上海市初产妇分娩意向及方式影响因素调查

目的了解无剖宫产指征的初产妇分娩意向及分娩方式,并分析其影响因素。方法采用非概率抽样方法对336例无剖宫产指征的初产妇进行问卷调查。结果336例无剖宫产指征的初产妇中,256例分娩意向为自然分娩,80例为剖宫产;276例初产妇选择了自然分娩,60例选择了剖宫产。分娩意向和分娩方式呈高度相关(r=0.809,P<0.01)。户籍、是否有医疗保险、分娩方式相关知识、丈夫文化程度、丈夫对分娩态度及朋友的分娩情况对初产妇的分娩意向产生影响,影响程度为43.2%;而年龄、待产时间、产前的分娩意向、与分娩方式相关的知识及丈夫态度对初产妇的实际分娩方式产生影响,影响程度为53.4%。结论初产妇对分娩方式的选择受到年龄、待产时间、产前的分娩意向、与分娩相关的知识及丈夫态度的影响。因此,应将家属纳入到产前的健康教育中、提高社会对自然分娩的正确认识和信心,并且提供更加人性化的分娩服务,以降低剖宫产率。     

Study on nulliparous women's preference for mode of delivery in Shanghai:the influencing factors

目的 了解无剖宫产指征的初产妇分娩意向及分娩方式,并分析其影响因素.方法 采用非概率抽样方法对336例无剖宫产指征的初产妇进行问卷调查.结果 336例无剖宫产指征的初产妇中,256例分娩意向为自然分娩,80例为剖宫产；276例初产妇选择了自然分娩,60例选择了剖宫产.分娩意向和分娩方式呈高度相关(r=0.809,P＜0.01).户籍、是否有医疗保险、分娩方式相关知识、丈夫文化程度、丈夫对分娩态度及朋友的分娩情况对初产妇的分娩意向产生影响,影响程度为43.2％；而年龄、待产时间、产前的分娩意向、与分娩方式相关的知识及丈夫态度对初产妇的实际分娩方式产生影响,影响程度为53.4％.结论 初产妇对分娩方式的选择受到年龄、待产时间、产前的分娩意向、与分娩相关的知识及丈夫态度的影响.因此,应将家属纳入到产前的健康教育中、提高社会对自然分娩的正确认识和信心,并且提供更加人性化的分娩服务,以降低剖宫产率.     

初产妇及其配偶妊娠期压力状况及相关因素分析

目的了解初产妇及其配偶的妊娠期压力状况，并分析其相关因素，为帮助其顺利渡过妊娠分娩期提供依据。方法采用方便抽样的方法，使用妊娠压力量表和自设问卷对妊娠期257对初产夫妇分别进行问卷调查。结果初产妇妊娠压力得分M=1．50、QR=0．52，配偶的妊娠压力得分M=1.47、QR=0．50；主要压力源是“为确保母子健康和安全而引发的压力感”。影响初产妇及其配偶压力的因素主要有：是否计划妊娠、是否愿意成为父母、是否有信心胜任父母角色（P〈0．05，P〈0．01）。结论初产妇及其配偶总体均处于中度妊娠压力水平，其中计划妊娠、愿意成为父母、有信心胜任父母角色者妊娠期压力较小。在护理干预中，要同时关注妊娠期初产妇及其配偶的压力状况，使之更好地渡过妊娠分娩期。     

产后期初产妇及其配偶知觉压力及应付方式研究

目的 了解产后期初产妇及其配偶的知觉压力状况和应付方式特点,为帮助其选择积极的应付方式、顺利渡过产后期提供依据.方法 对79名产后期初产妇及其配偶采用中文版知觉压力量表和应付方式问卷进行调查.结果 初产妇及其配偶在产后期知觉压力得分及应付方式各因素得分比较.差异无统计学意义(均P>0.05);应付方式6个因子中解决问题和求助得分排第1、2位;26.58%初产妇和24.05%配偶有健康危险性压力;有健康危险性压力的初产妇,幻想和退避得分高于无健康危险性压力者(均P<0.05);有健康危险性压力的初产妇配偶.解决问题得分低于无健康危险性压力者(P<0.05).幻想得分高于无健康危险性压力者(P<0.05).结论 初产妇及其配偶承受着同样程度的压力,有健康危险性压力者较无健康危险性压力者更倾向于采取幻想和退避等不成熟型应付方式,应有针对性地帮助有健康危险性压力者选择正确有效的应付方式.     

二甲医院护士组织支持感与职业获益感的相关性研究

目的了解二甲医院护士组织支持感与职业获益感的现状,分析两者的相关性。方法采用一般资料调查表,护士组织支持感量表和职业获益感量表对湖南省17所二甲医院的444名临床护士进行问卷调查。结果二甲医院护士组织支持感得分为3.06±0.47,职业获益感得分为4.06±0.58,组织支持感及其各维度得分与职业获益感及其各维度得分呈正相关(均P0.01)。结论二甲医院护士组织支持感处于中等水平,职业获益感处于较高水平,组织支持感越高的护士职业获益感越强,应通过增强组织支持感来提升临床护士的职业获益感。     

初产妇及其配偶妊娠期压力状况及相关因素分析

目的 了解初产妇及其配偶的妊娠期压力状况,并分析其相关因素,为帮助其顺利渡过妊娠分娩期提供依据.方法 采用方便抽样的方法,使用妊娠压力量表和自设问卷对妊娠期257对初产夫妇分别进行问卷调查.结果 初产妇妊娠压力得分M=1.50、QR=0.52,配偶的妊娠压力得分M=1.47、QR=0.50;主要压力源是"为确保母子健康和安全而引发的压力感".影响初产妇及其配偶压力的因素主要有:是否计划妊娠、是否愿意成为父母、是否有信心胜任父母角色(P<0.05,P<0.01).结论 初产妇及其配偶总体均处于中度妊娠压力水平,其中计划妊娠、愿意成为父母、有信心胜任父母角色者妊娠期压力较小.在护理干预中,要同时关注妊娠期初产妇及其配偶的压力状况,使之更好地渡过妊娠分娩期.     

妊娠期梅毒罹患因素调查

目的探讨罹患妊娠期梅毒的相关因素，为制定切实可行的相关孕期护理措施提供依据。方法自拟调查表对5家医院初次产前检查的孕妇和住院分娩的待产妇、确诊为妊娠期梅毒患者（675例）进行面对面的产前问卷调查。结果患者职业分布以干部和工人发生率较低；文化程度低、经济收入低、孕前不用或少用避孕套等是罹患妊娠期梅毒的主要相关因素。配偶（性伴）患过性病占24．0％，其中患过梅毒占14．7％，拒答占9．9％。孕妇文化程度、月收入均与健康知识知晓率存在密切关系（均P〈0．05）。结论妊娠期孕妇及配偶（性伴）罹患梅毒令人堪忧，采取有效护理措施可望赢得孕妇及其家属的理解和积极配合；健康教育应作为妊娠期梅毒的重要护理干预手段。     

妊娠期梅毒罹患因素调查

目的 探讨罹患妊娠期梅毒的相关因素,为制定切实可行的相关孕期护理措施提供依据.方法 自拟调查表对5家医院初次产前检查的孕妇和住院分娩的待产妇、确诊为妊娠期梅毒患者(675例)进行面对面的产前问卷调查.结果 患者职业分布以干部和工人发生率较低;文化程度低、经济收入低、孕前不用或少用避孕套等是罹患妊娠期梅毒的主要相关因素.配偶(性伴)患过性病占24.0%,其中患过梅毒占14.7%,拒答占9.9%.孕妇文化程度、月收入均与健康知识知晓率存在密切关系(均P＜0.05).结论 妊娠期孕妇及配偶(性伴)罹患梅毒令人堪忧,采取有效护理措施可望赢得孕妇及其家属的理解和积极配合;健康教育应作为妊娠期梅毒的重要护理干预手段.     

三级医院退休护士健康老龄化现状及影响因素研究

目的 了解退休老年护士健康老龄化现状,分析其影响因素,为健康老龄化卫生资源管理提供参考。方法 选取郑州市区3所三级医院96名退休老年护士,采用健康老龄化量表、一般自我效能量表进行调查。结果 老年护士健康老龄化总均分3.76±0.54,9个维度中自我照护维度得分最高,接受年老维度得分最低;一般效能感总均分为3.40±0.23,与健康老龄化总分呈正相关（r=0.629,P＜0.01）。多元回归分析显示,患慢性疾病数、自觉健康状况、一般自我效能感是老年护士健康老龄化水平的主要影响因素（调整R2=0.732,均P＜0.01）。结论 三级医院退休老年护士健康老龄化处于中等偏上水平,医院管理者需重视个体健康状况,视其特点实现护理人力资源再利用,以促进社会健康积极老龄化。     

短视频在父亲支持母乳喂养健康教育中的应用

目的 探讨基于短视频的健康教育在父亲支持母乳喂养中的应用效果。方法 选取103对住院分娩的初产妇及其配偶按照住院时间顺序分组。对照组52对,给予常规健康教育;干预组51对,在常规健康教育的基础上增加基于短视频的健康教育。结果 干预组产后42 d父亲支持母乳喂养自我效能评分、初产妇对配偶参与母乳喂养满意度评分、产后3 d及42 d纯母乳喂养率显著优于对照组（均P<0.05）。结论 基于短视频的健康教育能够提高父亲支持母乳喂养自我效能,提升产妇对配偶参与母乳喂养的满意度,进而促进纯母乳喂养。     

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.     

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.