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    20 December 2023, Volume 58 Issue 24
    Special Planning——Diabetes Care
    Application of self-monitoring of blood glucose information management platform based on medical consortium in community patients with type 2 diabetes
    WU Quanying, GUO Lixin, SUN Chao, PAN Qi, ZHOU Qi, YU Shuyi
    2023, 58(24):  2949-2956.  DOI: 10.3761/j.issn.0254-1769.2023.24.001
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    Objective To study the effect of self-monitoring of blood glucose information management platform based on the medical consortium on the level of blood glucose control by improving the implementation rate of self-monitoring of blood glucose prescriptions for type 2 diabetes patients in the community. Methods A convenient sampling method was used to select 121 patients with type 2 diabetes from April 2021 to April 2023 who were enrolled in a community of a tertiary hospital medical consortium in Beijing. They were randomly divided into 61 patients in an experimental group and 60 patients in a control group. The control group received routine blood glucose monitoring and guidance education,while the experimental group was managed by a self-monitoring of blood glucose information management platform based on the medical consortium with nurses as the main body. Glycated hemoglobin,glucose test,fasting blood sugar,blood glucose 2 hours after meal,and the completion of self blood glucose monitoring prescriptions were evaluated and analyzed in the first week and the twelfth week of the 2 groups. Results 61 cases in the experimental group and 58 cases in the control group completed the follow-up,and the patients who completed the follow-up were analyzed. There was no statistically significant difference in glycated hemoglobin between the 2 groups at baseline(P=0.117). After 12 weeks,the reduction standard-reaching rate in glycated hemoglobin in the experimental group was significantly different from that in the control group(P=0.014). The number of self-monitoring of fasting blood glucose and the total number of other time periods in experimental group were significantly higher than those in the control group(P<0.001);the implementation rate of self-monitoring prescription in the experimental group was better than that in the control group(P<0.001). Conclusion A self blood glucose monitoring information platform was built to manage community type 2 diabetes patients,so that patients can master and implement the personalized blood glucose monitoring prescription formulated by the medical union team with nurses as the main body,and it is conducive to improving the frequency of blood glucose monitoring and the level of blood glucose control of diabetes patients.

    Construction of an intervention program for diabetic retinopathy patients undergoing surgery based on the theory of ‘Timing It Right
    ZHANG Mengyue, SHI Yinghui, ZHANG Xiaoxian, CHEN Chen, HONG Yirong, XIA Weidan, CHEN Yanyan
    2023, 58(24):  2957-2963.  DOI: 10.3761/j.issn.0254-1769.2023.24.002
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    Objective To construct an intervention program for diabetic retinopathy(DR) patients undergoing surgery based on the theory of ‘Timing It Right’. Methods Guided by the theory of ‘Timing It Right’,based on literature review and semi-structured interview,the first draft of the intervention program was formulated. From December 2022 to February 2023,15 medical and nursing experts in ophthalmology and endocrinology from 5 provinces(cities) in Zhejiang,Sichuan,Shanxi,Chongqing and Shanghai were interviewed by Delphi expert for 2 rounds to seek their advice and revision,and the final draft was formed. Results The effective recovery rate of 2 rounds of expert consultations was 93.75% and 100%. The authority coefficients were 0.87. The importance and feasibility of Kendall’W coordination coefficients were 0.325,0.138 and 0.193,0.141 in 2 rounds,respectively(P<0.001). The finalized intervention program consisted of 6 months,which included 5 first-level items,18 second-level items and 43 third-level items. Conclusion The intervention program for DR patients undergoing surgery based on the theory of ‘Timing It Right’ is reliable,scientific,feasible and practical,and it can meet the needs of such patients,providing a reference for improving their self-management ability,improving their negative emotions and delaying disease progression.

    Nursing care of a case of fulminant type 1 diabetes mellitus related to immune checkpoint inhibitor
    ZHANG Xing, ZENG Lirong, PEI Jia, CHEN Haoying
    2023, 58(24):  2964-2966.  DOI: 10.3761/j.issn.0254-1769.2023.24.003
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    The observation and nursing care of a case of fulminant type 1 diabetes mellitus related to immune checkpoint inhibitor were summarized. To improve prognosis of the disease and guarantee patients’ safety,key points of nursing are as following:sufficient early liquid resuscitation to improve renal perfusion;dynamic monitoring and summary of blood glucose changes,implementing a target-oriented blood glucose management program;providing nutritional support;regularly follow-up and health education. After positive rescue and careful nursing,no serious complications occurred;blood glucose was controlled well;nutritional status was improved;the patient was in stable conditions and was discharged. Telephone follow-up of the patient for 3 months showed stable blood glucose and good condition.

    Guidelines for prenatal calories and 3 nutrients allocations in patients with gestational diabetes mellitus:a systematic review
    XING Nianlu, ZHOU Yingfeng, FANG Yuan, CHEN Shuyu
    2023, 58(24):  2967-2975.  DOI: 10.3761/j.issn.0254-1769.2023.24.004
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    Objective To systematically evaluate relevant guidelines on calories and 3 nutrients allocations during pregnancy in patients with gestational diabetes mellitus,and to compare the similarities and differences in recommendations between these guidelines. Methods Domestic and foreign guideline networks,websites of specialist associations related to diabetes,obstetrics and gynecology,as well as databases,were systematically searched from January 2010 to June 2022. There were 2 appraisers who used the Appraisal of Guidelines for Research & Evaluation II to evaluate the quality of guidelines and then used the content analysis method to synthesize the recommendations of each guideline and compare similarities and differences. Results This study included 18 guidelines with fair overall quality(10 with grade A,2 with grade B and 6 with grade C). The guidelines provided recommendations in 5 aspects of meal allocation,calories,carbohydrates,proteins,and fats,totaling 57 recommendations. While the recommendations for meal allocation were consistent across guidelines,there were significant differences in the recommendations for calories and the 3 major nutrients. Conclusion The recommendations regarding the distribution of calories and the 3 major nutrients mostly rely on expert consensuses,with low-quality evidence but mostly strong recommendations. These guidelines exhibit significant variations from one to another. Consequently,future studies with higher quality on the distribution of calories and 3 nutrients should be conducted,and high-quality evidence-based nutrition guidelines for gestational diabetes should be developed in China.

    The effect of topical oxygen therapy on the intervention of patients with diabetic foot ulcers:a Meta-analysis
    XIE Xiaoran, XU Rong, ZHANG Jing, TAO Jing, BIAN Xuna, HOU Jinjie
    2023, 58(24):  2976-2983.  DOI: 10.3761/j.issn.0254-1769.2023.24.005
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    Objective To systematically analyze and compare studies related to the intervention effect of topical oxygen therapy on patients with diabetic foot ulcers,and provide references for nursing practice. Methods We searched PubMed,Embase,Web of Science,CENTRAL,CINAHL,Clinical Trial,China Biomedical Literature Database,CNKI,Wanfang Database,and VIP from inception to February 1,2023,to collect studies on the effect of topical oxygen therapy interventions on patients with diabetic foot ulcers. 2 researchers independently screened the literature,and extracted the information,and a meta-analysis of the included literature was performed by RevMan 5.4 software. Results 8 studies with 622 patients were included. Meta-analysis results showed that compared with conventional care,topical oxygen therapy improved the response rate[RR=1.59,95%CI(1.16,2.17),P=0.004] and the reduction of diabetic foot ulcer area[MD=28.78,95%CI(14.83,42.73),P<0.001],and the method did not increase the incidence of adverse events[RR=0.83,95%CI(0.63,1.10),P=0.190],but the difference was not statistically significant in terms of healing time[MD=9.86,95%CI(-15.39,35.11),P=0.440]. Conclusion Topical oxygen therapy helps to improve the response rate and reduce the ulcer size in patients with diabetic foot ulcers with a better safety profile,but the effect of the intervention on healing time is unclear. Further high-quality randomized controlled trials should be conducted in the future to validate the efficacy of topical oxygen therapy in patients with diabetic foot ulcers.

    Research progress in acceptance of disability of diabetic foot amputees
    ZHOU Qianya, YANG Dan, DING Shanni, XU Yihong, SHI Wenli, PAN Hongying
    2023, 58(24):  2984-2988.  DOI: 10.3761/j.issn.0254-1769.2023.24.006
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    Acceptance of disability(AOD) is a key factor in psychosocial adjustment of disabled groups,and a good level of AOD plays an important role in promoting health outcomes of patients. At present,studies on AOD have been carried out in many disease fields. Therefore,this article focuses on the relevant concepts,evaluation tools,manifestations,influencing factors,intervention strategies and other aspects of AOD in diabetic foot amputation patients,aiming to improve patients’ prognosis,quality of life and life satisfaction and other aspects for references and help.

    Specialist Practice and Research
    Development and application of a follow-up checklist for postoperative patients with cervical cancer
    SUN Yue, WANG Zhimin, HU Ying, GE Jingling
    2023, 58(24):  2989-2995.  DOI: 10.3761/j.issn.0254-1769.2023.24.007
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    Objective To formulate a scientific and standardized follow-up checklist for postoperative patients with cervical cancer,and provide a scientific tool to support the follow-up work. Methods The first draft of the follow-up checklist was constructed through literature review and semi-structured interviews,and the final draft of the follow-up checklist was formed by conducting 2 rounds of correspondence with experts using the Delphi method from October to December 2022,screening experts’ opinions and revising and improving the checklist. The convenience sampling method was adopted to select 8 nurses and 15 patients with cervical cancer after surgery from a tertiary A hospital in Liaoning Province from February to March 2023 as the research subjects. The nurses made telephone follow-up visits to the patients with the postoperative follow-up list and evaluated the follow-up list.Results The positive coefficients of the experts in the 2 rounds of correspondence were 88.89% and 100%,respectively;the authoritative coefficients were 0.88 and 0.89,respectively;the Kendal harmony coefficient of the primary,secondary and tertiary indicators were 0.177,0.245 and 0.179 in the first round and 0.170,0.118 and 0.107 in the second round,respectively(P<0.05). The final follow-up checklist for postoperative patients with cervical cancer included 4 primary indicators of physical and daily life support,information support,psychological support,and social support,12 secondary indicators,and 45 tertiary indicators. Both nurses and patients believed that the follow-up list was comprehensive with strong professional and clinical practicability. Conclusion The follow-up checklist is reasonable in structure,comprehensive in content,and reliable,specialized and practical,which can provide a scientific and standardized tool to support post-discharge follow-up of patients with cervical cancer.

    Relational model of factors influencing fluid management in hemodialysis patients based on the health belief model
    CHEN Chen, ZHENG Jing, LIU Xu, LIU Jiali, YOU Liming
    2023, 58(24):  2996-3003.  DOI: 10.3761/j.issn.0254-1769.2023.24.008
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    Objective To investigate the influencing factors and pathways of fluid management adherence and interdialytic weight control in hemodialysis patients based on the health belief model. Methods Using convenience sampling,433 patients receiving hemodialysis were included from 4 hospitals in Guangdong province. The demographic and clinical data questionnaire,Health Belief Scale of Fluid Restriction,and Fluid Intake Adherence Scale were used. The relative-interdialytic weight gain(R-IDWG) was calculated. Results The mean score of patients’ fluid management adherence was 3.08±0.97,indicating a moderate level,with 35.57% of patients exceeding the required R-IDWG standard. Regarding health beliefs,perceived benefits(β=0.161) and self-efficacy(β=0.685) of fluid restriction directly affected fluid adherence;perceived threats of poor fluid restriction indirectly affected fluid management adherence through perceptions of benefits and self-efficacy(β=0.235);perceived barriers were indirectly and negatively associated with fluid management adherence through self-efficacy(β=-0.246). Higher fluid management adherence was associated with better control of R-IDWG(β=-0.361). Regarding the coordinating factors,age,educational level,hemodialysis vintage and diabetes were influential factors of fluid management adherence(|β|:0.050-0.162) and R-IDWG control(|β|:0.049-0.309). The coefficients(β) of each path were statistically significant(P<0.05). Conclusion Healthcare providers should comprehensively assess patients’ health beliefs,focus on patients with lower educational levels and diabetes,and identify weakness in their fluid management to achieve the required R-IDWG standard.

    Community Care
    A qualitative study on the experience and needs of dignity-conserving care for the disabled elderly people in nursing homes
    CHEN Lingshan, SHEN Cuizhen, ZHU Qianyin, MU Tingyu
    2023, 58(24):  3004-3010.  DOI: 10.3761/j.issn.0254-1769.2023.24.009
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    Objective This study aimed to explore the experience and needs of dignity-conserving care of disabled elderly people in nursing homes,and to provide a basis for formulating a quality evaluation system for dignity-conserving care. Methods This descriptive qualitative study,involving a semi-structured in-depth interview of 13 disabled elderly people based on purposive sampling,was conducted from August to November 2022 at a nursing home in Hangzhou. Based on the harmony nursing theory,the directional content analysis method was performed in order to summarize and extract themes from the interview texts. Results The dignity-conserving care experience and needs of disabled elderly people were extracted and classified into 5 themes,including physical safety(physical health maintenance,privacy protection,hygiene and image maintenance),psychological health (psychological counseling,psychological support),social communication(well communication environment,harmonious way of communication),spiritual culture(self-realization,respect for faith),needs of dignity-conserving care (individualized health needs,activity participation needs,dignified communication needs,spiritual needs of respecting the elderly ). Conclusion When conducting the dignity-conserving care,nursing homes should pay attention to the physical health of the disabled elderly,actively maintain the image and privacy of the disabled elderly people,pay attention to the needs of psychological health,provide psychological counseling and support,strengthen the construction of barrier-free environments and cultural environments,build mutual respect way of communication,fully respect the religious beliefs of disabled elderly people,promote the realization of self-value of disabled elderly people,broaden the channels of personalized service and activity participation,strengthen the interaction of the dignity and spirit of the respect for the elderly of nursing homes,comprehensively improve the quality of dignity-conserving care in nursing homes.

    Caring dilemma of adolescent caregivers with mood disorder with non-suicidal self-injury behavior at different stages:a qualitative study
    GAO Zhiyuan, SHANG Chaona, YAN Fang, ZHANG Junlei, ZHANG Donghong
    2023, 58(24):  3011-3017.  DOI: 10.3761/j.issn.0254-1769.2023.24.010
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    Objective Based on“timing it right” framework,this study explored the dynamic changes of care dilemma in caregivers of adolescents with mood disorder and non-suicidal self-injury at different stages of disease development,and provided support for the construction of intervention programs. Methods This study adopted phenomenological research and purposive sampling method to select 11 caregivers of adolescents with mood disorders and non-suicidal self-injury behavior who were treated and hospitalized in a tertiary A psychiatric hospital in Henan Province from May 2022 to February 2023 as research subjects. According to the “timing it right” theory,5 semi-structured interviews were conducted with caregivers during the adolescent diagnostic period,hospitalization period,discharge preparation period,adjustment period,and adaptation period. The data was analyzed by the Colaizzi 7-step analysis method. Results The following themes were summarized.①Diagnostic period:complex emotional reactions,facing a dilemma at a loss.②Hospitalization period:lack of knowledge of disease and childcare,self-conscious care difficulties.③Discharge preparation period:lack of confidence in home care and lower expectations for the future of adolescents.④Adjustment period:lack of care skills and desire professional care support.⑤Adaptation period:negatively coping with diseases,with persistent care difficulties. Conclusion The care dilemma of caregivers of adolescents with mood disorders and non-suicidal self-injury behavior in different stages of disease development is dynamic. Medical staff should provide personalized professional support in a planned and continuous manner based on their different stages of care experience and needs,in order to improve the quality of their care and promote adolescent rehabilitation.

    Nursing care of a patient in the second trimester of pregnancy who underwent hypothermia after ruptured cerebellar arteriovenous malformation
    YU Jie, WANG Jun, JI Yuanyuan, ZHANG Naqin
    2023, 58(24):  3018-3022.  DOI: 10.3761/j.issn.0254-1769.2023.24.011
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    The nursing experience of a pregnant woman with ruptured cerebellar arteriovenous malformation and hemorrhage with consciousness disorder at 20+ weeks of pregnancy was summarized. The key points of nursing include:postoperative management of pregnancy combined with brain arteriovenous malformation composite surgery,nursing management of hypothermia treatment in the second pregnancy,the safety of patients and fetus and the whole prevention of complications;early rehabilitation training in stages,and postpartum management based on the recovery of neurological function. Through careful and professional treatment and nursing,the patient had a good prognosis,and was transferred to the rehabilitation department to continue rehabilitation treatment.

    Perinatal nursing care of a patient with twin pregnancy and delayed delivery of the second fetus with placenta previa
    ZHANG Xuerong, PU Yuqun, LU Shuping
    2023, 58(24):  3023-3027.  DOI: 10.3761/j.issn.0254-1769.2023.24.012
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    To summarize the experience of perinatal nursing for 27 days of delayed delivery of the second fetus of a twin pregnancy with placenta previa. Key nursing points include:the start of high risk warning during delayed delivery,and being alert to placenta previa hemorrhage;effective prevention of infection,reducing the incidence of maternal sepsis and chorioamnionitis;actively inhibiting the contractions to prolong gestational age and improving the perinatal survival rate of the second fetus;strengthening in utero fetal monitoring,identifying the early signs of fetal distress;targeted implementation of personalized psychological nursing,to ensure the mental health of patients. The rescue plan during delivery should be improved to ensure the safety of mother and child. Postpartum prevention and treatment of massive bleeding was actively conducted, as well as the prevention of puerperal infection. After 79 d of active treatment and intensive nursing care,the patient was treated and discharged from the hospital without any signs of infection or a massive bleeding. The second newborn,whose delivery was delayed,was discharged from the hospital 59 d after birth,and the follow up was continued for a month until the reach to the standard growth development parameters and the overall physical examination was good.

    Evidence SynthesisI Research
    Rehabilitation experience of patients after total knee arthroplasty:a qualitative meta-synthesis
    ZHANG Wenzhong, JI Hong, WANG Ning, SUN Kangming, LI Jing, XU Zhenzhen, LIU Cuihong
    2023, 58(24):  3028-3036.  DOI: 10.3761/j.issn.0254-1769.2023.24.013
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    Objective To systematically evaluate the rehabilitation experience of patients after total knee arthroplasty,and to provide references for improving the effect of rehabilitation treatment and formulating related clinical nursing strategies. Methods We searched PubMed,Web of Science,the Cochrane Library,Embase,CINAHL,Scopus,ProQuest,CNKI,Wanfang database,VIP database and Chinese biomedical literature database. A qualitative study on the experiences,feelings,and needs of patients undergoing rehabilitation after total knee arthroplasty was retrieved from the database until April 2023. The quality of literature was evaluated using the Quality Evaluation Criteria of Evidence-Based Health Care Center(2016) of Joanna Briggs Institute in Australia,and the results were summarized and integrated by the aggregation integration method. Results A total of 25 studies were included;82 topics were summarized into 12 categories;4 integrated results were finally formed:rehabilitation treatment was faced with multiple difficulties,and patients lost confidence and needed professional guidance and supervision;unsatisfactory experience in rehabilitation;the perception of the benefits of rehabilitation therapy and the encouragement of medical staff,and firm faith in rehabilitation;seeking understanding and social support can promote the effect of rehabilitation therapy. Conclusion Healthcare professionals should pay attention to and reflect on the challenges and unsatisfactory experiences that patients may face during rehabilitation,and provide them with professional guidance and supervision,as well as personalized rehabilitation treatment.

    Evidence summary of non-pharmacological sleep management measures in critically ill children
    QI Shaodan, ZHU Ting, SHEN Weijie, YANG Yuxia, HU Jing, FAN Xiaorui, GU Ying
    2023, 58(24):  3037-3044.  DOI: 10.3761/j.issn.0254-1769.2023.24.014
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    Objective To retrieve,appraise and integrate the relevant evidence of non-pharmacological sleep management measures in critically ill children. Methods We conducted a systematical search on the topic of non-pharmacological sleep management measures in critically ill children across multiple databases,including BMJ best practice,UpToDate,International Guidelines International Network,National Institute for Health and Care Excellence,Scottish Intercollegiate Guidelines Network,Registered Nurses’ Association of Ontario,Joanna Briggs Institute Library,the American Academy of Sleep Medicine,International Pediatric Sleep Association,CNKI,WanFang database,VIP database,SinoMed,Cochrane Library,PubMed,Web of Science,and CINAHL. The literature retrieval time limit was from the establishment of the database to February 2023. The study design includes clinical practice guideline,evidence summary,clinical decision-making,expert consensus,and systematic review. The evidence was extracted and summarized according to the subject after the independent literature quality evaluation by 2 researchers. Results 10 relevant pieces of literature were identified,including 2 guidelines,1 consensus statement,4 systematic reviews,2 evidence summaries,and 1 top clinical decision. These sources provided a total of 28 pieces of evidence across 5 key themes,including sleep assessment,management principles and education,environmental management and sleep promotion. Conclusion This study summarizes the best available evidence on non-pharmacological sleep management measures in critically ill children. It is recommended that healthcare professionals should consider the clinical context when implementing evidence-based interventions,aiming to reduce nocturnal awakenings,extend sleep duration,and improve sleep quality in critically ill children.

    Review
    A scope review of self-management intervention research in patients with hematopoietic stem cell transplantation
    PAN Zhengwen, ZHOU Xiaoyu, JIN Aiyun, XU Liwei, ZHOU Weiwei, DING Shuyi, XU Zhe, CHENG Yin, HUANG Yixuan, YAN Jiali, CAO Kai, XIE Wei
    2023, 58(24):  3045-3053.  DOI: 10.3761/j.issn.0254-1769.2023.24.015
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    Objective To review the research of self-management intervention in patients with hematopoietic stem cell transplantation,clarify the intervention elements,so as to provide references for clinical practice and future related research. Methods According to the scoping review framework,a literature search was performed in the PubMed,Embase,CINAHL,Web of Science,Cochrane Library,CNKI,Wan fang Database,VIP,CBMdisc for all the studies on self-management intervention of patients with hematopoietic stem cell transplantation. The retrieval time was from the establishment of the database to December,2022. There were 2 researchers who extracted and analyzed the data of the included literature. Results A total of 12 articles were included,including 3 randomized controlled trials,8 quasi-experimental studies,and 1 mixed study. 6 studies were conducted with interventions based on the theoretical basis or nursing model such as self-management oriented 5A nursing model,continuous nursing model,problem-based learning theory. The intervention methods of 12 studies included nurse-led self-management guidance,mobile applications,multidisciplinary collaboration,and graphic cards. The intervention time was mostly 1~3 months. The outcome indicators included feasibility evaluation indicators such as operability,ease of use,and user satisfaction of the application,and effect evaluation indicators such as self-management ability,quality of life,and medication compliance of patients. The results showed that self-management interventions could improve patient self-management ability,quality of life,medication compliance,and improve their psychological and nutritional status. Conclusion The research on self-management intervention in patients with hematopoietic stem cell transplantation is still in the development stage,and its positive effect has been preliminarily verified. Medical staff should strengthen the self-management evaluation of patients with hematopoietic stem cell transplantation,play the role of multidisciplinary team,use electronic health intervention methods,and formulate multi-level,scientific and effective self-management intervention programs.

    Research progress on risk prediction models of intraoperative acquired pressure injury in surgical patients
    XING Luyao, YU Wenjing, HU Juanjuan, ZHOU Qi, XIA Tian, MEI Zhu
    2023, 58(24):  3054-3059.  DOI: 10.3761/j.issn.0254-1769.2023.24.016
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    Intraoperative acquired pressure injury is one of the common complications in surgical patients,with a high incidence and delayed postoperative recovery. This paper reviews the judgment,staging criteria and research status of risk prediction models of intraoperative acquired pressure injury in surgical patients. We also compare the construction methods,verification methods and independent risk factors of the models,and analyze the disadvantages,with an aim to provide bases for the prediction,warning and pre-control of the risk of intraoperative acquired pressure injury in surgical patients.