短视频在父亲支持母乳喂养健康教育中的应用

目的 探讨基于短视频的健康教育在父亲支持母乳喂养中的应用效果。方法 选取103对住院分娩的初产妇及其配偶按照住院时间顺序分组。对照组52对,给予常规健康教育;干预组51对,在常规健康教育的基础上增加基于短视频的健康教育。结果 干预组产后42 d父亲支持母乳喂养自我效能评分、初产妇对配偶参与母乳喂养满意度评分、产后3 d及42 d纯母乳喂养率显著优于对照组（均P<0.05）。结论 基于短视频的健康教育能够提高父亲支持母乳喂养自我效能,提升产妇对配偶参与母乳喂养的满意度,进而促进纯母乳喂养。     

家庭赋权护理对初产妇母乳喂养的影响

目的提高初产妇母乳喂养率。方法采取前瞻性非同期成组对照设计,将2020年4~6月建档并分娩的38例初产妇纳入常规组,2020年7~10月建档并分娩的39例初产妇纳入干预组。常规组给予常规护理,干预组给予家庭赋权护理。比较两组母乳喂养知识、家庭支持得分、母乳喂养自我效能、纯母乳喂养率。结果产后1周,干预组母乳喂养知识、家庭支持得分显著优于常规组(均P<0.01);干预组产后1周、1个月、6个月母乳喂养自我效能得分显著高于常规组,产后1个月、6个月纯母乳喂养率显著高于常规组(均P<0.01)。结论实施基于家庭赋权的护理能够改善初产妇母乳喂养自我效能,提高纯母乳喂养率。     

产褥期妇女自我效能感对其母乳喂养行为的影响

目的 调查初产妇产褥期母乳喂养行为与自我效能感状况,探讨自我效能感对其母乳喂养行为的影响.方法 采用问卷调查法,对首次产后复查的73例初产妇进行母乳喂养行为与自我效能调查.结果 73例初产妇中全母乳喂养率为52.1%;自我效能感平均得分为(27.82±5.75)分,处于中等水平;全母乳喂养者的自我效能感总分及其3个条目评分显著高于混合喂养者(P＜0.05,P＜0.01).结论 初产妇产褥期全母乳喂养率偏低,自我效能感高者更容易坚持全母乳喂养,应采取相应的健康教育提高初产妇的自我效能感,从而促进其母乳喂养行为.     

基于自我效能理论的伴侣参与式护理干预对母乳喂养的影响

目的探讨基于自我效能理论的伴侣参与式护理干预对母乳喂养自我效能和母乳喂养的影响。方法将200例初产妇按照住院日期分为观察组和对照组各100例。对照组采用常规护理措施,观察组实施基于自我效能理论的伴侣参与式护理干预,即按照自我效能理论构建护理方案并实施,包括直接性经验、代替性经验、言语劝说和启用社会支持系统,并加强延续护理。对两组产妇母乳喂养自我效能、喂养方式、母乳喂养知识掌握情况进行比较。结果产后第3天、1个月、3个月、6个月观察组母乳喂养自我效能得分、纯母乳喂养率显著高于对照组(均P0.01)。产后第3天观察组母乳喂养知识得分显著高于对照组(P0.01)。结论基于自我效能理论的伴侣参与式护理干预能增强产妇母乳喂养自我效能水平,促进纯母乳喂养行为,提高纯母乳喂养率。     

产褥期妇女自我效能感对其母乳喂养行为的影响

目的调查初产妇产褥期母乳喂养行为与自我效能感状况,探讨自我效能感对其母乳喂养行为的影响。方法采用问卷调查法,对首次产后复查的73例初产妇进行母乳喂养行为与自我效能调查。结果73例初产妇中全母乳喂养率为52．1％;自我效能感平均得分为（27．82&#177;5．75）分,处于中等水平;全母乳喂养者的自我效能感总分及其3个条目评分显著高于混合喂养者（P〈0．05,P〈0．01）。结论初产妇产褥期全母乳喂养率偏低,自我效能感高者更容易坚持全母乳喂养,应采取相应的健康教育提高初产妇的自我效能感,从而促进其母乳喂养行为。     

基于建构主义理论的立体化平台在母乳喂养健康教育中的应用

目的探讨基于建构主义理论的立体化平台在初产妇母乳喂养健康教育中的应用效果。方法将76例初孕妇随机分为实验组(36例)和对照组(40例)。对照组给予常规母乳喂养健康教育;观察组在此基础上加以母乳喂养立体化平台干预,即按照建构主义原理将立体化平台教学内容设计为母乳喂养讲堂、哺乳知识问答、支架式母乳技能操作演示、抛锚式母乳喂养案例分析、随机进入式在线互动答疑五大模块,依托微信公众平台、雨课堂App和微信群推送健康教育内容及组织互动。比较两组孕产妇干预前后母乳喂养知识、自我效能、6个月纯母乳喂养率及婴儿6个月身高、体质量的增长情况。结果观察组干预后2个月、产后住院期间母乳喂养知识、自我效能及6个月纯母乳喂养率显著高于对照组(均P0.01)。结论基于建构主义的母乳喂养立体化平台能有效提高孕产妇母乳喂养的知识,坚定母乳喂养信念,强化母乳喂养行为,促进母婴健康。     

基于助推理论的医院-社区-家庭三联动母乳喂养干预

目的 探讨以助推理论为指导的医院-社区-家庭三联动母乳喂养干预效果。 方法 选取孕28～32周的孕妇134例为研究对象，按其所居住社区分为对照组和干预组各67例；对照组妊娠期及产后接受常规护理及健康教育，干预组在常规护理基础上实施基于助推理论的医院-社区-家庭三联动母乳喂养干预。 结果 对照组56例、干预组60例完成全程研究。干预组产后1、3、6个月母乳喂养知识得分和自我效能得分显著高于对照组（均P＜0.05）；干预组产后1、3个月乳房问题发生率显著低于对照组（均P＜0.05），产后1~6个月纯母乳喂养率显著高于对照组（均P＜0.05）。 结论 基于助推理论的医院-社区-家庭三联动母乳喂养干预能有效提高社区孕产妇的母乳喂养知识储备与自我效能，改善母乳喂养相关乳房问题，提高6个月内婴儿纯母乳喂养率。     

家庭健康教育干预对产妇的影响

目的:探讨家庭健康教育干预对产妇的影响。方法:将2010年2～8月的初产妇150例作为对照组,对患者实施常规健康教育。将2010年9月～2011年3月的初产妇150例作为观察组,实施家庭健康教育干预。干预内容:对患者及家属实施产前、产中、产后的健康教育。观察两组产妇的试产情况、母乳喂养知识的掌握情况、新生儿护理知识掌握情况等。结果:实施家庭健康教育干预的产妇试产成功率高、母乳喂养知识的掌握率高、对新生儿护理知识掌握率高、患者及家属的满意度高,差异有统计学意义(P<0.01)。结论:家庭健康教育干预提高产妇试产成功率,有利于新生儿护理,提高母乳喂养率,促进产妇康复,提高患者及家属的满意度,提升产科护理服务内涵。     

护士产后返岗喂养行为抉择的质性研究

目的了解护士产后返岗喂养行为的抉择,分析其影响因素,为提高护士6个月纯母乳喂养率及持续母乳喂养率提供参考。方法采用质性研究中的现象学研究法,对13名产后返岗的初产妇护士进行深入访谈。结果在6个月内有2名坚持纯母乳喂养,5名配方奶喂养,6名混合喂养。采用Colaizzi分析法进行资料分析,得出知识缺乏、环境压力、社会支持、政策制度4个主题。结论产后返岗护士在6个月内纯母乳喂养比例较低,喂养行为的抉择与喂养态度、环境压力及自我效能、政策制度有关,可通过利用医院环境资源,提高母乳喂养知识,加强人性化管理,促进母乳喂养自我效能建设及政策支持来提高母乳喂养的行为。     

母乳哺育支持系统对初产妇产后母乳喂养的影响

目的探讨母乳哺育支持系统对初产妇产后母乳喂养的影响。方法将69例自然分娩的初产妇随机分为观察组35例和对照组34例,观察组新生儿出生后给予持续性母婴皮肤接触1h,由母乳哺育支持团队成员提供母乳喂养护理支持,出院后哺乳顾问持续跟踪并给予帮助;对照组则行皮肤接触至产妇会阴伤口缝合并检查完毕,给予常规产后护理。比较产后不同时间纯母乳喂养率及母乳喂养率。结果观察组出院时、产后7d、4个月及6个月的纯母乳喂养率显著高于对照组(P0.05,P0.01),观察组产后7d、4个月及6个月的母乳喂养率显著高于对照组(均P0.05)。结论医院母乳哺育支持系统能有效提高初产妇产后纯母乳喂养率和母乳喂养率。     

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.     

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.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.     

Risiko Schlaganfall — Öffentlichkeitsarbeit und Aufklärung dringend erforderlich

Zusammenfassung Das wesentliche — und zugleich noch wenig ausgeschöpfte — Potenzial der Schlaganfallmedizin liegt in der langfristigen Prophylaxe. Durch Beeinflussung von Lifestylefaktoren wie Ernährungsgewohnheiten, Zigarettenkonsum und körperlichem Training durch entsprechende Aufklärung ließe sich ein erheblicher Teil an zerebralen Ereignissen vermeiden. Ein weiterer in Deutschland noch zu wenig beachteter Faktor ist die konsequente Blutdruckeinstellung. Breitgestreute Aufklärung könnte außerdem potenziellen Patienten helfen, bereits auftretende Warnsymptome wie die transiente ischämische Attacke richtig einzuschätzen, um eine rechtzeitige Behandlung zu ermöglichen.