目的:水肿是慢性肾脏病患者较为常见的临床表现,本研究的目的是调查肾病患者水肿的发生情况及探索肾病水肿的相关风险因素.方法:我们回顾性收集于2017年9月-2018年8月期间在本中心住院治疗的肾病患者的临床资料,根据患者是否出现肾病水肿分为两组:非水肿组和水肿组,总结肾病患者水肿的发生率,并采用单因素和多因素逻辑回归分析影响肾病患者水肿发生情况的风险因素.结果:本研究共纳入417例肾病患者,平均年龄为(52.65±18.096)岁,男性比例为51.3％,肾性水肿发生率为48.7％.联合单因素和多因素逻辑回归分析表明原发病类型、血白蛋白水平、24h尿量、24h尿蛋白总量以及尿常规尿蛋白定性是肾病水肿发生的相关因素,其中原发病类型、血白蛋白水平、24h尿量、24h尿蛋白总量是肾病水肿发生的独立风险因素.结论:本研究结果表明肾病患者发生肾病水肿发生率高,血白蛋白和尿蛋白水平为肾病水肿发生的独立危险因素.这项研究提示临床医护人员应对肾病水肿的预防提高重视,同时为制定针对性强的治疗措施和宣教计划提供证据支持.

Objective:To establish the evaluation system of core competence of nurses in the independent traditional Chinese medicine (TCM) nursing clinic, and to provide references for the cultivation and development of nurses in the TCM nursing clinic.Methods:Based on Delphi's expert inquiry, and on the basis of the management norms of TCM nursing clinic in our hospital, and referring to domestic and foreign literatures, an expert inquiry questionnaire on core competence of TCM nursing clinic nurses was compiled. In the form of email questionnaires, 26 experts in the TCM nursing clinic who met the selection criteria were consulted for two rounds.Results:The response rates of the experts in the two rounds were 100.0% and 88.5%, respectively, with the average response rate more than 90.0%. The authority of consultation was 0.906.Conclusion:Experts invited by experts are highly authoritative as a whole and highly responsive to this study. It basically establishes the evaluation system of core competence of nurses in the TCM nursing clinic, and to a certain extent promotes the continuous improvement and development of TCM nursing clinic.

目的 探讨中医护理门诊护士应具备的资质及执业范围,旨在为中医护理门诊护士的培养与发展提供借鉴.方法 通过文献回顾、理论分析、临床调研等方法初步构建中医护理门诊出诊护士需具备的资质及执业范围;采用德尔菲法,对符合遴选标准的26名中医护理门诊的专家,进行两轮专家咨询.结果 两轮专家的应答率分别为100％和88.46％,平均应答率在90％以上;专家咨询的权威程度为0.906.结论 中医护理门诊护士资质及执业范围的确定科学合理、内容全面、专业特色突出,能为中医护理门诊护士的培养提供可靠的参考依据.

Objective:To observe the clinical effect of abdominal band compression in the prevention of tunnel port bleeding after peritoneal dialysis catheterization.Methods:56 patients who did not use abdominal band compression after peritoneal dialysis catheterization in 2018 were set as a control group, and 76 patients who used abdominal compression after peritoneal dialysis catheterization in 2019 were set as an observation group. The incidences of bleeding at the tunnel entrance were compared between the two groups.Results:The incidence of bleeding was lower in the observation group than in the control group (19.7% vs. 35.7%; P<0.05). Conclusion:Abdominal band compression method can effectively prevent tunnel port bleeding after peritoneal dialysis catheterization, so it is worthy of clinical application.

ObjectiveTo develop a questionnaire for evaluating the health information literacy（HIL）of patients with chronic kidney disease（CKD）and test its reliability and validity.MethodsThe item pool was completed based on theoretical research，and then prepared an initial questionnaire.The Delphi method was used to evaluate and modify the initial questionnaire.The item analysis was used to screen items.A total of 200 patients were surveyed to test the validity and reliability of the questionnaire.ResultsA 30⁃item pre⁃test questionnaire was formed according to the results of the expert consultation.After the project analysis，5 items that did not meet the criteria were deleted.Exploratory factor analysis extracted 6 factors，and the cumulative variance contribution rate was 70.742%.The six factors were named：health information acquisition ability，health information evaluation ability，health information literacy awareness，health information application ability，health information integration ability，and CKD health knowledge reserve.The Cronbach's α coefficient of the questionnaire was 0.922，the Cronbach's α coefficient of each dimension was 0.722~0.939，and the test⁃retest reliability was 0.877.ConclusionsHealth information literacy questionnaire for chronic kidney disease compiled in this study had good reliability and validity which with guiding significance for the health education of CKD.

Background Most patients with chronic kidney disease (CKD) fail to achieve blood pressure (BP) management as recommended. Meanwhile, the effects of promising intervention and telehealth on BP control in CKD patients remain unclear. We aimed to evaluate the efficacy of telehealth for BP in CKD non-dialysis patients. Methods Databases including MEDLINE, EMBASE, CENTRAL, CNKI, Wanfang, VIP and CBM were systematically searched for randomised controlled trials or quasi-randomised controlled trials on telehealth for BP control of CKD3-5 non-dialysis patients. We analysed systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), serum creatinine, and estimated glomerular filtration rate (eGFR) with a fixed-effects model. Results Three studies, with total 680 subjects, were included in our systematic review and two were included for meta-analysis. Pooled estimates showed decreased SBP (pooled mean difference (MD), -5.10; 95% confidence interval (CI), -11.34, 1.14; p > 0.05, p = 0.11), increased DBP (pooled MD, 0.45; 95% CI, -4.24, 5.13; p > 0.05, p = 0.85), decreased serum creatinine (pooled MD, -0.38; 95% CI, -0.83, 0.07; p > 0.05, p = 0.10) and maintained eGFR (pooled MD, 4.72; 95% CI, -1.85, 11.29; p > 0.05, p = 0.16) in the telehealth group. There was no significant difference from the control group. MAP (MD, 0.6; 95% CI, -6.61, 7.81; p > 0.05, p = 0.87) and BP control rate (p > 0.05, p = 0.8), respectively, shown in two studies also demonstrated no statistical significance in the telehealth group. Conclusions There was no statistically significant evidence to support the superiority of telehealth for BP management in CKD patients. This suggests further studies with improved study design and optimised intervention are needed in the future.

Objective To explore the effect of PDCA cycle in improving bacteria positive rate in peritoneal dialysis fluid.Methods This study was conducted in a historical control.A total of 76 peritonitis cases in the CAPD patients in the period from July 1,2016 to June 30,2018 were analyzed.31 patients not taking PDCA and included in the study from July 1,2016 to June 30,2017 were taken as a control group,while the study group (45 patients) were from July 1,2017 to June 30,2018,and received PDCA cycle on the basis of the control group.The bacteria positive rates of the two groups was compared.Results The bacteria positive rate in peritoneal dialysis fluid was 80.0％ in the observation group and was 64.5％ in the control group (x2=4.061,P=0.044).Conclusion PDCA cycle can effectively improve bacteria positive rate in peritoneal dialysis fluid.

24 h尿蛋白+排泄率是肾内科最为常用的检验项目,反映出患者24 h内的排泄情况,常用于24 h尿蛋白和尿肌酐的测定,其结果可辅助医生诊断和评估患者疾病情况. 精益管理来源于精益生产,最早是日本丰田汽车公司根据实际生产要求而开创的一种具有革命性的生产方式,随后被多家公司引进而衍变出精益管理. 精益管理即运用精益思维来管理企业的各项活动[1] ,现被广泛应用于各大知名企业的管理中,在企业的发展中起到了至关重要的作用. 运用精益管理思想和工具改善医院管理流程、提高工作效率和患者满意度是目前医院管理的热点,但是运用精益管理工具改进24 h尿标本留取流程方面的研究较少,基于此,本研究按照"自上而下与自下而上"相结合的精益原则,运用精益工具对肾内科24 h尿标本的留取流程进行优化,旨在提高我科 24 h 尿标本的留取准确率和便捷性.

Objective To develop external drug treatment for lower limb edema caused by kidney disease,and to reduce the patients' pain due to internal treatment.Methods Reviewing the literatures,we looked for some drugs to locally treated edema,and designed the package appearance to magnify its effect,and designed the operation process of external application of buckwheat medicine package so that it was convenient for both the patients and the nurses,so as to improve the work efficiency.Results and Conclusion The multi-functional and comfortable chair for moxa-moxibustion can guarantee the moxibustion effect,improve the moxibustion comfort,convenience,and safety,as well as the patients' satisfaction and the medical staff's work efficiency,and relieve the staff's labor source pressure,so as to provide some conditions for generalizing moxa-moxibustion.

目的:通过了解慢性肾脏病(CKD)患者参与慢病管理的情况,分析影响患者参与慢病管理的相关因素,为广大医护人员进行慢病管理提供参考和建议.方法:通过回顾性研究方法,收集了2016年07月～ 2016年12月在广东省中医院肾病科慢性病门诊就诊的392例患者资料,分析CKD患者参与慢病管理现状及影响因素.结果:211例患者参与慢病管理.Logistic回归分析显示,年龄(OR值=0.979,P=0.020)、教育程度(OR值=2.698,P＜0.001)、工作状态(OR值=0.535,P=0.020)和CKD分期(OR值=1.767,P＜0.001)为影响CKD患者参与慢病管理的独立危险因素.结论:慢病管理是CKD等慢性疾病管理的有效治疗方法,患者参与慢病管理的积极性有待提高.其普及也存在一定困难和阻碍因素,主要受患者年龄、教育程度、工作状态和CKD分期等因素影响,今后还需要采取有针对性的措施来提高患者对慢病管理的参与度,以提高其生活质量.

慢性肾脏病(chronic kidney disease,CKD)现已成为危害人类健康的主要慢性疾病之一.在中国,其患病率为10.8％[1],并呈逐年上升的趋势,严重威胁着我国国民健康.药物治疗是目前CKD治疗的主要手段,但是药物治疗的费用昂贵,给患者个人和家庭甚至国家带来巨大的经济负担,因此需要寻找其他方式,在缓解患者和社会经济负担的同时,辅助药物治疗,起到防治CKD的效果.CKD是一种生活方式疾病,于是营养治疗开始引起广大专家学者和临床工作者的注意,成为当前研究的热点之一.

To design a multi-functional moxibustion chair which can lift according to the body shape and position of the patients.The chair not only can improve the comfort,convenience,and safty of moxibustion,but also can increase the patients' satisfaction of hospital.What's more,it can enhance the efficiency of operations of medical staffs.In order to develop the new type of moxibustion chair,acupuncture,physics,heat transfer,and other related subjects were combined with industrial design method,which from the angle of the patients and medical staffs.To some extent,the pressure of medical human resources is alleviated and a firm foundation of the popularization and application of moxibustion is established.

Background Most patients with chronic kidney disease (CKD) fail to achieve blood pressure (BP) management as recommended. Meanwhile, the effects of promising intervention and telehealth on BP control in CKD patients remain unclear. We aimed to evaluate the efficacy of telehealth for BP in CKD non-dialysis patients. Methods Databases including MEDLINE, EMBASE, CENTRAL, CNKI, Wanfang, VIP and CBM were systematically searched for randomised controlled trials or quasi-randomised controlled trials on telehealth for BP control of CKD3-5 non-dialysis patients. We analysed systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), serum creatinine, and estimated glomerular filtration rate (eGFR) with a fixed-effects model. Results Three studies, with total 680 subjects, were included in our systematic review and two were included for meta-analysis. Pooled estimates showed decreased SBP (pooled mean difference (MD), −5.10; 95% confidence interval (CI), −11.34, 1.14; p > 0.05, p = 0.11), increased DBP (pooled MD, 0.45; 95% CI, −4.24, 5.13; p > 0.05, p = 0.85), decreased serum creatinine (pooled MD, −0.38; 95% CI, −0.83, 0.07; p > 0.05, p = 0.10) and maintained eGFR (pooled MD, 4.72; 95% CI, −1.85, 11.29; p > 0.05, p = 0.16) in the telehealth group. There was no significant difference from the control group. MAP (MD, 0.6; 95% CI, −6.61, 7.81; p > 0.05, p = 0.87) and BP control rate (p > 0.05, p = 0.8), respectively, shown in two studies also demonstrated no statistical significance in the telehealth group. Conclusions There was no statistically significant evidence to support the superiority of telehealth for BP management in CKD patients. This suggests further studies with improved study design and optimised intervention are needed in the future.

目的:探索慢性肾脏病(CKD)管理专科护士在疾病管理的作用.方法:2010年起成立CKD慢性病管理中心,组建以肾科医生、肾脏专科护士和营养师为团队,建立规范,明确岗位职责,优化随访流程,开展多元化的健康指导,培养内行病人达到全程递进管理,利用信息化建立患者档案资料.结果:专科护士在慢性肾脏病的管理中,既增加了患者的随访率,也增加了患者的满意度,提高患者自我管理的意识和能力,提高患者生存质量,获得较好的临床效果,同时也提高了专科护士的影响力.结论:CKD管理专科护士作为健康促进者教给患者疾病管理相关知识,其角色和作用在疾病管理中的实践中显得尤为重要,更能从专科角度发现问题、分析问题及解决问题,为CKD患者提供了有效的帮助和延续护理,提高病人的疾病自我管理能力,延缓疾病的进展和恶化.

目的:本研究主要观察步行对于维持性腹膜透析患者容量状态的影响,为透析人群的运动疗法提供一定的理论依据.方法:选取广东省中医院腹膜透析中心2015年3月-2015年12月维持性腹膜透析患者34例,按其主观意愿将分为对照组和干预组,对照组采用广东省中医院腹透患者基础治疗方案,干预组在腹膜透析基础治疗方案的基础上增加步行运动,一周3次,每次30 min,步频为110步/min,每次行走3 300步.结果:步行8周后,与治疗前相比,干预组患者容量状态指标细胞外水分含量明显减低,从治疗前的13.66 L下降至12.39 L(P=0.004),对照组从治疗前的12.85 L增加至14.08 L(P=0.005).与治疗前相比,干预组的细胞外水分比率有统计学差异;与治疗前相比,对照组的细胞外水分比率有统计学差异.与对照组相比,治疗组细胞外水分含量差值有统计学意义;细胞外水分比率差值比较差异有统计学意义.结论:步行对维持性腹膜透析患者的细胞外水分含量、细胞外水分比率存在一定影响,可促进腹膜透析患者体内多余水分的代谢.

目的分析治疗阳痿中成药处方的用药规律。方法收集《新编国家中成药》中关于阳痿治疗的120个处方,使用中药226味,基于中医传承辅助系统建立处方数据库,采用关联规则apriori算法、复杂系统熵聚类等方法开展研究,确定处方中各种药物的使用频次及药物之间的关联规则等。结果超过20次以上的使用频次的药物有25味,高频次药物有枸杞子、淫羊藿、熟地黄、人参、鹿茸等;高频次药物组合包含枸杞子+熟地黄、人参+鹿茸、淫羊藿+枸杞子等;挖掘出的新处方包括"木香、狗鞭、鹿鞭、牛鞭、驴鞭","续断、芡实、胡芦巴、覆盆子、沙苑子","龟甲、砂仁、酸枣仁、鹿角胶","狗肾、驴肾、鹿肾、核桃仁、荜澄茄"。结论治疗阳痿的高频中药以入肝、肾经居多,用药多为补益肝肾之品,组合新方呈"补肾壮阳、强筋益精"、"补肾壮精、收敛固涩"的特点。

目的：调查广东省不同等级医院生活护理实施情况及患者满意度情况。方法：采用整群抽样的方式，以广东省护理学会的“生活护理问卷”为调查工具，分两期在广东省7所三甲医院、12所其他等级的公立医院中开展了生活护理实施情况及患者满意度的调查。结果：生活护理落实情况显示，护士多倾向于技术生活护理项目，而清洁类项目落实少，且不同等级医院的患者对生活护理满意度评价存在差异（ P﹤0.05）。结论：广东省生活护理仍处于护工主导、护士和家属协助护理的模式，生活护理的质量、护士参与程度、满意度皆有待提高。