胃肠癌患者家属照顾者反应及与成人依恋关系的研究

目的了解胃肠癌患者家属照顾者反应水平及与成人依恋的相关性。方法采用修订版照顾者反应评估量表和亲密关系体验量表对192名胃肠癌患者家属照顾者进行调查。结果照顾者反应中自尊维度得分最高(4.33±0.45)分,缺乏家庭支持维度得分最低(1.86±0.55)分;照顾者依恋焦虑得分(3.51±0.85)分,依恋回避得分(2.62±0.80)分。依恋回避与自尊呈负相关,与缺乏家庭支持呈正相关;依恋焦虑与经济负荷、缺乏家庭支持呈正相关(均P0.01)。结论胃肠癌患者家属照顾者对照顾压力负荷既有积极感受也有消极反应,成人依恋可影响照顾者反应,以依恋理论为指导制定干预措施可以减轻照顾者负担。     

糖尿病视网膜病变患者残障接受度与家庭亲密度和适应性的关系研究

目的探讨家庭亲密度和适应性对糖尿病视网膜病变视力残障患者残障接受度的影响。方法便利抽样法抽取视力残障的糖尿病视网膜病变患者454例,采用残障接受度及家庭亲密度和适应性量表进行调查。结果患者残障接受度总分(184.01±46.15)分,86.4%的患者残障接受度为低中水平;实际家庭亲密度得分(53.19±5.79)分,实际家庭适应性得分(49.77±5.21)分。分层线性回归分析显示,控制人口学变量后,实际家庭亲密度、实际家庭适应性可以解释残障接受度变异量的22.8%。结论糖尿病视网膜病变视力残障患者的残障接受度处于中等偏低水平,可通过改善患者的家庭亲密度和适应性提高其对视力残障的接受度。     

老年失智症家庭照顾者管理策略现状及影响因素分析

目的 了解老年失智症家庭照顾者管理策略现状并探讨其影响因素,为针对性地开展老年失智症家庭照顾者管理策略指导提供参考.方法 以便利抽样法选取老年失智症家庭照顾者202人,采用一般资料调查表、失智症管理策略量表、照顾者积极感受量表、照顾者哀伤量表和社会支持评定量表进行问卷调查.结果 家庭照顾者的失智症管理策略各维度得分分别为积极管理(43.34±8.98)分,鼓励/支持(33.98±10.00)分,批评(28.03±12.64)分.家庭照顾者文化程度、疾病知识了解程度、哀伤和积极感受是批评维度的影响因素;家庭照顾者文化程度、与患者关系和积极感受是鼓励/支持维度的影响因素;失智症照顾经验、哀伤、积极感受和社会支持是积极管理维度的影响因素(P＜0.05,P＜0.01).结论 老年失智症家庭照顾者管理策略以积极管理和鼓励/支持为主,较少采用批评.医护人员需重视老年失智症家庭照顾者管理策略现状,充分利用家庭-社会支持系统,为家庭照顾者提供家庭管理培训,以形成健康的家庭管理策略.     

颈髓损伤患者残障接受度现状及影响因素分析

目的了解颈髓损伤患者的残障接受度,并分析其影响因素,为改善患者残障接受度,引导其理性自我评价提供参考。方法采用残障接受度量表对226例颈髓损伤患者进行问卷调查,比较不同临床特征患者的残障接受度的差别,并采用多元线性回归分析探讨影响因素。结果颈髓损伤患者残障接受度总分为(142.62±25.68)分,其中低接受度占59.29%,中接受度占28.32%,高接受度占12.39%。不同性别、家庭收入、JOA评分、损伤时间和抑郁程度患者残障接受度评分比较,差异有统计学意义(P0.05,P0.01)。多元线性回归分析结果提示JOA评分、损伤时间、抑郁评分、性别为颈髓损伤患者残障接受度的影响因素(P0.05,P0.01),可解释46.70%的变异。结论颈髓损伤患者残障接受度处于中等偏下水平,其受多种因素影响,需实施针对性干预措施,以改善颈髓损伤患者残障接受度。     

肠造口患者照顾者照顾负担及社会支持的纵向研究

目的调查肠造口患者照顾者在患者疾病不同阶段的照顾负担和社会支持水平,并探讨其相关性。方法采用Zarit照顾负担量表和多维感知社会支持量表对146例肠造口患者的照顾者分别于患者造口术后1个月、6个月、12个月及24个月进行调查。结果照顾者个人负担、责任负担得分及照顾负担总分在4个时间点差异存在统计学意义(P0.05),其中术后6个月的得分显著低于术后1个月、12个月及24个月(均P0.05)。照顾者在4个时间点获得的社会支持得分差异有统计学意义,其中术后12个月、24个月获得的家人、他人支持得分与社会支持总分显著高于术后1个月(均P0.05)。造口术后1个月、6个月照顾者个人负担、责任负担及照顾负担总分与社会支持呈负相关,术后12个月照顾者责任负担与社会支持呈负相关(P0.05,P0.01)。结论肠造口患者照顾者照顾负担普遍存在,且社会支持不足,医护人员应制定科学合理的干预对策,促进照顾者身心健康,提高照顾水平。     

COPD患者照顾者姑息照护接受度及影响因素分析

目的 调查慢性阻塞性肺疾病患者照顾者姑息照护接受度及影响因素,为实施针对性护理干预提供参考.方法 采用一般资料调查表、慢性病患者照顾者姑息照护接受度量表,对125名慢性阻塞性肺疾病患者照顾者进行调查.结果 患者照顾者姑息照护接受度总分65.98±11.03;不同文化程度、能否胜任照顾者角色、不同子女数、与家人关系是否融洽的照顾者姑息照护接受度得分比较,差异有统计学意义(P＜0.05,P＜0.01).结论 慢性阻塞性肺疾病患者照顾者对姑息照护接受度较高,有益于我国姑息照护服务的开展;仍需加强低文化程度、不能胜任照顾者角色、子女数目较多、与家人关系不够融洽的照顾者知识宣教,改善其身心状况,优化患者及照顾者的生活质量.     

以家庭功能为导向的首发脑卒中患者照顾者支持干预方案实施

目的 评价以家庭功能为导向的首发脑卒中患者照顾者支持干预方案的实施效果。 方法 便利抽取103名首发脑卒中患者照顾者,按时间段分为对照组51名和干预组52名。对照组实施常规护理;干预组在此基础上实施以家庭功能为导向的照顾者支持干预方案,共3个月。比较两组照顾者做好家庭护理的准备、综合照顾能力及家庭功能得分。 结果 干预组出院时照顾者做好家庭护理的准备得分显著高于对照组（P＜0.05）;两组综合照顾能力总分及各维度得分、家庭功能得分比较,组间效应、时间效应和交互效应差异有统计学意义（均P＜0.05）。 结论 以家庭功能为导向的照顾者支持干预方案的实施可提高首发脑卒中照顾者家庭护理准备、综合照顾能力及改善患者家庭功能水平,可帮助患者更好地从医院过渡到家庭。     

孤独症谱系障碍患儿照顾者家庭坚韧力状况及影响因素研究

目的探讨孤独症谱系障碍患儿照顾者家庭坚韧力状况及其影响因素。方法采用一般人口学资料问卷、儿童孤独症评定量表、家庭坚韧性量表和亲职压力简表对189例孤独症谱系障碍患儿照顾者进行问卷调查。结果孤独症谱系障碍患儿照顾者家庭坚韧力量表总分为(39.28±6.03)分。家庭坚韧力量表得分与亲职压力简表总分及各维度得分呈负相关(P0.05,P0.01);多元逐步线性回归分析结果显示,亲子愁苦、困难儿童、疾病程度和亲子互动关系失调因子可预测家庭坚韧力54.8%的变异量。结论孤独症谱系障碍患儿照顾者家庭坚韧力量表得分处于较低水平,医护人员应在关注患儿疾病的同时,通过心理咨询和提供亲子互动空间缓解患儿照顾者的亲职压力水平,积极发挥其主观能动性,提高家庭应激能力和坚韧力。     

肺癌化疗患者希望水平与自尊及领悟社会支持的相关性研究

目的探讨肺癌化疗患者希望水平及其与自尊、领悟社会支持的相关性,为临床护理干预提供理论依据。方法采用Herth希望量表、自尊量表和领悟社会支持量表对92例住院肺癌化疗患者进行问卷调查。结果肺癌化疗患者希望水平得分为(32.57±4.72)分,处于中等水平;自尊得分(29.49±3.26)分、领悟社会支持得分(55.76±8.34)分;肺癌化疗患者希望水平总分与自尊呈正相关(r=0.314,P<0.01),与领悟家庭内支持(r=0.293,P<0.01)、领悟家庭外支持(r=0.213,P<0.05)呈正相关。结论医务人员对患者希望进行干预时应将希望水平、自尊、领悟社会支持三者有机结合,重视自尊和领悟社会支持对希望水平的影响,增强患者的心理适应能力。     

肺癌幸存者社会疏离现状及影响因素调查分析

目的 调查肺癌幸存者社会疏离水平现状,并分析其影响因素.方法 采用一般疏离感量表、自尊量表、领悟社会支持量表对228例肺癌幸存者进行横断面调查.结果 肺癌幸存者社会疏离得分为(42.66±7.96)分;肺癌幸存者社会疏离得分与 自尊得分、领悟社会支持各维度得分及总分呈负相关(均P＜0.01);多元线性回归分析显示,文化程度、治愈后时间、自尊、领悟社会支持是社会疏离的主要影响因素(均P＜0.01),可解释总变异的52.9％.结论 肺癌幸存者存在中等以上水平的社会疏离,医护人员应关注文化程度较低、治愈后时间较短的患者,提高患者自尊水平和领悟社会支持水平,以降低患者的社会疏离水平.     

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.