乳腺癌患者经验性回避在医疗社会支持与失志综合征间的中介作用

目的 探讨乳腺癌患者经验性回避在医疗社会支持与失志综合征间的中介作用,为制订针对性的措施降低患者失志综合征水平提供参考。 方法 采用一般资料调查表、失志量表、接纳与行动问卷、医疗社会支持量表对364例乳腺癌患者进行调查。 结果 乳腺癌患者失志量表得分（32.04±12.10）分,经验性回避得分（23.05±8.21）分,医疗社会支持得分（65.05±14.88）分;乳腺癌患者失志量表总分及各维度评分与医疗社会支持量表总分及各维度评分呈负相关,与接纳与行动问卷评分呈正相关,医疗社会支持与接纳与行动问卷评分呈负相关（均P＜0.05）。Bootstrap分析显示,乳腺癌患者医疗社会支持对失志综合征的总效应为-0.570,直接效应为-0.339,间接效应为-0.231（均P＜0.05）,中介效应占总效应值的40.5%。 结论 乳腺癌患者经验性回避在医疗社会支持与失志综合征间起部分中介作用,医护人员应为患者提供全面支持,提高其自我接纳水平,进而降低其失志水平。     

新诊断糖尿病住院患者糖尿病痛苦现状及影响因素研究

目的调查新诊断糖尿病住院患者(新诊断患者)的糖尿病痛苦现状,探讨其影响因素,为开展针对性干预提供参考。方法采用领悟社会支持量表、医学应对方式问卷、中文版糖尿病痛苦量表对100例新诊断患者进行问卷调查。结果新诊断患者的糖尿病痛苦总分1.88±0.71;35.0%存在糖尿病痛苦;糖尿病痛苦总分及各维度得分与领悟社会支持总分及各维度呈负相关,与屈服、回避因子呈正相关(P<0.05,P<0.01);屈服应对方式、领悟社会支持和住院时间是患者糖尿病痛苦的影响因素(调整R2=0.414)。结论新诊断患者糖尿病痛苦发生率高,受屈服应对方式、领悟社会支持及住院时间的影响,医护人员应及时评估和引导患者积极应对,以减少其糖尿病痛苦。     

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。     

农村HIV感染者和AIDS患者应对方式、社会支持及心理健康状况调查分析

目的 了解农村HIV感染者和AIDS患者的应对方式、社会支持、心理健康状况及其相关性.方法 采用医学应对方式问卷(MCMQ)、领悟社会支持问卷(PSSS)及症状自评量表(SCL-90)对94例农村HIV感染者和AIDS患者进行调查分析.结果 MCMQ中面对得分最高(21.70±3.82),回避次之(17.19±3.49),屈服最低(10.36±3.25);PSSS总分为62.50士12.79,呈较高水平;除敌对因子外,SCL-90总分及各因子得分均超过阳性病例筛选分界线;53.3%(52/94)有心理障碍,89.4%(84/94)有轻度心理问题.屈服、回避与心理健康状况呈显著正相关(P＜0.05,P＜0.01),面对和社会支持与心理健康状况无显著相关性(均P＞0.05).结论 农村HIV感染者和AIDS患者采取的主要应对方式为面对,并拥有较好的领悟社会支持,但心理健康水平低下;应予进一步的心理支持,提高其心理健康水平.     

急性胰腺炎患者心理应激情况与医学应对方式的关系以及基于IMB模型干预方案的效果研究

目的 探讨急性胰腺炎（AP）患者心理应激情况与医学应对方式的关系,研究基于信息-动机-行为技巧（information-motivation-behavioral skill,IMB）模型的综合干预对患者心理应激情况及医学应对方式的作用。方法 前瞻性选取西安交通大学第二附属医院2016年3月至2019年1月期间收治的AP患者100例,随机分为两组,对照组（50例）实施常规临床干预+常规护理干预,干预组（50例）实施基于IMB模型的综合干预。根据焦虑自评量表（SAS）和抑郁自评量表（SDS）,对比两组干预前及干预后7 d的焦虑、抑郁等不良心理状态;根据Herth希望量表（HHI）评估患者干预前后的差异;根据医学应对方式问卷（MCMQ）评价患者干预前后的医学应对方式。随后,采用线性回归法,分析患者心理应激情况与医学应对方式的关系。结果 干预前两组SAS评分、SDS评分、HHI量表各维度评分及HHI总分均无统计学差异（P＞0.05）;干预后两组SAS、SDS评分均低于干预前,且干预组评分下降程度高于对照组,差异均有统计学意义（P＜0.05）;两组HHI量表各维度评分及总分均高于干预前,且干预组评分上升程度高于对照组,差异均有统计学意义（P＜0.05）。干预前两组患者MCMQ问卷各分量表评分均无统计学差异（P＞0.05）;干预后的面对分量表评分高于干预前,回避、屈服分量表评分均低于干预前,差异均有统计学意义（P＜0.05）;经协方差分析,调整干预前的各分量表评分后,干预组干预后的面对分量表评分高于对照组,回避和屈服分量表评分均低于对照组,差异均有统计学意义（P＜0.05）。线性回归分析,SAS评分对患者医学应对方式“面对”情况有显著负向影响,对患者“回避”“屈服”情况均有显著正向影响;SDS评分对患者“面对”情况有显著负向影响,对患者“回避”情况无影响,但对患者“屈服”情况有显著正向影响;HHI总分对患者“面对”情况有显著正向影响,但对患者“回避”“屈服”情况均有显著负向影响。结论 急性胰腺炎患者可发生焦虑、抑郁且希望水平下降,会影响其医学应对方式;基于IMB模型的综合干预方案不仅可改善患者的心理应激情况,而且可进一步改善其医学应对方式。     

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.     

肺癌化疗患者应对方式与生存质量的相关性研究

目的 探讨肺癌化疗患者应对方式并探讨其与生存质量的相关性.方法 采用肺癌患者生存质量量表(QLICP-LU)、医学应对问卷(MCMQ)对148例住院肺癌化疗患者进行问卷调查.结果 肺癌化疗患者生存质量总分59.16±10.42,81.08%患者生活质量处于一般水平,18.92%处于较好水平;患者应对方式评分由高到低为面对、回避和屈服;面对与患者生存质量呈正相关,而回避和屈服与患者生存质量呈负相关(P＜0.05,P＜0.01).结论 肺癌化疗患者生存质量一般,应对方式与其生存质量相关,应鼓励患者采用面对的应对方式,避免回避和屈服.     

肺癌化疗患者应对方式与生存质量的相关性研究

目的探讨肺癌化疗患者应对方式并探讨其与生存质量的相关性。方法采用肺癌患者生存质量量表（QLICP-LU）、医学应对问卷（MCMQ）对148例住院肺癌化疗患者进行问卷调查。结果肺癌化疗患者生存质量总分59．16±10．42,81．08％患者生活质量处于一般水平,18．92％处于较好水平;患者应对方式评分由高到低为面对、回避和屈服;面对与患者生存质量呈正相关,而回避和屈服与患者生存质量呈负相关（P〈0．05,P〈0．01）。结论肺癌化疗患者生存质量一般,应对方式与其生存质量相关,应鼓励患者采用面对的应对方式,避免回避和屈服。     

乳腺癌术后患者家庭复原力水平及影响因素的纵向研究

目的 了解乳腺癌患者术后6个月内家庭复原力水平变化轨迹及其影响因素。 方法 采用纵向研究设计，分别于术后确诊期（T0）、术后1个月（T1）、术后3个月（T2）、术后6个月（T3）4个时间点，应用患者一般资料调查表、家庭复原力量表、医学应对方式问卷、社会支持评定量表对222例术后乳腺癌患者进行随访调查。 结果 4个时间点乳腺癌患者家庭复原力总分依次为（98.95±11.31）分、（98.05±11.08）分、（99.38±10.57）分、（100.69±9.33）分。经广义估计方程分析，影响患者家庭复原力变化趋势的因素有：学历、居住地、在职状况、家庭月收入、子女数量、疾病分期、面对应对、社会支持（均P＜0.05）。 结论 乳腺癌患者术后6个月家庭复原力得分随着时间变化整体呈升高趋势，应重点关注学历低、居住偏远、无工作、家庭条件较差的患者，制定针对性干预策略，提高患者家庭复原力水平，促进家庭应对和疾病适应。     

妇科肿瘤患者医学应对及负性情绪在家庭关怀度与心理弹性间的中介作用

目的 评估妇科肿瘤患者心理弹性水平，并探讨与家庭关怀度、应对方式、负性情绪之间的关系。方法 采用家庭关怀度指数量表、医学应对量表、抑郁-焦虑-压力量表、心理弹性量表对224例妇科肿瘤患者进行调查。结果 妇科肿瘤患者心理弹性总分（50.88±15.17）分。家庭关怀度、医学应对的面对、回避维度与心理弹性呈正相关，负性情绪与心理弹性呈负相关（均P＜0.05）。结构方程模型显示，家庭关怀度对妇科肿瘤患者心理弹性的直接预测作用不显著；应对方式、负性情绪在患者家庭关怀度与心理弹性间起完全中介作用，并存在链式中介作用。家庭关怀度、屈服、回避、面对、负性情绪对心理弹性的总效应值分别为0.413、-0.356、0.200、0.186、-0.564。结论 家庭关怀度可以通过应对方式和负性情绪预测妇科肿瘤患者的心理弹性。医护人员可通过实施家庭干预为患者构筑家庭支持网络，指导患者采取合适的应对方式，科学管理负性情绪，以提高其心理弹性水平。     

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.     

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.     

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.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.