Influencing factors of hope among elderly patients treated with maintenance hemodialysis: a path analysis

目的 探讨影响老年维持性血液透析患者希望水平及其直接因素及间接因素,为制定干预措施提供依据.方法 采用自行设计的患者一般情况调查表、中文版Herth希望量袁、简易应对方式问卷、社会支持量表对广州市3所三级甲等医院血液透析中心的103例老年维持性血液透析患者进行调查.对希望影响因素进行路径分析.结果 患者希望总均分(31.27±3.59)分,75岁及以上患者希望水平总均分显著低于60～64岁患者及65～74岁患者(均P＜0.05)；社会支持是希望水平的直接保护因素(P＜0.01),积极应对方式(P＜0.01)、家庭收入水平(P＜0.01)是希望水平的间接保护因素,消极应对方式是希望水平的间接危险因素(P＜0.01).结论 患者希望整体水平中等,但75岁以上患者希望水平偏低.社会支持通过直接路径影响希望水平,家庭收入通过积极、消极应对方式及社会支持间接影响患者希望水平.应根据希望影响因素作用模式制定干预措施,提升患者希望水平.     

恶性肿瘤患者应对方式及其影响因素与身心症状关系的研究

目的探讨恶性肿瘤患者的应对方式及其影响因素与身心症状的关系。方法采用医学应对方式调查表(MC-MQ)、症状自评量表(SCL-90)和艾森克人格问卷(EPQ)对180例住院恶性肿瘤患者进行问卷调查评定。结果恶性肿瘤患者面对、屈服、回避3种应对方式的评分分别为(14.62±1.89、12.50±3.25、15.86±2.15)分;面对应对方式中,不同性别、文化程度、病程、经济状况差异有显著性意义(P<0.05,P<0.01),回避应对方式中,仅不同病程患者差异有显著性意义(P<0.01);屈服应对方式与EPQ中情绪稳定性维度呈显著正相关(P<0.01),与掩饰呈显著负相关(P<0.05);多元逐步回归分析示,病程、文化程度、经济状况为面对应对方式的主要影响因素(均P<0.01),情绪稳定性、文化程度为屈服应对方式的主要影响因素(均P<0.01),病程为回避应对方式的主要影响因素(P<0.01);3种应对方式的SCL-90总分及10个因子评分显著高于常模(P<0.05,P<0.01);对其身心症状相关分析示,面对和回避应对方式与SCL-90因子多呈负相关(P<0.05,P<0.01),屈服应对方式与SCL-90各项因子则多呈正相关(P<0.05,P<0.01)。结论恶性肿瘤患者的应对方式与其身心症状密切相关,在对恶性肿瘤患者进行生物学治疗的同时,应注重对患者进行心理干预。     

健康素养、特质应对方式对血液透析患者治疗依从性的影响

目的:了解血液透析患者的治疗依从性情况,并分析健康素养和特质应对方式对其治疗依从性的影响关系。方法:2016年09月～2017年08月,应用维持性血液透析患者治疗依从性量表、特质应对方式问卷和全面健康素养测量量表对196例维持性血液透析患者进行调查。结果:196例患者的治疗依从性得分为(70. 78±14. 48);不同文化程度、家庭人均月收入、居住地区、透析龄、周透析次数患者的治疗依从性得分差异具有统计学意义(P 0. 05);通过多元线性回归分析可知,特质应对方式及健康素养均可进入回归模型,可解释41. 1%的方差变异量(F值=23. 638,P 0. 01)。结论:血液透析患者的治疗依从性相对较差,临床医护人员可根据患者的健康素养情况加强疾病知识的健康教育,并注意引导患者采用积极的应对方式,以提升其治疗依从性。     

AIDS患者压力应对能力调查分析

目的 探讨获得性免疫缺陷综合征(AIDS)患者的生存压力及压力应对能力.为实施针对性护理提供依据.方法 采用自制一般情况问卷和压力应对能力量表对132例AIDS患者进行调查.结果 AlDS患者压力得分79.26±17.52.压力应对能力总分213.54±21.08;不同性别、居住地、宗教信仰、感染途径、配偶、付费方式压力及压力应对能力得分差异有显著性意义(P＜0.05,P＜0.01).结论 AIDS患者压力大,压力应对能力较差,尤其是男性、城市居住、无宗教信仰、因输血感染AIDS、无配偶及自费患者更甚.护理人员应全面了解AIDS患者的心理压力及应对能力.实施针对性的护理与支持,以减轻其心理压力,提高应对能力,改善生活质量.     

老年维持性血液透析患者希望影响因素的路径分析

目的探讨影响老年维持性血液透析患者希望水平及其直接因素及间接因素,为制定干预措施提供依据。方法采用自行设计的患者一般情况调查表、中文版Herth希望量表、简易应对方式问卷、社会支持量表对广州市3所三级甲等医院血液透析中心的103例老年维持性血液透析患者进行调查。对希望影响因素进行路径分析。结果患者希望总均分(31.27±3.59)分,75岁及以上患者希望水平总均分显著低于60～64岁患者及65～74岁患者(均P<0.05);社会支持是希望水平的直接保护因素(P<0.01),积极应对方式(P<0.01)、家庭收入水平(P<0.01)是希望水平的间接保护因素,消极应对方式是希望水平的间接危险因素(P<0.01)。结论患者希望整体水平中等,但75岁以上患者希望水平偏低。社会支持通过直接路径影响希望水平,家庭收入通过积极、消极应对方式及社会支持间接影响患者希望水平。应根据希望影响因素作用模式制定干预措施,提升患者希望水平。     

维持性血液透析老年患者心理弹性现状及相关因素研究

目的探讨老年维持性血液透析患者心理弹性现状及相关因素,为个体化护理提供参考。方法采用一般资料问卷、心理弹性量表、医学应对量表、血液透析患者自我管理量表,对110例维持性血液透析老年患者进行调查。结果患者的心理弹性总分(60.03±8.42)分,与文化程度、透析时间、医疗费用支付方式、家庭人均月收入呈显著正相关,与自我管理呈显著正相关,与医学应对中的面对、回避呈显著正相关,与屈服呈显著负相关(P0.05,P0.01)。结论维持性血液透析老年患者的心理弹性水平较低,医护人员应特别关注文化程度低、透析时间短、家庭人均月收入低、自我管理水平差的患者,鼓励倾向于采用屈服应对的患者,使患者的心理弹性水平得以提高。     

腹膜透析患者应对压力的方式与焦虑抑郁情绪的关系

目的：探讨应对压力的方式与腹膜透析患者的焦虑抑郁情绪的关系。方法：采用自填式结构问卷，对81例腹膜透析患者进行调查，了解患者的一般情况和患者应对措施，同时用综合性医院焦虑和抑郁情绪量表测量他们的焦虑与抑郁情绪。结果：控制年龄等因素后的等级回归分析表明：使用“面对”和“自我缓解”应对方式显著降低患者的焦虑情绪，采用“屈从”应对方式增加焦虑的发生；文化程度高的患者采用逃避应对方式则大大增加焦虑情绪的程度，女性和经济收入高者采用面对应对方式可以大大降低焦虑情绪的发生；“自我缓解”应对方式显著降低患者抑郁情绪发生的可能性。结论：不同的应对方式对腹膜透析患者的焦虑抑郁情绪存在差异。     

应对方式在2型糖尿病患者希望水平与益处发现间的中介效应

目的 调查2型糖尿病患者应对方式、希望水平和益处发现现状及其相互关系,为提升患者的益处发现水平提供参考.方法 采用医学应对方式问卷、Herth希望量表、益处发现量表对235例2型糖尿病住院患者进行问卷调查.结果 2型糖尿病患者应对方式中的面对得分17.72±5.16,回避得分12.65±2.70,屈服得分8.00(6.00,10.00);希望水平总分33.76±5.10;益处发现总分51.09±11.35.希望水平与益处发现呈正相关(P＜0.01);应对方式中面对与希望水平和益处发现呈正相关(均P＜0.01),回避、屈服与希望水平和益处发现呈负相关(均P＜0.01).面对、回避与屈服应对在希望水平与益处发现间均存在部分中介效应.结论 2型糖尿病患者希望水平及益处发现均处于中等水平,希望水平对患者益处发现存在影响.在应对疾病时多采取面对应对方式,并且应对方式在希望水平与益处发现间存在部分中介效应.医护人员应采取有效的干预措施来提高2型糖尿病患者的希望水平,促进其积极应对,提升患者的益处发现和生活质量.     

干部病房护士心理健康水平及应对方式调查

目的:探讨干部病房护士的心理健康状况及应对方式.方法:用症状自评量表(SCL-90)和简易应对方式调查问卷随机对保定市五所综合性二级甲等以上医院干部病房78名护士进行调查.结果:干部病房护士的心理健康在躯体化、强迫及精神病性3项因子方面,都高于一般人群(p<0.05);其他6项因子方面与一般人群无明显差别(p>0.05),其积极应对堆度平均分略低于常模组(p>0.05),消极应对堆度低于常模组(p<0.01).结论:干部病房护士心理压力高于一般人群,心理状况差于普通人群,是高压力人群.干部病房护士遇到挫折时能基本采用积极的应对方式,较少采用消极应对方式.管理者鼓励护士采取积极应对策略,将有利改善及缓解护士心理压力以保持良好的心理健康.     

泌尿系肿瘤患者希望水平及应对方式的相关性研究

目的了解泌尿系肿瘤(Tumors of the Urinary System,TUS)患者希望水平及应对方式现状,分析其相关性,为高效护理应对提供参考。方法采用Herth希望水平量表(HHI)及医学应对问卷(MCMQ)对147例TUS患者进行调查。结果 TUS患者HHI得分(35.41±3.22)分,不同TUS患者总体HHI及各子量表评分差异无统计学意义;MCMQ结果显示应对方式中采取面对的最多(55.8%),采取屈服的最少(12.9%),不同部位TUS患者间差异性无统计学意义。患者总体HHI与"面对"应对方式呈正相关(r=0.273,P0.01),与"屈服"应对方式呈负相关(r=-0.352,P0.01)。结论 TUS患者希望水平处于中等以上水平,希望水平越高的患者越有可能采取面对的应对方式,希望水平越低的患者越有可能采取屈服的应对方式,不同部位TUS患者希望水平及应对方式无明显差异。对此类患者可采取同质化心理支持,以提高TUS患者的希望水平,促进其积极应对。     

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.     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.