目的 创建湖南省三级医院"三梗一出血"预警防控模式,为逐步建立规范化和专业化的防控和救治模式提供依据.方法 将2017年2月至2020年1月在湖南省人民医院院内发生"三梗一出血"患者328例作为对照组,2020年2月至2023年1月发生的"三梗一出血"患者272例作为观察组.对照组实施常规干预,观察组在结合对照组情况的基础上实施预警防控干预模式.比较两组患者急救时间、住院时间、并发症发生率、致残率、致死率和诊疗服务满意度.结果 观察组患者急救时间、住院时间、并发症发生率、致残率和致死率均显著低于对照组,而诊疗服务满意度显著高于对照组,两组间比较差异有统计学意义(P＜0.05).结论 预警防控模式能够明显缩短"三梗一出血"患者的急救时间和住院时间,有助于降低并发症发生率和致残率、致死率,提升诊疗服务满意度,为建立逐步规范化和专业化的防控和救治模式提供了依据.

目的 Meta分析评价延续护理对经皮经肝穿刺胆管引流术(PTBD)后出院患者并发症发生率的影响.方法 检索中国知网(CNKI)、万方、维普(VIP)、中国生物医学文献服务系统(CBM)、PubMed、Cochrane Library、EMbase、Web of Science等数据库中关于PTBD后出院延续护理的随机对照研究文献.采用澳大利亚Joanna Briggs研究所(JBI)文献质量评价工具评价纳入文献的质量,RevMan 5.4软件对纳入文献作Meta分析.结果 最终纳入9篇有效文献,总样本量854例(对照组425例,干预组429例).Meta分析显示,延续护理有效降低了PTBD后出院患者胆道感染(RR=0.42,95％CI=0.30～0.57)、穿刺处伤口感染(RR=0.19,95％CI=0.06～0.65)、导管脱出或移位(RR=0.31,95％CI=0.18～0.54)、导管堵塞(RR=0.23,95％CI=0.13～0.42)、引流管周围皮肤感染(RR=0.30,95％CI=0.12～0.77)、导管相关原因再入院(RR=0.34,95％CI=0.18～0.65)发生率,均P＜0.05.结论 与常规出院护理相比,延续护理可有效降低PTBD后出院患者胆道感染、穿刺处伤口感染、导管脱出或移位、导管堵塞、引流管周围皮肤感染、导管相关原因再入院等并发症发生.

Objective To explore the risk factors for bleeding at the puncture site after femoral artery puncture intervention.Methods A computerized retrieval of observation studies,including cross-sectional studies,case-control studies,and cohort studies,about the risk factors for bleeding at the puncture site after femoral artery puncture intervention from the databases of China National Knowledge Infrastructure(CNKI),Wanfang,VIP,China Biomedical Literature Service(CBM),PubMed,Medline,The Cochrane Library,EMbase and Web of Science was conducted.The retrieval time period was from the establishment of the database to December 31,2022.Newcastle-Ottawa scale(NOS)was used to evaluate the quality of the included studies,and RevMan5.3 software was used to make meta-analysis of the literature data.Results A total of 8 articles with a total sample size of 35 250 patients were included in this analysis.There were 1 410 patients in the postoperative bleeding group and 33 840 patients in the non-bleeding group.The results of the meta-analysis showed that the aged(OR=2.71,95％ CI=2.17-3.38),female(OR=4.26,95％ CI=1.08-16.89),hypertension(OR=2.48,95％CI=1.69-3.63),obesity(OR=2.33,95％ CI=1.59-3.42),use of thrombolytic agents,anticoagulants or platelet antagonists(OR=2.95,95％ CI=2.24-3.89),manual compression(OR=6.78,95％ CI=1.34-34.43)were the risk factors for the bleeding at the puncture site after femoral artery puncture intervention.Conclusion The aged,female,hypertension,obesity,use of thrombolytic agents,anticoagulants or platelet antagonists,and manual compression are the risk factors for the bleeding at the puncture site after femoral artery puncture intervention.(J Intervent Radiol,2024,33:314-320)

Objective:To explore the influencing factors of puncture site bleeding in patients with liver cancer treated by femoral artery intervention.Methods:From July 2021 to January 2023, the clinical data of patients with liver cancer treated with percutaneous femoral artery intervention in our center were prospectively collected. Univariate and multivariate logistic regression analysis was used to determine the independent risk factors for bleeding at the puncture site in patients with liver cancer.Results:A total of936 patients with liver cancer were included for analysis, of which 109 (11.6%) had bleeding at the puncture site. Univariate analysis showed that gender, BMI, type of surgery, liver function, portal hypertension, platelets, prothrom-bin time, fibrinogen, sheath retention time, and number of vascular punctures were associated with bleeding at the puncture site (P < 0.1). Multivariate logistic regression analysis showed that female (OR = 16.421, 95%CI: 8.299~32.492), BMI≥28 kg/m2 (OR = 3.898, 95%CI: 1.489~10.202), liver cirrhosis Child-Pugh score 5~6 points (OR = 3.179, 95%CI: 1.754~5.761), liver cirrhosis Child-Pugh score≥7 points (OR = 8.171, 95%CI: 3.656~18.264), platelet count 50~100 × 109/L (OR = 6.228, 95%CI: 3.470~11.176), platelet count < 50 × 109/L (OR = 77.491, 95%CI: 16.321~367.917), sheath retention time > 240 min (OR = 4.060, 95%CI: 0.012~8.193), number of vascular punctures = 2 (OR = 9.422, 95%CI: 4.786~18.549), and number of vascular punctures > 2 (OR = 28.347, 95%CI: 12.217~65.773) were risk factors for bleeding at the puncture site. The use of hemostatic drugs (OR = 0.048, 95%CI: 0.015~0.151) one week before surgery was a protective factor.Conclusions:Female, obesity, liver cirrhosis, thrombocytopenia, sheath retention time > 240 min, and repeated vascular puncture are independent risk factors for bleeding at the puncture site. The higher the Child-Pugh score in cirrhosis, the more severe the thrombocytopenia, and the greater the risk of bleeding at the puncture site.

Jaundice is a detection index in many disease conditions commonly characterized by yellowish staining of the skin and mucous membranes. This work studies the postoperative care outcome in 1,246 patients (669 males and 577 females) with obstructive jaundice who underwent percutaneous transhepatic biliary drainage (PTBD). These patients were admitted to the interventional vascular surgery department of our hospital from February 2017 to February 2022. From the results, frequent wound re-dressing and maintenance of the drainage tube had significant positive influence on wound healing and patient recovery. The data also showed strict adherence by patients to the doctor's recommendation advising them to visit the interventional specialist care clinic in time for wound dressing change and drainage tube maintenance. As a result, there was no significant difference in wound allergy, exudation, redness and loosening among patients. A cross-sectional analysis of the effect of age on recovery revealed variations in the healing pattern (wound loosening and the redness) between patients of different ages although the relationship is not very clear due to the limited sample size. Efficient drainage tube maintenance promoted recovery and prevented the occurrence of related complications such as PTBD tube blockage and biliary tract infection. The establishment of the interventional specialist care clinic used in this study additionally ensures patients' safety, and the incidence of complications have been reduced drastically. These achievements are attributable to the implementation of regular dressing change, drainage tube maintenance and health education for patients with PTBD tube. These practices have also improved on the level of specialty in nursing practice, increased the professional value of nurses and better recognition by the society.

目的 探讨透明敷料IV3000联合粘性敷料在经皮肝穿刺胆道引流术(PTBD)患者管路固定中的应用效果.方法 将2019年7月至2021年3月在介入专科护理门诊行PTBD引流管维护的患者按就诊先后顺序分为两组:观察组194例,采用IV3000联合爱立敷固定导管,对照组200例,采用常规的蝶形导管固定装置思乐扣固定导管.1周后比较两组的固定牢固度、医用粘胶相关性皮肤损伤(MARSI)、器械相关性压力性损伤(DRPI)、材料费用、护理耗时、患者舒适度和满意度、护士评价得分等情况.结果 观察组的MARSI发生率、材料费用和护理耗时分别为2.58％、(85.00±0.00)元和(6.61±1.28)min,低于对照组的10.50％、(156.40±0.80)元和(12.08±2.22)min;观察组的患者舒适度、满意度、护士评价得分分别为94.33％、96.91％、(8.45±0.75)分,高于对照组的84.50％、88.00％、(8.05±0.68)分,上述指标比较,差异均有统计学意义(P＜0.05).两组导管均固定牢固,未发生脱管或管路移位现象,未见明显DRPI现象.结论 透明敷料IV3000联合粘性敷料爱立敷能有效固定PTBD导管,较思乐扣组不良反应少,材料费用和护理耗时更低,患者舒适度和满意度较高,可在临床推广应用.

The essentials for the nursing of DSA-guided percutaneous gastrostomy for 5 patients with motor neurone disease were summarized, mainly including observation, effective communication, maintaining airway patency, tube feeding nursing, fistula tube maintenance, prevention and treatment of postoperative complications, so as to improve patients' quality of life and survival.

1 临床资料 患者男,59岁.因"右上腹胀痛,伴右肩背部放射痛、皮肤、巩膜黄染、食欲不振1月余"于2022年4月1日入院,诊断为原发性肝细胞癌.查体:体温 36.6℃,脉搏 88次/min,呼吸20次/min,血压147/89 mmHg(1 mmHg=0.133 kPa).既往慢性丙型病毒性肝炎病史3年.完善相关检查和术前准备,4月29日局麻下行钇-90[90Y]树脂微球治疗.5月3日顺利出院.

Objective:To construct the interventional minimally invasive emergency process and key nursing measures of acute ischemic stroke and explore the application effect.Methods:The interventional minimally invasive first aid process and nursing points in the interventional specialized ward are applied in the first aid of ischemic stroke. Compared with the implementation of the department from December 2019 to July 2020 and from August 2020 to January 2021, treatment of patients with ischemic stroke, recognition of the professional ability of the medical team and satisfaction with nursing work.Results:After the implementation of minimally invasive emergency aid process and nursing points of ischemic stroke, the number of patients with vascular access and the number of life care was significantly higher than before the implementation; the professional ability of the medical team and satisfaction with nursing work were significantly improved, and the difference had statistical significance (P < 0.05).Conclusions:Construction and implementation of minimally invasive emergency of ischemic stroke intervention process and nursing points, can significantly improve the patient treatment rate, patients to medical team professional ability recognition and satisfaction with nursing work, make the patient get professional minimally invasive intervention treatment in the time window, ensure the safety of the patient, promote the patient recovery and the establishment of a harmonious medical team.

目的 研究基于英国国家早期预警评分(NEWS)构建的防控管理模型在致命性出血介入治疗患者中的应用效果.方法 选取2019年6月至2020年6月湖南省某三甲医院收治的200例致命性出血介入治疗患者作为研究对象,将其随机分为观察组(n=100)和对照组(n=100).对照组实施常规干预措施及流程,观察组在对照组基础上实施基于NEWS评分的防控管理,比较两组患者介入治疗急救时长、并发症发生率、死亡率和休克分期等情况.结果 观察组患者的预检分诊时间、多学科小组接诊时间、入院至B超出报告时间、入院至实验室出报告时间、急诊滞留时间、入院至到达手术室时间短于对照组,差异有统计学意义(P<0.05).观察组患者多器官功能障碍综合征(MODS)、感染、心跳骤停等并发症发生率和死亡率低于对照组,差异有统计学意义(P<0.05).观察组患者术后4 h休克分期情况优于对照组,差异有统计学意义(P<0.05).结论 基于NEWS评分的致命性出血防控管理模型有助于临床医护人员早期识别致命性出血的风险,通过评分值采取相应的急救防控措施能显著缩短介入治疗患者的急救时长,降低术后并发症的发生率及死亡率,改善术后患者的休克分期程度及预后.

目的 探讨聚焦解决模式对原发性肝癌术后患者总体幸福感的影响.方法 从湖南省某三级甲等医院筛选2020年1月至10月首次确诊原发性肝癌患者120例作为研究对象.将2020年1月至5月60例研究对象作为对照组,2020年6月至10月60例研究对象作为试验组.对照组采用常规护理方法,试验组采用常规护理+聚焦解决模式.聚焦解决模式共5个步骤,描述问题、构建目标、探查例外、给予反馈及评价进步.每天实施一个步骤,干预时长30～40 min/次,干预形式为面对面、一对一交流,并根据实际情况适当调整目标与干预次数.结果 干预前,两组干预对象总体幸福感量表各维度比较,差异均无统计学意义(P＞0.05).干预后,试验组与对照组对生活的满足和兴趣维度评分分别为(3.39±1.71)分和(0.14±1.96)分,差异有统计学意义(P＜0.05).总体幸福感量表对健康的担心维度干预前后评分分别为(0.27±1.50)分、(0.12±1.59)分,差异无统计学意义(P＞0.05).试验组、对照组精力维度、忧郁或愉快的心境维度、对情感和行为的控制维度以及松弛和紧张维度干预前后组间、组内差异均有统计学意义(均P＜0.05).结论 聚焦解决模式可以有效提升原发性肝癌患者术后总体幸福感,具有一定的临床推广价值.

Objective:To study the effect of regular interventional nursing outpatient dressing change and drain tube maintenance in patients after PTBD.Methods:72 patients admitted to our hospital from May 2018 to April 2019 who did not go to the interventional specialist nursing clinics on time for wound dressing change and drainage tube maintenance were taken as the control group. From May 2019 to April 2020,82 patients (242 times) who were admitted and went to the interventional specialist nursing clinics on time served as the observation group. The knowledge of wound and PTBD tube nursing, the self-care ability of indwelling PTBD tube, wound infection, and readmission due to accidental tube blockage and extubation were compared between the two groups.Results:Compared with the control group, patients in the observation group had lower rates of wound infection and readmission with significantly differences (P < 0.05). The patient's nursing knowledge of wound and PTBD tube and the self-care ability of indwelling PTBD tube of the observation group were significantly better than those of the control group (P < 0.05).Conclusions:Regular dressing change and drainage tube maintenance in interventional specialist nursing clinics after PTBD can obviously improve the patient's knowledge of wound dressing change and PTBD tube nursing, reduce the rate of wound infection and accidental tube blockage and extubation readmission, and improve the self-care ability and comfort of the patients.

目的 探讨患者参与管理模式在肝癌患者行TACE护理中的应用效果.方法 选择于行TACE术的原发性肝癌患者80例,2019年1至6月收治的40例患者为对照组,实施常规护理;2019年7至12月收治的40例患者为观察组,引入患者参与管理模式.比较两组患者TACE治疗自我护理能力、患者满意度和术后并发症发热、疼痛、胃肠道反应及穿刺点情况等方面的差异.结果 观察组患者自我护理能力评分、患者满意度、术后并发症(疼痛、胃肠道反应、穿刺点情况)方面均优于对照组,差异有统计学意义(P<0.05),术后并发症发热比较无明显区别,差异无统计学意义(P>0.05).结论 患者参与的管理模式能有效提升行TACE术患者的自我护理能力,降低术后并发症的发生,提升患者的满意度.

The nursing experience of a patient with chronic solitary iliac artery dissection combined with old myocardial infarction undergoing interventional therapy was summarized.The key points of nursing included: monitoring vital signs, chief complaints and cardiovascular accident symptoms, bleeding risk assessment, guidance on anti-platelet drugs, psychological care, etc. Through the above active and effective nursing care, the symptoms of internal iliac artery embolism syndrome (numbness and pain in the left lower limb and left buttock) were relieved.The patient recovered and was discharged on the 6th day after operation.

The key points of nursing care, continuous nursing practice methods and effects of patients after percutaneous biliary drainage were summarized, and the deficiencies and difficulties existing in the implementation of continuous nursing were analyzed, aiming to provide reference for clinical practice of continuous nursing care for patients after percutaneous biliary drainage.

目的 探讨应用清单管理模式对普通病区陪护人员实施新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)防疫管理工作的效果.方法 将陪护防疫管理工作的重点事项如入院流程(含密切接触史筛查、流行病学调查、分类处置)、告知宣教、日常监测及探陪管理等工作设计执行清单和台账,并根据清单提示逐一完成.结果 对科室148名住院陪护人员完成COVID-19筛查并登记在册,未发现COVID-19疫情,均完成了COVID-19防控宣教工作,陪护基本能遵守各项防控措施.结论 应用清单管理模式对陪护人员的严格筛查和管理,可以避免遗漏工作事项,防止陪护人员作为新冠传染源"输入"普通病区,切断传播途径,并有助于减少其他院内感染或交叉感染.

目的 观察阿帕替尼联合介入治疗肝癌的不良反应及针对性护理效果.方法 选取我院2017年12月—2018年3月收治的22例阿帕替尼联合介入治疗肝癌患者作为研究对象,观察服药的不良反应,加强患者心理护理和健康宣教,并针对患者常见的高血压、手足皮肤反应、恶心呕吐、食欲不振等不良反应采取针对性护理措施,观察不良反应的缓解程度.结果 22例患者中7例(31.82％)发生高血压,高血压发生率比说明书(35.23％)略低,比宋锦添等人报道(43.39％)低,且主要为中轻度,给予针对性治疗护理后血压均得到有效控制.腹泻发生5例(22.73％),给予针对性治疗护理后,均得以控制.恶心呕吐和食欲不振分别发生7例(31.82％)和9例(40.91％),针对性护理后均得到缓解,未因此导致药物治疗中断.本研究中腹泻(22.73％)、恶心呕吐(31.82％)和食欲不振(40.91％)发生率高于杨泽冉等人报道(23.81％).手足皮肤反应共发生5例(22.73％),手足皮肤反应发生率比说明书(27.84％)低,与廖景升等人报道(23.33％)基本一致,且护理后均缓解至1级,患者药物耐受性均较好.结论 阿帕替尼联合介入治疗肝癌患者的药物不良反应主要包括高血压、腹泻、恶心呕吐、食欲不振和手足皮肤反应,及早予以针对性的护理干预可以缓解其症状,保证治疗的顺利进行,提高患者的生存质量.

目的 探讨品管圈(QCC)活动在提高医护人员职业礼仪合格率中的应用效果.方法 通过鱼骨图分析2018年4月44名科室医护人员职业礼仪的不合格的主要原因,制定对策,并观察效果.结果 实施品管圈活动后,医护人员职业礼仪合格率由原来的53.2％提高到91.4％,差异具有统计学意义(P<0.05);患者对医护人员职业礼仪的满意度由82.5％上升到95.8％、医院人文素养精细化管理评分由80.5％上升到96.2％,差异均具有统计学意义(P<0.05).结论 QCC活动能有效提高医护人员职业礼仪的合格率,提升患者对医护人员职业礼仪的满意度及医护人员职业礼仪的精细化管理.

目的 总结1例青少年创伤性肝破裂合并肝动脉-门静脉瘘患者行双介入治疗手术的护理体会.方法 对患者进行全面的出血风险评估和处理,并采取针对性的疼痛护理、心理护理等.结果 经过出血中心监护室(hemorrhage intensive care unit,HICU)治疗护理5 d后,患者病情稳定转普通病房继续治疗2 d后康复出院.结论 青少年创伤性肝破裂合并肝动脉-门静脉瘘,具有多重出血风险,采用双介入治疗及个性化的护理,保障患者安全,促进患者快速康复,值得推广.

目的 了解病房护工在新型冠状病毒肺炎疫情下工作的真实体验,以便实施相应的知识培训、心理辅导等措施.方法 应用质性研究的现象学方法,对病房的护工进行面对面的半结构式深度访谈并现场录音,运用Colaizzi七步分析法进行资料的整理和分析.结果 本研究纳入护工9名,在新型冠状病毒肺炎疫情下工作的体验可归纳为6个内容:1.新冠病毒肺炎的工作流程防控知识缺乏.2.感知病毒危害性大,心理压力大.3.工作与生活内容增加,流程变复杂.4.希望家庭、单位及社会支持.结论 病房护工在新冠病毒肺炎疫情下工作压力大,防控知识和社会及家庭支持度缺乏,医院管理部门应深入了解其工作感受,采取针对性的措施,缓解其焦虑及紧张,使其适应新型冠状病毒肺炎疫情下的工作及生活.