Objective:To observe the effect of theophylline intravenous drip combined with high flow respiratory humidifier on serum pro Calcitonin (PCT) and lactate clearance rate (LCR) in elderly patients with chronic obstructive pulmonary disease (COPD) secondary to type II respiratory failure.Methods:We prospectively selected 120 elderly patients with COPD secondary to type II respiratory failure who were admitted to the Affiliated Hospital of Jining Medical University from March 2020 to March 2022. They were randomly divided into the control group ( n=60) and the observation group ( n=60). The control group was treated with non-invasive positive pressure ventilation combined with theophylline intravenous drip, and the observation group was treated with high flow respiratory humidification therapy apparatus combined with theophylline intravenous drip. The sputum viscosity of the two groups was counted, and the pulmonary function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1), FEV 1/FVC], blood gas analysis, respiratory mechanics, oxygen metabolism, and serum index levels, as well as the difference between acute physiology and chronic health assessment Ⅱ (APACHE Ⅱ) scores after treatment were compared between the two groups. Results:The overall sputum viscosity of the observation group was better than that of the control group ( P<0.05). Before treatment, there was no statistically significant difference in lung function and blood gas analysis indicators between the two groups (all P>0.05); After treatment, the lung function indicators, arterial partial pressure of oxygen (PaO 2), and oxygenation index (PaO 2/FiO 2) of both groups were significantly increased compared to before treatment (all P<0.05), while arterial partial pressure of carbon dioxide (PaCO 2) was significantly decreased compared to before treatment (all P<0.05), and the values of each indicator in the observation group after increasing or decreasing were significantly better than those in the control group (all P<0.05). Before treatment, there was no statistically significant difference in respiratory mechanics and oxygen metabolism indicators between the two groups (all P>0.05); After treatment, the arterial blood oxygen content (CaO 2) in the two groups was significantly higher than that before treatment (all P<0.05), while the oxygen uptake rate (ERO 2) in the two groups and the VO 2 max (VO 2Max), airway peak value, and respiratory resistance in the observation group were significantly lower than those before treatment (all P<0.05), and the values of each index in the observation group after rising or falling were significantly better than those in the control group (all P<0.05). Before treatment, there was no statistically significant difference in serum indicators and APACHE Ⅱ scores between the two groups (all P>0.05); After treatment, LCR and C-reactive protein (CRP) in the observation group were significantly higher than those before treatment ( P<0.05), while the scores of PCT, Interleukin 6 (IL-6), CRP and APACHE Ⅱ were significantly lower than those before treatment (all P<0.05), and the values of each index in the observation group after increase or decrease were significantly better than those in the control group (all P<0.05). Conclusions:Theophylline intravenous drip combined with high flow respiratory humidifier can improve respiratory mechanics, oxygen metabolism, reduce inflammatory reaction, and reduce the impact of disease on life in elderly patients with COPD secondary to type II Respiratory failure.

Objective:To investigate the value of multi-slice spiral CT (MSCT) combined with three myocardial markers in the diagnosis of acute chest pain etiology.Methods:A retrospective study was conducted on 120 patients with acute chest pain admitted to the Affiliated Hospital of Jining Medical University from January 2020 to December 2020. All patients underwent MSCT imaging examination upon admission, and serum creatine kinase isoenzyme MB (CK-MB), troponin I (cTnI), and myoglobin (MYO) levels were also tested. The final clinical diagnosis was used as the judgment standard to draw a 2×2 four-square table, and calculate the value of MSCT, CK-MB, cTnI, and MYO in the diagnosis of acute chest pain etiology.Resultsl:Among the 120 acute chest pain patients included, 75 were diagnosed with acute coronary syndrome (62.50%), 16 with aortic dissection (13.33%), and 29 with pulmonary embolism (24.17%). The coincidence rate of MSCT diagnosis of coronary heart disease was 86.67%(65/75), the diagnosis of aortic dissection coincidence rate was 12/16, and the diagnosis of pulmonary embolism coincidence rate was 75.86%(22/29). The serum CK-MB, cTnI, and MYO levels in the coronary heart disease group were significantly higher than those in the aortic dissection group and pulmonary embolism group, and the differences were statistically significant (all P<0.05). There was no significant difference in serum CK-MB, cTnI, and MYO levels between the aortic dissection group and pulmonary embolism group (all P>0.05). The sensitivity of CK-MB, cTnI, and MYO in the differential diagnosis of acute chest pain patients with coronary heart disease and non-coronary heart disease were 93.33%, 85.33%, and 89.33%, respectively, and the specificity were 73.33%, 80.00%, and 77.78%, respectively. The areas under the receiver operating characteristic (ROC) curve were 0.833, 0.826, and 0.836, respectively. Conclusions:MSCT can better identify coronary heart disease, aortic dissection, and pulmonary embolism in patients with acute chest pain, while the three myocardial markers can better distinguish patients with coronary heart disease and non-coronary heart disease. Therefore, MSCT combined with myocardial markers should be used for the diagnosis of acute chest pain patients in clinical practice to facilitate early clinical diagnosis.

目的 探讨心理授权、结构授权与护士职业生活质量现状及其相关性,为护理管理者制定针对性措施提供理论依据.方法 采用一般资料调查表、心理授权量表、结构授权量表以及护士职业生活质量量表对济宁市6所医院234名监护室护士进行问卷调查.结果 监护室护士职业生活质量总均分为(3.60±0.58)分,结构授权总均分(3.18±0.69)分,心理授权总均分为(3.61±0.44)分,心理授权和结构授权与护士职业生活质量呈相关性,监护室护士的年龄、工作性质、工作年限、职务、睡眠时间是影响护士职业生活质量重要因素.结论 监护室护士职业生活质量处于中等偏上水平,心理授权和结构授权对职业生活质量起不同程度的促进作用,护理管理者应提供授权的工作环境,提高护士心理授权和结构授权,进而提高护士职业生活质量,降低离职率.

目的 探讨导师制结合反思性教学在重症医学科实习护士带教中的作用.方法 将2019年3月至10月在重症医学科实习的21名护士设为对照组,另将2019年12月至2020年7月实习的21名护士设为研究组.对照组采取传统带教,研究组采取导师制结合反思性教学.对比两组带教前后理论和技术操作考核成绩、带教前后职业自我效能感及带教前后临床综合能力.采用SPSS 26.0进行t检验和卡方检验,等级分布采用秩和检验.结果 带教后两组理论和技术操作考核成绩等级分布对比差异均有统计学意义(P＜0.05),研究组理论和技术操作考核成绩优良率均高于对照组(P＜0.05);带教前两组护生职业自我效能感量表中工作职责和教育要求评分以及临床综合能力(观察病情能力、沟通能力、健康教育能力、人文关怀能力、应急能力、专业知识、准确执行医嘱能力、与医生配合能力)评分差异均无统计学意义(P＞0.05),带教后两组护生职业自我效能感量表评分、临床综合能力评分均升高(P＜0.05),研究组带教后实习护生职业自我效能感量表评分、综合能力评分均高于对照组(P＜0.05).结论 在重症医学科实习护生带教中采用导师制结合反思性教学,可提高实习护生职业自我效能感,提升教学效果,并可提高实习护生临床综合素质.

目的 疫情防控期间,调查山东省内不同地区不同科室临床一线医护工作人员的职业压力水平,分析医护人员职业压力影响因素,旨在为职业压力体系构建提供依据.方法 采用工作压力测量量表、职业幸福感量表、心理弹性量表对急诊、呼吸内科、ICU等10个科室338名医护人员进行问卷调查.结果 共发放问卷338份,回收338份,问卷有效回收率为100％.工作压力评分(33.40±6.85)分,职业幸福感评分(83.82±15.50)分,心理弹性评分(36.18±7.20)分.工作压力与心理弹性、职业幸福感及各维度均呈负相关(r值分别为-0.405,-0.406,-0.445,-0.267,-0.216,-0.289,-0.278).单因素分析结果显示:不同性别、婚姻状况、年龄、学历、职业、工作年限、职称、职务、科室及目前的工作地点工作压力比较,差异均有统计学意义(P<0.05).逐步线性回归分析结果显示:职业、学历、目前工作地点、心理弹性及职业幸福感中身心健康和经济收入是医护人员职业压力的主要影响因素.结论 医护人员的职业压力较高,医院应从职业、学历、工作科室等主要影响因素入手,关注医护人员身心健康,减轻医护人员身心压力,以此更好地完善突发公共卫生应急管理体系,为医疗安全质量提供更多保障.

84消毒液是一种以次氯酸钠为主要成分的含氯消毒液,为无色或淡黄色液体,且具有刺激性气味,有效氯含量5.5％～6.5％.口服者可引起口腔、咽喉、食管、胃黏膜充血水肿、烧灼感、恶心、呕吐、 呕血等,甚至危及生命[1].肺部感染是威胁人类健康的主要疾病之一,世界卫生组织2013年统计报告[2]显示,肺部感染是全球第三大死亡原因.老年患者往往在就诊的时候会诊断出两种甚至多种疾病.在治疗和护理的时候要同时兼顾这些疾病,促进患者恢复健康.2020年3月18日我科收治一例84消毒液中毒合并肺部感染的患者.现将对患者的护理和治疗总结如下.