本文总结1例耳穴压丸联合耳灸器灸法治疗耳石症复位后残余头晕患者的护理经验。在常规治疗护理的基础上，对患者进行护理评估，为患者实施了个体化的中医技术操作—耳灸器灸法联合耳穴压丸疗法，对患者头晕残余症状、睡眠质量、焦虑状态进行干预，中医治疗后患者的残余头晕症状、睡眠质量、焦虑状态得到了明显的改善，眩晕障碍量表（DHI）、匹兹堡睡眠质量指数量表（PSQI）、汉密尔顿焦虑量表（HAMA）分值均下降明显，耳穴压丸联合耳灸器灸法以中医理论为基础，有温通经脉、扶正祛邪、促进气血津液运行，濡养脑髓，可改善患者的预后，加速患者的康复进程，改善患者的焦虑状，提高患者的生活质量。

A diversified training mode including physician-nurse cooperation ward round based on “One Syndrome and One Product”, “one-to-one ” plan, video-assisted mode is effective to improve the enthusiasm of professional learning of nurses, and comprehensively improve the professional skills and comprehensive abilities of specialized nurses. Based on the “One Syndrome and One Product” project, Innovation and practice of professional training were made to improve the enthusiasm of professional learning of nurses, enhance understanding the nature of the specialized nursing care, improve quality of Traditional Chinese Medicine nursing, provide professional and standardized nursing service, reflect the professional values of nurses, build a service brand with Traditional Chinese Medicine specialized nursing techniques.

Objective To explore the rehabilitation effect of Traditional Chinese Medicine (TCM) ointment and rubbing technique on motor function in patients with hemiplegia in recovery stage of stroke. Methods Totally 60 patients with hemiplegia in recovery stage of stroke were randomly divided into observation group and control group, with 30 cases in each group. The observation group received TCM ointment and rubbing technique on the basis of routine treatment and care; while the control group only received routine treatment and care. After 2 weeks of intervention, the motor function and living ability were assessed and compared between two groups. Results After 2 weeks of intervention, the scores of motor function evaluation scale (MAS) and Barther Index (ADL) increased in both two groups, and scores in the observation group were significantly higher than those in the control groups , with a significant differnce (P＜0. 05) . Conclusion TCM ointment and rubbing technique can promote the recovery of motor function and quality of life in patients with hemiplegia after stroke.

目的 探讨中药水罐联合常规康复训练治疗中风后肩手综合征的临床疗效.方法 选择在北京中医药大学东直门医院脑病二科收治的96例中风恢复期存在肩手综合征患者,依据随机信封分为水罐组和对照组,水罐组在对照组常规康复训练及治疗的基础上,加用中药水罐治疗,20 min/次,每日1次,连续治疗14 d;以简化的Fugl-Meyer运动功能评定量表(FMA)评价患者上肢运动功能和视觉类比评分量表评(VAS)价患肢疼痛作为主要疗效指标,生活质量评分(SS-QOL)和治疗满意度为次要疗效指标评价治疗前后两组的疗效及满意度.结果 与本组治疗前比较,两组FMA和SS-QOL评分均有提高(P<0.01),VAS评分降低(P<0.01).与对照组比较,水罐组在治疗2周后FMA和SS-QOL评分均有提高(P<0.01),VAS评分降低(P<0.01).水罐组的患者满意度高于对照组,但差异无统计学意义(P>0.05).结论 中药水罐在治疗中风后肩手综合征的疗效确切,方法简便易行,患者依从性与满意度良好,适宜临床推广应用.

目的利用meta分析方法评价卒中急性期NIHSS评分与卒中后抑郁（post-stroke depression,PSD）发生的相关性,为临床防治PSD提供证据。方法计算机检索PubMed、中国知网、万方数据知识服务平台及维普数据库,搜集建库至2019年10月有关PSD与神经功能评分关系的病例对照研究,纳入符合标准的文献,由2名研究人员独立筛选文献、提取有效数据资料,并根据纽卡斯尔-渥太华量表进行质量评估。应用ReviewManager5.3软件对各研究中的原始数据进行统计,根据纳入研究的异质性检验结果选用固定效应模型或随机效应模型进行合并效应量分析。结果共纳入15篇文献,共计3050例研究对象,其中PSD组1157例,非PSD组1893例。整体meta分析结果显示:PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 0.92,95%CI 0.48～1.37,P＜0.01）。亚组分析结果显示:（1）以地域分组,在中国人群中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 0.81,95%CI 0.36～1.27,P＜0.01）;（2）以卒中是否首发分组,首发卒中人群中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 1.24,95%CI 0.82～1.67,P＜0.01）,再发卒中两组间NIHSS评分差异无统计学意义（MD-0.25,95%CI-1.53～1.03,P=0.70）;（3）以卒中类型分组,缺血性卒中PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 0.83,95%CI 0.38～1.29,P＜0.01）;（4）以PSD诊断时间分组,卒中1个月内诊断PSD的研究中,两组间NIHSS评分差异无统计学意义（MD 0.64,95%CI0.01～1.28,P=0.05）,卒中1个月以上诊断PSD的研究中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD1.29,95%CI 0.78～1.81,P＜0.01）;（5）根据NIHSS评估时间分组,在卒中后2周内进行NIHSS测评的研究中,PSD组NIHSS评分高于非PSD组,差异有统计学意义（MD 1.01,95%CI 0.62～1.41,P＜0.01）,在卒中后3～4周进行NIHSS测评的研究中,两组间NIHSS评分差异无统计学意义（MD 1.00,95%CI-0.96～2.96,P=0.32）。结论卒中急性期NIHSS评分与PSD的发生显著相关,NIHSS评分是影响PSD发生的重要危险因素,特别是在中国人群、首发卒中、缺血性卒中、卒中1个月后PSD及卒中发病2周内评估NIHSS的患者人群中。

Objective To investigate the effect of Traditional Chinese Medicine (TCM) ointment rubbing on in the treatment of hypermyotonia after cerebral infarction. Methods Totally 92 patients with hypermyotonia after cerebral infarction were selected and randomly divided into control group (n = 46) and treatment group (n = 46). Both groups were treated with basic medical treatment, acupuncture and moxibustion, physiotherapy, rehabilitation and other routine treatment for cerebral infarction, and the treatment group was treated with TCM ointment rubbing in addition to the comprehensive treatment. The two groups were treated for 2 months, and the modified Ashworth Scale of Muscle Spasticity (MMAS), NIHSS, Fugl-Meyer Assessment (FMA) and Barthel Activity of Daily Living Scale (BI) were compared before and after treatment and between the two groups. Results The score of NIHSS decreased in both treatment group and control group after intervention (P＜0. 05), and score of NIHSS in the treatment group was lower than that in the control group (P＜0. 05). Patients in the treatment group had a lower degree of MMAS compared with those in the control group after intervention(P＜0. 05). The scores of FMA and BI increased in both treatment group and control group after intervention (P＜0. 05), and scores of FMA and BI in the treatment group were higher than those in the control group (P＜0. 05). Conclusion TCM ointment rubbing is potentially effective to relieve the hypermyotonia of patients with cerebral infarction, improve limb function, and improve the activity of daily living.

Objective To investigate the effect of Traditional Chinese Medicine (TCM) nursing in prevention of pulmonary infection in patients with hypertensive cerebral hemorrhage. Methods Totally 120 patients with hypertensive cerebral hemorrhage were divided into control group (n = 60) and observation group (n = 60) according to different types of nursing care. Patients in the control group received routine care, and those in the observation group received TCM nursing on basis of routine care. The effective rate of nursing intervention between two groups was analyzed and compared. Results The total effective rate of nursing intervention in the observation group was higher than that in the control group (96. 67% vas. 73. 33%, P<0. 01). Conclusion In nursing management of patients with hypertensive cerebral hemorrhage, the TCM nursing intervention is potentially effective to prevent the pulmonary infection and improve the nursing efficiency.

Objective To investigate the effect of Shenfu injection in treating patients with acute internal watershed cerebral infarction. Methods Totally 154 patients with AIWCI admitted to the Department of Encephalopathy of Dongzhimen Hospital from October 2018 to October 2020 were divided into the experimental group (n=96)and the control group(n=58). All cases received a comprehensive treatment including anti-platelet aggregation, lowering blood lipid, regulating blood pressure, replenishing blood volume, improving microcirculation and protecting brain cells. Patients in the experimental group were additionally given Shenfu injection for 14 days as a course of treatment. Before and after treatment, the National Institutes of Health Stroke Scale (NIHSS) was used to score the neurological impairment, and transcranial doppler (TCD) was used to measure the blood flow velocity of the middle cerebral artery at the affected side. Results The blood flow velocity of middle cerebral artery in 2 groups was increased after treatment, and the experimental group had a better improvement in Peak systolic velocity (Vs) and end-diastolic flow velocity (Vd) compare with the control group(P<0. 01). The NIHSS score of the experimental group was lower than that of the control group after treatment (P＜0. 05). The overall response rate in the experimental group was higher than that of the control group(P＜0. 05). Conclusion Shenfu injection can significantly improve the blood flow velocity of the distal artery responsible for internal watershed cerebral infarction caused by middle cerebral artery stenosis, and reduce the severity of neurologic impairment.

Objective To observe the effect of Traditional Chinese Medicine (TCM)nursing intervention on vertigo in patients with acute stroke Methods Totally 80 acute stroke patients with vertigo were randomly divided into the observation group and control group, with 40 cases in each group. All patients received routine medication treatment and rehabilitation care. The routine TCM nursing interventions such as acupoint application and auricular point pressing therapy were conducted to relieve the symptom of vertigo among patients in both two groups, and an additional TCM intervention of massage therapy was carried out in the observation group. The intervention effect was evaluated at two weeks after intervention, and patient’s treatment compliance and satisfaction with TCM interventions were investigated. Results The overall effective rate of intervention in the observation group was higher than that in the control group (P<0. 05). Patients in the observation group had higher rate of compliance and higher degree of satisfaction with TCM nursing interventions compared with those in the control group (P<0. 05). Conclusion In addition to the routine TCM nursing, The TCM massage therapy is potentially effective to relieve the vertigo in patients with acute stroke and improve their treatment compliance and degree of satisfaction.

目的 探讨马应龙痔疮软膏治疗中风病后Ⅰ、Ⅱ期压疮的临床疗效.方法 选取2013年3月—2018年2月期间北京中医药大学东直门医院脑病科收治的中风病后Ⅰ、Ⅱ期压疮患者84例,根据随机数字表法分为干预组与对照组,每组各42例.干预组消毒或清创后予马应龙痔疮软膏治疗,对照组予利凡诺治疗.两组患者均连续治疗14 d后,以临床疗效中治愈率为主要疗效指标,以压疮愈合评价量表(Pressure ulcer scale for heal-ing,PUSH)、压疮愈合时间和治疗满意度为次要疗效指标评价治疗前后两组患者的疗效及满意度.结果 治疗后干预组治愈率为77.78％,对照组治愈率为52.83％,干预组优于对照组,两组比较,差异有统计学意义(P<0.05).治疗后两组中风后压疮患者PUSH量表评分均较治疗前明显降低,差异有统计学意义(P<0.01);且干预组治疗后PUSH量表评分明显低于对照组,两组比较,差异有统计学意义(P<0.01).治疗后干预组压疮创面愈合时间优于对照组,两组比较,差异有统计学意义(P<0.01).治疗后干预组满意率为97.62％,对照组满意率88.10％,干预组满意度明显高于对照组,两组比较,差异有统计学意义(P<0.01).结论 马应龙痔疮软膏在治疗中风后Ⅰ、Ⅱ期压疮的疗效确切,患者依从性与满意度良好,适宜临床推广应用.

Objective To investigate the effect of targeted nursing interventions for urine leakage after indwelling catheter placement in patients with cerebrovascular disease. Methods Totally 60 cerebrovascular disease patients with urine leakage after placement of indwelling catheter were divided into the observation group and control group, with 30 cases in each group. The control group received routine nursing, and observation group was given targeted nursing interventions in addition to routine management. The intervention efficacy and patients' satisfaction were evaluated and compared between two groups. Results The total effective rate in the observation group was significantly higher than that in the control group (96. 67% vs. 73. 33%, P＜0. 05). Satisfaction degree of patients in the observation group was higher than that of patients in the control group (P＜0. 05). Conclusion The targeted nursing intervention according to the causes of urine leakage was effective to leakage control and prevention of urinary tract infection in cerebrovascular disease patients with indwelling catheters .

目的 探讨案例教学法在中医护理专业教学实践中的应用效果.方法 选取在医院实习的120名学生作为研究对象,采用随机数字表法分为研究组和对照组,各60人.研究组在实习的过程中采用案例教学法,对照组采用传统的教学方法.比较2组出科成绩,匿名调查学生对中医护理技术掌握能力及学习主动性的情况.结果 研究组出科成绩总分高于对照组,差异有统计学意义(P＜0.05).研究组学生对中医护理技术掌握能力及学习主动性均优于对照组(P＜0.05).结论 案例教学法在中医护理教学方面有较明显的优势,能更好地满足临床护理教学需求.

目的 了解结肠镜检查前肠道准备度的现状并探讨其影响因素.方法 选取2018年11至2019年11月在北京市某三级甲等医院消化内镜中心行结肠镜检查的88例患者作为研究对象,收集其一般资料、肠道准备相关资料、患者满意度;肠镜检查过程中采用Boston肠道准备评分量表(BBPS)进行肠道清洁度评分.采用logistic回归分析肠道准备的影响因素.结果 患者肠道准备不合格发生率为23.86％.本研究结果显示,便秘史、穴位贴敷、服药方法正确与否、检查前末次排便性状是肠道准备的主要影响因素.结论 有便秘史、未进行穴位贴敷、服药方法不正确以及末次残渣样便对结肠镜检查具有重要影响.

目的 观察化湿通窍方辨证加味治疗耳石症复位后残余症状的临床疗效.方法 入组耳石复位后有残留症状患者60例,随机分为2组,每组各30例,治疗组予化湿通窍方颗粒剂,每次1袋,每日2次,对照组予甲磺酸倍他司汀片每次2片,每日3次;2组服药疗程均为2周,随访周期为半年.以2周时点头晕残留症状程度为主要评价指标(DARS量表、眩晕VAS评分),2周时点眩晕临床症候积分及半年时点复发率为次要评价指标.结果 与对照组相比,治疗组可改善耳石复位后残留症状,减轻眩晕程度,2周治疗后治疗组眩晕评定(DARS)量表评分、眩晕VAS评分、眩晕临床症候积分低于对照组(P<0.05);2组半年随访复发率比较,治疗组复发率6.67％,对照组复发率20.00％,但组间差异无统计学意义(P>0.05).结论 化湿通窍方辨证加减可减轻耳石复位后头晕残余症状及中医证候评分,但不能改善半年复发率.

目的 系统评价脑瘫患儿选择性脊神经后根切断术后进行康复训练的有效性,为术后康复护理提出可行性和合理化的建议和意见.方法 计算机检索PubMed、中国生物医学文献数据库、万方数据知识服务平台、中国知网、维普期刊资源整合服务平台等数据库中有关脑瘫患儿选择性脊神经后根切断术后进行康复训练的随机对照试验(RCT),检索时间限制为各数据库建库至2017年9月1日.由两位研究员按照纳入、排除标准分别独立对文献进行筛选并中提取资料,对纳入文献进行质量评价,利用Review Manger5.3分析软件进行统计学的Meta分析,并用GRADE Profiler 3.6.1软件进行GRADE评级.结果 最终纳入7篇原始研究文章,共644个病例.其中文献质量等级为A级的原始研究数量1篇,文献质量等级为B级的原始研究数量为4篇,质量等级为C级的原始研究数量为2篇.Meta分析结果显示:选择性脊神经后根切断术后进行康复训练能够提高患者的GMFM分数[MD=2.0,95％CI(0.42,3.57),P=0.04],经GRADE系统评级,证据体的质量为低等级别.结论 脑瘫患儿在选择性脊神经后根切断术后进行康复训练可以提高患儿的粗大运动功能评分(GMFM),提高患儿的肌张力与行走能力.但康复训练的具体方法各不相同,没有形成系统的体系,仍需大样本、多中心、高质量的研究对结果予以验证.

如今医患关系的维护成为良好医疗环境的关键,融洽的医患关系在医疗实践活动中起着至关重要的作用,因而如何建立良好的医患关系成为医疗工作者值得思考的问题,笔者认为拥有良好的医患沟通技巧以及与患者之间相互信任是促进建立良好的医患关系及现代和谐社会的重要组成部分.因此就医患关系现状,沟通与理解对建立良好的医患关系的重要作用及这一关系的发展前景展开讨论.