制定护士伦理守则是树立护士专业形象和专业尊严的需要,也是护理学科发展的需要.通过梳理国内外护士伦理守则相关文件,总结护士伦理守则的主要内容和应用,发现国内外护士伦理守则均是以"患者本位"为基本原则,探讨护士与患者、合作者、环境、社会、专业、个人发展等方面的关系,结合本土文化价值观对护理行业的期待,形成对护士行为的约束标准.国内护士伦理守则需进一步明确护理范畴,制定各专科领域行为规范,并贯穿临床评价、教育、管理等各方面,以促进其推广落实.

目的 探讨高龄衰弱患者基于健康体适能评价模型的抗阻运动对其活动能力和糖脂代谢的影响.方法 2020年3—4月选取北京某三级甲等医院老年病房住院的80岁及以上疾病稳定期患者64例,按随机数字表分为对照组和观察组.对照组给予6个月常规运动指导和健康教育,观察组在此基础上实施健康体适能评价模型的抗阻运动干预策略,观察比较2组患者的活动能力和糖脂代谢情况.结果 共有59例患者完成研究,对照组30例,观察组29例.在干预6个月末观察组日常活动能力高于对照组(F=8.022,P=0.006),观察组随时间变化日常活动能力逐渐改善,对照组随时间变化逐渐变差(P<0.05);糖代谢方面,血糖组间和组内比较均无统计学差异(P>0.05);脂代谢方面,在干预3个月末和6个月末高密度脂蛋白均优于对照组(F=6.048,P=0.018;F=14.051,P=0.001),观察组随时间变化逐渐改善(P<0.05).2组低密度脂蛋白、甘油三脂、总胆固醇比较差异无统计学意义(P>0.05),甘油三脂观察组随时间变化逐渐改善(P<0.05).结论 基于健康体适能评价模型的抗阻运动干预策略能有效提高高龄衰弱老年患者的活动能力,还可以在一定程度上改善血脂代谢情况,对血糖控制效果不明显.

目的 制订适合高龄老年卧床患者的低负荷小强度抗阻运动方案,评价其对患者肌力和心肺功能的影响.方法 便利选取北京市某三级甲等医院老年病房2020年3月—4月收治的80岁及以上疾病稳定期患者64例,随机分为试验组和对照组.试验组在常规治疗和护理的基础上,给予6个月的低负荷小强度抗阻训练,对照组给予常规治疗和护理,比较两组的肌力和心肺功能.结果 共有59例患者完成研究,试验组29例,对照组30例.试验组握力在3个月和6个月时高于对照组(P<0.05),仰卧举腿和30 s反复坐起次数在6个月时多于对照组(P<0.05).肺活量在6个月时高于对照组(P<0.05),两组血压、心率、左心室射血分数等比较,差异均无统计学意义(P>0.05).结论 低负荷小强度抗阻运动不仅能提高高龄卧床老年患者的肌力,还能有效改善患者的肺功能,但对改善心功能的效果不明显.

目的 构建新型老年综合评估(comprehensive geriatric assessment,CGA)干预平台,并观察其对老年衰弱患者衰弱程度和生活质量的影响,以期为患者提供一种衰弱干预的新方式.方法 选取2017年8月至2018年8月在本院老年病房住院的老年衰弱患者86例,采用随机数字法将患者随机分为试验组和对照组,每组各43例.对照组给予常规护理,试验组采用由本院老年科多学科人员组成的循证医学小组经过循证研讨,并与本院信息处合作建成的新型CGA平台,医护人员利用微信公众号和医院网站对老年衰弱患者进行住院期间的管理与出院后的随访.3个月后比较两组患者衰弱指数以及生活质量情况.结果 干预后,两组患者衰弱指数以及生活质量比较,均P<0.05,差异具有统计学意义,试验组患者衰弱指数改善优于对照组,生活质量总分及各维度得分均高于对照组.结论 新型CGA平台的应用,可有效降低老年衰弱患者衰弱状况,改善其生活质量,从而达到健康老龄化;同时该平台便于医生与护士开展诊疗活动,促进多学科的合作,值得临床推广应用.

目的 采用NRS2002评分(nutritional risk screening 2002,NRS2002)和体重指数(body mass index,BMI)分别调查妇科肿瘤患者的营养状况,为临床提供一种更敏感的营养风险筛查工具.方法 采用现况研究设计,采用便利取样方法,选择本市某三级甲等综合医院的750例妇科肿瘤患者,采用NRS2002评分和BMI分别对患者进行营养风险筛查.了解妇科肿瘤患者的营养状况,并比较NRS2002评分与BMI在妇科肿瘤患者营养风险筛查中的相关性和差异性.结果NRS2002评分筛查结果显示,23.1％(173/750)的妇科肿瘤患者明确存在营养风险,76.9％(577/750)的妇科肿瘤患者无营养风险;BMI筛查结果显示,15.1％(113/750)的妇科肿瘤患者明确存在营养风险,84.9％(637/750)的妇科肿瘤患者无营养风险.NRS2002评分和BMI筛查妇科肿瘤患者营养风险筛出率相关性分析,χ2=22.500,P<0.001,差异具有统计学意义.结论妇科肿瘤患者的营养风险发生率较高,营养状况不甚理想.采用BMI筛查妇科疾病患者的营养风险不如NRS2002评分敏感.

Objective:To investigate the prevalence of nutritional risk among hospitalized patients with gynecologic tumor and provide a reference for nutritional intervention.Methods:Hospitalized patients with gynecologic tumor in a grade A class 3 hospital in Beijing were consecutively enrolled from December 2016 to December 2017. Nutritional risk was measured by nutritional risk screening 2002(NRS 2002)within the first 24 h after admission. The relevant influencing factors were analyzed.Results:A total of 1 500 hospitalized patients who met entry criteria and obtained informed consent were consecutively enrolled. The prevalence of nutritional risk was 23.1%, and 53.1 % patients had at least one nutrition-related problem. The analysis of relevant influencing factors showed that patients of age under 30 years and over 50 years( χ2=108.014, P<0.01), malignancy( χ2=112.197, P<0.01), low differentiation pathological type( χ2=251.392, P<0.01), chemotherapy( χ2=339.999, P<0.01)accompanied with vomiting( χ2=121.402, P<0.01), diarrhea( χ2=49.920, P<0.01)had the relatively high prevalence rate of nutritional risk. Pathological stage and operation had no significant effect( P>0.05). Conclusions:The prevalence of nutritional risk among hospitalized patients with gynecologic tumor is relatively high. The main relevant influencing factors include age, kinds of diseases, pathological type, chemotherapy, vomiting and diarrhea.

Objective? To translate the attitudes towards vital signs monitoring scale (V-scale) and to test the reliability and validity of it. Methods? We carried out translation, back-translation and culture adaptation to confirm the Chinese version scale. From March to August 2018, we investigated 420 nurses of general wards from three Class Ⅲ Grade A general hospitals in Beijing with the Chinese version of V-scale. The reliability and validity of the scale was evaluated by exploratory factor analysis, confirmatory factor analysis and internal consistency test. Results? The Chinese version of V-scale had 16 items with 0.93 for the content validity. A total of 5 common factors (workload, operation skill, communication, key indicators and knowledge) were extracted by exploratory factor analysis with 65.724% for the total variance contribution. Confirmatory factor analysis showed that the scale was with the good level of fit indices in each item, and adaptation test values all reached the standard level. The Cronbach's α coefficient of the total scale was 0.761 and Cronbach's α coefficients of all dimensions ranged from 0.579 to 0.809. The retest reliability of the scale was 0.778. Conclusions? The Chinese version of V-scale has the good reliability and validity which could be used to assess ward nurses' attitudes towards vital signs monitoring to identify disease progression in China.

Objective To describe the clinical characteristics of a patient with maturity-onset diabetes of the young (MODY) type 6 (MODY6) and explore the molecular genetic mechanism.Methods The clinical data of a clinically suspected MODY patient was collected.The peripheral blood DNA was extracted from the patient.After next generation sequencing,Sanger sequencing was performed to verify the genetic test results.The function of genetic variation was predicted by genetic function software and protein structure was predicted by SWISS-MODLE.With other reported cases,we also reviewed and summarized the clinical feature of MODY6.Results This study found a novel neurogenic differentiation 1 (NEUROD1)mutation (p.R103L) of MODY6,which was located in the DNA binding area,a basic helix-loop-helix domain,resulting in dysfunctional regulation of the insulin gene.Heterozygous NEUROD1 mutation had an incomplete penetrance of the phenotype,with a strong clinical heterogeneity.In addition,pregnancy might be an important time window for diagnosing MODY6.The NEUROD1 gene mutation was considered being a susceptible gene of type 2 diabetes in the previous reported Chinese family of NEUROD1 mutation.However,we reported the first Chinese case of MODY6 that met the typical MODY characteristics:diabetes on set before the age of 25,no evidence of insulin resistance and autoimmunity and three successive generations of diabetes in his family.Conclusions A novel NEUROD1 gene mutation is identified and its possible pathogenic mechanism is described.It is the first case of MODY6 in Chinese population that meets the typical MODY characteristics.

Objective To elucidate the clinical characteristics and genotype-phenotype relationships of Chinese patients with neonatal diabetes mellitus (NDM) caused by forkhead box P3 (FOXP3) gene mutations (FOXP3-NDM).Methods A total of 50 suspected patients with NDM were recruited from Peking Union Medical College Hospital.After the detailed collection of clinical information,target sequencing of 21 known causative genes of NDM were performed for molecular genetic diagnosis.Results Three patients with FOXP3-NDM were identified,separately carrying FOXP3 p.R312H,p.V408M,and p.P133L hemizygous mutations.All these 3 patients showed simple permanent NDM,without other common manifestations of IPEX syndrome until 9-12 years old.And they only need insulin therapy.However,all the foreign reported cases presented multiple autoimmune diseases besides NDM,and needed immunosuppressive therapy,even with the same mutation.Conclusion This is the first report of Chinese FOXP3-NDM patients,which showed totally different clinical phenotypes from foreign reported cases.The underlying molecular mechanism remains to be further studied.

目的 探讨坐式八段锦对高龄衰弱老年患者疲乏程度和衰弱状态的影响.方法 选择2017年10月—2018年6月我科收治的高龄衰弱老年患者35名为研究对象,在规范临床治疗及护理的基础上,进行为期5个月的坐式八段锦锻炼,应用修订版Piper疲乏量表和Tilburg衰弱量表评价干预效果.结果 干预后高龄衰弱老年患者的疲乏量表等级和衰弱量表得分(包括心理衰弱维度、社会衰弱维度及总分)较干预前明显降低(P<0.05),而衰弱量表的躯体衰弱维度得分较干预前有所下降,但差异无统计学意义(P>0.05).结论 5个月的坐式八段锦锻炼可改善高龄衰弱老年患者整体衰弱状态,尤其是心理衰弱、社会衰弱2方面;不能有效改善其躯体衰弱状态,但可有效缓解其疲乏程度,值得广泛推广至社区.

Objective To analyze the clinical characteristics of 12 patients with fulminant type 1 diabetes mellitus (FT1DM).Methods A total of 12 hospitalized patients with FT1DM were enrolled in this study from Peking Union Medical College Hospital between January 2012 and February 2017.Clinical materials and biochemical indexes were collected and compared with FT1DM in Japan.Results All the 12 patients presented as adult onset and the average age was (35.0± 13.08) years old.Five patients were male.Seven patients had flu-like symptoms,and eight patients had thirst and polydipsia.All patients had abdominal symptoms and presented with ketoacidosis within one week.The average plasma glucose level was (30.62±9.21) mmol/L and the range of HbA1 c level was 5.0％7.0％.Islet-related autoantibodies (GAD,ICA,IA2) were negative and pancreatic beta cells were rapidly destroyed.More than 70 ％ patients had elevated serum pancreatic enzyme levels.Compared with FT1DM in Japanese patients,our patients tended to have lower plasma glucose[(31 ± 9) vs (44 ± 20) mmol/L],lower percent of diabetes symptoms (66.67％ vs 93.7％)and abnormal serum lipase values(42.86％ vs 84.75％),and higher arterial pH [(7.24±0.12) vs (7.12±0.12)](P＜0.05).Conclusion FT1DM was remarkably abrupt onset and lifelong injection of exogenous insulin is inevitable.Physicians should sharpen their awareness of FT1DM.

Objective To explore the best time window of intake and output volume observation after partial nephrectomy and its predictive value for acute renal injury. Methods The information of totally 134 renal cancer patients with regular subsequent visits after partial nephrectomy in Peking Union Medical College Hospital from December 2014 to December 2015 were collected. The intake and urine volume per hour was recorded. The receiver operating characteristic (ROC) curve was used to explore the best time wind of intake and output volume observation and its predictive value for acute renal injury in patients with partial nephrectomy. Results Acute renal injury was found in 19.4% of the 134 patients. The differences between intake and output volumes 10, 14, 16 and 18 h postoperatively in the acute renal injury group were bigger than those in the non acute renal injury group (P＜0.05). According to the multiple regression analysis, the intake and output volume 10 h postoperatively and the time of warm ischemia were the independent risk factors to postoperative renal injury (P＜0.05). The intake and output volume 10 h postoperatively had predictive power to acute renal injury, whose area under the ROC was 0.747 (95%CI:0.592-0.903, P＜0.05). Conclusions The intake and output volume 10 h postoperatively may be the best time window for observing the intake and output volume in patients with acute renal injury after partial nephrectomy.

Objective To elucidate the clinical characteristics and genotype-phenotype relationships of Chinese patients with neonatal diabetes mellitus (NDM) caused by ATP-sensitive potassium channel (KATP ) gene mutations (KATP-NDM). Methods Total of 23 suspected patients with NDM were recruited from Peking Union Medical College Hospital. Amplification and direct sequencing of all exons and exon-intron boundaries of the KCNJ11 and ABCC8 gene were done for molecular genetic diagnosis. Patients with a definite diagnosis of KATP-NDM were switched from insulin injection to oral glibenclamide. Results Thirteen patients with KATP-NDM were identified, including 9 cases of KCNJ11-NDM and 4 cases of ABCC8-NDM. Four novel mutations of KATP were identified: 1 in KCNJ11 (I182M) and 3 in ABCC8 (Q211R, I585F, R653W). Among 9 patients with KCNJ11-NDM, 2 were transient NDM (TNDM) and 7 were permanent NDM (PNDM), and 3 of which had intermediate developmental delay, neonatal diabetes (iDEND syndrome). Four patients with ABCC8-NDM were all PNDM, 2 of them had iDEND syndrome. Switching from insulin to glibenclamide monotherapy was successful in 9 patients (69.2%). Conclusions Different clinical severities and treatment responses to sulfonylureas exist even among patients with the same mutation or with different amino acids at the same mutation site. Early diagnosis of KATP-NDM and initiation of sulfonylureas are of great importance in the prevention of neurological abnormalities in patients with iDEND syndrome.

目的 了解乳腺癌患者对治疗诱导的围绝经期症状的应对方法,为围绝经期症状管理提供依据.方法 对124例术后辅助化疗和/或抗雌激素治疗并伴中重度围绝经期综合征的乳腺癌门诊随诊患者进行访谈,了解治疗诱导的围绝经期症状对患者生活的影响及患者的应对方法.结果 93.5％的患者认为围绝经期症状对其生活有影响,自诉影响生活的4个主要症状依次为体力及精力感觉非常疲乏、关节肌肉不适、潮热、睡眠障碍;59.7％的患者曾采取措施来缓解症状,但仅38.8％认为有效;服用中药是患者采用最多的方式(43.2％);71.8％的患者表示应对围绝经期症状存在困难,其中不知道如何寻求帮助是最大的困难(57.3％).结论 乳腺癌患者认为治疗诱导的围绝经期症状严重影响其生活质量,应对措施整体有效率较低;乳腺癌患者围绝经期症状需要规范管理.

ABSTRACT:Type 2 diabetes mellitus (T2DM)is a chronic,progressive disease characterized by insulin resistance and impairedβcell function.The prevalence of T2DM is growing steadily.In recent years,advanced knowledge of the pathologic mechanisms of T2DM,such as decreased incretin effect,neurotransmitter dysfunction and abnormal renal handing of hyperglycemia lead to the development and use of novel treatments that target the mechanisms for T2DM. The review will describe the effectiveness and safety of some novel oral hypoglycemic agents.

Objective To investigate the clinical and genetic characteristics of a Chinese pedigree with maturity onset diabetes of the young type 1(MODY 1). Methods A Chinese pedigree of MODY diagnosed in Peking Union Medical College Hospital in August 2015 was analyzed for the clinical features and laboratory data. Genomic DNA of related members in the pedigree were extracted. And Sanger sequencing was performed to identify mutations in hepatocyte nuclear factor (HNF)1α gene, HNF4α gene and glucokinase (GCK) gene in this pedigree. Results A heterozygous mutation in HNF4α gene (NM_000457.4) located in the exon 8 (c.992G>A; p.R331H) was identified in two members of the pedigree(the proband and his mother). After the genetic diagnosis of the MODY 1, the proband was given a small dose of sulfonylurea instead of insulin for glucose?lowering therapy. As a result, the proband got a much more stable blood glucose. Conclusions There are MODY 1 pedigrees caused by HNF4αgene heterozygous mutations in Chinese population. A correct genetic diagnosis can significantly improve the treatment and blood control of the patients. MODY may co-exist with type 2 diabetes in a same pedigree, which is tend to be misdiagnosed, and should be paid more attention.

Objective To investigate the prevalence of moderate to severe menopausal symptoms among the women with breast cancer and analyze relative factors. Methods A self- designed questionnaire and Menopausal Rating Scale were used to collect information of the women with breast cancer who were receiving chemotherapy or follow-up. Results The incidence of moderate to severe menopausal symptoms was 62.0% (124/200) among the 200 breast cancer women investigated. Logistic regression revealed that women with financial difficulties, chemotherapy related menopause and bachelor′s degree were more inclined to suffer from moderate to severe menopausal symptoms (OR=3.818, 3.570, 3.213, P < 0.05). Conclusions The prevalence of moderate to severe menopausal symptoms was high among the women with breast cancer under treatment. Nurses should pay close attention to women with financial difficulties, chemotherapy related menopause and bachelor′s degree. Timely risk assessment and intervention are needed to control and reduce the influence of menopausal symptoms.

The classic medications metformin is the first choice for the treatment of type 2 diabetes. Dipeptide base peptidase 4 (DPP - 4) inhibitors are a new type of drug for curing diabetes, promoting pancreatic hormone levels, promoting insulin secretion, protecting the function of β cels. Metformin and DPP-4 inhibitors complimentary mechanism of hypoglycemic marks fixed dose combinations (FDC) preparation has good clinical application prospects. Several studies have shown that DPP-4 inhibitors/metformin FDC preparation can effectively reduce the HbA1c, fasting blood glucose and postprandial blood sugar, lower incidence of hypoglycemia, withnot increasing weight, and can improve the patients' compliance.

Objective:To evaluate the reliability and validity of Chinese version of fistula self nursing ability eval-uation form.Methods:Susanne developing fistula patients self care ability evaluation form was introduced,a to-tal of 70 fistula patients were evaluated by researchers using fistula self care ability evaluation form,and to ana-lyze the validity and reliability of the scale.Results:The CVI of all items index of Chinese version fistula self care ability evaluation form ranged from 0.80 to 1,average 0.92,rater reliability was 0.92,with good discrimi-nation.Conclusion:Chinese version of fistula self care ability evaluation form has good reliability and validity. The introduction of the scale will be conducive to the continuous dynamic monitoring of self care ability of co-lostomy patients by medical staff,and provided evaluation tools.for new intervention effect.

注射用帕瑞昔布钠(商品名：耐信)为白色或类白色冻干块状物，是伐地昔布的前体药物，用于手术后疼痛的短期治疗。注射用埃索美拉唑(商品名：特耐)为胃壁细胞中质子泵的特异性抑制剂，通过特异性的质子泵抑制作用减少胃酸分泌，用于胃食管反流病。2014年6月，我科在静脉输注埃索美拉唑钠和注射用帕瑞昔布钠时发现两种药物产生了配伍反应，因及时处理，对患者未造成不良影响，现报道如下。