居家男性痛风患者服药依从性及影响因素分析

目的了解居家男性痛风患者服药依从性现状及相关影响因素。方法对425例痛风患者采用一般资料问卷、痛风影响量表和Morisky服药依从性量表进行调查。结果痛风患者服药依从性得分为(4.87±2.22)分,疾病影响评分为(60.08±15.77)分。除发作期间对活动的关注外,患者痛风影响程度总分及各维度得分与服药依从性总分呈负相关(P0.05,P0.01)。多元逐步回归分析显示,血尿酸、病程、痛风药物不良反应及未满足痛风治疗需要是影响居家男性痛风患者服药依从性的主要因素(P0.05,P0.01)。结论居家男性痛风患者服药依从性偏低,痛风影响程度是影响居家服药依从性的主要因素。需加强对患者疾病特征及药物治疗重要性的健康教育,提高患者对药物治疗的认识及重视程度,以提高其服药依从性。     

类风湿关节炎患者服药信念与服药依从性调查

目的了解类风湿关节炎患者服药信念和服药依从性现状及其相关性,为制定提高患者服药依从性的护理措施提供理论依据。方法采用风湿病用药依从性问卷(CQR)及服药信念量表(BMQ)对177例类风湿关节炎患者进行调查。结果仅33.9%类风湿关节炎患者的服药依从性好;患者服药信念中位数为1分;患者服药依从性的主要影响因素是服药信念及药物毒性(P0.05,P0.01)。结论类风湿关节炎患者的服药依从性较差,服药信念影响患者服药依从性。应加强对患者服药方面的健康教育,提高其服药信念,减少药物毒性等方面的顾虑,从而提高其服药依从性。     

个案管理模式下乳腺癌病人辅助内分泌治疗依从性分析

目的 分析个案管理模式下乳腺癌病人术后辅助内分泌治疗服药依从性的现状及影响其依从性的相关因素。方法 2013年6月～2017年7月在我院治疗并术后接受个案管理模式的需辅助内分泌治疗的乳腺癌病人2 072例,收集人口学和疾病相关资料,分析其对多学科专家集体制定(multi-disciplinary treatment,MDT)内分泌服药方案的依从性;采用χ2检验分析病人人口学资料和疾病相关因素对辅助内分泌治疗服药依从性的影响。采用Logistic回归分析其影响因素。结果 2 072例乳腺癌病人5年间的辅助内分泌治疗依从性分别99. 61%、98. 69%、97. 38%、94. 65%、84. 51%。服药中位时间(33. 5±15. 55)个月。对人口学和疾病相关资料进行分析显示,年龄、文化程度、肿瘤分期(TNM分期)、服药年限对服药依从性有影响(P 0. 05)。结论 个案管理模式有助于提高乳腺癌术后辅助内分泌治疗病人的服药依从性,进一步提高乳腺癌术后辅助内分泌治疗的服药依从性,尤其需要关注年龄≥65岁、肿瘤分期较早和服药年限3年的病人。     

成人肾移植受者服药依从性与服药信念的研究

目的了解肾移植受者服药依从性和服药信念的状况,并探讨二者间的关系。方法采用便利抽样法选取北京市某三甲医院移植随访门诊就诊的255例肾移植受者,采用一般情况调查表、免疫抑制药物依从性Basel评估量表、服药信念量表进行调查。结果 54.90%肾移植受者术后服药依从性差;服药信念各维度得分:服药必要性20.35±2.76、服药顾虑16.85±3.69、药物过度使用10.29±2.89、药物有害11.15±2.86,服药必要性与顾虑差值得分为3.50±4.06。服药依从性好和依从性差组的服药必要性、药物有害、药物过度使用及服药必要性与顾虑差值得分比较,差异有统计学意义(P0.05,P0.01)。结论门诊肾移植受者服药依从性亟待改善,服药依从性与服药信念有关,应提高患者的服药信念,以改善其服药行为。     

Beliefs about medicine and adherence among nephritic syndrome patients:a survey study

目的 评估肾病综合征患者的服药信念,并探讨患者的服药信念与服药依从性的相关性.方法 选取肾病综合征患者97例,采用服药信念和Morisky服药依从性问卷进行调查.结果 患者服药依从性得分为6.71±1.54,处于中等水平;患者的服药信念与服药依从性显著相关(P＜0.05).结论肾病综合征患者的服药信念与服药依从性相关,医护人员可通过了解患者的服药信念,从而帮助选择更合适的方法以提高患者服药依从性.     

综合护理干预对提高前列腺癌内分泌治疗患者服药依从性的效果评价

目的:探讨综合护理干预对提高前列腺癌内分泌治疗患者服药依从性的效果。方法:评价采用Morisky用药依从性问卷(MMAS-8)对2016年1月至2018年12月期间入院的43例前列腺癌内分泌治疗的患者进行综合护理干预效果。结果:患者在前列腺癌内分泌治疗1个月时MMAS-8评分较高[(7.8±1.1)分],3个月时明显下降[(6.2±1.9)分,P0.05],6个月时患者的依从性最高[MMAS-8评分(7.9±1.2)分,显著高于服药3个月时(P0.05)]。结论:综合护理干预能提高前列腺癌内分泌治疗患者服药依从性,改善治疗结局。     

肾病综合征患者服药信念与服药依从性的调查

目的评估肾病综合征患者的服药信念,并探讨患者的服药信念与服药依从性的相关性。方法选取肾病综合征患者97例,采用服药信念和Morisky服药依从性问卷进行调查。结果患者服药依从性得分为6.71±1.54,处于中等水平;患者的服药信念与服药依从性显著相关(P<0.05)。结论肾病综合征患者的服药信念与服药依从性相关,医护人员可通过了解患者的服药信念,从而帮助选择更合适的方法以提高患者服药依从性。     

乳腺癌患者内分泌治疗的服药依从性研究

目的 了解术后辅助内分泌治疗乳腺癌患者服药依从性现状,分析其相关危险因素.方法 选取在上海市某三级医院被确诊乳腺癌并需要接受术后辅助内分泌治疗的274例患者,通过门诊电子病历系统,回顾性分析2006～2012年所有内分泌医嘱记录,计算药物占有比(MPR).采用Logistic回归分析治疗第1年服药依从性不良的危险因素.结果 274例乳腺癌患者术后辅助内分泌治疗期间第1～5年的总体MPR平均值分别为91％、84％、85％、83％和71％;在治疗第1年,未化疗患者以及服用他莫昔芬的患者发生服药依从性不良的风险更高.结论 乳腺癌患者术后辅助内分泌治疗期间,治疗第5年总体服药依从性不良.在内分泌治疗的第1年,需要重点关注服用他莫昔芬以及未化疗的乳腺癌患者.     

吉林市社区老年人睡眠药物使用现状及影响因素分析

目的了解吉林市社区老年人睡眠药物使用现状并分析其影响因素,为实施干预提供参考。方法采用一般人口学资料调查表、中文版老年人睡眠类药物使用调查问卷、服药特异性信念量表对吉林市502名社区老年人进行调查。结果老年人睡眠药物使用得分12.91±1.99,服药信念得分0.76±0.23;广义线性分析显示,个人月收入、家人中有否医护人员、医疗付费方式、退休前职业及服药信念是老年人睡眠用药的影响因素(P<0.05,P<0.01)。结论吉林市社区老年人睡眠药物使用现状呈中等水平,服药信念偏低,受服药顾虑及人口学多种因素的影响;社区护理人员应加以重视,采取针对措施提高老年人服药信念,保障睡眠用药依从性和安全性。     

结直肠癌患者口服卡培他滨化疗不同时期的服药依从性及其影响因素分析

目的:探讨结直肠癌患者口服卡培他滨化疗不同时期的服药依从性及其影响因素。方法:选取2021年1～12月于我院就诊并接受卡培他滨口服化疗的120例结直肠癌患者为观察对象，患者化疗初期(第1个周期)、中期(第4个周期)、末期(第8个周期)均接受Morisky服药依从性问卷、服药信念特异性问卷、癌症生活质量问卷调查，分析化疗不同时期患者的服药依从性及其影响因素。结果:本组共20例患者放弃服用药物，其中16例于化疗前3个周期内放弃用药。坚持用药的患者化疗初期、中期、末期服药依从性评分分别为(7.41±1.02)分、(6.94±1.09)分和(6.81±1.27)分，各期患者服药依从性评分比较差异有统计学意义，P<0.05。影响化疗用药初期服药依从性的因素主要有食欲丧失、服药信念和文化程度，影响用药中期服药依从性的因素主要有疲乏、造口与否，影响用药末期服药依从性的因素主要为居住地。结论:结直肠癌口服卡培他滨化疗前3个周期最易放弃服药，能坚持用药的患者服药依从性较好，但化疗不同时期患者用药依从性受不同因素影响，医护人员应有针对性予以护理干预。     

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.