目的 探讨基于中药熏蒸配合穴位按摩的健康管理对稳定期肺肾气虚型慢阻肺的疗效。方法 选取2020年1月—2021年1月在我院接受治疗的稳定期肺肾气虚型慢阻肺患者120例为研究对象,随机分为对照组和干预组。对照组采用西医常规干预,干预组在此基础上实施为期1年的中药熏蒸配合穴位按摩的健康管理,比较干预前后2组患者肺功能、血氧指标以及生活质量的差异。结果 干预前,2组患者第1秒用力肺活量（FEV₁）、第1秒用力肺活量占预计值百分比（FEV₁%）、用力肺活量（FVC）、第1秒用力肺活量占用力肺活量的比值（FEV₁/FVC%）等指标比较差异无统计学意义（P>0.05）,干预后,2组患者的FEV₁、FEV₁%、FVC、FEV₁/FVC%明显上升,且干预组患者优于对照组（P<0.05）;实施相关干预前,干预组和对照组患者的血氧指标比较差异无统计学意义（P>0.05）,干预后,2组患者的PaO₂、和SpO₂上升,PaCO₂下降,且干预组的变化幅度大于对照组（P<0.05）;干预前2组患者在圣乔治问卷（SGRQ）生活质量评分比较差异无统计学意义（P>0.05）,干预后2组患者的SGRQ生活质量评分降低,且干预组患者的SGRQ生活质量指标评分更低（P<0.05）。结论 中药熏蒸配合穴位按摩应用于稳定期肺肾气虚型慢阻肺患者中,能够提高患者的肺功能,改善血氧指标,提高患者的生活质量。

Objective To explore the effect of health management based on traditional Chinese medicine fumigation combined with acupoint massage on stable chronic obstructive pulmonary disease（COPD）with lung-kidney deficiency．Methods A total of 120 patients with stable COPD and lung-kidney deficiency who received treatment in our hospital from January 2020 to January 2021 were selected as the study objects and randomly divided into control group and intervention group．The control group received conventional Western medicine intervention,and the intervention group received 1-year traditional Chinese medicine fumigation combined with acupoint massage on the basis of Western management．The differences of lung function,blood oxygen index and quality of life between the two groups were compared before and after intervention．Results Before intervention,there were no significant differences in forced expiratory volume in one second（FEV₁）,the first second forced vital capacity percentage of expected value（FEV₁%）,forced vital capacity（FVC）,the ratio of the first second forced vital capacity of forced vital capacity（FEV₁/FVC%）between the two groups（P>0.05）,but after intervention,the FEV₁,FEV₁%,FVC,FEV₁/FVC% of the two groups increased significantly,and those in the intervention group were better（P<0.05）．Before the implementation of relevant intervention,there was no difference in blood oxygen index between the two groups（P>0.05）．After the intervention,PaO₂ and SpO₂ of the two groups were significantly increased,while PaCO₂ was significantly decreased,and the change in the intervention group was significantly greater（P<0.05）．Before intervention,there were no significant differences in the quality of life scores of St George’s Respiratory Questionnaire（SGRQ）between the two groups（P>0.05）．After intervention,the scores of SGRQ of the two groups were significantly decreased,and the scores of the intervention group were significantly lower（P<0.05）．Conclusions Traditional Chinese medicine fumigation combined with acupoint massage can significantly improve lung function,blood oxygen index and life quality of stable COPD patients with lung-kidney deficiency．

目的 观察LACE风险模型下的护理干预策略在心脏瓣膜置换术后患者中的应用效果。方法 选取我院2021年3月—2022年3月心脏瓣膜置换术后患者82例作为研究对象,以患者入院顺序编号分为对照组、观察组,各41例。对照组予以常规护理,观察组予以LACE风险模型下的护理干预。比较2组出院时、干预后的自我管理能力及负性情绪;干预期间的术后并发症发生率、再入院率、用药依从性。结果 干预后观察组自我管理环境、自我管理行为、自我管理认知评分高于对照组（P<0.05）;观察组术后并发症发生率7.32%（3/41）、再入院率4.88%（2/41）均低于对照组24.39%（10/41）、21.95%（9/41,P<0.05）;观察组用药依从率97.56%（40/41）高于对照组78.05%（32/41,P<0.05）;干预后观察组汉密尔顿抑郁量表评分、汉密尔顿焦虑量表评分低于对照组（P<0.05）。结论 心脏瓣膜置换术后患者进行LACE风险模型下的护理干预后,患者的自我管理能力及用药依从性明显改善,同时其并发症发生率和再入院率有效降低,焦虑、抑郁等负性情绪得到缓解,具有良好护理效果。

Objective To observe the effect of nursing intervention strategy under LACE risk model in patients after heart valve replacement．Methods From March 2021 to March 2022,82 patients with heart valve replacement were enrolled as the study objects．The patients were divided into control group and observation group according to the order of admission,with 41 patients in each group．The control group was given routine nursing,and the observation group was given nursing intervention under LACE risk model．The self-management ability and negative emotions at discharge and after intervention were compared between the two groups．The incidence of postoperative complications,readmission rate and medication compliance during the intervention period were also compared．Results After intervention,the scores of self-management environment,self-management behavior and self-management cognition in the observation group were higher than those in the control group（P<0.05）．The postoperative complication rate of 7.32%（3/41）and readmission rate of 4.88%（2/41）in the observation group were lower than those of 24.39%（10/41）and 21.95%（9/41）in the control group（P<0.05）．The compliance rate of the observation group（97.56%）was higher than that of the control group（78.05%,P<0.05）．After intervention,the scores of Hamilton Depression Scale and Hamilton Anxiety Scale in the observation group were lower than those in the control group（P<0.05）．Conclusions After nursing intervention under LACE risk model for patients after heart valve replacement,the self-management ability and medication compliance of patients have been significantly improved,the incidence of complications and readmission rate have been effectively reduced,and negative emotions such as anxiety and depression have been alleviated,which has good nursing effect．

目的 分析近年来2型糖尿病自我管理水平的研究进展,讨论其自我管理水平的影响因素及给出相应的建议。方法 通过中国知网、万方医学、迈特思创外文期刊等检索工具,搜索“2型糖尿病”“自我管理”等关键词,收集2000年—2022年相关文献资料,采用文献研究方法进行分析。结果 共检索相关文献1 053条,通过阅读文献以及文献引文,共筛选出重要文献35篇。结论 归纳总结介绍了近年来有关2型糖尿病自我管理水平的研究进展、自我管理的各个方面,包括概念、评估工具、影响因素、与糖尿病并发症的关系及提升方法等,最后文章的总结部分提出了未来研究的方向和挑战。

Objective To analyze the research progress on self-management levels of type II diabetes in recent years,discuss the influencing factors of self-management levels,and provide corresponding suggestions．Methods This article collected relevant literature from 2000 to 2022 by searching tools such as CNKI,Wanfang Medical and Medline for keywords such as “type II diabetes”and“self-management”,and analyzed the literature using a literature research method．Results A total of 1,053 relevant literature were retrieved,and 35 important literature were selected through reading literature main body and citation．Conclusions This article summarizes the research progress on self-management levels of type II diabetes in recent years,including various aspects of self-management such as concepts,evaluation tools,influencing factors,the relationship with diabetic complications,and improvement methods．The conclusion part of the article proposes directions and challenges for future research．

目的 探讨精细化管理模式对消毒供应中心风险事件发生率的影响。方法 选取2020年6月—2022年5月为研究阶段,抽取本院消毒供应室1 000件医疗器械作为研究对象,随机分为对照组和研究组,各500件。对照组采用常规管理模式,研究组采用精细化管理模式,对比2组医疗器械不良事件发生率,观察30名工作人员分别在不同管理模式下发生职业风险暴露人数的变化,并进一步比较工作效率的不同。结果 研究组发生数量不等、物品过期、标签错误、型号错误、零部件差错等不良事件发生率均低于对照组（P<0.05）。研究组工作人员利器损伤和血制品污染者发生率低于对照组（P<0.05）,研究组工作人员工作效率评分高于对照组（P<0.05）。结论 精细化管理模式可有效减少消毒供应室医疗器械不良事件,降低工作人员职业暴露风险事件发生率,提高工作人员工作效率,改善管理工作质量。

Objective To explore the influence of refined management mode on the incidence of risk events in disinfection supply center. Methods From June 2020 to May 2022,1 000 pieces of medical devices were selected from the disinfection supply room of our hospital as the research object,and were randomly divided into control group and research group,with 500 pieces in each group. The control group adopted the conventional management mode,while the research group adopted the refined management mode. The incidence of adverse medical device events in the two groups was compared,and the changes in the number of 30 staff exposed to occupational risks under different management modes were observed,and the differences in work efficiency were further compared. Results The incidences of adverse events involving unequal quantities,expired items,mislabeling,modeling errors and parts errors were lower in the study group than in the control group(P<0. 05). The number of sharps injuries and blood product contamination among the staff in the study group was significantly lower than that in the control group(P<0. 05),and the staff efficiency scores of the study group were higher than those of the control group(P<0. 05). Conclusions Refined management mode can effectively reduce the adverse events of medical devices in disinfection supply room,reduce the number of occupational exposure risk events of staff,improve the work efficiency of staff and improve the quality of management.

介绍了欧洲标准评估框架(CAF)的具体内涵。从国家三级公立医院绩效考核、现代医院管理制度构建、医院高质量发展实现和全面推进健康中国建设四个方面对我国三级公立医院实施卓越绩效管理的必要性进行了分析。在此基础上,提出基于CAF的我国三级公立医院卓越绩效管理实现策略:将卓越绩效管理理念贯穿医院管理全过程;构建基于CAF的三级公立医院内部卓越绩效考核指标体系;构筑基于CAF的卓越绩效考核医院内部运行机制;打造符合院情的卓越绩效考核自评模式。

目的 观察首诊-复诊-住院-产后管理的模块化护理干预对妊娠期糖尿病(GDM)围产期患者的影响。方法 回顾性收集我院2020年1月—2021年1月GDM患者91例,按照患者意愿及不同护理方案分组。常规护理组45例予以常规护理,模块化管理组46例在常规护理基础上予以首诊-复诊-住院-产后管理的模块化护理。比较2组患者首诊时、分娩后血糖控制水平、围产期患者并发症发生情况、围产期新生儿并发症发生情况、护理工作满意度。结果 分娩前模块化管理组空腹血糖、餐后2 h血糖低于常规护理组(P＜0.05);模块化管理组围产期患者并发症发生率8.70%(4/46)低于常规护理组24.44%(11/45)(P＜0.05);模块化管理组围产期新生儿并发症发生率6.52%(3/46)低于常规护理组22.22%(10/45)(P＜0.05);模块化管理组护理工作满意度93.48%(43/46)高于常规护理组77.78%(35/45)(P＜0.05)。结论 首诊-复诊-住院-产后管理的模块化护理干预可改善GDM患者的血糖水平,降低围产期患者及新生儿并发症发生率,同时能提升患者护理工作满意度。

Objective To observe the effect of modularized nursing intervention on perinatal patients with gestational diabetes mellitus (GDM), including first visit, subsequent visit, hospitalization and postpartum management. Methods Ninety-one patients with GDM in our hospital from January 2020 to January 2021 were retrospectively grouped according to patients' wishes and different nursing plans, and their data were collected. Forty-five patients in the routine nursing group received routine nursing, and 46 patients in the modular management group received modularized nursing in addition to the routine nursing, including first visit, subsequent visit, hospitalization and postpartum management. The blood glucose level at the first visit and after delivery, the incidence of complications in perinatal patients, the incidence of complications in perinatal neonates, and the satisfaction of nursing work were compared between two groups. Results Before delivery, FPG and 2hPG levels in modularized management group were lower than those in routine nursing group (P<0.05). The incidence of perinatal complications in modularized management group was 8.70% (4/46), lower than that in routine nursing group (24.44%, 11/45, P<0.05). The incidence of neonatal complications in the modularized management group was 6.52% (3/46), lower than that in the routine nursing group (22.22%, 10/45, P<0.05). The nursing job satisfaction rate of modular management group was 93.48% (43/46), higher than that of routine nursing group (77.78%, 35/45, P<0.05). Conclusions Modularized nursing intervention of first visit, subsequent visit, hospitalization and postpartum management could improve the blood glucose level of patients with GDM, reduce the incidence of complications in perinatal patients and neonates, and improve patients' satisfaction with nursing work.

目的 探讨家庭药师与药物治疗管理对签约患者用药依从性及不合理用药干预效果。方法 选取2017年3月—2021年3月我院收治的慢性病患者100例作为前瞻性研究对象,按照随机余数法分为对照组和研究组各50例。其中,对照组实施首次随访调查,收集患者健康信息建立用药档案,末次随访评价。研究组采用收集患者健康信息,建立用药档案,填写调查表,对在用的药物治疗方案进行评价,家庭药师与家庭医生协作共同干预或直接干预,制定具体的解决方案,帮助患者达到治疗目标。比较2组患者干预前后的药物依从性、生活质量及用药情况的变化。结果 干预前,2组患者的药物依从性评分比较无统计学意义(P ＞0.05),干预后,2组患者药物依从性评分比较随时间增加而改善,而研究组的药物依从性评分显著高于对照组,统计学显示差异有统计学意义(P＜0.05)。2组患者的选择合理、给药频率合理、滴定合理、换药合理、联合用药合理均有明显改善且研究组多于对照组,比较差异有统计学意义(P＜0.05)。结论 家庭药师及药物治疗管理干预能够有效提高患者用药依从性及生活质量,改善用药情况,对慢性病患者干预具有一定参考价值。

Objective To explore intervention the effect of family pharmacist and medication management on medication compliance and unreasonable drug use in contracted patients. Methods A total of 100 patients with chronic diseases from March 2017 to March 2021 in our hospital were selected as prospective study subjects. According to the random remainder method,they were divided into control group and research group with 50 cases in each group. Among them,the control group was surveyed in the first followed-up,and the health information of patients was collected to establish drug use files,and evaluation was performed in the final follow-up. Family pharmacists and family physicians intervened together or directly to formulate specific solutions to help patients achieve the treatment goals and explain the treatment goals. The changes of medication compliance,quality of life and drug use before and after intervention were compared between the two groups. Results Before the intervention,the medication compliance scores of the two groups were not significantly different (P>0.05).After the intervention,the medication compliance scores of the two groups improved with time,while the medication compliance scores of the research group were significantly higher than the control group,statistics analysis showed that the difference was significant (P<0.05).The reasonable selection,the reasonable frequency,the reasonable titration,the reasonable drug change,and the reasonable combined medication in research group were significantly more than the control group,and the differences were statistically significant (P<0.05).Conclusions Family pharmacist and medication management intervention could effectively improve medication compliance and quality of life of patients,improve drug use,had a certain reference value for chronic disease patients.

目的 探究基于微信平台的健康管理对糖尿病老年患者焦虑、抑郁、主观幸福感、血糖水平和生存质量的影响。方法 采取便利抽样方法选取我院老年病科2型糖尿病患者106例,随机分为干预组和对照组各53例。干预组进行基于微信平台的健康管理,主要包括心理干预和健康宣教,对照组实施传统心理干预和健康宣教,比较2组患者的焦虑、抑郁、主观幸福感、空腹血糖、餐后2 h血糖、HbA1C和生存质量。结果 干预后,干预组焦虑发生率低于对照组(P＜0.05),而抑郁发生率与对照组比较,差异无统计学意义(P＞0.05);干预组患者SAS评分、GDS评分、主观幸福感总分空腹血糖、餐后2 h血糖水平、HbA1C、PCS和MCS评分降低或升高效果优于对照组,差异有统计学意义(t=2.823,3.231,-18.956,5.152,7.401,7.528,-3.165,-3.232;P＜0.05)。结论 基于微信平台的健康管理能有效控制糖尿病老年患者的血糖水平,降低焦虑抑郁症状水平,提升主观幸福感和生存质量。

Objective To explore the effect of health management based on WeChat platform on depressive symptoms and quality of life of elderly patients with diabetes. Methods 106 elderly patients with type 2 diabetes hospitalized in geriatrics department in our hospital were selected by convenient sampling method and divided into two groups randomly, with 53 cases in each group. The intervention group was given psychological nursing and health education based on WeChat platform, while the control group received traditional psychological nursing and health education. Finally, the levels of anxiety and depressive symptoms, subjective well-being, fasting blood-glucose, 2h postprandial blood glucose, HbA1C and quality of life, were compared in both groups. Results After the intervention, the incidence of anxiety in the intervention group was lower than that in the control group (P＜0.05), while the incidence of depression did not have statistical difference compared with that in the control group (P＞0.05). The decrease or evaluation of SAS, GDS, subjective well-being, fasting blood-glucose, 2h postprandial blood glucose, HbA1C, PCS and MCS of the intervention group were greater than those in the control group, (t=2.823,3.231,-18.956,5.152,7.401,7.528,-3.165,-3.232;;P＜0.05). Conclusion Psychological intervention and health education by WeChat may control the blood glucose level of elderly patients with diabetes, reduce the level of anxiety and depression symptoms and improve subjective well-being and quality of life effectively.

目的 运用DRG分析临床路径管理对患者住院费用的影响。方法 采用BJ-DRGs分组器,选取2016年广州某三级综合医院的出院患者病案首页信息及DRG分组信息,对比是否实施临床路径管理对患者的总体住院费用影响及各DRG组的住院费用差异。结果 路径组中位住院费用为9 239.41元,低于对照组的12 358.06元,差异有统计学意义(P<0.001)。费用构成分析发现,路径组的治疗费、检查费、药品费、手术费和其他费低于对照组,而材料费用相对较高。比较的14个DRG组中,6个DRG组的路径组住院费用低于对照组。结论 实行临床路径管理可降低患者住院费用、改变费用构成。结合DRG积极推进临床路径精细化管理,可有效控制病种成本,遏制医疗费用的不合理增长。

Objective Using DRG to analyze the impacts on inpatient costs of a hospital in Guangzhou as incurred by clinical pathway management. Methods As performed by BJ-DRGs, we selected DRG grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Guangzhou in 2016. Then we compared the impacts of clinical pathway management on overall inpatients costs and the difference of inpatient costs for the DRG group. Results The median of inpatient costs in the clinical pathway group was 9239.41 yuan, was lower than that of control group which was 12358.06 yuan, and the difference was statistical difference (P<0.001). Cost composition analysis found that the costs of treatment, examination, medicine, surgery and the others in the clinical pathway group were much lower than that of the control group, while the cost of materials was relatively high. Among the 14 DRG group study, there were 6 DRG groups which the inpatient costs of the clinical path group was obviously lower than the control group. Conclusion The implementation of clinical pathway management may reduce the inpatient costs and change the makeup of costs. Therefore, combining with DRG, we actively promote the refined management of clinical pathway, which may effectively control the costs of diseases and the unreasonable growth of medical expenses.

介绍我院应对新型冠状病毒感染防控工作的护理管理措施,包括发热病区的组建,护理应急队伍的建设,工作流程指引的修订和完善,院感防护措施的严格落实,后勤保障的严密管理等,并进行护理质量控制与持续改进,为其他医院的防控工作提供借鉴。

It introduces nursing management measures of novel coronavirus infection prevention and control in our hospital, including the establishment of fever ward, the construction of nursing emergency team, the revision and improvement of working process guidelines, the strict implementation of hospital sensory protection measures, tight management of logistical support, and quality control and continuous improvement of nursing. It offers experiences for other hospitals.