护理实验室开放管理的实践

目的探讨护理实验室开放管理的教学效果.方法将2003级护理本科4个教学班随机分为传统实验室管理模式组(传统组,98人)和开放实验室管理模式组(开放组,104人),分别实施不同的实验室管理方案,课程结束后进行操作技能考核和问卷调查,评价2种实验室管理模式的教学效果.结果开放组学生操作技能综合评分、掌握知识牢固程度、技能操作水平、学习兴趣评分显著高于传统组(均P<0.01).结论护理实验室开放管理在培养学生动手能力、综合运用知识能力及创新能力方面起到非常重要的作用,有助于护理实践教学质量的提高.     

以家兔模拟患儿行儿科护理综合能力训练的实践

目的探讨以家兔模拟患儿行儿科护理综合能力训练的可行性及效果。以培养学生的学习能力、创新能力、实践能力和社会适应能力。方法对205名护理专业本科学生以家兔模拟患儿进行儿科护理操作技能训练，编写儿科护理技能实训手册、确定实践教学目的，以学生分组进行病例讨论、角色扮演，对家兔执行医嘱和完成护理计划，以各小组在每个环节中的综合表现和个人完成实训报告情况进行评分。结果学生综合能力考核评分为（83．5±5．5）分，其中小组评价评分为（75．5±6．5）分，个人评价评分为（88．5±4．5）分；综合能力考核优良率为84．9％；学生对教学效果满意度达97．1％。结论以家兔模拟患儿进行儿科护理操作技能训练，可提高学生儿科护理综合能力，是为适应现代社会培养高素质、实战性强的护理专业人才的有效方法和途径。     

情景教学法在内科护理学教学中的应用

目的 探讨情景教学法在中专护生内科护理教学中的应用效果。方法 将72名学生随机分为两组，实验组（35人）采用情景教学法，建立以学生为主体的课堂教学格局，即通过导读、导思、导能，创设语言情詈、问题情景及临床模拟情景，使学生有难必思、有疑必问、有理必讲。对照组（37人）采用传统教学法，教师授课，学生自由提问。课程结束后评价两组教学效果。结果 实验组出科考试理论成绩、操作技能、综合素质评分显著优于对照组（均P〈0．01）。结论 运用情景教学法进行内科护理学教学有利于提高学生的理论成绩和操作技能及综合素质。     

开放式护理实验室的管理与教学模式探讨

目的探索科学实用的开放式护理实验室的管理与教学模式。方法在开放式护理实验室中实施学生参与型的管理模式和基础技能训练、综合技能训练及设计技能训练3个层次的教学模式。结果实验室开放式学时数显著增加，学生学习成绩和优良率显著优于管理前（P〈0.01，P〈0.05）。学生认为开放式护理实验室的管理和教学模式有利于教学，能提高动手能力、分析问题和解决问题能力及增强协作精神。结论开放式护理实验室管理和教学模式提高了实验室利用率，有助于学生护理技能的提高。     

本科护理教育课程设置的改革与评价

目的 探讨新时期本科护理教育的改革方向，建立更好的教学体系。方法 改革原有的课程设置．对50名2000级学生按传统课程授课。50名2001级学生按改革后的课程授课。均于第4学年实习期末采用问卷形式对两级学生及其临床带教老师（随机抽取75人）进行理论知识水平和操作技能等7个方面的自评及他评。结果 无论是学生自评还是教师评价，2001级学生在理论知识和操作技能、整体护理、健康教育、沟通交流能力、授课能力、论文写作方面评分均显著高于2000级（均P〈0．05）。结论 改革教学模式可使学生知识、能力、素质获得综合提高、全面发展．时满足现代化高等护理人才的需求至关重要。     

急救护理学实验课程教学方法改革探讨

目的 探讨根据临床病例设计急救护理实验，综合应用各项急救护理技术进行实验教学的教学效果。方法 将139名护理专业本科生随机分为对照组（49名）和实验组（90名）。对照组按传统的单项急救护理实验项目教学，实验组在传统教学的基础上，根据临床真实病例设计急救护理预案，综合应用各项急救护理技术进行演练、培训。结果 实验组学生认为实验改革增强了综合急救技能，培养了创新能力．提高了分析问题及解决问题能力；实验组学生操作技能及理论考核成绩与对照组比较，差异有显著性意义（均P〈0．01）。结论 改革实验教学方法，根据，临床病例设计急救护理实验并结合各项急救护理技术进行演练，增强了学生的综合急救能力和创新能力。     

建构主义理论在内科护理学教学中的应用

目的 探讨建构主义理论在内科护理学教学中的应用效果。方法 将140名学生随机分为实验组（92人）和对照组（48人）。对照组采用传统教学法，实验组运用建构主义基础理论指导下的教学法，即采用创设情景，引问激思，导入新课．小组讨论，归纳总结等方式进行教学；课程结束后评价教学效果。结果 实验组理论成绩、操作技能、综合分析能力显著优于对照组（均P〈0．01）。结论 运用建构主义理论进行内科护理学教学有利于提高学生的理论成绩和操作技能及综合能力。     

音乐治疗对ICU术后患者焦虑抑郁的影响

目的 探讨课题作业法在临床护理教学中的应用效果。方法 将103名护生随机分为实验组（57人）和对照组（16人）。对照组采用传统教学法，实验组采用课题作业法；于实习3周后评价教学效果。结果 理论作业、综合应变能力、科研能力实验组显著优于对照组（均P〈＜0．01）；操作技能、沟通能力、健康教育方面两组比较，差异无显著性意义（均P＞0．05）。结论 课题作业法有利于提高护生的科研和综合应变能力。     

社区护理与护理教学相结合的实施效果

目的将社区护理与护理教学相结合，探讨其实施效果。方法将2000级普通中专护理班学生120人随机分为两组，实验组（60人）采用护理教学与社区护理相结合教学法。对照组（60人）采用常规的教学法。结果实验组理论和操作技能考试成绩均显著优于对照组（均P〈0．01）。结论实施社区护理与护理教学相结合．可获良好的教学效果。     

开放式护理实验室学生自主管理的实践

对护理实验室实行全面开放和预约开放相结合的开放方式，采取助理实验员、学生自主管理委员会、学生自主管理责任小组等多种形式学生自主管理的方法，对开放式护理实验室进行管理，以有效发挥护理实验室效能，提高学生的综合能力、操作能力和创新能力。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.