心理护理在围手术期人工全膝关节置换患者中的应用

目的　探讨人工全膝关节置换术围手术期心理护理的理论和临床疗效。方法　将60例人工全膝关节置换术患者随机分为观察组和对照组各 3 0例。对照组采用常规护理 ,观察组实施围手术期心理护理 ,从患者正性情绪表现、术后活动与饮食的恢复、平均住院天数三方面进行评价。结果　实验组围手术期正性情绪表现为 ( 3 .76± 1.3 9)、术后活动与饮食的恢复为 ( 4 .69±1.86)、平均住院天数为 ( 16.89± 1.77) ,与对照组比较 ,差异有显著性意义 (P <0 .0 1)。结论　心理护理能有效缓解围手术期人工全膝关节置换术患者的心理障碍 ,促进其身心康复。     

系统心理干预对围术期病人心身的影响

将144例行择期手术的病人随机分为对照组和观察组,各72例,对照组行常规围术期护理,观察组予系统心理干预.结果心理干预后观察组围术期的的血压、心律较对照组稳定,焦虑值显著低于对照组,术后肠蠕动恢复及下床活动时间较对照组显著提前(均P＜0.01).提示心理干预能减轻病人围术期的应激反应,并能促进病人术后恢复.     

精神病病人住院期间开放管理模式探讨

目的 探讨舒适护理对精神病病人住院生活质量及疾病康复的影响。方法 将2001年5月至2002年6月住院的416例精神病病人(观察组)实施全开放管理,即24 h允许病人自由出入病区所有区域,7:00-19:00允许病人自由进入病区与医院大门,允许陪护。每天责任护士按护理程序护理病人。与同期住院实行半封闭管理(由护士引导病人出入病室及进行相关医疗活动,不设陪护,按常规护理)的461例精神病病人(对照组)比较满意度、舒适度、治疗有效率、平均住院时间及痊愈病人平均住院时间。结果 观察组满意度评分(96.81±2.33)和舒适度评分(86.81±2.51)显著高于对照组(91.55±3.67、55.84±3.15),均P<0.01;平均住院时间[(31.67±4。13)d]和痊愈病人平均住院时间[(40.38±4.08)d]显著少于对照组[(77.20±5.15)d、(79.48±5.66)d],均P<0.01。结论 对住院精神病病人实施全开放管理可提高病人住院生活质量,缩短康复时间。     

SARS流行期发热病人焦虑情绪的心理干预

对SARS流行期发热伴有焦虑情绪的26例病人(干预组)实施心理干预,并与采用常规护理的24例发热伴有焦虑情绪的病人(常规组)用焦虑量表评分比较.结果显示,干预组就诊1周后平均粗分为37.19±6.57,常规组为41.71±3.13,两组比较,差异有显著性意义(P<0.01).提示对SARS流行期发热病人的焦虑情绪进行早期心理干预很有必要.     

围术期综合护理对于唇腭裂手术患儿的应用效果

目的 探究围术期采用综合护理对于唇腭裂手术患儿的护理效果。方法 选取2022年2月-2023年 2月本院收治的60例唇腭裂手术患儿作为研究对象,随机分为对照组和观察组,各30例。对照组采用常规 护理,观察组采用围术期综合护理,比较两组疼痛程度、并发症发生情况、满意度、生活质量及心理状 况。结果 观察组疼痛评分为（1.53±0.87）分,低于对照组的（2.01±0.92）分（P ＜0.05）;观察组并 发症发生率为10.00%,低于对照组的36.67%（P ＜0.05）;观察组满意度为96.67%,高于对照组的73.33% （P ＜0.05）;观察组生活质量评分均高于对照组（P ＜0.05）;观察组心理健康率为93.33%,高于对照组 的73.33%（P ＜0.05）。结论 围术期综合护理的实施能够有效提升唇腭裂患儿的术后恢复情况,减少并发 症,提高满意度,同时能够更好的满足患儿的心理需求,值得应用。     

剖宫产围术期心理护理对分娩结果的影响

目的观察剖宫产围术期心理护理对产妇分娩结果的影响。方法选取于我院实施剖宫产手术的产妇380例,随机分为观察组200例和对照组180例,对照组患者进行剖宫产前后常规护理;观察组患者在对照组常规护理的基础上,实施针对性较强的心理护理。结果观察组患者经实施心理护理后术前平均焦虑总分显著低于对照组(P<0.01);术前观察组患者的血压平均变化值明显小于对照组患者(P均<0.05);观察组产妇在脉搏、睡眠时间、泌乳时间以及下床活动时间等方面均显著优于对照组(P<0.05)。结论对剖宫产产妇实施围手术期的心理护理干预,可显著降低产妇在术中的紧张、焦虑程度,同时对术后各项指标的恢复也有积极的促进意义。     

围手术期康复对腰椎间盘突出症术后功能恢复影响

目的:探讨围手术期康复护理对腰椎间盘突出症术后功能恢复的影响。方法:将51例进行椎板减压内固定手术的腰椎间盘突出症患者随机分为观察组26例和对照组25例,对照组进行手术前后常规基础护理,观察组在常规护理的基础上进行心理护理、体位训练、功能锻炼等围手术期康复护理。对比两组术前及术后3个月VAS和ODI评分,分析两组术后功能恢复情况。结果:观察组和对照组术前VAS平均评分分别是8.3分和7.8分,术后3个月分别是2.03分和3.3分;两组患者术前ODI平均评分分别是52.3分和54.6分,术后3个月分别是20.2分和24.7分。两组患者术前VAS和ODI评分均无显著性差异(P0.05),术后3个月观察组患者VAS和ODI评分改善程度显著优于对照组(P0.05)。结论:围手术期康复护理能够有效缓解腰椎间盘突出症患者术后疼痛、麻木、无力等症状,促进康复。     

心理干预对重症多形性红斑病人心理健康的影响

随机将 82例重症多型红斑病人分为观察组与对照组 ,各 4 1例 ,对照组行常规护理 ,观察组在此基础上实施心理干预。采用自评症状量表 (SCL 90 )对两组病人进行心理状况评定。结果干预后两组SCL 90各因子分及总分、总均分比较 ,均P <0 .0 5 ,差异有显著性意义 ;住院时间对照组 (15 .80± 3.90 )d ,观察组 (10 .80± 2 .10 )d ,两组比较 ,P <0 .0 5 ,差异有显著性意义。提示护理干预可促进病人身心健康 ,缩短住院时间。     

腹腔镜胆囊切除术围术期快速康复外科护理效果分析

目的分析腹腔镜胆囊切除术(LC)围术期快速康复外科(FTS)护理的效果。方法将76例接受择期LC的患者随机分为2组,每组38例。对照组围术期常规护理,研究组围术期实施FTS护理。比较2组的护理效果。结果研究组术后下床活动时间、肛门排气时间,以及住院时间短于对照组;术后并发症发生率低于对照组;患者及家属对临床工作满意度高于对照组。差异均有统计学意义(P0.05)。结论对接受择期LC的患者围术期实施FTS护理,能促进患者术后胃肠功能恢复,减少术后并发症风险,有利于加快患者康复。     

护理干预预防老年病人胸腹部术后呼吸道感染效果观察

将64例老年胸腹部手术病人随机分为两组,对照组32例,手术前后行常规护理;观察组32例,在常规护理基础上予呼吸、咳嗽训练和预防性雾化吸入等护理干预。结果术后第10天观察组呼吸道感染发生率6.25%,咳嗽持续时间(3.81±1.24)d;对照组则为28.12%、(5.55±1.41)d,两组比较,差异有显著性意义(均P<0.05)。提示对老年胸腹部手术病人围术期应重视呼吸功能的训练及预防性的雾化吸入,可有效防止呼吸道感染的发生。     

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.     

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.     

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.