目的:探讨健康意识理论护理在老年髋部骨折患者术后康复中的应用效果.方法:将2019年7月1日～2020年7月31日89例老年髋部骨折手术患者随机分为对照组43例和实验组46例,对照组实施常规康复护理,实验组在此基础上实施健康意识理论护理,比较两组护理效果.结果:实验组住院时间、首次下床时间短于对照组(P<0.05),下肢肿痛发生率、下肢深静脉血栓形成(DVT)发生率低于对照组(P<0.05);实验组护理后血液指标优于对照组(P<0.05),髋关节功能评分、生活质量评分高于对照组(P<0.05).结论:健康意识理论护理可缓解老年髋部骨折患者术后下肢肿痛,降低术后DVT发生率,缩短住院时间,改善患者髋关节功能和血液指标,提高生活质量,促进患者术后康复.

目的 分析全胃术后患者运用快速康复理念支持下的护理干预效果.方法 方便选取2019年10月—2020年11月该院收治的全胃切除术术后患者62例,根据不同护理方案分为常规组(n=31)、快速组(n=31).快速组采用快速康复理念支持下护理干预,常规组采用常规护理.对比两组住院总费用、住院时间、护理满意度评分、术后肛门排气时间、并发症发生率.结果 快速组住院时间(17.2±2.4)d、住院总费用(4.7±0.8)万元、术后肛门排气时间(17.8±2.4)h、并发症发生率(6.45％)均低于常规组住院时间(19.8±3.2)d、住院总费用(5.2±1.1)万元、排气时间(20.2±3.8)h、并发症发生率(25.81％),差异有统计学意义(t=3.619、2.047、2.973,χ2=4.292,P<0.05);快速组护理满意度评分(93.6±2.1)分显著高于常规组(80.9±3.5)分,差异有统计学意义(t=17.324,P<0.05).结论 全胃术后患者运用快速康复理念支持下不留置胃管等护理干预可缩短住院时间,降低并发症发生率.

目的:探讨网络平台的延续护理在维持性血液透析(MHD)青年患者自我管理中的应用效果.方法:采用便利抽样法选择60例MHD青年患者,按照随机数字表法分为对照组和实验组各30例,对照组实行常规护理,实验组在常规护理基础上实施网络平台的延续护理.比较两组干预前后自我管理行为[采用血液透析患者自我管理行为量表(SMSH)].结果:干预后,实验组SMSH中问题解决、执行自我护理得分及自我管理行为总分均优于对照组(P<0.01).结论:在MHD青年患者中实施网络平台的延续护理方案,能改善其自我管理行为.

目的 研究重症监护室患者院内获得压力性损伤的临床特征以及危险因素,为针对性干预提供参考.方法 通过病例对照研究,利用美国波士顿BID医疗中心重症监护病房建立的重症医学数据库,分析重症监护病房患者2级以上获得性压力性损伤发生危险因素.结果 共30 171例纳入分析,1 667例发生2级以上压力性损伤,46.8％为70岁以上老年患者,73.4％的患者于入院后1周内出现压力性损伤.44.4％压力性损伤发生部位在骶尾部.Logistic回归分析得出急性生理学评分,Braden评分中的摩擦力与剪切力、移动能力、营养摄取能力,血红蛋白、血管升压药物、镇静药物、机械通气、脓毒血症、类风湿性关节炎、糖尿病、肾衰竭、瘫痪、体质量减轻、肥胖为压力性损伤发生的危险因素(P＜0.05,P＜0.01).结论 重症监护室患者获得压力性损伤发生率较高,影响因素多,需进一步细化研究;同时医护人员应进行个性化评估及预防.

With the acceleration of the aging process of the population, the demand for joint replacement continues to increase. Under the background of enhanced recovery after surgery, outpatient joint replacement has become a safe, economic and effective model to shorten the average length of stay and reduce the cost of hospitalization. It has been widely used in foreign countries, but there are still some limitations in the development and promotion in China. Therefore, this study intends to review the perioperative management plan and implementation effect of joint replacement in foreign countries, in order to provide reference for the implementation and improvement of the concept of fast track surgery for bone and joint in China.

目的 了解基于预警视角下医联体内医护人员对肺癌患者院内静脉血栓栓塞症(VTE)的防治能力现状,探索医联体医院院内VTE防治体系建设的指标及其影响因素,为医院管理者探索区域化医联体内院内VTE防治体系建设提供参考依据.方法 山东第一医科大学第一附属医院/山东省千佛山医院于2020年1—3月采用便利抽样法,使用自制问卷调查量表调查本院医联体内89家医院828名医护人员对肺癌患者院内VTE发生的防治能力现状,比较不同年龄、工作年限、职称等临床医护人员对VTE预防知识的知晓情况、对VTE预防相关知识的培训需求等,比较不同级别医院的VTE防治体系建设情况,分析有关医院VTE预防指标的差异及其影响因素.结果 828名被调查的临床医护人员中,三级医院、本科学历、工作年限为6～10年的人员居多.不同年龄、工作年限的临床医护人员药物使用知识、预防知识、危险因素知识、基础知识的得分及总得分比较,差异均有统计学意义(P<0.05);不同职称临床医护人员的药物使用知识、预防知识的得分及总得分比较,差异均有统计学意义(P<0.05).不同工作年限的临床医护人员对VTE预防相关知识的培训需求得分比较,差异有统计学意义(P<0.01),其中,工作年限为11～15年的临床医护人员对VTE预防相关知识的培训需求得分最高,工作年限为16～20年的临床医护人员对VTE预防相关知识的培训需求得分最低.二级医院与三级医院VTE防治体系建设中的9个方面比较,差异均有统计学意义(P<0.05).结论 不同级别医疗机构院内VTE防治体系建设、防治能力参差不齐,总体水平较低,医疗机构需要加大医务人员医院VTE防治能力的提升,主管部门应加大医联体内部VTE防治体系建设,积极开展医联体内同质化知识培训,提高医护人员VTE防治工作能力,以提高肺癌患者的生活质量.

目的 对2014—2019年山东省济南市猩红热的流行病学和时空聚集性进行分析,为猩红热的防控工作提供依据.方法 从国家疾病监测信息报告管理系统中获取济南市2014—2019年猩红热疫情资料,采用描述性流行病学方以及时空重排扫描统计方法分析猩红热的流行特征和时空分布特征,计算不同年份各乡镇(街道)猩红热发病的RR值,绘制RR值等高线地图.结果 2014—2019年济南市累计报告猩红热9715例,期间年发病数与发病率总体呈现逐渐上升趋势,每年均出现冬季和春季2个季节性发病高峰.时空聚集性分析探测到8个时空聚集区,其中2017年3月至2019年12月间在历城、历下区聚集性最强(RR=3.45,LLR=577.88,P<0.001).2014—2019年期间各年RR值等高线地图分布相似,RR值密集度最高的地区位于济南中部.结论 2014—2019年济南市猩红热中部地区高发,具有明显的时空聚集性,济南中部、西南部及东部地区存在聚集区,有向东部章丘和西南部平阴扩散的趋势.

探讨规范化培训结合客观结构化临床考核(OSCE)在新入职护士岗位培训中的应用效果.选取116名新入职护士随机分为对照组和实验组,对照组采用规范化培训措施培训,实验组在对照组基础上额外给予基于OSCE模式的培训,对比两组护士培训结束后的核心能力和评判性思维能力.结果显示,实验组的评判性思维能力、核心胜任力和知识考核得分高于对照组(P<0.05);实验组的提高护患交流能力、促进护理问题提出、提高护理决策能力、提高防范护理差错能力得分高于对照组(P<0.05).结果表明,规范化培训结合OSCE能提高新入职护士的评判性思维能力和核心胜任力.

[目的]调查不同年龄、学历和性别的农村居民预防新型冠状病毒肺炎知识知晓、技能掌握和护理需求现状的差异,为不同群体人群提供差异化的干预措施提供依据。[方法]应用预防新型冠状病毒肺炎知识、技能和护理需求调查问卷对872名福建省农村居民进行调查。[结果]农村居民预防新型冠状病毒肺炎知识知晓率为80. 5%～96. 1%,技能掌握率为51. 7%～67. 0%,护理需求率为31. 7%～83. 7%。居民年龄越大,知识知晓率、技能掌握率、口罩和消毒液防护品需求越低（均P＜0. 05）;居民学历越高者,技能掌握率、口罩和消毒液需求率越高（均P＜0. 05）;男性居民的技能掌握率高于女性（均P＜0. 05）;年龄越小和学历越高,通过网络新闻和微信平台获取知识的比例越高（均P＜0. 05）。[结论]年龄较大、学历较低和女性居民预防新型冠状病毒肺炎知识知晓率和技能掌握率较低,在进行社区健康教育时应给予重点关注。

Objective: To investigate the effect of comprehensive nursing intervention on patients with lumbar oblique lateral interbody fusion (OLIF) . Methods: Preoperative and postoperative care and complications were prevented in 19 patients who underwent OLIF in the treatment of lumbar degenerative diseases in our hospital. The postoperative drainage, indwelling catheter time and postoperative ambulation time were evaluated and compared with traditional lumbar vertebrae. Results: Compared with traditional lumbar surgery, 19 patients with OLIF had fewer days of indwelling drainage tube, less postoperative drainage, shorter postoperative ambulation time and less days of hospitalization, and a smaller proportion of indwelling catheters. The difference was statistically significant. Conclusion:OLIF surgery has obvious advantages compared with traditional surgery, but its nursing has special characteristics, requiring nursing staff to observe dynamically and provide personalized nursing intervention.

目的 研究联动式健康教育在糖尿病患者护理中的应用价值.方法 以2016年10月—2017年10月间我院收治的114例糖尿病患者为观察对象,按入院时间予以编号后,采用随机抽签的方式将其分为2组,各57例.对照组给予常规随访和院外护理指导,研究组给予联动式健康教育.对比2组的干预效果.结果 研究组患者知识测评得分高于对照组;研究组患者干预后空腹血糖、餐后2 h血糖以及糖化血红蛋白水平均低于对照组,差异均有统计学意义(P<0.05).结论 将联动式健康教育应用于糖尿病出院患者的护理中,能够提升患者对相关知识的认知水平,有效提升病情治疗和控制效果,具有较高的应用价值.

Objective To investigate the application effect of specific innovative rehabilitation nursing on the surgical patients of minimally invasive hypertensive cerebral hemorrhage.Methods Since July, 2015, this hospital applied specific innovative rehabilitation nursing to the nursing practice of surgical patients of minimally invasive hypertensive cerebral hemorrhage.Before (from January to June, 2015) and after (from July to December, 2015), the 48 patients of minimally invasive hypertensive cerebral hemorrhage hospitalized in this hospital were the research objects.Results After intervention,Bathel index and life quality score of minimally invasive surgical patients in experimental group were obviously higher than that of the control group,but NDF score was obviously lower than that of the control group (P<0.05).Conclusion Specific innovative rehabilitation nursing is applied to have intervention on the surgical patients of minimally invasive hypertensive cerebral hemorrhage,which can obviously improve the rehabilitation effect and living quality of these patients.

目的:探讨人工机械瓣膜置换术后患者早期华法林治疗过程中的自我体验和需求,发现个体存在的相关抗凝问题,为制定有效的干预措施提供参考依据.方法:采用现象学研究方法,选取12例人工机械瓣膜置换术后患者进行半结构式一对一深入访谈,采用Colaizzi 7步法分析资料.结果:通过分析得出5个主题:抗凝治疗认识不充分,生命安全的担忧,日常生活的困惑,焦虑、恐惧,希望得到医护人员专业跟踪指导.结论:人工机械瓣膜置换术后患者早期华法林治疗期间存在知识误区导致心理压力大,加强患者对华法林药物的正确认识,教会患者正确识别华法林治疗的并发症,做好延伸护理,进一步完善社区、医疗服务体系.

目的:了解非计划内肠造口患者真实的心理体验,为提供针对性的干预措施提供科学依据.方法:采用质性研究中的现象学分析法,对12例非计划内肠造口患者进行半结构式访谈.结果:非计划内造口患者存在冲击行为、社交障碍、过分依赖、造口知识极度缺乏等心理体验.结论:医务人员应重视非计划内肠造口患者的心理问题,积极采取有效措施帮助患者尽早接受造口、回归社会.

目的：探究细节护理对急性脑出血患者的护理效果。方法：对笔者所在医院2013年2月-2015年10月接收的60例急性脑出血患者进行护理，按照入院的先后顺序将其分为对照组及观察组，各30例。对照组采用常规护理，观察组在对照组基础上进行细节护理，观察两组效果并比较。结果：观察组患者并发症发生率为3.33%，明显低于对照组的13.33%，差异有统计学意义(P<0.05)。观察组患者护理总满意率为96.67%，明显高于对照组的76.67%，差异有统计学意义(P<0.05)。结论：细节护理对急性脑出血患者的护理效果良好，能够减少患者并发症的发生，同时提高患者对于护理工作的满意率，因而值得在临床中借鉴使用。

目的 为先天性心脏病术后患儿选择一种较为理想、安全、有效的吸氧方法,提高氧疗效果.方法 选取先天性心脏病术后患儿60例,随机分为三组各20例,于气管插管拔管后分别给予单侧鼻导管给氧、鼻外导管双孔给氧、面罩给氧.监测三组患儿干预前(气管插管拔除前)和干预后(拔除气管插管吸氧1h后)的心率(HR)、呼吸频率(RR)、经皮血氧饱和度(SpO2)、动脉血气分析值(pH值、PaO2、SaO2、PaCO2),以及患儿皮肤是否温暖干燥、口唇是否红润、对治疗的依从性.结果 三组HR、RR、pH值、PaCO2、SaO2比较,差异无统计学意义(均P＞0.05);三组SpO2、PaO2值及依从性比较,差异有统计学意义(P＜0.05,P＜0.01).面罩给氧PaO2最高,鼻外导管双孔给氧依从性最高.结论 先天性心脏病术后患儿气管插管拔除后采用3种给氧方法,均能达到良好的氧疗效果;患儿对鼻外导管双孔给氧的依从性优于单侧鼻导管给氧和面罩给氧.但给氧时间仅为1h,长时间应用的氧疗效果需进一步探讨.

目的：探讨团队复苏护理在心肺复苏（CPR）溶栓患者中的应用效果。方法：将72例院外心搏骤停（CA）患者随机分为团队组和对照组各36例，团队组至少有3人及以上组成的复苏团队行 CPR 并同时静脉溶栓治疗，对照组参与复苏抢救人员少于3人，分析两组复苏方式对院外 CA 患者预后的影响。结果：两组恢复自主循环（ROSC）率比较差异有统计学意义（P ＜0.05）。结论：团队复苏有利于提高初步复苏成功率。

术后胃瘫综合征( Post sur gical gastopa resi s syndro me ， PGS)指腹部手术后继发的以胃排空障碍为主要征象，不伴有输出段和吻合口梗阻的功能性胃排空障碍所致的胃动力紊乱综合征[1]。在胃外科手术技术日臻成熟的今天，胃瘫综合征成为胃大部切除毕Ⅱ式吻合术后较常见的并发症之一，严重影响了患者的术后康复。我院2009年6月至2013年6月共发生胃瘫综合征患者17例，经过医务人员的精心治疗与护理，除一例患者自动出院外，其余患者均康复出院，现将护理体会总结如下。

OBJECTIVE To explore the clinical efficacy of percutaneous transhepatic cholangial drainage in treatment of the patients with acute severe bile duct infections .METHODS A total of 100 cases of acute severe cholangitis , who were treated in emergency departments from Jan 2010 to Jan 2013 ,were enrolled in the study and divided into the experimental group and the control group according to the treatment strategies ,with 50 cases in each ;the pa-tients in the experimental group underwent the percutaneous transhepatic cholangial drainage ,the patients in the control group underwent the conventional laparotomy ;then the intraoperative bleeding volume ,complication ,and length of hospital stay as well as the change of white blood cells and total bilirubin within one week after surgery were observed and compared between the two groups .RESULTS The intraoperative bleeding volume was (161 .4 ± 53 .7)ml in the experimental group ,significantly less than (191 .2 ± 62 .2)ml in the control group ;the incidence of postoperative complications was 34 .0% in the experimental group ,significantly lower than 66 .0% in the control group (P<0 .05);the mean hospitalization duration was (18 .4 ± 4 .16)days in the experimental group ,signifi-cantly shorter than (12 .9 ± 4 .57)days in the control group (P<0 .05) .The levels of the white blood cells and to-tal bilirubin of the two groups of patients were significantly lower after the surgeries than before the surgeries (P<0 .05) .One week after the surgeries ,the level of the white blood cells was (7 .16 ± 3 .53)× 109/L in the ex-perimental group ,(8 .35 ± 3 .96) × 109/L in the control group ;the level of the total bilirubin was (47 .75 ± 12 .53) mmol/L in the experimental group ,(57 .38 ± 13 .45) mmol/L in the control group ,there were statistically signifi-cant differences (P<0 .05) .CONCLUSION The percutaneous transhepatic cholangial drainage ,as is used for the treatment of the patients with acute severe bile duct infections ,may shorten the hospitalization duration ,effective-ly decrease the intraoperative bleeding volume ,reduce the incidence of complications as well as the levels of white blood cells and total bilirubin ,and improve the clinical efficacy .

OBJECTIVE In order to meet the visit demands of ICU patients and their families ,and achieve patients-oriented service concept ,and to study the effect of the appointment visiting system combined with restrictive visit-ing on hospital infections in the intensive care units .METHODS A total of 185 patients were divided into before implementation group (90 cases between Jan .2007 to Dec .2009) and after implementation group (95 cases between Jan .2010 to Jan .2013) in the ICU between Jan .2007 to Jan .2013 ,to compare the change of the patient and family satisfaction ,monitoring indexes in ward and the nosocomial infection rate after the appointment visiting system combined with restrictive visiting ,and giving medical staff for the questionnaire .SPSS13 .0 software was used for statistical analysis .RESULTS After the appointment visiting system combined with restrictive visiting , patients satisfaction rate increased from before 77 .8% to 89 .5% ,family satisfaction rate from 81 .5% to 81 .5% ;Hospital infection rate fell to 3 .2% from 4 .4% before the implementation ;Air and infection index monitoring results had significant difference (P< 0 .05) .CONCLUSION The appointment visiting system combined with restrictive visiting can satisfy the demands of most of the patients and their families to visit ,and there is no increasing the risk of hospital infection .The impact of visiting on the health care fall to the lowest which is condu-cive to the rehabilitation of the disease to meeting the view of human nature .