系统化护理对骨关节炎手术治疗效果的影响

目的 研究系统化护理干预骨关节炎手术后病人的临床效果和对神经功能影响。方法 选取我院2015年5月至2016年1月间收治的骨关节炎手术后病人118例,采用随机数字法将所有病人分为对照组和观察组,每组各59例,对照组病人采用常规护理干预,观察组病人则采用系统化护理干预。观察两组病人的护理效果和并发症发生率,同时比较护理前后两组病人的神经功能缺损程度量表（national institutes of health stroke scale, NIHSS）评分差异。结果 观察组的治疗总有效率为91.53%,高于对照组的76.27%,差异有统计学意义（χ²=5.08,P=0.02）。观察组护理后2周和4周的NIHSS评分均明显低于对照组,观察组的住院时间、首次下床活动时间及总并发症发生率均明显少于对照组,差异均有统计学意义（均P＜0.05）。结论 采用系统化护理干预可明显提高骨关节炎手术后的康复效果,加快病人术后的康复速度,促进病人神经功能恢复,同时较好地预防了并发症的发生,护理安全性较高。     

快速康复外科在结直肠癌根治术围手术期护理中的效果

目的:探讨结直肠癌根治术患者围手术期护理中应用快速康复外科(ERAS)的效果。方法:选取2018年10月至2019年6月,本院行结直肠癌根治术患者64例,按随机数字表法分为观察组和对照组,各32例。对照组采用常规护理干预,观察组在对照组护理基础上联合ERAS干预。对比2组护理满意度、焦虑和抑郁评分、术后指标及并发症情况。结果:观察组护理满意度高于对照组(P<0.05);焦虑和抑郁评分优于对照组(P<0.05);术后指标优于对照组(P<0.05);并发症发生率低于对照组(P<0.05)。结论:结直肠癌根治术患者围手术期应用ERAS干预,可改善患者焦虑及抑郁情绪,降低术后并发症发生率,促进患者早日康复。     

手术室综合性护理干预对硬膜外麻醉肛肠病手术的应用效果观察

目的:观察手术室综合性护理干预对硬膜外麻醉肛肠病手术的应用效果。方法:将94例行硬膜外麻醉肛肠病手术患者随机分为对照组和观察组,每组47例。对照组患者采用常规护理干预,观察组患者采用手术室综合性护理干预,比较2组患者护理前后焦虑与疼痛情况、术后并发症情况以及患者满意度。结果:护理前2组患者焦虑自评量表(self-rating anxiety scal, SAS)、疼痛视觉模拟评分法(VAS)评分比较差异无统计学意义(P>0.05),护理后观察组患者SAS、VAS评分均低于对照组(P<0.05);观察组患者术后并发症发生率低于对照组(P<0.05),患者满意度高于对照组(P<0.05)。结论:手术室综合性护理干预对硬膜外麻醉肛肠病手术患者护理效果明显,可有利于缓解患者的焦虑情绪,减轻疼痛,降低术后并发症发生率,提高患者满意度。     

颅内血肿清除术后患者康复积极性及康复情况的研究

目的 探讨全程无缝化护理对颅内血肿清除术后患者康复积极性及康复情况的影响。方法 分析2018年9月至2022年4月本院收治的104例行颅内血肿清除术患者的临床资料，以2018年9月到2021年1月收治的52例为对照组，实施常规护理；以2021年2月到2022年4月收治的52例为观察组，实施全程无缝化护理，评价两组干预效果。结果 干预前，两组NIHSS、BI评分差异不显著（P>0.05），干预后，观察组NIHSS评分更低、BI评分更高（P<0.05）；干预前，两组康复积极性评分差异不显著（P>0.05），干预后观察组积极举动评分更高、放弃举动评分更低（P<0.05）；观察组术后并发症率为5.77%，明显较对照组19.23%低（P<0.05）。结论 对颅内血肿清除术患者而言，应用全程无缝化护理价值较高，可减轻患者神经缺损程度、提高活动能力，还可提高康复积极性，减少术后并发症，值得应用。     

FTS理念下的临床护理路径在结直肠癌术后的应用效果观察

目的:观察快速康复外科(FTS)理念下临床护理路径在结直肠癌术后的应用效果。方法:选取2021年1月至2022年12月在我院接受手术治疗的66例结直肠癌患者为研究参与者，将其随机分为对照组和观察组，每组33例。对照组患者采用常规护理，观察组患者采用FTS理念下的临床护理路径干预，比较2组患者术后康复情况、日常活动度及术后并发症发生情况。结果:观察组患者术后首次排气时间、首次下床活动时间、住院时间均短于对照组(P<0.05),护理后观察组患者日常活动度评分高于对照组(P<0.05),术后并发症发生率明显低于对照组(P<0.05)。结论:结直肠癌手术患者应用FTS理念下的临床护理路径干预有助于缩短术后康复时间，提高患者的日常活动度，减少并发症的发生，临床应用效果确切，建议临床推广应用。     

医院到家庭连续护理干预对持续植物状态出院患者的效果

目的探讨对持续植物状态出院患者实施医院到家庭连续护理干预的效果。方法将47例持续植物状态出院患者按照不同社区分为对照组(23例)和观察组(24例)。对照组采用常规出院康复指导及电话随访,观察组建立一个微信群实施医院到家庭的持续护理干预。干预1年后对两组患者的并发症发生率及再住院、急诊、门诊就诊次数进行统计。结果观察组干预1年后并发症发生率及再住院次数显著低于对照组(P<0.05,P<0.01)。结论医院到家庭连续护理干预可降低持续植物状态出院患者并发症发生率及再住院率。     

快速康复外科理念在膀胱肿瘤电切术围术期护理中的应用

目的探讨快速康复外科理念在经尿道膀胱肿瘤电切术患者围术期护理中的应用效果。方法将100例经尿道膀胱肿瘤电切患者随机分为观察组与对照组各50例。对照组采用传统治疗护理,观察组应用快速康复外科理念进行干预。比较两组患者并发症发生率、住院时间及住院费用。结果观察组住院费用及住院时间、并发症发生率显著短/低于对照组(P<0.01,P<0.05)。结论经尿道膀胱肿瘤电切术患者围术期护理中应用快速康复外科理念,可有效地促进患者康复。     

以Cameron适时理论为基础的全程护理模式在烧伤后瘢痕整形患者中的应用

目的：研究以Cameron适时理论为基础的全程护理模式对烧伤后瘢痕整形患者的干预效果。方法：选择2021年9月-2022年6月笔者医院收治的60例烧伤后瘢痕整形患者为研究对象,采用随机数字表法分为对照组（30例）和观察组（30例）。对照组给予常规护理干预,观察组在对照组的基础上采用以Cameron适时理论为基础的全程护理模式进行干预,两组均干预8周。统计比较两组瘢痕恢复效果、并发症发生情况、心理状态、应对方式及护理满意度。结果：干预后,观察组创面渗出持续时间、疼痛持续时间均短于对照组（P<0.05）;两组创面愈合时间、色素沉着率比较差异无统计学意义（P<0.05）。干预8周后,观察组瘢痕恢复总有效率显著高于对照组（P<0.05）;观察组心理韧性评分高于对照组（P<0.05）,焦虑、抑郁、心理困扰评分低于对照组（P<0.05）;观察组屈服、回避评分低于对照组（P<0.05）,面对评分高于对照组（P<0.05）;观察组护理总满意率高于对照组（P<0.05）。干预期间,观察组总并发症发生率低于对照组（P<0.05）。结论：以Cameron...     

家庭康复护理对截瘫患者生活质量的影响

目的探讨家庭康复护理对截瘫患者生活质量的影响。方法将64例外伤性截瘫患者随机分为对照组(30例)和观察组(34例)。对照组常规进行出院指导,观察组增加家庭康复护理。采用FIM量表对患者的日常生活活动能力和改良式Fugl-Meyer量表对肢体运动功能进行评分;观察并发症的发生情况。分别于出院时、1个月、3个月进行评定。结果观察组出院1个月和3个月FIM和Fugl-Meyer评分显著优于对照组(P<0.05、P<0.01);关节僵硬、肌肉萎缩、骨质疏松发生率显著低于对照组(P<0.05、P<0.01)。结论针对性的家庭康复护理能明显改善截瘫患者的肢体运动功能,增强其日常生活活动能力,降低并发症;有效地促进截瘫患者的康复,提高其生活质量。     

赏识干预对老年骨折患者负性情绪及生活质量的影响

目的 探讨赏识干预对老年骨折患者负性情绪及生活质量的影响.方法 将120例老年骨折患者随机分为对照组和观察组各60例,对照组行常规护理,观察组在此基础上增加赏识护理干预,即了解患者乐意回忆的往事(正性刺激因子),每次先以正性刺激因子为主题与患者进行交流后实施康复护理.连续干预8周后评价效果.结果 观察组SDS、SAS评分及并发症发生率显著低于对照组(P＜0.05,P＜0.01);GQOLI-74评分(除外物质生活维度)显著高于对照组(均P＜0.05).结论 赏识干预可显著改善老年骨折患者的负性情绪,提高生活质量,降低并生症发生率.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.