2型糖尿病患者应用出院计划服务的效果评价

目的评价2型糖尿病患者应用出院计划服务的效果。方法将100例2型糖尿病患者随机分为对照组和观察组各50例。对照组接受常规教育和随访,观察组在此基础上实施出院计划服务。结果出院3个月后观察组自我管理行为得分显著高于对照组,空腹血糖、餐后2h血糖及糖化血红蛋白显著低于对照组(均P0.01)。结论出院计划服务可提高2型糖尿病患者的自我管理行为,有效控制血糖。     

糖尿病APP用于门诊2型糖尿病患者健康管理效果探讨

目的探讨糖尿病APP管理模式对2型糖尿病患者血糖控制以及自我管理的效果。方法将189例门诊初始使用胰岛素治疗的2型糖尿病患者随机分为对照组94例与观察组95例,在教会患者胰岛素注射方法的基础上,对照组给予常规健康教育指导,观察组应用糖尿病APP管理,连续3个月后评价效果。结果观察组空腹血糖、餐后2h血糖及糖化血红蛋白改善程度显著优于对照组(均P0.01),自我管理行为能力得分显著高于对照组(P0.05,P0.01)。结论对门诊2型糖尿病患者采用糖尿病APP进行健康管理可提高患者自我管理能力,从而较好地控制血糖水平。     

社区糖尿病患者个性化健康管理的效果评价

目的提高社区糖尿病患者健康管理能力,有效控制血糖水平。方法便利选取社区糖尿病患者120例,将患者随机分为对照组和观察组各60例,对照组按照常规进行健康管理,观察组在常规健康管理基础上,利用知己生活方式疾病综合防治健康管理系统、家庭保健员培训、糖尿病同伴支持小组活动共同实施个性化健康管理。结果实施管理后,两组空腹血糖、餐后2h血糖、糖化血红蛋白均处于达标水平,两组达标率比较,差异无统计学意义(均P0.05);观察组膳食结构合理率、运动充分率显著高于对照组(均P0.01)。观察组空腹血糖、餐后2h血糖、糖化血红蛋白显著低于对照组(P0.05,P0.01)。结论对社区糖尿病患者实施个性化健康管理,可改进患者健康行为,有利于血糖水平的控制。     

应对技能干预对糖尿病患者自我管理行为及血糖的影响

目的 探讨应对技能干预对2型糖尿病患者自我管理行为及血糖控制的影响.方法 将100例2型糖尿病患者随机分为观察组和对照组各50例.对照组给予常规糖尿病健康教育;观察组在此基础上给予应对技能干预.两组均电话随访6个月,分别于干预前、干预后3个月和6个月评价患者的自我管理行为并监测患者的糖化血红蛋白.结果 观察组干预后自我管理行为总分及各维度均分显著高于对照组(P＜0.05,P＜0.01);干预后3个月两组患者的糖化血红蛋白均较干预前有所下降,观察组较对照组改善更为显著(P＜0.01).结论 应对技能干预能提高2型糖尿病患者的自我管理行为,有效维持血糖在较理想的范围.     

对出院2型糖尿病患者团队干预的效果

目的探讨团队干预对出院2型糖尿病患者血糖水平的影响。方法选择糖化血红蛋白≥10%的出院2型糖尿病患者60例按住院号的单双号分成对照组与观察组各30例。对照组给予常规门诊健康教育和每个月1次的电话随访;观察组由运动专家、神精科(心理)医生、营养师以及糖尿病专科的医护人员等组成干预团队,分别对患者出院后定期的电话随访进行运动指导、营养治疗、心理支持及用药指导和血糖监测等方面的健康教育。结果干预6个月后,观察组餐后2h血糖水平显著低于对照组(P0.05)。两组糖化血红蛋白仍高于7%,差异无统计学意义(P0.05)。结论团队干预有利于出院2型糖尿病患者血糖的控制,应将本干预常态化,以获得更满意的效果。     

团队式授权教育在2型糖尿病患者运动治疗中的应用

目的 探讨团队式授权教育对2型糖尿病患者运动治疗的效果.方法 将90例2型糖尿病患者随机分为常规组和授权组各45例;分别采用常规糖尿病运动教育和团队式授权教育.结果 干预3个月后,两组空腹血糖、餐后2h血糖、糖化血红蛋白水平及患者运动依从性比较,授权组患者显著优于常规组,差异有统计学意义(均P＜0.01).结论 以授权理论指导的糖尿病运动治疗教育,能显著改善患者血糖控制水平,提高患者运动依从性.     

中青年糖尿病患者基于微信平台的延伸护理

目的探讨基于微信平台的延伸护理对中青年糖尿病患者自我管理行为及血糖的影响。方法将158例中青年糖尿病患者随机分为对照组(80例)和观察组(78例),对照组按常规行健康教育及出院随访,观察组在常规护理基础上实施基于微信平台的延伸护理。结果出院6个月后观察组在正确服药、合理饮食、坚持运动、血糖监测、足部护理的自我管理行为得分显著高于对照组,空腹血糖、餐后2h血糖、糖化血红蛋白、BMI显著低于对照组(均P0.01)。结论基于微信平台的延伸护理能提高中青年糖尿病患者的自我行为管理能力,进而使患者血糖和BMI得到有效控制。     

专科门诊回访教育对糖尿病患者慢性并发症筛查及血糖的影响

目的探讨专科门诊回访教育对糖尿病患者慢性并发症筛查的影响及血糖控制效果。方法将118例糖尿病患者随机分成观察组58例和对照组60例。对照组实施常规出院后健康教育和随访,观察组由4名专科护士组成随访小组,采取多形式的回访教育,包括专题讲座、小组互动活动及优惠测血糖活动。两组均干预6个月。结果干预期间观察组血脂、尿微量白蛋白以及眼部、足部、神经病变筛查率显著高于对照组(P<0.05,P<0.01);干预后观察组空腹血糖、餐后2h血糖及糖化血红蛋白显著低于对照组(均P<0.01)。结论专科门诊回访教育有利于糖尿病患者采取有益的健康行为,积极参与慢性并发症筛查,维持较好的血糖。     

对出院2型糖尿病患者团队干预的效果

目的探讨团队干预对出院2型糖尿病患者血糖水平的影响。方法选择糖化血红蛋白≥10％的出院2型糖尿病患者60例按住院号的单双号分成对照组与观察组各30例。对照组给予常规门诊健康教育和每个月1次的电话随访；观察组由运动专家、神精科（心理）医生、营养师以及糖尿病专科的医护人员等组成干预团队，分别对患者出院后定期的电话随访进行运动指导、营养治疗、心理支持及用药指导和血糖监测等方面的健康教育。结果干预6个月后，观察组餐后2h血糖水平显著低于对照组（P〈0．05）。两组糖化血红蛋白仍高于7％，差异无统计学意义（P〉0．05）。结论团队干预有利于出院2型糖尿病患者血糖的控制，应将本干预常态化，以获得更满意的效果。     

基于互联网平台的2型糖尿病患者健康管理模式研究

目的探讨基于互联网平台的健康管理模式对2型糖尿病患者血糖管理的效果。方法采用整群随机抽样法抽取2个院区住院的2型糖尿病患者,分别纳入观察组和对照组各100例。观察组采用互联网平台构建的健康管理模式,对照组进行常规糖尿病管理。干预前、干预12个月后,测评两组代谢指标(包括空腹血糖、餐后2 h血糖、糖化血红蛋白、三酰甘油、血清总胆固醇、体重指数)、自我管理能力。结果干预后,观察组代谢指标显著优于对照组;观察组足部护理、饮食控制、规律锻炼、血糖监测评分显著高于对照组(均P0.01)。结论基于互联网平台的健康管理能改善2型糖尿病患者代谢指标,提高患者自我管理能力。     

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.     

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.     

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.