Objective:To construct and evaluate the effect of precise oral nutrition guidance program for colorectal cancer patients with accelerated rehabilitation after operation.Methods:This study was a quasi experimental study. A total of 116 patients with colorectal cancer from department of Colorectal Surgery, Jiangsu Cancer Hospital from March to Deamber, 2021 were selected by convenience sampling method. They were divided into two groups according to their admission time, the experimental group (58 cases), was given precise oral nutrition guidance program after colorectal cancer surgery based. In the control group, 58 cases were treated with the conventional dietary guidance for rapid rehabilitation. The gastrointestinal tolerance rate, the compliance rate of oral nutritional supplements, the first defecation time after operation, albumin, total albumin, prealbumin and other nutritional indexes were compared between the two groups before and after intervention.Results:Finally, 111 cases were included, induding 56 in the experimental group and 55 in the control group. The compliance rate of oral nutritional supplements after intervention in the experimental group was 73.2% (41/56), higher than that in the control group 40.0%(22/55), and the difference between the two groups was statistically significant ( χ2 = 12.47, P<0.05). The first defecation time after operation in the experimental group was (29.51 ± 5.52) h, while in the control group was (61.48 ± 8.39) h, the difference between the two groups was significant ( t = -12.06, P<0.05). The postoperative enteral nutrition tolerance rate of the experimental group was 91.1% (51/56), which was higher than the 69.1%(38/55) in the control group, the difference between the two groups was statistically significant ( χ2 = 8.44, P<0.05). The serum total protein, albumin and prealbumin levels of the experimental group at discharge were (66.56 ± 5.15), (46.78 ± 7.62) g/L and (276.07 ± 53.57) mg/L, compared with the (60.27 ± 4.37), (39.12 ± 6.41) g/L and (230.14 ± 44.58) mg/L in the control group, the differences were statistically significant ( t = 6.66, 5.02, 4.91, all P<0.05). Conclusions:The implementation of precise oral nutrition guidance program is conducive to guiding the clinical practice of oral nutritional supplements in patients with colorectal cancer after surgery, improving patient compliance, reducing gastrointestinal intolerance, promoting intestinal function recovery, and improving nutritional status of patients.

目的:整合养老机构老年人的生活体验,为指导和改善我国机构养老护理服务质量提供依据.方法:计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、EMbase、PsycINFO、the Cochrane Library和CINAHL数据库,收集有关养老机构老年人生活体验的质性研究,检索时限为建库至2021年3月31日.采用澳大利亚the Joanna Briggs Institute(JBI)发布的质性研究论文质量评价工具进行文献质量评价.通过汇集性整合方法整合结果.结果:共纳入14篇文献,提炼出39个结果,归纳为硬件设施、基础生活、基础医疗、制度管理、环节管理、监督管理、正性情感、负性情感、情感需求9个新类别,进一步综合形成基础居住环境体验、机构管理体验、情感体验及需求3个整合结果.结论:应重视养老机构内老人的感受和体验,完善照护及管理保障服务,建立长效的心理护理机制体系,提供多方面情感支持.

目的 系统评价无菌棉拭子取样法诊断糖尿病足感染(DFI)致病菌的准确性.方法 计算机检索Cochrane图书馆、JBI循证护理中心图书馆、Pubmed、Web of science、Embase、Medline、知网、万方、维普数据库发表的无菌棉拭子取样法判断糖尿病足感染细菌的诊断性实验,采用Cochrane协作网推荐的诊断性试验准确性系统评价中质量评价的标准QUADAS工具评价纳入文献的质量,使用Meta Disc 1.4软件进行Meta分析,评价无菌棉拭子诊断糖尿病足感染致病菌的准确性.结果 共纳入6项研究338例患者.Meta分析结果 显示,无菌棉拭子取样法对于DFI致病菌的诊断有较高的敏感度,但特异度偏低;亚组分析结果 显示,深部感染组敏感度和特异度均低.结论 无菌棉拭子取样法对于DFI致病菌的诊断具有一定的价值,但深部感染应采用组织活检法以获得准确的细菌培养及药敏试验结果 .

背景 负压伤口治疗是全球公认的有效技术,国外广泛应用于医院、社区和家庭.国内主要在医院环境中实施,研究能否在家庭环境中安全、有效开展此技术,对提高我国慢性伤口患者的家庭治疗水平和效果有积极意义.目的 评价家庭模式负压治疗处理慢性伤口的安全性与效果,为在家庭中开展此技术提供依据.方法 2015年1月—2018年12月共纳入128例慢性伤口患者,非随机分为对照组62例和干预组66例,对照组在伤口护理门诊接受负压伤口治疗(门诊模式),干预组在家庭环境中接受负压伤口治疗(家庭模式),均连续治疗14 d,然后采用标准湿性疗法随访治疗3个月.安全性指标:负压治疗过程中观察伤口出血、皮肤浸渍、漏气报警、潮湿相关性皮肤损伤发生率.效果指标:观察负压治疗前和治疗后14 d细菌阳性率、面积缩小率、深度缩小率及随访治疗3个月的伤口治愈率、愈合时间.结果 对照组脱落率为8.1％(5/62)、干预组脱落率为1.5％(1/66),差异无统计学意义(P>0.05).对照组57例、干预组65例完成了3个月的负压治疗和随访,两组负压治疗时间接近〔(17.5±7.6)d比(18.4±7.9)d,P>0.05〕.两组皮肤浸渍、漏气报警次数及潮湿相关性皮肤损伤发生率比较,差异无统计学意义(P>0.05),两组均无一例发生伤口出血.干预组治疗14 d的面积缩小率〔(49.4±22.1)％〕高于对照组〔(33.4±20.2)％〕,差异有统计学意义(P<0.05).干预组和对照组的伤口治愈率比较〔(81.5％(53/65)比54.4％(31/57)〕,差异有统计学意义(P<0.05),前者愈合时间短于后者〔(51.7±16.9)d比(61.9±17.1)d〕,差异有统计学意义(P<0.05).结论 家庭模式负压伤口治疗能够安全、有效地用于各类慢性伤口,改善伤口治疗效果,可用于慢性伤口的家庭护理.

Objective:To systematically review the risk factors of delayed healing of venous leg ulcer (VLU) so as to provide a guide for developing the personalized nursing strategies.Methods:The Cochrane Library, PubMed, Web of Science, ScienceDirect, Clinicaltrials.gov, ProQuest and Open Grey was retrieved with the English keywords of "varicose ulcer/venous ulcer, non-healing/delayed healing/poor healing, factor/risk factor/influence factor"; the China Biological Medicine (CBM) , Chinese National Knowledge Infrastructure (CNKI) , WanFang Data and VIP was retrieved with the English keywords of "venous leg ulcer/venous ulcer, delayed healing/refractory, risk factors/influencing factors"; the retrieval time ranged from building database to 1st April 2019. Two researchers independently screened literatures, extracted data and assessed the quality of included literatures. The RevMan 5.3 was used to the meta-analysis.Results:Finally, a total of 11 literatures were included and involved 3 894 subjects, 520 cases lost to follow up, 914 cases in case group and 2 460 in control group. Meta-analysis showed that there were 7 risk factors related to delayed healing of VLU including the ages [ OR=1.02, 95% CI (1.01, 1.03) , P<0.01], range of motion of ankle [ OR=4.77, 95% CI (1.79, 12.73) , P<0.01], size of ulcer [ OR=1.27, 95% CI (1.10, 1.47) , P<0.01], duration of ulcer [ OR=1.08, 95% CI (1.01, 1.16) , P=0.03], history of deep vein thrombosis (DVT) [ OR=2.21, 95% CI (1.06, 4.63) , P=0.03], ankle-brachial index<0.8 [ OR=8.71, 95% CI (4.22, 17.99) , P<0.01]and rheumatoid arthritis [ OR=1.37, 95% CI (1.08, 1.73) , P<0.01]with statistical differences, and factors irrelevant to delayed healing of VLU including the body mass index (BMI) [ OR=0.98, 95% CI (0.83, 1.16) , P=0.82], >50% wound covered with fibrin [ OR=1.88, 95% CI (0.99, 3.57) , P=0.06], diabetes mellitus [ OR=1.10, 95% CI (0.70, 1.75) , P=0.67], history of hip or knee replacement [ OR=1.73, 95% CI (0.50, 6.00) , P=0.39]. Conclusions:Evidence shows that the independent risk factors of delayed healing of VLU include the ages, range of motion of ankle, size of ulcer, duration of ulcer, history of DVT, ankle-brachial index<0.8 and rheumatoid arthritis. Those evidences can help to identify the clinical high-risk population of delayed healing of VLU and provide targeted nursing intervention to reduce the healing time of VLU and improve patients' quality of life.

对1倒手术切口细菌生物膜感染并迁延不愈的临床资料进行分析及文献回顾,探讨术后切口细菌生物膜感染的临床特点、识别及处理方法.研究结果提示,细菌生物膜感染的术后切口易对抗生素产生耐药,迁延不愈,治疗难度大.个体化身心整体干预结合局部伤口处理有助于治疗此类感染伤口.

ObjectiveTo identify the risk factors of incontinence⁃associated dermatitis(IAD) in critically ill patients using Meta-analysis.MethodsLiteratures on IAD risk factors of critically ill patients were searched in PubMed,Cochrane Library,Web of Science,CINAHL,MedLine,Springer,CNKI,CMB,VIP and Wanfang database. Two researchers independently screened the literatures according to inclusion and exclusion criteria,conducted quality evaluation and data extraction.And Meta-analysis was performed by RevMan5.3 software.Results14 references met the inclusion criteria,with a total sample size of 1 618 cases,522 cases in the IAD group and 1 096 cases in the non-IAD group.A total of 23 factors were included for analysis.Meta analysis showed that age,diabetes,coronary heart disease,fever,coma,urinary and fecal incontinence,watery stool,fecal incontinence frequency no less than three times a day,antibiotics,enteral nutrition and hypoalbuminemia were associated with the occurrence of IAD in critically ill patients.ConclusionWe should fully understand the individual situation of patients,and formulate targeted measures to prevent the occurrence and development of IAD by overall assessing,predicting and identifying the high⁃risk patients.

目的 探讨不同职称的护士的职业认同与工作投入水平及两者关系.方法 采用护士职业认同评定量表和Utrecht工作投入量表中文版对南京地区2所医院的426名护士实施问卷调查,采用Pearson相关分析和多元逐步回归探讨不同职称护士职业认同与工作投入的关系.结果 护士的职业认同和工作投入水平均处于中等水平;不同职称护士的职业认同水平与工作投入水平均呈正相关.结论 针对不同职称的护士实施岗位管理,合理引用激励理论,提升护士职业认同和工作投入水平,能为护理对象提供更高效、优质的护理服务.

足跟部为压力性损伤的第二大高发部位,与其他部位相比更易引起肢体功能障碍,严重影响患者的生活质量,目前已引起国内外学者的广泛关注.本文从流行病学、危险因素、评估与护理等方面全面分析足跟部压力性损伤的研究现状,以期为临床实践提供借鉴.

目的 分析淋巴水肿护理现状及发展趋势,梳理研究的热点问题,为进一步开展淋巴水肿护理研究提供参考.方法 采用文献计量学方法以"淋巴水肿"+"护理"为主题词对收录在中文期刊全文数据库(CNKI)、万方数据知识服务平台、维普全文数据库中从建库至2017年10月1日与淋巴水肿护理相关的文献进行检索并分析.结果 共检索到210篇相关文献,其中4篇文献为硕士学位论文,其余206篇文献发表在109种期刊上;第一作者单位分布于我国28个省、直辖市或自治区;论文作者合作度为2.22;基金论文比例为5.71％;研究内容主要集中在乳腺癌相关淋巴水肿的护理研究,占比为87.1％.结论 我国淋巴水肿护理的相关研究总体呈上升趋势,但重视程度有待加强,论文质量有待提高.

Objective To investigate the clinical research status and hotspot distribution in the prevention and nursing of diabetic foot, analyze the existing problems, and provide references for further improvement in this area through the bibliometric analysis of clinical researches published in 12 domestic nursing journals. Methods Literatures of clinical researches in the prevention and nursing of diabetic foot were retrieved from 12 domestic nursing journals in CNKI, WanFang Database and VIP. The retrieval time was from the time of database foundation until September 30th, 2017. NoteExpress software was used for algorithm removal, while SPSS was applied for the database foundation. The basic information and clinical research content of the literature were analyzed, and the quality of the randomized controlled trial was evaluated. Results Totally 349 papers were included. The number of published papers was rising. The amount of published papers and foundation projects in the eastern region were superior to those in the middle and western regions. Quantitative study accounted for the largest proportion among different types of research. Research on different grades of foot care, health education, and cognitive or behavioral status of diabetic foot were the hot topics in this field; however, the quality of researches was not high up to now. Conclusions The clinical researches on the prevention and nursing of diabetic foot develop rapidly, but the design and quality of researches need to be improved. In the future, we should standardize the design, refine the research content, and provide high quality evidence for effective prevention and nursing of diabetic foot. Key words: Diabetic foot; Nursing; Bibliometrics; Prevention

目的 抗菌蛋白酶敷料是一种新型生物酶类抗菌敷料,近年来应用于感染伤口的局部治疗已获得初步成效.总结目前研究进展,以指导今后临床应用.方法 综述该敷料抗菌作用机制、抗细菌生物膜作用和抗耐药菌作用的研究进展,归纳其在预防和治疗烧伤感染伤口、手术切口感染、压疮和其他感染伤口中的应用效果.结果 该敷料可高效特异杀菌,实验研究证实其具有抗击细菌生物膜和抗耐甲氧西林金黄色葡萄球菌特性.临床研究显示,早期应用可预防伤口感染,减轻伤口肿胀;对已感染伤口可控制感染,缩短伤口愈合时间.但以上研究存在样本量不足、分组方法不严谨等研究设计问题,循证依据有限.结论 未来应将该敷料用于临床破除细菌生物膜研究,增加单一应用或联合应用的比较研究,并扩大样本量、规范研究设计,以获取最佳证据指导临床实践.

因体内支架导致大肠杆菌感染引起败血症的病例,每年在全球也就两三例.上海交通大学附属第六人民医院便成功治愈了这样一位患者,在近3年的时间里,他在沪上5家三甲医院住院20次.2009年9月16日,在经过了7个多小时、4项大规模手术后,生命的奇迹终于出现.