ObjectivesInvasive fungal super-infection (IFSI) is an added diagnostic and therapeutic dilemma. We aimed to develop and assess a nomogram of IFSI in patients with healthcare-associated bacterial infection (HABI).MethodsAn ambispective cohort study was conducted in ICU patients with HABI from a tertiary hospital of China. Predictors of IFSI were selected by both the least absolute shrinkage and selection operator (LASSO) method and the two-way stepwise method. The predictive performance of two models built by logistic regression was internal-validated and compared. Then external validity was assessed and a web-based nomogram was deployed.ResultsBetween Jan 1, 2019 and June 30, 2023, 12,305 patients with HABI were screened in 14 ICUs, of whom 372 (3.0%) developed IFSI. Among the fungal strains causing IFSI, the most common was C.albicans (34.7%) with a decreasing proportion, followed by C.tropicalis (30.9%), A.fumigatus (13.9%) and C.glabrata (10.1%) with increasing proportions year by year. Compared with LASSO-model that included five predictors (combination of priority antimicrobials, immunosuppressant, MDRO, aCCI and S.aureus), the discriminability of stepwise-model was improved by 6.8% after adding two more predictors of COVID-19 and microbiological test before antibiotics use (P<0.01).And the stepwise-model showed similar discriminability in the derivation (the area under curve, AUC=0.87) and external validation cohorts (AUC=0.84, P=0.46). No significant gaps existed between the proportion of actual diagnosed IFSI and the frequency of IFSI predicted by both two models in derivation cohort and by stepwise-model in external validation cohort (P=0.16, 0.30 and 0.35, respectively).ConclusionThe incidence of IFSI in ICU patients with HABI appeared to be a temporal rising, and our externally validated nomogram will facilitate the development of targeted and timely prevention and control measures based on specific risks of IFSI.

目的:探讨风险分级护理模式对围术期患者压力性损伤的预防效果.方法:选取 2021 年 4 月 1 日～2022 年 10 月 31 日150 例多发重症骨折手术治疗患者根据入院时间分为观察组和对照组各 75 例;对照组采用常规围术期护理,观察组在对照组基础上采用风险分级护理模式.比较两组压力性损伤风险分级情况、压力性损伤程度、患肢肿胀程度和护理满意度.结果:两组压力性损伤风险Ⅰ期、Ⅱ期、Ⅳ期比例比较差异无统计学意义(P>0.05),观察组Ⅲ期比例低于对照组(P<0.05),且压力性损伤面积小于对照组(P<0.05);观察组围术期患者压力性损伤程度低于对照组(P<0.05);术后 1 d,两组患肢肿胀程度比较差异无统计学意义(P>0.05);术后 7、14 d,观察组患肢肿胀程度均低于对照组(P<0.05);观察组护理总满意度高于对照组(P<0.05).结论:采用风险分级护理模式能够有效减少患者围术期压力性损伤发生率,减轻压力性损伤程度和患肢肿胀程度,有利于患者康复,同时还能提升患者护理满意度.

Objective:To explore applications of essential balm K-point stimulation on the swallowing rehabilitation in patients with minimally consciousness state, so as to provide reference for patients rehabilitation.Methods:This was a prospective randomized controlled study. A total of 60 minimally consciousness state patients were enrolled by convenience sampling method from Henan Provincial People Hospital from January to December 2021, who were divided into experimental group and control group according to the random number table method, with 30 cases in each group. Both groups received routine rehabilitation therapy, based on this, the control group was given routine K-point stimulation, the experimental group implemented essential balm K-point stimulation. Before and after 4 weeks of intervention, the Kubota water swallowing test and Coma Recovery Scale-revised (CRS-R) was used for assessment.Results:Before intervention, there was no significant difference in Kubota water swallowing test grade and CRS-R scores between two groups (both P>0.05). After 4-week intervention, Kubota water swallowing test Ⅰ-Ⅴ grade were 1, 6, 13, 7 and 3 cases in the control group, while 4, 12, 8, 3 and 3 cases in the experimental group, the difference was statistically significant ( Z = 2.09, P<0.05); the scores of oral motor/verbal function scale were (2.60 ± 1.16) in the experimental group, higher than in the control group (1.90 ± 0.32), the difference was statistically significant ( t = 2.18, P<0.05). Conclusions:Essential balm K-point stimulation can effectively promote swallowing function of patients with minimally consciousness state, and improve patient′s oral motor function.

目的 评价智能消毒机器人在重症监护病房(ICU)终末消毒的应用效果.方法 2021年6月—2022年2月,采用现场消毒试验方法,探究智能消毒机器人对呼吸重症监护病房(RICU)的终末消毒效果.结果 该消毒机器人采用紫外线+超干雾雾化模式,以紫外线灯辐照量 108 mJ/cm2、超干雾发生器喷雾量 280 g/h,用量 9 g/m3,持续消毒1 h.消毒后物体表面菌落数为(3.20±0.57)cfu/cm2,检测合格率为95.0%;消毒后空气菌落数为(0.23±0.12)cfu/(30 min.ϕ90 皿),检测合格率为 100.0%,整个消毒时长为(69.58±5.21)min.结论 智能消毒机器人在ICU中应用能提升终末消毒效果,节约人力.

目的:调查郑州市三级医院护士营养护理能力,分析影响因素,为后续实施针对性的干预措施奠定基础.方法:2021年12月—2022年2月采用便利抽样法选取647名临床护士为调查对象,采用一般资料调查表、临床护士营养护理能力自评量表通过问卷星对其进行调查,分析郑州市护士营养护理能力的影响因素.结果:共收回642份有效问卷,有效回收率为99.23％.护士营养护理能力总分为(236.95±41.31)分.多重线性回归分析显示:定期开展营养培训、定期督查病人营养状况、科室、是否为营养支持专科护士是护士营养护理能力的主要影响因素(P<0.05).结论:郑州市三级医院护士的营养护理能力仍有待提升,管理者应定期开展营养培训,尤其加强外科、重症医学科、妇产科、儿科等科室的营养培训,重视营养支持专科护士的培养,完善督导机制,增强护士营养护理能力.

目的 探讨肺癌患者胸腔镜下肺叶切除术中转开胸的高危因素.方法 选择行胸腔镜下肺叶切除术的肺癌患者120例,依据术中是否中转开胸将患者分为开胸组(24例)及未开胸组(96例),分析肺癌患者胸腔镜下肺叶切除术中转开胸的相关危险因素.结果 开胸组年龄≥65岁、肺结核病史、肿瘤直径≥3.5 cm、病变位于肺上叶、胸膜粘连程度≥4级发生率均高于未开胸组,差异有统计学意义(P<0.05);年龄、既往病史(肺结核)、肿瘤位置(肺上叶)、胸膜粘连程度(≥4级)是影响肺癌患者胸腔镜下肺叶切除术中转开腹的独立危险因素(P<0.05).结论 对于年龄较大、具有肺结核病史、病变位于肺上叶、胸膜粘连程度≥4级的肺癌患者需慎重选用胸腔镜手术,以降低术中中转开胸的风险.

我国进入人口老龄化社会,老年人肌肉衰减症问题日益严重.肌肉衰减症的特点是肌肉质量和含量偏低,易导致患者发生跌倒等不良事件,增加死亡风险.中外学者对肌肉衰减症患者特点及影响因素的研究指出抗阻力量训练可改善肌肉质量,预防肌肉丢失;高蛋白膳食可促进骨骼肌蛋白合成,抑制蛋白分解,有效促进肌肉生长,保持肌肉功能.同时提出我国现在抗阻力量训练强度与高蛋白膳食最佳摄入量存在争议.分析表明老年人应尽早从低负荷渐进式抗阻力量训练开始,逐渐增加强度,以保持足够的肌肉质量和力量.建议长期高蛋白膳食应在临床监测下进行,定期对老年人肝肾功能、尿酸、血糖水平、骨骼肌肌量、力量和功能等指标进行评估,检测干预效果并及时调整.抗阻力量训练结合高蛋白膳食可以更大程度地减少肌肉衰减症的发生发展,提高骨骼肌质量,但老年人很难坚持长期运动和高蛋白膳食,因此要大力发展社区和家庭支持教育,推动医院-社区-家庭联合管理模式,使老年人得到系统完善的康复治疗.

目的:基于Logistic回归模型分析影响高血压脑出血(HICH)患者术后肺部感染的危险因素.方法:回顾性分析 2021 年 1 月至 2022 年 12 月在河南省人民医院接受手术治疗的 80 例HICH患者的临床资料,按照术后肺部感染与否分为肺部感染组(30 例)与肺部未感染组(50 例).记录肺部感染组的病原菌检出情况;对两组患者的临床资料、脑出血情况、手术情况进行统计学分析;将分析结果中有统计学意义的指标采用Logistic回归模型展开多因素分析.结果:肺部感染组 30 例患者痰培养共检出 30 株病原菌,以肺炎克雷伯杆菌、金黄色葡萄球菌及鲍曼不动杆菌为主;肺部感染组血浆白蛋白水平＜30 g/L、术前格拉斯哥昏迷(GCS)评分＜6 分、基底节出血、机械通气时间≥24 h及留置鼻饲管时间≥10 d者占比较肺部未感染组更高,差异有统计学意义(P＜0.05);Logistic回归分析发现,血浆白蛋白水平＜30 g/L、术前GCS评分＜6 分、基底节出血、机械通气时间≥24 h、留置鼻饲管时间≥10 d等可能是HICH患者术后肺部感染的独立危险因素(P＜0.05).结论:HICH患者术后肺部感染的病原菌以肺炎克雷伯杆菌、金黄色葡萄球菌及鲍曼不动杆菌为主,独立危险因素包括血浆白蛋白水平＜30 g/L、术前GCS评分＜6 分、基底节出血、机械通气时间≥24 h及留置鼻饲管时间≥10 d等,临床需据此给予适当干预,从而降低HICH患者术后肺部感染的发生风险.

总结1例老年糖尿病并发肺部感染合并胸腔积液的护理经验.护理要点包括:全面评估患者的营养状况,根据老年人的代谢特点,加强对症及营养支持治疗、血糖控制、抗感染护理、肠内外营养护理、胸腔引流护理、下肢静脉血栓的护理.经过多学科综合治疗及对精心舒适的护理照顾,该患者血糖控制较好,感染、胸腔积液好转,营养状况较前明显改善,预后较好,最终康复出院.

目的:分析早期营养支持护理干预对食管癌手术患者术后营养状况、免疫功能及胃肠功能恢复的影响。方法:选取2019年6月至2020年6月在河南省人民医院收治的食管癌患者97例。根据干预方式不同分为对照组(46例)，实施常规干预，观察组(51例)实施早期营养支持干预。对比两组术后营养状况、免疫功能、胃肠功能恢复情况以及不良反应。结果:两组干预前营养状况比较差异无统计学意义( P>0.05)，而干预后白蛋白(ALB)、前白蛋白(PA)、血清转铁蛋白(TRF)水平明显上升，观察组ALB、PA、TRF水平明显高于对照组，差异有统计学意义( P<0.05)；干预前两组免疫功能比较差异无统计学意义( P>0.05)，干预后免疫功能均提高，但观察组免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平明显高于对照组，差异有统计学意义( P<0.05)；观察组肛门排气时间、排便时间、肠鸣音恢复时间均明显短于对照组，差异有统计学意义( P<0.05)；观察组不良反应发生率为5.88%，明显低于对照组28.26%，差异有统计学意义( P<0.05)。 结论:早期营养支持护理干预可提高食管癌患者术后营养状况及免疫功能，并可促进胃肠功能恢复，减少不良反应。

Objective:To explore the effect of the discharge preparation plan based on community linkage in the out-of-hospital continuous nursing of chronic obstructive pulmonary disease (COPD) patients.Methods:From March 2019 to March 2020, convenience sampling was used to select 206 COPD patients hospitalized in the Respiratory Department of Henan Provincial People's Hospital. The patients were randomly divided into the observation group and the control group, with 103 cases in each group. The control group received routine management of COPD, and the observation group implemented a community-linked discharge preparation plan on the basis of the control group, and carried out a six-month intervention. The COPD Assessment Test (CAT) score, Patient Assessment of Chronic Illness Care (PACIC) score, body mass index, degree of airflow obstruction, dyspnea and exercise capacity (BODE) index, and the patient readmission rate during the intervention period were compared between the two groups before and after the intervention.Results:After the intervention, the item scores and total scores of the CAT of the observation group were lower than those of the control group. Except for cough and sputum, the differences in the other items and total scores were statistically significant ( P<0.05) . The item scores and total scores of the CAT of the observation group after intervention were lower than those before intervention, and the differences were statistically significant ( P<0.05) . The dimension scores and total score of the PACIC of the observation group after the intervention were higher than those before the intervention, and were higher than those of the control group after the intervention, and the difference was statistically significant ( P<0.05) . The BODE index score of the observation group after intervention was lower than that of the control group, and the difference between the two groups was statistically significant ( P<0.05) . The readmission rate in the observation group within six months was 13.59% (14/103) , which was lower than 31.07% (32/103) in the control group, and the difference between the two groups was statistically significant (χ 2=9.068, P=0.003) . Conclusions:The discharge preparation plan based on community linkage can improve the quality of life and lung function of COPD patients, increase the patient's recognition of chronic disease management, reduce the rate of hospital readmission, and achieve the overall quality improvement in continuous nursing of patients.

Background: Mesenchymal stem cells (MSCs) and their derived exosomes have shown potentials in the control of myocardial dysfunction. This study aimed to reveal the function of bone marrow (BM)-MSC-derived exosomes in sepsis-induced myocardial injury and the molecular mechanism. Methods: BM-MSC-derived exosomes were obtained and identified. A mouse model with sepsis was induced by cecalligation puncture (CLP) and treated with exosomes. The myocardial function of mice, the production of creatine kinase MB (CK-MB) and lactate dehydrogenase (LDH) in serum, the phosphorylation of a key myocardial contractility-related protein phospholamban (PLB), and the pathological changes in the myocardial tissues were examined. A microRNA (miRNA) microarray analysis was performed to examine the candidate miRNAs carried by the exosomes. Rescue experiments were conducted to validate the involvement of miR-141. Results: CLP treatment led to sepsis and notably reduced the myocardial function in mice. Further treatment of BM-MSC-derived exosomes alleviated the CLP-induced myocardial impairment, production of CK-MB and LDH, and inflammatory infiltration and cell apoptosis in mouse myocardial tissues, and restored the PLB phosphorylation. miR-141 was the most upregulated miRNA in the myocardial tissues after exosome treatment. Downregulation of miR-141 blocked the myocardium-protective functions of the exosomes. miR-141 was found to bind to and suppress PTEN expression, which further enhanced the activity of beta-catenin. Conclusion: This study suggested that BM-MSC derived exosomes ameliorates myocardial injury in septic mice through conveying miRNA-141 and regulating the PTEN/beta-catenin axis, and exosomes may serve as promising tools for the management of myocardial injury induced by sepsis or other factors.

目的 分析ICU内老年重症肺炎患者呼吸道感染的血清流行病学特征,为临床预防和治疗提供参考依据.方法 以2019年1月至2020年1月收治于河南省人民医院ICU的200例老年重症肺炎患者为研究对象,收集患者血清,采用间接免疫荧光法(Indirect immunofluorescence assay,IFA)检测患者血清中9种呼吸道病原体IgM抗体,即肺炎支原体(Mycoplasma pneumoniae,MPn)、肺炎衣原体(Chlamydia pneumoniae,CPn)、嗜肺军团菌(Legionella pneumophila,LP)、呼吸道合胞病毒(Reispiratory syncytial virus,RSV)、腺病毒(Adenovirus,ADV)、Q热立克次体(Coxiella burnetti,COX)、甲型流感病毒(Influenza A virus,INFA)、乙型流感病毒(Influenza B virus,INFB)和副流感病毒(Para-influenza virus,PIV).采用SPSS统计分析9种病原体阳性率及构成比,及其在不同性别、年龄段及季节的检出情况.结果 200例参与研究的ICU老年重症肺炎患者检出病原体134例,阳性率为67.00％.9种病原体中MPn检出44例,阳性率28.00％为最高;MPn在9种病原体中占构成比35.82％,亦为最高.比较不同性别病原体阳性率,男性患者阳性率(75.21％)显著高于女性患者(54.43％).不同年龄段阳性率中,大于80岁患者阳性检出率最高,为78.72％.不同季节呼吸道感染病原体检出情况证实,春(76.81％)、冬(75.00％)季阳性率显著高于夏(42.86％)、秋(48.39％)季.结论 本地ICU老年重症肺炎患者呼吸道感染病原体阳性率与性别、年龄及季节密切相关.其中MPn为主要病原体,男性感染率高,且年龄越大阳性率越高,高发季节为春季及冬季.本地ICU可根据以上特点做出具有针对性的预防及治疗方案.

Objective:To investigate the acceptance of advance care planning and its influencing factors in heart failure patients.Methods:A total of 208 patients with heart failure were surveyed by general data questionnaires and advance care planning acceptance questionnaires.Results:The total score of advance care planning acceptance of heart failure patients was (44.26 ± 11.73), the score of feeling dimension was (13.67 ± 5.72), the score of attitude dimension was (30.59 ± 6.33). 53.4%(111/208) of patients were willing to accept the talking about advance care planning. Regression analysis results showed that education level, New York Heart Association (NYHA) classification, communication status with medical staff and whether they had received life-sustaining treatment were important factors influencing of the acceptance of advance care planning in patients with heart failure.Conclusion:Patients with heart failure had higher acceptance of advance care planning. In clinical work, it is necessary to strengthen the scientific popularization of advance care planning in patients with low education level, low NYHA grade and no exposure to life-sustaining treatment. And strengthen the daily communication with patients to prepare for the follow-up advance care planning related communication.

目的:探讨临床护理路径应用于急性心力衰竭的护理的效果.方法:抽取本院(2019年01月-2019年12月)急性心力衰竭患者400例纳入研究中,以随机数表方式将患者分为常规组、观察组,每组200例,分别实施基础护理路径与临床护理路径,对比两组治疗质量、二次入院率和病死率、护理满意率.结果:对比两组治疗质量,观察组住院时间、生活质量、住院费用均低于常规组,对比两组二次入院率和病死率,观察组均高于常规组,对比两组护理满意率,观察组高于常规组,P＜0.05.结论:急性心力衰竭在整个治疗的过程中应用临床护理路径,患者心功能以及生活质量得到改善,降低了二次入院率和病死率,同时对于护理满意度更高,应用效果理想.

To heighten the diagnostic efficiency, in this study, the algebraic reconstruction technology (ART)-based echocardiography (ECG) was used to analyze severe fever with thrombocytopenia syndrome bunyavirus (SFTSV) complicated by atrial fibrillation. From Jan. 2015 to Dec. 2019, 200 elderly patients with SFTSV infection and hypertrophic cardiomyopathy (HCM) admitted to our hospital were selected as the observation group, and 20 healthy volunteers were in the control group. Then 200 patients were randomly divided into two groups with 100 people in each group. One group received routine clinical observation after surgery, and the other group received artificial intelligence atrial fibrillation monitoring. ECG displayed the left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left ventricular end diastolic volume index (EDVI), and end systolic volume index (ESVI) of patients. The accuracy and satisfaction of different methods in observation were recorded. The risk factors of postoperative atrial fibrillation in elderly patients with HCM were evaluated, and changes in their white blood cell levels were detected. The results showed that, there was a significant difference in ECG between normal people and patients after surgery. Also, differences were noted in accuracy and satisfaction of the two methods in observation group (P < 0.05). The atrial fibrillation group and the non-atrial fibrillation group showed notable differences in smoking history and age (P < 0.05); the white blood cell content of the atrial fibrillation group was 8.64 × 109, and that in non-atrial fibrillation group was 3.25 × 109. The content of ST-2 in postoperative atrial fibrillation group was 21.3 g/mL, and the content of Gal-3 was 9.57 g/mL, while the content of ST-2 in non-atrial fibrillation group was 17.24 g/mL, and the content of Gal-3 was 5.21 g/mL. There was no significant difference in LVEF, LVMI, EDVI, ESVI between postoperative atrial fibrillation and the non-atrial fibrillation group. In summary, ECG can effectively detect HCM, and the digital model demonstrated superb capabilities in monitoring atrial fibrillation after cardiac sympathetic block. The atrial fibrillation group showed a higher level of white blood cells after surgery and was more likely to develop SFTSV infection. Measures should be taken to prevent infection.

总结1例蜂蛰伤并重度急性呼吸窘迫综合征病人应用体外膜肺氧合(ECMO)辅助治疗的精细化护理管理.及时准确评估病情,密切监测ECMO运行状况及时记录病人病情变化,发现异常情况及时给予有效的护理干预.经过精心治疗和护理,病人30 d后康复出院.

目的 探讨床旁超声监测胃残余量在机械通气老年脓毒症患者肠内营养中的应用效果.方法 将102例机械通气老年脓毒症患者分为超声组和对照组,每组51例.两组均行气管插管接呼吸机辅助通气,给予鼻胃管持续泵入肠内营养液.超声组应用床旁超声监测胃残余量指导肠内营养治疗,对照组应用传统注射器抽吸法评估胃残余量指导肠内营养治疗.比较两组患者肠内营养达标时间、护士操作时间、给予肠内营养治疗前后血清白蛋白水平,记录两组并发症发生情况.结果 超声组肠内营养达标时间、护士操作时间短于对照组(P<0.05),给予肠内营养前后两组血清白蛋白水平差异无统计学意义(P>0.05).两组患者的腹胀、腹泻和营养液泵入中断发生率差异无统计学意义(均P>0.05).结论 采用床边超声监测机械通气老年脓毒症患者的胃残余量,可以有效地指导肠内营养治疗方案的调整,缩短护士操作时间和患者肠内营养达标时间.

[目的]探讨疼痛评估在蛛网膜下隙出血护理中的应用及对病人并发症发生的影响.[方法]选取蛛网膜下隙出血病人90例为研究对象,采用随机数字表法将其分为观察组和对照组各45例.观察组给予疼痛评估护理,对照组给予常规护理,观察并比较两组病人的疼痛情况、心理状况及并发症发生情况.[结果]干预后,观察组病人活动性疼痛强度、静息性疼痛强度及疼痛控制满意度均优于对照组(P<0.05);干预后观察组病人SAS评分和SDS评分均低于对照组(P<0.05);观察组病人并发症总发生率低于对照组(P<0.05).[结论]疼痛评估护理能改善蛛网膜下隙出血病人的疼痛程度、负性心理以及并发症发生情况,对提升病人的诊疗效果和护理质量起到重要作用.

目的 探讨重型颅脑损伤患者气管切开术后温湿化氧疗的效果.方法 选取2018-02-2020-01间收治的120例重型颅脑损伤气管切开术后患者,按照随机数字表法分为2组,每组60例.观察组采用温湿化气道氧疗系统氧疗,对照组采用雾化面罩持续湿化气道氧疗.比较2组患者的痰液黏稠度、动脉血气相关指标,以及肺部感染发病率.结果 治疗1周后,观察组患者的痰液黏稠度较对照组显著降低,差异有统计学意义(P＜0.05);2组患者的动脉血气各项指标均较治疗前显著改善(均P＜0.01),其中观察组患者的各项指标改善程度显著优于对照组患者,差异均有统计学意义(P＜0.05);观察组患者的肺部感染率显著低于对照组患者,差异有统计学意义(P＜0.05).结论 与传统雾化面罩持续湿化气道氧疗比较,采用温湿化氧疗对重型颅脑损伤患者气管切开术后的气道湿化和氧合效果更佳,有利于降低肺部感染率.