胫骨平台骨折术后患者动静平衡康复训练的实施

目的探讨动静平衡康复训练对胫骨平台骨折术后患者平衡和行走功能的影响。方法按随机数字表法将66例胫骨平台骨折钢板内固定术后患者分为观察组和对照组各33例,对照组术后按常规进行康复训练,即在无痛状态下指导患者进行肢体被动、主动锻炼,观察组进行动静平衡康复训练,于术后4周比较两组患者康复疗效、膝关节功能、肌力及活动舒适度。结果观察组关节功能康复效果、肌力恢复程度及膝关节功能评分显著优于或高于对照组(P0.05,P0.01)。结论遵循"动静平衡"原理,采取制动休息与主被动活动指导不同类型的胫骨平台骨折患者进行康复功能煅炼,使训练过程达到了一种动态的平衡,取得良好的康复效果。     

自制功能锻炼量化表在髋臼骨折患者围术期的应用

目的探讨自制功能锻炼量化表在髋臼骨折切开复位内固定术患者围术期的应用效果。方法将200例髋臼骨折切开复位内固定术患者按时间段分为对照组和观察组各100例,对照组采用常规的功能锻炼方法,观察组采用自制功能锻炼量化表进行功能锻炼。结果观察组术后并发症、患者满意度、术后6个月Harris评分显著优于对照组（P〈0.05,P〈0.01）。结论功能锻炼表因人制定锻炼计划,不易漏项,保证工作的连续性及规范性,有助于预防术后并发症,提高患者康复效果和对护理工作的满意度。     

自制功能锻炼量化表在髋臼骨折患者围术期的应用

目的探讨自制功能锻炼量化表在髋臼骨折切开复位内固定术患者围术期的应用效果。方法将200例髋臼骨折切开复位内固定术患者按时间段分为对照组和观察组各100例,对照组采用常规的功能锻炼方法,观察组采用自制功能锻炼量化表进行功能锻炼。结果观察组术后并发症、患者满意度、术后6个月Harris评分显著优于对照组(P0.05,P0.01)。结论功能锻炼表因人制定锻炼计划,不易漏项,保证工作的连续性及规范性,有助于预防术后并发症,提高患者康复效果和对护理工作的满意度。     

微信平台用于强直性脊柱炎早期患者功能锻炼指导

目的探讨微信平台用于早期强直性脊柱炎患者功能锻炼指导的效果。方法将78例早期强直性脊柱炎患者按奇偶数分为对照组(39例)与观察组(39例)。对照组实施常规护理;观察组在此基础上借助微信平台建立微信群及远程视频,与患者进行互动并给予专业性督导,通过微信平台进行心理干预。分别于干预后3、6个月评价效果。结果干预后3个月枕墙距、晨僵时间、胸廓活动度、疼痛程度、睡眠质量及心理状况评分,观察组改善程度显著优于对照组(P0.05,P0.01);干预后6个月功能锻炼依从性观察组显著高于对照组(P0.01)。结论微信平台用于强直性脊柱炎早期患者功能锻炼指导,可有效提高锻炼效果,同时有利于改善睡眠质量及心理状况,从而提高患者生活质量。     

漱口运动法用于甲状腺癌术后患者颈部功能锻炼

目的探讨漱口运动法对甲状腺癌术后患者颈部功能恢复的影响,以指导临床护理。方法将住院手术治疗的137例甲状腺癌患者按时间段分为对照组62例,观察组75例。术后对照组常规指导患者进行颈部功能锻炼;观察组在漱口时配合颈部功能锻炼。连续1周后评价颈部功能锻炼依从性和满意度,手术满1个月后评价瘢痕挛缩情况。结果观察组颈部功能锻炼依从性及满意度显著高于对照组,瘢痕挛缩发生率显著低于对照组(均P<0.01)。结论将漱口法与颈部运动相结合,护士的全程指导提高了患者早期颈部功能锻炼的依从性,同时也保证了患者的舒适与安全,有效避免瘢痕挛缩的发生,患者满意度得到明显提高。     

指骨骨折患者分期康复护理效果探讨

目的 探讨指骨骨折术后分阶段康复护理的长期效果.方法 将166例指骨骨折术后患者随机分为对照组与观察组各83例;对照组行常规术后康复护理,观察组采取分阶段康复护理,于干预4个月后评价效果.结果 观察组患肢指关节功能优良率、患肢关节功能及基本功能评分显著高于对照组,康复护理满意度显著高于对照组(均P＜0.01).结论 对指骨骨折术后患者分阶段落实各项重点护理措施,可更有效改善患肢功能,提高患者康复护理满意度.     

自助式下肢训练带用于老年股骨粗隆间骨折患者术后功能锻炼

目的探讨自助式下肢训练带对老年股骨粗隆间骨折患者术后功能锻炼依从性的影响。方法将入选的80例老年股骨粗隆间骨折患者随机分为观察组和对照组各40例。两组均接受骨科常规护理,对照组术后由责任护士指导患者进行踝关节背伸跖屈、股四头舒缩及屈膝屈髋锻炼,观察组在此基础上使用自助式下肢训练带进行功能锻炼,比较两组患者功能锻炼的依从性。结果观察组术后功能锻炼计划完成情况及功能锻炼依从性显著高于对照组(P0.05,P0.01)。结论使用自助式下肢训练带可以提高老年粗隆间骨折患者术后功能锻炼的依从性,促进患者早日康复。     

首诊责任护士家庭跟进照料对老年卧床患者出院指导依从性的影响

目的 探讨首诊责任护士家庭跟进照料模式对老年卧床患者出院指导依从性及护理满意度的影响.方法 将出院后回归家庭的120例老年卧床患者分为对照组与观察组各60例.对照组为轮班制责任护士按常规登记资料及评估患者情况,访视及实施护理干预措施;观察组则为首诊责任护士从入院首次接诊到患者回归家庭全程负责该患者的访视及护理干预.比较两组患者对出院指导依从性及护理满意度.结果 观察组在系统治疗、康复锻炼、并发症预防、生活方式、按时复诊方面依从性显著高于对照组（P＜0.05,P＜0.01）,护理满意度显著高于对照组（P＜0.01）.结论 采用首诊责任护士家庭跟进照料模式可密切护患关系,提高患者对出院指导的依从性和护理满意度,改善老年卧床患者健康预后.     

首诊责任护士家庭跟进照料对老年卧床患者出院指导依从性的影响

目的探讨首诊责任护士家庭跟进照料模式对老年卧床患者出院指导依从性及护理满意度的影响。方法将出院后回归家庭的120例老年卧床患者分为对照组与观察组各60例。对照组为轮班制责任护士按常规登记资料及评估患者情况,访视及实施护理干预措施;观察组则为首诊责任护士从入院首次接诊到患者回归家庭全程负责该患者的访视及护理干预。比较两组患者对出院指导依从性及护理满意度。结果观察组在系统治疗、康复锻炼、并发症预防、生活方式、按时复诊方面依从性显著高于对照组(P0.05,P0.01),护理满意度显著高于对照组(P0.01)。结论采用首诊责任护士家庭跟进照料模式可密切护患关系,提高患者对出院指导的依从性和护理满意度,改善老年卧床患者健康预后。     

专科护士主导的护理干预对高龄髋部骨折患者的影响

目的 提高高龄髋部骨折患者围手术期护理效果。 方法 按照入院时间，将2018年1月至2019年12月收治的50例高龄髋部骨折患者作为对照组，2020年1月至2021年12月收治的47例高龄患者作为观察组。对照组按责任制整体护理模式实施围手术期护理常规；观察组实施专科护士主导的多学科合作模式的全程护理干预，包括综合评估患者、集束化预防护理、结合康复日志的康复锻炼、出院准备及随访。比较两组疼痛干预效果、功能锻炼依从性及并发症发生率。 结果 观察组疼痛干预有效率显著高于对照组，围手术期并发症发生率显著低于对照组，功能锻炼依从性显著高于对照组（均P＜0.05）。 结论 高龄髋部骨折患者实施专科护士主导的多学科合作模式的护理干预，有利于提高护理质量，改善患者临床结局。     

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.