ObjectiveTo analyze the correlation between the lung allocation score (LAS) and the risk of early death in patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. MethodsClinical data of 275 patients with IPF were retrospectively analyzed. The correlation between LAS and the risk of early death in IPF patients after lung transplantation and the correlation between LAS and complications at postoperative 1 year was assessed by univariate and multivariate Cox regression analyses. ResultsAmong 275 recipients, 62, 83, 95 and 108 cases died within postoperative 30, 90, 180 and 365 d, respectively. LAS was significantly correlated with 30-, 90-, 180- and 365-d fatality of IPF patients (all P<0.05), whereas it was not correlated with the incidence of primary graft dysfunction (PGD) and acute kidney injury (AKI) at 365 d after lung transplantation (both P>0.05). ConclusionsLAS is correlated with the risk of early death of IPF patients after lung transplantation. However, it is not correlated the incidence of PGD and AKI early after lung transplantation. Special attention should be paid to the effect of comprehensive factors upon PGD and AKI.

目的 调查重庆市临床护士对雾化吸入治疗的知信行现状,并分析其影响因素.方法 采用自制"雾化吸入治疗知信行调查表",使用方便抽样法对重庆市二级及以上医院的453名临床护士进行问卷调查,并采用单因素及多元线性回归分析确定影响临床护士知信行得分的因素.结果 收回有效问卷425份,有效回收率为93.82％.临床护士对雾化吸入治疗的知识、态度、行为维度得分及总分分别为(7.72±2.66)、(24.79±3.94)、(58.26±8.42)及(90.77±11.08)分.多元线性回归分析结果显示,临床护士雾化吸入治疗知识的影响因素为性别、科室、在本专科任职时间及聘用形式,态度的影响因素为在本专科任职时间及聘用形式,行为的影响因素为态度、职称及医院等级.结论 重庆市临床护士对雾化吸入治疗的态度较积极,但知识及行为水平有待提高,护理管理者应根据临床护士的不同特征进行雾化吸入治疗相关知识的培训.

Objective:To explore the early prognosis on patient of idiopathic pulmonary fibrosis (IPF) combined with different degrees of pulmonary arterial hypertension (PAH) undertake lung transplantation (LTx).Methods:From January 2017 to December 2020, the clinical data of 134 patients with IPF who underwent LTx in Wuxi People's Hospital were analyzed retrospectively. According to the average pulmonary artery pressure detected by right cardiac catheter before operation, the patients were divided into mild PAH group (63 cases), moderate PAH group (47 cases) and severe PAH group (24 cases). The donor data and the recipient's preoperative, intraoperative and postoperative data were collected; the postoperative survival curve to analyze early survival among the three patient groups.Results:With the increase of pulmonary artery pressure, the rate of abnormal right ventricular function increased, the end diastolic diameter of left ventricle decreased before operation, and the rate of using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) increased during the surgery ( P<0.05). Multivariate analysis found that combined severe PAH had significant effects on primary graft dysfunction (Primary graft dysfunction, PGD), retracheal intubation or tracheotomy, hypovolemic shock within 72 h, and 6-month survival after LTx. The survival surve showed that 30-day survival rates of patients with IPF complicated with mild, moderate and severe PAH were 85.7%, 80.8% and 66.7% respectively, and the 6-month survival rates were 80.9%, 74.0% and 62.2%, respectively. Conclusion:Patient of IPF combined with different degrees of PAH had a significant impact on cardiac function and intraoperative ECMO selection of LTx, and severe PAH could significantly reduce the early survival rate after LTx.

Objective:To compare the effect of extracorporeal membrane oxygenation(ECMO)on pulmonary transplantation(LTx)in patients with idiopathic pulmonary fibrosis(IPF)complicated with pulmonary hypertension(PH).Methods:From January 2017 to December 2020, clinical data were retrospectively reviewed for 112 IPF patients complicated with PH undergoing LTx assisted by venous ECMO(VV-ECMO group, n=68)or venous arterial ECMO(VA-ECMO group, n=44). Gender, age, mechanical ventilation time, oxygenation index, cold ischemic time, preoperative gender, age, smoking history, PO 2, PCO 2, PH degree, NYHA cardiac function grade, right cardiac function, ejection fraction(EF)and complications(hypertension & diabetes)of two groups were compared. Intraoperative approach, operative duration, ECMO transfer time, blood loss, blood transfusion, urine volume, postoperative blood transfusion, mechanical ventilation time, ICU stay time, re-thoracotomy, pulmonary infection, primary graft dysfunction(PGD)and renal insufficiency were recorded. And the effects of two different diversion modes on early postoperative complications and short-term outcomes of LTx were further analyzed by multiple factors. Cox proportional risk model was employed for comparing VV-ECMO and VA-ECMO flow patterns with factors related to recipient survival after transplantation. Results:The preoperative PO 2 of 58.3(51.3, 72.0)mmHg was significantly lower in VV-ECMO bypass group than that of 73.2(63.3, 96.8)mmHg in VA-ECMO group and the difference was statistically significant( P<0.006). Compared with VV-ECMO group, 24(54.5%), 15(34.1%)and 22(50.0%)had NYHA class Ⅲ, severe PH and preoperative right heart enlargement in VA-ECMO group respectively and the differences were statistically significant compared with 17(25.0%), 6(8.8%)and 16(23.5%)in VV-ECMO group( P<0.05 for all). No significant inter-group differences existed in postoperative PGD, postoperative mechanical ventilation time(≥3 d), pulmonary infection, postoperative thoracotomy ratio, postoperative renal insufficiency, ICU stay, hospital stay and other aspects( P>0.05). And 6-month postoperative survival rates of VV-ECMO and VA-ECMO groups were 80.9% and 61.4%, respectively and no significant inter-group difference existed in short-term survival rate(6 months)after adjustment by multivariate Cox regression model( P>0.05). Multivariate statistics indicated that the risk of delayed postoperative withdrawal was 14.452-fold higher in VV-ECMO group than in VA-ECMO group and the inter-group difference was statistically significant(95% CI: 2.448-85.323, P=0.03). Conclusions:No differences exist in postoperative complications or short-term survival rate between IPF recipients with mild PH on VV-ECMO mode and IPF recipients with severe PH on VA-ECMO mode. VV-ECMO flow reversal can delay the transplant back-off time.

目的 了解重庆市某三甲医院临床护士科研能力现状及影响因素,为提高临床护士科研能力提供依据.方法 采用科研能力自评量表对重庆市某三甲综合医院183名临床护士进行问卷调查.结果 临床护士科研能力总分为(71.55±26.06)分,整体科研能力较低,不同年龄、专业技术职务、职务、学历及人事状态的临床护士科研能力比较,差异均有统计学意义(P＜0.05);多元线性回归分析结果显示,职务及学历是影响临床护士科研能力的主要因素.结论 重庆市某三甲医院临床护士的整体科研能力偏低,应对不同年龄、学历、专业技术职务及人事状态的临床护士展开针对性培训.

目的 了解稳定期慢性阻塞性肺疾病(COPD)患者自我管理能力的影响因素,为控制病情,有效提高患者生活质量提供参考依据.方法 采用自我管理能力量表对于该院住院治疗后出院并在门诊随访的111例患者进行问卷调查.结果 稳定期COPD患者自我管理能力总分为(166.04±35.46)分;不同年龄、文化程度、家庭关系及家庭月收入的患者自我管理能力总分比较,差异有统计学意义(P<0.05);多元线性回归分析显示家庭月收入是影响稳定期COPD患者自我管理能力的独立因素(R2=0.212,P<0.05).结论 稳定期COPD患者自我管理能力的整体水平不高,与COPD患者自我管理能力有关的因素有年龄、文化程度、家庭关系及家庭月收入.

目的 探讨新型冠状病毒肺炎(COVID-19)疫情下护理专科生网络自主学习情况及影响因素.方法 于2020年5月采用分层抽样法选取某医药高等专科学校护理专业2018级、2019级在校学生734例作为研究对象.应用护理专业学生网络自主学习评价量表、自主学习能力测评量表进行相关调查.结果 纳入研究对象的网络自主学习评价总分为(123.74±26.02)分,自主学习能力总分为(88.79±13.63)分.相关性分析结果显示,学生网络自主学习评价量表各项目得分与自主学习能力测评量表各项目得分均呈正相关(P<0.05).年级、学习层次、是否制订职业规划、学校学习氛围、对网络学习是否满意、自我管理能力、信息能力和学习合作能力是影响网络自主学习评价总分的因素(P<0.05).结论 在COVID-19疫情下,专科护理学生网络自主学习能力总体达到中等水平,仍有待进一步提高,应针对性予以指导和培训.

目的:探讨新冠肺炎疫情下居家隔离医务人员的身心状况,以期为以后的心理疏导、继续投入工作及政府、医疗机构的组织管理、培训提供依据.方法:运用现象学研究方法,对重庆市某三甲医院2020年1月20日～2月29日因各种原因被居家隔离的10名医务人员进行质性访谈,将获取的资料运用Colaizzi法进行分析.结果:提炼出3个主题:医务人员隔离期间出现了焦虑等负性心理或伴有睡眠异常;隔离期间的期望是获得社会支持、疫情相关信息及为疫情做贡献;隔离后体会到防控意识、防护物资的重要性.结论:医疗机构应提高医务人员应对传染性疾病的人文素质,增强抗压能力,良好的社会支持是其应对压力的关键,加强医务人员对重大公共卫生事件的核心应急能力,优化物资管理以保障足够的防护物资应对疫情.

目的 了解重庆地区医务人员应对新型冠状病毒肺炎(COVID-19)的核心应急能力,分析影响COVID-19应急能力的相关因素.方法采用方便抽样法,参考医务人员传染病突发事件核心应急能力指标体系设计调查问卷,调查分析重庆地区医务人员的COVID-19核心应急能力.结果共收集725名医务人员的有效调查问卷,COVID-19核心应急能力总分为(128.14±25.38)分,多元线性回归分析显示,医务人员的年龄、职称、岗位类别、医院级别、科室及是否参加过COVID-19相关知识培训是影响医务人员核心应急能力的主要因素.结论 重庆地区医务人员的COVID-19核心应急能力处于中等水平,管理者应针对不同年龄、职称、岗位类别、科室进行培训,加强应急演练,提高医务人员对传染病突发事件的核心应急能力.