背景Braden量表是全球公认的有良好信效度的压力性损伤危险预测工具，但因应用人群不同，其最佳预测界值也存有争议。该量表在我国临床应用的预测界值为≤16分，欧美国家多以≤18分为界值，但其在我国住院患者中的预测作用的研究较少。目的 横断面调研全国13个省/自治区、46所三级医院成年住院患者压力性损伤的流行病学特征，分析Braden量表及其6个分量表预测压力性损伤发生的效能及其最佳界值。方法 由解放军东部战区总医院负责成立多中心合作研究课题组，在全国公开招募≥500张床位的三甲医院，经过资格审查和签订合作研究双向协议后，共纳入13个省/自治区、46所符合条件的医院作为多中心研究单位，纳入住院时间≥24 h、年龄≥18岁的患者为研究对象。入选护龄≥2年的伤口护理骨干护士作为调研人员，共入选1 060名调研护士。在2021-03-30和2021-05-29，使用专用调查记录表记录患者的一般情况；检查全身皮肤，判断是否发生压力性损伤及分期情况；采用Braden量表（从感知觉、潮湿度、活动能力、移动能力、营养、摩擦和剪切力6个分量表逐项评分）判断压力性损伤的发生危险。绘制受试者工作特征（ROC）曲线，分析Braden量表及其6个分量表预测成年住院患者发生压力性损伤的效能及其最佳界值。结果 本次调研共获得60 555例有效数据，其中压力性损伤现患率为1.67%（1 010/60 555），医院获得性压力性损伤现患率为0.74%（448/60 555）。男性压力性损伤现患率[2.08%（677/32 518）]高于女性[1.19%（333/28 037）]（χ2=73.394,P＜0.001）。≥80岁和ICU患者压力性损伤现患率最高，分别为5.98%（311/5 198）和10.58%（324/3 061）。多因素Logistic回归分析结果显示，年龄、性别、血清白蛋白、血红蛋白、失禁类型、卧床、Braden量表总分是成年住院患者发生压力性损伤的影响因素（P＜0.05）。Braden量表预测成年住院患者发生压力性损伤的ROC曲线下面积（AUC）为0.95[95%CI（0.94,0.95）]，灵敏度和特异度分别为96%和83%，约登指数为0.79，对应的最佳界值为17.50分。Braden量表预测不同科室和年龄患者发生压力性损伤的AUC为0.78～0.97，灵敏度为83%～97%，特异度为61%～91%，约登指数为0.47～0.88，最佳界值为13.5～18.5分。摩擦和剪切力、移动能力和活动能力3个分量表预测成年住院患者压力性损伤发生危险的AUC分别为0.87、0.84、0.80，约登指数分别为0.56、0.56、0.54，最佳界值分别为1.50、2.50、1.50分。结论 本次调研得出我国13个省/自治区、46所三级医院成年住院患者压力性损伤现患率为1.67%（1 010/60 555），医院获得性压力性损伤现患率为0.74%（448/60 555）。Braden量表适用于我国三级医院住院患者预测压力性损伤发生危险，总分≤18分有更好的预测作用，其中摩擦和剪切力、移动能力和活动能力分量表的预测作用最大，在人员紧张或特殊环境下可采用此3个分量表预测压力性损伤危险，最佳界值的预测作用需在应用中进一步验证。

目的 通过多中心横断面调查,分析老年住院患者压力性损伤(pressure injury,PI)、失禁相关性皮炎(incontinence-associated dermatitis,IAD)和皮肤撕裂伤(skin tear,ST)3类皮肤损伤的现患率及危险因素,为预防皮肤损伤提供依据.方法 2021年3月31日,来自20个省(区、市)50所医院的1067名护士对所在医院年龄≥60岁的患者进行全身皮肤检查,以判断皮肤损伤发生情况及类型,并收集患者的一般资料、病情资料和有无PI发生危险等资料.使用Logistic回归分析3类皮肤损伤的独立危险因素.结果 共调查14470例老年住院患者,年龄为(73.35±8.90)岁,皮肤损伤总现患率为6.69％,PI、IAD、ST的现患率分别为3.91％、1.89％和0.89％.Logistic回归分析显示,有PI发生危险、协助自理、低蛋白血症、汉族、贫血、慢性病数量≥2种和年龄≥71岁为老年住院患者发生PI的独立危险因素;有PI发生危险、协助自理、低蛋白血症、慢性病数量≥2种、住院时间≥8 d和年龄>80岁为IAD的独立危险因素;有PI发生危险、低蛋白血症为ST的独立危险因素(均P<0.05).结论 老年住院患者3类皮肤损伤均为多因素综合作用的结果,不同类型皮肤损伤的危险因素不尽相同.制订预防策略时既要关注危险因素的独立作用,也要考虑其联合作用,采取综合预防措施,以提高预防效果.

Objective:To understand the current situation of nurses in 52 hospitals in China on mastery of knowledge about skin injury in the elderly based on the background of mixed-mode homogenization training.Methods:Using the convenient sampling method, a total of 1 067 nurses from 52 hospitals in China were selected as the research objects in January 2021. A self-designed questionnaire on knowledge of skin injury in the elderly was used to investigate the nurses through the questionnaire star and univariate analysis was used to analyze the influencing factors. A total of 1 067 questionnaires were distributed and 1 067 valid questionnaires were recovered, and the effective recovery rate was 100%.Results:The knowledge scores of pressure injury, incontinence-associated dermatitis, skin tear and xerosis cutis among 1067 nurses were (95.66±7.37) , (95.65±9.15) , (91.37±15.45) and (87.67±15.91) , respectively. The results of univariate analysis showed that hospital grade was the influencing factor of nurses' knowledge score of pressure injury, skin tear and incontinence-associated dermatitis ( P<0.05) , educational background was the influencing factor of nurses' knowledge score of skin tear ( P<0.05) , professional title was the influencing factor of nurses' knowledge scores of pressure injury, incontinence-associated dermatitis and xerosis cutis ( P<0.05) . Conclusions:Hospitals at all levels need to strengthen the theoretical and practical knowledge training for nurses on skin xerosis and skin tear in the elderly, especially for nurses with primary titles and lower education in grassroots hospitals.

目的:探究一病一品项目对妊娠期糖尿病产妇妊娠结局的影响。方法:选取该院2019年2月至2020年2月收治的妊娠期糖尿病产妇114例，按照入院先后顺序分为对照组和观察组各57例。对照组行常规护理，观察组行一病一品项目护理。比较两组患者母婴结局、护理满意度及护理质量评分。结果:观察组总不良妊娠结局发生率低于对照组；观察组出院指导、健康教育、入院告知、护士操作、护士反应及护士态度评分高于对照组；观察组各护理质量评分高于对照组( P<0.05)。 结论:一病一品项目实施于妊娠期糖尿病产妇中可优化妊娠结局，提高护理质量，值得在临床进一步推广。

目的：横断面调研全国13个省46所三级医院住院患者压力性损伤的流行特征，分析Braden量表及其六个分量表预测压力性损伤和医院获得性压力性损伤危险的作用。方法：招募入选46所医院参与横断面调研， 1060名培训合格的护士采用便利抽样，在统一时间内使用一致的调研工具、方法和流程，纳入18岁以上的成年住院患者，检查全身皮肤是否发生压力性损伤，并采用Braden量表从感知觉、潮湿度、活动能力、移动能力、营养摄入、剪切和摩擦力六个分量表逐项评分，总分6-23分，分数越低发生压力性损伤危险越高。统计软件分析Braden量表及其六个分量表预测压力性损伤和医院获得性压力性损伤的受试者工作特征曲线下面积（AUC）及其敏感度、特异度和约登指数。 结果：共获得有效资料60555例，男性32518例（53.70%），女性28037例（46.30%），平均年龄55.88±17.16岁，压力性损伤总现患率1.67%（n=1010），其中医院获得性压力性损伤现患率0.74%（n=448）。男性现患率高于女性（2.08%vs 1.19%），ICU和≥80岁者压力性损伤现患率最高（10.58%和5.98%）。Braden量表预测成人压力性损伤和医院获得性压力性损伤危险的AUC分别为 0.95和 0.91 ，敏感度分别为0.92和0.90， 特异度分别为0.87和0.79，约登指数分别为0.79和0.69。Braden量表≤19分界值预测压力性损伤危险的AUC和约登指数最大（0.83和0.51），其中活动能力、摩擦和剪切力、移动能力三个分量表预测压力性损伤发生危险的AUC（0.92-0.81）和约登指数最大（075-0.71）。结论：Braden量表适用于我国三级医院住院患者预测压力性损伤发生危险，总分≤19分有更好的预测作用，其中活动能力、摩擦和剪切力以及移动能力分量表的预测作用最大，在人员紧张或特殊环境下采用三个分量表预测压力性损伤危险，可提高效率，节约时间。

Background Population aging is a major challenge in the global healthcare field. Due to pathological and physiological changes in ageing skin, skin injuries are highly prevalent in older population. And epidemiological studies on skin injuries in this population has become a research hotspot recently. Objective To examine the prevalence and epidemiological characteristics of three types of skin injuries 〔pressure injuries (PI) , incontinence-associated dermatitis (IAD) and skin tears (ST) 〕in elderly inpatients using a multicenter cross-sectional study, providing a basis for formulating strategies for the prevention of skin injuries in older people. Methods A multicenter study was carried out in 52 hospitals selected from 16 provinces, two autonomous regions and two municipalities of China, from which 1 067 nurses who had completed the online homogenization training conducted by our research group and passed the relevant examination were selectedas investigators. Every 2-3 nurses were divided into a investigation group. Eligible older inpatients were selected as participants. Full body skin examination for screening skin injuries was conducted in participants in each hospital by nurses using the same tools and methods. PI, IAD and ST were defined and classified by relevant international guideline or expert consensus, respectively. Then demographics, length of stay (LOS) , chronic disease history, use of medications in the past month, living independence and risk of PI assessed by the Braden Scale of the participants were collected. After that, two nurses of each group signed to confirm the results, and uploaded to https://www.wjx.cn. SPSS 22.0 was used for statistical analysis. Results A total of 14 675 elderly inpatients were investigated, and all of them responded effectively (100.0%) . The respondents had an average age of (73.5±9.0) years and a median LOS of 7 (4, 13) days, among whom 56.3% (8 262/14 675) were men, and 43.7% (6 413/14 675) were women; 95.5% (14 020/14 675) were Han people, and 4.5% (655/14 675) were 19 ethnic minorities. The overall prevalence of the three types of skin injuries was 6.0% (881/14 675) , of which the prevalence of PI, IAD, ST and at least two types of skin injuries was 3.3% (484/14 675) , 1.4% (199/14 675) , 0.8% (110/14 675) and 0.6% (88/14 675) , respectively. Epidemiologic characteristics: Han people had higher prevalence of skin injuries compared with ethnic minorities (6.2% vs 2.9%, P=0.001) . Eighty-year-olds had higher prevalence of skin injuries than 71-80-year-old (10.2% vs 6.1%, P<0.001) and 60-70-year-old (10.2% vs 3.8%, P<0.001) . Those suffering from at least two chronic diseases had higher prevalence of skin injuries compared with those without chronic diseases (5.7%-12.0% vs 2.9%, P<0.005) or those with only one chronic disease (5.7%-12.0% vs 4.4%, P<0.005) . Users of two or more medications had higher prevalence of skin injuries compared with non-medication users (6.1%-10.2% vs 2.7%, P<0.005) or users of one medication (6.1%-10.2% vs 4.6%, P<0.005) . Those with LOS of over 30 days had higher prevalence of skin injuries compared with those with LOS of 8-30 days (10.7% vs 4.4%, P<0.016 7 ) or ≤7 days (10.7% vs 7.1%, P<0.016 7) . The prevalence of skin injuries in those with PI risk was higher than that in those without risk (20.5% vs 1.6%, P<0.05) . The prevalence of skin injuries in dependent-living individuals was higher than that of independent-living individuals (7.0% vs 0.9%, P<0.05) . The frequently-occurring sites were caudal sacral (57.9%) and heel (14.3%) for PI, peri-anal region (68.3%) and hip fissure (24.6%) for IAD, and lower limbs (38.2%) and upper limbs (28.2%) for ST. PI combined with IAD mostly occurred in sacrococcygeal region (71.0%) . PI combined with ST were common in sacrococcygeal region (50.0%) and heel (35.7%) . ST combined with IAD mostly occurred in caudal sacral (33.3%) , perianal region (33.3%) and gluteal fissure (33.3%) . PI, IAD and ST coexisted mostly in caudal sacral (50.0%) and gluteal fissure (50.0%) . Conclusion The prevalence of skin injuries in Chinese older people is high, and may increase with age, prevalence of chronic diseases and use of systemic medications, and dependent-living. In particular, PI risk may be associated with significantly higher possibility of developing skin injuries. Coexistence of multiple types and anatomical sites of skin injuries are important characteristics. The above-mentioned epidemiologic characteristics should be considered when formulating prevention strategies of skin injuries in the elderly.

目的:观察指导性护理下行Orem自我护理理论对结直肠癌患者术后自我效能及胃肠功能的影响。方法:选取2018年2月至2020年1期间在该院行结直肠癌根治术患者102例作为研究对象，并采用随机双盲法分为对照组和研究组，各51例。对照组行常规护理，研究组在指导性护理下给予Orem自我护理理论进行护理，比较两组患者护理前后的自我效能(GSES)评分和生存质量评分，以及护理后的肠胃功能恢复情况。结果:护理前，两组患者GSES评分和各项生存质量评分比较差异无统计学意义( P>0.05)；护理后，研究组患者GSES评分、各项生存质量评分和肠胃功能恢复情况均明显优于对照组( P<0.05)，数据差异存在统计学意义。 结论:采用指导性护理下行Orem自我护理理论的护理模式为结直肠癌根治术患者进行临床护理，可明显提高患者的GSES评分，有利于促进患者肠胃功能恢复，达到提升患者各项生存质量评分的目的，对增强患者预后具有明显效果，值得临床推广。

目的 老年人是皮肤损伤的高发群体,护士对皮肤损伤的识别能力是有效护理的关键,如何提高护士的识别能力是一个研究重点.文章分析、比较52所医院中参研护士掌握老年人皮肤损伤知识现况和培训效果.方法 课题组对来自全国52所参与多中心研究医院的1067名参研护士先线上测评其皮肤损伤知识,再采用线上统一培训和组织受训护士在1 h内对20张皮肤损伤照片为题干的60个问题进行在线答题和提交.采用统计软件分析结果.结果 参研护士培训前得分(79.76±9.14)分,培训后得分(93.07±7.10)分,差异有统计学意义(P<0.01),≥90分优秀率83.13％,较培训前提高了25.21％.其中三级医院护士得分明显高于二级医院(P<0.01).结论 52所医院参研护士在培训前的皮肤损伤相关知识得分均偏低,线上培训可作为多中心研究中有效的同质化培训方法,能提升护士的相关知识水平.

Background/Objective: Dry skin (xerosis cutis) is a most skin problem that puzzles older persons. To determine the prevalence, skin care, associated factors and impact on life of dry skin in the older inpatients.Design: A multicentre cross-sectional study was designed and conducted in 52 Chinese medical institutions on March 31 and May 29, 2021.Settings/participants: Skin examination and associated data were available for 33769 participants aged over 60 years in 52 medical institutions from 20 provinces, autonomous regions and municipalities directly under the central government.Methods: A whole-body skin examination and overall dry skin score (ODS) was performed by 1067 qualified nurses, the associations between dry skin and gender, health conditions, and skin care status were analysed.Results: About 34.4% participants had dry skin and 21.2% cases with dry skin had pruritus, mainly located on extremities. There was a positive correlation between ODS and pruritus(r=0.301, P＜0.001). Nearly 87.3% cases with pruritus complained that sleep and daily life was affected by skin pruritus. Only 20.1%-67.0% participants were able to implement skin care measures according to the recommendations. The known risk factors included increasing age, diabetes, medications, statins and diuretics and less known risk factors included decreased self–care ability, lower Braden scores, length of stay(LOS) over 30days,numbers of chronic diseases and medications, parkinsonism, renal and pulmonary impairment, varicose veins, coronary disease were associated with more dry skin.Conclusions: The prevalence of dry skin in the older inpatients in Chinese medical institutions was higher, associated with multiple factors. Skin cares were inadequate. Prevention should pay attention to these characteristics.Registration: It has been registered in the Chinese Clinical Trial Registry (ChiCTR2100042893).Tweetable abstract : Dry skin among the older inpatients is common but skin care is far from adequate @workforcesoton @ijn2022Keywords: Older inpatients; dry skin; prevention; cross-sectional survey; risk factors

目的 探讨应用两种压力性损伤危险评估量表对肿瘤患者压力性损伤发生的预测效果.方法 对入院符合纳入标准的261名患者建立资料登记表,并在入院2h内对其进行首次评估.由2名经过培训的护士独立应用两种量表对不同危险的患者进行压力性损伤危险评估,每天观察受试者皮肤情况,有无压力性损伤发生及其分期,直到患者压力性损伤观察期满3周或出院、死亡.结果 OH量表的最佳诊断界值为1.25,灵敏度、特异度、阳性预测值、阴性预测值分别为84％、62.7％、19.3％、97.4％;Braden评估量表的最佳诊断界值为15.5,灵敏度、特异度、阳性预测值、阴性预测值分别为72％、80.5％、28.1％、96.4％;OH量表和Braden量表的Youden指数分别是0.467和0.525;OH评估量表在ROC曲线下的面积为0.766,低于Braden评估量表0.819.结论 OH量表在肿瘤住院患者压力性损伤高危风险预测中并不优于Braden量表,但OH量表与Braden量表的Youden指数均较高且相差不大,提示两者均可以用于恶性肿瘤晚期患者的压力性损伤危险预测,从而有效指引护理人员进行压力性损伤预防措施的选择.

[目的]调查老年癌痛病人疼痛信念及口服阿片类药物依从性情况,分析其影响因素.[方法]采用疼痛信念与感知量表、Morisky自陈式依从性问卷对147例老年癌痛病人进行问卷调查.[结果]老年癌痛病人口服阿片类药物依从性得分为(6.17±2.68)分,其中依从性优36例(24.5％),依从性良好54例(36.7％),依从性差57例(38.8％).疼痛信念总分为(0.96±6.57)分,认为会持续疼痛维度得分最高[(1.67±2.29)分],其余依次为感到疼痛很神秘[(0.73±3.27)分]、认为疼痛不可解除[(0.02±2.46)分]、自责感[(-1.47±2.00)分].口服阿片类药物依从性与感到疼痛很神秘、认为会持续疼痛、疼痛信念总分呈负相关(P<0.05).服药依从性和疼痛信念受年龄、性别、文化水平和疼痛持续时间等因素影响.[结论]老年癌痛病人持有负性疼痛信念,疼痛信念与阿片类药物服药依从性呈负相关,负性信念越强依从性越差.

目的 探讨KPS评分与营养水平对肿瘤患者发生院内获得性压力性损伤的影响,为临床筛选重点预防对象、采取干预措施提供依据.方法 选取2017年1月-2018年1月入住肿瘤内科的恶性肿瘤晚期患者261例,评估患者的一般资料及KPS评分、血清白蛋白、血红蛋白、Braden评分,给予相应的预防措施,每天观察院内获得性压力性损伤的发生情况.结果 院内获得性压力性损伤发生率为13.03％(34/261).不同KPS评分、年龄、皮肤类型、血清白蛋白、血红蛋白含量、Braden评分患者压力性损伤发生情况差异有统计学意义(P＜0.05).高龄、KPS评分≤30分、低血清白蛋白、低血红蛋白、Braden评分≤16分患者压力性损伤发生率更高.结论 肿瘤患者KPS评分、血清白蛋白、血红蛋白水平与压疮发生密切相关,压疮的高发生率提示晚期肿瘤患者需要早期干预、强化结构化的压力性损伤预防措施.

目的 探讨集束化护理在预防留置针静脉炎的中的应用效果.方法 肿瘤中心收治患者190例根据收治病区不同分为2组.干预组85例患者使用静脉留置针后给予集束化护理,对照组患者105例使用静脉留置针后给予常规护理.比较2组静脉炎发生情况.结果 干预组静脉炎发生率24.70％ (21/85),对照组为61.90％(65/105),2组比较差异有统计学意义(P＜0.05).结论 集束化护理干预能有效预防肿瘤患者留置针静脉炎的发生风险.

Objective To analysis the causes and preventive measures of acquired pressure ulcers in hospitalized patients, and to provide evidences and references for strengthening hospital management of pressure ulcers.Methods We took a retrospective study to collect relevant information of 201 patients with hospital-acquired pressure ulcers from January 2012 to December 2014, and conducted a descriptive statistical analysis on the cause of the developed, high-risk departments and high-risk areas, then came up with preventive suggestions.Results The high incidence of 201 hospital-acquired pressure ulcers was oncology department, which accounted for 33.83%;the most common part was the sacrococcygeal region, which accounted for 59.2%;stage II was the most common stage of pressure ulcer, which accounted for 76. 12%; 64. 67% of the pressure ulcers happens within the first two weeks in hospital. Braden scoring less than 12 points that accounted for 58. 21%;anemia accounted for 72. 14%; hypoalbuminemia accounted for 75. 62%; forced postures caused by pain or hydrothorax and ascite accounted for 26.87%; medical equipment pressure accounted for 10.95%. The use of vacuum pad accounted for 87.56%;turning over once every 2 hours accounted for 41.79%. Skin nursing according to the guide accounted for 62. 19%; nutritional support through the mouth or vein accounted for 38.81%. Reporting to the nursing department timely after the occurrence accounted for 95.52%; found in ward rounds accounted for 1.99%; reported by patients or their families accounted for 1.49%; failure to report and found in the medical records accounted for 1.00%,the patient or family members to report accounted for 1.49%. Conclusions Cancer patients are high-risk groups of nosocomial pressure ulcers. The sacrococcygeal region is the high-risk area;stage II is the most common stage, and most of them happens within the first 2 weeks in hospital. Main reasons are hypoalbuminemia, anemia, forced postures, unable to turn over periodically, and the preventive care implementation is not enough. For cancer patients, preventive care is recommended, especially those patients with cancer pain, malnutrition and forced postures.

目的：了解本院临床护士对压疮防治知识的掌握情况，以便有针对性地进行分层次培训。方法采用问卷调查法对本院临床护士的压疮防治知识进行调查和分析。结果本院临床护士在压疮预防、压疮分期及处理等方面都存在问题。结论本院临床护士的压疮防治知识还有待进一步提高，可以根据薄弱点分层次开展培训工作。

目的 探讨过渡期护理模式对直肠癌术后永久性肠造口出院患者生活质量的影响. 方法 选取2010年10月~2011年10月期间本科收治的直肠癌术后永久性肠造口患者51例为研究对象,将其随机分为观察组26例,干预6个月后病例脱落1例,最后纳入研究25例和对照组( 25例). 对观察组施行过渡期护理模式,对照组进行常规护理宣教. 使用欧洲癌症研究与治疗组织的生活质量核心量表分别对两组患者出院6个月的生活质量进行评分.结果 观察组躯体功能、情绪功能、社会功能和总体健康状况方面在出院后6个月时均优于对照组,差异有统计学意义( P<0.05). 结论 过渡期护理模式为出院患者提供了不间断连续性护理服务,满足了患者肠造口知识的需求,增强患者回归社会的信心,并能显著改善肠造口患者的生活质量.

目的:探讨护理软技能在乳腺癌患者中的应用.方法:将100例乳腺癌患者在常规健康教育基础上,采取护理软技能服务模式进行护理,对乳腺癌患者心理状况和生活质量进行评价.结果:乳腺癌患者心理状况中抑郁、焦虑、人际关系维度较前有所改善,生活质量有所提高,差异有统计学意义.结论:护理软技能服务有利于改善乳腺癌患者心理状况和生活质量.