目的 探讨延续性4C管理模式护理干预对老年高血压患者治疗依从性、自我护理能力、情绪及生活质量的影响.方法 将151例老年高血压患者按入院时间分为两组,对照组(75例)予以常规护理干预,研究组(76例)在对照组基础上联合延续性4C管理模式护理干预,观察3个月.比较两组治疗依从性、护理满意度、血压控制达标率及干预前后正性负性情绪量表、自我护理能力测定量表、社会功能缺陷筛选量表、杜氏高血压生活质量量表评分.结果 研究组治疗总依从率、护理总满意率显著高于对照组(P<0.05或0.01).干预1个月、3个月末研究组正性负性情绪量表的正性情绪评分显著高于对照组(P<0.01),负性情绪评分低于对照组(P<0.01),自我护理能力测定量表的健康知识水平、自我护理技能、自护责任感、自我概念维度评分及血压控制达标率显著高于对照组(P<0.01),社会功能缺陷筛选量表、杜氏高血压生活质量量表评分显著低于对照组(P<0.01).结论 延续性4C管理模式护理干预能显著改善老年高血压患者治疗依从性、情绪及自我护理能力,提高其血压控制达标率、生活质量及护理满意度.

目的:探讨电话随访式延续性护理对慢性心力衰竭患者心理状态、自我效能及生活质量的影响。方法:选取2017年9月至2018年9月该院收治的慢性心力衰竭患者82例，随机分为对照组(41例，给予常规护理)与观察组(41例，在对照组基础上给予电话随访式延续性护理)。记录并比较两组患者护理前后心理状态(HAMD、HAMA评分)、自我效能评分及生活质量量表(GQOLI-74)评分。结果:护理后两组患者HAMD、HAMA评分均明显降低，护理后观察组患者HAMD、HAMA均明显低于对照组，技能、内心活动以及自我效能总评分均分别明显高于对照组，心理功能、物质功能、社会功能均分别明显高于对照组，差异均有统计学意义(均 P<0.05)。 结论:对慢性心力衰竭患者给予电话随访式延续性护理可明显改善患者心理状态、提升患者自我效能及生活质量，值得推广应用。

Objective:To explore the application of attributional training in postoperative emotion management of patients with non-small cell lung cancer (NSCLC) .Methods:Using the convenient sampling method, a total of 128 NSCLC patients after surgery who were admitted to the First Affiliated Hospital of Zhengzhou University from August 2017 to July 2019 were selected as research objects. A total of 64 NSCLC patients after surgery who were enrolled from August 2017 to July 2018 were set as the control group, and the other 64 NSCLC patients after surgery who were enrolled from August 2018 to July 2019 were set as the observation group. Patients in the control group were given routine nursing while patients in the observation group were given attribution training based on routine nursing. Attribution Style Questionnaire (ASQ) , Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Cancer Therapy-Lung Cancer (FACT-L4) were used to evaluate the effect of intervention.Results:After intervention, the total ASQ score of the observation group was higher than that of the control group, and the difference was statistically significant ( P<0.01) . After intervention, the scores of anxiety and depression dimensions in HADS of the observation group were lower than those of the control group, and the differences were statistically significant ( P<0.01) . After intervention, the total score and scores of all dimensions of FACT-L4.0 of the observation group were all higher than those of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:Attribution training can help postoperative NSCLC patients to establish positive attribution styles, effectively alleviate their negative emotions and improve their quality of life.

Objective To investigate the effect of anal sphincter training combined with manual protection to reduce the risk of obstetric anal sphincter rupture. Methods Totally 720 primipara were randomly divided into two groups by random number table method, with 360 cases in each group. The control group was given manual protection during midwifery. The observation group was given anal sphincter training before delivery and manual protection during midwifery. Postpartum anal pressure (anal resting pressure, anal systolic pressure), rectal pressure (rectal resting pressure, rectal defecation pressure) were measured. The incidence of postpartum anal incontinence (gas incontinence, liquid fecal incontinence, and solid fecal incontinence), defecation (urgent defecation, anal pain during defecation, pushing rectal defecation, protrusion of anal canal after defecation) and rupture of anal sphincter were recorded. Results Postpartum rectal resting pressure and rectal defecation pressure were (4.50±0.44) and (65.41±10.66) mmHg (1 mmHg=0.133 kPa) in the observation group and (5.68±0.61) and (56.75± 9.83) mmHg in the control group, respectively. There were significant differences between the two groups (t=6.011, 8.027, P<0.01). The incidence of postpartum gas incontinence, liquid fecal incontinence and solid fecal incontinence were 2.22% (8/360), 0.56% (2/360) and 0.56% (2/360) respectively in the control group and 0.56% (2/360) in the observation group. The incidence of postpartum gas incontinence, liquid fecal incontinence and solid fecal incontinence were 0.56% (2/360), 0.27% (1/360) and 0.27% (1/360), respectively. There were significant differences between the two groups ( χ2=4.120, P<0.05). The incidences of postpartum urgency, anal pain, pushing and pressing rectal defecation and anal canal prolapse were 3.33% (12/360), 3.89% (14/360), 3.89% (14/360), 3.89% (14/360), 1.11% (4/360) in the control group and 1.67% (6/360), 2.22% (8/360), 1.67% (6/360) and 0.56% (2/360) in the observation group, respectively ( χ2=5.101, P<0.01). The incidence of rupture of anal sphincter was 0.56% (2/360) in the observation group and 3.33% (12/360) in the control group. There was significant difference between the two groups ( χ2=5.887, P<0.05). Conclusion Anterior anal sphincter training combined with manual protection during midwifery can effectively reduce the risk of anal sphincter rupture and protect the rectal and anal functions of pregnant women.

目的:观察沙库巴曲缬沙坦对左心疾病相关性肺动脉高压(PH-LHD)患者的临床症状及血浆内皮素-1(ET-1)和血清可溶性细胞间粘附因子-1(sICAM-1)及人可溶性CD40配体(sCD40L)水平的影响,探讨沙库巴曲缬沙坦治疗PH-LHD的临床疗效及机制.方法:选取60例心力衰竭合并肺动脉高压的患者随机分为对照组和观察组,每组30例.对照组在一般治疗(吸氧、利尿、扩血管)的基础上给予缬沙坦80 mg,1次/d.观察组在一般治疗的基础上,加用50 mg沙库巴曲缬沙坦,2次/d持续口服.比较两组患者治疗前和治疗90 d的6 min步行距离(6MWD)、肺动脉高压功能分级以及通过超声心动图检测左室舒张末内径(LVEDD)、右室舒张末内径(RVEDD)、左房内径(LAD)、三尖瓣反流速率(TRV)、左心室射血分数(LVEF)、肺动脉收缩压(PASP).用酶联免疫吸附法测定治疗前和治疗后90 d的血浆N末端前脑钠肽(NT-proBNP)、ET-1及血清sICAM-1、sCD40L的水平.结果:治疗后,两组患者肺动脉高压功能分级均优于治疗前,观察组差异具有统计学意义(P＜0.05),对照组差异无统计学意义(P＞0.05);两组患者6 min步行距离、心脏彩超相关指标均优于治疗前,差异具有统计学意义(P＜0.05),血浆NT-proBNP和ET-1及血清sICAM-1和sCD40L水平较治疗前降低,差异具有统计学意义(P＜0.05);与对照组相比,观察组的6 min步行距离的差值、肺动脉高压功能分级、心脏彩超相关指标改善更加显著,血浆NT-proBNP和ET-1及血清sICAM-1和sCD40L水平降低的程度更加明显,差异具有统计学意义(P＜0.05).结论:沙库巴曲缬沙坦可以更加有效地降低左心衰患者的肺动脉收缩压以及血ET-1、sICAM-1和sCD40L的水平,缓解临床症状,改善预后.

目的 观察重组人脑利钠肽(rhBNP)对心力衰竭患者血浆基质金属蛋白酶(MMP-2)和转化生长因子-β1 (TGF-β1)水平的影响,评价rhBNP治疗心力衰竭的疗效并初步探索其抗心肌纤维化的作用机制.方法 选取2017年4月至2018年4月郑州大学第一附属医院收治的40例心功能Ⅳ级患者,随机分为rhBNP治疗组和对照组,每组20例.两组均按照美国心脏病学会发布的2017年心力衰竭的管理指南给予抗心衰药物治疗,rhBNP治疗组在对照组治疗的基础上加用重组人脑利钠肽(rhBNP)静脉泵注.用心脏彩超分别测定两组患者治疗前及停药后第7和第30 d的左室舒张末期内径(LVEDD)、每搏量(SV)以及左室射血分数(LVEF).用酶联免疫分析法分别测定2组治疗前和停止用药后第7和第30 d血浆MMP-2和TGF-β1水平的变化.结果 患者治疗后的LVEDD、LVEF、SV及血浆MMP-2和TGF-β1水平较治疗前均明显改善,差异具有统计学意义(P ＜0.001).rhBNP治疗组疗效明显优于对照组,且疗效持续时间更长,差异具有统计学意义(P＜0.001).结论 rhBNP治疗心力衰竭疗效显著而持久,其机制可能与rhBNP抑制MMP-2和TGF-β1的水平,改善心肌纤维化,延缓心力衰竭心室重构的发生发展有关.

目的 探讨激励教学法在临床心血管内科护理教学中的作用及效果.方法 将60名在我科实习的护理实习生采用整体随机分组法分为试验组(激励教学组)和对照组(传统教学组),每组30名.对两组护理实习生的考核成绩、科室评分、学生互评、综合素质、满意度及护生对导师评价结果 进行比较.结果 试验组理论考核成绩、技能考核成绩、科室评分、学生互评、综合素质及满意度评分均高于对照组,差异有统计学意义(P<0.05).结论 激励教学法在临床护理教学中效果理想,可以提高教学质量,值得推广.

目的 观察和分析在急性心肌梗死(AMI)患者的护理工作中应用聚焦解决模式的临床应用价值.方法 选取我院2013年3月-2015年3月间收治的80例AMI患者作为临床研究对象,使用随机列表法将其随机分成研究组(n=40)和对照组(n=40).对照组患者采用常规护理服务,研究组患者在对照组的护理基础上加用聚焦解决模式进行干预.观察两组患者的护理效果.结果 经护理干预后,研究组患者在疾病基础知识掌握、遵医情况、护理满意度及自我护理能力等方面均明显优于对照组,差异有统计学意义(P＜0.05).结论 聚焦解决模式在AMI患者护理工作中具有良好的临床应用价值,值得临床进一步推广应用.