Objective:To summarize the best evidence on the use of hyperbaric oxygen therapy in chronic wound management, and provide guidance and reference for the use of hyperbaric oxygen in chronic wound management.Methods:Relevant evidence on the use of hyperbaric oxygen therapy in chronic wound treatment was systematically retrieved from databases at home and abroad, including guidelines, expert consensus, systematic reviews, randomized controlled trials, etc. The search time was from the establishment of the database to December 31, 2020. The literature quality was evaluated by 2 researchers, and evidence was extracted from the literature that met the inclusion criteria.Results:Finally, 12 articles were included, including 2 guidelines, 2 expert consensus, 3 randomized controlled trials, and 5 systematic reviews; 14 pieces of best evidence were extracted in terms of the mechanism, application scope, evaluation content, and usage recommendations of hyperbaric oxygen therapy.Conclusions:This study summarizes the best evidence for the use of hyperbaric oxygen therapy in the management of chronic wounds. Medical staff should select evidence in a targeted manner based on the actualities of patients with chronic wounds, and formulate scientific, reasonable, and personalized treatment protocols for them to improve quality of care.
目的:探讨中老年出院患者自我效能、出院准备度和"互联网+护理服务"采纳意愿之间的关系及内在作用机制.方法:选取天津市某三级甲等医院即将出院的中老年患者共307例,采用一般资料问卷、出院准备度量表、一般自我效能量表及"互联网+护理服务"采纳意愿问卷开展调查,测量其自我效能水平、出院准备度及"互联网+护理服务"采纳意愿,使用SPSS 21.0和AMOS 21.0对数据进行统计分析.结果:患者出院准备度、自我效能和"互联网+护理服务"采纳意愿之间呈正相关(P＜0.001);出院准备度既可直接影响患者对"互联网+护理服务"的采纳意愿,又可以通过自我效能对"互联网+护理服务"采纳意愿起间接作用.结论:自我效能在中老年患者出院准备度与"互联网+护理服务"意愿之间起中介作用,管理者应充分重视提高此类人群的自我效能水平,提升其互联网医疗就诊意愿.
目的:调查危重症病人医疗器械相关性压力性损伤不良事件发生情况,并对现状进行分析.方法:采用便利抽样方法,选取2020年7月—2020年12月天津某三级甲等综合医院重症医学科收治的802例具有医疗器械相关性压力性损伤发生风险的危重病人,调查其医疗器械相关性压力性损伤发生情况及影响因素.结果:医疗器械相关性压力性损伤发生率为20.45％.危重病人住院时间长,体温高,心率、呼吸频率、血压等指标异常,血氧饱和度低,血清肌酐浓度高,血红蛋白浓度低,乳酸水平高,白蛋白水平低,手术史,使用镇静及血管活性药物是医疗器械相关性压力性损伤发生的危险因素(P<0.05).结论:医护人员需有针对性就危险因素的监管及预防提出进一步改善措施,进而降低医疗器械相关性压力性损伤发生率,为病人的治疗提供更安全、更高质量的优质护理.
目的 探讨留置经外周静脉置入的中心静脉导管(PICC)的肿瘤患者发生导管相关性感染的危险因素.方法 前瞻性追踪401例留置PICC肿瘤患者,分析患者发生导管相关性感染的相关因素,并进一步行Logistic回归分析.结果 401例留置PICC肿瘤患者的总导管留置时间为43155 d,发生PICC导管相关性感染46例,感染率为1.07/1000导管日.单因素分析显示,MARSI史、经PICC输注刺激性药物、血小板水平、APTT水平、置管地点、置管次数、导管移动、导管维护周期延迟、维护人员资质对PICC导管相关感染的发生有影响,差异有统计学意义(P<0.05);多因素分析提示,MARSI史、经PICC输注刺激性药物、置管次数是肿瘤PICC患者发生感染的独立危险因素;APTT水平、维护人员资质是其保护因素.结论 针对危险因素应采取有效的预防处理措施,以期降低留置PICC的肿瘤患者发生导管相关性感染风险.
Objective:To analyze the research hotspots of medical device related pressure injuries at home and abroad with the method of bibliometric analysis.Methods:Literatures were retrieved in the Chinese National Knowledge Infrastructure (CNKI) and PubMed from building database to July 2019. Bibliographic Items Co-occurrence Matrix Builder was used to carry out bibliometric analysis, and the CiteSpace and gCLUTO was used to visual clustering analysis on high-frequency keywords.Results:A total of 116 literatures were included, 75 (64.7%) of them in Chinese and 41 (35.3%) of them in English. Researches in this field at home and abroad were all in the early stage and number of literatures gradually increased, but researches abroad started early. Among 75 Chinese literatures, a total of 176 keywords were extracted with 23 for the highest frequency; among 41 English literatures, a total of 63 keywords were extracted with 26 for the highest frequency. Chinese literatures clusters included three hotspots, preventive intervention, causes and risk factors assessment methods of medical device related pressure injuries; English literatures clusters included four hotspots, occurrence site, causes of medical device related pressure injuries, types of medical equipment and preventive methods.Conclusions:Researches in this field at home and abroad have hotspots of causes and preventive intervention in common. English literature focus on experimental study and quasi-experimental study, and pay attention to the empirical application of concrete strategy; Chinese literatures are mainly correlational study and analytic research, but lack of proving. Therefore, researches at home need to be expanded further.
目的 遴选并获取预防医疗器械相关压力性损伤的临床实践依据,并对相关证据进行总结.方法 针对医疗器械相关压力性损伤提出问题,检索国内外数据库相关文献,检索时限为建库至2019年10月.由2名研究者依据JBI循证卫生保健中心的文献评价标准和证据分级系统,对各类研究进行文献质量评价及证据级别评定,纳入符合质量标准的文献,并提取证据.结果 共纳入证据8篇,包括指南6篇、专家共识1篇、系统评价1篇.最终形成包括皮肤评估、皮肤清洁、医疗器械的安置与移动、合理使用敷料和教育培训5个方面的最佳证据.结论 本研究总结了预防医疗器械相关压力性损伤的临床实践依据,在临床应用证据时,建议评估相关医疗机构的就医环境、设备条件及医护人员应用证据时的促进及阻碍因素、患者意愿等因素,筛选调适后,进行有针对性的证据使用,以促进证据有效地向临床转化,为临床护理实践提供更多科学依据,从而提升护理质量.
目的 探讨医用粘胶相关性皮肤损伤(medical adhesive related skin injury,MARSI)在PICC肿瘤患者中的发生情况及影响因素,为降低医用粘胶相关性皮肤损伤的发生提供护理依据.方法 采用前瞻性队列研究的方法,选取2018年4月1日—11月20日在天津市某三级甲等医院行PICC置管的396例肿瘤患者作为研究对象,调查医用粘胶相关性皮肤损伤的发生率,并分析医用粘胶相关性皮肤损伤类型、医用粘胶相关性皮肤损伤发生部位及影响因素.结果 肿瘤患者医用粘胶相关性皮肤损伤发生率为26.8％(106/396);医用粘胶相关性皮肤损伤类型以接触性皮炎13.9％(55/396)以及机械性皮肤损伤中的张力性损伤/水疱6.3％(25/396)为主,其次为潮湿相关性皮肤损伤1.3％(5/396),毛囊炎1.0％(4/396).医用粘胶相关性皮肤损伤多发生在贴膜下皮肤63.2％(67/106).多因素Logistic回归分析发现PICC导管相关感染(P<0.001,OR=3.271,95％CI:1.697～6.306)、穿刺次数(P=0.018,OR=2.474,95％CI:1.171～5.226)、导管维护周期延迟(P=0.018,OR=2.537,95％CI:1.176～5.473)是肿瘤PICC患者发生医用粘胶相关性皮肤损伤的危险因素.结论 肿瘤患者PICC置管部位医用粘胶相关性皮肤损伤发生率较高,且好发于贴膜下皮肤;医用粘胶相关性皮肤损伤类型以接触性皮炎和机械性皮肤损伤居多;而感染、穿刺次数、导管维护周期延迟是医用粘胶相关性皮肤损伤发生的危险因素.
目的 对国内外PICC导管相关感染预防相关临床实践指南进行质量评价,为制定PICC导管相关感染的预防措施提供依据.方法 检索国内外数据库、指南网站及相关组织网站,严格按照纳入排除标准筛选指南,使用AGREEⅡ系统对纳入指南进行质量评价,并汇总指南推荐意见.结果 共纳入18篇PICC导管相关感染预防指南,其中英文指南12篇,中文指南6篇.18篇指南在AGREEⅡ6个领域平均得分由高到低依次为范围和目的(71.4％)、清晰性(68.5％)、应用性(60.3％)、参与人员(59.5％)、制定的严谨性(58.5％)、编写独立性(51.3％).纳入指南主要包括教育与培训、质量控制、置管前评估、置管中护理、置管后护理等5个方面内容.结论 本研究纳入的指南质量整体较好,但国内指南质量尚需要不同程度的完善和更新,以期制定出符合中国国情的实践指南,为临床实践提供参考借鉴.
目的:了解部分地区孕妇对“全面二孩”政策看法及其生育意愿的影响因素.方法:采用便利抽样的方法,于2016年4月至8月对北京、天津、河南省、江苏省地区的在三甲综合医院就诊的232名孕妇进行问卷调查和访谈.结果:部分地区的孕妇对二孩政策知晓率较高(93.5％),选择支持二孩政策的调查对象仅占19.8％,有29.3％的人有生育二胎意愿,62.9％没有生育二胎意愿.通过对部分地区孕妇访谈得知,影响她们生二胎的因素包括:生育成本因素、职业发展因素、新生育观念因素等.结论:本研究调查对象多属80、90后人群,正值育龄阶段,但仅部分女性有生育二胎的意愿.生育意愿是来自宏观的社会政策、文化和来自微观的个人、家庭等因素多方面作用的结果,因此在调整计划生育政策的时候需要对生育意愿进行全面的考量,才能实现人口的健康发展.
