目的 构建ICU机械通气患者渐进式肢体康复操方案.方法 采取查阅文献分析与德尔菲法对15名专家进行咨询,经过2轮函询后形成ICU机械通气患者渐进式肢体康复操方案.检索时限为自建库至2021年12月31日.结果 2轮咨询表回收率均为100％,构建的ICU机械通气患者渐进式肢体康复操方案包括4个一级指标、14个二级指标、15个三级指标、31个四级指标,针对一级指标、二级指标、三级指标、四级指标,专家给出的权威系数分别为0.84、0.84、0.81、0.79,重要性协调系数分别为0.54、0.68、可行性协调系数分别0.62和0.72,采用x-检验,差异均有统计学意义(P＜0.01).结论 ICU机械通气患者渐进式肢体康复操方案具有一定的科学性和可靠性,可为国内开展ICU机械通气患者康复护理实践和研究提供一定的参考.

Objective: To examine the effects of clearance breathing on pulmonary function and treatment compliance in patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease undergoing first non-invasive ventilation.Methods: A total of 99 patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease undergoing the noninvasive ventilation for the first time in the Intensive Care Unit were recruited in a tertiary grade A hospital in Wuxi from June 2020 to December 2021 and they were randomly assigned to the control group（n=49） or the observational group（n=50）by a random number table. Patients in the observational group received the clearance breathing while patients in the control group received routine care. Non-invasive ventilator treatment compliance, blood gas changes at different time periods,pulmonary function, tracheal intubation rate, average length of hospital stay, mMRC and CAT scores were compared between the two groups. Results: The treatment compliance, arterial pH, oxygenation index, and FEV1/FVC ratio of patients in the observational group were significantly higher than those in the control group（P＜0.05）. The mMRC, CAT score, average length of hospital stay and intubation rate were significantly lower than those in the control group（P＜0.05）. Conclusion:Clearance breathing for patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease undergoing first noninvasive ventilation can effectively improve the pulmonary function, improve the treatment compliance, and increase the success rate of ventilation. The clearance breathing is worth of promotion in clinical settings.

Objective:To analyze the preventive effect of grading management on risk events in the management of critically ill respiratory patients.Methods:A total of 86 patients with respiratory critical illness admitted to the Second People's Hospital of Wuxi from September 2017 to December 2019 were randomly divided into reference group and experimental group, with 43 patients in each group.Traditional nursing management was used in the reference group, and hierarchical management was used in the experimental group. Self-Rating Anxiety Scale (SAS) score, Self-Rating Depression Scale (SDS) score, arterial blood gas index, incidence of risk events, duration of mechanical ventilation, length of stay in ICU and hospital stay were compared between the two groups.Results:The SAS, SDS score and arterial partial pressure of carbon dioxide (PaCO 2)of the experimental group were significantly lower than those of the reference group, and the SpO 2 and PaO 2 of the experimental group were significantly higher than those of the reference group. The incidence of risk events of in the experimental group was significantly lower than that in the reference group. The mechanical ventilation time, ICU time, and hospitalization time of the experimental group were significantly shorter than those of the reference group, with statistically significant differences( P<0.05). Conclusions:Grading management can effectively reduce the adverse emotions of patients with respiratory critical illness, maintain the stability of arterial blood gas indexes, reduce the incidence of risk events, and shortern the treatment time.

目的:分析基于eCASH理念的最小化镇静策略联合早期目标导向活动在ICU机械通气患者中的应用效果.方法:选择2019年1月—12月期间入院的56例ICU机械通气患者,随机分为干预组与对照组.给予对照组患者镇痛、镇静及ICU常规肢体活动护理,干预组患者实施基于eCASH理念的最小化镇静策略联合早期目标导向活动护理方案.比较两组患者镇静剂用量、舒适度、谵妄发生率、肌力、机械通气时间、ICU住院天数和一次性成功拔管率.结果:干预组患者镇静剂用量、机械通气时间、ICU住院天数少于对照组(P<0.05),舒适度、肌力、一次性成功拔管率高于对照组(P<0.05),谵妄发生率低于对照组(P<0.05).结论:对ICU机械通气患者实施基于eCASH理念的最小化镇静策略联合早期目标导向活动,可减少镇静剂使用量,提高患者舒适度、一次性成功拔管率,降低患者谵妄发生率,缩短机械通气时间,减少ICU住院天数,促进疾病康复.

Objective:To construct competency index of nurses in public health emergencies based on iceberg mode.Methods:Based on the analysis of the work of public emergencies in the past five years, the deficiencies were summarized, and the competence index of nursing staff in public health emergencies was preliminarily formulated with the Iceberg Model as the theoretical framework and the literature review. The Delphi expert consultation method was used to select 15 experts from 7 Class Ⅲ Grade A general hospitals and Class Ⅲ Grade A specialized hospitals in Jiangsu Province who met the standards of admission and discharge from January to June 2020 for two rounds of consultation, and the competency index was finally formed.Results:The competency index of nursing staff in public health emergencies included 5 first-level indicators and 27 second-level indicators. The authority coefficient of experts on the first-level index and second-level index were 0.84 and 0.81. The coordination coefficients were 0.68 and 0.72, respectively. The differences were statistically significant( χ2 values were 73.22, 95.30, P<0.01). Conclusions:The competency index of nurses in public health emergencies in this study is highly reliable and scientific, and can provide reference for the reserve, training and assessment of nurses in public health emergencies.

目的 探讨基于eCASH理念下镇痛镇静策略对ICU机械通气患者谵妄及预后的影响.方法 选取2018年1月—2019年1月ICU收治的96例进行机械通气治疗的患者为研究对象,按入院时间分为对照组和观察组各48例,两组均给予ICU常规预防谵妄护理,观察组遵循eCASH理念改进镇痛镇静护理方法.结果 观察组谵妄发生率低于对照组(P<0.05);观察组镇静药物使用剂量显著低于对照组(P<0.05);观察组机械通气时间和ICU住院时间显著短于对照组(P<0.001);观察组睡眠质量评分高于对照组(P<0.05).结论 eCASH理念在ICU机械通气患者中应用,可有效改善患者睡眠质量,减少患者谵妄发生,缩短机械通气时间,有利于患者疾病恢复,提高患者的生活质量.

目的:探讨早期目标导向活动（EGDM）方案对ICU机械通气病人获得性衰弱的影响。方法:选取2018年7月—2019年7月我院ICU收治的56例机械通气病人,随机分为对照组和观察组各28例。对照组采用ICU护理常规及功能锻炼,观察组在常规护理锻炼基础上结合EGDM方案,根据病情评估制定每日早期活动目标方案。比较两组病人医学研究委员会（MRC）评分、Barthel指数评分、ICU获得性衰弱发生率、机械通气时间、ICU治疗时间、匹兹堡睡眠质量指数（PSQI）评分及不良事件发生情况。结果:观察组ICU获得性衰弱发生率、机械通气时间、ICU治疗时间、PSQI评分低于对照组,MRC评分、Barthel评分高于对照组（P＜0.05）。观察组实施EGDM方案过程中无严重不良事件发生。结论:EGDM方案可有效增强ICU机械通气病人的肌力,减轻其呼吸肌疲劳,改善睡眠质量,预防获得性衰弱发生,缩短机械通气时间,促进病人机体恢复。

Objective:To investigate the effect of the operation instruction of eCASH in the analgesia and sedation of patients with mechanical ventilation in ICU.Methods:From July 2018 to July 2019, 56 patients with mechanical ventilation in ICU were randomly divided into control group ( n=28) and experimental group ( n=28). The control group was treated with routine sedation and analgesia management, while the experimental group was treated with sedation and analgesia management with the operation instruction of eCASH. The hospitalization time, mechanical ventilation time, PSQI, delirium incidence, one-time successful extubation rate, and prognosis of disease of the two groups were compared. Results:The duration of mechanical ventilation and hospitalization in the experimental group were significantly shorter than those in the control group (all P<0.05); the PSQI score in the experimental group was significantly lower than that in the control group ( P<0.05); the incidence of delirium in the experimental group was significantly lower than that in the control group (7.14% vs. 42.86%) ( P<0.05); the one-time successful extubation rate and the rate of transferring to other departments in the experimental group were significantly better than those in the control group (92.86% vs. 60.71%, 89.29% vs. 53.57%) (all P<0.05). Conclusion:The application of the operation instruction of eCASH in the analgesia and sedation of patients with mechanical ventilation in ICU can shorten the time of mechanical ventilation, improve the one-time successful extubation rate, and promote the recovery of disease.

目的 探索重度AECOPD患者接受机械通气期间实施早期康复治疗的临床效果.方法 40例重度AECOPD患者为试验对象,采用数据库随机分组式,各20例,分别进行机械通气治疗、机械通气联合早期康复治疗.结果 观察组并发症、VAP发生率、CAT评分低于对照组,住院时间、总机械通气时间、有创机械通气时间、无创机械通气时间短于对照组,FEV1、PaO2、拔管成功率高于对照组(P<0.05).结论 重度AECOPD患者机械通气期间联合早期康复治疗可显著改善临床疗效.

Objective To develop and apply an ICU orientation program based on the Miller pyramid competency model.Methods 10 new ICU nurses in 2016 and 2017 were selected as the experimental group.The experimental group received the new orientation program,including the orientation of preceptors,workshop-centered orientation courses,checklists-precepting and comprehensive competency evaluation methods.10 new ICU nurses in 2014 and 2015 were selected as the control group.The control group received the conventional orientation program,including focused theory classes and traditional precepting.New nurses' satisfaction on the orientation and the competency were analyzed before and after intervention in the two groups.Results Satisfaction with the orientation,self-evaluated competency,and peer-evaluated competency in the experimental group were (13.71±1.11) points,(116.52±2.31) points,and (90.00±1.68) points respectively,which were much better than those in the control group [(10.41±1.01) points,(105.77±4.13) points,(75.59±2.25) points],with statistically significant differences between the two groups (P＜0.05).Conclusion The ICU new nurse orientation program based on the Miller pyramid competency model can improve the new nurses' satisfaction on the orientation and the competency after the orientation.

Objective To analyze the application value of indirect calorimetry in early enteral nutrition nursing care of mechanical ventilation patients.Methods The data of 62 patients treated with mechanical ventilation at our hospital from September,2017 to September,2018 were retrospectively analyzed.The patients were randomly divided into a study group and a control group,31 cases for each group.The two groups were given early enteral nutrition and routine nursing care;in addition,the study group carried out the nursing mode supported by indirect calorimetry.The serum nutritional indicators and physical changes were compared between the two groups.Results On the 1st day,there were no statistical differences in serum albumin,hemoglobin,total protein,muscle circumference of upper arm,and skin fold thickness of triceps between the study group and the control group (all P ＞ 0.05).On the 7th day,the serum albumin,hemoglobin,and total protein as well as the muscle circumference of upper arm,and skin fold thickness of triceps were (37.94±3.59) g/L,(21.28 ±4.29) g/L,(65.67±4.26) g/L,(26.04 ±3.27) cm,and (13.05 ±1.89) cm in the study group,respectively,which were better than those in the control group (all P ＜ 0.05).Conclusion According to indirect calorimetry,early enteral nutrition in mechanical ventilation can promote the recovery of nutritional indicators,correct malnutrition,and promote the metabolic function of patients,and has clinical application value.

目的 探讨eCASH理念结合早期活动在ICU机械通气患者中的应用效果.方法 将96例ICU机械通气患者按入院时间分为对照组和观察组各48例,对照组给予常规镇痛镇静及护理,观察组实施基于eCASH理念的舒适化浅镇静管理结合早期活动.结果 观察组谵妄发生率和ICU获得性衰弱发生率显著低于对照组,MRC肌力评分显著高于对照组.机械通气时间和ICU住院天数显著短于对照组(P＜0.05,P＜0.01).结论 eCASH理念结合早期活动应用于ICU机械通气患者,可降低患者谵妄和ICU获得性衰弱,缩短机械通气和ICU入住时间,促进患者康复.

Objective To explore the effect of oral care with extracts of folium isatidis on cleaning tongue coatings of patients with severe acute pancreatitis,and to reduce the incidences of bad breath and oral infection.Methods 90 patients with severe pancreatitis,tongue coatings,and complications of bad breath were divided into a control group and an experimental group,45 cases for each group.The control group received routine oral care (0.02％ chlorhexidine solution for oral care solution),and an the observation group took routine oral care after scrubbing with the extracts of folium isatidis,2 times per day,3 days per period.And after 7 days,the effects of cleaning tongue coatings and bad breath were compared between the two groups.Results After 7 days of oral care with extracts of folium isatidis,the tongue coatings of most patients were significantly improved and the difference of effects between the two groups was statistically significant (P ＜ 0.05).Conclusions Oral care with extracts of folium isatidis combined with chlorhexidine solution has a good effect on cleaning tongue coatings and bad breath.It is worth for clinical application and promotion.

气管镜检查是临床常用检查,能够有效排查不明原因的咳嗽、疑似肿瘤等疾病,但检查过程中使用的精密器械均需清洗消毒.传统的清洗方法为人工清洗,不仅耗费大量的人力、物力,且对精密器械的损害也较大.本研究设计的机械振动式器械清洗装置是利用水的循环撞击来清洗器械,不仅节约了水资源,且减轻了护理人员的工作负荷,同时对精密器械的损伤也大大减少.

呼吸科监护室患者病情严重,需长期留置导尿管[1].常规的导尿管固定带松紧度难以控制,易引起脱落和患者不适,且操作繁琐,易引起感染.本研究设计了一种新型的尿管固定装置,现介绍如下.

目的:探讨老年慢性阻塞性肺气肿并发气胸的护理.方法:对我院2013~2014年收治的56例老年慢性阻塞性肺气肿并发气胸的临床资料及护理进行回顾性分析.结果:治愈51例,死亡5例.结论:对老年慢性阻塞性肺气肿并发气胸的病人要加强心理护理及基础护理,防止并发症,以降低死亡率.

This paper analyzes the causes and prevention measures of the disputes between nurses and patients on the department of surgery,which suggests the nurses in the surgery should change ideas,strengthen the legal system,safety education,enhance service awareness,regulate practice,improve service attitude and service quality.Nurses should promote the communication between the nurses and the patients,which is the key to reducing nurse-patient disputes and improving the self-protection awareness.

目的:探讨妇科单孔腹腔镜术后饮食改进的护理.方法:将100例妇科单孔腹腔镜患者术后随机分为观察组度改对照组各50例.观察组实施常规护理,对照组在此基础上给予饮食改进护理.结果:对照组患者病情恢复明显高于观察组.体会:饮食改进护理能促进病情恢复.

急性坏死性胰腺炎(acute necrotizing pancreatitis, ANP)起病急、病情重、并发症多、死亡率极高,我院手术治疗的20例ANP患者,加强围手术期的系统化整体护理,取得较好疗效,现报告如下.