前列腺癌患者放射性肠炎预防护理流程改进的行动研究

目的 基于行动研究法改进前列腺癌患者放射性肠炎预防护理流程,并探讨其有效性。方法 便利选取112例前列腺癌拟行根治性放疗患者,按时间段分为对照组和行动研究组。对照组采用前列腺癌放射性肠炎优化护理;行动研究组采用行动研究法,通过计划-行动-观察-反思螺旋式循环,继续改进护理流程,共开展2个循环。比较对照组与行动研究组放射性肠炎发生率及严重程度、心理困扰程度以及生活质量。结果 行动研究组放射性肠炎发生率、心理困扰程度显著低于对照组(均P<0.05),生活质量总分及维度得分(除性行为维度外)显著高于对照组(均P<0.05)。结论 应用行动研究法优化前列腺癌患者放射性肠炎预防护理流程,可降低放射性肠炎发生率,改善患者心理困扰程度,提高生活质量。     

射波刀治疗前列腺癌致放射性直肠炎的护理

目的:探讨射波刀治疗前列腺癌放射性直肠炎的护理及对其效果的影响方法:选取68例前列腺癌患者作为观察组行特色放射性直肠炎护理、射波刀护理、皮肤护理,出院指导等各项针对性护理措施,提高射波刀治疗效果,同时以54例前列腺癌患者作为对照组,采用传统护理方法。比较两组患者射波刀治疗过程中放射性直肠炎的发生率及严重程度。结果:观察组患者放射性直肠炎发生率显著低于对照组(2.9% vs 13.0%,P0.05);两组放射性直肠炎严重程度比较,差异无统计学意义(P0.05)。结论:放射性直肠炎特色护理措施,可明显降低射波刀治疗过程中放射性直肠炎发生率,提高射波刀治疗前列腺癌的效果,值得在临床上广泛运用。     

放射性肠炎患者保留灌肠法的改进

目的探讨改良保留灌肠法治疗放射性肠炎的效果。方法将40侧放射性肠炎患者随机分为观察组和对照组各20例，对照组按照常规方法保留灌肠。观察组采用增加药液剂量和插管深度等改良方法，比较两组治疗效果。缮果观察组治愈率显著高于对照组（P〈0．05）。结论改良保留灌肠法可提高放射性肠炎治疗效果。     

放射性肠炎患者保留灌肠法的改进

目的 探讨改良保留灌肠法治疗放射性肠炎的效果.方法 将40例放射性肠炎患者随机分为观察组和对照组各20例,对照组按照常规方法 保留灌肠,观察组采用增加药液剂量和插管深度等改良方法,比较两组治疗效果.结果 观察组治愈率显著高于对照组(P＜0.05).结论 改良保留灌肠法可提高放射性肠炎治疗效果.     

白玉膏预防放射性皮炎效果观察

目的观察白玉膏预防放射性皮炎的效果。方法将69例接受放射治疗（下称放疗）的肿瘤患者随机分为观察组（34例）和对照组（35例），对照组行常规护理，观察组于每次放疗后采用白玉膏均匀外涂放疗野皮肤，直至放疗结束后2周。结果观察组放射性皮炎发生率及发生程度显著少于和轻于对照组，发生时间较对照组显著延迟（均P〈0．01）。结论白玉膏外敷对预防恶性肿瘤放疗患者放射性皮炎效果较好。     

白玉膏预防放射性皮炎效果观察

目的 观察白玉膏预防放射性皮炎的效果.方法 将69例接受放射治疗(下称放疗)的肿瘤患者随机分为观察组(34例)和对照组(35例),对照组行常规护理,观察组于每次放疗后采用白玉膏均匀外涂放疗野皮肤,直至放疗结束后2周.结果 观察组放射性皮炎发生率及发生程度显著少于和轻于对照组,发生时间较对照组显著延迟(均P＜0.01).结论 白玉膏外敷对预防恶性肿瘤放疗患者放射性皮炎效果较好.     

宫颈癌放射性皮肤损伤的标准化护理

目的减轻宫颈癌同期放化疗患者放射性皮肤损伤程度。方法将434例宫颈癌同期放化疗患者随机分为观察组与对照组各217例。两组均接受放疗联合同期化疗,对照组按常规进行放射性皮肤损伤防护;观察组根据患者放疗剂量及患者局部情况设计标准化防护方案、规范评估方法、统一防护操作技术防护流程,进行严格质量控制。结果观察组放射性皮肤损伤严重程度显著轻于对照组,会阴部卫生清洁合格率及内裤穿着合格率显著高于对照组(均P0.01)。结论标准化防护方案的实施可有效减轻宫颈癌同期放化疗患者放射性皮肤损伤程度,提高患者卫生防护行为。     

放射性口腔黏膜炎患者医护一体化疼痛护理干预

目的探讨基于医护一体化的疼痛护理干预对放射性口腔黏膜炎患者生存质量及营养状态的影响。方法将100例鼻咽癌放疗患者分为观察组和对照组各50例,对照组实施常规护理,观察组给予医护一体化管理模式下的疼痛护理干预。比较两组患者放射性口腔黏膜炎及放射性口腔疼痛发生程度、营养状况及生存质量评分。结果观察组患者放射性口腔黏膜炎、放射性口腔疼痛发生程度显著轻于对照组(均P0.01),营养风险评分显著低于对照组,生存质量评分显著优于对照组(均P0.01)。结论医护一体化疼痛管理模式可降低鼻咽癌放疗患者放射性口腔黏膜炎及放射性口腔疼痛的发生程度,改善营养状况及生活质量。     

早期功能锻炼减轻鼻咽癌患者放疗反应的效果观察

目的 探讨早期功能锻炼减轻鼻咽癌患者放疗反应的效果。方法 将126例鼻咽癌放疗患者随机分为观察组（64例）和对照组（62例）。对照组行放疗常规护理．观察组在常规护理的基础上实施系统化的早期功能锻炼，即患者入院后．参加头颈部放疗患者功能锻炼培训班，由健康教育护士授课，讲解早期功能锻炼的方法并带领患者进行集体康复操锻炼。结果 观察组放疗后口腔黏膜反应、张口困难、副鼻窦炎、中耳炎、角膜损伤等放疗反应发生率显著低于对照组（均P〈0．05）。结论 早期功能锻炼有助于减轻患者放疗反应，顺利完成治疗。     

抑菌护理凝胶联合阴道冲洗对宫颈癌患者急性放射性阴道炎的影响

目的探讨抑菌护理凝胶联合阴道冲洗预防宫颈癌所致急性放射性阴道炎的疗效及安全性。方法将接受根治性放疗宫颈癌患者100例随机分为观察组和对照组各50例,观察组采用阴道冲洗联合抑菌护理凝胶阴道涂抹,对照组采用常规阴道冲洗,比较两组急性放射性阴道炎发生情况。结果对照组急性放射性阴道炎发生率为86.0%,观察组为50.0%,观察组显著低于对照组,且观察组放射性阴道炎程度显著轻于对照组,发生时间显著晚于对照组(均P<0.01)。结论对宫颈癌根治性放疗患者行阴道冲洗联合抑菌护理凝胶阴道涂抹,可降低放射性阴道炎发生率及其严重程度。     

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.     

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.