Objective This study investigated the impact of a hierarchical management model on enhancing the quality of nursing services within the nursing department (ND). Methods A retrospective comparative cohort study was conducted on outpatients treated at the hospital from January 2021 to December 2022. A total of 68 patients admitted from January 2021 to December 2021 were assigned to the control group, while 75 patients admitted from January 2022 to December 2022 were assigned to the observation group. During the study period, a consistent group of nurses was responsible for outpatient care and underwent hierarchical management beginning in January 2022. We compared nursing quality and patient satisfaction between the two groups and documented adverse events (AEs), which included medical disputes and misdiagnoses. The psychological status of the patients was assessed using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Results In comparison to the control group, the observation group demonstrated significantly higher scores for nursing quality and patient satisfaction (P < .05) and a lower incidence of AEs (P < .05). Following diagnosis and treatment, the observation group exhibited decreased SAS and SDS scores, significantly lower than the control group (P < .05). Conclusions Implementing a hierarchical management model positively impacts nursing quality within the ND and enhances patient satisfaction. Therefore, it is recommended as an effective approach for improving nursing care quality and patient satisfaction.

总结1例腹膜透析术后患者切口脂肪液化的护理经验。主要内容包括：在做好术后切口常规护理的基础上，为患者切口进行红纱条填塞换药，且表面用10%浓氯化钠注射液外敷；结合患者病情进行腹膜透析、饮食与营养指导、心理护理。

总结1例腹膜透析患者重度水肿合并心力衰竭的护理经验。护理重点：通过利尿、调整腹膜透析治疗方案、三日饮食日记、个性化饮食方案、建立患者专属微信群、腹膜透析相关理论知识与操作的培训，联合中药灌肠、中药超声透药、五行音乐与耳穴贴压等中医护理特色技术，使患者水肿与心衰情况得到明显改善。

： Summarize the nursing experience of a patient with severe edema complicated with heart failure in peritoneal dialysis. Focus of nursing:Through diuresis, adjustment of peritoneal dialysis treatment plan, 3-day food diary, personalized diet plan, establishment of patient-specific wechat group, training of related theoretical knowledge and operation of peritoneal dialysis, combined with traditional Chinese medicine enema, traditional Chinese medicine ultrasonic penetration, five-elements music and ear acupoint sticking and other traditional Chinese medicine nursing characteristics, the patients' edema and heart failure have been significantly improved.

为探讨中医干预腹膜透析治疗的科研力量分布、研究热点、现状及未来发展趋势,以1993 年1 月—2022 年12 月在中国知网(CNKI)发表的中医干预腹膜透析治疗相关文献为数据源,应用CiteSpace 6.1.R6 软件,从发文作者、研究机构、关键词及突现词等不同角度,分析中医药干预腹膜透析治疗领域中的核心团队、团队间合作网络、研究热点等分布情况,并将分析结果进行可视化展示.分析发现:中医药干预腹膜透析的科研工作受到广大学者的重视,发文量总体呈现上升趋势;研究机构以中医院校,大型中医医院为主,核心团队突出,团队内部合作为主,研究群体之间交集不多,研究力量较为分散;主要研究热点为中医证型分析,中医干预腹膜透析相关并发症的辨证施治及临床疗效评价等.针对分析中提出的问题,建议进一步推进中医干预腹膜透析治疗的研究,加强跨机构的多元化科研合作交流,以促进我国中医干预腹膜透析治疗取得高质量、科学化、多元化发展.

血液透析治疗是慢性肾脏病终末期患者肾脏替代治疗的有效方法之一,被广泛应用于临床,但长期规律血液透析病程较长、发症较多、患者心理压力你和经济压力较大.其中认知功能障碍在长期规律血液透析患者中的发生率较高,而知晓率相对较低,严重影响患者的生活质量,降低患者治疗依从性,增加死亡风险.文章通过查阅大量文献并结合临床实际工作,对长期规律血液透析患者认知功能障碍的流行病学特征、发生的危害、相关影响因素(人口学因素、疾病相关因素、血液透析治疗相关因素、心理因素、尿毒症毒素因素)及干预措施等情况的研究进展进行分析、总结与综述,以期为相关研究与临床实际工作提供参考.

目的 探索医疗失效模式与效应分析在居家腹膜透析(腹透)患者管理的应用价值.方法 选取2020年1-6月该院腹透中心管理的居家规律腹透3个月及以上、年龄18～75岁患者68例作为研究对象,应用医疗失效模式与效应分析(HFMEA)对患者的管理进行风险评估,制订具体改进措施,比较该管理模式实施前后风险优先指数(RPN)值,以及患者居家腹透相关理论知识、腹透操作与外出口换药操作考核结果等.结果 应用HFMEA进行居家腹透患者管理后水肿、饮食与出入量不平衡、腹膜炎、心力衰竭、运动量不足等主要失效模式的RPN值明显下降,差异均有统计学意义(t=26.159、19.490、9.752、4.813、6.062,P<0.05);患者理论知识、透析操作与外出口换药操作考核成绩均明显提升,差异均有统计学意义(t=5.976、2.820、3.886,P<0.05).结论 应用HFMEA模式对居家腹透患者进行管理,对解决患者居家腹透相关问题、提高患者理论知识与操作能力是有效、可行的.

Objective To investigate the effect of five-element music therapy combined with auricular acupoint pressing on emotional status and sleep quality of patients with peritoneal dialysis. Methods Totally 80 peritoneal dialysis patients with catheter placement were randomly divided into the control group and the intervention group, with 40 cases in each group. All patients received routine care and emotion nursing, and those in the intervention group were given five-element music therapy combined with auricular acupoint pressing. The anxiety, depression status and sleep quality of patients were evaluated. Results The scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) decreased in both groups after a two-week intervention, and were lower in the intervention group than those in the control group (P<0. 01). The score of Pittsburgh Sleep Quality Index (PSQI) decreased in both groups after a two-week intervention, and was lower in the intervention group than that in the control group (P<0. 01). Conclusion On the basis of routine care and emotion nursing, the five-element music therapy combined with auricular acupoint pressing is effective to improve the emotional status and sleep quality of patients with peritoneal dialysis.

[目的]采用失效模式与效应分析(FMEA)对肾病科病人尿标本采集流程进行分析与优化,建立肾病科病人尿标本标准化采集流程.[方法]应用 FMEA对尿标本采集流程进行风险评估,制订具体改进措施,比较改进措施实施前后风险优先指数(Risk Priori-ty Number,RPN)值、病人尿标本采集与送检质量、病人满意度等情况.[结果]实施后宣教不到位、监督力度不够、病人理解不到位、标本采集与送检流程不清晰、多人管理、职责不明确等失效模式的 RPN 值与实施前比较明显下降(P<0.05);病人标本留取方法与留取量正确率分别由 85.75％、91.19％上升至 97.41％、98.59％;条码漏扫率与标本丢失率分别由12.69％、7.51％下降至4.71％、3.29％,病人满意度由 91.41％上升至 97.81％,差异均有统计学意义(P<0.05).[结论]应用 FMEA 模式对肾病科病人尿标本采集与送检流程进行管理,对提高病人尿标本采集与送检质量及病人满意度是有效可行的.

目的:探讨分析中西医结合护理干预对提高糖尿病肾病患者依从性及改善预后的效果.方法:选择某医院2019年1月～2019年12月期间收治的100例糖尿病肾病患者为本次研究对象,将100例患者按照随机数字表法分为对照组和研究组,各50例,对照组予以常规护理,研究组实施中西医结合护理干预,观察两组依从性和预后情况.结果:研究组总依从性高于对照组,终末期肾衰竭发生率低于对照组,均P<0.05.结论:在糖尿病肾病患者的临床护理中,采用中西医结合护理干预效果显著,可有效提高患者依从性,并改善预后.

该文从慢性肾衰竭患者中药结肠透析原理、透析前准备、肠道清洗、透析液成分、透析时患者卧位、探头插入深度、中药灌肠保留时间、结肠透析频率及护理干预对透析效果的影响等进行综述,以期为相关研究及临床工作提供参考.

目的 观察改良式结肠透析联合中药保留灌肠治疗慢性肾衰竭(CRF)的临床疗效.方法 将100例CRF患者按照随机数字表法分为2组,对照组50例予常规结肠透析联合中药保留灌肠治疗,治疗组50例采用改良式结肠透析联合中药保留灌肠治疗.2组均治疗8周后比较2组治疗前后中医症状评分(包括恶心呕吐、食少纳呆、少气乏力及腰膝痠软)及肾功能指标[包括血清尿素氮(BUN)、肌酐(Cr)及尿酸(UA)]水平变化情况,比较2组治疗4、8周后主观不适感受腹胀、腹痛及肛门坠胀评分变化情况.结果 2组治疗后中医症状恶心呕吐、食少纳呆、少气乏力及腰膝痠软评分与本组治疗前比较均明显降低(P<0.05),且治疗后治疗组各项评分均低于对照组(P<0.05).2组治疗后BUN、Cr及UA水平与本组治疗前比较均明显降低(P<0.05),但2组治疗后组间比较差异均无统计学意义(P>0.05).2组治疗4周后腹胀、腹痛及肛门坠胀评分组间比较差异均无统计学意义(P>0.05),但治疗8周后治疗组腹胀、腹痛及肛门坠胀评分均低于对照组(P<0.05).结论 改良结肠透析联合中药保留灌肠治疗CRF临床疗效确切,可明显改善患者中医临床症状,降低BUN、Cr及UA水平,缓解治疗期间的主观不适感受.

北京市中医管理局于2016年启动了中医护理传承工作,首都医科大学附属北京中医医院获批了“桂梅芬中医护理传承工作室”项目,通过跟师查房、学术探讨等方式,培养一支医德高尚、技术精良、传承创新的中医护理队伍,为建立中医护理老专家临床经验传承体系和共享平台打下基础.