脊柱侧弯矫形患者术前自身悬吊牵引效果观察

目的探讨自身悬吊牵引对脊柱侧弯患者术前辅助治疗的可行性.方法将1 20例拟住院行矫形术的脊柱侧弯患者随机分为观察组与对照组各60例.观察组于术前在护士指导下于家中进行自身悬吊牵引,对照组住院期间于术前按常规行骨盆牵引.结果两组牵引后的Cobb角均显著改善(均P＜0.05),两组比较,差异无显著性意义(P＞0.05).结论自身悬吊牵引是脊柱侧弯术前简单、经济、疗效可靠的一种必要辅助治疗方法.     

脊柱侧弯矫形患者术前自身悬吊牵引效果观察

目的探讨自身悬吊牵引对脊柱侧弯患者术前辅助治疗的可行性.方法将1 20例拟住院行矫形术的脊柱侧弯患者随机分为观察组与对照组各60例.观察组于术前在护士指导下于家中进行自身悬吊牵引,对照组住院期间于术前按常规行骨盆牵引.结果两组牵引后的Cobb角均显著改善(均P＜0.05),两组比较,差异无显著性意义(P＞0.05).结论自身悬吊牵引是脊柱侧弯术前简单、经济、疗效可靠的一种必要辅助治疗方法.     

心脏穿透伤行心脏修补术患者的急救护理

目的探讨保持患者术前血压、心率平稳的方法。方法将100例择期手术患者随机分为观察组和对照组，各50例。两组均行术前健康教育、观察组在此基础上行放忪训练、即采用深吸静息式全身肌肉放松的方法进行训练。两组均于入院后及手术前1d晚临睡前（术前晚）、入手术室后麻醉前（麻醉前）分别测量其血压和心率。结果两组术前晚血压均有下降（均P〈0．05）、而观察组较对照组更为显著（均P〈0．05）；观察组心率较对照组平稳（P〈0．05）．两组心率麻醉前加快、对照组较观察组更为显著（P〈0．05）。结论知识教育配合放松训练能使术前患者血压、心率平稳。     

血液灌流辅助抢救急性重度有机磷农药中毒的疗效观察

目的探讨血液灌流（HP）辅助抢救急性重度有机磷农药中毒（ASOPP）疗效。方法根据时间段将ASOPP患者分为观察组（46例）和对照组（20例），两组均常规采用内科抢救治疗方法，观察组在此基础上加用HP治疗。结果观察组治愈率显著高于对照组（P〈0．05），而病死率、并发症发生率及阿托品总用量显著低于对照组（P〈0．01，P〈0．05）；患者昏迷时间、住院时间显著较对照组短（P〈0．01．P〈0．05）。结论系统内科治疗辅助HP，可提高ASOPP患者治愈率，降低病死率及并发症发生率；严密的病情观察及护理是抢救成功的关键。     

鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎的临床研究

目的探讨鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎的临床价值。方法选择40例患者在鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎，并与常规开放上颌窦根治术的患者比较，观察两组手术时间、术中出血以及总住院时间，并统计两组术后发生的并发症。结果观察组术中出血显著少于对照组（P〈0．05），总住院时间显著短于对照组（P〈0．05），观察组术后出现引流不畅、上唇麻木以及术后出血的比率均显著低于对照组（P〈0．05）。结论鼻内镜辅助下上颌窦根治术治疗真菌性上颌窦炎其手术创伤小，术后恢复快，并发症少，值得临床推广。     

慢性乙型肝炎患者卫生行为的调查及其健康教育

目的 探讨阶段性护理干预对复发性抑郁症患者生活质量、服药依从性及复发的影响。方法 将96例复发性抑郁症患者随机分为观察组和对照组各48例。两组均予以氟西汀系统治疗，对照组行常规护理；观黍组在此基础上分阶段实施护理干预，时间为8周，随后进行为期2年的随访。采用生活质量量表（QOL-100）分别于治疗前及随访结束时进行评估，并于随访6个月、1年、2年时了解两组患者的服药依从性、复发率及再住院情况。结果 随访结束时，两组患者的生活质量均有所改善（P〈0．05，P〈0．01），但观察组患者的生活质量总评、心理领域、独立性领域及社会关系领域评分显著优于对照组（P〈0．05，P〈0．01）。观察组复发率及再住院率分别为10．42％和6．25％，均明显低于对照组的33．3％和27．1％（P〈0．05，P〈0．01）；而服药依从性显著高于对照组（P〈0．05，P〈0．01）。结论 分阶段实施护理干预有助于改善复发性抑郁症患者的生活质量，提高服药依从性，降低复发及再住院率。     

结直肠癌患者术前肠道准备方法的改进

目的探讨肠内营养素和复方聚乙二醇电解质散口服应用于结、直肠癌患者术前肠道准备的效果。方法将46例结、直肠癌择期手术患者随机分为观察组和对照组各23例。观察组于术前3d开始口服整蛋白型肠内营养素，并于术前1d15：00后口服复方聚乙二醇电解质散行肠道准备。对照组术前3d行传统的半流质、流质、禁食补液方法，于术前1d15：00后口服甘露醇进行肠道准备。观察并比较两组肠道准备期间不良反应发生情况，大便排空时间，肠道清洁度及肠道准备后的体重、血红蛋白、总蛋白、白蛋白及前白蛋白水平。结果两组肠道清洁度及大便排空时间比较，差异无显著性意义（均P〉0．05）。观察组不良反应发生率显著低于对照组（P〈0．05），肠道准备后的前白蛋白显著高于对照组（P〈0．05）。结论结、直肠癌患者实施改进后的术前肠道准备法可减少不良反应发生，同时改善患者营养状况。     

雾化吸入普米克令舒辅助治疗儿童哮喘效果观察

目的 探讨雾化吸入普米克令舒辅助治疗儿童哮喘的效果。方法 将79例哮喘急性发作期患儿随机分为观察组（44例）和对照组（35例），对照组行常规平喘、抗感染及对症处理，观察组在此基础上雾化吸入普米克令舒。结果 观察组治疗后FVC、FEV，及PEF值较治疗前显著改善（均P〈0．01），与对照组比较，差异有显著性意义（均P〈0．05）；观察组治疗效果明显优于对照组（P〈0．01），且住院时间明显缩短（P〈0．01）。结论 雾化吸入普米克令舒对儿童哮喘具有良好的治疗效果，且安全、经济。     

系统呼吸训练对肺癌患者术后肺功能的影响

目的 探讨系统呼吸训练对肺癌患者术后肺功能的影响。方法 将152例肺癌术后惠者随机分为观察组（82例）和对照组（70例），对照组行常规胸部术后护理；观察组在此基础下行缩唇呼气训练及深呼吸训练6个月，并于术前、术后2周、3个月、6个月评估两组患者肺功能（FVC，FEV1，FEV1／FVC）。结果 两组术后不同时段肺功能均较术前下降（P〈0．05，P〈0．01）。观察组术后3、6个月肺功能较术后2周显著改善（均P〈0．05）；与对照组同时段比较，差异有显著性意义（均P〈0．05）。而对照组仅FEV1在术后3、6个月有所改善，与术后2周比较，差异有显著性意义（均P〈0．05）。结论 术后呼吸训练能够改善肺癌患者术后肺功能。     

集体治疗对精神分裂症患者康复的影响

目的 探讨集体治疗对住院精神分裂症患者康复期的影响。方法 将80例男性精神分裂症患者随机分为集体治疗组（观察组40例）与常规治疗组（对照组40例），分别于病情稳定后进行集体治疗和常规治疗，治疗前和治疗后4周、8周、12周末分别用简明精神病评定量表（BPRS）和住院患者护士观察量表（NOSIE）进行治疗效果评定。结果 治疗后8周、12周末观察组BPRS评分与对照组比较，差异有显著性意义（均P〈0．05）；观察组NOSIE各因子改善优于对照组（P〈0．05，P〈0．01）。结论 集体治疗能促进精神分裂症患者精神症状的改善，提高生活自理能力和社会适应能力，有利于患者回归社会。     

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.