Objective:To explore the application effect of flipped classroom teaching model in hemodialysis clinical nursing practice teaching, so as to lay a foundation for improving and promoting this teaching model.Methods:A total of 60 nursing students in this hospital from July 2020 to April 2021 were selected as the research objects and divided into control group and observation group.The control group adopted the traditional teaching mode, the observation group used the flip classroom teaching mode.At the end of the internship, theoretical examination and practical skills assessment will be conducted.Questionnaires about teaching effect and satisfaction were distributed and collected.SPSS 22.0 was used for statistical analysis of the assessment and the questionnaires results.Results:The scores of theoretical assessment and practical operation evaluation in the observation group were significantly higher than those in the control group ( P<0.05), and the difference of scores distribution between the two groups was statistically significant ( P<0.05). The observation group was higher than the control group in stimulating learning interest, improving learning consciousness, enhancing theoretical level, improving nursing skills and enhancing teacher-student interaction, and the differences between groups were statistically significant ( P<0.05). The total satisfaction of the observation group was 90%, and the total satisfaction of the control group was 76.67%.The distribution (frequency) of satisfaction evaluation between the two groups was significantly different ( P<0.05). Conclusions:The flipped classroom teaching model has a good effect on nursing practice teaching and can significantly improve the comprehensive ability of nursing students.Students′ satisfaction with practice teaching has been significantly improved, so it has a certain value of promotion and application.

目的 探讨常规血液透析(HD)、高通量血液透析(HFHD)、组合型人工肾对慢性肾功能衰竭(CRF)患者血清成纤维细胞生长因子 23(FGF23)、β2-微球蛋白(β2-MG)、瘦素以及骨代谢指标的影响.方法 选择 2019 年 1 月至 2020 年 1 月河南科技大学第一附属医院收治的 105 例CRF患者,随机数字表法分为 3 组,每组各 35 例,分别采用HD(HD组)、HFHD(HFHD组)、组合型人工肾(人工肾组)治疗.比较 3 组治疗前、治疗 6 个月(治疗后)肾功能、钙磷代谢以及血清FGF23、β2-MG、瘦素及骨代谢指标的差异.结果 人工肾组、HFHD组治疗后尿素氮(BUN)、血肌酐(SCr)、尿白蛋白排泄率(UAER)、P3-、甲状旁腺激素(PTH)、FGF23、β2-MG、瘦素、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平均明显下降(P＜0.05),Ca2+、骨碱性磷酸酶(B-ALP)、Ⅰ型前胶原氨基端前肽(PINP)明显上升(P＜0.05),HD组治疗后BUN、SCr、UAER降低(P＜0.05),其它指标无明显变化(P＞0.05).人工肾组治疗后BUN、SCr、UAER、P3-、PTH、FGF23、β2-MG、瘦素、β-CTX水平低于HFHD组和HD组(P＜0.05),Ca2+、B-ALP、PINP高于HFHD组和HD组(P＜0.05).HFHD组治疗后BUN、SCr、UAER、P3-、PTH、FGF23、β2-MG、瘦素、β-CTX水平低于HD组(P＜0.05),Ca2+、B-ALP、PINP 高于HD 组(P＜0.05).结论 组合型人工肾更有助于清除FGF23、β2-MG、瘦素,改善CRF患者钙磷代谢、肾功能和骨代谢.

目的 探讨求助者中心疗法对血液透析患者心理危机及应对方式的影响.方法 将90例血液透析患者按随机数字表法分为两组,每组45例.对照组予以常规护理干预,观察组在对照组基础上予以求助者中心疗法,观察3个月.干预前后采用症状自评量表评定心理状态,医学应对问卷评定应对方式,社会支持评定量表评定社会支持度,生存质量量表评定生存质量纽卡斯尔护理满意度量表评定护理满意度.结果 干预后观察组症状自评量表躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性及其他因子评分均显著低于对照组(P<0.01);医学应对问卷屈服、回避维度评分均显著低于对照组(P<0.01),面对维度评分显著高于对照组(P<0.01);社会支持评定量表主观支持、客观支持、支持利用度评分均显著高于对照组(P<0.01);生存质量量表生理领域、社会关系领域、心理领域维度评分均显著高于对照组(P<0.05).观察组护理满意率(93.3％)显著高于对照组(71.1％)(P<0.01).结论 求助者中心疗法应用于血液透析患者,可缓解或消除心理危机,增强社会适应能力,建立积极应对方式,改善生存质量,提高护理满意度.

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