目的 通过流行病学调查和工时测定确定急诊抢救室的护理工作量,探讨其人力资源的合理配置.方法 回顾性分析2017年1月—2019年12月北京市某三级甲等医院急诊抢救室收治患者的情况,编制护理项目观察表,培训观察员,采用观察法测量每项护理操作的平均工时及总护理工作量,进而对护理人力资源进行合理配置.结果 2017年—2019年急诊抢救室共收治患者9735例,年龄以60～70岁居多(23.4％),以循环系统疾病患者为主(34.2％),患者抢救室中位滞留时间为0.94 d,收治患者高峰时间段为12:00—17:59和21:00—23:59.急诊抢救室护理操作项目涉及直接护理85项、间接护理18项,平均每例患者24 h护理项目总工时为411.13 min,理想床护比为1:1.69,理想护患比为1.54:1.结论 急诊抢救室护理工作量较大,护士人力配置较为不足.护理管理者可根据患者人群特点,加强护士理论培训,增加人员配备,动态补充人力,优化队伍结构,改善医院支持系统,提高急诊抢救室工作效率.

Objective To explore the feasibility of oxygen saturation related diffusion index for assessing oxygenation status,and to establish the critical value of the oxygen saturation related diffusion index,so as to provide more approaches to monitoring oxygenation status.Methods A total of 30 patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation support were retrospectively reviewed.Totally 340 cases were collected at corresponding time points,and were divided into mild,moderate and severe groups according to ARDS Berlin criteria.Results There was a positive correlation between oxygen saturation related diffusion index and oxygenation index (r=0.698,P＜0.001);the critical value between the moderate and severe groups of oxygen saturation related diffusion index was 171(sensitivity 84.7％,specificity 68.2％),and the critical value between mild group and moderate group was 440 (sensitivity 56.9％,specificity 91.9％).Conclusion The oxygenation index was consistent with the oxygen saturation related diffusion index in judging the oxygenation status of ARDS patients.As a noninvasive and continuous index,the oxygen saturation related diffusion index provides a new method for nursing assessment.

Ventilator-associated pneumonia (VAP) has become one of the most common and severe complications in patients with mechanical ventilation due to its high morbidity and mortality rates, and is an important cause of death in critically ill patients. Pathogenic oropharyngeal colonization mostly accumulates in the subglottic secretion, which is easy to be ignored and difficult to be cleaned. The leakage of subglottic secretion can result in pathogenic oropharyngeal colonization in the lung, and in turn cause VAP. Flushing of the subglottic secretion can effectively prevent VAP. Selection and amount of rinses, flushing frequency and proper cuff pressure maintenance during flushing were reviewed in the current study.

Objective To explore whether oxygen saturation-related dispersion index can be used as a non-invasive index for nurses to monitor ARDS patients' oxygenation and conditions.Methods Totally 23 patients with mechanical ventilation-associated complication and ARDS admitted in Peking Union Medical College Hospital between April 2015 and April 2016 were reviewed. Their PaO2, SpO2, PEEP and FiO2 values were recorded, and oxygenation index (OI) and oxygen saturation-related dispersion index were calculated for 132 case-times, respectively.Results The patients in the death group showed lower OI and oxygen saturation-related dispersion index than the patients in the survival group (P<0.05). The difference in oxygen saturation-related dispersion index between the light, middle and heavy groups were statistically significant (P<0.05).Conclusions Oxygen saturation-related dispersion index can be used to determine the prognosis of ARDS patients and the severity of the disease, especially the conditions of severe ARDS patients. As a non-invasive and continuous indicator, it provides a new measure for the nursing assessment of patients with mechanical ventilation-associated complication and ARDS.

临床中应用有创呼吸机辅助呼吸的患者,由于长期卧床、运动及感觉功能障碍、营养不良等多种危险因素,已成为压疮发生的高危人群.在日常压疮护理工作中,应当以预防为重,通过评估患者在早期识别压疮的危险因素,并采取积极有效的预防护理措施,可降低压疮的发生几率,避免增加患者痛苦,延缓疾病康复。

>静脉输液是利用大气压和液体静压原理将大量无菌液体、电解质、药物由静脉输入体内的方法。它是一种迅速有效的补液和给药途径,是临床给药的主要方法之一,也是医院治疗抢救患者的一个重要手段,在临床治疗疾病过程中占有重要地位。在临床实践中,大多数患者由于长期反复静脉穿刺易造成手背浅表静脉不同程度损毁,静脉变硬,甚至闭塞。以上这些情况都给静脉穿刺增加了难度,为缓解患者输

>患者男,14岁,2004.年始出现多饮多尿,每日饮水量与尿量均在3 000 ml以上,间断出现"嗜睡"情况,同时身高较同龄儿为矮。多年来家中未予以重视,患者嗜睡情况愈加严重,出现嗜睡不醒、言语迟钝症状。患者于外院行CT、MRI检查发现"鞍区占位",并出现发热39℃、意识不清、尿失禁后就诊于北京协和医院急诊科。患者入院生命体征:血压

>腹膜透析是将腹膜作为半渗透膜,应用重力作用将透析液经导管灌入患者的腹腔,利用弥散和渗透作用,通过不断更换腹膜透析液来达到清除体内代谢产物、毒性物质及纠正水、电解质平衡紊乱的目的。腹膜透析由于其操作简单而方便、疗效确切,一般情况下不需要特殊设备便可以在家中进行,目前已作为终末期肾病患者一体化治疗的首选初始治疗。而有49.6%的腹膜透析患者存在营养不良,这不仅直接影响到患者的生存时间和生活质量,也是使并发症和病死率增加的一个重要因素。在临床使用中,没有任何一种单一的指标能够综合反映患者的蛋白质能量营养状态,因而应采用多方面的、有效的指标综合评估维持腹膜透析患者的营养状态,多种指标相结合可使营养不良的判断更具敏感性和特异性。本文将就长期腹膜透析患者营养评估方法进行综述。

[目的]对白家庄小学5年级、6年级学生肥胖状况及运动、睡眠、学习时间分配的情况进行描述和分析.[方法]采用问卷调查的方法,收集运动、睡眠、学习时间和身高体重的资料进行统计分析.[结果]在调查的282人中,体质指数(BMI)均值为19.58 kg/m2.其中肥胖超重组97人(37%),BMI均值为22.59 kg/m2;正常组162人(63%),BMI均值为17.77 kg/m2.肥胖超重组与正常组日平均学习时间差异有统计学意义(P＜0.05),肥胖超重组和正常组运动时间差异有统计学意义(P＜0.05).[结论]学生的肥胖状况与运动、学习时间有关系,应指导学生提高时间分配的效度,控制肥胖率.

>氧合指数即动脉血氧分压与吸入氧浓度之比（PaO 2 /FiO 2 ）,为动脉血气计算值,是反映肺换气功能的常用指标,在各类肺部疾患诊治中,氧合指数操作简单、计算方便并可连续比较其趋势,有助于了解病情的进展以及对治疗的反应,在临床中该指标应用甚广。尤其在急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）鉴别诊断及病情判断中,氧合指数具有一定意义,自1994年欧美联合会议制订ALI和ARDS诊断标准后,该标准