目的 观察以患者和家庭为中心的信息化探视在IC U的应用效果.方法 将246例患者和对应的246名家属根据院区分为对照组(122例患者和122名家属)及观察组(124例患者和124名家属).对照组实行远程电话探视,观察组实行以患者和家庭为中心的信息化探视.比较两组患者的谵妄发生率,评估两组患者家属的焦虑及抑郁程度、满意度.结果 观察组患者的谵妄发生率为8.9％,低于对照组的16.4％,差异无统计学意义(P>0.05);观察组患者家属的焦虑自评量表评分为(49.19±6.68)分、抑郁自评量表评分为(52.08±6.54)分,均低于对照组的(53.99±7.45)分、(55.77±7.58)分,P均<0.05;观察组患者家属的重危患者家属满意度量表评分为(112.23±11.10)分,高于对照组的(106.00±14.10)分,P<0.05.结论 以患者和家庭为中心的信息化探视可缓解IC U患者家属的焦虑、抑郁情绪并提高其满意度.

Objective:To systematically evaluate the application effect of high flow nasal cannula (HFNC) in patients with chronic obstructive pulmonary disease (COPD) .Methods:Cochrane Library, PubMed, Ovid, CNKI, Wanfang database and other Chinese and English databases were searched for randomized controlled trials or cohort studies on the effect of HFNC in COPD patients. The retrieval time limit was from the establishment of the databases to September 30, 2021. Two researchers independently screened the literature, evaluated quality of the literature and extracted data. RevMan 5.0 software was used to conduct a meta-analysis on the literature that met the inclusion criteria.Results:A total of 8 literatures were included, including 4 English literatures and 4 Chinese literatures, with a sample size of 575 cases. Meta-analysis results showed that there were no statistically significant statistical differences between the HFNC group and the non-invasive mechanical ventilation group patients in the 24-hour heart rate [ WMD=-2.65, 95% CI (-7.17-1.86) , P=0.25], 24-hour mean arterial pressure [ WMD=0.45, 95% CI (-3.10-4.00) , P=0.80], 24-hour arterial partial pressure of oxygen [ WMD=-0.08, 95% CI (-0.89-0.74) , P=0.85], 24-hours arterial blood carbon dioxide partial pressure [ WMD=-0.96, 95% CI (-2.29-0.36) , P=0.15], 24-hour oxygenation index [ WMD=0.87, 95% CI (-4.85-6.58) , P=0.77], length of stay in ICU [ WMD=-0.83, 95% CI (-1.79-0.14) , P=0.09], tracheal intubation rate [ RR=0.98, 95% CI (0.58-1.64) , P=0.93], incidence of aspiration [ RR=0.30, 95% CI (0.08-1.18) , P=0.08]and 28-day mortality rate [ RR=1.12, 95% CI (0.61-2.03) , P=0.72] ( P>0.05) . Compared with non-invasive mechanical ventilation, HFNC could reduce the 24-hour respiratory rate in COPD patients [ WMD=-0.78, 95% CI (-1.48--0.08) , P=0.03], the incidence of nasal and facial pressure injury [ RR=0.14, 95% CI (0.05-0.39) , P=0.000 1] and improved 24-hour arterial blood pH [ WMD=0.03, 95% CI (0.01-0.04) , P<0.01]. Conclusions:Compared with non-invasive mechanical ventilation, HFNC can reduce the 24-hours respiratory rate, the incidence of nasal and facial pressure injury and improve the 24-hours arterial blood pH in COPD patients. However, more high-quality, multicenter randomized controlled trials are needed to verify the results of this study in the future.

目的 观察安全给药情景模拟培训在新入职护士临床教育中的应用效果.方法 按安全给药情景模拟培训前后进行分组,2017届新入职护士87人作为对照组,2018届新入职护士105人作为观察组.对照组采用常规培训,观察组在对照组基础上增加安全给药情景模拟培训.两组采用安全给药评价表、口服给药操作考核进行评价,观察组同时采用中文版Jeffries模拟教学设计量表对培训效果进行评价.结果 观察组新入职护士安全给药评价正确率高于对照组,经比较,差异有统计学意义(P<0.01);观察组口服给药操作考核得分(96.10±1.33)分,高于对照组的(84.84±5.17)分,经比较,t=19.794,P<0.01;观察组中文版Jeffries模拟教学设计量表5个维度同意率达到96.2％ ～99.0％.结论 安全给药情景模拟培训能有效提高新入职护士安全给药的培训效果.

新型冠状病毒肺炎病原体为2019新型冠状病毒(WHO已将其正式命名为COVID-19),系β冠状病毒属 [1].据国家卫健委官方发布的最新数据显示,截至2020年2月17日24:00,全国累计报告确诊新型冠状病毒肺炎患者72436例,累计死亡1868例,治愈12552例.面对当前严峻的抗疫形势,浙江省卫健委积极响应国家号召,统一部署,于2020年1月24日就组建了首批抗击新型冠状病毒肺炎紧急医疗队,成员均为浙江省各大医院医、技、护专业骨干.1月25日,浙江紧急医疗队抵达疫情中心城市武汉,并进驻武汉市某定点三甲医院开展抗疫工作.护理团队作为此次救援行动的主体,在抗疫一线发挥了决定性作用.快速组建护理团队并规范管理,对于争取时间迅速开展救援至关重要,现将支援期间我们积累的经验总结报道如下.

总结浙江医疗队在联合救治模式下,建设重症护理团队抗击新型冠状病毒肺炎的管理经验.从护理队伍的管理与分配、病房日常工作流程及管理、身心支持探讨了重症护理团队建设要点.

重症监护室(ICU)是医院危重患者治疗、护理和周转的核心科室,面对病情变化需做到准确的预测、及时的诊断、有序的处理、防止并发症的发生. 目前,ICU多以N1层级护士为主,该层级的护士具备最基本的理论和操作知识,但在抢救应急能力、综合能力素养等方面还有所欠缺. 因此,加强ICU NI层级护士的核心能力的培训显得尤为重要. 传统的ICU护士能力培养多以被动式的知识传授为主,忽略了临床评价、及时反馈、主动改进的重要性,常常难以达到预期的效果[1]. 迷你临床演练评量 (mini-clinical evaluation exercise, Mini-CEX)是1995年由美国内科医学会提出,用于评价住院医师临床能力的评量工具,2008年由我国台湾学者将Mini-CEX推广至临床护理专业,因其具有注重临床、反馈及时的特点,已在护理人员职业素养、行为规范、护理技能培养方面取得了较好的成绩.我院于2018年3月将Mini-CEX应用于ICU N1层级护士培训中,并探究其应用效果,旨在为临床培训工作提供参考.

笔者于2017年5-8月作为访问学者赴美国上州医科大学医院进行了为期4个月的进修学习.期间对ICU进行了访问学习,深入了解美国ICU的服务模式和护理管理实践.本文对美国ICU的护理管理概况进行介绍,概括美国ICU护理管理的特点,旨在为我国ICU护理管理提供借鉴.

在医院和浙江省科协的大力资助下,笔者有幸于2017年5月-8月作为访问学者,在美国纽约州上州医科大学医院(Upstate Medical University Hospital)进行为期4个月的护理管理和临床护理的进修学习.美国纽约州上州医科大学医院是纽约州一所培养医生、护士及卫生保健相关专业人员的学术中心,开展医学学术研究,并提供医疗护理服务,是该地区一级(Level-I)创伤中心,也是该地区唯一的儿童医院.医院有近8 000名员工,其中注册护士约为2 200名,床位740张,每月出院患者数约为2 800例.进修期间笔者深入了解该医院以患者和家庭为中心的人性化护理模式.现报告如下.

为了提高脓毒症和感染性休克患者的抢救成功率,2015年我院重症医学科建立了脓毒症快速反应团队,并制定了脓毒症预警触发标准,脓毒症快速反应团队职责和实施抢救的流程等.脓毒症快速反应团队建立后,从2016年1月至2017年12月,共抢救脓毒症和感染性休克患者247例;脓毒症快速反应团队实施后,黄金3小时的脓毒症集束化治疗的执行率从33.3％ 提高到100.0％,24小时抢救成功率从90.7％ 提高到99.2％,脓毒症患者28天存活率从71.3％ 提高到77.3％.脓毒症快速反应团队的应用,对抢救脓毒症及感染性休克患者具有非常重要的意义.

<正>护理毕业生是医院中的一个特殊群体,在实习期间,也是与患者接触最多的医务工作者之一。笔者在2010-2011年招聘护理新员工,通过考核护理操作过程中现场观察的方法,记录护理毕业生手卫生的执行情况,现报道如下。

脓毒血症是指感染和创伤等诱发的剧烈全身性炎症反应,并引起组织器官继发性损伤的临床症候群[1].临床上严重脓毒症和脓毒性休克是重症监护患者最常见和主要的死亡原因,病死率可达20%～80%[1].连续性肾脏替代疗法(CRRT) 是近年来血液净化技术的革新与进步,它具有清除血液中炎症性细胞因子及代谢废物的功能,可极大提高高分解代谢型急性肾功能衰竭(ARF)、严重心力衰竭(以下简称心衰)、重症胰腺炎、成人呼吸窘迫综合征、多器官功能衰竭等患者的抢救水平,且临床疗效已日益被国内外多位学者肯定[2].近年来笔者采用CRRT技术治疗老年脓毒血症,取得了较好的疗效,现将结果报道如下.

脓毒症是指感染和创伤等诱发的剧烈全身性炎症反应,并引起组织器官继发性损伤的临床症候群[1].严重脓毒症和脓毒性休克是重症监护患者最常见和主要的死亡原因,病死率可达20%～80%[1-3].连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)是近年来血液净化技术的革新与进步,它具有清除血液中炎性细胞因子及代谢废物的功能,极大地提高了高分解代谢型急性肾功能衰竭、严重心力衰竭、重症胰腺炎、成人呼吸窘迫综合征、多器官功能衰竭等抢救水平,临床疗效日益被肯定[4].

<正>爆发性心肌炎是严重心肌损害性疾病,发病急骤,病情进展迅速,病程凶险,病死率高,临床表现有阿-斯综合征、心力衰竭、心源性休克、急性肾功能衰竭等[1]。2010年9月,本院ICU收治1例爆发性心肌炎伴全心衰竭、心源性休克、急性肾功能衰竭患者,经积极抢救,病情稳定后转普通病房继续治疗。现将急救护理报告如下。

总结30例脓毒症患者实施胰岛素强化治疗的护理经验。认为成立血糖控制小组,进行血糖知识和血糖监测技能培训,24h监控质量;正确执行胰岛素强化治疗方案,准时监测血糖;控制感染,做好降温护理;重视低血糖反应;保持血糖稳定在4.4-6.1mmol/L;预防皮肤完整性受损等并发症是成功实施胰岛素强化治疗的关键,可提高脓毒症患者的生存率。

<正>毛细血管渗漏综合征(capillary leak syndrome,CLS)临床上常见于严重创伤、脓毒症、体外循环术后及再灌注损伤、毒蛇咬伤、急性肺损伤或急性呼吸窘迫综合征(ARDS)、烧伤等,是由于在炎症介质的作用下,毛细血管内皮细胞损伤、血管通透性增加而引起毛细血管水肿,大量血浆蛋白渗

脓毒血症患者在感染应激情况下,抗调节激素和细胞因子大量分泌,糖的生成率超过糖的清除率是产生应激性高血糖的主要原因.近年来的研究[14]显示,在危重疾病状态下应用胰岛素控制血糖水平可降低ICU病死率,减少发生并发症的危险.我院ICU自2006年4月至2007年8月对30例脓毒血症患者进行了强化胰岛索治疗,笔者就治疗过程中的临床观察、血糖监测及护理方法进行了经验总结,报告如下.

Objective To summarize nursing experience on septic patients undergoing initial fluid resuscitation.Method 48 septic patients were enrolled and underwent initial fluid resuscitation in 6 hours after admission.Monitoring on vital signs,central venous pressure(CVP),central venous oxygen saturation(SCVO2) or venous oxygen saturation(SVO2) and urinary output per hour was performed on admission and after fluid resuscitation,and the role of nursing care on fluid resuscitation was evaluated.Result Effective nursing care during fluid transfusion and vasoactive drugs administration,catheters care as well as mental health care contributed to the goals achievement of fluid resuscitation.Conclusion Normalized initial fluid resuscitation combined with excellent nursing care could increase survival rate in septic patients.

Objective: to probe into the application values of pressure monitoring of artificial airway gasbag in nursing care of critical senile patients accepted endotracheal catheterization. Method: a total of 60 critical senile patients with establishment of artificial airway were divided into both test and control groups randomly. Patients of test group were used PORTEX aerocyst pressure monitoring meter to aerify and to take pressure. While patients of control group were applied traditional fingers-nipping to aerify. Air leakage of the two group patients was checked via ventilator. Both aerifying volume and pressure of aerocysts, incidence of complication of the two group patients were compared with each other. Results: when aerocysts pressure of test group patients was at 2.452 kPa ± 0.490 kPa, aerocysts volume of them was 10.0 mL ± 4.7 mL,there was no air leakage checked via ventilator. However, when aerocysts pressure of control group patients was at 3.923 kPa ± 0.736 kPa, aerocysts volume of them was 15.0 mL ± 5.1 mL,there was no air leakage checked via ventilator either. In terms of both tracheal mucous injury and aerocyst broken incidences, there were statistical significances between the two groups patients （P<0.05）. There were no statistical significances between the two group in terms of either aspiration and esophago-tracheal fistula incidences among all patients （P>0.05）. Conclusion: to establish artificial airway and keep the aerocyst pressure at 1.961 kPa～2.942 kPa for critical senile patients could avoid either aspiration or tracheal mucous injury effectively.