多学科协作干预防治鼻咽癌患者放化疗所致口腔黏膜炎

目的探讨多学科协作干预对鼻咽癌患者放化疗所致口腔黏膜炎的防治效果。方法将63例局部晚期鼻咽癌患者按照住院时间分为对照组30例和观察组33例。两组均接受根治性调强放射治疗,同期化疗,对照组实施放化疗常规护理,观察组实施康复、营养、中医等多学科协作干预。比较两组口腔黏膜炎发生时间和严重程度。结果观察组口腔黏膜炎发生时间显著晚于对照组,口腔黏膜炎程度显著轻于对照组(P0.05,P0.01)。结论多学科协作干预有利于延缓鼻咽癌放化疗患者口腔黏膜炎发生时间,降低患者口腔黏膜损伤的严重程度。     

低温氧气雾化在放射性口腔黏膜炎患者的应用

目的 探讨低温氧气雾化吸入在鼻咽癌患者放射性口腔黏膜炎中的防治效果。方法 将101例接受放疗的鼻咽癌患者按照整群随机法分为对照组(54例)和干预组(47例)。放疗期间,两组均以生理盐水和粒细胞刺激因子150 μg为雾化液,每日进行2次雾化,每次持续吸入20 min。对照组接受常温超声雾化吸入,干预组接受低温氧气雾化吸入。结果 干预组放射性口腔黏膜炎的严重程度以及持续时间显著轻于或短于对照组,而出现时间、唾液流量长于或高于对照组（均P＜0.05）。但两组放射性口腔黏膜炎的发生率及在放射剂量达33 Gy时的口腔pH值比较,差异无统计学意义（均P＞0.05)。结论 低温氧气雾化可减轻鼻咽癌放疗患者放射性口腔黏膜炎的严重程度,延缓放射性口腔黏膜炎的出现并缩短病程,同时在保护口腔唾液腺、维持口腔内环境方面也有一定的效果。     

护士主导的多学科协作鼻咽癌同步放化疗患者营养管理

目的改善鼻咽癌患者放化疗期间的营养状况及其放化疗不良体验。方法将74例鼻咽癌患者按住院时间分为对照组36例和观察组38例。两组均行根治性调强放疗加同期化疗,行常规临床护理;对照组实施常规营养管理,观察组实施由护士主导的多学科团队协作的营养管理。放化疗疗程完成后(7周)评价效果。结果放化疗完成后观察组PG-SGA评分、BMI、总蛋白、白蛋白、血红蛋白值显著优于对照组(P<0.05,P<0.01);观察组放化疗相关并发症及重度营养不良发生率显著低于对照组(均P<0.01)。结论护士主导的多学科协作营养管理可有效改善鼻咽癌同步放化疗患者营养状况,降低放化疗相关不良反应发生率。     

参麦饮联合金因肽防治急性放射性口腔黏膜炎效果观察

目的探讨参麦饮联合金因肽防治急性放射性口腔黏膜炎的疗效。方法将80例接受放射治疗的头颈部肿瘤患者随机分为观察组和对照组各40例。观察组从放疗第1天开始持续至放疗结束,每天含服中药参麦饮,至放疗剂量达20Gy时使用金因肽;对照组仅放疗剂量达20Gy时开始使用金因肽。两组治疗时间均为7周。分别于放疗第4、7周末依据RTOG急性放射性黏膜炎的分级标准评价两组患者口腔黏膜反应情况。结果观察组第4周末和第7周末放射性口腔黏膜炎分度显著低于对照组(P0.05,P0.01)。结论参麦饮联合金因肽防治急性放射性口腔黏膜炎效果优于单独使用金因肽,且无不良反应。     

应用口腔护理液治疗放疗后口腔溃疡

目的观察中西医结合口腔护理药液治疗头颈部肿瘤患者放疗后口腔溃疡的临床疗效。方法将80例头颈部肿瘤放疗性口腔溃疡患者随机分为观察组与对照组各40例,观察组使用中西医结合口腔护理药液,对照组使用锡类散行口腔护理。结果干预1周后,观察组口腔溃疡严重程度和疼痛评分显著低于对照组(均P0.05)。结论中西医结合口腔护理药液对放疗性口腔溃疡起到良好的治疗作用。     

对头颈癌放疗患者实施营养相关症状管理教育的效果研究

目的 探讨症状管理教育对头颈癌放疗患者营养相关症状水平和营养状况的影响。 方法 将128例头颈癌放疗患者按不同病区分为对照组与干预组各64例;对照组实施放疗常规护理,干预组在对照组基础上增加分阶段持续性症状管理教育。分别在放疗第1、4、7周和放疗后1个月应用头颈患者症状清单进行营养相关症状评估,同时测量体质量、血清白蛋白及血红蛋白。 结果 干预组不同时间点营养相关症状总分及疼痛、恶心和抑郁严重程度显著低于对照组,体质量、血清白蛋白、血红蛋白显著高于对照组（干预主效应均P＜0.05）。 结论 分阶段持续性症状管理教育能够提高头颈癌放疗患者的症状管理能力,有效减轻患者营养相关症状负荷,改善患者营养状况。     

口腔癌患者围术期个案管理模式的应用

目的探讨个案管理模式在口腔癌患者围术期的干预效果。方法将口腔癌手术患者按照入院时间分为对照组90例和观察组112例。对照组实施口腔癌围术期常规护理及术后随访,观察组由多学科个案管理团队实施个案管理。结果干预后,观察组各项营养相关指标及生活质量得分显著高于对照组,焦虑评分显著低于对照组(均P<0.01)。结论个案管理模式较常规护理可改善口腔癌患者围术期营养状况、焦虑水平和生活质量。     

腹部术后切口疼痛护理干预效果观察

目的探讨对腹部术后切口疼痛的护理干预措施和效果。方法随机将100例接受腹部手术的患者分为观察组和对照组,各50例。对照组采用常规护理,观察组在对照组基础上采取疼痛护理干预措施,比较2组的护理干预效果。结果观察组患者术后的VAS评分、自控镇痛泵使用率及生存质量平均评分均优于对照组,差异有统计学意义(P0.05)。结论对接受腹部手术的患者,在常规护理的基础上,采取疼痛护理干预措施,可显著缓解患者切口疼痛的程度,对提升患者的生存质量评分和护理质量具有重要临床意义。     

降温贴预防甲氨蝶呤化疗患儿口腔黏膜炎的效果

目的探讨降温贴预防儿童大剂量甲氨蝶呤化疗所致口腔黏膜炎的疗效。方法将102例接受大剂量甲氨蝶呤化疗的急性淋巴细胞白血病患儿随机分为对照组和观察组各51例。对照组采用常规口腔护理,观察组在此基础上采用降温贴冷敷患儿两侧颊部1周。结果干预后,观察组口腔pH值显著高于对照组,口腔黏膜炎发生率显著低于对照组、口腔黏膜炎分级显著轻于对照组,且口腔疼痛评分显著低于对照组(均P0.05)。结论降温贴冷敷有利于改善口腔内pH值,有效预防化疗性口腔黏膜炎,减轻口腔黏膜炎严重程度及口腔疼痛。     

龙珠软膏联合维生素E防治鼻咽癌放射性皮炎

目的探讨龙珠软膏与维生素E联用防治鼻咽癌放射性皮炎的效果。方法将94例首次放疗的鼻咽癌患者随机分为对照组47例和观察组47例,对照组皮肤按常规护理,不使用任何药物;观察组每日早晚及放疗前1h分别涂维生素E与龙珠软膏于放疗野皮肤约1～3mm厚,覆盖整个放疗区域并超出1cm,并轻轻按摩,涂至放疗结束后2周。观察两组放射性皮炎发生时间与程度。结果两组放射性皮炎发生时间与程度比较,差异有统计学意义(P0.01)。结论龙珠软膏与维生素E联用防治鼻咽癌放射性皮炎效果好,使用方便、安全。     

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.