医护人员癌痛认知状况调查研究

目的了解肿瘤康复科医护人员对癌痛管理的认知状况,为完善临床癌痛管理方案提供依据.方法采用自行设计的问卷对138名肿瘤康复科医护人员进行癌痛管理的态度和知识调查.结果医护人员对癌痛管理的态度较积极,但对癌痛管理知识相对缺乏;对癌痛管理的态度医生和护士比较,差异无显著性意义(P>0.05);对药物成隐性发生的知晓情况医生与护士比较,差异有显著性意义(P<0.05).结论医护人员癌痛管理知识缺乏是临床癌痛不能有效控制的主要因素,医院管理者应当制定相关政策,采取有效的培训措施,以加强癌痛管理力度,提高患者生活质量.     

儿科护士化疗药物认知现状调查分析

目的了解儿科护士对化疗药物认知现状。方法采用问卷调查表对115名儿科护士对化疗药物认知现状进行调查。结果化疗药物认知良好率为31．30％～94．78％。平均60．10％；≥10年护龄护士对化疗药物认知程度、配割药物过程中存在的危害性以及药物溅身时如何处理的认知显著高于〈10年护龄护士（P〈0．05．P〈0．01）；处理剩余亿疗药物认知上差异无显著性意义（P〉0．05）。结论儿科护士自我保护意识不强．缺乏必要的防范措施。护理管理前应引起重视，针对不同护龄的护士进行相关知识和技能培训，配备必要的防护设施．以提高护士工作安全度。     

颈痛平治疗神经根型颈椎病80例疗效观察

[目的]观察颈痛平治疗神经根型颈椎病的临床疗效和安全性。[方法]开放性临床对照试验。选择神经根型颈椎病患者80例，分为治疗组和对照组。治疗组采用颈痛平治疗，对照组采用颈复康颗粒治疗。分别在治疗后第3周复查，评价两组治疗前后的临床疗效和安全性。[结果]治疗3周后两组疾病疗效比较：治疗组总有效率为86．5％（32／37），对照组总有效率为68．6％（24／35），两组比较有统计学差异（P〈0．05）；两组症候疗效比较：治疗组有效率为89．2％（33／37），对照组有效率为80．0％（27／35），两组比较无显著性差异（P〉0．05）；两组分别进行治疗前后症候积分比较，均有显著性差异（P〈0．05），但两组治疗前后差值比较，无显著性差异（P〉0．05）。[结论]颈痛平治疗神经根型颈椎病在疾病疗效方面明显优于颈复康；在改善中医症候方面两种药物均有明显疗效，且疗效相当；在安全性方面两种药物均无明显不良反应。颈痛平是值得临床推广的治疗神经根型颈椎病的有效药物。     

c-met、E-钙黏蛋白、β-连环蛋白在肝细胞癌中的表达及意义

目的 探讨c-met、E-钙黏蛋白（E—cadherin）、β-连环蛋白（β-catenin）在肝细胞癌（HCC）侵袭转移中的作用，旨在初步明确其在HCC预后判断中的作用。方法 采用免疫组化（ABC—HRP）对47例肝细胞癌手术切除标本中c-met、E-cadherin、β-catenin的表达进行了检测，评估c—met的表达与HCC临床病理因素的关系及与E-cadherin、β-catenin表达的关系。结果 c—met、E—cadherin、β-catenin在肝细胞癌组织中阳性表达率分别为38．3％、59．6％、38．3％，在正常肝组织中分别为12％、84％、64％，两者比较有显著性差异（P〈0．05）。c—met阳性表达率在肝细胞癌的转移（P〈0．05）、淋巴浸润（P〈0．05）、包膜形成（P〈0．05）以及细胞分化方面有显著性差异（P〈0．05）；而在性别、年龄、肿瘤的大小、分期方面则没有差异。E—cadherin、β-caienin的表达在肝细胞癌的转移（分别为P=0．032，P=0．022）、包膜形成（分别为P=0．016，P=0．034）方面的有显著性差异；c—met表达与E—cadherin、β-catenin的异常表达比较有显著性差异（分别为P=0．023，P=0．016）。结论 上述结果提示在HCC的转移中，c—met可能是通过HGF／c—met通路影响E-cadherin、β-catenin的改变来促进细胞的扩散进而出现转移，对于HCC的转移、复发及预后判断具有意义。     

医护人员对病历管理的认知调查

目的了解医护人员对病历管理的认知程度。方法采用自编问卷对随机抽取的262名医护人员进行病历管理的认知调查。结果医护人员对病历能否复印、病历能否全部复印2项的知晓率较高，分别为93．51％、84．35％；对病历的归属、办理复印病历的场所知晓率较低，分别为58．20％、62．98％。医生对复印病历的法律依据和复印病历的程序知晓率显著高于护士（均P〈0．05）。结论医护人员对病历管理的相关知识了解不够，提高医护人员的法律知识，加强医院内部的宣传和培训对病历管理及合理利用有重要意义。     

慢性乙肝患者健康教育效果评价

目的探讨健康教育对慢性乙型病毒性肝炎（CHB）患者的影响。方法对89例2次住院的CHB患者。通过指导阅读健康教育手册、个别指导、集体座谈的形式进行系统的健康教育，并其出院时、再次入院时采用CHB相关知识测试题、自我管理能力测评表进行健康教育效果评价。结果教育后患者CHB相关知识掌握优良率、自我管理能力明显提高。与教育前比较。差异有显著性意义（均P〈0．01）。再次入院时．患者虽对CHB相关知识掌握优良率有所下降，但与出院时比较，差异无显著性意义（P〉0．05）；而患者自我管理能力明显下降．与出院时比较，差异有显著性意义（P〈0．05，P〈0．01）。结论健康教育能提高患者CHB相关知识掌握水平和自我管理能力，但须强化教育．使患者在自身健康方面达到知识、信心及行为的长久统一，并指导其处理好隐私与传染意识的对立统一关系。     

双黄连雾化吸入防治头颈部肿瘤急性黏膜放射反应

目的评价双黄连雾化吸入在头颈部肿瘤放疗中防治急性黏膜放射反应的临床效果。方法将162例接受放射治疗的头颈部肿瘤患者随机均分为观察组与时照组。观察组采用双黄连300mg、地塞米松5mg加生理盐水20ml雾化吸入治疗；对照组采用庆大霉素8万U、地塞米松5mg加生理盐水20ml雾化吸入治疗。结果放射剂量（DT）为30Gy时．两组黏膜反应发生率比较，差异无显著性意义（P〉0．05）；DT为50、70Gy时，观察组急性黏膜放射反应发生率显著低于时照组（均P〈0．05）；观察组放疗疗程显著短于对照组（P〈0．05）。结论双黄连雾化吸入可降低头颈部肿瘤患者急性黏膜放射反应发生率，缩短放疗疗程。     

转录因子Prox-1对大肠癌中淋巴管生成的作用

目的 探讨大肠癌中转录因子Prox-1的表达及对淋巴管生成、淋巴结转移的作用。方法 采用RT-PCR检测大肠癌正常组织、癌交界组织、癌组织中Prox-1的表达；用免疫组织化学sP法测定淋巴管密度（1ymphatic vascular density，LVD）。结果大肠癌组织、癌交界组织中Prox-1的表达水平均显著高于正常组织（P〈0．05）。癌交界组织中Prox-1的表达水平在DukesA＋B期和C＋D期、有无淋巴结转移之间比较差异有统计学意义（P〈0．05）。正常组织与癌交界组织的LVD比较差异有统计学意义（P〈0．05）；癌交界组织中LVD在DukesA＋B期和C＋D期、有无淋巴结转移之间比较差异有统计学意义（P〈0．05）。癌交界组织中Prox-1mRNA的表达水平与LVD呈正相关（r=0．54，P=0．018）。结论Prox-1的过度表达诱导淋巴管内皮细胞的分化、生成；Prox-1是预测肿瘤淋巴转移影响的有效因子之一，但不是独立因子；在进行预测时应选用癌交界组织。     

护理人员获取网络资源信息的能力调查

目的了解护理人员利用网络资源获取信息的能力。方法采用自行编制的护理人员信息能力调查表对147名在职护士进行现场问卷调查。结果仅13．6％、38．1％护理人员能够熟练掌握计算机技能和信息检索知识；仅4．8％有较高的英语水平。不同学历、职称护理人员利用网络资源获取信息的途径（除使用专业搜索引擎外）比较，差异无显著性意义（均P〉0．05）。护理人员认为查找和利用信息的最大困难为缺乏加工和利用信息的能力（89．8％），缺乏提炼信息的能力（85．0％），缺乏检索知识（38．1％）以及没有时间（32．0％）。结论护理人员利用网络资源获取、加工、提炼和利用信息的能力存在不足，在使用专业搜索引擎上存在学历差异，应采取针对性措施提高护士网络时代获取信息的能力。     

急诊科护士职业紧张状况研究

目的 探讨急诊科护士的职业紧张状况，提出相应的防治措施。方法 采用职业紧张量表对71名急诊科护士进行调查，并与630名其他临床科室护士进行比较。结果 急诊科护士职业任务得分显著高于内科、外科、妇产科、儿科、手术室、门诊和其他科室护士（均P〈0．05）；不同科别护士紧张反应、应对资源得分比较，差异无显著性意义（均P〉0．05）。结论 急诊科护士职业紧张程度较高，要从提高个体应对能力，改善组织应对和争取家庭社会应对方面降低其职业紧张水平。     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

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.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

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.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.