前列腺素E1对肝移植术中肺通气及血流的影响

目的探讨前列腺素E1(PGE1)对新肝期肺通气、血流的影响.方法 20例背驮式原位肝移植患者,随机分为两组,试验组在移植肝血流开放后,经Swan-Ganz导管右房通道持续泵入PGE1 10～20ng·kg-1·min-1.同时监测血液动力学、氧代谢等参数.结果新肝期5min及30min试验组肺动脉压(PAP)较对照组降低(P<0.05),肺内分流亦有所改善(P<0.05).结论在肝移植手术新肝期,小剂量应用PGE1可有效地降低肺动脉压,减少肺内分流,改善氧合,而对体循环无影响.     

前列腺素E1在治疗风湿性心脏病合并肺动脉高压患者中的时-效关系和量-效关系

目的:探讨前列腺素E1(prostaglandin E1,PGE1)在治疗风湿性心脏病合并肺动脉高压中的时-效关系和量-效关系.方法:选择49例肺动脉高压患者,应用PGE1 20 ng/(kg·min)后分别于0、5、10、20、30min时检测平均动脉压(mAP)、平均肺动脉压(mPAP)、平均肺毛细血管楔压(mPCWP)、心脏指数(CI)、心率(HR)、动脉血氧分压(PO2)、动脉血二氧化碳分压(PCO2)、血氧饱和度(SO2)、平均气道压力(mVP)等血流动力学指标的变化,以探讨其时-效关系.分别应用PGE1 5、10、20、40、80 ng/(kg·min)不同剂量后检测上述指标的变化,以确定其量-效关系.结果:应用PGE1 20 ng/(kg·min)5 min后,上述各项指标变化不明显(P＞0.05).用药10 min后mPA及mPCWP明显降低(P＜0.05),CI明显增加(P＜0.05),其他指标变化不明显(P＞0.05).用药20min后mPAP及mPCWP进一步降低(P＜0.05),CI进一步升高(P＜0.05).用药30 min后mPAP及mPCWP不再进一步降低(P＜0.05),CI不再进一步升高(P＜0.05),上述三项指标变化趋于稳定,其他指标无明显变化(P＞0.05).应用PGE1剂量为5、10 ng/(kg·min)后,上述各项指标变化不明显(P＞0.05).应用PGE1 20 ng/(kg·min)后mPAP及mPCWP明显降低(P＜0.05),CI明显升高(P＜0.05),其他指标变化不明显(P＞0.05).应用PGE1 40、80 ng/(kg·min)后mPAP及mPCWP有进一步降低、CI进一步升高的趋势.应用PGE1为40 ng/(kg·min)时各变化指标达最高峰,但20、40、80 ng/(kg·min)剂量间差异无显著性(P＞0.05).应用PGE1超过80 ng/(kg·min)后,mPAP及mPCWP不再进一步降低,CI不再进一步升高,而mAP则明显降低(P＜0.05),HR明显增加(P＜0.05),其他指标无明显变化(P＞0.05).结论:应用PGE1 20 ng/(kg·min)对风心病引起的肺动脉高压的治疗作用于10 min后开始起作用,20、30min后趋于平稳,PGE1的最佳有效剂量为20～40 ng/(kg·min).     

心脏介入治疗和微循环及心功能的关系

目的评价心脏介入治疗前后微循环的血流变化及其意义.方法用指尖脉搏图波幅高度的变化反映微循环血流和心脏介入治疗的关系.结果(1)PTCA、PMR和显性预激组介入治疗后指尖脉搏图波幅明显高于治疗前(P<0.001),隐匿性WPW组治疗前后无明显变化(P>0.05);(2)PTCA组治疗前、治疗后指尖脉搏图波幅均高于PMR组(P<0.001);(3)隐匿性WPW组治疗前指尖脉搏图波幅高于显性WPW组(P<0.001),但治疗后两者无显著性差异(P>0.05);(4)显性WPW组治疗前指尖脉搏图波幅高于PTCA组(P<0.05),但治疗后无显著性差异(P>0.05).结论冠状动脉血管狭窄和心脏除极顺序的改变均可使微循环灌注减少;心脏介入治疗后微循环灌注均有改善.     

急性呼吸窘迫综合征绵羊模型的建立

目的探讨静脉泵入小剂量内毒素(LPS)建立绵羊急性呼吸窘迫综合征(ARDS)模型的可行性。方法13只绵羊在全麻和肌松后,3μg/kgLPS于30分钟或6μg/kgLPS于60分钟内静脉泵入,每0.5小时监测血流动力学和氧代谢、肺气体交换和肺机械力学参数的变化,观察4小时内是否达到ARDS诊断标准以及动物的血流动力学和肺机械力学是否稳定。结果静脉泵入LPS后(3.1±1.2)小时内,10只绵羊达到ARDS诊断标准。与基础值相比,LPS静脉泵入后1小时,氧合指数明显下降(P<0.05),之后缓慢降低,3小时后稳定;心排血指数明显下降(P<0.05),3.5小时后恢复至基础值水平并稳定;氧输送也显著降低(P<0.05),3.5小时后稳定。实验过程中,肺动脉楔压为1.10～1.60kPa,中心静脉压为0.90～1.70kPa。与基础值相比,LPS静脉泵入后1.5小时,气道阻力、气道峰值压和平均气道压明显上升,动态肺顺应性明显下降(t值分别2.8、4.2、5.3和3.1,P均<0.05),分别于3.0小时和2.5小时后平稳,均无显著改变。达到ARDS诊断标准后(8.1±1.4)小时内,该模型动物血流动力学和肺机械力学均处于稳定状态。结论全麻和肌肉松弛状态下,小剂量LPS静脉泵入可快速复制血流动力学和肺机械力学均稳定的ARDS绵羊动物模型。     

醋酸精氨酸对严重烧伤家兔免疫功能的影响及其量效关系

目的 :研究醋酸精氨酸对严重烧伤家兔免疫功能的影响及其量效关系。方法 :采用家兔 (6 4只 ) 30 %体表面积 度烧伤后灌喂醋酸精氨酸模型 ,5 2只存活兔随机分成 6组 :正常对照组 (8只 ) ,烧伤对照组 (9只 )及醋酸精氨酸喂养 2 .4 g· kg- 1 · d- 1 组 (9只 )、1.2 g· kg- 1 · d- 1 组 (9只 )、0 .6 g· kg- 1 · d- 1 组 (9只 )、0 .3g· kg- 1· d- 1组 (8只 )。烧伤对照组予 1.2 g· kg- 1· d- 1酪氨酸 ,观察给药 7日后不同剂量精氨酸对烧伤家兔免疫功能的影响。结果 :烧伤 7日后各组动物免疫功能均明显下降 ,淋巴细胞转化率、白细胞吞噬率及趋化指数、血浆免疫球蛋白、CD4 / CD8比值均不同程度下降。精氨酸 1.2 g· kg- 1 · d- 1 组和 2 .4 g· kg- 1 · d- 1 组各项免疫指标均明显优于烧伤对照组 ,0 .3g· kg- 1· d- 1组和 0 .6 g· kg- 1· d- 1组与烧伤对照组相比变化不明显 ,但 2 .4 g· kg- 1 · d- 1 组动物死亡率有所上升。结论 :严重烧伤家兔机体免疫功能下降 ,经肠道补充精氨酸1.2 g· kg- 1· d- 1和 2 .4 g· kg- 1· d- 1能有效提高伤后免疫功能 ,以 1.2 g· kg- 1· d- 1效果最好 ,动物死亡率最低     

生脉注射液静注对麻醉犬血流动力学影响的实验研究

目的探讨静注生脉注射液对麻醉犬血流动力学的影响。方法10只健康杂种犬麻醉后,静注生脉注射液5～10ml。于用药前和用药后连续监测主动脉内收缩压、舒张压、平均动脉压和心率等变化。并测定用药前后心输出量变化。结果生脉注射液静注后5分钟内血压开始下降,20分钟时主动脉平均动脉压降至(9.5±2.2)kPa(1kPa=7.5mmHg),与用药前〔（14.9±7.0)kPa〕相比有显著性差异(P<0.05)。但此时心率与用药前相比无显著变化(P>0.05)。且不同注射剂量的生脉注射液产生的降压幅度存在差异,提示生脉注射液存在一定的量效关系。同时发现静注生脉注射液对心输出量无影响。结论生脉注射液静注对麻醉犬正常血压有明显的降压作用,对心率和心输出量无明显影响。     

浅快呼吸指数和气道闭合压作为呼吸机撤离指标的临床研究

目的探讨浅快呼吸指数(RVR)和气道闭合压对机械通气患者撤机的指导意义.方法将准备撤机的90例患者按呼吸衰竭病因分为慢性阻塞性肺疾病(COPD)急性恶化组和急性呼吸衰竭(ARF)组.床旁监测呼吸频率(RR)、潮气量、每分钟通气量(MV)、气道阻力(Raw)、顺应性、气道闭合压、内源性呼气末正压(PEEPi);在自主呼吸试验开始3分钟和30分钟时分别测定RR、潮气量,比较常规撤机指标(RR、潮气量、MV)与RVR、气道闭合压对撤机的预测价值.结果撤机成功与失败组RVR分别为COPD急性恶化组(63±22)次*min-1*L-1与(91±20)次*min-1*L-1,P<0.05;ARF组(63±21)次*min-1*L-1与(81±21)次*min-1*L-1,P<0.05;全部患者组(63±21)次*min-1*L-1与(88±20)次*min-1*L-1,P<0.05.撤机成功与失败组的气道闭合压分别为COPD急性恶化组(0.28±0.08)kPa与(0.47±0.07)kPa,P<0.05;ARF组(0.27±0.05)kPa与(0.40±0.08)kPa,P<0.05;全部患者组(0.28±0.08)kPa与(0.45±0.08)kPa,P<0.05.以RVR≤105次*min-1*L-1为标准预测撤机成功的诊断正确率、灵敏度和特异度,3组分别为COPD急性恶化组79%、91%和40%;ARF组79%、96%和17%;全部患者组79%、93%和33%.以气道闭合压≤0.44 kPa为标准预测撤机成功的诊断正确率、灵敏度和特异度,3组分别为COPD急性恶化组82%、87%和67%;ARF组83%、96%和50%;全部患者组83%、90%和62%.以撤机后果作为因变量进行Logistic回归分析显示只有RVR与气道闭合压是回归模型中有显著性的两个指标.结论RVR与气道闭合压在预测撤机后果上优于常规撤机指标.     

脑梗死患者血清IL-6和TGF-β1的动态检测及其意义

目的探讨脑梗死患者发病后血清白细胞介素-6(IL-6)和转化生长因子β1(TGB-β1)的变化特点及其意义.方法采用双抗体夹心酶联免疫吸附试验(ELISA)法对31例脑梗死患者血清IL-6和TGF-β1进行动态检测.结果脑梗死患者血清IL-6在发病后第1天升至最高[(48.4±10.4)ng/L],随后逐渐下降,第3天和第7天分别下降至(38.2±9.6)ng/L和(31.4±6.8)ng/L,第7天仍显著高于对照组[(23.7±5.9)ng/L,P<0.01].轻、中、重三型脑梗死组间在同一时间段差异无显著性(P>0.05).在不同大小梗死灶间除发病后第1天组间差异有显著性外(F=4.13,P<0.05),其它时间段差异无显著性(P>0.05),其峰值与病情轻重无关(rs=0.186,P>0.05),而其与梗死灶大小呈正相关(rs=0.508,P<0.01);脑梗死患者血清TGF-β1在发病后第1天为最低,随后渐升,至第7天接近对照组[(42.1±8.2)μg/L],其变化与病情轻重或梗死灶大小无显著相关(P>0.05).结论结果提示IL-6和TGF-β1可能都参与了脑梗死的免疫-炎症反应;动态检测IL-6和TGF-β1有助于脑梗死的病情监测和治疗.     

多巴酚丁胺负荷超声心动图结合应变率评价冠心病的临床研究

目的探讨多巴酚丁胺负荷超声心动图(DSE)结合应变率技术诊断冠心病的价值。方法对28例可疑冠心病者进行大剂量DSE,测量12个节段正常者和冠心病缺血的节段收缩期最大应变率(SRSYS)。经冠状动脉造影证实10例为单支病变,8例为多支病变,10例正常。结果正常人SRSYS随着DSE剂量的增加而逐渐增大。单支病变者,缺血节段的SRSYS静息状态、10、20μg·kg-1·min-1时逐渐增大,但30μg·kg-1·min-1时再无显著增大,40μg·kg-1·min-1时反而减小。多支病变者,缺血节段的SRSYS10μg·kg-1·min-1时增大,20μg·kg-1·min-1时已无明显增加,40μg·kg-1·min-1时显著降低。结论DSE与应变率结合定量评价局部心肌运动变化可为临床诊断冠心病提供有价值的信息。     

多巴酚丁胺负荷试验对原发性扩张型心肌病心室同步性影响的研究

目的　探讨多巴酚丁胺对原发性扩张型心肌病(DCM)电机械活动同步性的作用。方法　18例DCM患者应用多巴酚丁胺超声心动图负荷试验(DSE)并结合心肌组织多普勒成像技术(DTI),分别于基础状态和多巴酚丁胺剂量为5、10、20μg·kg-1·min-1时测量左侧房室环左室电机械活动时间离散度(校正EM D)、左室心肌运动速度差(Sm D)和血流动力学等指标。结果　校正EM D和Sm D在基础状态和不同剂量多巴酚丁胺负荷时差异均无显著性意义(P>0. 05);血流动力学指标在负荷前后有显著变化(P<0. 05)。结论　多巴酚丁胺在改善DCM血流动力学的同时,没有恶化左心室电机械活动的同步性和心肌运动的同步性。     

The relationship standards and assumptions of violent versus nonviolent husbands

The present study was designed to compare the relationship standards and assumptions of violent and nonviolent husbands, using theRelationship Beliefs Inventory (Epstein & Eidelson, 1981) and theInventory of Specific Relationship standards (Epstein, Baucom, Rankin, & Burnett, 1991). Two groups of maritally violent and distressed men were recruited: 16 men arrested for violence and court-ordered to domestic violent treatment programs and 19 men from the community. Two noviolent comparison groups were recruited: 20 martially distressed men and 20 nondistressed men. A series of apriori contrasts revealed no significant differences between the violent/distressed and nonviolent/distressed groups. All demonstrated significant differences were between the distressed and nondistressed groups. Relative to nondistressed men, unhappily married men endorsed more dysfunctional standards and assumptions; they also reported being less satisfied with how their standards were being met by their partners and being more upset when their relationship standards were not met. The theoretical and clinical implications of the findings are discusse. This research was funded by a NIMH grant R-29-MH-46927, awarded to the first author. We would like to thank all of the research assistants who made this study possible; we particularly thank Nely Keinanen, Rose Young, Lori Bruner, Jay Jankowski, and Amy Pangburn.     

护患双方认知的差异性对建立和谐护患关系的影响

[目的]了解护患双方对医患关系认知的差异性,为建立和谐护患关系提供实践指导依据。[方法]采取整群随机抽样方法,对浙江省某市城区4家医院的部分护士和病人进行问卷调查。[结果]护患双方除了对医患关系重要性的认知一致外,对医患关系的性质和发展趋势、医患冲突的常见诱因、主要解决方式等方面的认知情况均有统计学意义。[结论]护患双方对医患关系的认知差异是导致护患间有效沟通的障碍,相互理解和彼此尊重是解决认知分歧和建立和谐护患关系的根本要求。     

护患关系和患际关系对住院病人的影响及护理对策

分析护患关系和患际关系对住院病人影响的途径,阐述护患关系和患际关系对住院病人的影响及其表现,提出改善护患关系和患际关系的护理对策.     

'Take my hand, help me out': mental health service recipients' experience of the therapeutic relationship

ABSTRACT: The purpose of this study was to describe mental health service recipients' experience of the therapeutic relationship. The research question was ‘what is therapeutic about the therapeutic relationship?’ This study was a secondary analysis of qualitative interviews conducted with persons with mental illness as part of a study of the experience of being understood. This secondary analysis used data from 20 interviews with community‐dwelling adults with mental illness, who were asked to talk about the experience of being understood by a health‐care provider. Data were analysed using an existential phenomenological approach. Individuals experienced therapeutic relationships against a backdrop of challenges, including mental illness, domestic violence, substance abuse, and homelessness. They had therapeutic relationships with nurses (psychiatric/mental health nurses and dialysis nurses), physicians (psychiatrists and general practitioners), psychologists, social workers, and counsellors. Experiences of the therapeutic relationship were expressed in three figural themes, titled using participants' own words: ‘relate to me’, ‘know me as a person’, and ‘get to the solution’. The ways in which these participants described therapeutic relationships challenge some long‐held beliefs, such as the use of touch, self‐disclosure, and blunt feedback. A therapeutic relationship for persons with mental illness requires in‐depth personal knowledge, which is acquired only with time, understanding, and skill. Knowing the whole person, rather than knowing the person only as a service recipient, is key for practising nurses and nurse educators interested in enhancing the therapeutic potential of relationships.     

The Mother-Child Relationship in the HIV-1 Positive Family

Qualitative data (N=80) from a larger study of HIV-1 positive mothers have revealed mother-child relationships, that is, a strong attachment along with a bond of secrecy. The relationship is described as a strong attachment along with a bond of secrecy. Children are perceived by the mothers as sources of support as well as sources of stress in the relationship. We conclude that practice and policy decisions concerning HIV-1 positive mothers should include emphasis on maintaining the health of the mother-child dyad, providing respite to mothers and providing support for future planning.     

Reachable Moment

If thou art one to whom petition is made, be calm as thou listenest to the petitioner's speech. Do not rebuff him before he has swept out his body or before he has said that for which he came. A petitioner likes attention to his words better than the fulfilling of that for which he came… It is not [necessary] that everything about which he has petitioned should come to pass, [but] a good hearing is a soothing of the heart. Vizier Ptah-Hotep, ca. 2450 B.C.E. (Before the Common Era, as cited in Ceresko, 1992, p. 275).     

Pilot Study for Back Pain Classes in the Elderly Community

No abstract available for this article.     

Stories: caring about caring

Nurses are with people as they experience a variety of life situations that are paradoxical in nature. In other words, these life experiences hold happiness and sadness, opportunities and limitations all at once.     

Heterosexual women rate perceived anabolic steroid-using men as less attractive for long-term romantic relationships

ABSTRACT

Background: Physical attractiveness is a major motive for anabolic-androgenic steroid (AAS) use. Since majority of AAS users are men, we investigated heterosexual women’s ratings of the physical, sexual and romantic attractiveness of AAS-using and non-using men.

Methods: A sample of 112 AAS-non-using heterosexual women (age range: 15–81, M = 29.61 years) was randomized to two independent conditions: food (n = 50) and AAS (n = 62). After exposure to a vignette (varied in AAS use or food consumption) and the target image of a moderately muscular man (same across conditions), participants in both conditions rated their respective target on physical, short-term sexual, and long-term romantic attractiveness. We compared ratings of the two targets using an independent t-test.

Results: Compared to the non-using target, the AAS-using target received lower ratings (t = ?2.61, p < .05, Cohen’s d = 0.50) on long-term romantic attractiveness.

Conclusion: Heterosexual women rate perceived AAS-using men as less attractive for long-term romantic relationships. Preventive and harm reduction interventions may benefit from highlighting this finding.     

对构建和谐医患关系的再思考

医疗卫生行业是社会和谐的窗口,构建和谐的医患关系,有利于社会安定团结,有利于医疗行业健康发展。本文剖析了现阶段造成不和谐医患关系的主要原因,提出了构建和谐医患关系的5点对策。