目的:构建脑卒中吞咽障碍患者居家护理模式并评价其效果.方法:选取脑卒中吞咽障碍患者78例为研究对象.采用计算机产生随机序列法将患者随机分为观察组和对照组,每组各39例.对照组给予常规健康教育,观察组在常规健康教育基础上给予居家护理服务计划和干预措施,干预12周后,评价并比较2组患者干预前后的吞咽障碍情况、神经功能缺损程度、营养风险、自理能力、日常活动能力、心理状态及康复依从性.结果:干预12周后,2组吞咽障碍功能较治疗前明显提高(P＜0.05),且观察组更优于对照组(P＜0.05).干预后,观察组患者神经功能缺损、营养风险、抑郁评分明显低于干预前及对照组(均P＜0.05),观察组患者自理能力、日常活动能力、依从性得分均高于干预前及对照组(均P＜0.05);对照组各项指标干预前后比较除营养风险和抑郁评分外,其余各项指标差异有统计学意义(均P＜0.05).结论:脑卒中吞咽障碍患者居家护理模式有较高的实用价值,对改善脑卒中吞咽障碍患者吞咽情况,提高患者生活质量,促进患者康复,实现医院-社区-家庭的无中断长期护理服务有重要作用.

Objectives? To test the reliability and validity of the Chinese version of the Social Impact Scale (SIS) for the stigma of stroke patients in China, and to provide an effective tool for assessing the stigma of stroke patients. Methods? A total of 170 stroke patients who met the inclusion criteria were selected by the Rehabilitation Medicine Department of a tertiary hospital in Xi'an, Shaanxi Province. The Chinese version SIS was used to investigate the stigma. Using the degree of discrimination, coefficient of variation, and correlation analysis to analyze the scale items, Cronbach's alpha, content validity index, and exploratory factor analysis were used to evaluate the reliability, content validity, structural validity of the scale. The criterion-related validity is used to measure the correlation between social impact scale and daily activity ability, self-esteem, and depression. Results? A total of 170 questionnaires were distributed, and 164 valid questionnaires were returned. The response rate was 96.5%. The SIS can identify high and low groups (P＜0.01), the coefficient of variation of each item of the scale is over 15%, and the correlation coefficient between each dimension and total score of the scale is 0.739-0.875 (P＜0.01). The correlation coefficient between the score and the total score of the scale is 0.325-0.738 (P＜0.01). The results of the exploratory factor analysis retain 18 items, and one common factor is extracted for each dimension. The contribution of each common factor to variance is more than 45%. Finally, each dimension contained no less than three items, and the factor load is ＞ 0.60. The content validity index of each item of the scale is 0.875-1.000, and the content validity index of the scale is 0.944. The revised social impact scale consists of 4 dimensions and 18 items. The internal consistency of the total scale Cronbach's α coefficient is 0.908, and the Cronbach's α coefficients of each dimension are 0.711, 0.662, 0.840, 0.777, respectively. The correlation coefficient of each item is 0.457-0.783 (P＜0.01). The correlation coefficient of each dimension is 0.449-0.867 (P＜0.01). The revised SIS score was negatively correlated with daily activity ability and self-esteem score (r=-0.238, -0.309, P＜ 0.01), and positively correlated with depression score (r=0.537, P＜0.01). Conclusions? The revised SIS has ideal reliability and validity and can be used to evaluate the stigma in stroke patients in China.

目的 针对患者脊髓血管瘤术后神经源性膀胱合并泌尿系感染、尿道黏膜损伤,同时合并皮肤黏膜消毒剂Ⅲ型安尔碘过敏的情况进行护理.方法 在严格执行无菌导尿操作标准的基础上,根据患者出现的并发症及时修订护理方案进行有效地干预,同时做好患者及家属的心理支持及疾病的沟通告知,使其积极配合护理方案的有效实施.结果 经过精心护理,解除了消毒剂所致的尿道口、阴囊、会阴部皮肤的过敏炎性反应,患者间歇性导尿方案顺利实施,患者自主排尿建立,膀胱功能恢复.结论 神经源性膀胱患者在实施间歇性导尿过程中发生皮肤黏膜过敏损伤通过采取个案化护理措施,能有效治疗并发症,促进患者膀胱功能恢复.

目的 研究阶段性护理干预对腰椎间盘突出患者微创术后恢复的影响.方法 将2014年3月至2014年10月在我科住院的腰椎间盘突出微创手术患者72例采用随机数字法分为观察组和对照组,每组36例,对照组实施围手术期常规护理,观察组实施阶段性护理干预措施,采用日本骨科协会评估治疗分数(JOA)评价护理前后效果,并对两组患者护理优良率进行比较.结果 对两组患者护理前后JOA评分进行比较,治疗前两组患者JOA评分无差异性;治疗后2周及治疗后6个月两组患者JOA评分显著高于护理干预;组间对比,观察组患者护理后2周和6个月的JOA评分均高于对照组,差异有统计学意义(P＜0.05);护理优良率比较,观察组患者优良率高于对照组,差异有统计学意义(P＜0.05).结论 阶段性护理干预措施有助于腰椎间盘突出患者微创术后恢复,改善预后.

Objective To explore the clinical effects of clinical nursing pathway ( CNP) in the radiofrequency ablation treatment for the lumbar intervertebral disc protrusion. Methods The 50 patients who underwent radiofrequency ablation treatment for the lumbar intervertebral disc protrusion from Oct. 2012 to Mar. 2013 were chosen as the control group, and received conventional nursing and health education. Another 50 patients who underwent the same treatment from Apr. 2013 to Sep. 2013 were chosen as the observation group, and received nursing and health education according to the methods and contents of CNP. The average operation time, intraoperative and postoperative complications, hospi-talization duration, hospitalization expenses, and the patients' satisfaction rate about nursing of the two groups before and after the implementation of CNP were compared. Results The average operation time, hospitaliztion duration, hospital-ization expenses, operative complications, awareness rate of health education, and the satisfaction rate on nursing care of the observation group were significantly superior to that of the control group, and the difference was statistically signif-icant ( P<0. 05 ) . Conclusion The application of CNP during the radiofrequency ablation treatment for the lumbar in-tervertebral disc protrusion can reduce the operative complications, shorten the operation time and hospital duration, lower the hospitalization expenses, and raise the health education awareness rate and satisfaction rate.