目的 分析多学科团队模式下的个案管理在糖尿病足患者中的应用效果.方法 采用便利抽样法,选取2019年1月至2020年12月于上海市第八人民医院就诊的糖尿病足患者60例为研究对象.采用简单随机法将其分为观察组(n=30)和对照组(n=30).对照组给予常规伤口护理,观察组给予多学科团队模式下的个案管理,比较两组患者在糖尿病管理自我效能、伤口愈合、血糖控制等方面的干预效果.结果 干预后(随访6个月后),观察组患者自我效能、伤口愈合率、血糖均优于对照组(P＜0.05).结论 多学科团队模式下的个案管理可帮助糖尿病足患者提高自我效能、促进糖尿病足伤口愈合及有效控制血糖,值得临床推广.

目的 通过调查了解区域医联体范围内护士及患者对"互联网+护理服务"的认知和态度,为更好地推动相关护理工作提供参考.方法 2021年4-5月,采用自行设计的"互联网+护理服务"认知和态度调查问卷,对上海市第八人民医院及区域医联体内6家社区卫生服务中心的护士及患者进行在线调查.医院工作的护士及患者为调查对象,采用自行设计的调查表对护士及患者对"互联网+护理服务"意愿进行问卷调查.结果 共调查护士648名、患者143例,问卷有效回收率分别为98.9％和97.9％.被调查护士和患者对于"互联网+护理服务"的开展大都表示支持,但仅有4.32％的护士曾参与过相关服务,仅5.59％的患者对该项服务非常了解;92.9％的护士和0.42％的患者均认为提供相关服务的护士需经过专业培训并取得相关资质;但对于收费标准护患双方的期待存在一定差异,64.97％的护士认为一次上门服务的价格应在200～300元,而82.52％的患者希望价格低于200元/次.此外,有79.63％的护士担心参与"互联网+护理服务"的安全问题;78.40％的护士希望参与相关服务可以与绩效奖励及晋升等挂钩.结论 区域医联体内大多护士和患者均支持"互联网+护理服务"的开展,但对相关服务的内涵尚了解不足,部分护士存在一定顾虑,且护患双方对服务收费的态度在一定差异.为更好地推动"互联网+护理服务"的开展,需从政策、医院及第三方平台等各方面着手,进一步加强"互联网+护理服务"的宣传,平衡护士及患者的需求,制订切实可行的实施方案及配套政策,更好地满足患者健康需求.

对国内外老年失禁相关性皮炎的概念、流行病学、影响因素、评估及最新护理研究进行综述,旨在为临床老年失禁导致失禁性皮炎护理提供帮助.

目的 了解住院老年直肠癌患者术后尿失禁发生现状及影响因素,为制订老年直肠癌患者术后护理方案提供科学依据.方法 选取2017年5月—2018年5月收治于上海交通大学附属第六人民医院徐汇分院的直肠癌围手术期老年患者,采用自制一般资料问卷及国际尿失禁咨询委员会尿失禁问卷表简表(ICIQ-SF)进行调查.共发放问卷170份,回收有效问卷159份,有效回收率93.5％.结果 159例直肠癌术后老年患者中,发生尿失禁者38例(23.9％).单因素分析显示,患者的年龄、糖尿病史、腹部及盆腔手术史、体质量指数(BMI)、手术时间、术后尿路感染发生情况均影响老年直肠癌患者术后尿失禁的发生(P<0.05).Logistic回归分析显示,年龄较大、围术期发生尿路感染、BMI>25、有腹部及盆腔手术史是老年直肠癌患者术后尿失禁的主要影响因素.结论 直肠癌术后老年患者尿失禁发生情况不容乐观.护士术前需评估患者相关情况,特别是年龄、有无腹部或盆腔手术史、体质量指数、是否存在围术期尿路感染等,并针对相关原因尽早进行护理干预.

[目的]了解住院老年结直肠癌病人围术期尿失禁发生及危险因素状况,为制定老年结直肠癌围术期护理方案提供科学依据.[方法]采用病例回顾法抽取2016年—2017年1所二级甲等医院、1所三级甲等医院60岁以上的病人346例为研究对象,将病人年龄、体重、并发症、手术名称、留置导尿时间等相关资料进行统计分析.[结果]体质指数(BMI)、腹部手术史、术前有尿失禁史、手术方式、术后镇痛泵使用时间、术后发生尿路感染是老年结直肠癌病人围术期尿失禁的独立因素(P<0.05),尿失禁的类型以充溢性尿失禁为主.[结论]老年结直肠癌围术期病人尿失禁与体质指数、腹部手术史、手术方式、使用镇痛泵时间、术后尿路感染有关.

目的 探讨尿失禁知识宣教对老年腰椎间盘突出症围术期尿失禁患者排尿功能的影响.方法 采用非概率抽样的方法,选取2018年9月1日-12月31日上海市某三级甲等医院诊断为腰椎间盘突出症围术期出现尿失禁症状的老年患者,将前两个月收治的38例患者设为对照组,后两个月收治的37例患者设为观察组.对照组实施常规护理,观察组在对照组的基础上再给予包含运动、饮食、药物、心理、危险因素控制这五大部分的尿失禁知识.以国际尿失禁咨询委员会尿失禁问卷表(ICI-Q-LF)及尿失禁生活质量问卷(I-QOL)作为评估工具.干预12周后比较两组患者排尿功能、尿失禁生活质量评分.结果 观察组患者国际尿失禁问卷简表得分低于对照组(P＜0.05),尿失禁生活质量评分明显高于对照组(P＜0.05).结论 尿失禁知识宣教可改善老年腰椎间盘突出症围术期尿失禁患者排尿功能、提高患者生活质量.

Objective? To explore the related factors of urinary incontinence among patients with surgery for lumbar disc herniation (LDH). Methods? From 1st June 2017 to 31st May 2018, we selected 336 medical records of LDH patients with surgical therapy at a ClassⅢ Grade A hospital and a ClassⅡGrade A hospital in Shanghai by convenience sampling. Single factor analysis and multiple factors analysis were used to patients' basic data, diagnosis, segments of LDH, symptoms, complications, types of surgery, types of anesthesia, laboratory examination, patient-controlled analgesia and indwelling urinary catheters. Results? A total of 336 medical records of LDH patients were investigated with 29.5% for the incidence of urinary incontinence. Multiple factors analysis showed that the independent risk factors of patients with surgery for LDH included 9 factors involving the childbearing history, complications (diabetes, heart disease, cerebral infarction, lumbar spinal stenosis), symptoms (constipation and urinary tract infection), indwelling urinary catheters and indwelling days (P＜0.05). Conclusions? The incidence of urinary incontinence of patients with surgery for LDH is high and is related to many factors. Medical staff should carry out screening in time and early intervention for high-risk patients according to related factors to reduce the incidence of urinary incontinence.

目的 评估产后引起压力性尿失禁(stress urinary incontinence,SUI)的风险因素.方法 方便抽样选取上海市某三级甲等医院产后6～8周复查时患有SUI的产妇126例,同法选择同期复查时无SUI的产妇150例作为对照组.通过病历资料及国际尿失禁咨询委员会尿失禁问卷表(International Consultation on Incontinence questionnaire short-form,ICIQ-SF)收集数据并进行分析.结果 产妇顺产、胎儿体重较重和胎儿头顶径较大的产妇发生产后SUI的比例较高.多元逻辑回归结果显示是否顺产和胎儿体重是产妇产后发生SUI的独立预测因素(P＜0.05).将患者根据分娩方式进行亚组分析,结果显示:胎儿体重是剖宫产产妇发生产后SUI的独立预测因素(P＜0.05),产妇年龄和胎儿头顶径是顺产产妇发生产后SUI的独立预测因素(P＜0.05).结论 产后患者引起压力性尿失禁的风险因素众多.医护人员应针对不同人群的风险因素,实施有针对性的健康宣教,以预防产后压力性尿失禁的发生.

Objective? To construct the perioperative urinary incontinence nursing outcomes intervention plan suitable for elderly patients with rectal cancer. Methods? From December 2017 to June 2018, we preliminarily developed the perioperative urinary incontinence nursing plan for elderly patients with rectal cancer by literature review and case investigation. We selected 11 experts undertaking rectal cancer and urinary incontinence clinical care, clinical nursing and nursing management by purpose sampling in Shanghai to demonstrate the intervention plan with the method of expert meeting so as to confirm the final intervention plan. Results? The expert authority coefficient was 0.93. The nursing plan included 4 primary indexes, 9 secondary indexes and 42 tertiary indexes. Conclusions? The expert authority coefficient is high in this study. The construction of perioperative urinary incontinence nursing plan based on nursing outcomes classification system for elderly patients with rectal cancer provides the reference for carrying out practice and researches of perioperative urinary incontinence management for elderly patients with rectal cancer.

目的 基于症状管理理论,构建老年腰椎间盘突出症患者围手术期尿失禁护理方案.方法 选取2017年6月-2018年5月收治于同济大学附属同济医院和上海市第八人民医院的腰椎间盘突出行手术治疗患者336例,基于文献研究法,初步拟定老年腰椎间盘突出症患者围手术期尿失禁护理方案(草稿).遴选10名医疗护理专家召开专家会议,对初步拟定的护理方案进行修订补充,确定最终方案.结果 构建了老年腰椎间盘突出症患者围手术期尿失禁护理方案,包括症状体验、症状管理策略及管理效果3个方面,术前、术后早期、术后中长期、并发症预控及随访5个维度,共86个条目.专家权威系数为0.93,权威度较高,结果较为可靠.结论 本研究构建的老年腰椎间盘突出症患者围手术期尿失禁护理方案,有助于提高脊柱外科护理质量,有助于患者围手术期得到有效的康复和护理.

This study was to investigate the incidence and the risk factors of postpartum stress urinary incontinence (SUI), and the effect of comprehensive care and rehabilitation program (CCRP) on preventing postpartum SUI.In stage I, 479 puerperae were recruited within 1 week postpartum, then the postpartum SUI incidence at 8th week and its risk factors were investigated. In stage II, 240 vaginal delivery puerperae were enrolled within 1 week postpartum and randomly assigned to CCRP group or control group as 1:1 ratio. The postpartum SUI incidence and pelvic floor muscle function indexes were evaluated at 8th week.In stage I, the postpartum SUI incidence was 25.7%, and SUI puerperae presented with higher body mass index (BMI), vaginal delivery rate, newborn weight, and larger newborn head diameter compared with non-SUI puerperae. Besides, the vaginal delivery, the elevated age and BMI were independent risk factors for postpartum SUI. In stage II, the postpartum SUI incidence in CCRP group was decreased compared with control group, and the vaginal resting pressure, vaginal squeezing pressure, and vaginal contraction duration were increased in CCRP group compared to control group at 8th week postpartum.The incidence of postpartum SUI is 25.7%, and the vaginal delivery, increased age, and BMI are independent risk factors for postpartum SUI. More importantly, CCRP strengthens pelvic floor muscle functions and decreases postpartum SUI incidence in puerperae.

随着老龄化社会的来临,老年结直肠癌病人手术逐年增多,由于各种原因导致的尿失禁也成为一个困扰手术预后及老年人生活质量的重要因素.主要通过文献检索了解围术期老年结直肠癌尿失禁的影响因素及改善措施,为围术期老年结直肠癌病人尿失禁问题的研究提供理论参考依据.

Objective To construct nursing program for incontinence patients with cerebral apoplexy, in order to reduce the incidence of incontinence and improve the quality of life of patients and their families. Methods Using the methods of literature review, theoretical analysis and clinical practice, the first draft of the urinary incontinence nursing intervention program for stroke was formulated. Through Delphi expert consultation method, the dimensions, indicators, and entries of the incontinence nursing intervention for stroke were finally determined. The weight coefficient of the index at all levels was established by hierarchy method. Results A total of 14 experts were selected for stroke, nursing, rehabilitation and urology. The positive coefficient of the two rounds of expert consultation questionnaire was 1.0. The authority coefficient were 0.873 and 0.893 respectively. The expert coordination coefficient tests were all P＜0.01. The identified stroke urinary incontinence nursing intervention program includes 5 dimensions, 10 secondary indicators, and 37 tertiary items. Conclusions Nursing intervention program of urinary incontinence after stroke is formed by scientific method. The expert opinion is consistent, which could provide reference for clinical practice.

随着老龄化社会的来临,老年病人手术逐年增多.由于各种原因导致的尿失禁也成为一个困扰手术预后及老年人生活质量的重要因素.通过文献检索了解影响老年人围术期尿失禁的因素及改善措施,为老年人围术期尿失禁问题的研究提供理论参考依据.

肠造口周围皮肤炎症是结肠造口患者常见的并发症.肠造口护理工作是一项复杂而细致的工作,需要护理人员具有扎实的专业知识和丰富的临床经验.本研究分析1例结肠造口过敏伴黏膜移植患者,通过实施积极的治疗与护理措施,患者预后良好.

疥疮是由人型疥螨引起的接触传染皮肤病,易在家庭和集体宿舍中传播流行。多发于皮肤细嫩、皱褶处,奇痒难忍,传染性极强,蔓延迅速。常常由于人群对疥疮预防的忽视及发病后未能及时就诊治疗或治疗不彻底,造成本病在家庭内或集体居住者中传播流行[1]。我院于2013年7月收治1例贫血合并疥疮感染病人,采取护理干预措施后,3周治愈出院。现将护理总结如下。

Objective To improve the nurses′ cognition of work-related low back pain through taking the related knowledge training.Methods A self-designed questionnaire was distributed to 48 qualified nurses in our hospital from March 2009 to April 2010.According to the result of survey the nurses were given comprehensive intervention for 5 months and investigated by the same questionnaire.Their cognition level before and after intervention was compared.Results After intervention,the nurses′ cognition level was significantly increased from 0% to 100%(P0.001).Conclusion The targeted comprehensive intervention can effectively improve the nurses′ cognition of work-related low back pain,their self-protection behavior,and their life quality.

Objective To assess the effect of improving the nurse-aids' self-protection cognition by comprehensive intervention.Methods A self-designed questionnaire was distributed to 60 qualified nurse-aids in Shanghai 8th People's Hospital.Comprehensive intervention was given to them according to the result of the survey for 5 months,the same questionnaire was used to conpare their self-protection cognition before and after intervention.Results After the intervention,the level of their selff-protection cognition was sognificantly raised from 71.4% before intervention to 100% afterwards(P0.001).Conclusion Through the pertient comprehensive intervention,the level of the nurse-aids' self-protection cognition was raised effectively,their self-protection behaviour was improved and the nursing quality and safety of both nurse-aids' and patients' health were certainly achieved.