自我角色认同护理在躁狂症护理中的应用效果分析

目的探讨自我角色认同护理在躁狂症中的应用效果。方法选取2017-2019年沈阳市铁西区精神卫生中心收治的成人躁狂症发作期患者50例,随机分为对照组和干预组各25例。对照组给予常规护理,干预组给予自我角色认同护理。分别采用激越行为量表和社交技能量表对两组的干预效果进行评价。结果干预后两组激越行为量表和社交技能评定目录量表各维度评分及总分差异均有统计学意义(P<0.05)。结论自我角色认同护理能进一步改善躁狂症患者的激越行为和社交技能,值得临床推广应用。     

S100B蛋白与小儿七氟烷麻醉躁动的相关性研究

目的 探讨星形胶质细胞标志物S100B蛋白浓度变化与七氟烷麻醉躁动中的相关性.方法 选择在全麻下行择期白内障手术的患儿30例,美国麻醉医师协会麻醉风险评分(ASA)Ⅰ或Ⅱ级,年龄3～6岁.吸入麻醉诱导为8％七氟烷,待患儿睫毛反射消失后插入喉罩.术中采用3.0％～3.5％的七氟烷维持,调节氧流量2～3 L/min,保持患儿自主呼吸.术毕停止吸入七氟烷,拔除喉罩,记录躁动发生情况.分别于吸入七氟烷前,吸入七氟烷后15 min和术后10 min 3个时间点采集外周静脉血2～3 ml,静置离心后,检测血清S100B蛋白的浓度.结果 30例患儿术前、术中和术后血清S100B蛋白平均浓度分别为(62.76±32.51)、(47.90±22.20)、(48.05±23.53)ng/L,术中和术后浓度值较术前明显降低(P＜0.01),但术中和术后二者浓度值的差异无统计学意义(P＞0.05).其中,躁动患儿术中和术后平均血清S100B蛋白浓度均较术前明显下降[(49.71±25.20) ng/L vs.(68.26±39.40) ng/L,(55.59±30.54)ng/L vs.(68.26±39.40)ng/L,P均＜0.01],术中和术后的差异无统计学意义(P＞0.05);未发生躁动患儿术中和术后平均血清S100B蛋白浓度均较术前明显降低[(46.71±20.64)ng/Lvs.(59.1 1±27.62)ng/L,(43.18±16.95)ng/L vs.(59.11±27.62)ng/L,P均＜0.01],术中和术后的差异无统计学意义(P＞0.05).躁动患儿术前、术后S100B蛋白浓度差值与与躁动评分无相关性(r=0.045,P＞0.05).结论 S100B蛋白浓度在麻醉恢复期患儿躁动发生时明显下降,星形胶质细胞并未在躁动过程中表达增强,S100B蛋白浓度的变化与躁动的严重程度无相关性.     

地佐辛复合芬太尼超前镇痛预防全麻苏醒期躁动的临床观察

目的：观察地佐辛复合芬太尼超前镇痛对全麻患者苏醒期躁动的预防作用。方法：选取行全身麻醉上腹部手术患者100例,A S AⅠ～Ⅱ级,随机分为地佐辛组（A组）、芬太尼组（B组）、地佐辛复合芬太尼组（C组）和对照组（D组）,每组25例。A、B、C三组切皮前10min分别给予静脉注射地佐辛0．2mg／kg、芬太尼1μg／kg、地佐辛0．15mg／kg＋芬太尼0．6μg／kg。围术期以首次剂量1／2,间隔30～40min静脉注射持续镇痛;D组静注等量生理盐水。麻醉维持采用持续输注丙泊酚、瑞芬太尼,间断静脉注射罗库溴胺。记录四组患者手术缝皮后（T0）、拔管时（T1）、拔管后5min （T2）,血压（BP）、心率（HR）的变化;记录睁眼时间、拔管时间;拔管前Riker镇静躁动评分、RSS躁动评分。结果：A组、D组T1、T2时的BP、HR明显高于T0时（P＜0．05）,B组、C组同时间点BP、HR明显低于D组（P＜0．05）;B组睁眼时间、拔管时间明显长于A组、D组;C组Riker镇静躁动评分患者躁动发生率明显低于D组（ P＜0．05）。结论：地佐辛＋芬太尼联合超前镇痛能预防全麻患者苏醒期躁动,不会延长患者的睁眼时间和拔管时间。     

Effect of Dexmedetomidine on Sevoflurane Requirements and Emergence Agitation in Children Undergoing Ambulatory Surgery

Purpose

Dexmedetomidine, a potent selective α2-adrenergic agonist, produces sedation and analgesia. This study was conducted to assess the effect of dexmedetomidine infusion on sevoflurane requirements, recovery profiles, and emergence agitation in children undergoing ambulatory surgery.

Materials and Methods

Forty children undergoing ambulatory hernioplasty or orchiopexy were randomized into two groups. The dexmedetomidine group (Group D, n=20) received dexmedetomidine 1 µg/kg, followed by 0.1 µg/kg/h until the end of surgery, whereas the saline group (Group S, n=20) received volume-matched normal saline. Sevoflurane was used for induction and maintenance of anesthesia and caudal block was performed in all children. End-tidal sevoflurane concentration (ET-sevo), the incidence of emergence agitation, pain scores, and sedation scores were recorded. Hemodynamic changes and other adverse effects were assessed in the perioperative period.

Results

ET-sevo of Group D was significantly reduced in 23.8-67% compared to Group S during surgery. The incidence of emergence agitation was lower in Group D than in Group S (5% vs. 55%, p=0.001). Postoperative pain was comparable, and discharge time was not different between the groups. Mean arterial pressure and heart rate were significantly lower in Group D during surgery.

Conclusion

Intraoperative infusion of dexmedetomidine reduced sevoflurane requirements and decreased emergence agitation without delaying discharge in children undergoing ambulatory surgery. However, caution should be taken in regard to bradycardia and hypotension.     

Effect of Agitation of EDTA with 808-Nanometer Diode Laser on Removal of Smear Layer

Introduction

Near-infrared diode lasers can be used for several applications, which range from disinfection to smear layer removal in endodontics. This study evaluated the efficacy of agitation of 15% EDTA with an 808-nm diode laser on removal of the smear layer.

Methods

Sixty extracted human maxillary central incisor teeth were instrumented up to ProTaper F4 (Dentsply Maillefer, Ballagues, Switzerland) and then randomly divided into 6 groups (n = 10 for each group) according to the different final irrigating protocols as follows: 5% sodium hypochlorite for 120 seconds performed with the NaviTip (Dentsply Maillefer, Ballaigues, Switzerland) (control group); 15% EDTA for 120 seconds performed with the NaviTip; and agitation of 15% EDTA with an 808-nm diode laser for 10, 20, 30, and 40 seconds. Specimens were observed under a scanning electron microscope, and open dentinal tubules were counted using Adobe Photoshop software (Adobe Systems, San Jose, CA). The data were analyzed with 1-way analysis of variance and Tukey post hoc tests (P = .05).

Results

The number of open dentinal tubules was higher in the middle thirds than in the apical thirds. The differences between the apical and middle thirds were statistically significant (P < .05). Statistically significant differences were also found between the control group and the other groups in both the middle and apical thirds of the root canals (P < .05).

Conclusions

The results indicated that agitation of 15% EDTA with an 808-nm diode laser for 20 seconds was effective in removing the smear layer in the apical thirds of root canals.     

Effect of application mode on interfacial morphology and chemistry between dentine and self-etch adhesives

Objective

To investigate the influence of application mode on the interfacial morphology and chemistry between dentine and self-etch adhesives with different aggressiveness.

Methods

The occlusal one-third of the crown was removed from un-erupted human third molars, followed by abrading with 600 grit SiC under water. Rectangular dentine slabs were prepared by sectioning the tooth specimens perpendicular to the abraded surfaces. The obtained dentine slabs were treated with one of the two one-step self-etch adhesives: Adper Easy Bond (AEB, pH ∼ 2.5) and Adper Prompt L-Pop (APLP, pH ∼ 0.8) with (15 s, active application) or without (15 s, inactive application) agitation. The dentine slabs were fractured and the exposed adhesive/dentine (A/D) interfaces were examined with micro-Raman spectroscopy and scanning electron microscopy (SEM).

Results

The interfacial morphology, degree of dentine demineralization (DD) and degree of conversion (DC) of the strong self-etch adhesive APLP showed more significant dependence on the application mode than the mild AEB. APLP exhibited inferior bonding at the A/D interface if applied without agitation, evidenced by debonding from the dentine substrate. The DDs and DCs of the APLP with agitation were higher than those of without agitation in the interface, in contrast to the comparable DD and DC values of two AEB specimen groups with different application modes. Raman spectral analysis revealed the important role of chemical interaction between acid monomers of self-etch adhesives and dentine in the above observations.

Conclusion

The chemical interaction with dentine is especially important for improving the DC of the strong self-etching adhesive at the A/D interface. Agitation could benefit polymerization efficacy of the strong self-etch adhesive through enhancing the chemical interaction with tooth substrate.