目的:了解某三级甲等医院医护人员对慢性病患者医务社会工作服务的认知及需求,为更有效地在临床开展慢性病患者医务社会工作服务提供参考.方法:采用质性研究中的现象学研究方法,于2021年9月—10月使用目的抽样法选取广州市某三级甲等医院从事慢性病相关专科工作的12 名医护人员进行"一对一"半结构式深入访谈,采取Colaizzi?7 步分析法进行资料分析.结果:从访谈结果中提炼出 4 个主题:医护人员认同慢性病患者医务社会工作服务介入临床的重要性;对医务社会工作的认知不足;对慢性病患者医务社工角色的期待;临床合作实践中存在的阻碍因素.结论:医护人员对慢性病患者医务社会工作认识不足,但都表现出对开展慢性病患者医务社会工作服务的肯定,建议改善慢性病患者医务社会工作服务的基础条件,加强宣传力度,提高医护人员的认知水平,在资源有限的情况下,双方应积极克服现实因素,努力创造条件,共同推进慢性病患者医务社会工作服务临床实践的开展.

目的:观察竹盐脐灸联合健康指导干预亚健康疲劳状态的有效性及安全性.方法:纳入 134 例亚健康疲劳状态患者,随机分为对照组和干预组.2 组均采用健康指导干预,干预组加用竹盐脐灸干预.2 组干预时间均为 4 周.干预前后评定疲劳量表-14(FS-14)的躯体疲劳评分、脑力疲劳评分、总分及主观疲劳程度视觉模拟评分法(VAS)评分.评价干预组患者对竹盐脐灸的接受程度,观察竹盐脐灸过程中是否出现不适症状或不良反应.结果:干预后,干预组躯体疲劳评分、脑力疲劳评分均较治疗前下降(P＜0.05);对照组干预前后的躯体疲劳评分、脑力疲劳评分比较,差异均无统计学意义(P＞0.05);干预组躯体疲劳评分、脑力疲劳评分均低于对照组(P＜0.05).干预组FS-14 总分较治疗前下降(P＜0.05);对照组干预前后的FS-14 总分比较,差异无统计学意义(P＞0.05);干预组FS-14 总分低于对照组(P＜0.05).2 组主观疲劳程度VAS评分均较治疗前下降(P＜0.05),干预组主观疲劳程度VAS评分低于对照组(P＜0.05).干预 5 次后,干预组怕冷、腰背疼痛、睡眠障碍、月经不调、脘腹胀满、食欲不佳、受寒腹泻、情绪忧虑、大便不畅评分均较治疗前下降,差异均有统计学意义(P＜0.05).未见患者反映竹盐脐灸过程中出现不适症状或不良反应.结论:在健康指导的基础上加用竹盐脐灸能有效改善亚健康疲劳状态人群的疲劳状态和相关临床症状,且竹盐脐灸具有操作简单、安全有效、患者易于接受等优点.

慢性肾脏病（chronic kidney disease，CKD）是一种长期不良生活方式导致的慢性疾病，具有“三高”“三低”的流行病学特点。目前，我国CKD的管理模式尚处于摸索阶段，为提高CKD患者的管理效率，规范诊疗管理过程，本研究就广东省中医院慢病管理中心5A模式的慢病管理模式的建立及应用情况进行报道，期望为我国CKD非透析期患者的诊疗和管理提供参考策略。

目的 了解近10年患者授权教育研究的热点和发展趋势,以期为我国护理人员推进该健康教育模式的应用提供参考依据.方法 选用Pub Med数据库,检索2010年-2020年患者授权教育相关文献,将文献的主要主题词导入书目共现分析系统(bibliographic items co-occurrence matrix builder,BICOMB)软件进行文献计量学分析,得到高频主题词,形成主题词词篇矩阵、共现矩阵,采用g CLUTO软件进行双聚类分析和可视化分析.结果 最终纳入954篇文献,提取28个高频主要主题词-副主题词;文献计量显示,患者授权教育研究文献量逐年增长.双聚类分析、可视化矩阵显示,近10年该领域研究热点共7个,分别为远程医疗、互联网+健康教育、医患关系、依从性与生活质量、慢性病患者参与决策、电子医疗档案和自我照护.结论 患者授权教育研究处于良好发展态势.研究热点主要集中远程医疗、互联网+健康教育,涉及医患关系、依从性与生活质量、患者参与决策、自我照护,今后可以为研究的切入点,完善、优化患者授权教育研究的内容与质量,以提升患者授权教育的质量.

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.

Objective:To explore whether the action research on the pre-service training evaluation system of "Internet + TCM Nursing" guided by CIPP (context, input, process and product) and Kirkpatrick Model can improve the training effect of nursing staff under the background of internet and TCM nursing service.Methods:Taking 211 nurses of "Internet + TCM Nursing" in Guangdong Provincial Hospital of TCM from 2019 to 2020 as the research objects, action teams were made, and the data were collected and analyzed by various methods. According to the collected data, the action teams constructed the training scheme of "Internet + TCM Nursing", the compilation requirements of "internet + TCM Nursing", the case optimization scheme of "internet + TCM Nursing" process, and the evaluation model of "internet + TCM Nursing". After the training, the nurses' knowledge, skills and related attitudes, the general reaction and feelings to the training programs, and the evaluation of nurses' work performance by the competent leaders, medical staff and clients were compared by comparing their scores and issuing self-made questionnaires. SPSS 20.0 software was used for statistical analysis.Results:The results showed that the theoretical scores of nurses after training were (85.16±6.22) points, and the case assessment scores after training [(81.22±7.03) points] were higher than the previous theoretical scores [(61.23±12.90) points] and the case assessment scores [(59.54±14.41) points], with statistical significance ( P<0.001). The results of self-made questionnaire showed that there were significant differences in theoretical knowledge, skills and related attitudes among nurses after training ( P<0.001). In the process of training, there were statistically significant differences in training content, teacher training, training implementation and training guarantee at the end of training ( P<0.001). After training, there were significant differences in the evaluation of nurses' job performance by leaders in charge, medical staff and clients improved in knowledge and skills, professional ethics, working process and learning ability, and the improvement rate ( P<0.001). Conclusion:Action research is an effective research method to continuously improve nursing training. The optimization scheme of "internet + TCM Nursing" nurses based on CIPP and Kirkpatrick Model through action research can effectively improve the training effect.

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 understand the demand and status of the patients with chronic diseases in The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine for standardized health education service, and to provide the basis for the development of the standardized health education service process of chronic diseases of traditional Chinese medicine.Methods:From March to May, 2020, 162 patients treated at Chronic Disease Management Center of The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine were investigated by using Questionnaire of Standardized Health Education Service Needs of Traditional Chinese Medicine. Among which, there were 86 males and 76 females, and 10 cases were ≤30 years old, 25 cases 31-40, 27 cases 41-50, 38 cases 51-60, and 62 cases ＞60. The patients' main knowledge of chronic diseases, health education, and demand level were mainly understood. Results:One hundred and sixty-two questionnaires were collected; 82.7% (134/162) of them were from Guangdong Province; and the chronic diseases were mainly nephrotic diseases (48.8%, 79/162), followed by chronic respiratory diseases (43.2%, 70/162); and 92.6% (150/162) of the patients received health education and management of The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The patients who were over 30 years old, whose education level was high, and who did not have a fulltime job had higher scores of the disease knowledge (all P＜0.05). The patients received health education mainly in the forms of offline (71.0%, 115/162) and online (68.5%, 111/162). The demand for offline health education was mainly in classroom (67.3%, 109/162). The online health education was mainly based on articles of WeChat official accounts (74.7%, 121/162), mobile videos (73.5%, 119/162), and WeChat consulting (60.5%, 98/162). The top three health consultation contents demanded by the patients were disease knowledge, diet nutrition, and medication knowledge. The types of health demand of the patients were different in gender, education level, and care type (all P＜0.05). Conclusions:Health education service for patients with chronic diseases needs to carry out various forms of health education service activities, and to formulate diversified and targeted health education programs for patients with different group characteristics to meet their health education demand. At the same time, it provides references for standardizing the health education service process of chronic diseases of traditional Chinese medicine.

慢性肾脏病( chronic kidney disease,CKD)是一个全球性的健康问题[1].研究表明:机体活动量减少是CKD发病和疾病进展的独立危险因素[2].督促CKD患者进行科学合理的运动锻炼,有利于稳定血压,改善血脂,改善睡眠,减轻机体的免疫炎性反应,同时也有助于减少肾病患者的全因死亡率[3].因此,了解CKD患者运动习惯及活动水平现状,为肾病患者探索科学运动处方,提供必要的研究基础和理论依据.故而,本研究就广东省中医院肾病慢病管理中心的241 例门诊 CKD 患者,展开横断面调查,现将结果汇报如下[1].

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 探讨基于自我管理的5A模式随访对缺血性脑卒中支架成形术后患者服药依从性、自我效能及日常生活活动能力的影响.方法 将2015年10月至2016年12月纳入的缺血性脑卒中支架成形术患者50例作为对照组,出院后行普通门诊管理;2017年1月至2018年1月50例患者作为观察组,行5A模式随访管理.应用Morisky服药依从性量表、一般自我效能感量表和Bar-thel指数(BI评分)分别于出院时、出院后6个月、12个月对患者进行评分.结果 两组服药依从性、自我效能感及BI评分的组间效应、时间效应及交互效应差异有统计学意义(均P＜0.01).结论 基于自我管理的5A模式随访能提高缺血性脑卒中支架成形术后患者日常生活活动能力,维持患者较好的服药依从性,增强患者的自我效能感.

Standard is the basis of quality management and quality control.There are few reports on medical standards in China.We will report the whole standard-setting process of and focus on the key of nursing service in the ward of our hospital.We drew lessons from advanced standards,guidelines and norms,organizing expert consensus,and combination with clinical practice.This paper tries to build a comprehensive standardsetting system for the whole process of hospitalization nursing for patients.

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.

目的:探讨经络拍打操对伴有焦虑、抑郁的原发性高血压病患者心理状态、动态血压及生活质量的影响,为中医外治法改善高血压患者的生活质量、心理状态和血压提供理论依据. 方法:选择2013年6月~2015年7月来我院进行治疗的伴有焦虑、抑郁原发性高血压病患者60例作为研究对象,将其随机等分为观察组和对照组,所有患者均进行常规抗高血压治疗,观察组在此基础上进行经络拍打.对比分析两组患者的血压状况、心理状况、生活质量和治疗满意度.结果:治疗后观察组患者的收缩压和舒张压明显低于对照组(P<0.05),而脉压差高于对照组(P<0.05).治疗后观察组患者的焦虑、抑郁得分均明显低于对照组(P<0.05).观察组患者在躯体活动功能、躯体功能对角色功能的影响、疼痛、健康总体评价、活力、社会功能、情绪对角色功能的影响、心理功能等方面的得分均高于对照组(P<0.05).观察组患者对治疗的总体满意度明显高于对照组(P<0.05). 结论:将经络拍打操应用于伴有焦虑、抑郁的原发性高血压病患者的治疗中,能够更好的降低血压,改善患者的心理状态,提高患者的生活质量和患者满意度.

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:观察石决牡蛎汤治疗难治性高血压的临床疗效.方法:难治性高血压患者98例,随机分为治疗组和对照组.对照组给予氯沙坦钾片,苯磺酸氨氯地平片治疗;治疗组在对照组治疗基础上给予石决牡蛎汤治疗.疗程为12周.记录2组治疗前后的血压、中医证候,同时检测治疗前后患者的生化指标[总胆固醇(TC)、甘油三脂(TG)、肌酐(Scr),血尿酸(UA)]水平.结果:治疗后治疗组血压控制疗效优于对照组,差异有统计学意义(P＜0.05).治疗后治疗组中医症状控制疗效优于对照组,差异有统计学意义(P＜0.05);2组治疗前TC、TG、SCr、UA比较,差异无统计学意义(P＞0.05).治疗后2组TC、TG、SCr、UA水平均较治疗前降低,与本组治疗前比较,差异有统计学意义(P＜0.05);治疗后治疗组TC、TG、SCr、UA均低于对照组,与对照组比较,差异有统计学意义(P＜0.05).结论:石决牡蛎汤治疗难治性高血压与单纯西药降压比较,其降压过程平稳,安全性高.

目的:观察运用子午流注择时中药浴足改善肝火亢盛型高血压病效果.方法:将肝火亢盛型高血压患者60例随机分为2组各30例.对照组选择晨起、下午或晚上睡前进行中药沐足;观察组固定在午时(11:00～13:00)给予中药足浴.观察2组治疗前后血压、中医症状评分情况.结果:治疗1周后,2组血压均较前下降,治疗前后比较,差异有显著性或非常显著性意义(P＜ 0.05,P＜ 0.01);2组间比较,差异有显著性意义(P＜0.05).观察组血压改善情况优于对照组.2组头晕、心痛、心悸胸闷、纳差、眠差、口干口苦治疗前后比较,差异均有非常显著性意义(P＜0.01).观察组头晕、心悸胸闷、纳差、眠差、口干口苦与对照组比较,差异有显著性意义(P＜0.05).结论:运用子午流注指导中药沐足可有效降低肝火亢盛型高血压痛患者的血压,并改善临床症状.

目的:观察复脉颗粒治疗房颤的疗效及对房颤患者心房重构的影响.方法:将符合纳入标准的61例房颤患者随机分为2组,对照组30例予常规治疗,治疗组31例在对照组基础上予口服复脉颗粒治疗.分别在治疗前与治疗4周后,记录2组患者B型尿钠肽(BNP)、C-反应蛋白(CRP)、基质金属蛋白酶9(MMP-9)、基质金属蛋白酶抑制因子1(TIMP-1);心房内径(LAD)、射血分数(EF);临床症状的变化,并初步探讨复脉颗粒的作用机理,同时观察2组患者治疗期间的不良反应.结果:治疗组治疗前后平均心室率、BNP、MMP-9、TIMP-1、CRP组内比较,差异均有显著性意义(P＜0.05).上述指标2组治疗后比较,差异也有显著性意义(P＜0.05).2组治疗前后心悸、胸闷、气短、乏力、头晕等中医症状体征积分组内比较,差异均有显著性意义(P＜0.05).2组治疗后比较,差异也有显著性意义(P＜0.05).证候疗效治疗组总有效率为90.32％,对照组为66.67％,2组比较,差异有显著性意义(P＜0.05).在观察过程中,治疗组无不良反应的证据;对照组2例患者出现恶心、腹泻,未予处理,症状消失.结论:复脉颗粒治疗房颤疗效肯定,且无明显毒副反应.

目的 客观评价耳疗联合自我管理对高血压病患者血压和中医临床症状的影响.方法 将199例高血压患者随机分为试验组99例和对照组100例,对照组施行常规治疗,试验组在对照组的基础上实施耳疗联合自我管理,疗程20周,以血压动态变化和中医临床症状积分变化进行疗效评价.结果 试验组经干预后,在收缩压和舒张压方面,随疗程变化,与对照组比较,差异均有统计学意义(P＜0.05);中医临床症状方面,试验组与对照组比较,差异也均有统计学意义(P＜0.05).结论 耳疗联合自我管理,能降低血压,改善患者中医临床症状,提高其生存质量.

目的观察庆大霉素湿敷加红外线照射治疗永久性心脏起搏器植入术后囊袋血肿的疗效并探讨其原因。方法对我科5例植入起搏器后发生囊袋血肿的患者采用庆大霉素湿敷加红外线照射。结果 5例囊袋血肿均消退且无感染发生。结论庆大霉素湿敷加红外线照射可以有效治疗永久性心脏起搏器植入术后囊袋血肿及预防感染。