两种置管深度用于神经外科鼻饲患者的比较

目的比较两种鼻饲管置入深度在神经外科危重患者的临床应用效果。方法将60例需留置鼻饲管患者随机分为对照组和观察组,对照组采用常规留置鼻饲管深度,观察组置管深度加深15 cm,2组鼻饲全程抬高床头30°⁴5°,观察并比较2组患者胃潴留的发生率。结果对照组胃潴留的发生率为30.00%,观察组为16.67%,差异有统计学意义(P<0.05)。结论加深鼻饲管置入深度,可更准确回抽胃内残留,预见性判断发生胃潴留,降低神经外科危重患者胃潴留的发生率。     

综合营养护理干预对老年管饲患者并发症的影响

目的探讨综合营养护理干预对管饲老年患者并发症的影响。方法将120例轻、中度营养不良的老年管饲患者随机分为对照组和观察组各60例。对照组进行常规护理；观察组进行为期1个月的综合营养护理干预，包括改进置管方法（选用小管径胃管和延长胃管插入长度），采取抬高床头角度≥30&#176;的管饲体位，成立由医生、营养师、护士组成的营养支持小组为患者制订个性化的营养计划，掌握管饲的速度和管饲液的温度，进行早期吞咽功能和摄食功能的训练，对管饲患者及其照顾者进行出院前管饲知识和管饲技能培训，患者出院后护士定期上门家访和健康指导等。统计两组患者干预期间呕吐、反流、腹泻、血糖和电解质紊乱、吸入性肺炎发生率。结果观察组上述并发症的发生率显著低于对照组（P〈0．05，P〈0．01）。结论综舍营养护理干预可减少管饲老年患者并发症的发生率，提高患者的生存质量。     

护理干预降低鼻饲患者并发症发生的效果观察

目的:探讨护理干预降低鼻饲患者并发症发生的效果。方法:将83例鼻饲患者随机分成对照组与干预组。对照组41例常规护理,干预组42例采用改良鼻饲管、改变插管深度、改变鼻饲体位、心理支持、自制营养餐等进行护理干预,观察分析两组鼻饲患者并发症(胃出血、食物反流、并发肺炎、胃潴留、一次置管成功率)的发生情况。结果:干预组并发症明显低于对照组(P<0.05)。结论:护理干预能明显降低鼻饲患者的并发症的发生。     

综合营养护理干预对老年管饲患者并发症的影响

目的 探讨综合营养护理干预对管饲老年患者并发症的影响.方法 将120例轻、中度营养不良的老年管饲患者随机分为对照组和观察组各60例.对照组进行常规护理;观察组进行为期1个月的综合营养护理干预,包括改进置管方法(选用小管径胃管和延长胃管插入长度),采取抬高床头角度≥30°的管饲体位,成立由医生、营养师、护士组成的营养支持小组为患者制订个性化的营养计划,掌握管饲的速度和管饲液的温度,进行早期吞咽功能和撮食功能的训练,对管饲患者及其照顾者进行出院前管饲知识和管饲技能培训,患者出院后护士定期上门家访和健康指导等.统计两组患者干预期间呕吐、反流、腹泻、血糖和电解质紊乱、吸入性肺炎发生率.结果 观察组上述并发症的发生率显著低于对照组(P＜0.05,P＜0.01).结论 综合营养护理干预可减少管饲老年患者并发症的发生率,提高患者的生存质量.     

脑卒中病人行输注法鼻饲营养的效果观察

为探讨脑卒中昏迷或严重吞咽困难病人鼻饲营养的有效方法 ,将 2 12例脑卒中病人随机分为两组 ,对照组 ( 112例 )采用灌注法鼻饲 ,观察组 ( 10 0例 )用输注法鼻饲 ,比较两组鼻饲后食物返流及并发症 (吸入性肺炎、窒息 )发生率。结果观察组食物返流及并发症发生率显著低于对照组 ,两组比较 ,差异有极显著性意义 (均 P<0 .0 1)。提示输注法鼻饲是一种较好且安全的鼻饲方法 ,也可用于其他重危、昏迷病人     

腹腔镜胆囊切除术病人的体位改进

将 90例腹腔镜胆囊切除术病人随机分为对照组和观察组各 45例 ,对照组术中采用常规体位 ,观察组采用床头 (上半身 )抬高 30°,右侧高左侧低 (手术床侧斜 30°) ,膝关节处垫一小软枕的体位。结果观察组体位改变后静脉压 ( 30 .0± 4.0 )cmH2 O ,对照组 ( 39.8± 3 .3)cmH2 O ,两组比较 ,差异有极显著性意义 (P <0 .0 1)。提示腹腔镜胆囊切除术病人采取上半身抬高 30° ,有利于下肢静脉血回流 ,减少下肢静脉瘀滞、血栓形成等并发症。     

颅脑损伤患者鼻饲量及间隔时间的探讨

目的探讨颅脑损伤患者单次鼻饲量及鼻饲间隔时间,选择最佳鼻饲模式。方法将60例颅脑损伤鼻饲患者按随机数字表法分为观察组和对照组各30例,两组在鼻饲置管方法、鼻饲体位、鼻饲速度、匀浆膳品种、日鼻饲总量相同前提下,对照组按常规每日鼻饲匀浆膳6次,每次200ml,1次/3h;观察组每日鼻饲匀浆膳4次,每次400～450ml,1次/5h。结果鼻饲20d后两组营养状况及鼻饲并发症发生率比较,差异无显著性意义（均P〉0.05）;观察组每日鼻饲所耗时间显著短于对照组,胃休息时间显著长于对照组（均P〈0.01）。结论增加单次鼻饲量及延长鼻饲间隔时间,有利于患者胃休息,不影响其营养状况,且可减轻护士工作量。     

老年病人使用浅静脉留置针的血管选择

目的：探讨老年病人使用浅静脉留置针时置管反应的发生是否与血管管径有关。方法：将232例浅静脉置管的老年病人，按置管静脉部位分为A组（主静脉组）和B组（分支静脉组），B组又分为B1组（管径≥3.0mm）和B2组（管径＜3．0mm）对三组病人置管反应的发生率及发生时间进行对比观察。结果：A组置管反应发生率为27．9％，B组为73．8％，两者比较，P＜0．01，差异有极显著性意义；A组于置管后第4天出现置管反应，B组置管后第2天即开始有置管反应。B组中B1组置管反应发生率52．6％，B2组为100．0％，两者比较，P＜0．01，差异有极显著性意义；B1组置管反应出现于置管后4－5d,B2组置管反应发生于置管后2－4d。结论：老年病人留置套管针时其置管反应的发生与血管管径大小有关。为老年病人留置套管针时，应尽可能选择直径≥3.0mm的血管，并科学掌握留置时间。     

抬高床头在胎膜早破孕妇体位护理中的应用

目的确保胎膜早破先露部未入盆衔接孕妇正常分娩，提高其舒适度。方法将74例胎膜早破孕妇随机分为对照组和观察组各37例。对照组采用常规平枕头低臀高位（抬高床尾15～18cm），观察组在此基础上抬高床头5～7cm。结果两组均未发生脐带脱垂、顺利娩出健康胎儿，羊水流出量比较，差异无统计学意义（P〉0．05）；对照组头晕、纳差、胸闷及心慌发生率显著高于观察组（均P〈0．05）。结论对胎膜早破胎先露部未入盆衔接孕妇适当抬高床头，可确保孕妇顺利分娩并提高其舒适度。     

截瘫病人留置尿管及膀胱训练的护理体会

目的 :截瘫病人大部分对排尿无感觉 ,进行膀胱训练后能自主排尿。方法 :通过对 6 0例截瘫病人心理护理、置管护理、膀胱功能训练等环节的观察 ,并与既往 32例病人比较 ,对比两组病人膀胱训练的情况。结果 :训练自主膀胱的成功率两组无显著性差异 ,治疗组尿路感染率降低 ,与对照组比较 (P <0 .0 5) ;治疗组留置尿管的时间比对照组明显缩短 (P <0 .0 1 )。结论 :病人在尿常规检验正常时进行膀胱自主排尿训练 ,可减少尿路感染及缩短尿管留置时间。     

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.     

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.     

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.     

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.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.