基于人际关系理论的延续性护理模式在复发性多软骨炎患者的应用

目的探讨基于人际关系理论的延续性护理模式在复发性多软骨炎患者中的应用效果。方法将96例复发性多软骨炎患者随机分为观察组(n=47)和对照组(n=46),对照组按常规进行延续性护理,主要措施包括出院前健康宣教、发放健康宣教手册、电话随访、家庭访视、建立微信群等。观察组在对照组基础上实施基于人际关系理论的延续性护理。于干预前及干预6个月后测评服药依从性和生存质量。结果干预后观察组服药依从性及生存质量得分显著高于对照组(P0.05,P0.01)。结论基于人际关系理论的延续性护理模式用于复发性多软骨炎患者具有可行性,能够提高患者的服药依从性和生存质量。     

Impact of family-based nursing intervention on quality of life among lung cancer patients after Gamma Knife treatment

目的 探讨家庭护理干预对体部伽玛刀治疗肺癌患者生活质量的影响.方法 将60例体部伽玛刀治疗的肺癌患者按住院时间分为对照组和干预组各30例.对照组进行常规出院指导,干预组在此基础上实施家庭访视、电话访视和网上咨询等综合家庭护理干预,为期6个月.两组均采用WHO推荐的家庭支持量表和欧洲癌症研究治疗组织核心问卷生活质量评价表进行评价.结果 干预组家庭支持情况显著优于对照组,生活质量中躯体功能、情绪功能、角色功能及认知功能评分显著高于对照组(P＜0.05,P＜0.01).结论 家庭护理干预有助于伽玛刀治疗肺癌患者获得家庭支持,提高其生活质量.     

延续护理对重度烧伤患者生活质量的影响

目的探讨延续性护理对重度烧伤患者出院后生活质量的影响。方法将82例重度烧伤临床愈合患者于出院前分为对照组39例、观察组43例。对照组给予常规出院指导和随访;观察组实施延续性护理干预,包括成立延续护理小组,发放烧伤患者康复手册,制定康复训练计划,安排专职护士家庭访视、电话回访等。实施6个月后采用欧洲癌症研究与治疗组织的生活质量核心量表(EORTC QLQ-C30)评价效果。结果干预后观察组EORTC QLQ-C30总分及各维度得分显著高于对照组(均P0.01)。结论对重度烧伤患者出院后实施延续性护理干预,有助于提高患者生活质量。     

微信平台辅助下的延续性护理方式对脊髓损伤患者生存质量及康复的影响

目的 探讨微信平台辅助下的延续性护理方式对脊髓损伤患者生存质量及康复的影响。方法 选取该院2020年1月～2021年1月治疗出院的58例脊髓损伤患者作为研究对象,按随机数字法分为观察组、对照组各29例。对照组患者采用常规康复护理,观察组患者在常规康复护理的基础上采用延续性护理模式。对所有患者进行6个月、12个月的随访,比较两组患者膀胱功能重建率,并发症发生率,生活功能量表(activity of daily living, ADL)评分。结果 出院6个月及12个月后,两组患者的尿路感染、褥疮及肺部感染并发症发生率具有统计学差异(P<0.05)。出院6个月后,两组患者的膀胱功能恢复无明显差异;出院12个月后,观察组患者的膀胱功能重建率明显优于对照组(P<0.05)。出院6个月后,两组ADL评分无统计学差异;出院12个月后,观察组评分显著高于对照组(P<0.05)。结论 通过微信平台辅助下的延续性康复护理,可以有效改善脊髓损伤患者的远期综合生活质量,降低并发症发生率,值得在临床推广。     

无骨折脱位颈脊髓中央损伤综合征的手术疗效及其影响因素

目的 :评估无骨折脱位颈脊髓中央损伤综合征(traumatic central cord syndrome,TCCS)的手术疗效,探讨其影响因素。方法:2007年1月~2014年1月我院收治无骨折脱位的颈椎TCCS患者66例,评估损伤后24h内、术前、术后5d、末次随访时的ASIA评分和JOA评分,测量椎管最大狭窄程度(maximum canal compromise,MCC)及脊髓最大受压程度(maximum spinal cord compression,MSCC)。了解年龄、性别、手术方式、椎管狭窄程度、椎管狭窄节段数及术前ASIA评分与手术前后ASIA评分及JOA评分改善率之间的相关性。按受伤至手术治疗时间分为A(1周)、B(1~3周)、C(3周)3组,在不同时间点评估3组患者的脊髓功能情况。结果:66例患者术后5d及末次随访时的JOA评分与ASIA评分均较术前明显增加(P0.05);MCC平均为(52.64±10.89)%,MSCC平均为(26.71±13.27)%;MSCC与末次随访时的JOA评分改善率及ASIA评分呈显著性负相关(P0.05);患者年龄与JOA评分改善率呈负相关(P0.05);术前ASIA评分与末次随访ASIA评分呈正相关(P0.05);性别、MCC、椎管狭窄节段数、手术入路与JOA评分改善率及末次随访ASIA评分的无显著相关性(P0.05)。3组伤后不同时间手术患者之间年龄、性别、手术方式、术前ASIA评分均无统计学差异,末次随访时A组患者JOA评分及ASIA评分明显高于B、C组(P0.05);A、B、C组患者的JOA评分改善率平均为(78.4±6.7)%、(71.3±7.8)%、(63.2±9.1)%,三组间具有显著性差异(P0.05)。结论 :采用手术治疗无骨折脱位的颈椎TCCS安全有效,术前ASIA评分、脊髓受压程度、患者年龄影响TCCS预后;尽早(1周内)行减压手术可能更有利于颈脊髓功能恢复。     

家庭护理干预对伽玛刀治疗肺癌患者生活质量的影响

目的探讨家庭护理干预对体部伽玛刀治疗肺癌患者生活质量的影响。方法将60例体部伽玛刀治疗的肺癌患者按住院时间分为对照组和干预组各30例。对照组进行常规出院指导,干预组在此基础上实施家庭访视、电话访视和网上咨询等综合家庭护理干预,为期6个月。两组均采用WHO推荐的家庭支持量表和欧洲癌症研究治疗组织核心问卷生活质量评价表进行评价。结果干预组家庭支持情况显著优于对照组,生活质量中躯体功能、情绪功能、角色功能及认知功能评分显著高于对照组(P<0.05,P<0.01)。结论家庭护理干预有助于伽玛刀治疗肺癌患者获得家庭支持,提高其生活质量。     

医护合作模式对脊髓损伤患者生活质量的影响

目的探讨医护合作模式对脊髓损伤患者生活质量的影响。方法将脊柱一科32例脊髓损伤患者设为对照组,按医生开医嘱护士执行的常规医疗护理模式对患者实施诊疗及护理;将脊柱二科33例脊髓损伤患者设为观察组,采取医护合作模式,即分别由1名医生2名责任护士组成医护合作小组管理诊疗患者,共同决策护理方案。比较两组患者入院24h及干预后第4周、第3个月的日常生活活动能力(MBI)以及生存质量(WHOQOL-BREF)评分。结果观察组干预后第4周、第3个月MBI、WHOQOL-BREF得分显著高于对照组(P0.05,P0.01)。结论医护合作模式有利于促进脊髓损伤患者日常生活活动能力的恢复和改善患者的生活质量。     

脊柱骨折伴脊髓损伤患者术后生存质量影响因素

目的研究脊柱骨折伴脊髓损伤(spinal cord injury SCI)患者术后生存质量的相关影响因素,指导改善脊髓损伤患者术后生存质量的干预方式。方法通过电话访谈及门诊随访,对87例脊柱骨折伴脊髓损伤患者进行问卷调查,采用WHO生存质量测定简表(WHOQOL-BREF)及国际脊髓损伤生活质量基础数据集,进行生存质量评分,通过单因素分析及多重线性回归分析,筛选影响患者生存质量的相关因素。结果单因素分析显示,收入水平、病程、损伤平面、损伤性质、自理能力、二便控制、并发症、慢性疼痛等8项因素对生存质量的各项得分有影响,差异有统计学意义(P0.05)。多因素分析显示:对整体生活满意度、身体健康满意度及心理健康满意度得分有影响的主要因素为:生活自理能力、二便控制、有无并发症及慢性疼痛(P0.05);其中慢性疼痛的严重程度越重,整体生活满意度、身体健康满意度、心理健康满意度越低(P0.05)。结论生活自理能力、二便控制、并发症、慢性疼痛是影响SCI患者术后生存质量的主要因素。     

康复期精神分裂症患者的过渡期护理研究

目的 探讨过渡期护理模式对康复期精神分裂症患者服药依从性、自我效能及生存质量的影响。 方法 将64例住院康复期精神分裂症患者按居住的社区分为观察组和对照组各32例。对照组进行常规护理与出院宣教,出院后电话随访1次;观察组在对照组基础上增加过渡期护理,包括随访（电话和家庭随访）、康复知识讲座和社区康复活动等。干预前及干预12周分别采用自拟服药依从性调查表、一般自我效能量表、世界卫生组织生存质量测定量表简表对患者进行调查,干预12周比较两组患者复发率。 结果 干预12周,观察组服药依从性和自我效能、生存质量评分显著高于对照组,复发率显著低于对照组（均P＜0.05）。 结论 过渡期护理模式能提高康复期精神分裂症患者服药依从性和自我效能,提高生存质量,降低复发率。     

随访护理对成人癫痫患者焦虑抑郁情绪及生活质量的影响

目的 探讨随访护理对改善成人癫痫患者焦虑抑郁情绪及生活质量的作用.方法 将60例成人癜痫患者按入院顺序分为对照组和观察组各30例,对照组在住院期间及出院时实施常规的护理及健康教育,观察组实施电话随访、家庭访视、健康讲座等措施.实施6个月后评价.结果 观察组出院3、6个月SAS、SDS评分显著低于对照组,癜痫患者生活质量（QOLIE-31）评分显著高于对照组;且随着时间延长,观察组SAS、QOLIE-31、SDS评分较出院时显著改善（均P＜0.05）.结论 随访护理可显著改善成人癫痫患者焦虑、抑郁情绪和生活质量.     

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.     

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.     

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.     

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.