of no staging pressure sore.Methods A total of 35 patients (99 parts) with no staging pressure sore in our hospital from August 2009 to May 2012 were selected as research object,and they were randomly divided into group A (Nano silver antibacterial gel group) and 11 cases (33parts),group B (Algoplaque group) 12 cases (33 parts) and group C (Nano silver antibacterial gel combined with Algoplaque group) 12 cases (33 parts).The total effective rate,wound healing time,dressing change times,promoting granulation time and survival condition before and after the treatment of two groups were compared.Results The total effective rate of group C was higher than those of group A and group B.Wound healing time and promoting granulation time were shorter than those of group A and group B.Dressing change times was less than that of group A and group B.Survival condition score after the treatment at first and second week were higher than those of group A and group B,all P ＜ 0.05,there were all significant differences.Conclusions The clinical effect of Nano silver antibacterial gel combined with Algoplaque in the treatment of no staging pressure sore is better than that of only Nano silver antibacterial gel or Algoplaque,and it can more effectively improve the comprehensive survival condition of patients.

[目的]探讨临床护理路径在单侧腹股沟疝无张力修补术病人中的应用价值。[方法]将362例单侧腹股沟疝无张力修补手术病人分为对照组和观察组,对照组实施常规护理,观察组应用临床护理路径,比较两组病人住院时间、住院费用、满意度、并发症发生率及健康教育知晓率。[结果]与对照组比较,观察组住院时间、住院费用和并发症发生率均较低、健康教育知晓率和满意度较高(均P<0.05)。[结论]应用临床护理路径对单侧腹股沟疝无张力修补手术病人实施护理,能有效减少术后并发症、缩短住院时间、减少住院费用、提高健康教育知晓率和满意度。

Objective: To study the application effect of peristomal skin care powder combined with skin protective film and hydrocolloid transparent dressing in the treatment of intestinal stoma fecal dermatitis.Methods: 96 patients with intestinal stoma fecal dermatitis in our hospital from August 2008 to February 2012 were selected as research object,and they were randomly divided into control group(peristomal skin care powder combined with skin protective film group) 48 cases and observation group(peristomal skin care powder combined with skin protective film and hydrocolloid transparent dressing group) 48 cases,then the total effective rate,degree of comfort and quality of life before and after the treatment of two groups were compared.Results: The total effective rate of observation group was higher than that in the control group,the degree of comfort was better than the control group,the difference was statistically significant(P < 0.05).Conclusion: The application effect of peristomal skin care powder combined with skin protective film and hydrocolloid transparent dressing in the treatment of intestinal stoma fecal dermatitis is better,it is worthy of popularization and application.

Objectives Discussion of quality nursing care in clinical application value.Methods Develop"2011gastrointestinal surgery promote quality care services plan",and according to the work plan,work,constantly optimize the service process,detailed work link,pay attention to the details of services,improve service quality.ResultsIn 2011 the gastrointestinal surgery were treated 2300 cases of patients,satisfaction of patients with > 98%,and along with the continuous deepening of the work,satisfaction to further improve.Conclusions Quality nursing care can improve the nursing system,effectively improve the quality of nursing work,optimize the doctor-patient relationship.

Objectives Stainless steel back type ofhip bath chair on abdominal perineal resection of rectal cancer patients afterhip bath compliance observation.Methods 110 cases of radical resection for rectal carcinoma after the bath of patients were randomlydivided into experimentalgroup (n=55) and controlgroup (n=55).The experimentalgroupUsed stainless steelhip bath chair backrest type, controlgroup with simple bath rack bath.Results The experimentalgroup showed no adverse events occurred, sitz bath time success rate, bath compliance, satisfaction washigher than that of the controlgroup, by comparison, P<0.05, with statisticaldifference.Conclusions Stainless steel backhip bath chair, can significantly reduce the incidence of adverse events, and improve the patient compliance and satisfaction rate, worthy of clinical application.