暴发性心肌炎患者急诊标准化急救流程的临床实践

目的 探讨暴发性心肌炎患者急诊标准化急救流程的实施效果。方法 将急诊科就诊的疑似暴发性心肌炎患者80例,按照患者就诊时间顺序分为对照组40例和观察组40例。对照组按常规急救流程实施救治及护理,观察组按照科室构建的暴发性心肌炎标准化急救流程实施救治及护理。结果 对照组31例、观察组40例完成研究。观察组急诊预检分诊准确率显著高于对照组,确诊患者急诊候诊时间及实施前后急诊科停留时间显著短于对照组(均P<0.05);实施标准化急救流程后急诊医护人员安全态度的安全氛围、管理感知维度得分显著高于实施前(均P<0.05)。结论 暴发性心肌炎患者急诊标准化急救流程的建立与实施,有利于早期筛查识别暴发性心肌炎患者,缩短急诊候诊时间及停留时间,可提高患者救治效率。     

探讨急救绿色通道对提高严重创伤救治水平的临床应用

目的分析急救绿色通道对提高严重创伤救治水平的效果。方法对2012-10-2013-10间30例严重创伤的急救患者(观察组)实施通过急救绿色通道快速救治,并与2008-01-2009-01间实施传统救治方式的30例严重创伤的急救患者(对照组)对比分析救治情况。结果观察组患者的急诊室逗留时间、特殊检查时间、急诊至手术室时间、入院至手术时间等指标均明显优于对照组,观察组救治成功率高于对照组,两组患者对比,差异均有统计学意义(P0.05)。结论实施急救绿色通道对严重创伤患者进行救治,可缩短救治时间及提高救治成功率,应不断完善和提高急救绿色通道建设。急诊绿色通道的建立和完善,缩短了患者的救治时间,显著降低了病死率,提高了救治成功率,保证了创伤急救的时效性和整体性。     

不同部位主动脉插管在A型主动脉夹层手术中的应用体会

目的评价无名动脉插管作为主动脉夹层手术患者体外循环插管的可行性以及安全性。方法选择湖南省人民医院(湖南师范大学附属第一医院)心脏大血管外科2019年1月至2022年12月收治的行急性A型主动脉夹层急诊孙氏手术的259例患者为研究对象,按入选及排除标准选取71例进行回顾性研究。观察组32例,主动脉灌注插管位于无名动脉;对照组39例,主动脉灌注插管位于右侧腋动脉。结果两组比较,观察组手术时间短于对照组,为(338.0±15.2)min vs.(373.1±14.3)min(P=0.001);体外循环时间、主动脉阻断时间、深低温停循环时间、72 h内引流量以及72 h内红细胞输注量无差异(P>0.05)。观察组有2例(6.2%)二次开胸止血,均为近端吻合口少量渗血,与插管位置无关。呼吸机辅助呼吸时间、ICU停留时间、住院时间、肾功能不全发生率两组间比较无统计学差异(P>0.05)。71例患者中,无30 d内死亡;术后脑卒中观察组有2例(6.2%),对照组有3例(7.7%),且两组各有1例患者因此出现术后右侧肢体活动障碍,经2个月左右康复治疗后均能扶拐行走。术后在出院前均复查主动脉电子计算机断层扫描血管造影(computed tomography angiography,CTA),未见插管处腋动脉、头臂干新发夹层或存在狭窄。结论无名动脉插管和腋动脉插管在主动脉夹层手术中都是安全可行的,具体选择哪种方法需要根据患者的具体情况和手术需求来确定。     

急救绿色通道对急性脑血管病救治价值分析

目的探讨急救绿色通道在急性脑血管病患者救治中的价值。方法对326例急性脑血管病患者,据是否拨打120急救电话进入急救绿色通道进行规范化救治分为观察组(183例)和对照组(143例)。比较2组患者自发病至急性卒中单元开始规范救治时间及治疗效果。结果观察组发病至开始规范救治时间为(86.72±31.67)min,对照组时间为(140.76±46.59)min。观察组规范救治时间显著短于对照组,(P0.05),抢救有效率(90.62%)高于对照组(71.88%)对照组(P0.05),差异均有统计学意义。结论对急性脑血管病患者,急救绿色通道可以迅速明确诊断明、显缩短救治时间,及时规范有效救治,可提高救治成功率,改善预后。     

创伤中心联合多学科协作模式在烧伤整形外科护理中的应用

研讨创伤中心联合多学科协作模式在烧伤整形外科护理中的应用效果。方法 选取2022年 5月-2023年5月东莞市厚街医院收治的采用创伤救治中心结合多学科协作诊疗模式的90例烧伤患者设为观 察组；选取2021年4月-2022年4月东莞市厚街医院收治的经传统医疗模式诊治的行常规护理的90例烧伤患 者设为对照组。比较两组临床指标、生活质量、生活能力及并发症发生情况。结果 观察组急诊医师到诊 时间、急诊检查时间、急诊清创时间短于对照组（P ＜0.05）；观察组护理3个月后及复诊时生活质量各项 评分均高于对照组（P ＜0.05）；观察组护理3个月后和复诊时Barthel指数评分均高于对照组（P ＜0.05）； 观察组并发症发生率为2.22%，低于对照组的11.11%（P ＜0.05）。结论 创伤中心联合多学科协作模式应用 于烧伤整形外科护理中，能缩短急诊医师到诊时间、急诊检查时间和急诊清创时间，降低相关并发症发生 几率，提高生活能力和生活质量，值得临床应用。     

急救护理路径在抢救急性心肌梗死患者中的应用

目的 探讨急救护理路径在急性心肌梗死患者中的应用价值.方法 制订急性心肌梗死急救护理路径,对58例患者(观察组)按路径实施护理,并与实施传统急诊护理流程的140例(对照组)进行比较.结果 观察组进-出急诊室时间、急诊-球囊扩张时间显著短于对照组(均P<0.01);院内心肌梗死复发率、院内再PCI率显著低于对照组(均P<0.05).结论 急救护理路径应用于急性心肌梗死患者,可为抢救患者赢得有效时机.     

急诊预检分诊信息系统对危重患者病情分级的效果研究

目的探讨急诊预检分诊信息系统在危重患者病情分级中的应用效果。方法将1000例急诊患者按时间段分为对照组和观察组各500例,对照组采用常规预检分诊模式分诊;观察组采用急诊预检分诊信息系统分诊。评价比较两组危重患者过检率、危重患者漏检率、危重患者分诊时间及危重患者分诊时间与期望分诊时间差。结果观察组危重患者过检率、漏检率、分诊时间及分诊时间与期望分诊时间差显著低于对照组(P0.05,P0.01)。结论急诊预检分诊信息系统提高了危重患者病情分级的准确率和效率,符合危重患者的分诊时间期望,提高急诊分诊的满意度。     

慢性心力衰竭专病护士团队的组建及实践

目的 探讨专病护士团队在慢性心力衰竭患者治疗护理中的作用。方法 将2017年6～12月收治的300例慢性心力衰竭患者作为对照组，实施常规治疗护理和出院后随访；2018年1～6月收治的300例慢性心力衰竭患者作为观察组，由专病护士团队针对患者进行评估、跟踪，筛查临床前期患者，对临床期患者制定个性化的健康指导和出院后的团队延续护理，帮助终末期患者选择合适的治疗方案、实施急救措施、心理支持及社会援助；同时重视质量控制和专病护士的考评和管理，协助心力衰竭治疗中心和示范基地的建设。于干预6个月后比较两组疾病自我管理能力评分、再住院情况，以及医护患满意度。结果 干预6个月后，观察组疾病自我管理能力、患者对护理工作满意度显著高于对照组，再住院率和再住院时间显著降低和缩短（均P<0.01）。医生、护士对专病护士团队的工作满意度较高。结论 专病护士团队针对慢性心力衰竭不同阶段进行分工分期管理，可以提高患者生活质量和临床结局，有利于护士职业发展。     

绿色通道在急诊心脏介入治疗中的实施

目的 探讨绿色通道在心脏介入治疗中的实施效果.方法 对49例急性心肌梗死行急诊PCI术患者(对照组)行常规护理及管理,对134例患者(观察组)实施绿色通道及管理.结果 观察组从就诊至导管室的时间及入导管室至手术的时间显著短于对照组(P＜0.05,P＜0.01).结论 绿色通道的实施为急性心肌梗死行急诊PCI患者的救治赢得了宝贵的时间.     

急救护理路径在抢救急性心肌梗死患者中的应用

目的探讨急救护理路径在急性心肌梗死患者中的应用价值。方法制订急性心肌梗死急救护理路径，对58例患者（观察组）按路径实施护理，并与实施传统急诊护理流程的140例（对照组）进行比较。结果观察组进-出急诊室时间、急诊-球囊扩张时间显著短于对照组（均P〈0．01）；院内心肌梗死复发率、院内再PCI率显著低于对照组（均P〈0．05）。结论急救护理路径应用于急性心肌梗死患者，可为抢救患者赢得有效时机。     

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.