目的:调查某医院抗击新冠肺炎一线护士疲劳现状及其影响因素,为降低护士疲劳、增强身心健康水平提供参考依据.方法:采用疲劳量表(FS-14)通过问卷星对某医院161名临床一线护士进行问卷调查.结果:护士的躯体疲劳得分为(4.202±2.404)分,脑力疲劳得分为(1.693±1.649)分,疲劳总分为(5.896±3.550)分,性别、工作年限是护士疲劳的重要影响因素(P＜0.05),工作年限与疲劳具有相关性(r=0.226,P＜0.05).结论:某医院抗击新冠肺炎一线护士具有一定程度疲劳,受多种因素影响,管理者应采取有针对性的措施,帮助护士缓解疲劳,改善护士的身心状况.

目的:总结颅脑外伤合并多发伤病人的临床资料,探讨胃肠营养条件下发生重度营养不良的危险因素.方法:分析我院255例颅脑外伤合并多发伤行鼻饲胃肠营养病人的临床资料,筛选发生重度营养不良的危险因素,经多因素Logistic回归分析确定独立危险因素.结果:颅脑外伤合并多发伤病人伤后1个月时发生重度营养不良90例(35.29％).Logistic回归分析显示,入院时AIS-ISS创伤评分、全身麻醉手术治疗、肺部感染、泌尿系感染、吸烟史为病人发生重度营养不良的独立危险因素(P<0.05).结论:颅脑外伤合并多发伤病人护理工作中应全面评估病人伤情和营养状况,早期合理提供肠内营养支持,加强肺部和导管感染的预见性护理,防止发生重度营养不良.

目的 了解ICU护士预防呼吸机相关性肺炎集束化护理方案临床实施不佳的原因,为护理管理提供参考.方法 采用质性研究的现象学方法,对在我中心ICU工作1年以上的19名护理人员进行深入访谈,按现象学研究方法整理分析资料.结果 通过阅读、分析、反思、分类,提炼4个主题,包括病情限制不能实施相关护理、低学历低年资护士缺乏业务知识和临床经验、护理任务繁重而人员相对短缺的困扰、医嘱执行中的不规范问题.结论 ICU护士预防呼吸机相关性肺炎集束化护理方案实施不佳的主要原因有多方面,需引起护理管理者的重视,采取有效应对来促进护理质量持续改进.

目的 探究危重症患者高血糖护理及血糖调控对预后的相关影响.方法 本次实验主要是选取2015年6月-2016年6月医院收治的84例危重症患者作为本次实验的研究对象,按照随机性的原则将这些患者平均分为实验组和对照组,每组42例.对照组患者主要是采用常规性的护理方式,实验组患者采取高血糖护理以及血糖调控护理.对比两组患者的实际治疗效果以及患者对护理方式的满意程度.结果 实验后,两组患者的病情均有所改善,但是实验组患者的实际治疗效果要明显的优于对照组患者(P<0.05).实验组患者对护理方式的满意程度要明显的高于对照组患者(P<0.05).结论 根据实验的结果可以明显的看出,使用高血糖护理以及血糖调控有着极好的临床效果,不仅可以提高治疗的效果,更可以极好地控制住患者的血糖情况,患者对治疗方式的满意程度较高,所以说这种护理方式值得在临床治疗上推广和应用.

目的 总结急性重度有机磷农药中毒患者并发症的预防护理经验.方法 对18例急性重度有机磷农药中毒患者可能出现的反跳、呼吸机相关性肺炎、下肢静脉血栓等并发症进行相关因素分析,并采取预见性护理措施.结果 18例患者中,2例因服毒量过大、多脏器功能衰竭死亡.16例抢救成功,除1例发生下肢胭静脉血栓外,其余无并发症发生.结论 护理人员及时采取预见性护理措施,可以提高急性重度有机磷农药中毒患者的抢救成功率,有效预防并发症的发生,促进患者早日康复.

Objective To summarize the measures for nursing mechanical ventilated patients who suffered from respiratory failure caused by acute severe organophosphorus pesticide poisoning (ASOPP). Method Retrospectively, the nursing clinical data of 18 mechanically ventilated patients who suffered from ASOPP-induced respiratory failure in ICU from January 2013 to December 2014 were analyzed for summarizing the nursing measures concerning preventive extubation, airway humidification and sputum sucking, prevention of ventilator-associated pneumonia and final extubation. Result Sixteen ASOPP patients successfully recovered after hospital discharge and another two died from multiple organ function failure because of excessive pesticides. Conclusions Effective observation and nursing care of airways based on their characteristics in ASOPP patients including prevention of unexpected shedding , appropriate humidity of airways and prevention of infection of ventilator-associated pneumonia(VAP). All of these measures can reduce complications and contribute to the early recovery of patients.

Objectives: Finding the insecure factors in executing medical advice in the ICU and giving measures to strengthen foresighted nursing and promote nursing safety and quality.Methods: 50 nurses' medical advice execution status in 3 ICUs in a hospital was investigated by self design questionnaire.Results: Problems such as accuracy(26%),timeliness(39%),integrity(29%) and criterion(6%) in medical advice execution were found.Conclusions: Medical advice execution quality is related to nurse's age(P0.01),title(P0.01) and working shift(P0.01) in ICU.By strengthening professional moral education and law training,continuous improving management mechanism and standardizing medical advice execution can improve nursing quality and safety and prevent medical dispute and medical negligence.

Objective:To observe effect of cluster based on old osteology patient with continued radial artery pressure monitoring and role of catheterization complications. Method:Patients were randomly divided into control group and treatment group. Artery catheterization success rate and complications were compared between the control group and cluster based group. Result:The artery catheterization success rate was higher(P0.05) in treatment group. While the incidence of catheter complications was significantly lower in treatment group(P0.01) . Conclusion:①Cluster-based is an effective method of clinical of critically ill patients,but also a reflection of the quality management philosophy. ②Cluster-based care can improve the success rate and decrease complications of catheterization in old osteology patients. ③ Cluster-based benefits for bothe patients and doctors.

循证护理是一种以有价值、可信的科学研究结果为依据,提出问题,寻找实证,用实证对患者实施最佳护理的方法.但术后并发肠瘘是一种严重并发症.其病程长,病死率高,治疗护理难度大.我院采用循证护理对实施左半结肠癌并急性肠梗阻Ⅰ期切除吻合术后并发肠瘘的患者进行护理,瘘口均自行愈合,效果良好,现报告如下.

目的探讨ICU机械通气患者行镇静治疗时的观察要点及护理方法。方法ICU机械通气患者50例均选用力月西、芬太尼和/或丙泊酚微量注射泵静脉泵入镇静治疗,治疗期间采取注意镇静药物的选择、镇静效果的评估、循环功能监测、呼吸道的管理及监测、肢体功能锻炼、加强基础和安全护理、用药护理和每日唤醒等护理措施。结果患者均达到镇静目标,SAS评分在3～4分,顺利渡过机械通气期,未发生其他意外事件。结论严密观察病情,加强监护,预防并发症,对确保ICU机械通气患者治疗顺利进行及其恢复起到重要作用。

Objective In order to identy the risk factors of mechanical entilation patients in ICU out of inspection and ensure the patients' safe.Methods A total of 50 patients with mechanical ventilation in ICU was employed,and the risk factors were analyzed.Results The risk factors related to inspection out of ward among those subjects were following: the state of illness change, the accident injury, the treatment interrupted or even delayed,the pipeline failed off, which due to the f complexity of the disease itself and the inappropriate treatment and care .Conclusions The measures should be carried out before and during the process of inspection out of ward; comprehensive disease assessment and preparation, continuous using of breathing machines, close observation patient's condition, ensure the normal breathing machines running, timely deal with abnormaabilities.After the examination, close monitoring vital signs and specific nursing can ensure the check smoothly.

[目的]了解重症监护病房(ICU)护理人员对法律知识的认知程度,提高ICU护理人员的法律意识。[方法]采用自行设计的调查表,对综合ICU、神经内科监护室、心脏内科监护室、移植ICU的100名护理人员进行调查。[结果]82%的护理人员接受过法律知识的培训,不同学历护理人员对法律知识的认知程度比较差异有统计学意义(P<0.05)。[结论]ICU护理人员对相关法律知识认知不足,法律意识、风险意识及举证意识不强。医院要重视法制教育,提高护理人员的法律意识,保证危重病人的护理质量和医疗安全。

护理安全是指在实施护理的全过程中,患者不发生法律和法定的规章制度允许范围以外的心理、机体结构或功能上的损害、障碍、缺陷或死亡.

Objectives: To research and analyze the problems on integrated ICU nursing record and find countermeasures to increase nursing record writing quality and assure nursing safety. Methods: Random selected 200 integrated ICU nursing records in our hospital from 2003 to 2004, and to analyze the related problems in these records. Results: The problems can be divided into 22 aspects within 6 catalogues in these 200 nursing records. They are timeliness (8.8%), veracity (20.6%), facility (28.5%), integrality (26.1%), objectivity (5.1%), and criterion (10.9%). These problems are related to work years, education background, and duty times. Conclusions: The quality of integrated ICU nursing records is related to education background and duty times and so on. In order to realize increasing the quality of description constantly and avoid medical accident and tangle, related training should be exercised on particular nurses, related standard should be established and administration on quality should be actualized.

目的 探讨ICU危重患者在肺部物理治疗中存在的问题,提出有效的解决对策,以保证其肺部物理治疗的安全、有效性,提高危重患者的救治率.方法 自行设计ICU患者肺部物理治疗安全问题调奋表,按照总后卫生部和全军重症监护工作指南进行质量考评.结果 发现ICU肺部物理治疗在规范性、卧位是否符合医疗要求、及时性、准确性等方面存在一定问题.根据这些问题,有针对性地提出解决对策.结论 加大了对ICU患者肺部物理治疗临床操作的培训力度,加强了预见性护理,可以提高重病护理的质量和安全,有利于提高危重患者的救治率,杜绝和避免医疗事故和纠纷的发生.

地震灾害致挤压综合征引起急性肾衰竭是病人死亡的第二位原因.连续性肾脏替代治疗(continuous renal replacementtherapy,CRRT)是救治肾衰竭的有效方法之一.而挤压伤后行截肢、切开减压等处理,使病人具有高出血的危险.2008年5月14日-2008年7月10日,在汶川地震后临时CRRT病房对8例地震挤压综合征合并高出血危险的病人早期实施CRRT治疗,加强预见性和精细化的护理管理,所有病人肾功能恢复,未发生任何护理并发症.现报告如下.

[目的]分析连续肾替代治疗(CRRT)中护理问题,并提出对策,以确保病人安全.[方法]采用深静脉置管术建立外循环通路,使用德国贝朗Diapact CRRT机和聚砜膜滤器HIPS18,置换液使用上海华源长富药业(集团)有限公司生产的血液滤过置换液,对47例病人行CRRT治疗,时间为22 h～760 h.[结果]经采用CRRT救治47例病人,抢救成功31例,死亡14例,病人亲属认为治疗效果不佳、签字出院2例.在对这些病人的护理过程中,护理问题有:CRRT血流下降,其中由翻身所致4例(8.51%)、对机器报警处理不及时2例(4.26%);发生热原反应2例(4.26%);发生穿刺部位局部感染1例(2.13%);未发生电解质紊乱.[结论]严密监测和具有预见性的护理是预防并发症、保证治疗顺利进行的关键所在.

Objectives: To evaluate the clinical effectiveness of in charged nurse responsibility system in ICU in Affiliated No. 2 Hospital, P.L.A. Methods: Case control methods were applied. Cases were selected randomly and control group was set up. A couple of qualified rates before and after in charged nurse responsibility system, such as basic nursing, nursing records, room management, medical dispute and nursing errors were compared. Results: There were significant changes before and after in charged nurse responsibility system among those indexes. Conclusions: In charged nurse responsibility system realized continual nursing management in 24 hours and process control. By this system, hospital management was applied and promoted crisis patient nursing quality and safety. This system also benefited for nursing human resources construction and improved total nursing quality.

1 病例介绍 [例1] 病人,男,46岁,因纳差、乏力、腹胀9年,加重1年,诊断为肝硬化收入院.病人曾于1996年在外院行脾切除术,此次住院要求行肝移植术.