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 探讨协同护理措施在重症患者失禁相关性皮炎中的应用效果.方法 选择我院70例重症患者作为研究对象.采用随机数字表法将患者分为对照组和观察组,每组各35例.对照组采用常规护理,观察组采用协同护理.比较两组的失禁相关性皮炎、皮肤完整性及护理满意度.结果 观察组的失禁相关性皮炎、皮肤完整性及护理满意度优于对照组(P<0.05).结论 协同护理可有效改善患者皮肤完整性,降低患者失禁相关性皮炎的发生风险.

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.

Objective:To explore the effect of teaching based on cognitive load theory (CLT) in the teaching of intensive care medicine.Methods:A total of 70 practical nursing students studying intensive care medicine in the Affiliated Hospital of Jining Medical College from January 2019 to September 2020 were taken as the research objects. The nursing students who practiced from January 2019 to November 2019 were included in the control group ( n=35), and the students from December 2019 to September 2020 were included in the observation group ( n=35). The control group was given routine teaching, and the observation group was given CLT-based teaching. The differences of training load (clinical nursing student training load survey scale), empathy ability (Jefferson empathy scale for nursing students in Chinese version), self-learning ability (self-learning ability evaluation scale for nursing students) and critical medical nursing professional ability (comprehensive evaluation scale for core competence of intensive care nursing students) were compared between the two groups at the end of teaching. Chi-square test and t-test were performed by SPSS 19.0. Results:At the end of teaching, the scores of all dimensions of the observation group's clinical nursing student training load survey scale were lower than those of the control group (all P<0.05); the scores of all dimensions of observation group's nurses Jefferson empathy scale for nursing students in Chinese version, self-learning ability evaluation scale for college nursing students, and comprehensive evaluation scale for core competence of intensive care nursing students were higher than those of the control group (all P<0.05). Conclusion:When CLT-based teaching is applied in the teaching of intensive care medical nursing, it helps to reduce the training load of learners, and promote empathy, independent learning ability, and professional ability of intensive care medical nursing skills.

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.

Objective? To explore the psychological experience and feelings of family members of middle-aged and young patients in emergency intensive care unit (EICU). Methods? The family members of EICU patients from a hospital were selected by purposive sampling between August and September 2018. The 8 family members of middle-aged and young EICU patients received in-depth semi-structural interview using qualitative methods. Colaizzi method was used for analysis of the data. Results? The psychological experience of the 8 family members of middle-aged and young EICU patients could boil down to 5 themes: negative emotions such as anxiety, fear, worry and self-accusation; positive emotions such as hope and facing the reality; heavy economic burden on family; change of social roles; and desire for social support. Conclusions? Medical workers should pay attention to the psychological experience of family members, and provide them with psychological and informational support; meanwhile, they should utilise the social support system, and assist family members to get help from hospital, society and community so that family members' psychological burden can be alleviated, thus enabling the recovery and return to society in the middle-aged and young patients.

目的 调查济宁市某三甲医院急诊监护室护士结构授权和心理授权的现状及其影响因素,为管理者制订针对性的组织干预措施提供理论依据.方法 采取整群抽样法选取急诊监护室45名临床护士,采用中文版结构授权量表及心理授权量表进行问卷调查.结果 结构授权总得分为(18.45±4.02)分,心理授权总得分为(14.55±1.70)分;工作性质、月收入以及性格,内向与外向在结构 授权总分上存在差异(P＜0.05);职务、职称以及月收入在心理授权总分上存在差异(P＜0.05).结论 EICU护士结构授权和心理授权处于中等水平,管理者应制订针对性的干预措施,积极为护士创造授权的工作环境,提高护士满意度,降低职业倦怠及离职率.

总结了急性百草枯中毒患者的急救与护理,包括:急性期护理及恢复期护理等.认为早期催吐、洗胃、导泻和灌肠能够减少毒物吸收,早期血液灌流能够减轻毒物对多脏器损伤,积极有效的救治和护理能够明显降低中毒患者死亡率.