目的 探讨ICU专科护士心理资本、获益支持、工作倦怠的现状以及三者间的路径关系,并分析心理资本在获益支持和职业倦怠感之间是否存在中介作用.方法 采用获益目标回应感知量表、心理资本问卷、MBI-GS职业倦怠量表对江苏省273名ICU专科护士进行调查.结果 ICU专科护士心理资本得分(85.37±14.04)分.获益支持的4个维度(主动-建构回应、被动-建构回应、主动-破坏回应、被动-破坏回应)得分分别为(13.15±3.60)分、(13.59±3.03)分、(12.55±3.65)分、(12.00±3.43)分.工作倦怠得分(3.63±1.13)分.心理资本及各维度与主动-建构回应呈正相关(P<0.001),与被动-建构回应、主动-破坏回应、被动-破坏回应、工作倦怠总分呈负相关(P<0.01).工作倦怠及各维度与主动-建构回应呈负相关(P<0.001),与被动-建构回应、主动-破坏回应、被动-破坏回应呈正相关(P<0.001).多元逐步回归分析结果显示心理资本(P<0.01)和主动-建构回应(P<0.001)可以显著负相预测工作倦怠、被动-破坏回应可以显著正向预测工作倦怠(P<0.001).结构方程模型结果显示心理资本在主动-建构回应和职业倦怠感中起到部分中介作用(13％);心理资本在被动-破坏回应和职业倦怠中起到部分中介作用(17％).结论 研究证实了获益支持中不同的回应方式会对心理资本和职业倦怠感产生影响,重视积极事件的分享,以及对积极事件的正向反馈,对提升ICU专科护士的心理资本,降低职业倦怠感有积极意义.

目的 翻译获益目标回应感知量表,并检验该量表在中国护士群体中的信效度.方法 遵循Brislin模型对量表进行翻译,用中文版获益目标回应感知量表对南京市某三级甲等综合性医院的610名临床护士进行测试,检验其信效度,并进一步探讨其与生活满意度和积极与消极情感的关系.结果 获益目标回应感知量表共12个条目,探索性因子分析产生4个公因子,累计方差贡献率为85.085％,分别为主动-建构回应、被动-建构回应、主动-破坏回应、被动-破坏回应4个维度.量表内容效度为0.94;总量表Cronbach'sα 系数为0.881～0.911,重测信度为0.768～0.866.主动-建构回应与护士的生活满意度、正性情绪呈正相关(P<0.001);与负性情绪呈负相关(P<0.001).被动-建构回应、主动-破坏回应及被动-破坏回应分别与护士的生活满意度及正性情绪呈负相关(P<0.05,P<0.001);与负性情绪呈正相关(P<0.001).结论中文版获益目标回应感知量表具有良好的信效度,对于评价我国护士获益目标回应感知具有一定的应用价值.

目的 将口渴痛苦量表(TDS)翻译成中文版,并在维持性血液透析患者中进行信效度评价.方法 严格遵循量表的跨文化调试指南对源量表进行直译、回译和跨文化调试.选取在南京市第一医院血液净化中心进行维持性血液透析治疗的患者177例,使用中文版TDS量表和视觉模拟评分法(VAS)对患者进行调查,并评价中文版TDS量表的信度和效度.结果 中文版TDS量表各条目水平的内容效度指数为0.83～1.0,量表水平的平均内容效度指数为0.95;通过探索性因子分析提取出1个公因子,累积方差贡献率为48.909％;中文版TDS量表与VAS量表间的相关系数为0.798;中文版TDS量表的Cronbach's α系数为0.825,重测组内相关系数为0.86.结论 中文版TDS量表具有良好的信度和效度,可以作为维持性血液透析患者口渴痛苦程度的评估工具.

Objective? To explore the status quo of thirst in patients receiving cardiopulmonary bypass (CPB) during fasting and water deprivation after extubation and to analyze its influencing factors. Methods? Totally 120 patients undergoing CPB in a Class Ⅲ Grade A hospital in Nanjing from December 2017 to May 2018 were selected in this prospective study. The general information questionnaire was used to collect the data, and the patients' thirst score and unstimulated salivary flow rate (USF) were measured. SPSS 22.0 was used to analyze the factors affecting postoperative thirst in the patients. Results? The incidence rate of thirst in the CPB patients 6 h post extubation was 100%, and their thirst score was (6.20±1.90); and the patients' thirst intensified over time. Univariate analysis showed that the patients' postoperative thirst was positively correlated with postoperative body temperature, respiratory rate, serum sodium concentration and urinary volume (r=0.172, 0.105, 0.209, 0.258; P＜ 0.05), and negatively correlated with postoperative fluid balance volume and USF (r=-0.222, -0.565; P＜ 0.05). Multivariate analysis showed that USF and fluid balance volume were the main influencing factors to thirst in the patients (P＜0.05). Conclusions? The incidence rate of thirst in CPB patients is relatively high and it is associated with multiple factors. Nurses should pay attention to the patients' thirst and take targeted measures to ameliorate their thirst to improve their comfort in nursing practice.

目的 了解非糖尿病患者冠状动脉搭桥术后血糖波动特点及其与院内预后的相互关系,提高护理人员对术后血糖波动的关注度,进一步提高术后护理质量.方法 以便利抽样的原则,选取2017年3—9月于某三级甲等医院心胸外科拟行冠状动脉搭桥术的非糖尿病患者120例,收集一般临床资料及术毕即刻、术后4 h,术后3 d血糖值,采用血糖不稳定指数作为血糖波动情况的评价指标.以血糖不稳定指数总数的第P50位百分数将患者分为低水平血糖波动组(58例)和高水平血糖波动组(62例)2组,比较相关指标的组间差异.结果 术后第1天患者平均血糖值、血糖不稳定指数最高,随后逐渐降低;共有56(46.6%)例患者出现相应并发症,包括手术切口并发症22(18.3%)例、肺部并发症26(21.6%)例、发生恶性心律失常18(15%)例、出现肾功能损害13(10.8%)例;与低水平血糖波动组相比,高水平血糖波动组术后ICU滞留时间、术后住院时间更容易延长(P<0.001)且发生相关并发症的风险更高(P<0.05).结论非糖尿病患者术后血糖峰值及血糖不稳定指数峰值出现时间较早;血糖波动水平可以在一定程度上预测患者院内预后情况的好坏,血糖波动幅度较高的患者术后预后情况显示不佳,临床医护人员应重视非糖尿病患者术后血糖波动情况,维持术后血糖的稳定性.

Objective To investigate the effect of early combined functional exercise on lower limb rehabilitation of vessel bridge taken in coronary artery bypass surgery. Methods From January to October 2017,90 patients undergoing coronary artery bypass surgery were randomly divided into control group and experimental group by coin toss, with 45 patients in each group. The control group was given routine nursing care, and the experimental group was given early combined functional exercise (foot dorsiflexion, ring rotation exercise and straight leg raising exercise) on the basis of routine nursing care. The difference of correlation index between two groups was compared. Results In the experimental group, the number of swelling in the thigh, crus and ankle were 20, 25 and 35 respectively; the control group was 32, 35, 43, the difference was statistically significant(χ2=6.55, 5.00, 8.38, P<0.05). The remission of limb swelling in the experimental group was also better than that in the control group(P<0.01). The incidence of limb wound complications: 6 cases in the experimental group, 18 cases in the control group(χ2=11.79,P<0.01));limb muscle strength grade Lovett:experimental group 0 case with grade 3,19 cases with grade 4,26 cases with grade 5,control group 9 cases with grade 3,26 cases with grade 4,10 cases with grade 5, there were significant differences between two groups (χ2=17.20, P<0.05). The limb comfort score,postoperative bed time,postoperative hospital stay was(7.11±1.15)points,(5.28±1.07)d, (11.04±2.01)d in the experimental group and(5.18±1.13)points,(6.97±1.21)d,(12.67±1.59)d in the control group,the differences were significant(t=-8.02,6.97,4.23,P<0.01). Conclusions To carry out early functional exercise can not only take angiogenesis effectively reduce limb swelling rate after coronary artery bypass grafting,relieve the severity of limb swelling,but also can reduce the incidence of incision complications,promote the recovery of limb muscle strength,shorten the postoperative recovery time and postoperative hospitalization time,is worthy of promotion and use in clinical nursing work.

对手术后患者口渴发生现状、影响术后口渴的因素、口渴对患者的影响、口渴的评估及干预方法进行综述.阐述了影响术后口渴的因素包括疾病及治疗因素、患者因素、环境与心理因素等;评估口渴的工具有视觉模拟评分法、数字评分法、口渴痛苦量表;口渴的干预措施主要为缩短手术前后禁食禁水时间、湿润口腔、刺激唾液腺分泌、刺激口咽部受体.

目的 探讨冠心病住院患者认知情绪调节策略及其与负性心理的关系,为心理护理的实施提供参考.方法 采取方便抽样万法,抽取心内科首次确诊的冠心痛住院患者200例,使用患者一般情况调查表、认知性情绪调节问卷(CERQ)和非精神科住院患者心理状态评定量表(MSSNS)进行调查.结果 住院冠心病患者非适应性情绪调节分量表得分为44.03±4.82,适应性情绪调节分量表得分为52.37±4.90.55.50％的冠心病患者在首次住院期间会出现不同程度的负性心理.不同性别、文化程度、居住地、医保类型、居住模式的患者认知情绪调节策略比较,差异有统计学意义统计(均P＜0.01).患者焦虑、抑郁、孤独、愤怒与非适应性情绪调节策略呈显著正相关,与适应性情绪调节策略呈负相关(P＜0.05,P＜0.01).结论 女性、长期独居、文化水平低、自费、居住于农村地区的冠心病患者更倾向于采取非适应性情绪调节策略.住院冠心病患者习惯性采用的认知情绪调节策略与其负性心理有着一定的相关性.因此,在临床工作中护理人员应早期识别习惯性采用非适应性情绪调节的患者,尽早、及时采取适当的心理护理干预措施以帮助患者在住院期间维持良好的心理状态.