四川省手术室专科护士培训基地学员自主学习能力调查

目的 调查四川省手术室专科护士培训基地学员自主学习能力水平现状及其影响因素。方法 方便抽样选取四川省手术室专科护士培训基地343名学员为调查对象,应用自主学习能力测评量表进行调查。结果 手术室专科护士培训学员的自主学习能力总分为(113.39±18.26)分。多元线性回归分析显示,婚姻状况、最高学历、平均月工资、参加专科护士培训及外出参加学习或交流次数是学员自主学习能力的主要影响因素(P<0.05,P<0.01)。结论 手术室专科护士培训学员自主学习能力总体水平一般。护理管理者应鼓励学员提高自身学历水平、积极参加专科护士培训或学习,培训基地负责人应探索创新培训模式,多措并举提升学员自主学习能力。     

形成性评价在省级心血管专科护士培训中的应用

目的探讨形成性评价对省级心血管专科护士培训效果的影响。方法选取2014级和2015级心血管专科护士学员共32名为研究对象,2014级15名学员设为对照组,2015级17名学员设为观察组。对照组采用传统的终结性评价方式,观察组采用典型案例随堂评价、读书报告会展示、客观结构化临床考试等形成性评价方式。培训结束后,采用统一的心血管专业知识试卷、护理人员实践能力评定表和自主学习能力评定量表分别评价学员的专业理论成绩、临床实践能力和自主学习能力。结果观察组理论成绩、实践能力考核成绩、自主学习能力得分显著高于对照组(P0.05,P0.01)。结论在心血管专科护士培训中采用形成性评价可提高学员的理论学习成绩、临床实践能力和自主学习能力。     

PACU和ICU序贯模式在ICU专科护士培训中的应用

目的设计并应用一种较为理想的ICU专科护士培训方式,提高ICU专科护士的培训效果。方法将60名护士随机分成实验组与对照组各30人,两组理论培训2周后,实验组先在麻醉后监测治疗室(PACU)学习2周后再过渡到ICU学习4周,对照组直接进入ICU学习6周。在培训前和培训后分别对其进行理论和临床技能操作考试。结果实验组培训后理论及临床技能测试成绩显著高于对照组(均P<0.01)。实验组学员综合能力满意度为89.3%,对照组为65.3%,两组比较,差异有统计学意义(P<0.05)。结论 PACU和ICU序贯培训模式可循序渐进,提高培训效果。     

新护士基于学习风格的规范化培训效果评价

目的 探讨基于学习风格的培训模式在新护士规范化培训中的应用效果。方法 将2021年新护士63名设为对照组,2022年新护士61名设为观察组。对照组按照《新入职护士培训大纲(试行)》进行培训;观察组在培训大纲基础上根据学习风格分类匹配带教老师,同时根据新护士的学习方式偏好和学习特点提供相对应的学习环境及相匹配的教学方法。结果 培训1年后,观察组自主学习能力总分和各维度评分及临床推理能力得分显著高于对照组(均P<0.05);观察组理论考核成绩、客观结构化临床考试成绩及培训满意度显著高于对照组(均P<0.05)。结论 新护士基于学习风格的规范化培训有利于提升新护士自主学习能力、临床推理能力,提高培训效果及培训满意度。     

基于互动理论的深度学习模式在新护士急救能力培训中的应用

目的探讨互动式的深度学习教学模式在新护士的培训中的应用效果。方法将48名新护士随机分为实验组与对照组各24名,实验组采用移动终端互动式深度学习模式进行培训,对照组采用传统教学模式培训,培训结束后比较两组护士急救知识和技能水平,并采用临床急救能力评价表和教学培训调查问卷对培训效果进行评价。结果培训后实验组理论和操作考核成绩显著高于对照组,实验组急救能力、教学培训综合评价显著优于对照组(均P0.01)。结论应用基于互动理论的深度学习法能有效提高新护士的急救能力。     

睡眠管理培训对ICU护士睡眠管理能力及患者睡眠的影响

目的提高ICU护士对患者睡眠的管理能力,以及改善患者睡眠质量的效果。方法对40名ICU护士进行患者睡眠管理培训。将89名患者按照入住ICU的时间分成对照组和干预组,对照组实施常规护理措施,干预组在此基础上由接受睡眠管理培训的护士进行睡眠管理。结果培训后ICU护士的睡眠管理能力测评得分由培训前的(59.87±13.63)分上升至(80.89±15.02)分(P<0.01);干预组患者睡眠质量评分为(8.98±3.11)分,显著低于对照组的(11.27±4.01)分(P<0.01)。结论对ICU护士实施患者睡眠管理培训可以提高其睡眠管理的能力,对患者的睡眠状况进行正确评价,采取改善睡眠的措施,进而提高患者的睡眠质量。     

新护士岗前军事化封闭式培训的实践

目的探讨提高新护士岗前培训效果的有效方法。方法将102名新护士分为实验组(54名)和对照组(48名),分别采用军事化封闭式培训与传统方法培训。结果培训后实验组理论、操作成绩及对培训效果的评价显著优于对照组(均P<0.01)。结论军事化封闭式培训可提高新护士岗前培训效果。     

三联教学法在手术室新护士规范化培训中的应用

目的探讨三联教学方法在手术室新护士培训中的应用效果。方法对2011年7月至2013年7月入科的40名新护士(实验组)采用以授课为基础的教学方法 (LBL)、以问题为导向的教学方法 (PBL)及多媒体计算机(CAI)三联教学方法培训;对2008年7月至2010年7月入科的40名新护士(对照组)采用单一以授课为基础的传统教学法进行培训。结果实验组护士理论考试成绩、专科操作考试成绩显著高于对照组(均P0.05),实验组90.0%~97.5%对教学方法持肯定评价。结论三联教学方法在新护士规范化培训中起到良好的效果。     

地佐辛复合丙泊酚在宫腔镜电切术中麻醉的应用研究

目的 探讨地佐辛复合丙泊酚在宫腔镜电切术中的临床麻醉效果。方法 对本院收治的80例宫腔镜电切术患者资料进行分析,根据不同麻醉方法将患者分为对照组和实验组。对照组采用单纯丙泊酚麻醉,实验组采用地佐辛复合丙泊酚麻醉,比较两组麻醉效果。结果 实验组术后收缩压为(113.2±8.7)mm Hg、舒张压为(64.3±9.7)mm Hg、HR指标为(63.8±6.6)次/分,显著低于对照组(P<0.05);两组患者术后Sp O2差异不显著(P>0.05);两组麻醉起效时间差异不显著(P>0.05);实验组丙泊酚总用量为(220.2±24.2)分钟、意识恢复时间为(4.9±0.4)分钟,显著少于对照组(P<0.05);实验组清醒后5分钟VAS评分为(1.9±1.1)分、10分钟VAS评分为(1.7±1.2)分、20分钟VAS评分为(1.7±1.2)分、30分钟VAS评分为(1.8±1.2)分,显著低于对照组(P<0.05);实验组麻醉后不良反应发生率为7.5%,显著低于对照组(不良反应发生率为17.5%)(P<0.05)。结论 宫腔镜电切手术患者中采用地佐辛复合丙泊酚麻醉效果理想,值得推广使用。     

概念图护理查房对护士评判性思维能力的影响

目的探讨在护理查房中运用概念图对培养护士评判性思维能力的效果。方法将40名儿科护士按病区分为传统查房组(20名),采用传统模式进行护理查房;概念图查房组(20名)运用概念图进行护理查房。两组均每个月查房1次,持续12个月。采用评判性思维测评量表(CTDI-CV)测量干预前后两组评判性思维能力。结果实施前两组评判性思维总分及各特质得分比较,差异无统计学意义(均P>0.05);实施后两组评判性思维能力有不同程度的提高,但概念图查房组除寻找真相和认知成熟度外,其他特质和总分较传统查房组显著提高(P<0.05,P<0.01)。结论在护理查房中运用概念图,可开放思想,增强临床护士的求知欲和分析能力及系统化能力,提高评判性思维能力。     

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.     

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.     

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.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.