妇科癌症患者化疗致周围神经病变与平衡功能及生活质量的相关性研究

目的探讨妇科癌症患者化疗致周围神经病病变(CIPN)、平衡功能和生活质量的的相关性,为患者化疗期间护理干预提供参考。方法采用便利抽样法选取妇科癌症患者219例,应用一般资料调查表、化疗致周围神经病变评估量表、Berg平衡量表、癌症患者生活质量量表进行横断面调查。结果妇科癌症患者化疗致周围神经病变的症状体验得分为(83.08±47.74)分、化疗所致周围神经病变对日常生活影响得分为(41.35±20.59)分;68.49%患者有跌倒风险,癌症患者生活质量量表得分为(50.65±17.74)分;有跌倒风险的妇科癌症患者CIPN症状得分、CIPN对日常生活的影响得分较高(均P0.01)。相关性分析显示妇科癌症患者整体生活质量与CIPN症状得分、CIPN对日常生活的影响得分呈负相关(均P0.01)。结论 CIPN在妇科癌症患者中比较常见,影响患者的日常活动,增加跌倒风险,在一定程度上导致其生活质量下降。医务人员应及时采取有效措施减轻化疗致周围神经病变,以提高患者生活质量。     

柔韧性训练对老年糖尿病周围神经病变患者平衡功能的影响

目的 探讨柔韧性训练对老年糖尿病周围神经病变患者平衡功能的影响。方法 在上海市两家社区卫生服务中心招募老年糖尿病周围神经病变患者88例，采用抽签法分为干预组(45例)和对照组(43例)。对照组接受社区糖尿病健康教育和常规运动干预，干预组接受社区糖尿病健康教育和柔韧性训练，均干预3个月，观察两组踝关节活动度、平衡功能及步态稳定性。结果 干预组43例、对照组42例完成研究。干预3个月后，干预组闭眼单足站立测试时间、起立-行走计时测试时间、足底压力中心轨迹曲线异常比例及全足压力变化曲线比例显著优于对照组(均P<0.05)。结论 柔韧性训练可改善老年糖尿病周围神经病变患者的平衡功能及步态稳定性。     

居家不出老年人奥塔戈运动锻炼项目的实施

目的探讨奥塔戈运动锻炼项目对居家不出老年人移动能力和跌倒效能的影响。方法以家庭访视和电话随访的形式,对36例居家不出老年人进行个体化的、为期6个月的奥塔戈运动训练。结果 30例居家不出老年人完成此训练项目;干预期间发生3例(5例次)跌倒事件;干预6个月后,居家不出老年人的计时起立—行走测试时间显著低于干预前,平衡力得分、跌倒效能得分显著高于干预前,差异有统计学意义(均P0.01)。结论奥塔戈运动锻炼可提高居家不出老年人的移动能力和跌倒效能,对预防老年人跌倒有一定的作用。     

肢体运动训练对多发性骨髓瘤化疗致 周围神经病变患者的影响

目的 探讨基于周围神经病变的运动模式(Exercise for Peripheral Neuropathy, EPN)改良版肢体运动训练对多发性骨髓瘤化疗致周围神经病变患者生活质量及周围神经病变的改善效果。方法 将多发性骨髓瘤化疗致周围神经病变患者61例按随机数字表法分为对照组和干预组。对照组进行常规基础运动训练,干预组进行EPN改良版肢体运动训练,持续4周。干预前后对两组生活质量、神经病变严重程度进行比较。结果 共59例患者（干预组31例,对照组28例）完成研究。干预后,干预组生活质量得分(107.23±12.21)分,周围神经病变严重程度得分［7.00(7.00,9.00)］分,对照组分别为(95.04±15.11)分、［9.00(9.00,10.00)］分,两组比较,差异有统计学意义(均P<0.05)。结论 基于EPN改良版肢体运动训练能提高多发性骨髓瘤化疗致周围神经病变患者生活质量,有效改善其周围神经病变情况,且简便易行,安全有效。     

坐站训练联合视觉反馈平衡训练对偏瘫患者平衡功能和ADL的影响

目的:探讨坐站训练联合视觉反馈平衡训练对偏瘫患者平衡功能和ADL的影响.方法:脑卒中偏瘫患者48例,随机分为两组,对照组24例,观察组24例,两组患者均给予常规康复治疗,观察组在此基础上给予强化坐站训练和站立位视觉反馈平衡训练,共治疗4周.分别于治疗前后评估跌倒指数、起立-行走计时测试、巴氏指数.结果:治疗前观察组与对照组间跌倒指数分布、起立-行走计时测试和巴氏指数的差异均无显著性意义(P>0.05),经过4周治疗,两组的跌倒指数分布、起立-行走计时测试和巴氏指数均较治疗前明显改善(P＜0.05);各指标在观察组均优于对照组,差异有显著性意义.结论:坐站训练联合视觉反馈平衡训练明显改善了脑卒中偏瘫患者的平衡能力,促进了日常生活能力的提高,是有效的偏瘫康复治疗手段.     

平衡及肌力运动操降低老年患者跌倒

目的探讨平衡及肌力运动操降低老年患者跌倒的效果。方法将80例具有一定行走能力的老年患者随机分为对照组和观察组各40例。对照组采用常规预防跌倒的措施并强调加强散步等体育锻炼;观察组在此基础上,进行平衡及肌力运动操训练。结果训练8周后观察组Berg平衡量表评分及Motricity指数中下肢肌力积分显著高于对照组（均P〈0.01）;观察组住院期间跌倒发生率低于对照组。结论平衡及肌力运动操能提高老年患者的平衡能力及肌力,从而降低老年患者的跌倒风险。     

基于PASS理论的方步运动方案在卒中后认知障碍患者中的应用

目的 观察基于PASS理论构建的方步运动方案对卒中后认知障碍患者认知功能、平衡功能、跌倒风险的影响。方法 将卒中后认知障碍患者随机分为观察组41例，对照组39例。对照组实施常规专科护理、康复训练和认知训练，观察组在对照组基础上采取基于PASS理论构建的方步运动方案干预，比较两组干预效果。结果 干预1个月、3个月、6个月后，观察组蒙特利尔认知评估量表评分、Berg平衡量表评分显著高于对照组，Morse跌倒评估量表评分显著低于对照组(均P<0.05)。结论 基于PASS理论构建的方步运动方案能够改善卒中后认知障碍患者的认知功能、平衡能力，降低患者跌倒风险。     

平衡及肌力运动操降低老年患者跌倒

目的探讨平衡及肌力运动操降低老年患者跌倒的效果。方法将80例具有一定行走能力的老年患者随机分为对照组和观察组各40例。对照组采用常规预防跌倒的措施并强调加强散步等体育锻炼;观察组在此基础上,进行平衡及肌力运动操训练。结果训练8周后观察组Berg平衡量表评分及Motricity指数中下肢肌力积分显著高于对照组(均P0.01);观察组住院期间跌倒发生率低于对照组。结论平衡及肌力运动操能提高老年患者的平衡能力及肌力,从而降低老年患者的跌倒风险。     

平衡功能训练对康复期脑卒中患者预防跌倒的作用

目的探讨平衡功能训练对康复期脑卒中患者跌倒预防的作用。方法将108例康复期脑卒中患者采用随机数字表法分为观察组与对照组各54例,对照组按常规进行康复训练,观察组在常规康复训练基础上实施静态坐位及站立的平衡功能训练。比较出院后3个月两组跌倒和Berg平衡量表得分情况。结果观察组跌倒发生率显著低于对照组,Berg平衡量表得分显著高于对照组(P0.05,P0.01)。结论对康复期脑卒中患者早期开展并长期坚持平衡功能训练,能有效提高患者身体平衡能力,降低跌倒的发生。     

结直肠癌患者化疗间歇期静态行为现状及影响因素分析

目的 调查结直肠患者化疗间歇期静态行为现状,并分析其影响因素,为提高患者体力活动水平提供参考。 方法 采取便利抽样方法抽取200例住院结直肠化疗间歇期患者,采用一般资料问卷、静态行为问卷、国际跌倒效能感量表、运动障碍量表和家庭关怀度量表进行调查。 结果 结直肠癌患者化疗间歇期静态行为时间为7.6（5.5,8.6）h,静态行为≥6 h 136例（68.00%）。年龄、化疗周期、疼痛、跌倒效能感水平、家庭关怀度是结直肠癌患者化疗间歇期静态行为的影响因素（均P＜0.05）。 结论 结直肠癌患者化疗间歇期静态行为时间较长,医护人员需根据危险因素采取针对性的措施积极干预,改善患者的静态行为。     

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.