Table of Content

10 November 2022, Volume 3 Issue 6 Previous Issue    Next Issue

Research Paper

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The construction and application of dynamic warning plan for emergency clinical deterioration of patients with acute aortic dissection LIU Yuwen, LI Qingyin, LIU Tian, ZHANG Yanjuan, ZHAO Rui, PANG Ran, REN Hua 2022, 3 (6):  485-490.  doi: 10.3761/j.issn.2096-7446.2022.06.001 Abstract ( )   PDF (831KB) ( )   Save Objective To construct a dynamic warning plan for emergency clinical deterioration of patients with acute aortic dissection and evaluate the application effect. Methods Based on the literature and the previous research results,the research group improved the National Early Warning Score to construct the first draft of the plan for dynamic waning of emergency clinical deterioration in patients with acute aortic dissection. Through the expert meeting,the final draft was formed. 26 patients with acute aortic dissection in the emergency department from a tertiary class A cardiovascular hospital in Beijing were selected by convenient sampling. The patients were divided into the control group（14 cases） and the intervention group（12 cases） by random number table method. The control group was given routine care,and the intervention group received the dynamic waning plan of emergency clinical deterioration. Results A total of 14 clinical and nursing experts participated in the expert meeting,and the authority coefficient of the experts was 0.89. Dynamic warning scheme of the emergency clinical deterioration in patients with acute aortic dissection consisted of evaluation index and the clinical response of nursing measures, evaluation index included systolic blood pressure, heart rate,breathing, SpO2, consciousness level and the degree of pain, clinical response nursing measures were responded according to three levels from low to high graded by the score of evaluation index. After the application of this plan,the frequency of consciousness and pain assessment of nurses in the experimental group was higher than that in the control group（P<0.001）,and the frequency of informing doctors in the experimental group was higher and the mortality rate was lower,but the differences were not statistically significant（P>0.05）. Conclusion The dynamic warning plan constructed in this research provided suggestions for clinical nursing strategies according to the change of different assessment indicators,which can further improve emergency nursing for acute aortic dissection patients. References | Related Articles | Metrics

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Status and correlation of role stress and professional benefits of nurses in emergency department in Shandong Province GAO Di, YIN Xinyue, BI Yingxin, LI Fengyan, GU Linlin, DAI Huizhen 2022, 3 (6):  491-496.  doi: 10.3761/j.issn.2096-7446.2022.06.002 Abstract ( )   PDF (884KB) ( )   Save Objective To investigate the current situation of role stress and professional benefits of nurses in emergency departments in Shandong Province,and to analyze the relationship between personal factors,role stress and professional benefits. Methods From February to March 2022,277 emergency nurses from 8 tertiary hospitals and 17 secondary hospitals in Shandong Province were selected as research subjects by stratified random sampling. The general data questionnaire,Role Stress Scale and Questionnaire of Nurses' Perceived Professional Benefits were used for cross-sectional investigation. Results The total score of professional benefits of emergency nurses in Shandong Province was（120.41±20.80）,which was above the medium level. The total score of role stress was（31.01±8.93）,which was at a medium level. The total score of role stress and various dimensions were negatively correlated with professional benefits（r=-0.580,P<0.05）. Age,title,monthly night shift number,average monthly salary,role conflict,and role ambiguity were the main influencing factors of professional benefits,and a total of 48.8% of the variations were explained. Conclusion Reducing the role stress of nurses is conducive to enhance the sense of professional benefits. Managers should include senior,low-paid nurses and nurses with many nigh shifts as key population,strengthen scientific management,reduce role stress,improve positive career perception to promote the long-term and stable development of the emergency nursing team. References | Related Articles | Metrics

Special Planning—Trauma Emergency Nursing

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The application of ultrasound guided venous blood specimen collection process in emergency traumatic shock patients WANG Ping, WANG Yuwei, WANG Sa, ZHANG Yukun 2022, 3 (6):  497-501.  doi: 10.3761/j.issn.2096-7446.2022.06.003 Abstract ( )   PDF (877KB) ( )   Save Objective To explore the application effect of ultrasound-guided venous blood sample collection process in emergency patients with traumatic shock. Methods From September 2020 to December 2021,patients with emergency traumatic shock in the emergency room of a tertiary Grade A hospital in Hangzhou were selected as the research objects. Patients after the application of the process（from May to December 2021） were included in the experimental group,and patients before the application of the process（from September 2020 to April 2021） were included in the control group. A total of 56 cases in the experimental group received venous blood collection process guided by ultrasound,while 52 cases in the control group received venous blood collection guided by ultrasound without collection process. The success rate of first puncture,puncture time,blood routine and ABO blood group delivery time,emergency room retention time,complication rate,sample hemolysis rate and patient comfort were compared between the two groups. Results Compared with the control group,the puncture time,blood routine and ABO blood group delivery time of the experimental group were significantly reduced,the retention time of emergency room was significantly shortened,and the success rate of the first puncture was significantly increased（P< 0.05）. The complication rate and hemolysis rate of subcutaneous hematoma in the experimental group were significantly lower than those in the control group（P< 0.05）. The total score of the comfort scale in the experimental group was higher than that in the control group,and the difference was statistically significant（P< 0.05）. Conclusion s The application of ultrasound-guided venous blood sample collection process can effectively guide the clinical blood collection of emergency traumatic shock patients,reduce the incidence of complications and hemolysis rate,and increase the comfort of patients. References | Related Articles | Metrics

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Construction of evaluation index system of core competence of advanced practice nurses in emergency trauma WU Zuojia, WANG Sa, WANG Yuwei, YAN Danping, ZHANG Yukun, JIN Jingfen 2022, 3 (6):  502-507.  doi: 10.3761/j.issn.2096-7446.2022.06.004 Abstract ( )   PDF (910KB) ( )   Save Objective To construct the evaluation index system of the core competence of emergency trauma advanced practice nurses,and to provide reference for the training and evaluation of emergency trauma advanced practice nurses. Methods The draft of the evaluation index of the core competence of advanced practice nurses in emergency trauma was prepared by referring to domestic and foreign literature and research group discussion. From March to May 2021,18 experts were consulted by Delphi method for two rounds to complete the screening and modification of the index,and the weight of the index was determined by analytic hierarchy process. Results The evaluation index system of the core competence of advanced practice nurses in emergency trauma included 4 first-level indexes（clinical nursing practice ability,trauma nursing non-technical ability,quality continuous evaluation ability,professional development ability）,14 second-level indexes and 42 third-level indexes. The authority coefficients of the two rounds of expert consultation were 0.914,and the effective response rates were 100%. The Kendall harmony coefficients of the first,second and third indexes of the second round of expert consultation were 0.056,0.187 and 0.216,respectively（all P< 0.001）. Conclusion The evaluation index of the core competence of advanced practice nurses in emergency trauma is scientific,reasonable,comprehensive and targeted,which can provide reference for the training and evaluation of advanced practice nurses in emergency trauma. References | Related Articles | Metrics

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Analysis on the existing problems and countermeasures of the marine emergency rescue security system in Hainan Province ZHANG Na, ZHOU Ming, WANG Xuren, MEI Yuan, CHENG Shaowen, ZHANG Hua 2022, 3 (6):  508-512.  doi: 10.3761/j.issn.2096-7446.2022.06.005 Abstract ( )   PDF (862KB) ( )   Save To analyze the current situation and problems of the maritime emergency rescue security system of Hainan Province and put forward corresponding countermeasures to provide a basis for effectively responding to various emergencies at sea. We suggested to use the theory of management,integrate all forces to construct professional teams and integrate the allocation of emergency rescue materials,standardize and optimize the procedures of maritime emergency rescue,and speed up the legislative process of maritime emergency,so as to improve the maritime rescue security system in Hainan Province. References | Related Articles | Metrics

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Summary of best evidence for in-hospital management of spontaneous hypothermia in emergency adult trauma patients WU Jinyu, SHUAI Junkun, SHANGGUAN Feifan, FANG Guizhen 2022, 3 (6):  513-519.  doi: 10.3761/j.issn.2096-7446.2022.06.006 Abstract ( )   PDF (1064KB) ( )   Save Objective To search,evaluate and integrate the best evidence for in-hospital management of spontaneous hypothermia in emergency adult trauma patients to provide a reference for clinical practice. Methods BMJ-BestPractice,UpToDate,Cochrane Library,Joanna Briggs Institute Library,the clinical practice guideline websites such as International Guidelines Collaboration,professional association websites such as American Association of Acute Care,PubMed,Embase,CINAHL,Web of Science,China Knowledge Infrastructure,Wanfang Database,and Chinese Biomedical Literature Database were searched for guidelines,expert consensus,systematic review,evidence summary,clinical decision-making,and best practice related to traumatic hypothermia. The search period was from database establishment to December 31,2021. After evaluating the quality of literatures,two researchers carried out the extraction,classification and synthesis of evidence and evaluate the grade and recommendation grade. Results A total of 15 articles were included,including one best practice,two clinical decisions,five guidelines,one expert consensus,five evidence summaries,and one systematic review. Totally 27 pieces of evidence were summarized from eight aspects：the related concepts of traumatic hypothermia,body temperature monitoring,body temperature management principles,rewarming measures,rewarming precautions,rewarming assessment,transport management and quality management. Conclusion This study summarized the best evidence for in-hospital management of spontaneous hypothermia in emergency adult trauma patients,the body temperature management program for emergency adult trauma patients can be formed according to the contents of the best evidence and combined with the characteristics of the hospital and the clinical environment,so as to improve the standardization of in-hospital hypothermia management in trauma patients. References | Related Articles | Metrics

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Research progress on trauma specialist nurses and the core competence JING Chenchen, WANG Shujuan, WEI Lanling 2022, 3 (6):  520-524.  doi: 10.3761/j.issn.2096-7446.2022.06.007 Abstract ( )   PDF (827KB) ( )   Save This article introduces the definition,core competence,requirements of core competence in different treatment links,and problems faced in the development of core competence of trauma specialist nurses,and puts forward some suggestions for developing the core competence of specialist nurses in trauma. It is necessary to define the core competence of specialist nurses in trauma for the professional development of trauma nursing. But the core competence evaluation system and training curriculum need to be further improved. References | Related Articles | Metrics

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Nursing care of a patient with high flow enterocutaneous fistula secondary to severe thoracoabdominal combined injury SUN Xiaoyan, ZHANG Qiaoling 2022, 3 (6):  525-527.  doi: 10.3761/j.issn.2096-7446.2022.06.008 Abstract ( )   PDF (675KB) ( )   Save To summarize the nursing experience of a patient with high flow enterocutaneous fistula secondary to severe thoracoabdominal combined injury. In terms of high flow enterocutaneous fistula,severe corrosion of local wound,malnutrition,water electrolyte disorder and anticipatory grief,dual double pipe flushing drainage technology and colostomy nursing technology combined high absorbent dressings,multimodal nutrition support scheme,continuous monitoring and correcting of water and electrolyte disorder,encouraging psychological venting and positive effective psychological counseling were adopted. The granulation tissue of the wound grew 108 days after admission,the enterocutaneous fistula healed 170 days after admission,and the wound healed and the patient was discharged 231 days after admission. References | Related Articles | Metrics

Emergency Care Research

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Analysis and nursing strategies of adverse reactions of acetylcysteine in emergency infusion patients HAO Weiwen, XIE Min, CAO Yun, JIN Hua, QIAO Jie, SUN Hao, WANG Gannan, LI Mei, ZHANG Jinsong 2022, 3 (6):  528-531.  doi: 10.3761/j.issn.2096-7446.2022.06.009 Abstract ( )   PDF (630KB) ( )   Save Objective To analyze the characteristics and nursing strategies of adverse reactions of acetylcysteine in emergency infusion patients,in order to provide reference for clinical safe medication. Methods 26 patients who had adverse drug reactions of acetylcysteine during emergency infusion were selected from November 2019 to August 2022 in a tertiary hospital in Nanjing. The analysis was performed on indication,dosages,type and amount of solvent,drip speed of acetylcysteine injection and time of adverse reactions,clinical manifestation,severity,outcome,influence on original diseases and relation evaluation. Results All of the adverse drug reactions were general adverse reactions,and had no obvious influence on their original diseases. The average time from acetylcysteine intravenous infusion to the occurrence of observed adverse drug reactions was 99.7 minutes,and drip speed ranged from 10 to 69 droplets per minute. The manifestations of adverse drug reactions were common in skin and digestive system symptoms. In relevance evaluation,“probable” and “definite” cases accounted for 88.5% of all adverse drug reactions cases. Conclusion Acetylcysteine should be strictly administrated in emergency infusion patients according to instructions. And its drip speed should be strictly controlled during the treatment. The clinical manifestation during the first 2 hours after the administration of drugs should be closely monitored. References | Related Articles | Metrics

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Multidisciplinary collaborative nursing of patients with maternal cardiac myxoma in middle and late pregnancy CHEN Jianhong, WANG Yuan, FENG Jiehui 2022, 3 (6):  532-534.  doi: 10.3761/j.issn.2096-7446.2022.06.010 Abstract ( )   PDF (551KB) ( )   Save To summarize the nursing experience of two cases of middle and late pregnancy complicated with maternal cardiac myxoma. Key points of nursing：in view of the important and difficult problems of preoperative maternal and fetal monitoring and perioperative nursing,a multidisciplinary collaboration was adopted to build an emergency response team,provide preoperative rigorous obstetric monitoring,tumor monitoring and being caution with tumor incarcerated valve obstruction,embolism early warning management; Intraoperative maintenance of hemodynamic stability,observation and nursing of active uterine bleeding after heparinization; Postoperative accurate volume management; Individual psychological care. The patient was discharged 13 days and 6 days after surgery respectively. References | Related Articles | Metrics

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Nursing care of patients with acute myocardial infarction undergoing interventional therapy supported by extracorporeal membrane oxygenation YU Ping, PAN Yongli, ZHANG Ying, ZHOU Li, LOU Qiuying 2022, 3 (6):  535-537.  doi: 10.3761/j.issn.2096-7446.2022.06.011 Abstract ( )   PDF (511KB) ( )   Save To summarize the nursing experience of 12 patients with acute myocardial infarction combined with cardiac arrest undergoing percutaneous coronary intervention（PCI） supported by extracorporeal membrane oxygenation（ECMO）. Nursing points：preoperative high-quality cardiopulmonary resuscitation; Active and quick completion of various inspections; Establishment of ECMO as soon as possible; Safe and effective hospital transfer; Coronary revascularization in the shortest time; Intraoperative condition monitoring and pipeline nursing; Analgesia and sedation nursing; Early prevention of complications and postoperative care. Among the 12 cases,4 patients improved and were discharged,of which 3 patients were in stable condition and were followed up regularly and one patient left neurological dysfunction. References | Related Articles | Metrics

Critical Care Research

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Nursing care of patients with human parvovirus B19 infection after renal transplantation LIU Hongyan, AI Ping, SHEN Qin, ZHOU Xiaojun, ZHOU Yefang 2022, 3 (6):  538-540.  doi: 10.3761/j.issn.2096-7446.2022.06.012 Abstract ( )   PDF (522KB) ( )   Save To summarize the nursing experience of human parvovirus B19（HPV-B19） infection after kidney transplantation. Aiming at the problem that patients with HPV-B19 infection after kidney transplantation were prone to rejection,infection and adverse drug reactions during antiviral therapy,the observation of rejection and early symptoms of infection,the guide to take standard immunosuppressive drugs,various measures and health guidance for infection prevention were implemented. Adverse drug reactions were monitored during intravenous immuno-globulin,and a ward HPV-B19 management system was established to prevent the occurrence of complications related to antiviral treatment. Thirty-seven patients with HPV-B19 infection after renal transplantation were dis-charged after comprehensive treatment and nursing. Four patients were hospitalized again because of the recurrence of HPV-B19 infection after discharge,and recovered after hospitalization treatment. References | Related Articles | Metrics

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Nursing care of a child with bilateral lung transplantation for idiopathic pulmonary fibrosis ZENG Fei, JIN Xiaojuan, LIANG Jiangshuyuan 2022, 3 (6):  541-543.  doi: 10.3761/j.issn.2096-7446.2022.06.013 Abstract ( )   PDF (596KB) ( )   Save The nursing experience of a child with idiopathic pulmonary fibrosis after successful bilateral lung transplantation was summarized. Key points：effective ventilation oxygen therapy,drug control,pain relief,early bedside rehabilitation exercise,infection prevention and complication control. The child recovered and was discharged 36 d after surgery,and was in good condition for 6 months of follow-up after discharge. References | Related Articles | Metrics

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Nursing care of a patient with intestinal infection and portal vein pneumatosis after renal transplantation WANG Yawei, GAN Siyun, CHEN Kun, DENG Ronghua, YANG Zhiyan 2022, 3 (6):  544-546.  doi: 10.3761/j.issn.2096-7446.2022.06.014 Abstract ( )   PDF (556KB) ( )   Save To summarize the nursing experience of a patient with intestinal infection and portal vein pneumatosis 5 years after renal transplantation. In view of the low body resistance caused by long-term use of immunosuppressive drugs,induced intestinal infection and hepatic portal vein pneumatosis,critical illness and rapid progress,it was necessary to quickly control infection and prevent intestinal ischemic necrosis,and adopt single isolation to prevent cross infection; adjust the use of immunosuppressive drug; implement sedation and analgesia; adopt anal expansion,enema,rectal finger stimulation,gastrointestinal decompression and others for conservative treatment of hepatic portal venous pneumatosis; give nutrition support therapy,and etc. After personalized treatment and nursing,the infection was controlled,the symptoms of hepatic portal vein pneumatosis disappeared,and the intestinal function recovered. The patients were transferred to the general ward on the 8th day after admission,and were discharged on the 14th day. References | Related Articles | Metrics

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Nursing care of a patient with cardiopulmonary failure secondary to acute severe organic fluorosis WANG Lizhu, GUO Jingjing, XU Jianfeng, WU Jinjing, YU Xiang, ZHANG Rui 2022, 3 (6):  547-549.  doi: 10.3761/j.issn.2096-7446.2022.06.015 Abstract ( )   PDF (532KB) ( )   Save To summarize the nursing process of a patient with acute severe organic fluorine gas poisoning. Aimed at the main problems of this patient such as hypoxemia,toxic pulmonary edema,cardiopulmonary failure,we have adopted measures such as active control of toxic pulmonary edema,precise airway management,effective pulmonary rehabilitation,and cardiopulmonary protection strategies. After active treatment and meticulous care,the patient was discharged on the 27th day after admission. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Summary of best evidence for humidification management of artificial airways in adult ICU patients TENG Jiao, QIN Hanzhi, GUO Wenchao, ZHANG Zhenwei, SUN Jian 2022, 3 (6):  550-555.  doi: 10.3761/j.issn.2096-7446.2022.06.016 Abstract ( )   PDF (839KB) ( )   Save Objective To search,evaluate,and summarize the best evidence on artificial airway humidification management for adult ICU patients at home and abroad,and to provide a reference for clinical practice. Methods We searched all relevant databases and websites about all relevant literature related to the management of airway humidification in adult ICU patients,then selected the literature that met the inclusion criteria,evaluated their quality and extracted evidence. The retrieval period was from the inception of databases to April 2022. Results A total of 13 articles were included, including 1 clinical decision, 3 guidelines, 5 systematic reviews, 2 evidence summaries, and 2 expert consensuses. From 7 dimensions including the scope of application of artificial airway humidification,humidification device, humidification method,humidification fluid, assessment and monitoring,auxiliary therapy,and personnel organization,15 best evidences were summarized. Conclusion This study summarizes the best evidence for the management of airway humidification in adult ICU patients. Medical staff should also select the evidence in a targeted manner based on the actual clinical situation before application,to improve the effects of airway humidification and reduce the incidence of airway complications in patients. References | Related Articles | Metrics

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Visualization study on research of fluid management in adult patients PAN Yueshuai, CHENG Shihui, WANG Gang, LI Runze, YIN Mingshi, ZHOU Ting, YANG Tingting, WEI Lili 2022, 3 (6):  556-561.  doi: 10.3761/j.issn.2096-7446.2022.06.017 Abstract ( )   PDF (778KB) ( )   Save Objective To analyze the research hotspots and trends of fluid management in adult patients. Methods CiteSpace 5.7.R2 software was used to analyze the literature on fluid management in adult patients from 2011 to 2021 in China National Knowledge Infrastructure（CNKI） and Web of Science（WOS） core collection database. Results A total of 506 Chinese literatures and 1 801 English literatures were retrieved. The number of articles published on fluid management showed an overall upward trend,but the number of articles published in English was much higher than that in Chinese,and reached the peak in 2017. Keyword co-occurrence analysis showed that research hotspots focused on septic shock,fluid responsiveness and hemodynamic monitoring. The cluster analysis showed Chinese literature formed nine clusters including cardiac function,volume management,hemodynamics,perioperative period,central venous pressure,fluid management,septic shock,qualitative research and enhanced recovery surgery. English literature formed 10 clusters,including major abdominal surgery,historical cohort study,acute kidney injury,perioperative fluid management,fluid responsiveness,colloid solution,cardiopulmonary resuscitation,emergency department patient,ill patient,controlled trial. The burst keyword “goal-directed fluid management in perioperative period” reflected the research frontier of fluid management. Conclusion The research objects focused on critically ill patients,and the research theme mainly involved hemodynamic monitoring,fluid responsiveness and intravenous infusion. The research trend is goal-directed fluid management in perioperative period,but the research tends to be medical,and needs to be expanded in the field of nursing. References | Related Articles | Metrics

Review

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Research progress of moral distress measurement tools for pediatric ICU nurses YE Xian, CHEN Junqing, XU Hongzhen 2022, 3 (6):  562-565.  doi: 10.3761/j.issn.2096-7446.2022.06.018 Abstract ( )   PDF (548KB) ( )   Save Moral distress measurement of pediatric ICU nurses is the basis of understanding the current status of the moral distress and exploring the concerned factors,further facilitating the targeted interventions. This article reviews the main contents,characteristics,application status,advantages and limitations of pediatric ICU nurses' moral distress measurement tools at home and abroad,in order to provide a reference for the application and development of moral distress measurement tools for pediatric ICU nurses. References | Related Articles | Metrics

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A review on peripheral perfusion index for hemodynamic therapy in critically ill patients and its enlightenment CHEN Xiangping, ZHANG Yi, LAO Yuewen, ZHANG Jiajia, CHEN Feng, HE Xuehua, GONG Xiaoyan, ZHUANG Yiyu 2022, 3 (6):  566-569.  doi: 10.3761/j.issn.2096-7446.2022.06.019 Abstract ( )   PDF (595KB) ( )   Save With the development of the hemodynamic incoherence concept,peripheral circulation including skin,subcutaneous tissue and muscle has become the focus of hemodynamic therapy in critically ill patients. This article introduces the concept,normal range and influencing factors of peripheral perfusion index,as well as summarizes the application status of peripheral perfusion index for hemodynamic therapy in critically ill patients. Furthermore,it proposes recommendations to apply peripheral perfusion index in critical care nursing,aiming to provide new perspectives for the skin nursing care and scientific research. References | Related Articles | Metrics

Technology Innovation

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Design and application of intelligent alternating decompression inflatable pillow WANG Wenmei, LING Yun, ZHU Jihua, JIANG Weihong, JIN Chendi, XU Jianying, LU Qingqing 2022, 3 (6):  570-573.  doi: 10.3761/j.issn.2096-7446.2022.06.020 Abstract ( )   PDF (1367KB) ( )   Save Objective To design the intelligent alternating decompression inflatable pillow and test its application effect. Methods The intelligent alternating decompression inflatable pillow was composed of six parts：adhesive foam dressing,water bag,inflatable cushion,inflatable tube,chip and remote controller. 50 children admitted from October 2020 to April 2021 were selected as the experimental group,and intelligent alternating decompression inflatable pillow was adopted. A total of 50 children admitted to the cardiac intensive care unit of a tertiary class A hospital in Zhejiang Province from March to September 2020 were selected as the control group and traditional self-designed water bag pillow was used. The changes of blood pressure,heart rate and SpO2,the occurrence of skin pressure injury of head and occipital area,skin moisture and the occurrence of neck skin folds ulcers were compared between the two groups. To investigate the nurses' satisfaction with using the intelligent decompression inflatable pillow. Results The changes of blood pressure,heart rate and SpO2 were not statistically different before and after the application in the experimental group（P> 0.05）,while there were statistically different in the control group（P< 0.05）. The incidence of pressure injury and skin moisture of the children in the experimental group were lower than those in the control group,and the difference were statistically significant（P< 0.05）. The overall satisfaction rate of the nurses was 97.14%. Conclusion The intelligent alternating decompression inflatable pillow is simple and convenient to operate,and can effectively reduce the incidence of head and occipital pressure injury,reduce the fluctuation of hemodynamics. The nurses have high satisfaction. References | Related Articles | Metrics