早产儿经口喂养综合干预方案的构建与实践

目的 探讨经口喂养综合干预 对NICU早产儿经口喂养能力的影响。 方法 便利选取104例在NICU住院的早产儿,按时间段分为对照组和干预组各52例。对照组进行常规发育支持护理;干预组在常规发育支持护理的基础上进行口腔运动干预、吞咽训练及触觉/动觉刺激联合应用的经口喂养综合干预 。 结果 对照组49例,干预组47例完成全程研究。两组早产儿非营养性吸吮功能评分均逐渐升高,干预组干预第7天、14天时非营养性吸吮功能评分显著高于对照组（均P＜0.05）;开始经口喂养时,干预组经口喂养效率、喂养成效、摄入奶量比显著高于对照组（均P＜0.05）;达完全经口喂养时,干预组早产儿喂养效率和喂养成效显著高于对照组（均P＜0.05）;干预组实现完全经口喂养所需时间显著低于对照组（P＜0.05）。 结论 经口喂养综合干预有助于提高早产儿经口喂养能力,改善经口喂养表现,缩短早产儿经口喂养进程。     

发展性照顾联合婴儿主导喂养方式在低出生体质量早产儿中的应用

目的 探讨对低出生体质量早产儿采用发展性照顾联合婴儿主导喂养方式护理干预的效果。方法 选择新生儿科收治的低出生体质量早产儿120例,随机分成观察组(60例,完成研究56例),对照组(60例,完成研究53例);在发展性照顾的基础上,观察组采用婴儿主导喂养方式干预,对照组采用医生主导喂养方式干预,干预时间为4周。观察两组经口喂养康复、生化、免疫、生长发育指标以及并发症情况。结果 干预4周后,观察组完全经口喂养时间、完全经口喂养时的纠正胎龄、过渡时间,以及NICU住院时间显著短于对照组,血清胃泌素和前白蛋白水平显著高于对照组,神经元特异性烯醇化酶显著低于对照组,CD3⁺和CD4⁺水平显著高于对照组,CD8⁺显著低于对照组,早产儿头围、身长和体质量增长显著高于对照组(均P<0.05);两组并发症发生率比较,差异无统计学意义(均P>0.05)。结论 发展性照顾联合婴儿主导喂养方式能提升低出生体质量早产儿的免疫功能,促进生长发育,改善营养状态和预后。     

母乳嗅觉刺激联合非营养性吸吮对早产儿喂养效果的影响

目的 探讨母乳嗅觉刺激联合非营养性吸吮对早产儿喂养进程及肠内营养并发症的影响,为早产儿营养支持提供参考。 方法 将114例早产儿按照随机数字表法分为对照组和干预组各57例。对照组给予常规管饲喂养护理;干预组在对照组基础上实施母乳嗅觉刺激联合非营养性吸吮,即用0.1 mL母乳（3滴）滴至早产儿舌下,并给予安抚奶嘴进行非营养性吸吮,同时用3 mL母乳将大棉签浸润后放置在距离早产儿鼻腔2～3 cm处进行嗅觉刺激。 结果 干预后,干预组全经口喂养时间、胃管留置时间、肠外营养维持时间及住院时间显著短于对照组（均P＜0.05）。两组开始经口喂养时间、出院体质量、喂养不耐受率及医院感染发生率差异无统计学意义（均P＞0.05）。 结论 母乳嗅觉刺激联合非营养性吸吮有利于缩短管饲喂养早产儿喂养过渡时间、胃管留置时间、肠外营养维持时间及住院时间,促进早产儿生长发育。     

多潘立酮联合腹部按摩治疗早产儿喂养不耐受效果观察

目的观察多潘立酮联合腹部按摩治疗早产儿喂养不耐受的效果。方法将78例喂养不耐受早产儿随机分为观察组（40例）和对照组（38例）．均给予保暖、抗感染、静脉营养、留置胃管鼻饲喂养．同时予以妈咪爱及胃蛋白酶助消化治疗。观察组在此基础上加用多潘立酮、腹部按摩,观察患儿喂养不耐受好转情况。结果观察组腹胀消失时间、达经口全胃肠喂养时间、拔除胃管时间均缩短．胃潴留量减少,与对照组比较,差异有统计学意义（均P〈0．01）。结论多潘立酮联用腹部按摩治疗早产儿喂养不耐受疗效显著。     

自编呼吸训练操在口腔喂养能力障碍早产儿中的应用

目的 探讨呼吸训练操应用于改善早产儿口腔喂养能力的效果。方法 将96例住院早产儿按时间段分为两组各48例,对照组行常规护理,观察组在此基础上采用自编呼吸训练操实施干预。结果 观察组干预10 d、15 d后非营养性吸吮评分显著高于对照组（均P＜0.01）;观察组留置胃管时间、经口喂养至全口喂养过渡时间显著短于对照组（均P＜0.01）。结论 呼吸训练操应用于早产儿可提高口腔喂养能力,加快经口喂养进程。     

嗅味觉刺激对管饲喂养早产儿的影响

目的 探讨嗅觉和味觉刺激对管饲喂养早产儿喂养进程及肠内营养并发症的影响,为早产儿营养支持提供参考.方法 将165例早产儿按照住院时间分为对照组76例和干预组89例.对照组给予常规管饲喂养护理,干预组在对照组基础上开展嗅觉和味觉刺激,即在管饲喂养前5 min用浸润母乳的纱布接近早产儿鼻孔提供嗅觉刺激,将母乳涂抹于早产儿嘴唇和舌头提供味觉刺激.结果 干预后,干预组喂养过渡时间、留置胃管时间、肠外营养维持时间显著短于对照组(P<0.05,P<0.01).两组住院时间及坏死性小肠结肠炎、自发性肠穿孔并发症发生率差异无统计学意义(均P>0.05).结论 开展嗅觉和味觉刺激有利于缩短管饲喂养早产儿喂养进程,缩短喂养过渡时间、留置胃管时间及肠外营养维持时间,促进早产儿康复.     

基于最佳证据的早产儿喂养护理实践

目的基于最佳证据建立早产儿喂养护理方案,探讨其临床应用效果。方法遵循JBI循证卫生保健模式,获得早产儿喂养的最佳证据。将2019年1～3月住院早产儿96例列入对照组,2019年5～7月住院早产儿129例列入观察组。对照组按常规喂养护理;观察组实施基于最佳证据的早产儿喂养护理方案。统计住院期间母乳喂养率、早产儿喂养不耐受发生率、开始经口喂养时间、达到全胃肠喂养时间、住院时间。结果观察组母乳喂养率显著高于对照组,早产儿喂养不耐受发生率显著低于对照组,住院时间显著短于对照组(P0.05,P0.01);两组早产儿开始经口喂养时间、达到全胃肠喂养时间比较,差异无统计学意义(均P0.05)。结论对早产儿实施基于最佳证据的早产儿喂养护理方案,可规范护士喂养行为,提高母乳喂养率,降低早产儿喂养不耐受发生率,提升早产儿护理质量。     

早期肛门刺激预防早产儿胎粪排出延迟的研究

目的观察早期肛门刺激预防早产儿胎粪排出延迟的效果。方法将100例早产儿按住院号分为干预组和对照组各50例,对照组予常规治疗与护理,干预组在此基础上于早产儿出生后12h内用10～12F医用橡胶肛管进行肛门刺激。结果两组初次排胎粪时间、每天大便次数、胎粪排清时间、需光疗例数及喂养不耐受例数、体质量增长速度等比较,差异有统计学意义(P<0.05,P<0.01)。结论早期肛门刺激能有效预防早产儿胎粪排出延迟,减轻黄疸,减少喂养不耐受,加快体质量增长。     

微量胃肠喂养联合肠外营养在早产儿中的应用观察

目的:评价微量胃肠喂养联合肠外营养在早产儿中的应用价值.方法:回顾性分析采用微量胃肠喂养联合肠外营养喂养方法的20例早产儿的体重增长及并发症相关情况.结果:20例均于生后9天内恢复出生时体重,5例出现并发症,经积极对症治疗,均康复出院.结论:微量胃肠喂养联合肠外营养应用于早产儿效果肯定,适宜推广应用.     

喂养延续护理对营养风险早产儿生长发育的影响

目的 对营养风险早产儿进行喂养延续护理管理,促进早产儿生长发育。 方法 将80例存在营养风险的早产儿随机分为对照组和观察组各40例。对照组进行常规护理,观察组采用延续护理喂养方案干预,评估出院早产儿纠正月龄1个月、3个月、6个月体格生长发育情况;进行体格生长发育Z评分;比较两组早产儿家长再入院率及纯母乳喂养情况。 结果 纠正月龄3、6个月观察组身长及其Z评分、体质量及其Z评分显著高于对照组（P＜0.05,P＜0.01）。观察组早产儿再入院率显著低于对照组,母乳喂养率显著高于对照组（P＜0.05,P＜0.01）。 结论 对营养风险早产儿进行喂养延续护理管理,能促进早产儿生长发育及母乳喂养。     

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.     

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.     

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.