目的:探讨ICU护士执行身体约束缩减行动的障碍因素,为制定身体约束标准化管理方案提供依据.方法:基于理论域框架(TDF)制定访谈提纲,采用目的抽样法对天津市某三级甲等医院的12名ICU护士进行半结构式访谈,按照TDF的相关领域对转录后的资料进行归类,用内容分析法对访谈资料进行分析.结果:ICU护士对身体约束缩减行动理解存在偏差、对约束替代措施内容的不熟悉是其执行身体约束缩减行动的障碍因素之一;身体约束缩减方案评估工具、决策流程的不规范对缩减约束行动的开展造成了一定阻碍;环境因素的限制及对缩减约束结果的担忧,使ICU护士没有足够的信心去执行;科室缺乏支持缩减约束的组织氛围,难以引起护士对执行约束缩减行动的重视,进而削减执行的动力.结合理论域框架将上述因素分别归属为知识、自我效能、环境背景和资源、社会影响、行为规范5个领域.结论:知识、自我效能、环境背景和资源、社会影响及行为规范为ICU护士执行身体约束缩减行动的障碍因素.科室要在明确障碍因素的基础上,加强领导层对执行缩减约束的重视和支持.制定缩减约束评估决策规范化流程以及培训方案,倡导团队协作,创造支持身体约束缩减行动的组织氛围,坚定ICU护士执行缩减约束的信心,促进身体约束缩减行动的持续实施.

Objective:To explore the risk factors of postoperative delirium in patients undergoing cardiac surgery through Meta-analysis, so as to provide a scientific basis for early clinical identification of postoperative delirium.Methods:The Chinese and English databases were searched by computer, and the retrieval time limit was from the establishment of the database to May 28, 2021. The articles on the risk factors of delirium in adult patients after cardiac surgery was collected and Meta-analysis was conducted with RevMan 5.4 software.Results:A total of 19 articles were included, including 10 731 subjects, including 1 901 cases in the case group and 8 830 cases in the control group, involving 14 risk factors. Meta-analysis showed that the risk factors with statistical differences included age ≥ 65 years ( OR=3.39) , history of cerebrovascular disease ( OR=2.00) , history of diabetes ( OR=1.88) , history of cognitive impairment ( OR=3.88) , history of depression ( OR=3.65) , history of atrial fibrillation ( OR=2.90) , preoperative Mini Mental State Examination (MMSE) score≤27 ( OR=3.96) , prolonged operation time ( OR=1.29) , postoperative mechanical ventilation time>24 hours ( OR=3.44) , postoperative cardiac insufficiency ( OR=2.56) and poor sleep quality ( OR=4.43) . Conclusions:Age≥65 years, cerebrovascular disease history, diabetes history, cognitive impairment history, depression history, atrial fibrillation history, MMSE≤27, prolonged operation time, postoperative mechanical ventilation time>24 hours, postoperative cardiac insufficiency, poor sleep quality are the risk factors of delirium after cardiac surgery in adults.

总结1例慢性肾衰竭行血液透析治疗并发心搏骤停患者的护理经验.护理要点包括:心搏骤停抢救联合目标温度管理,改善神经功能预后;组建多学科医护团队,共同决策实施床旁超声心动监护容量,警惕发生过敏反应,预防心搏骤停发生;实施个体化血液透析护理方案,多形式心理护理等.经过积极救治和个性化护理,患者住院14 d,病情好转出院.

Objective. The study focused on the nursing strategies of patients with ventilator-associated pneumonia (VAP) and multicriteria decision analysis (MCDA) in nursing supervision, so as to improve the survival rate and prognosis of patients with VAP. Methods. 200 patients of the database in the ICU who required mechanical ventilation were selected as research subjects. They were divided into control group and intervention group according to different nursing measures. The incidence of VAP was compared between the two groups, and 15 experts were consulted on the prevention measures of VAP. On the basis of ARIMA-GARCH mathematical modeling, using the method of multicriteria decision analysis, the cluster nursing strategy for ventilator-associated pneumonia patients was developed and verified. Results. In the control group, of the 34 patients infected with VAP, Gram-positive bacteria were detected in 11 cases, including 6 cases of Streptococcus pneumoniae, 3 cases of Escherichia coli, and 2 cases of golden yellow Staphylococcus. Gram-negative bacteria were detected in 10 cases, including 5 (50%) cases of Acinetobacter baumannii, 2 cases of Klebsiella pneumoniae, 2 cases of Brucella Bacillus, and 1 case of Pseudomonas aeruginosa. In the intervention group, 18 cases were diagnosed with VAP, including 4 (44.4%) cases of bacterial infection, 3 (44.4%) cases of virus infection, and 2 (22.2%) cases of fungal infection. According to the opinions of the 15 experts, a total of 6 bundled measures were adopted to prevent VAP, including 0.1% chlorhexidine for oral care; strict implementation of hand hygiene; the daily wake-up for spontaneous breath training and extubation assessment; continuous subglottic suction; raising the bed head by 30°–45°; and nasal feeding through the nasal tube without special condition. Conclusion. There are many factors that affect the occurrence of VAP in mechanically ventilated patients in the ICU, and the imperfect measures of bundles of care are the main one. The implementation rates of distinct intervention strategies are different. The implementation rate of 2 measures is lower than 95%, which are the continuous subglottic suction and daily wake-up for spontaneous breath training and extubation assessment.