对NICU出院早产儿母亲实施网络支持干预的研究

目的探讨网络支持干预对新生儿重症监护室(NICU)出院早产儿母婴的影响。方法将符合入组条件的早产儿母亲77人按时间分组,2013年6~9月入组的早产儿母亲38人设为对照组,2013年12月至2014年3月入组的早产儿母亲39人设为观察组。对照组接受早产儿常规出院指导,观察组在此基础上实施网络支持干预,持续12周。结果观察组母亲在早产儿出院后4周、12周角色适应评分及育儿胜任感评分显著高于对照组(均P0.01);观察组早产儿出院后12周体质量、身长、头围显著高于对照组(均P0.01),再入院率显著低于对照组(P0.01)。结论网络支持干预能帮助NICU出院早产儿母亲适应母亲角色,提升育儿胜任感,有利于早产儿体格生长发育,降低早产儿再入院率。     

早产儿母亲出院准备度现状及影响因素分析

目的 探讨早产儿母亲出院准备度现状,并分析影响因素,为提高产妇出院准备水平提供参考.方法 选取青岛市3所三级甲等医院NICU早产儿母亲257名,住院期间实施三阶段干预培训母亲照护技能;采用出院准备度量表、领悟社会支持量表、儿科护士与患儿父母伙伴关系量表进行调查,分析影响因素.结果 257名早产儿母亲出院准备度总分83.31±9.44,社会支持总分48.38±5.42,早产儿母亲与护士的伙伴关系总分146.55±15.65.是否具有育儿经验、不同受教育程度的早产儿母亲出院准备度得分差异有统计学意义(P＜0.05,P＜0.01);出院准备度总分与早产儿母亲和护士的伙伴关系、社会支持总分呈正相关(均P＜0.01);育几经验、社会支持水平、伙伴关系水平是早产儿母亲出院准备的主要影响因素(均P＜0.01).结论 医护人员可从影响早产儿母亲出院准备度的主要因素着手,给予早产儿母亲足够的社会支持同时制定策略加强其与护士的伙伴关系,从而提高其出院准备水平.     

晚期早产儿出院后母乳喂养质量现状与影响因素分析

目的探讨晚期早产儿出院后母乳喂养质量及其影响因素,为针对性干预提供参考。方法采用一般资料调查表、爱丁堡产后抑郁量表及母乳喂养质量评定量表对NICU出院的123例晚期早产儿母亲进行调查和影响因素分析。结果晚期早产儿出院后母乳喂养质量总分(16.8±2.7)分,有效喂养65例,占52.8%;多元线性回归分析显示,早产儿母亲文化程度、24 h挤奶次数是主要影响因素(调整R 2=0.720,均P<0.05)。结论晚期早产儿出院后母乳喂养有效率较低,主要受早产儿母亲低文化程度和挤奶次数少的影响,亟需加以重视并开展针对性干预,以提高早产儿出院后母乳喂养质量和效率。     

NICU早产儿住院期间母婴依恋关系现状及影响因素研究

目的 调查NICU早产儿住院期间母婴依恋关系的现状及影响因素，为促进母婴依恋关系的建立提供参考。方法 采用焦虑自评量表、爱丁堡产后抑郁量表和母婴依恋量表对285名早产儿母亲进行横断面调查，采用多元线性回归分析影响因素。结果 285名住院早产儿母亲的母婴依恋关系得分26～104分，中位数为71.00分。母亲年龄、家庭经济状况、产后抑郁是母婴依恋关系的主要影响因素（P<0.05,P<0.01）。结论 NICU早产儿母亲母婴依恋水平中等，应加强对年轻、家庭经济状况较好，有抑郁情绪的母亲有关母婴依恋知识的教育指导，为母亲提供育儿支持，改善母婴依恋关系，促进儿童心理健康发展。     

NICU早产儿母亲疾病不确定感的影响因素分析

目的探讨NICU早产儿母亲疾病不确定感的相关影响因素,为临床干预提供参考。方法采用一般资料调查问卷、疾病不确定感父母量表、焦虑和抑郁自评量表等对100例NICU早产儿母亲进行问卷调查。结果 NICU早产儿母亲的疾病不确定感总分为82.84±29.13,焦虑总分为43.36±13.03,抑郁总分为60.74±16.85。多元线性回归分析显示,接受信息支持、分离时间、受教育程度、抑郁评分和现居住地均进入疾病不确定感回归方程,共同解释疾病不确定感总变异的31.4%。结论 NICU早产儿母亲存在较高程度的疾病不确定感,接受信息支持、分离时间、受教育程度、抑郁评分和现居住地是其主要影响因素。临床护理人员在护理早产儿时,应该重视其母亲的心理需求,帮助她们降低疾病不确定感,促进身心健康。     

NICU早产儿母亲疾病不确定感与社会支持的相关性研究

目的了解NICU早产儿母亲疾病不确定感、社会支持状况及其相关性,为临床干预提供依据。方法运用疾病不确定感父母量表(PPUS-FM)和社会支持评定量表(SSRS)对180例NICU早产儿母亲进行调查。结果早产儿母亲疾病不确定感总分(98.71±11.50)分,社会支持总分(38.95±6.68)分,疾病不确定感总分、不可预测性、不明确性及复杂性与社会支持总分、客观支持、主观支持、支持利用度呈负相关(均P0.01)。结论 NICU早产儿母亲疾病不确定感与社会支持水平相关;临床护理人员在护理早产儿的同时,应该重视其母亲的心理需求,帮助她们寻求来自家庭和社会的可利用资源,以降低其疾病不确定感,促进身心健康。     

社会支持期望落差及喂养方式对高危妊娠产妇育儿胜任感的影响

目的了解高危妊娠产妇的社会支持期望落差及喂养方式现状,并分析其对产妇育儿胜任感水平的影响。方法对160例高危妊娠产妇于产后6~8周复查时采用中文版育儿胜任感量表(C-PSOC)和中文版产后社会支持量表(C-PSQ)进行调查。结果高危妊娠产妇的育儿胜任感总分68.88±12.75,其中育儿自我效能得分34.17±6.08,育儿满意度得分34.11±8.81;产后社会支持期望落差为27(6.0,54.5)。纯母乳喂养率26.9%,纯母乳喂养产妇的育儿胜任感水平及各维度评分显著高于其他喂养方式的产妇(均P<0.05)。多元线性逐步回归分析显示,纯母乳喂养、产后抑郁得分、信息支持落差是影响高危妊娠产妇育儿胜任感水平的主要因素(调整R^2=0.393)。结论产科工作者应重视高危妊娠产妇抑郁的筛查,提供促进产妇康复、早产儿育儿知识与母乳喂养指导等方面的信息支持,提高早产儿的纯母乳喂养率,以提高高危妊娠产妇的育儿胜任感水平。     

早产儿母亲心理健康问题及干预研究进展

描述早产儿住院及出院不同阶段早产儿母亲心理健康问题,主要包括焦虑抑郁、担忧、内疚、自责、不安、无助、抱怨等情绪;干预措施主要包括早产儿母亲自我效能干预,改革NICU封闭式环境,同伴支持,早产儿母亲自我正向行为支持,袋鼠式护理,延续性护理,医务人员加强相应研究及其他社会支持等;提出现存问题及建议,以期促进母婴健康。     

住院早产儿母婴互动状况分析

目的研究早产儿母婴互动现状,为提高早产儿生活质量提供支持。方法选择住院低危早产儿(38例)及其母亲(38名),分别在住院期间母亲首次探视和出院后首次随访时采用婴儿哺喂评估量表(NCAFS)对早产儿母婴互动状况进行评分。结果早产儿母缨NCAFS评分低于美国正常水平;在早产儿出院后首次随访(纠正胎龄40周)时NCAFS评分为45.79±7.58,首次探视时(纠正胎龄35周)评分为39.53±7.16,不同时间评分比较,差异有统计学意义(P0.01)。结论早产儿母婴互动水平较低,与婴儿发育和健康水平有关。我国现行的病区管理模式不利于母婴互动,需建立积极干预措施促进早产儿母婴互动。     

产妇育儿胜任感现状及与产后抑郁的相关性研究

目的探讨产妇育儿胜任感现状及与产后抑郁的相关性,为实施提高产妇育儿胜任感水平、降低产后抑郁措施提供参考。方法采用中文版育儿胜任感量表和爱丁堡产后抑郁量表对254名产后1周内的产妇进行调查。结果产妇育儿胜任感量表总分为(74.17±9.31)分,产后抑郁总分为(7.81±4.07)分。育儿胜任感量表总分及各维度得分与产后抑郁总分及焦虑维度得分呈显著负相关(均P0.01),育儿胜任感量表总分及满意度维度得分与抑郁维度得分呈显著负相关(均P0.01)。结论产妇育儿胜任感水平有待提高,提高产妇的育儿胜任感水平有助于改善其焦虑、抑郁情绪。     

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.