目的 探究基于流程改造的精益管理模式对门诊伤口管理中心接诊效率及患者就诊满意度的影响.方法 对2018年1月—2020年2月来医院伤口造口门诊就诊的患者,在就诊各个环节进行现场调研统计,找出传统管理模式存在的问题,然后运用基于流程改造的精益管理模式,对比改进前后伤口造口门诊接诊效率及患者就诊满意度.结果 精益管理模式实施后,患者首诊时间、候诊时间均明显短于实施前(P<0.05),患者就诊满意度评分明显高于实施前,差异均有统计学意义(P<0.05).结论 门诊伤口管理中心引用基于流程改造的精益管理模式,通过优化流程,可有效提高伤口门诊管理中心接诊效率,提高患者就诊满意度.

目的 探讨血清Copeptin与老年慢性心力衰竭(chronic heart failure,CHF)患者病情严重程度关系及对预后预测作用.方法 选取符合纳入及排除标准的老年CHF 198例作为观察组,另选取同期健康体检者198例作为对照组.观察比较观察组和对照组以及不同NYHA心功能分级老年CHF患者血清Copeptin、N-末端脑利钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)水平及左室射血分数(left ventricular ejection fractions,LVEF),应用受试者工作特征(ROC)曲线分析血清Copeptin和NT-proBNP预测老年CHF患者预后不良的价值,采用多因素Cox回归分析对老年CHF患者预后影响因素进行分析.结果 观察组血清Copeptin及NT-proBNP水平高于对照组,LVEF低于对照组,差异有统计学意义(P<0.01).不同NYHA心功能分级老年CHF患者血清Copeptin、NT-proBNP水平及LVEF总体比较差异有统计学意义(P<0.01).老年CHF NYHA心功能Ⅱ级患者血清Copeptin和NT-proBNP水平低于NYHA心功能Ⅲ级和Ⅳ患者,LVEF高于NYHA心功能Ⅲ级和Ⅳ级患者;NYHA心功能Ⅲ级患者血清Copeptin水平低于NYHA心功能Ⅳ患者,LVEF高于NYHA心功能Ⅳ级患者,差异均有统计学意义(P<0.01).ROC曲线分析结果显示,血清Copeptin和NT-proBNP联合预测老年CHF患者预后不良的曲线下面积(AUC)高于血清Copeptin和NT-proBNP单独预测老年CHF患者预后不良的AUC,差异有统计学意义(P<0.01).多因素Cox回归分析结果显示,年龄≥70岁、LVEF<45％及血清Copeptin≥22.50 pmol/L、NT-proBNP≥4350 ng/L是老年CHF患者预后不良的独立危险因素(P<0.01).结论 血清Copeptin水平可反映老年CHF患者病情严重程度,可用于预测其近期预后,据血清Copeptin水平对老年CHF患者进行危险分层,有助于实现个体化干预,改善患者预后.

Objective To explore the effects of mindfulness training combined with auricular acupressure on sleep quality and negative emotion in patients with stroke. Methods Totally 70 stroke patients hospitalized in Rehabilitation Department of the First Affiliated Hospital of Harbin Medical University between October and December 2018 were selected by convenient sampling, and randomly divided into the observation group (n=35) and the control group (n=35). Patients in the control group received routine rehabilitation nursing, while patients in the observation group received mindfulness training combined with auricular acupressure on this basis. The Pittsburgh Sleep Quality Index Scale (PSQI), Self-Depression Scale (SDS) and Self-Anxiety Scale (SAS) were used to evaluate the sleep quality and negative emotion of the two groups of patients before and after the intervention. Results After the intervention, the PSQI, SDS, and SAS scores of the observation group were lower than those of the control group, and the differences were statistically significant (P< 0.05). Conclusions Mindfulness training combined with auricular acupressure can effectively ameliorate the sleep quality and negative emotion in patients with stroke.

Objective To compare changes of heart rate(HR) and pulse oximetry oxygen saturation(SpO2) between open endotracheal suction(OSS) and closed endotracheal suction(CSS) in ventilated premature infant.Methods Totally 83 ventilated premature infant were randomly divided into two groups, 42 cases received OSS(OSS group), and 41 cases received CSS(CSS group). The changes of HR and SpO2were compared in the two groups. Results There were significantly less deviation from baseline in HR and SpO2with CSS. Recovery time in the OSS group were twice than that of the CSS group. Conclusion CSS maintains better HR and SpO2stability in ventilated premature infants.

目的 探讨急性冠脉综合征PCI术后应用替罗非班的观察和护理方法.方法 对88例急性冠脉综合征PCI术后患者应用替罗非班的临床观察和护理进行分析.结果 88例患者PCI手术全部成功,术后24 h,36 h及30 d主要不良心血管事件(MACE)发生较少(约1.13％),住院期间观察无出血事件发生.结论 替罗非班应用于急性冠脉综合征患者PCI术后效果良好,安全性高.

[目的]探讨早产儿经鼻持续呼吸道正压通气(N-CPAP)过程中喂养的临床观察及护理。[方法]将80例接受N-CPAP治疗的新生儿呼吸窘迫综合征患儿随机分为对照组和观察组,每组40例,对照组采取常规治疗及护理,观察组在常规治疗及护理的基础上给予微量喂养、非营养性吸吮、温生理盐水通便或灌肠和腹部按摩等护理干预。比较两组患儿喂养不耐受的发生情况、体重变化情况及胎粪排尽时间。[结果]观察组早产儿发生腹胀、胃残余量>30%及禁食>2次等喂养不耐受发生率低于对照组;观察组早产儿胎粪排尽时间短于对照组。[结论]对行N-CPAP治疗的新生儿呼吸窘迫综合征患儿早期实施微量喂养、非营养性吸吮、温生理盐水通便或灌肠和腹部按摩等护理措施,可减少早产儿在接受N-CPAP过程中所致的不良反应。

目的:探讨舒适护理在蓝光治疗新生儿高胆红素血症中的效果。方法:将80例行蓝光治疗的高胆红素血症患儿随机分为对照组和观察组各40例,对照组按新生儿光疗给予常规护理,观察组在光疗护理常规护理的基础上,针对新生儿蓝光治疗的护理问题采取相应的舒适护理措施,比效两组的护理效果。结果:观察组护理问题发生率明显低于对照组(P<0.05)。结论:舒适护理应用于蓝光治疗高胆红素血症的患儿,可降低新生儿光疗时的不愉快感,使其安静、舒适地配合光疗。因此,舒适护理可有效地降低蓝光治疗新生儿高胆红素血症中存在的护理问题。

Objective To investigate the appropriate dressing change frequency of peripherally inserted central catheter(PICC) in neonates.Methods Totally 307 neonates with PICC were randomly divided into three groups.The transparent dressings were changed every 3 days,5 days or 7 days in the three groups,respectively.The incidence rates of catheter related bloodstream infection(CRBSI) were compared among the three groups.Results The incidence rates of exit site infection in the three groups were 3.96%,4.90% and 5.77%,respectively.The incidence rates of catheter colonization were 6.10%,7.06% and 6.02%,respectively.The incidence rates of CRBSI were 0.99%,1.96% and 0.00%,respectively.No significant differences were found in the incidences of exit site infection,catheter colonization and CRBSI(P>0.05).Conclusion It is suggested to change transparent dressing every 7 days in neonates with PICC.The dressing should be replaced timely in case of being damp or loosened.

<正>哮喘的定义是:"哮喘是一种慢性气道炎症性疾病。其中有许多细胞组分参与起作用,特别是肥大细胞、嗜酸粒细胞和T淋巴细胞。在易感人群中这种炎症会造成反复的喘息、呼吸困难、胸闷和咳嗽,尤其在夜间和(或)清晨[1]"。国际上对哮喘的认识不断发展。我国是全球哮喘防治的创议(GI-NA)[2]制定参与国,随着该方案在我国的普及,我国儿科领域在哮喘病的诊断、防治、科研及管理方面取得了很大的进步。支气管哮喘儿童的家庭护理是一门学问,护理措施得当,病情就恢复得快,甚至痊愈。护理不当,就会促使此病复发或导致病情加重。因此,儿童家长掌握一些简单的家庭护理与

目的:探讨超未成熟儿的临床特点和护理要点。方法:回顾性调查2007年10月~2009年12月在我院NICU住院的9例超未成熟儿的临床资料,总结护理方法。结果:9例超未成熟儿生后2 d死亡1例,出生55 d好转签字出院1例,其余7例治愈出院。结论:对超未成熟儿采取科学、规范、合理的综合性临床护理管理,维持中性体温与轻柔操作,减少不必要的干预,加强呼吸及营养管理、防治感染,严密观察病情,及时预防并发症,可获得较高的存活率,但并发症仍较多,需加强观察护理。

Objective To explore the relationship between frequency of dressing change and PICC insertion site infection in neonates. Methods A prospective study was undertaken. 95 neonates were randomized into 3 groups, group 1 changed dressing every 3 days, group 2 changed dressing every 5 days, group 3 changed dressing every 7 days. Insertion site infection was observed and underwent pathogenic detection,complications associated with dressing change were also observed in all the 3 groups. Results 31 neonates were randomized to group 1 ,there were 3(9.68%)episodes of insertion site infection,34 neonates were randomized to group 2,there were 2(5.88%)episodes of insertion site infection, 30 neonates were randomized to group 3, there were 5(16.67%)episodes of insertion site infection. Rates of insertion site infection did not differ in the 3 groups.8 strains of staphylococcus epidermidis(2 of them were methicillin resistant staphylococcus epidermidis)were founded in 10 neonates who developed insertion site infection,positive rate was 80%. Skin excoriation occurred in 4 of 31 neonates in group 1,no neonates in the other two groups developed skin excoriation. Conclusions We suggest change dressing of neonatal PICC every 7 days,replace dressing if the dressing becomes damp or loosened at any time.

目的分析新生儿医院感染特点及主要危险因素,加强护理,降低医院感染率。方法对2001年1月—2008年12月在新生儿科住院的9 324例新生儿的医院感染发生情况进行回顾性分析,包括医院感染率、主要的感染部位、医院感染的危险因素等。结果新生儿医院感染率为4.88%,感染部位以呼吸系统感染为主,占47.0%。Logistic回归分析提示侵入性操作、出生体质量、住院时间是新生儿医院感染的主要危险因素(OR值分别为3.485、2.854、2.341,P<0.05)。结论新生儿医院感染发生率较高,加强低出生体质量儿的护理,减少侵入性操作、缩短住院时间是预防和控制新生儿医院感染的关键措施。

Objective To study the effects of a psychological intervention mode for patients around period of operation PTCA and stent implantation.Methods Sixty patients from a Grade Ⅲ Class A hospital were enrolled and randomly divided into two equal groups.The control group received routine psychological care.The intervention group(n=30) was treated with measures established by the psychological intervention mode(information intervention,psychological care,mood dredge,cognitive intervention,behavioral intervention). The mental states of the two groups were compared.Results After psychological intervention,the score of anxiety and depression showed a significant reduction in the intervention group compared with the control group(P0.05).The differences of dynamic change in blood pressure and pulse change on different time burns were significantly bigger in the control group than that in the intervention group(P0.01).Conclusions The psychological intervention mode can reduce patients' negative emotions as well as decrease side effects and the complication incidence in patients with coronary heart disease (CHD) who receive the PTCA and stent implantation operation and help them maintain suitable psychosomatic status.

>经皮冠状动脉支架介入手术(简称经皮冠脉介入术,PCI)已成为治疗冠心病的主要手段,如何预防、减少术后并发症的发生,成为保证手术质量和手术成功的关键环节,也是医护关注的重点。我科2006年2-9月收治3例经皮冠脉介入术后皮下注射低分子肝素抗凝药物数日后出现腹壁淤青、大血肿患者,经精心护理后取得了满意的效果,现报道如下。

目的 探讨双管同步抽注法和全自动换血法治疗新生儿高胆红素血症的疗效.方法 分别检测采用双管同步抽注法的10例高胆红素血症新生儿和采用全自动换血法的13例高胆红素血症新生儿换血前后胆红素、血电解质、血常规、血糖、pH值变化.结果 双管同步抽注法组换血前后总胆红素值分别为(391.13±107.62)mmol/L、(193.40±37.86)mmol/L,总胆红素换出率为50.4%.全自动换血组换血前后总胆红素值分别为(430.33±121.92)mmol/L、(216.83±63.66)mmol/L,总胆红素换出率为49.8%.2组换血前后总胆红素值差异均有显著意义(P＜0.01),2组总胆红素换出率无显著性差异(P＞0.05).结论 全自动换血法简便易行,安全有效,是新生儿换血中较理想的方法。

目的：探讨护理干预对慢性心力衰竭(CHF)伴抑郁患者相关性的影响。方法：对147例此类患者生存质量,疾病康复的相关性进行分析,采取各种方式干预、评估。结果：CHF伴抑郁严重影响患者长期生存质量,增加再住院率和死亡率。结论：长期有针对性地进行护理教育和康复训练可提升患者的生存质量。

外周导入中心静脉置管(peripherally inserted central catheter,PICC)是一种从外周静脉导入且导管末端位于上腔静脉的深静脉穿刺技术,在国外的临床护理中达到相当的比例[1].我科自2002年10月开展该项技术,至2004年10月共完成83例,取得良好效果,现报告如下.

扩张型心肌病所致心力衰竭是心肌细胞舒缩功能减弱,心肌细胞失去增值能力或增值能力极低[1].增加具有舒缩功能的心肌细胞数目是改善心功能的关键.干细胞是具有自我更新、多分化潜能的早期未分化细胞[2].骨髓干细胞(MSCs)移植可分化成心肌细胞,增加有功能的细胞,新生的血管内皮细胞形成的侧支循环改善了供血及心脏局部和整体收缩功能[3].我科于2004年8月开展MSCs移植术治疗心力衰竭病人12例,均采用导管介入移植手术,在病人同意下行自体MSCs冠状动脉内注射,MSCs移植与经皮冠状动脉成形术一并进行,现将其护理总结报道如下.

护理服务成本是医院成本核算不可缺少的一部分,临床护理服务在疾病诊治与康复中占很大的比重,而护理服务成本却普遍降低,护士的劳动价值没有受到足够的重视.

目的探讨新生儿小脑畸胎瘤的临床护理.方法回顾性总结分析1例新生儿小脑畸胎瘤的治疗和护理.结果建立完善的产前筛查可早期发现小脑肿瘤.凡新生儿,小婴幼儿早期出现不明原因呕吐、无热抽搐,除考虑低钙低镁抽搐外,均应警惕脑肿瘤.结论新生儿难以陈述症状,严密观察生命体征,注意颅缝分离,头围增大的表现动态观察及记录,早期发现颅内高压症状;采取抬高头部15°～30°头偏向一侧,以利颅内静脉回流,减轻脑水肿,降低颅内压.保持呼吸道通畅,防止窒息或吸入性肺炎,是护理的关键环节.