Objective C-reactive protein (CRP) is a powerful predictor of and risk factor for cardiovascular disease. However, the relationship between CRP and sudden death (SD) is controversial. Therefore, we performed a meta-analysis to evaluate the association between CRP and SD. Methods We conducted a comprehensive search of the databases of PubMed, Web of Science, Embase, Cochrane Library, Wanfang, CNKI, China Biology Medicine disc, and Weipu. Two researchers independently screened the literature, extracted data, and evaluated the data quality. The overall effect size was meta-analyzed using Stata software version 12.0 (StataCorp, College Station, TX, USA). Results Twelve prospective studies involving 36,646 patients were included in the present meta-analysis. The data revealed that patients with higher CRP concentrations had a greater risk of SD (hazard ratio, 1.19; 95% confidence interval, 1.09–1.29). When the hazard ratio of SD was calculated by multivariate analysis of nine studies, CRP was confirmed to be an independent predictive factor for SD (hazard ratio, 1.05; 95% confidence interval, 1.03–1.07). Conclusions This meta-analysis confirmed that CRP is an independent predictor of SD. These results support the recommendation of recording the CRP concentration for risk assessment of SD in clinical practice.

目的 构建慢性心力衰竭(chronic heart failure,CHF)患者个体化液体摄入管理方案,并分析其应用效果.方法 基于前期研究结果,结合入组时体内水分过多(overhydration,OH)值,制订CHF患者个体化液体摄入管理方案.2020年5月—10月通过便利抽样法,选择江苏省某三级甲等医院住院CHF患者278例,随机分为试验组和对照组各139例.试验组采用个体化液体摄入管理方案,对照组采用指南推荐的液体摄入量,分析两组应用效果.结果 试验组OH值、估计血浆容量、临床淤血评分、口渴痛苦感、明尼苏达心力衰竭生活质量、出院后3个月和6个月再入院率均低于对照组,差异具有统计学意义(P<0.05);试验组出院后3个月和6个月心源性死亡率较对照组低,但差异无统计学意义(P>0.05).结论 个体化液体摄入管理方案能改善CHF患者的容量状态、缓解口渴痛苦感、提升生活质量、降低再入院率,可为CHF患者的液体摄入管理提供依据.

目的 系统总结国内外心力衰竭临床决策支持系统临床应用现状与效果,为我国开展相关研究提供参考.方法 检索中英文数据库中心力衰竭临床决策支持系统相关文献,检索时限为建库至2021年4月.采用Cochrane RoB工具、JBI清单、CASP清单等工具评价文献质量.结果 共纳入27篇文献.心力衰竭临床决策支持系统在协助临床诊断、识别早期风险、协助调整用药方案、提高患者自我管理能力、提高医护患对指南的依从性和临床决策效率等方面具有积极影响.结论 心力衰竭临床决策支持系统在临床实践中发挥了积极作用,但在系统内容设计、适用对象和服务范围、评价工具方面仍需完善.

目的 检索、评价和整合脑卒中后认知障碍患者管理的相关证据,为临床实践提供参考.方法 应用循证护理的方法,系统检索关于脑卒中认知障碍管理的所有证据,包括临床实践指南、专家共识、最佳临床实践信息册、系统评价、证据总结,检索时间为2014年1月-2019年12月.采用JBI循证卫生保健中心的文献评价标准和证据分级系统,对各类研究进行质量评价及证据级别的评定.结果 共纳入21篇文献,其中指南7篇,专家共识2篇,系统评价12篇.从筛查、评估、治疗、预防、健康教育5个方面,以及认知障碍受损不同领域的管理共总结出69条最佳证据.结论 卒中认知障碍管理的证据总结过程科学,实用性强,临床护理人员可根据认知障碍受损的不同功能,结合临床环境、患者及家属的需求,针对性的应用最佳证据,建立更加科学完善的管理制度.

对国内外慢性病护理质量评价指标体系构建的理论框架、方法以及构建范围进行归纳总结,认为我国慢性病护理质量评价指标体系中应加强对患者结局指标的关注,应注意指标体系构建方法的科学性,还应积极探索多病种慢性病护理质量评价指标体系,构建统一的适合我国国情的慢性病护理质量评价指标体系.

目的:探讨应用 ICF检查表调查老年慢性心力衰竭患者健康状态的信效度及优势.方法:对 140 例患者采用 ICF检查表与生活质量调查量表 36(SF-36)和坎斯坦城心肌病生活质量量表(KCCQ)进行评估,应用信效度比较以上量表的临床效果,应用 ROC曲线探索 ICF检查表在不同年龄层患者的界值点,使用频数表现不同年龄段患者 ICF类目特点.结果:ICF 检查表 Cronbach’s α系数为 0.933～0.962,75 岁以上人群 Cronbach’s α系数为0.962,SF-36 量表Cronbach’s α系数为0.904～0.906.ICF检查表内部效度 spearman相关系数为 0.411～0.944 (P<0.01),总分与 SF-36 量表外部效度 r系数为-0.483～-0.678(P=0.000).ICF检查表与 SF-36 量表 ROC曲线下面积分别为0.700～0.790,0.340～0.493,前者界值点兼具良好的灵敏度与特异度.不同年龄段人群总体或各维度高频 ICF类目不尽相同,相比而言 60～74 岁人群 b 134.睡眠功能、d 920.娱乐与休闲功能损伤问题更突出;75 岁以上人群 b 440.呼吸功能、d 430.举起与搬运物体、s 430.呼吸系统的结构和 s 110.脑的结构功能损伤问题更突出.结论:相比于 SF-36 与KCCQ量表,ICF检查表在老年CHF患者中应用具有更好的信效度与病情严重度的诊断价值,不同年龄段患者损伤的功能种类存在差异,今后临床工作应有针对性的进行评估与治疗.

Objective:To deeply explore the comprehensive function impairment of chronic heart failure (CHF) patients and analyze its influencing factors.Methods:From November 2018 to January 2019, this study selected medical workers (doctors and nurses) , CHF patients or their family members in Department of Cardiovascular at a Class Ⅲ Grade A hospital in Jiangsu Province as subjects by purposive sampling. Semi-structured interview was carried out for the subjects with the phenomenological method. Colaizzi analysis was used to extract concepts. Two researchers matched the concept with the international classification of functioning, disability and health (ICF) based on Cieza link rules. This study took ICF category no more than 5% of the former after two interviews as the sample size saturated standard.Results:Finally, a total of 28 interviewees were included. A total of 80 ICF categories were linked, 31 (38.8%) of them in body function, 5 (6.2%) in body structure, 28 (35.0%) in activity participation and 16 (20.0%) in environmental factors. Other 482 concepts could not be linked with ICF categories with health status (30.7%) for the most followed by personal factors (27.4%) .Conclusions:ICF could be used to describe the comprehensive function impairment of CHF patients and its influencing factors. Being linked with multitudinous ICF categories indicates the complex function impairment and the numerous influencing factors. This study will be beneficial to carry out the individualized, detailed and dynamic treatment and nursing based on comprehensive evaluation for CHF patients.

Objective:To construct the different functional graded care programs for elderly patients with chronic heart failure (CHF) .Methods:In March 2019, convenience sampling was used to select 24 nursing experts from 14 ClassⅢ Grade A hospitals in Northeast, North China, East China, South China, Central China and Northwest China as the subjects of correspondence. Based on the "International Classification of Functioning, Disability and Health" (ICF) , we took the function as the starting point to construct the different functional graded care programs for elderly CHF patients through systematic reviews, expert meeting and expert consultations.Results:In three rounds of questionnaires, the recovery rates were 100.00%, 100.00% and 95.83%; the authority coefficients of experts were 0.912, 0.914 and 0.913; the coordination coefficients were 0.348, 0.451 and 0.752, respectively; the differences were all statistical ( P<0.001) . The finally constructed different functional graded care programs for elderly CHF patients included heart function, respiratory function, water and electrolyte function, energy and drive function, emotional function, skin protection function, sleep function, and activity and participation function, totaling 8 ICF functions, 14 nursing measures and 161 nursing activity. Conclusions:The different functional graded care programs for CHF patients is comprehensive and systematic, which can not only improve nurses' nursing decision-making, standardize nursing behaviors, but also can be dynamically adjusted. It is scientific and feasible, and can satisfy the individualized and differentiated care demands of CHF patients with impaired function in different disease stages. At the same time, it also provides a theoretical framework for the future development of nursing information systems.

Objective? To explore the status quo of thirst distress in patients with heart failure and its influencing factors and to provide a basis for developing intervention measures. Methods? Totally 445 patients with heart failure were selected from 3 ClassⅢ Grade A hospitals in Jiangsu and He′nan Provinces by convenient sampling, and investigated with the general information questionnaire, Thirst Distress Scale-Heart Failure (TDS-HF), Minnesota Heart Failure Quality of Life Scale (MLHFQ) and 24-hour Input and Output Record between August and December 2018. The influencing factors to thirst distress in patients with heart failure were also analyzed. Results? A total of 445 questionnaires were sent out, and 401 questionnaires were effectively recovered. The TDS-HF and MLHFQ scores of the patients with chronic heart disease were (21.98±9.70) and (57.77±28.34), and there was a positive correlation between the two (P=0.003). Univariate analysis revealed that there was a statistically significant difference in TED-HF scores between the patients with different body surface area, BMI,drinking alcohol or not,7 d fluid intake, 7 d fluid output, 7 d input-output difference, proportion of morning input, proportion of afternoon input, proportion of night input, cardiac function, left ventricular ejection fraction (LVEF), NT-proBNP, estimated plasma volume status (ePVS), with or without edema and estimated glomerular filtration rate (eGFR) (P＜0.05). Multiple linear regression analysis was conducted taking TDS-HF scores as dependent variables and the statistically significant variables found in univariate analysis as independent variables. The results showed that patients′ BMI, body surface area, 7 d fluid intake, 7 d input-output difference, proportion of morning input, proportion of afternoon input, cardiac function, ePVS, edema grading and eGFR were the main influencing factors to thirst distress in patients with heart failure (P＜ 0.05). Conclusions? The thirst distress is severe in patients with heart failure, which is affected by limited water, individual variation between patients and disease conditions. It is necessary for medical and nursing workers develop targeted intervention measures, reduce thirst distress while achieving the best outcomes, and improve the patients′ quality of life.

总结《国际功能、残疾和健康分类》(ICF)评估工具的开发现状、评估内容、应用情况及作用,以期为我国今后ICF在护理程序中的融合应用有所增益.