麻醉科护士岗位胜任力与工作投入的相关性分析

目的了解麻醉科护士的岗位胜任力和工作投入现状及其相关关系,为提升麻醉护理质量提供参考.方法采用方便抽样法对湖南省14所三级医院210名麻醉科护士采用麻醉护士岗位胜任力量表和Utrecht工作投入量表进行调查.结果麻醉科护士岗位胜任力得分为(2.56±0.66)分,工作投入得分为(4.44±1.05)分,两者呈正相关(P...     

湖北省二级及以上医院麻醉护理现状调查

目的了解湖北省麻醉护理发展现况,为规范化管理提供参考。方法采用自行设计的调查问卷对湖北省76所二级及以上医院麻醉护士工作及相关现况进行调查。结果 76所医院中27所设置了麻醉护理单元,20所在筹备中;52所设置了麻醉护理岗位,共有麻醉护士264人(三级医院222人,二级医院42人),三级医院麻醉护士学历分布显著优于二级医院(P0.01);麻醉科护理单元设护士长及护理组长管理12所,手术室护士长代管15所;业务范围包括麻醉苏醒室观察、麻醉前后访视及麻醉中管理等;麻醉护士反映的主要问题为人员过少、机制不完善,继续教育欠缺。结论湖北省麻醉护士达到一定规模,但发展水平不均衡;应特别重视二级医院的麻醉护理建设,明确麻醉护士职责,加强继续教育,提升麻醉护士队伍水平,促进麻醉护理的发展。     

上海市医院麻醉科护士人力资源管理现状调查

目的 调查并分析上海市医院麻醉科护士人力资源的配置、工作内容及管理情况,为上海市麻醉科护理人员的配置与管理提供参考依据.方法 采用自制调查表,应用整群抽样法,以电子邮件方式对上海市99家二级及以上医院进行调查分析.结果 回收问卷98份,调查的98家医院共有麻醉科护士401名,21.4%的医院未配备麻醉科护士;仅有22.1%的医院设置了专门的麻醉科护士长岗位;麻醉科护士目前主要以PACU患者护理、麻醉药品管理、麻醉前准备、镇痛泵配置与术后镇痛随访等为工作内容,围麻醉期护理尚未成为其工作重点.结论 目前,上海市医院麻醉科作为一级临床科室人力资源配置不合理;麻醉科普遍存在护士配备不足、麻醉护士数量和素质难以适应麻醉学科发展与围麻醉期护理实践需求等问题.     

广东省三级医院麻醉科护士工作岗位现状调查

目的 了解广东省三级医院麻醉科护士人力、工作岗位现况,为麻醉护理单元的建设提供参考。方法 采用自制问卷,对广东省76所三级医院麻醉科护士及工作岗位、时长进行调查。结果 76所医院共有麻醉科护士547名,麻醉医护比例为1∶0.25。工作岗位开展中最高为总务工作,开展率96.05%,最低为麻醉诱导室护理（18.42%）。工作周时长最高56 h,最低8 h,中位数37 h。结论 广东省三级医院麻醉科护士工作岗位开展不均,下一步学科建设应以人力配备、工作规范及专科培训为主。     

麻醉科专科护士岗位胜任力评价指标体系的构建

目的 构建适合我国的麻醉科专科护士岗位胜任力评价指标体系,为麻醉科专科护士培养及评价提供参考.方法 通过文献回顾法、小组讨论法、德尔菲专家函询法以及层次分析法,确定麻醉科专科护士岗位胜任力各级评价指标及权重.结果 麻醉科专科护士岗位胜任力评价指标体系包含专业知识、专业技术、专业能力、管理能力和个人特质5项一级指标和38项二级指标.两轮函询专家积极系数分别为89.47％和94.12％,专家权威系数分别为0.865和0.889,肯德尔协调系数分别为0.182、0.237(均P＜0.01).结论 构建的麻醉科专科护士岗位胜任力评价指标体系,可作为麻醉科专科护士岗位胜任力水平的测评工具,为麻醉科专科护士培训、考核及任用提供参考.     

ICU护士心理资本对岗位胜任力的影响研究

目的 了解ICU护士心理资本和岗位胜任力现状,探讨心理资本对岗位胜任力的影响.方法 采用护士心理资本问卷和自设ICU护士岗位胜任力问卷,对254名ICU护士进行调查.结果 ICU护士心理资本得分为(90.50±17.75)分,岗位胜任力得分为(140.92±42.28)分,ICU护士心理资本与岗位胜任力呈正相关(P＜0.01);心理资本中的自我效能维度和乐观维度对ICU护士岗位胜任力具有显著影响(均P＜0.01).结论 ICU护士的心理资本和岗位胜任力呈中等偏上水平,护理管理者应充分关注ICU护士心理资本,尤其是自我效能感和乐观心理品质的培养和开发.     

急诊科护士岗位胜任力指标体系的构建

目的探索急诊科护士岗位胜任力指标体系、评价指标和临床护理管理体系。方法运用文献回顾法、行为事件访谈法、专家咨询法,初步建立急诊科护士岗位胜任力指标体系,并形成调查问卷,对228名护士进行调查。结果 2轮专家咨询的应答率均>90.0%,专家的权威程度系数Cr=0.91,一、二、三级指标的协调系数分别为0.32、0.16、0.21(均P<0.01)。最终形成的急诊科护士岗位胜任力指标体系包括关爱与服务、职业与认知、人际与发展、自我概念特征4个一级指标,权重分别为0.26、0.29、0.27、0.18,16个二级指标权重为0.02～0.09。结论所构建的急诊科护士岗位胜任力的指标体系,除体现护士外显特征如知识、技能外,还增加胜任力的深层次特征"自我概念",可用于医院选拔、培训急诊科护士。     

基层医院低年资护士岗位胜任力评价指标的构建

目的构建基层医院低年资护士岗位胜任力的评价指标。方法通过文献资料法、理论分析法、质性研究等方法构建含4个一级指标、18个二级指标及36个三级指标基层医院低年资护士岗位胜任力评价指标初稿,运用Delphi法向15名专家进行2轮函询。结果专家的权威系数为0.880,协调系数为0.363~0.451,最终确定基层医院低年资护士岗位胜任力评价体系包括一级指标3条、二级指标13条、三级指标37条。结论本评价指标构建过程规范,可用于基层医院低年资护士岗位胜任力评价,后一步将对本指标体系进行信效度验证。     

临床护理教师岗位胜任力现状调查及影响因素分析

目的 调查临床护理教师岗位胜任力现状，分析其影响因素,为临床选拔、评价、培训临床护理教师提供参考。方法 采用临床护理教师岗位胜任力问卷对北京市某三甲医院735名临床护理教师进行横断面调查，并进行岗位胜任力影响因素的单因素分析和多元线性回归分析。结果 临床护理教师岗位胜任力总均分为（92.27±9.07）分，处于较好水平；排序后5位的条目属于专业知识和教学能力2个维度。多元逐步回归分析显示，工作年限、临床教学年限、是否承担过科室教学干事（护理单元总带教）、科室教学氛围、护士长支持力度、临床教学时间满意度为岗位胜任力的独立影响因素（P<0.05,P<0.01）。结论 三级甲等医院临床护理教师总体胜任力水平较好，但是需要对其教学方法、法律、法规、人文方面加强培训，同时护理管理者应建立科学合理的科室教学管理机制，给予更多支持，从而在个人和组织两个层面提升临床护士的教学岗位胜任力。     

军队医院护士岗位胜任力分层培训的实践

目的探讨基于护士岗位胜任力培训的方法与效果,培养适应责任制整体护理和军事护理需要的应用型人才。方法按照护士岗位管理方案,对1 212名护士进行与岗位胜任力相匹配的分层培训和考核。结果培训后护士岗位胜任力、护理质量显著高于培训前(均P0.01);护理科研能力及综合保障能力提高。结论基于岗位胜任力的军队医院护士分层培训,有助于提升各层级护士的综合素质,能更好地适应责任制整体护理和军事护理的需要。     

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.