自2022年3月以来,因新型冠状病毒(新冠)奥密克戎毒株传播快、潜伏期短、隐匿性强致上海市短时间内多点出现疫情,感染人数显著增加.我院作为上海市新冠肺炎后备定点医院承担特殊时期新冠感染患者的救治任务.本研究基于全面质量管理理论"4M1E"法制定的整建制转化方案,使医院在接到上级指令后,迅速、高效完成整体转化,有序收治患者.现将整建制转化方案及实践经验报道以供参考.

Objective:To study the effect of high flow humidification oxygen inhalation on hypoxemia in patients undergoing cardiac surgery and the effect of postoperative weaning time.Methods:A total of 80 patients with hypoxemia after cardiac surgery from January 2018 to January 2020 were selected for the study, according to the random number table, they were divided into the observation group and the control group, 40 cases each.The control group was treated with noninvasive positive pressure ventilation, while the observation group was treated with high flow humidification and oxygen absorption. The weaning time, the changes of the arterial oxygen partial pressure (PaO 2), partial pressure of carbon dioxide (PaCO 2), oxygenation index (PaO 2/FiO 2), pH value, spontaneous breathing frequency (RR), heart rate before and after treatment 2 h, 6 h, 24 h, and the incidence of complications were compared between the two groups. Results:The weaning time in the observation group was (35.51±4.61) h, and that in the control group was (44.04±3.85) h, the difference was statistically significant( t value was 8.982, P<0.01). The PaO 2 in the observation group at 2, 6, 24 h after treatment were (73.96±4.32), (79.82±3.61), (94.82±2.71) mmHg(1 mmHg=0.133 kPa), and those in the control group were (70.72±3.10), (75.63±3.88), (90.27±3.55) mmHg, the differences were statistically significant( t values were 3.854, 5.000, 6.443, P<0.01). The PaO 2/FiO 2 in the observation group at 2, 6, 24 h after treatment were (239.45±18.74), (269.85±20.09), (291.83±17.30) mmHg, and those in the control group were (226.74±20.72), (251.12±16.74), (279.65±19.40) mmHg, the differences were statistically significant( t values were 2.877, 4.530, 2.964, P<0.01). The RR in the observation group at 2, 6, 24 h after treatment were (24.74±2.03), (22.61±1.86), (18.63±2.05) times/min, and those in the control group were (26.07±1.89), (24.24±1.73), (20.11±1.87) times/min, the differences were statistically significant( t values were 3.033, 4.058, 3.373, P<0.01). The heart rate in the observation group at 2, 6, 24 h after treatment were (83.32±4.88), (76.06±4.71), (70.34±3.82) times/min, and those in the control group were (86.06±3.29), (80.91±4.31), (75.71±6.22) times/min, the differences were statistically significant( t values were 2.944, 4.805, 4.653, P<0.01). The total incidence of complications in the observation group was 7.50%(3/40), and that in the control group was 25.00%(10/40), the difference was statistically significant( χ 2 value was 4.501, P<0.05). Conclusions:High flow humidification and oxygen absorption is well for patients with hypoxemia after cardiac surgery, which effectively improve the blood gas index, shorten the weaning time, reduce the incidence of complications, and have good safety, which is worth popularizing.

目的 了解临床护士团队心理安全、职业应对效能感现状,分析两者间的关系.方法 采用团队心理安全气氛量表、护士职业应对自我效能感量表对2 988名临床护士进行问卷调查.结果 临床护士团队心理安全气氛、职业应对效能感得分分别为(60.12±6.57)、(33.60±7.93)分,两者呈正相关(P＜0.05).结论 临床护士团队心理安全气氛、职业应对效能感得分偏低;团队心理安全感越高,临床护士的职业应对效能感越高.需采取措施提高其心理安全感及职业应对效能.

目的：探讨循证护理对心脏手术体外循环患者术后并发症及生活质量的影响。方法选取我院2014年12月至2015年4月收治的需进行体外循环手术的心脏病患者80例，随机分为观察组和对照组各40例，对照组术后给予常规护理，观察组在对照组的基础上为预防术后并发症实施循证护理，比较两组患者术后并发症的发生情况及出院前的生活质量。结果观察组术后的早期并发症、呼吸机相关性肺炎(VAP)、神经系统并发症、腹部并发症的发生率均低于对照组，差异有统计学意义(P<0.05)。观察组出院前在睡眠状态、躯体感觉、精神状态等生活质量评分均高于对照组，差异有统计学意义(P<0.05)。结论循证护理以科学为实证，结合临床护理经验能够减少心脏手术体外循环患者的术后并发症，提高患者的生活质量。