目的 构建护理本科生内科临床带教老师核心能力的培训体系.方法 于2022年4-7月,以核心能力为目标,基于文献回顾、半结构式访谈、德尔菲专家函询及层次分析法,确定护理本科生内科临床带教老师核心能力培训体系的内容和各指标权重.结果 2轮咨询问卷有效回收率分别为95.24％和100％;专家权威系数分别为0.853和0.873;Kendall's W分别为0.184～0.442和0.201～0.468(P＜0.001).最终形成的护理本科生内科临床带教老师核心能力培训体系包含4个一级指标、18个二级指标、98个三级指标.结论 构建的护理本科生内科临床带教老师核心能力培训体系具有较好的科学性、实用性和针对性,为内科临床护理教师的规范化培训提供了参考依据.

目的 探讨透析中运动对维持性血液透析认知衰弱患者衰弱状况、认知功能和微炎症状态的影响.方法 采用随机数字表法,将符合纳入标准的43例维持性血液透析认知衰弱患者分为干预组21例和对照组22例.对照组接受透析中常规护理;干预组在此基础上接受透析中运动干预.比较两组干预后衰弱相关指标(包括衰弱表型评分、无握力、步数)、简易精神状态检查量表评分、临床痴呆评定量表评分和C反应蛋白水平的差异.结果 两组各21例患者完成全程研究.干预后干预组衰弱表型评分、临床痴呆评定量表评分和C反应蛋白水平显著低于对照组,简易精神状态检查量表评分、握力、步速显著高于对照组(均P＜0.05).结论 透析中运动有利于改善维持性血液透析认知衰弱患者的衰弱状况,提高患者认知功能,减轻患者微炎症状态.

This study aimed at comparing the prevalence of cognitive frailty and explore the differences in the influencing factors between elderly and middle-young patients receiving maintenance hemodialysis (MHD). In this cross-sectional study, the frailty phenotype, mini-mental state examination, and clinical dementia rating were used to assess the current status of cognitive frailty in 852 patients receiving MHD from four hospitals in Lianyungang City and Xuzhou City, Jiangsu Province, China; the influencing factors were then analyzed for statistical significance. Of the total 852 patients receiving MHD, 340 were classified into an elderly group (≥ 60 years) and 512 into a middle-young group (< 60 years). The prevalence of cognitive frailty was 35.9% and 8.8%, respectively. The results of multivariate logistic regression analysis showed that the independent factors of cognitive frailty were age (P < 0.001), education level (P = 0.010), nutritional status (P = 0.001), serum albumin level (P = 0.010), calf circumference (P = 0.024), and social support level (P < 0.001) in the elderly group and comorbidity status (P = 0.037), education level (P < 0.001), nutritional status (P = 0.008), serum creatinine level (P = 0.001), waist circumference (P < 0.001), and depression (P = 0.006) in the middle-young group. The prevalence of cognitive frailty was significantly higher in the elderly group than in the middle-young group, and the influencing factors differed between the two populations.

目的 构建维持性血液透析合并肌少症患者透析中运动干预方案并评价其应用效果.方法 基于证据总结和德尔菲专家函询法,构建维持性血液透析合并肌少症患者透析中运动干预方案.将2021年3月—7月在连云港市某三级甲等医院行维持性血液透析合并肌少症的51例患者随机分为试验组25例和对照组26例,试验组在常规护理的基础上实施透析中运动干预方案,方案包括运动前评估、运动处方、运动监测、运动相关支持和运动效果评价5个部分.对照组给予常规透析护理.干预后比较两组肌少症患病率、骨骼肌质量指数、上臂肌围、小腿围、握力、步速和简易躯体功能量表评分的差异.结果 试验组干预后肌少症患病率低于对照组(P=0.014),握力、步速、小腿围和简易躯体功能量表评分均高于对照组(P<0.05).结论 构建的维持性血液透析合并肌少症患者透析中运动干预方案科学可靠,应用该方案能有效改善患者肌少症相关指标,降低肌少症患病率,为临床护理实践提供借鉴.

Background: Sarcopenia is a common complication in maintenance hemodialysis (MHD) and can increase patient hospital-ization and mortality. No simple and reliable tools to identify sarcopenia exist. We aimed to develop a screen-ing tool to predict MHD patients at high risk for sarcopenia.Material/Methods: This cross-sectional study included 589 and 216 MHD patients for training and validation sets, respectively. We used diagnostic criteria developed by the Asian Working Group on Sarcopenia to screen for sarcopenia. The risk prediction model was established by univariate and multivariate logistic regression analyses. We used the area under the receiver operating characteristic curve (AUROC), calibration curve, Hosmer-Lemeshow test, and decision curve analysis (DCA) to evaluate the model's discrimination ability, calibration ability, and clinical utility.Results: The incidence of sarcopenia was 17.1% in the training set and 18.1% in the validation set. We constructed pre-diction models applying age, body mass index, calf circumference, and serum creatinine and plotted a nomo-gram. The training set model had an AUROC of 0.922, sensitivity of 85.1%, specificity of 85.9%, and chi-square value (Hosmer-Lemeshow test) of 5.603 (P>0.05); the DCA diagram showed that when the threshold probabil-ity was 0 to 0.95, the model predicted a net benefit for sarcopenia in MHD patients. The validation set mod-el had an AUROC of 0.913, sensitivity of 94.3%, specificity of 82.9%, and chi-square value (Hosmer-Lemeshow test) of 9.822 (P>0.05).Conclusions: The screening tool has good discrimination ability, calibration ability, and clinical utility. It could help to identi-fy MHD patients at a high risk for sarcopenia.

目的:调查维持性血液透析患者认知衰弱现状,并分析其影响因素.方法:选取连云港市3所医院共452例维持性血液透析患者为研究对象,采用衰弱表型、简易精神状态检查量表及临床痴呆评定量表进行认知衰弱的筛查,收集相关临床资料,并分析患者认知衰弱的影响因素.结果:93例(20.6％)患者存在认知衰弱,Logistic回归分析结果显示,高龄、女性、腰围较大、存在营养不良风险和抑郁是认知衰弱的危险因素,较高的文化程度和血清肌酐水平是认知衰弱的保护因素(P<0.05).结论:维持性血液透析患者认知衰弱的发生率较高,医护人员应加强对该人群的关注,及早识别并采取针对性的干预措施.

目的 构建维持性血液透析患者骨骼肌质量下降的预测模型,并验证模型的预测效果.方法 采用便利抽样法,选取2020年5月—8月在连云港市某三级甲等医院的304例维持性血液透析患者作为模型构建组,将骨骼肌质量下降组(n=74)和骨骼肌质量未下降组(n=230)的各项指标进行单因素分析,采用Logistic回归分析构建预测模型,并对模型进行简化,通过受试者工作特征曲线评估模型的预测效果.选取徐州市某三级甲等医院的309例维持性血液透析患者进行模型预测效果的外部验证.结果 该研究最终纳入性别、BMI、小腿围、透析前肌酐4个影响因素,并构建了预测模型,受试者工作特征曲线下面积为0.911,简化模型的受试者工作特征曲线下面积为0.911,实际应用的正确率为75.40％.结论 该研究构建的模型具有良好的预测效果,指标简单易得,可为医护人员早期识别并及时对高风险患者采取预防性干预措施提供借鉴.

目的 探讨维持性血液透析患者小腿围与骨骼肌质量指数、握力、步速的关系,分析小腿围在评估肌少症中的效果,为护理人员筛查维持性血液透析患者肌少症高危人群提供参考.方法 2020年5月—9月,采用便利抽样法,选取江苏省连云港市和徐州市2所三级甲等医院的613例维持性血液透析患者进行横断面研究,其中男379例,女234例.采用生物电阻抗法测量患者的骨骼肌质量指数,并进行握力、步速、小腿围等指标的测量.分析小腿围与骨骼肌质量指数、握力、步速之间的关系,采用受试者工作特征曲线得出小腿围的最佳截断值.结果 小腿围与骨骼肌质量指数、握力、步速呈正相关.小腿围与骨骼肌质量下降的受试者工作特征曲线显示,男性小腿围的最佳截断值为32.7 cm(曲线下面积为0.909,灵敏度为0.889,特异度为0.799);女性小腿围的最佳截断值为30.2 cm(曲线下面积为0.837,灵敏度为0.744,特异度为0.808).小腿围与肌少症的受试者工作特征曲线显示,男性小腿围的最佳截断值为32.7 cm(曲线下面积为0.889,灵敏度为0.907,特异度为0.745);女性小腿围的最佳截断值为29.7 cm(曲线下面积为0.844,灵敏度为0.766,特异度为0.797).结论 维持性血液透析患者小腿围与骨骼肌质量指数、握力、步速均呈正相关,当男性<32.7 cm,女性<29.7 cm时,提示患者有可能存在骨骼肌质量下降及发生肌少症,护理人员可通过测量小腿围筛查维持性血液透析患者肌少症高危人群,早期采取预防性干预措施.

This paper reviewed the evaluation methods，influencing factors and non⁃pharmacological intervention measures of sarcopenia in maintenance hemodialysis patients.The paper is aimed at providing reference for early clinical identification and intervention of maintenance hemodialysis patients with sarcopenia.

目的 调查血液透析过程中患者发生饮食不良反应的现状,并分析其影响因素.方法 采用一般资料问卷、饮食行为问卷对连云港市3所三级甲等医院、1所三级乙等医院的368例血液透析患者进行横断面调查,并分析患者发生饮食不良反应的影响因素.结果 301例(81.8％)的患者在血液透析过程中饮食,其中42例(14.0％)患者出现低血压,14例(4.7％)的患者出现呛咳,5例(1.7％)患者出现恶心.Logistic回归分析结果显示,合并糖尿病、透析龄长、血液透析中后2h饮食、饮食前收缩压低是低血压发生的影响因素(P＜0.05);高龄、平卧位饮食是呛咳发生的影响因素(P＜0.05);饮食前收缩压高是恶心发生的影响因素(P＜0.05).结论 血液透析过程中大部分患者存在饮食行为且易发生饮食不良反应,医护人员应加强对血液透析过程中饮食患者的关注,并指导其在血液透析过程中的饮食行为,减少饮食不良反应的发生.