护理干预对髋关节置换术后老年患者髋关节功能恢复的影响

目的 探讨护理干预对髋关节置换术后老年患者髋关节功能恢复的影响,总结可行的护理干预方法。方法 选择2012年1月至2014年06月67例老年人股骨颈骨折、需行髋关节置换术的患者,随机分为对照组32例,给予常规护理;干预组35例,给予护理干预。比较两组患者术后髋关节功能恢复情况,并发症发生情况。结果 干预组患者髋关节功能恢复、评分结果较对照组的好,评分结果的差异有统计学意义(P<0.05)。干预组患者术后并发症的发生率比对照组低,差异有统计学意义(P<0.05)。结论 合适的护理干预能有效地提高老年患者髋关节置换术后髋关节的功能,降低髋关节置换术后并发症的发生率,提高老年患者髋关节置换术后的生活质量。     

渐进式功能锻炼对老年髋部骨折患者术后肢体功能恢复的影响

目的 探讨渐进式功能锻炼对老年髋部骨折患者术后肢体功能恢复的效果.方法 将68例老年髋部骨折患者按入住病房分为干预组和对照组各34例.干预组于术后第1天至出院后3个月给予渐进式功能锻炼方案,对照组接受常规护理和门诊随访.比较两组骨折前、出院时、出院后1个月、出院后3个月的Harris评分.结果 干预后,干预组Harris髋关节总评分和疼痛维度、功能维度及关节活动度维度评分显著高于对照组(P<0.05,P<0.01);全髋置换术患者术后髋关节功能预后水平高于内固定手术患者(P<0.01);不同组别和不同手术方式之间在髋关节总评分和各维度评分方面无交互作用(P>0.05).结论 渐进式功能锻炼可有效促进老年髋部骨折患者术后髋关节功能恢复.     

家庭干预对老年全髋关节置换术后患者康复效果的影响

目的 探讨家庭干预对股骨颈骨折全髋关节置换术后老年患者置换髋功能的影响.方法 将100例股骨颈骨折全髋关节置换术后老年患者随机分为观察组和对照组各50例,对照组予常规出院指导,观察组在此基础上,在出院后6个月内进行家庭干预.比较患者术后1、3、5个月的Harris评分.结果 观察组Harris 评分显著优于对照组(P<0.05).结论 家庭干预可提高老年股骨颈骨折全髋关节置换术后置换髋的功能.     

实施出院计划对全髋关节置换患者康复效果的影响

目的探讨出院计划对全髋关节置换患者术后康复效果的影响。方法将97例全髋关节置换患者随机分为干预组49例与对照组48例。对照组实施骨科常规护理指导,干预组在常规护理的基础上接受出院计划服务。统计两组术后并发症情况,并于干预前、出院后1个月及3个月时评价两组日常生活活动能力、髋关节功能。结果干预组术后并发症发生率低于对照组;出院后1个月及3个月时,干预组日常生活活动能力得分及牛津髋关节功能量表得分显著优于对照组(均P0.01)。结论出院计划护理模式可提高全髋关节置换患者日常生活活动能力与髋关节功能,促进患者术后康复。     

康复日记结合护理随访在老年髋关节置换术后功能康复的应用效果研究

目的探讨康复日记结合微信随访干预在老年全髋关节置换术患者功能康复的应用效果。 方法将119例行老年人工全髋关节置换术的患者按照入院先后顺序随机分为干预组和对照组，对照予常规出院指导及门诊随访，干预组患者在常规指导的基础上，责任护士术前发放康复日记并进行相应指导，在出院后1个月、3个月、6个月实施微信随访。采用髋关节Harris量表及日常生活自理能力Barthel指数评定两组患者出院时、出院后1个月、3个月、6个月髋关节功能恢复及日常生活自理能力的改善情况。 结果干预组和对照组出院时、出院后1个月、3个月、6个月的Harris量表评分、Barthel指数进行重复测量设计的方差分析，显示干预组和对照组间差异有统计学意义（P<0.05），组别与时间点之间存在交互作用，除第一个时间点两组无统计学意义，其它各时间点两组差异均具有统计学意义（P<0.05），各组在各时间点间差异均有统计学意义（P<0.05），干预组优于对照组。 结论互动康复日记结合护理随访有助于改善髋关节置换术后患者髋关节功能恢复，有效提高患者出院后的生活质量。     

渐进式功能锻炼对老年髋部骨折患者术后肢体功能恢复的影响

目的探讨渐进式功能锻炼对老年髋部骨折患者术后肢体功能恢复的效果。方法将68例老年髋部骨折患者按入住病房分为干预组和对照组各34例。干预组于术后第1天至出院后3个月给予渐进式功能锻炼方案,对照组接受常规护理和门诊随访。比较两组骨折前、出院时、出院后1个月、出院后3个月的Harris评分。结果干预后,干预组Harris髋关节总评分和疼痛维度、功能维度及关节活动度维度评分显著高于对照组（P〈0．05,P〈0．01）;全髋置换术患者术后髋关节功能预后水平高于内固定手术患者（P〈0．01）;不同组别和不同手术方式之间在髋关节总评分和各维度评分方面无交互作用（P〉0．05）。结论渐进式功能锻炼可有效促进老年髋部骨折患者术后髋关节功能恢复。     

教育-恐惧暴露干预对全髋关节置换术后恐动症患者的影响

目的 探讨教育-恐惧暴露干预对全髋关节置换术后恐动症患者的影响。方法 将96例全髋关节置换术后恐动症患者按住院时间分为对照组和干预组各48例。对照组给予常规护理干预,干预组给予教育-恐惧暴露干预。于患者出院前评价干预效果。结果 干预组疼痛数字评分、恐动症评分显著低于对照组(均P<0.05);髋关节功能评分、一般自我效能感评分及出院准备度评分显著高于对照组(均P<0.05)。结论 教育-恐惧暴露干预可降低全髋关节置换术后患者恐动症程度,缓解术后疼痛,提高自我效能感及出院准备度,促进髋关节功能恢复。     

老年人工全髋关节置换术患者围术期的综合护理

目的探讨老年人工全髋关节置换术患者围术期综合护理的方法和效果。方法对46例人工全髋关节置换术的老年患者围术期实施心理调节、康复锻炼、疼痛干预和出院指导等综合护理措施。结果本组46例患者均成功实施手术并顺利出院。出院后均获随访6~8个月,随访期间未发生假体脱位及松动等并发症,髋关节功能恢复满意。结论对人工全髋关节置换术老年患者进行围术期综合护理,能减少术后并发症发生率,增加髋关节功能恢复效果,提高术后患者生活质量。     

综合康复干预对全髋关节置换术后患者功能水平的影响

目的 探讨综合康复干预措施对全髋关节置换术后患者功能康复的作用。方法 将符合纳入标准的人工全髋关节置换术患者70例,等量随机分为两组,即实验组（35例）和对照组（35例）,对照组执行骨科常规治疗及护理,实验组在骨科临床治疗及躯体照护基础上, 以个体化原则设计康复干预计划,突出全程化功能锻炼指导的观念,重视术前康复程序的实施并将干预措施向院外延伸;所有病人随访＞6个月,于出院时、术后3个月、6个月不同时间点,采用Harris髋关节功能评分量表及Barthel日常活动能力指数量表评价两组患者相关功能水平。结果 实验组在术后3个月、6个月两个时间点的Harris及Barthel量表评分均优于对照组(P<0.05)。 结论 综合康复干预措施可有效促进患者髋关节的功能恢复、改善患者的日常活动能力,对提高全髋关节置换术后患者远期预后具有重要价值。     

基于回授法的专科视频教育在老年髋关节置换患者延续护理的应用

目的探讨基于回授法的视频教育对髋关节置换患者出院后生活质量及髋关节活动能力的影响。方法将80例全髋关节置换术后老年患者按照住院时间顺序分为干预组和对照组各40例。对照组实施常规健康教育和随访护理,干预组开展基于回授法的专科视频教育。比较两组出院时,出院后1个月、3个月Harris髋关节评分及Barthel指数评分。结果干预组出院后3个月Harris髋关节功能评分显著高于对照组,出院后1个月、3个月Barthel指数评分显著高于对照组(均P0.01)。结论基于回授法的专科视频教育能有效提高髋关节置换术后老年患者的髋关节活动能力及生活质量。     

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.     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.