社区高血压老年人智慧医养照护志愿服务实践效果评价

目的 探讨智慧医养照护志愿服务在社区高血压老年人健康管理中的实践效果。方法将100例社区高血压老年人随机分为对照组和观察组各50例,对照组给予常规接触式社区医养照护志愿服务管理,观察组给予智慧医养照护志愿服务管理。管理6个月后,比较两组管理前后血压、血糖、健康促进生活方式及依从性的变化。结果管理后观察组收缩压、舒张压、空腹血糖、餐后2 h血糖、糖化血红蛋白显著低于对照组;健康促进生活方式得分显著高于对照组（均P<0.05）。结论智慧医养照护志愿服务能有效控制社区高血压老年人的血压、血糖水平,提高其自我健康管理能力,可为医养照护志愿服务模式及社区慢病智慧化管理提供参考。     

聚焦解决模式在老年高血压患者健康教育中的应用

目的 探讨聚焦解决模式在老年高血压患者健康教育中的应用方法及效果.方法 将100例住院老年高血压患者随机分为观察组与对照组各50例.对照组按照常规内容和模式进行健康教育,观察组按照聚焦解决模式5个步骤进行健康教育.分别于健康教育前、后对两组患者的高血压知识知晓率、服药依从性及血压进行比较评价.结果 观察组患者服药依从性和高血压知识知晓率显著优于对照组(均P＜0.05);血压水平显著低于对照组(P＜0.05).结论 采用聚焦解决模式对住院老年高血压患者实施健康教育,可显著提高健康教育效果,增强患者服药依从性,有效控制血压水平,从而提高患者的生活质量.     

聚焦解决模式在老年高血压患者健康教育中的应用

目的 探讨聚焦解决模式在老年高血压患者健康教育中的应用方法及效果。方法 将100例住院老年高血压患者随机分为观察组与对照组各50例。对照组按照常规内容和模式进行健康教育，观察组按照聚焦解决模式5个步骤进行健康教育。分别于健康教育前、后对两组患者的高血压知识知晓率、服药依从性及血压进行比较评价。结果 观察组患者服药依从性和高血压知识知晓率显著优于对照组（均P〈0．05）；血压水平显著低于对照组（P〈0．05）。结论 采用聚焦解决模式对住院老年高血压患者实施健康教育．可显著提高健康教育效果．增强患者服药依从性，有效控制血压水平，从而提高患者的生活质量。     

E-Coach慢病管理模式在高血压控制中的应用研究

目的探讨E-Coach慢病管理模式在高血压患者中的应用效果。方法将232例原发性高血压患者随机分为研究组(116例)和对照组(116例)。对照组采取常规门诊管理,研究组在常规门诊管理的基础上接受由专科护士为主导的E-Coach慢病管理模式管理。干预6个月后评价效果。结果对照组98例、研究组102例患者完成全程干预。研究组血压控制率、平均每周有氧锻炼时间、认知症状管理及与医生沟通评分显著高于对照组,收缩压显著低于对照组(P0.05,P0.01)。结论 E-Coach慢病管理模式有利于改善高血压患者的自我管理行为,提高血压控制率。     

健康教育配合自我推拿对轻度高血压患者血压的影响

目的 观察健康教育配合自我推拿对轻度高血压患者动态血压的影响.方法 将60例轻度高血压患者随机分为观察组和对照组各30例,两组均进行健康教育;观察组配合自我推拿干预,对照组口服氢氯噻嗪治疗.连续3个月观察动态血压的变化.结果 观察组干预前后24 h血压、白昼及夜间血压均值有统计学差异(均P＜0.01);对照组24 h血...     

高血压患者药物素养促进计划的制订与实施

目的提高高血压患者的药物素养。方法将长沙市6个社区卫生服务中心随机分为对照组和干预组各3个,对照组153例患者接受社区卫生服务中心提供的常规健康服务;干预组144例患者依据制订的高血压患者药物素养促进计划实施为期1个月的干预。结果干预后第3个月,干预组血压控制水平显著优于对照组,服药依从性、药物素养、服药自我效能得分显著优于对照组(P0.05,P0.01)。结论实施高血压患者药物素养促进计划可以提升患者药物素养、服药自我效能及服药依从性,从而改善患者血压控制水平。     

基于物联网远程血压监测结合APP管理对高血压患者的影响

目的探讨基于物联网远程血压监测结合APP管理对高血压患者血压及自我护理行为的影响。方法将123例原发性高血压患者随机分为观察组62例和对照组61例,对照组采用门诊常规管理,观察组实施远程血压监测结合APP管理。结果干预4个月后,观察组收缩压、舒张压下降幅度、血压达标率显著高于对照组,自我护理行为(除外情绪减压)显著高于对照组(P0.05,P0.01)。结论对高血压患者实施远程血压监测与APP管理有利于提高患者血压达标率和改善自我护理行为,是实施慢性病管理的有效方法。     

心力衰竭管理手册对患者自我护理能力及生存质量的影响

目的探讨心力衰竭管理手册在慢性心力衰竭患者自我护理能力及生存质量中的应用效果。方法将入住我院心内科的慢性心力衰竭患者按病区分为干预组和对照组各76例。对照组实施常规健康教育,干预组在此基础上结合心力衰竭管理手册实施健康教育。结果干预后,干预组自我护理维持、自我护理管理、自我护理信心及生存质量评分改善显著优于对照组(均P0.01)。结论心力衰竭管理手册作为一种管理工具,使慢性心力衰竭患者出院后通过自我管理,仍能得到针对性、延续性、全面化的服务支持和帮助,满足患者对慢病诊疗的需求,提高患者的自我护理能力及生存质量。     

思维导图用于0级糖尿病足患者健康教育效果探讨

目的提高糖尿病足患者健康教育效果,防止足病发展。方法将68例0级糖尿病足患者随机分为对照组和干预组各34例。对照组采取常规发放宣教手册结合PPT授课实施健康教育;干预组设计和采用思维导图,通过PPT授课实施健康教育,于患者出院6个月后评价效果。结果干预组患者自我效能及自护能力评分显著高于对照组,糖尿病足预防效果及健康教育满意率显著优于对照组(P0.05,P0.01)。结论思维导图式健康教育可有效提高教育效果,控制足病发展。     

冠心病介入患者基于自我超越理论的护理干预

目的 探讨基于自我超越理论的护理干预对冠心病介入患者希望水平、应对方式、自我管理行为及健康素养的影响。方法 将126例冠心病介入患者随机分为对照组与观察组各63例。对照组实施常规护理,观察组在此基础上基于自我超越理论进行护理干预。干预前及干预后2周比较两组希望水平、应对方式、自我管理行为及健康素养评分。结果 干预后观察组希望水平、积极应对方式、自我管理行为及健康素养评分显著高于对照组,消极应对方式得分显著低于对照组(均P<0.05)。结论 基于自我超越理论的护理干预可提高冠心病介入患者希望水平,增强积极应对及自我管理能力,提高健康素养。     

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.     

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.     

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.     

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.