医院伦理氛围与护士临终关怀态度的相关性研究

目的 调查临床护士对医院伦理氛围感知和临床关怀态度现状,分析两者之间的关系,为开展针对性干预以改善护士临终关怀态度提供参考。方法 以便利抽样法选取220名临床护士,采用医院伦理氛围量表和中文版佛罗梅尔特临终关怀量表进行调查。结果 护士对医院伦理氛围感知得分为（107.05±11.91）分,临终关怀态度得分为（106.22±9.39）分。临床护士对医院伦理氛围感知与临终关怀态度呈正相关（P＜0.01）。结论 临床护士对医院伦理氛围感知与临终关怀态度处于中等偏上水平,医院管理者通过营造良好的医院伦理氛围,可改善护士对医院伦理氛围感知,从而提高护士临终关怀态度的积极性。     

ICU护士噪声控制知识态度行为现况调查

目的 调查ICU 护士噪声控制知识、态度与行为现况,为针对性采取措施优化ICU 护理环境提供参考。方法 以方便抽样法 选取无锡市4所三甲医院ICU 护士158人,采用自行设计的ICU 护士噪声控制知识、态度与行为问卷进行调查。结果ICU 护士 噪声控制知识得分为(7.82±2.91)分,态度得分为(28.85±4.19)分,行为得分为(27.31±4.37)分。结论 ICU 护士对噪声控制 的关注态度积极,但知识有待提高,所采取的行为有待加强。应积极构建ICU 噪声控制的规范化标准,并将其纳入ICU 护士培 训,促进护理环境的提升。     

城乡养老院护士安宁疗护知识态度与死亡焦虑的差异分析

目的 调查江苏省城市与农村养老院护士的安宁疗护知识、态度和死亡焦虑状况，分析两者的差异，为提高安宁疗护服务质量提供参考。方法 从江苏省13个地级市各选取1所城市和1所农村养老院，共546名护士，采用一般资料调查表、姑息护理知识问卷、临终关怀态度量表、死亡焦虑量表进行调查。结果 江苏省养老院护士安宁疗护知识得分(9.07±2.43)分，城市与农村养老院护士得分差异无统计学意义(P>0.05);临终关怀态度量表中，农村养老院护士的消极维度得分显著高于城市养老院护士(P<0.05);死亡焦虑量表中，农村养老院护士的情感、压力与痛苦维度、总分显著高于城市养老院护士(均P<0.05)。多元线性回归分析显示，护理过临终患者和接受过安宁疗护相关课程培训是安宁疗护知识的影响因素；工作年限、与患者或家属讨论过死亡话题、接受过安宁疗护相关课程培训、养老院地域是临终关怀态度的影响因素；年龄、学历、工作年限、养老院地域是死亡焦虑的影响因素(均P<0.05)。结论 江苏省养老院护士安宁疗护知识有待提高，其临终关怀态度与死亡焦虑存在城乡差异，需加强养老院护士安宁疗护教育培训，尤其是农村养老...     

APACHEⅡ对老年胸科危重病人预后评估的护理学意义

采用APACHEⅡ评分系统对 6 0例年龄≥ 6 5岁开胸手术病人进行回顾性评分。结果 6 0例病人APACHEⅡ评分均值为 14 .6 0± 7.14 ;死亡组 (7例 )评分为 2 2 .14± 8.11,存活组 (5 3例 )为 13.80± 6 .4 7,死亡组评分显著高于存活组(P <0 .0 1)。随着APACHEⅡ评分的增高 ,并发症增多 ,实际病死率与预测病死率均呈上升趋势 ,两者之间呈显著相关性 (r=0 .80 ,P <0 .0 1)。提示APACHEⅡ评分系统对预测老年胸科危重病人的术后并发症及病死率有重要的临床护理意义。     

星级服务在护理管理中的应用

为探讨优质高效的新型护理服务模式 ,对全院护理人员实施星级服务管理。结合各科不同工作特点制定相应的量化考评标准 ,根据护理部、科室及病人三方面的阶段性综合测评结果 ,确定四种星级护士。结果各科护理综合质量总分从 91.94± 3.2 6提高到 95 .74± 2 .0 2 ;病人满意度从 93.2 0 %提高到 99.40 % ;护士操作技术评分从82 .40± 4.84提高到 87.78± 4.13;护士“三基”理论水平得分从 90 .6 5± 6 .40提高到 94.5 2± 5 .18。提示推行星级护理既规范了护理管理 ,又规范了护士行为 ,同时 ,对提高护士综合素质和激发护士工作热情也起到积极的促进作用     

护理人员死亡态度及调适处理能力的调查

目的 探讨护理人员对死亡的态度及调适处理能力,以更好地实施临终关怀,提高护理质量.方法 采用自行设计的问卷对300名护理人员进行调查.结果 护理人员对死亡的态度及调适处理能力评分为34.52±8.84;不同学历、职称护理人员评分比较,差异有显著性意义(均P＜0.05).结论 护理人员死亡态度及调适处理能力一般,尤其低学历、职称者得分较低,应针对性进行临终关怀教育,使其树立正确的死亡观,掌握临终关怀理论知识,提高应Ζ对技能,保证临终护理质量.     

体验式学习对脊柱侧弯专科实习护生康复护理认知及护理态度的影响

目的 评价体验式学习对脊柱侧弯专科实习护生其康复护理认知及护理态度的影响.方法 将2015年1～12月的36名本科实习护生及2016年1～12月的34名本科实习护生分别纳入对照组和观察组,对照组按照实习生护理实习计划进行学习,观察组在对照组的基础上穿插以"护生为主,教师为辅"的依次经历感知、体验与反思、总结与应用三阶段的体验式学习,采用医院成熟应用的护理认知调查问卷调查护生的护理认知的改变,考察指标包括脊柱侧弯专科理论得分、操作技能得分、康复知识得分和态度得分.结果 3周实习结束后,观察组对脊柱侧弯的专科理论得分、操作技能得分、康复知识得分、态度得分分别为(90.91±4.11)分、(88.62±5.12)分、(52.86±4.62)分、(84.79±8.32)分,均显著高于对照组的(82.14±4.09)分、(80.78±4.67)分、(45.83±7.30)分、(68.91±7.87)分,差异均有统计学意义(P均<0.05).结论 体验式学习的模式有利于实习护生对脊柱侧弯病人护理态度的转变,提高实习护生的专业理论知识、康复知识水平和操作技能水平.     

老年病房善别护理流程的建立与实践

目的探索老年科病房善别护理流程的建立和实践,构建老年住院患者临终关怀护理模式。方法建立老年科临终关怀组织架构,制定老年科住院患者善别护理流程,从老年患者入院到死亡后的丧亲安抚,以团队合作方式,提供连续的、一致的全程护理服务。结果实施3年来患者家属对病室环境、护理服务、巡视沟通、健康教育、临终关怀5个方面的满意率逐年上升,总满意率由94.67%上升至96.20%。结论开展善别护理能帮助老年患者改变对待死亡的态度,提高家属对死亡的接受度,提升护理服务满意率。     

老年病房护士对机械通气相关知识掌握情况调查分析

目的了解老年病房护士对机械通气相关知识的掌握情况、知识来源及需求程度.方法采用自行设计的机械通气相关知识问卷调查表,随机对北京市3所三级甲等医院老年病房的154名护士进行调查.结果老年病房护士机械通气相关知识得分为55.00±11.36;主管护师得分显著高于护士、护师(均P<0.05),呼吸专科护士得分显著高于非呼吸专科护士(P<0.05);相关知识主要来源于临床教师或医生,总需求率为98.70%.结论需加强老年病房护士机械通气相关知识的继续教育,充分发挥高年资及专科护士的业务专长进行专业知识培训,以满足临床护理需求.     

空巢老人舒缓照护志愿服务对本科护生临终关怀及死亡态度的影响

目的评价空巢老人舒缓照护志愿服务对本科护生临终关怀及死亡态度的影响。方法将2014级本科176名护生随机分为两组,每组88名。对照组开展临终关怀课程,观察组在对照组的基础上开展空巢老人舒缓照护志愿服务。干预前后,采用临终关怀态度量表、死亡态度描绘量表评估护生临终关怀及死亡态度。结果干预后,观察组临终关怀态度量表得分显著高于对照组,死亡态度描绘量表中死亡恐惧、死亡逃避、逃离接受维度得分显著低于对照组,而自然接受及趋近接受维度得分显著高于对照组(均P0.01)。结论开展空巢老人舒缓照护志愿服务有利于改善护生临终关怀照护态度及对待死亡的态度,为日后从事临终关怀工作做好准备。     

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.     

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.     

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.