应用同伴教育法对职业人群进行健康管理的研究

目的探索对职业人群开展有效的健康管理方法。方法选取功能社区98名体重指数（BMI）≥25的在职人员为研究对象,随机分为观察组（48人）和对照组（50人）。对照组采用集体健康教育、饮食指导等干预;观察组在此基础上进行小组管理,采用授课、座谈、知己能量监测仪等进行为期1年的饮食和运动干预。观察两组人群BMI、腰围,每日有效运动量、时间和次数的变化。结果干预后,观察组BMI、腰围显著降低（均P〈0．05）,每日有效运动热量消耗、有效运动比、有效运动时间和次数显著高于对照组（均P〈0．05）。结论应用同伴教育法对职业人群进行健康管理,可以使他们长期坚持有效运动。降低BMI、腰围。     

非酒精性脂肪肝患者的行为干预

目的 探讨对非酒精性脂肪肝患者进行以饮食干预及有氧运动为主的行为干预的效果.方法 选择非酒精性脂肪肝患者87例,将其随机分为对照组(51例)和干预组(36例).对照组进行常规健康教育,干预组进行以饮食及运动干预为主的行为干预.结果 干预1年后,干预组体重、体重指数(BMI)、胆固醇(TC)、三酰甘油(TG)、舒张压显著低于干预前(P＜0.05,P＜0.01),其中体重、BMI、TC、TG显著低于同时期对照组(P＜0.05,P＜0.01),干预组治疗有效率72.22%,对照组31.37%,两组比较,差异有显著性意义(P＜0.01).结论 采取饮食加有氧运动为主的行为干预能改善非酒精性脂肪肝患者的临床指标,提高治疗效果.     

循经刮痧与微信运动用于痰湿体质单纯性肥胖人群的干预效果

目的分析循经刮痧结合微信运动对痰湿体质单纯性肥胖人群的干预效果,为临床单纯性肥胖患者的健康管理提供思路。方法将80例痰湿体质单纯性肥胖患者随机分为两组各40例。对照组采用微信运动配合饮食调整及常规健康宣教进行干预,观察组在此基础上施以循经刮痧。分别在干预前,干预12周后比较两组的体质量、腰围、体重指数、中医痰湿体质评分、总胆固醇、甘油三酯、低密度脂蛋白。结果干预12周后,观察组体质量、腰围、体重指数、总胆固醇、中医痰湿体质评分显著优于对照组(P 0. 05,P 0. 01)。结论循经刮痧结合微信运动更能降低痰湿体质单纯性肥胖患者的体质量、腰围、体重指数、中医痰湿体质评分。     

计划行为理论在血脂异常护士饮食行为干预中的应用

目的探讨基于计划行为理论的饮食行为干预方案在血脂异常护士群体中的应用效果。方法将90名血脂异常护士按医院分为对照组和干预组各45名。对照组给予2次健康讲座,干预组以计划行为理论为指导设计饮食行为干预方案并实施,共干预6个月。结果干预4个月及6个月时,干预组护士的饮食行为倾向总分、膳食知识总分显著优于对照组(均P0.01);干预组护士腰围、BMI呈现持续下降趋势(P0.05,P0.01),对照组基本无变化(均P0.05)。结论基于计划行为理论的饮食行为干预方案有助于护士饮食行为的改善和膳食知识的掌握,并能有效控制腰围和BMI。     

补益肝肾药膳联合轻断食疗法对围绝经期肥胖的改善效果

目的 探讨补益肝肾药膳联合轻断食疗法对围绝经期肥胖的改善效果.方法 将72例围绝经期肥胖患者随机分为对照组和干预组各36例.对照组采取线上、线下相结合模式对患者进行营养与饮食健康教育;干预组在对照组基础上实施补益肝肾药膳联合轻断食疗法,连续干预8周.结果 干预后干预组体质量、腰围测量值显著低于对照组(均P＜0.05);围绝经期生活质量4个维度评分显著优于对照组(均P＜0.01);蛋白质、脂肪、碳水化合物三大营养素供能比改善效果显著优于对照组(均P＜0.01).结论 补益肝肾药膳联合轻断食疗法用于围绝经期肥胖患者,不仅规范营养素摄入情况,有效降低体质量,且对生活质量的改善有积极作用.     

饮食和运动干预对代谢综合征患者自测健康的影响

目的 探讨饮食和运动干预对社区代谢综合征患者自测健康的影响.方法 对66例社区代谢综合征患者(干预组)实施为期3个月的饮食和运动干预,并与正常生活的66例患者(对照组)比较干预前后自测健康状况.结果 干预后干预组患者在身体症状与器官功能、身体活动功能、正向情绪、角色活动与社会适应、社会资源与社会接触、社会支持等方面得分显著高于干预前和同期对照组(P＜0.05,P＜0.01).结论 饮食和运动干预能有效改善社区代谢综合征患者的自测健康状况.     

日记式认知干预对原发性高血压患者心理及血压的影响

目的 探讨日记式认知干预方法对原发性高血压患者心理及血压的影响,为良好控制该人群的情绪及血压提供参考.方法 将54例原发性高血压住院患者随机分为观察组与对照组各27例.观察组采用日记式认知干预,即用日记记录负性情绪、每日的饮食及用药等,责任护士阅读患者日记并针对问题采取干预.对照组采用常规护理.结果 干预后观察组除敌对性和精神病性因子外,其它7个因子(躯体化症状、强迫、人际关系敏感、焦虑、抑郁、恐怖和偏执)的评分显著低于对照组(P＜0.05,P＜0.01).干预后观察组患者血压下降幅度显著(P＜0.05).结论 日记式认知干预可以使原发性高血压患者的负性情绪得到明显的改善,使血压趋于平稳.     

整体护理干预对血液透析患者营养状况及透析并发症的影响

目的 改善血液透析患者的饮食营养状况,降低透析并发症.方法 应用护理程序对126例血液透析患者(观察组)实施整体护理干预,与105例实施常规护理的血液透析患者(对照组)比较,观察患者饮食营养状况、透析并发症发生率及患者满意率.结果 观察组饮食控制依从性及血浆白蛋白、血红蛋白均显著高于对照组(P＜0.05,P＜0.01),水负荷过高、血压异常及内瘘闭塞发生率显著低于对照组(P＜0.05,P＜0.01),患者满意率显著高于对照组(P＜0.01).结论 应用护理程序实施整体护理干预对提高血液透析患者的饮食营养状况、减少并发症、提高其生活质量有积极意义.     

冬令营式干预改善低BMI型COPD患者生活质量的研究

目的 改善低体重指数(BMI)型慢性阻塞性肺疾病(COPD)患者的生活质量.方法 将98例低BMI型COPD患者按自愿原则分为观察组(48例)和对照组(50例).对照组予常规社区护理3个月;观察组立冬时入驻冬令营,实施营养支持、呼吸操训练、空气监测、低流量吸氧及健康教育等措施,连续3个月,于立春日结束.结果 干预后,观察组BMI、6 min步行距离及肺功能改善程度显著优于对照组(均P＜0.05);两组干预前后QOL评分比较,差异有显著性意义(均P＜0.05).结论 冬令营式的综合干预可显著改善低BMI型COPD患者BMI及肺功能,从而改善其生活质量.     

社区强化饮食教育对糖尿病患者饮食依从性的影响

目的 探讨社区强化饮食教育对糖尿病患者饮食治疗依从性的影响,为进一步探讨糖尿病健康教育模式提供依据.方法 将283例住院糖尿病患者随机分为观察组(145例)和对照组(138例),两组住院期间接受糖尿病常规健康教育,观察组在常规健康教育基础上,出院后实施延伸护理服务,在社区继续实施强化饮食教育.采用量表评定两组患者干预前后糖尿病饮食认知状况及饮食治疗依从性.结果 干预3个月后观察组糖尿病饮食认知评分及饮食治疗依从性评分显著高于对照组(P＜0.05,P＜0.01).结论 将强化饮食教育延伸至社区,可以有效提高糖尿病患者饮食认知水平,提高其饮食治疗的依从性.     

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.     

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.     

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.