心外科术后患者的早期康复护理流程管理

目的 探讨康复护理小组进行流程管理在心脏外科ICU患者早期活动中的可行性及效果分析。方法 按住院时间先后将心外科术后入住ICU的患者分为对照组（158例）、观察组（127例）。对照组以常规床上康复运动为主,观察组由ICU康复护理管理团队制定针对心脏外科手术后ICU患者的早期渐进式分级活动流程,进行全程康复护理与质量控制。结果 观察组开始进行离床活动时间、ICU停留时间、术后住院时间与对照组比较,差异有统计学意义（P＜0.05,P＜0.01）;观察组出ICU时的肌力评分显著高于术后(P＜0.01)。结论 对心脏外科术后患者实施早期康复流程管理,有利于促进其康复进程。     

乳腺癌患者术后延伸护理服务的应用

目的 探讨延伸护理服务对乳腺癌患者术后康复的影响.方法 按标准纳入行改良根治术的乳腺癌患者67例,按随机数字表法分为干预组33例和对照组34例,对照组采用常规健康宣教方法,干预组在此基础上开展延伸护理服务,比较两组患者功能锻炼依从性、锻炼效果及患者满意度.结果 干预组患者功能锻炼依从性优于对照组,差异有统计学意义（x^2=9.326,P＜0.05）;干预组的患肢上抬高度、外展及旋转功能优良情况均优于对照组,差异有统计学意义（x^2=11.547,P＜0.05）;干预组患者满意度高于对照组,差异有统计学意义（x^2=15.336,P＜0.05）.结论 乳腺癌改良根治术后采取延伸护理服务,可提高患者功能锻炼的依从性和锻炼效果,促进患者康复,提高患者满意度.     

沉浸式虚拟现实技术在肺癌患者肺康复健康教育中的应用

目的 探讨沉浸式虚拟现实技术在早期肺癌患者肺康复健康教育中的应用效果，促进患者术后康复。 方法 将120例早期肺癌患者随机分为对照组与干预组各60例。对照组实施常规健康教育；干预组在常规健康教育基础上，采用沉浸式虚拟现实技术进行肺康复健康教育。 结果 干预组健康教育内容掌握率、肺康复训练依从性、6 min步行距离、Barthel指数及健康教育满意度显著高于对照组，Borg气促与劳累评分显著低于对照组（均P＜0.05）。 结论 沉浸式虚拟现实技术用于早期肺癌患者肺康复健康教育，有助于患者对健康教育内容的掌握，提高肺康复训练的依从性及健康教育满意度，促进患者康复。     

脚踏车运动在ICU腹部术后机械通气患者加速康复中的应用

目的 探讨脚踏车运动在ICU腹部术后患者加速康复中的可行性和效果。方法 将符合纳入标准的96例患者随机分为对照组和观察组各48例。对照组行传统床上运动；观察组在传统运动基础上加脚踏车运动，每次20 min，每天2次。结果 观察组46例，对照组40例完成研究；观察组术后48 h内运动实施率与对照组比较,差异无统计学意义（P＞0.05），但住院期间实施率显著高于对照组（P＜0.01）；未实施原因与对照组比较，差异无统计学意义（P＞0.05）；两组均无导管移位、损伤等不良事件发生；观察组机械通气时间、ICU住院时间显著短于对照组，且出院时下肢肌力、床边坐立例数和床边站立例数显著高于对照组（均P＜0.05）。结论 ICU腹部术后机械通气患者对脚踏车运动依从性较好，且不增加术后不良事件。脚踏车运动可改善患者肺功能和下肢运动功能，促进患者康复。     

高血压脑出血术后偏瘫患者康复护理体会

目的观察高血压脑出血术后偏瘫患者早期康复护理的效果。方法将58例高血压脑出血术后偏瘫患者随机分为2组,各29例。对照组行常规护理干预,干预组行早期康复护理干预。观察2组护理干预前及护理干预后8周的Fud-Meyer评分和Barthd指数。结果护理干预后8周时2组患者Fud-Meyer评分及Barthel评分高于干预前(P0.05)。干预组Fud-Meyer评分和Barthel评分较对照组明显改善(P0.05)。结论高血压脑出血术后偏瘫患者早期康复护理,能有效改善肢体运动功能,提高生活质量。     

心脏起搏治疗患者基于运动危险分层康复方案的构建与实施

目的 基于运动危险分层评估构建心脏起搏治疗患者运动康复方案,并评价其应用效果。 方法 将行心脏起搏治疗的108例患者按入院时间分为对照组和观察组各54例,对照组给予常规活动指导,观察组在常规活动指导基础上制订并实施基于运动危险分层的康复方案。术后第1天和出院前评价患者运动恐惧、上肢功能、活动状况指数、自我管理效能。 结果 对照组49例、观察组53例完成全程研究。干预后观察组运动恐惧、上肢功能、活动状况指数、自我管理效能评分显著优于对照组（均P＜0.05）。 结论 心脏起搏治疗术后患者实施基于运动危险分层的康复方案,可减轻患者的运动恐惧心理,提高自我管理效能,促进患者功能康复。     

综合性护理干预对老年湿疹患者症状改善及依从性的影响

目的 探讨综合性护理干预对老年湿疹患者症状改善及依从性的影响。方法 选取我院皮肤诊断 与治疗中心2020年12月-2022年10月收治的40例老年湿疹患者为研究对象，通过随机数字表法分为对照组 与观察组，每组20例。对照组实施常规性护理干预，观察组实施综合性护理干预，比较两组症状改善情况 和依从性评分。结果 两组干预后EASI、SCORAD评分均低于干预前，且观察组低于对照组（P＜0.05）； 观察组干预后治疗依从性评分高于对照组（P＜0.05）。结论 老年湿疹治疗期间实施综合性护理干预可改 善临床症状，提高治疗依从性，值得临床应用。     

针对性护理干预对老年湿疹患者瘙痒的改善效果

目的 分析针对性护理干预对老年湿疹患者瘙痒的改善效果。方法 选取2022年1月-2023年9月山 东大学附属威海市立医院收治的48例老年湿疹患者为研究对象,随机分为对照组和观察组,每组24例。 对照组实施常规护理干预,观察组实施针对性护理干预,比较两组心理状态[焦虑自评量表（SAS）、 抑郁自评量表（SDS）]、护理效果[湿疹面积及严重程度指数（EASI）、自我护理能力测定量表评分 （ESCA）]、依从性评分、护理满意度评分。结果 两组护理后SDS、SAS评分低于护理前,且观察组低 于对照组（P＜0.05）;两组护理后EASI评分低于护理前、ESCA评分高于护理前,且观察组EASI评分低于对照 组,ESCA评分高于对照组（P＜0.05）;观察组依从性、护理满意度评分高于对照组（P＜0.05）。结论 针对 性护理干预可改善老年湿疹患者瘙痒程度,提升自我护理能力、依从性和护理满意度,值得临床应用。     

高血压脑出血术后偏瘫患者早期康复训练的方法和效果

目的探讨高血压脑出血术后偏瘫患者早期康复训练的方法和效果。方法选取2017-11—2019-09间鹤壁市人民医院收治的78例高血压脑出血术后患者,用随机数字表法分为2组,每组39例。对照组予以常规护理,观察组在常规护理基础上行早期心理支持,肢体、语言、生活自理功能训练等综合康复干预。观察2组患者干预后的功能锻炼依从性。采用Fugl-Meyer运动功能评定量表和Barthel指数评价干预前后2组患者的运动功能及生活自理改善效果。结果干预后观察组患者功能锻炼依从性、Barthel指数、Fugl-Meyer评分均优于对照组,差异均有统计学意义(P<0.05)。结论对高血压脑出血术后偏瘫患者实施早期康复训练,可改善其神经和肢体功能,提高术后生活质量。     

早期床上脚踏车运动对ICU机械通气患者康复的影响

目的探讨早期床上脚踏车运动对ICU机械通气患者康复的影响。方法将124例机械通气患者随机分为干预组和对照组各62例。对照组行常规床上活动;干预组在此基础上加床上脚踏车运动,每天2次,每次20min。结果两组均60例完成研究。运动第7、14天,干预组肌肉总量、骨骼肌、体脂肪、四肢水分、前白蛋白值及潮气量、呼吸频率、二氧化碳分压与对照组比较,差异有统计学意义(均P0.05);干预组机械通气时间、ICU住院时间、VAP发生率、谵妄发生率显著低于对照组(P0.05,P0.01)。结论床上脚踏车运动实现早期活动,可改善机械通气患者的营养指标和心肺功能,促进患者康复。     

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.