新净界应用于经口气管插管行机械通气患者口腔护理的效果观察

目的:观察新净界应用于经口气管插管行机械通气患者口腔护理的效果.方法:将90例经口气管插管行机械通气患者随机分为试验组和对照组各45例,对照组采用常规擦洗+冲洗法进行口腔护理,试验组在对照组方法的基础上,最后用新净界进行口腔喷涂.观察两组患者口腔清洁度及各种并发症的发生率.结果:试验组和对照组比较,患者口腔清洁度明显改善(P＜0.05),口腔溃疡、霉菌感染率、牙菌斑及VAP发生率明显降低(P＜0.05).结论:经口气管插管行机械通气患者在进行口腔护理后应用新净界进行喷涂能改善患者的口腔清洁度,并能有效的降低口腔溃疡、霉菌感染、牙菌斑及VAP的发生率.     

干湿棉球擦拭法口腔护理预防呼吸机相关性肺炎的研究

目的探讨干湿棉球擦拭法口腔护理对呼吸机相关肺炎的预防效果。方法将150例经口气管插管机械通气的患者随机分为对照组与观察组各75例。对照组采用湿棉球擦拭法进行口腔护理,观察组先用干棉球擦拭,再用湿棉球擦拭。结果观察组呼吸机相关肺炎发病率,2级以上口腔异味和黏膜溃疡发生率显著低于对照组(P<0.05,P<0.01)。结论采用干湿棉球擦拭法进行口腔护理能有效清除表面的分泌物和附着在口腔内的细菌,促进口腔舒适清洁,因而降低机械通气患者的呼吸机相关肺炎发生率。     

常规刷牙预防呼吸机相关性肺炎的效果观察

目的探讨常规刷牙在预防呼吸机相关性肺炎(VAP)中的作用,为寻找更为有效的口腔护理方法提供依据。方法将98例经口气管插管机械通气患者随机分为两组,对照组(48例)应用传统擦拭法进行口腔护理,观察组(50例)采用常规刷牙方法进行口腔护理;两组口腔护理后均给予口腔冲洗和咽部深吸引。比较两组机械通气1周后VAP发生率、机械通气时间及ICU住院时间。结果观察组机械通气1周后VAP发生率显著低于对照组(P<0.05),机械通气时间及ICU住院时间显著短于对照组(均P<0.01)。结论常规刷牙配合口腔冲洗及咽部深吸引能显著降低VAP的发生率,缩短机械通气及ICU住院的时间。     

正颌术后患者口腔冲洗方法的改进

目的提高口腔冲洗效果。方法将47例牙颌面畸形正颌术后患者随机分为两组,观察组24例采用改良法行口腔冲洗,即将吸唾管放置口角低位处,用1.5%过氧化氢溶液和生理盐水进行口腔冲洗,同时用棉签按先上后下、由后向前擦拭牙面及口腔黏膜。对照组23例行常规口腔冲洗。结果观察组冲洗后牙菌斑指数显著少于对照组(P<0.01)。结论对正颌术后患者采用改良口腔冲洗法护理效果显著优于常规方法。     

急诊气管插管患者插管后不同时间口腔牙菌斑及细菌变化分析

目的分析急诊气管插管患者插管后不同时间口腔牙菌斑、细菌变化情况及其相关因素。方法选取急诊就诊并行气管插管患者64例,在插管后即刻及6、8、10、12h分别进行牙菌斑评分和牙菌斑采样细菌培养。结果急诊气管插管后不同时间点牙菌斑及牙菌斑细菌培养评分比较,差异有统计学意义(均P0.01)。手术、居住地与牙菌斑及牙菌斑细菌培养评分有相关性,有吸烟史与牙菌斑评分显著负相关(均P0.05)。结论急诊气管插管后患者口腔牙菌斑评分及细菌数量随着插管时间的延长而升高,插管后即刻至6h变化程度最为显著,其次为6~8h;手术患者、有吸烟史和居住在农村的患者口腔护理时间可适当提前。     

经口气管插管患者不同口腔护理频次的效果观察

目的 探讨不同口腔护理频次对经口气管插管进行机械通气患者的效果.方法 将147例经口气管插管进行机械通气患者按入住ICU先后顺序分成四组.每日分别进行1次、2次、3次、4次口腔护理,观察口腔清洁度及并发症发生率.结果 不同口腔护理频次口腔清洁、口腔溃疡发生率比较,差异有显著性意义(P<0.05,P<0.01);霉菌感染、VAP发生率比较.差异无显著性意义(均P>0.05).结论 2次/d以上口腔护理可以增加口腔清洁度,减少口臭、口腔溃疡发生.     

菌斑显示剂在经口气管插管患者口腔护理中的应用

目的探讨菌斑显示剂在经口气管插管患者口腔护理中的应用效果。方法将56例经口气管插管患者随机分成对照组和干预组各28例。对照组按常规进行口腔护理,操作前后常规评估/评价口腔;干预组将菌斑显示剂用于口腔护理,即操作前根据菌斑显示剂显示菌斑数量及部位指导口腔护理操作,操作后再次使用菌斑显示剂显示菌斑数量。第4天评价口臭发生率、口腔卫生状况达标率及呼吸机相关性肺炎的发生率。结果干预后干预组口臭发生率及呼吸机相关性肺炎发生率显著低于对照组,而口腔卫生达标率显著高于对照组(P0.05,P0.01)。结论将菌斑显示剂用于经口气管插管患者口腔护理,能改善经口气管插管患者口腔卫生状况,提高口腔护理质量,并降低呼吸机相关性肺炎的发生率。     

口腔种植修复对牙列缺损患者牙菌斑与牙周袋指数及美观影响的研究

目的:探讨口腔种植修复在牙列缺损中的应用及对牙菌斑、牙周袋指数及美观的影响。方法:选择笔者科室2015年6月-2016年11月收治的86例牙列缺损患者,随机分为试验组和对照组,每组患者43例。对照组给予常规修复治疗,试验组给予口腔种植修复治疗。观察比较两组患者治疗后的临床疗效,治疗前后相关指标评分,牙菌斑指数及牙周袋深度及治疗后并发症发生率。结果:治疗后,试验组有效率高于对照组,差异有统计学意义(P0.05);两组相关指标(舒适度、美观效果、固位力、语言功能、咀嚼效率)评分均得到了明显提高,试验组提高程度较对照组更为显著,差异具有统计学意义(P0.05);两组患者牙菌斑指数及牙周袋深度均明显降低,试验组较对照组显著降低,组间差异具有统计学意义(P0.05);试验组并发症发生率明显低于于对照组,差异具有统计学意义(P0.05)。结论:口腔种植修复应用于牙列缺损患者具有较高疗效,能明显降低其牙菌斑指数及牙周袋深度,同时具有较好的美观效果及并发症发生率较低的优点,值得临床推广运用。     

电动牙刷刷牙冲洗法用于经口气管插管口腔护理

目的探讨应用小儿电动牙刷刷牙冲洗法对经口气管插管患者口腔护理的效果。方法将160例经口气管插管重症患者随机分为观察组和对照组各80例。观察组采用电动牙刷刷洗及负压吸引行口腔护理;对照组采用生理盐水棉球行口腔护理。结果观察组牙菌斑、口腔异味、口腔残留物发生率及口腔细菌阳性率显著低于对照组,口腔pH值显著高于对照组(均P<0.01)。结论对经口气管插管患者采用电动牙刷刷牙冲洗法进行口腔护理效果优于传统棉球擦洗法。     

口腔正畸联合种植义齿治疗对前牙错畸形与牙列缺损患者牙齿功能及菌斑附着的影响

探讨对前牙错牙合畸形与牙列缺损患者予以口腔正畸联合种植义齿治疗对其牙齿功能及菌斑 附着的影响。方法 回顾性选取2020年2月-2023年2月永州职业技术学院附属医院收治的前牙错牙合畸形与牙列 缺损患者100例，依据治疗方法不同分为口腔正畸联合种植义齿治疗组（联合治疗组）、单独种植义齿治疗 组（单独治疗组），各50例。比较两组牙齿功能、菌斑附着指数、软垢指数、临床疗效。结果 联合治疗组牙 齿咬合、咀嚼功能、吞咽功能、发音功能评分均高于单独治疗组，差异有统计学意义（P＜0.05）；联合治 疗组菌斑附着指数、软垢指数均低于单独治疗组，差异有统计学意义（P＜0.05）；联合治疗组治疗总有效 率为92.00%，高于单独治疗组的72.00%，差异有统计学意义（P＜0.05）。结论 前牙错牙合畸形与牙列缺损口腔 正畸联合种植义齿治疗较单独种植义齿治疗效果更好，可有效减轻患者的菌斑附着，改善患者牙齿功能。     

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.     

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.