慢性阻塞性肺疾病患者延迟就医原因的质性研究

目的明确慢性阻塞性肺疾病(COPD)患者延迟就医的原因,为引导COPD患者及时就医提供参考。方法对15例延迟就医的COPD患者进行半结构式访谈,采用质性研究内容分析法对访谈资料分析与提炼。结果受访者延迟就医时间20～90 d。延迟就医原因提炼出5个主题,分别是自行处理与暂时缓解、判断疾病错误、妥协疾病症状、就医能力不足、医疗条件限制。结论 COPD患者延迟就医现象普遍,患者及家属应学会正确判断就医时机,改变不良就医习惯;医护人员及社会相关部门需重视患者及家属的健康教育,并提供必要的支持,引导COPD患者及时就医。     

乳癌患者就医延迟及其疾病认知现状调查

目的了解乳癌患者就医延迟和对乳癌疾病认知的现状,为促进乳癌的早期防治干预提供参考。方法自行设计就医情况调查表和乳癌相关知识问卷对92例乳癌住院患者进行调查。结果乳癌患者就医延迟发生率为31.5%,平均就医延迟时间为(155.7±75.2)d;在疾病认知方面,仅6.5%患者对乳癌知识掌握度高,68.5%患者对乳癌知识掌握度低。结论乳癌患者就医延迟现象严重,乳腺疾病相关知识掌握度低,乳房自检意识缺乏,有必要对妇女进行乳癌相关知识健康教育和自检技能的培训,提高妇女对于乳癌知识的认知率,降低就医延迟率。     

男性乳腺癌患者患病体验的质性研究

目的揭示男性乳腺癌患者就医经历和体验,为优质护理服务提供参考。方法对7例男性乳腺癌患者采用深度访谈法收集资料,运用现象学分析法分析资料。结果访谈资料共提炼出9个主题,分别归属于正性、负性体验。正性体验包括理性接受现实和对家庭支持的感知,负性体验包括就医延迟、震惊与绝望、尴尬与不自在、不确定感、不能承担社会及家庭责任、经济负担沉重以及信息支持不足。结论男性乳腺癌患者负性体验明显多于正性体验,存在较多的社会及心理问题,有必要对男性乳腺癌患者进行心理干预,并在公众尤其是在男性群体中普及男性乳腺癌知识。     

基于社会生态系统理论的阴茎癌患者患病体验的质性研究

目的 了解阴茎癌患者的患病体验，为制定针对性的护理干预提供借鉴。 方法 以社会生态系统理论为理论框架，采用目的抽样法选取11例阴茎癌患者为访谈对象，基于现象学研究对其进行面对面半结构式访谈并收集资料，采用定向内容分析法对资料进行处理与分析。 结果 共归纳出3个主题，10个亚主题，即微观系统（舒适改变、实际需求未得到满足、持续的负性情绪、就医延迟），中观系统（经济负担沉重、角色缺失、家庭关系紧张），宏观系统（缺乏信息支持、就医体验及诊疗水平待改善、社会压力）。 结论 阴茎癌患者的社会生态系统状况存在诸多问题，医护人员应重视疾病给患者身心健康带来的改变，采取有效措施以满足患者身心健康需求，维持其社会生态系统的稳定。     

糖尿病足患者就医延迟的研究进展

介绍糖尿病足患者就医延迟的概念、分析糖尿病足患者就医延迟影响因素(包括个人因素、疾病因素、社会因素),并提出加强基层糖尿病防治团队专业能力建设、开展远程医疗、推进科普宣传、完善社会和医疗保障制度管理策略,旨在为开展健康教育及构建干预方案提供参考,促进患者积极就医。     

脑卒中患者就医延迟关键风险因素分析与策略研究

目的 探讨导致脑卒中患者就医延迟的关键风险因素,构建就医延迟风险评价体系,为提出有针对性的风险管理策略提供参考。方法 采用文献研究、专家访谈和2轮专家函询识别脑卒中患者就医延迟风险因素, 形成包含44项风险因素的脑卒中患者就医延迟风险因素调查表,使用调查表分别对447例脑卒中患者和202名医生进行问卷调查,运用主观评价法和逼近理想排序法（TOPSIS法）2种方法对患者及医生数据中各阶段的风险因素进行重要性排序分析,结合二八定律提取就医延迟的关键风险因素。结果 44项风险因素中共提取出16项关键风险因素：患者延迟阶段7项,转运延迟阶段4项,院内延迟阶段5项。结论 脑卒中患者就医延迟受诸多因素影响,应针对16项关键风险因素构建多维全程的患者就医风险管理机制, 提高患者自身风险应对能力,提高120急救系统使用率,围绕就医环节完善相关流程和制度。     

经皮冠状动脉介入治疗患者自我管理影响因素的质性研究

目的探讨经皮冠状动脉介入治疗患者自我管理行为改变的影响因素,为临床护理提供参考。方法对15例经皮冠状动脉介入治疗患者进行深入访谈,采用扎根理论分析资料的方法进行编码、归类及分析。结果提炼出自我管理动力因素和自我管理障碍因素两大类属,其中自我管理动力因素呈现4个下位类属,包括疾病危机意识、自我管理知识和技能获得、家庭责任驱动和自我管理益处感知;自我管理障碍因素呈现4个下位类属,包括疾病不良体验、家庭阻碍因素、社会负性健康文化和信息获得障碍。结论医护人员应帮助经皮冠状动脉介入治疗患者正确转变角色,接受疾病挑战,提高患者知识技能转化能力,注重家庭共同教育;社会应正确引导支架舆论,加强心脏康复宣教,同时完善健康信息网络平台建设,为患者自我管理提供有效支持。     

心力衰竭患者就医延迟的研究进展

介绍心力衰竭患者就医延迟的定义和现状,从患者因素和社会因素两方面分析心力衰竭患者就医延迟的主要影响因素,并从患者自身应对及外部干预方法综述缩短心力衰竭患者就医延迟的措施,旨在为国内相关研究及针对性干预提供参考.     

糖尿病患者治疗延误行为意向的现象学研究

目的明确糖尿病患者治疗延误的内心体验,探索治疗延误的影响因素,为针对性干预提供参考。方法对11例糖尿病患者治疗延误的影响因素进行半结构式深入访谈,运用现象学方法进行资料分析与提炼。结果受访者治疗延误时间1~20年;影响因素为疾病知识掌握欠缺,消极的疾病应对方式,不良情绪反应,对现有的医疗服务不满意,社会支持的影响。结论受访者治疗延误现象普遍,医护人员应针对患者方面及医疗方面的问题进行针对性干预与改进,促使患者及时就医。     

脑卒中患者神经源性肠道功能障碍自我管理体验的质性研究

目的 了解脑卒中患者神经源性肠道功能障碍的自我管理体验,为制订针对性护理干预措施提供参考。方法 采用现象学研究方法,对14例住院脑卒中神经源性肠道功能障碍患者进行半结构式访谈,应用Colaizzi 7步分析法分析访谈资料。结果 提炼出3个主题9个亚主题,即自我管理动力不足(神经源性肠道功能障碍认知不足、内驱力不足、反馈激励不足)、自我管理困扰体验(习惯固化、机体功能受损、用药困扰)、自我管理适应与调节(依赖药物、积极生活方式调整、应急行为调适)。结论 脑卒中患者神经源性肠道功能障碍自我管理动力不足、困扰较多,医护人员应加强相关知识普及和专科指导,多途径提高患者自我管理意识和能力。     

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 comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

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.