房颤患者华法林自我管理现状及影响因素调查

目的了解房颤患者华法林自我管理现状,并探讨其影响因素,为房颤患者华法林自我管理干预措施的制定提供依据。方法便利抽取221例在心内科门诊就诊的口服华法林抗凝治疗的房颤患者,采用疾病感知问卷、服药信念量表与房颤患者口服华法林自我管理量表进行调查。结果房颤患者口服华法林自我管理总分为(31.93±5.51)分,疾病感知总分为(52.56±9.63)分,服药信念总分中位数为0.50分;不同居住方式、服药种数以及有无出血史患者口服华法林自我管理评分比较,差异有统计学意义(P0.05,P0.01)。房颤患者口服华法林自我管理总分与疾病感知总分、服药必要信念呈正相关(均P0.05),与服药顾虑信念呈负相关(P0.05)。多元逐步回归分析结果显示,疾病感知总分、服药必要信念与服药顾虑信念是房颤患者口服华法林自我管理的主要预测变量(调整R~2=0.882)。结论护理人员应关注房颤患者口服华法林自我管理水平,采取措施提高患者疾病感知水平,树立积极的服药信念,以提高患者口服华法林自我管理能力。     

社区老年高血压患者自测健康水平与自我管理状况的相关性研究

目的 了解社区老年高血压患者自测健康水平及自我管理现状,探讨两者之间的关系,为提高老年高血压控制率提供依据.方法 采用自测健康评定量表、自我管理状况问卷对福州市某社区342例老年高血压患者进行调查.结果 社区老年高血压患者的自测生理健康总分130.91±11.61,自测心理健康总分116.77±3.80,自测社会健康87.50±7.79;自我管理状况佳者18.13%,自我管理差者35.67%.自测健康与饮食控制、不吸烟、不饮酒、坚持运动、服药依从性、按时随访、体质量控制均呈显著相关;自测健康各子量表与自我管理部分项目显著相关(P＜0.05,P＜0.01).结论 高血压患者的自我管理状况与自测健康水平关系密切,社区护理人员应通过有效措施提升其社会健康水平,从而改善自我管理现状.     

社区老年类风湿关节炎患者自我管理行为对睡眠质量的影响

目的:探讨社区老年类风湿关节炎患者焦虑、抑郁水平及其睡眠质量,并分析两者的相关性。方法:采用慢性病自我管理量表和匹兹堡睡眠质量指数对220例社区老年类风湿关节炎患者进行问卷调查。结果:社区老年类风湿关节炎患者自我管理行为总分为(26.10±5.45)分,睡眠质量总分为(9.73±3.56)分,患者自我管理行为与睡眠质量总分呈负相关(r=-0.696,P<0.01)。结论:社区老年类风湿关节炎患者自我管理行为与睡眠质量密切相关。在今后工作中,应重视患者对疾病的自我管理行为,提供针对性的干预措施,提高患者的睡眠质量。     

空巢老年糖尿病患者自我管理水平与生存质量的相关性分析

目的研究分析空巢老年糖尿病患者的自我管理水平与生存质量的相关性。方法选择空巢老年糖尿病患者80例,对其自我管理水平、生存质量进行调查,并行相关性分析。结果 80例空巢老年糖尿病患者生存质量总分为(41.54±10.20)分。遵医嘱用药与生理功能、社会关系、治疗、生存质量总分呈正相关(均P<0.05);血糖自我监测与生理功能、心理、生存质量总分呈正相关(均P<0.05);运动自我管理、足部护理与心理、生理功能、社会关系、治疗和生存质量总分呈正相关(均P<0.05)。结论空巢老年糖尿病患者生存质量处于中等以上水平,其自我管理水平与生存质量呈正相关。医护人员应根据患者的实际情况制定合理、有效的健康计划,尽可能提高患者自我管理水平,从而改善其生存质量。     

社区老年高血压患者自测健康水平与自我管理状况的相关性研究

目的了解社区老年高血压患者自测健康水平及自我管理现状．探讨两者之间的关系．为提高老年高血压控制率提供依据。方法采用自测健康评定量表、自我管理状况问卷对福州市某社区342例老年高血压患者进行调查。结果社区老年高血压患者的自测生理健康总分130．91±11．61．自测心理健康总分116．77±3．80,自测社会健康87．50±7．79;自我管理状况佳者18．13％,自我管理差者35．67％。自测健康与饮食控制、不吸烟、不饮酒、坚持运动、服药依从性、按时随访、体质量控制均呈显著相关;自测健康各子量表与自我管理部分项目显著相关（P〈0．05,P〈0．01）。结论高血压患者的自我管理状况与自测健康水平关系密切,社区护理人员应通过有效措施提升其社会健康水平,从而改善自我管理现状。     

社区老年高血压患者自我超越与资源利用的相关性

目的了解社区老年高血压患者自我超越、资源利用现状,分析两者间的关系。方法应用自我超越量表、慢性病资源问卷对764例社区老年高血压患者进行调查。结果社区老年高血压患者自我超越(42.21±7.95)分,资源利用(77.84±11.47)分;自我超越与资源利用及其各维度呈正相关(P0.05,P0.01)。结论社区老年高血压患者自我超越、资源利用均处于中等水平,而且自我超越水平越高的患者其资源利用水平越高。     

养老机构糖尿病老年人并发症风险感知现况及影响因素研究

目的 了解养老机构糖尿病老年人并发症风险感知现况，分析其影响因素，为针对性干预提供参考。方法 采用一般资料调查表、糖尿病风险感知量表、广泛性焦虑障碍量表、简版老年抑郁量表对河北省5所养老机构中320例糖尿病老年人进行问卷调查。结果 养老机构糖尿病老年人并发症风险感知总分为2.03(1.89,2.24)分，焦虑总得分为6.00(5.00,8.00),抑郁总得分为6.00(4.00,8.00)。多因素分析结果显示，年龄、文化程度、家族史、病程、焦虑和抑郁是养老机构糖尿病老年人风险感知水平的主要影响因素(均P<0.05)。结论 养老机构糖尿病老年人并发症风险感知水平总体偏低，应针对性地采取干预措施，提高其并发症风险感知水平，以降低并发症发生率，延缓病情进展。     

老年COPD患者失志现象、健康内外控与疲劳感知关系的研究

目的探讨老年慢性阻塞性肺疾病(COPD)患者失志现象、健康内外控与疲劳感知的现状,为医护人员采取措施降低患者疲劳感提供参考。方法采用方便抽样法,COPD稳定期老年患者共249例为研究对象,使用失志量表、多维度健康内外控量表、多维度疲劳感知评估量表及自制患者一般资料调查表对患者进行调查。结果老年COPD患者失志现象、健康内外控、疲劳感知总均分分别为(3.87±0.83)分、(3.78±1.00)分、(3.67±1.07)分。老年COPD患者的失志现象、健康内外控与疲劳感知呈显著正相关(均P0.01)。结论老年COPD患者失志现象、健康内外控及疲劳感知处于中等偏上水平,失志现象、健康内外控越强,疲劳感知越高。医护人员应调动老年人自我管理疾病的积极性,不断强化健康教育,使其掌握COPD基本护理知识和技能,鼓励老年人参与力所能及的活动,减少对他人的依赖,唤起生命意义感,降低疲劳感,最终改善其身心健康状态。     

老年慢性肾脏病早期患者疾病相关知识与自我管理能力的相关性

目的了解老年慢性肾脏病早期(1～3期)患者自我管理能力及疾病相关知识掌握现状,分析疾病相关知识对自我管理能力的影响,为针对性干预提供依据。方法采用疾病相关知识问卷和慢性肾脏病早期患者自我管理量表,对213例老年慢性肾脏病早期患者进行调查。结果 213例患者自我管理能力得分为(76.85±19.21)分,处于中等水平;疾病相关知识得分为(20.56±10.82)分,处于低等水平;自我管理能力及各维度与疾病相关知识呈显著正相关(均P0.01);疾病相关知识能解释自我管理能力35.7%的变异,对自我管理能力有正向预测作用(P0.01)。结论老年慢性肾脏病早期患者的疾病相关知识和自我管理能力均有待提高,应加强对该类患者的健康宣教,提高其疾病相关知识水平及自我管理能力,达到延缓疾病进展和增进健康的目的。     

直肠癌保肛术后患者肠道症状自我管理行为与社会支持现状调查

目的了解直肠癌保肛术后患者肠道症状的自我管理行为与社会支持现状,为改进肠道症状管理提供参考。方法采用直肠癌保肛术后患者肠道症状自我管理行为问卷(BSSBQ)和社会支持评定量表(SRSS)对102例直肠癌保肛术后患者进行问卷调查。结果直肠癌保肛术后患者肠道症状自我管理行为得分为(26.35±8.97)分;社会支持总分为(30.71±4.84)分;自我管理行为与社会支持评分呈正相关(P0.01)。结论直肠癌保肛术后患者肠道症状自我管理水平有待改善,增强社会支持有助于提高其肠道症状的自我管理水平。     

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.     

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.