目的 了解下肢PICC置管穿刺鞘断裂不良事件的根本原因并进行系统改进.方法 成立专家团队,根据RCA2实施步骤进行事件调查,识别近端原因,采用质量检测、资料比对和问题树分析法等寻找根本原因,从建立风险评估管理体系、完善标准操作程序、建立床旁超声急会诊分级管理机制三方面进行改进.结果 PICC导管选择符合率由75.51％提升至100.00％,穿刺鞘使用规范率由82.65％提升至96.26％,一次性置管成功率由95.92％提升至100.00％;紧急床旁超声到位时间从平均26 min缩短至14 min,床旁超声急会诊到位时间达标率由33.33％提升至100.00％.未再出现断鞘事件.结论 应用RCA2寻找不良事件系统根因并进行改进,有利于强化事前风险管理,增强团队合作,建立组织质量安全文化,从而保障患者安全.

ObjectiveTo systematically evaluate the relevant guidelines for pain management in hospice care and compare the similarities and differences among the recommendations，so as to provide references for clinical evidence-based decision making.MethodsThe relevant guidelines were searched in CBM，Wanfang Data，CNKI，PubMed，NGC，GIN and the websites of relevant societies and industry institutions.The retrieval period was from the database establishment to March 29，2020.Two researchers screened literatures according to the include and exclude standard.The quality of guidelines were evaluated by using AGREEⅡ，and the recommendations for pain management in palliative care were summarized.ResultsIn the end，eight guidelines were included，and the formulation time was from 2011 to 2019.Among which，three guidelines were from Canada，two were from the United States，one was from the United Kingdom，one was from Europe and one was from China.The recommendation level of seven guidelines was A，and one was B.Related recommendations mainly involved pain assessment，drug management，psychosocial support，and pain education.ConclusionThe recommendations of eight guidelines could provide a basis for further regulating the pain management of terminal patients.It was suggested that，based on referring to relevant foreign guidelines，clinical staff should combine the specificity of China's regional culture and value needs to establish practical guidelines for pain management in palliative care.

案例背景: 随着疼痛医学的发展,疼痛护理工作日益受到国内外相关专家的重视.国际上已将疼痛列为第五生命体征.2018年美国国立综合癌症网络(NCCN)指南数据显示:64％的晚期患者、59％的经治患者、33％的根治性治疗后患者,以及1/3治疗后幸存者均存在不同程度的疼痛.

目的 探讨口腔按摩对放疗后鼻咽癌患者口咽舒适度的影响.方法 选择我科2016年1月至2017年3月首次行鼻咽癌放射治疗的85例患者作为研究对象,在患者知情同意的基础上,按随机数字表法将其分为研究组(n=43)和对照组(n=42).研究组采用口腔按摩和常规护理,对照组采用常规护理.干预3个月后比较两组患者口干、张口困难、咽痛及口腔舒适度评分情况.结果 研究组口干发生率、张口困难发生率及咽痛的数字评分法(numeric rating scale,NRS)评分、口腔舒适度评分低于对照组(P＜0.05).结论 在常规护理的基础上,对放疗后鼻咽癌患者实施口腔按摩,可降低口干和张口困难的发生率,减少咽痛评分,提高口腔舒适度.

Objective To investigate the effects of peer education on mouth－opening training compliance among patients with nasopha?ryngeal carcinoma after radiotherapy.Methods A total of 239 patients with nasopharyngeal carcinoma undergoing radiotherapy were divided into two groups.The control group (n＝121) was given routine care,and the experimental group(n＝118) received peer education.The inter?vention was provided from a week before radiotherapy to six months after radiotherapy.Results All patients completed radiotherapy.The ex?perimental group had lower incidence of difficulty in mouth－opening than the control group,and had higher mouth－opening training compliance compared with control group at the end of radiotherapy,3 months and 6 months after radiotherapy (P＜0.01 or P＜0.05).Conclusion Peer edu?cation can effectively improve mouth－opening training compliance in patients with nasopharyngeal carcinoma after radiotherapy,and decrease the incidence of difficulty in mouth－opening.

目的 降低鼻咽癌放疗患者重度放射性口腔黏膜炎发生率.方法 成立多学科协作团队,通过现状调查、原因解析,明确了6项真因,针对性制定干预措施并执行,分别为:建立综合性评估体系,制定阶梯式干预方案,实施全维度提醒策略.结果 鼻咽癌放疗患者重度放射性口腔黏膜炎发生率由56.67％降低至22.22％.结论 开展品管圈活动可促进多学科协作团队管理,降低了鼻咽癌放疗患者重度放射性口腔黏膜炎发生率,使放疗中断率下降,提高了疗效和患者生活质量.

Objective To explore the effects of mindfulness-based intervention model on the quality of life and psychological status of lung cancer patients during chemotherapy.Methods A total of 76 patients with lung cancer during chemotherapy were randomly divided into control group and observation group,the control group were given routine nursing.In addition,patients in observation group received mindfulness-based intervention.The EORTC QLQ-30 and SAS scales,SDS scales were used to evaluate the quality of life of the patients before and after the 8-week intervention.Results Before intervention,there was no significant difference in quality of life (QOL) between the two groups.After 8 weeks of intervention,the overall health score of observation group was 59.6± 5.0,the control group was 59.6 ± 5.0.In fatigue,pain,nausea and vomiting,the score of observation was 43.2±2.7,26.2±4.3,30.5±5.6,and the control group was 57.8±4.2,47.8±3.9,51.4±5.6,the difference was statistically significant,the QOL of the observation group was better than control group,P＜0.05.Two groups of patients with anxiety,depression scores were reduced.The SAS score of observation group was 38.64 ± 5.02,the control group was 44.06± 5.24.And the SDS score of observation group was 41.26 ± 5.2,the control group was 46.89 ± 5.34,the psychologic status of observation group was better than the control group,P＜0.05.Conclusions Mindfulness-based intervention can effectively improve the psychological status and quality of life of lung cancer patients during chemotherapy.