助产士主导的家庭群组式孕期保健服务的实践

目的探究以助产士主导的家庭群组式孕期保健服务模式对孕妇的干预效果。方法将109例初产妇随机分为干预组(54例)和对照组(55例)。对照组参加孕期检查、孕妇学校教育和孕妇学校微信群;干预组实施以助产士主导的家庭群组式孕期保健服务的实践,即参加孕期检查、群组活动教育和群组微信群。比较两组孕晚期增重、分娩结局、新生儿体质量等。结果干预组孕妇分娩前体质量、孕晚期每周增重显著低于对照组(均P0.01);干预组自然分娩率显著高于对照组;两组新生儿体质量比较,差异有统计学意义(P0.05);两组妊娠期并发症发生率、巨大儿发生率差异无统计学意义(均P0.05)。结论以助产士主导的家庭群组式孕期保健服务模式能有效管理孕妇孕期体质量,改善分娩结局。     

孕期预见性护理干预对预防抑郁倾向孕妇产后抑郁症的效果

目的:探讨孕期预见性护理干预对预防抑郁倾向的孕妇产后抑郁症的效果.方法:于2009年10月至2010年12月采用抑郁白评量表(SDS)对在本院进行孕期检查并决定在本院进行分娩的孕妇进行同卷调查,将D值≥11分的孕妇96例随机分为干预组(n=48)和对照组(n=48),对照组进行常规检测及分娩指导,干预组进行预见性护理干预.分别于产后2、4、6周3次发放爱丁堡产后抑郁量表(EPDS),并根据量表评分统计产后抑郁发生情况.结果:干预组产后抑郁发生率明显低于对照组(p＜0.005).结论:预见性护理干预能有效降低抑郁倾向孕妇的产后押郁发生率.     

心理筛查异常孕妇产后抑郁发生状况及影响因素分析

目的 调查建档产检时心理筛查异常孕妇产后抑郁症状发生情况并分析其影响因素.方法 纳入建档产检时心理筛查异常孕妇681例.根据爱丁堡产后抑郁量表筛查结果判定产妇是否存在产后抑郁症状,采用Logistic回归分析探讨产后抑郁症状的影响因素.结果 681例中出现产后抑郁症状105例(占15.4％).个人精神心理疾病史,孕晚期存在焦虑症状、抑郁症状和焦虑抑郁症状并存是发生产后抑郁症状的危险因素(P＜0.05,P＜0.01).结论 建档产检时心理筛查异常产妇产后抑郁症状发生率不高,提示可能需要重新考虑合适的孕期心理筛查时间点和量表.需重视孕晚期心理筛查异常孕妇和有精神心理疾病史孕妇的跟踪随访,同时提高从业者的心理保健能力,保障心理保健效果.     

社会支持和育儿胜任感对高危孕妇抑郁的影响

目的了解高危孕妇妊娠晚期抑郁状况及与社会支持、育儿胜任感的关系。方法采用领悟社会支持量表、育儿胜任感量表、爱丁堡产后抑郁量表对180例妊娠晚期高危孕妇进行调查。结果高危孕妇产前抑郁症状发生率为37.22%,抑郁组社会支持和育儿胜任感及各维度得分显著低于非抑郁组(均P0.01)。社会支持和育儿胜任感及其各维度与抑郁评分呈负相关(P0.05,P0.01);回归分析显示,家庭收入、计划妊娠、家庭支持、育儿满意度是高危孕妇抑郁的影响因素(调整R2=0.469)。结论高危孕妇妊娠晚期抑郁症状发生率较高,尤其低收入、非计划妊娠、育儿胜任感低及家庭支持少的高危孕妇更容易出现抑郁症状,应该采取必要的措施预防高危孕妇发生抑郁症状。     

产后抑郁症的综合护理干预

目的分析产后抑郁症综合护理干预的效果。方法将160例产妇随机分为2组,每组80例。对照组实施常规护理,观察组在常规护理的基础上实施综合护理干预。结果 2组均于产后42 d采用爱丁堡产后抑郁量表(EPDS)评分进行评定,观察中阳性抑郁症发生2例(2.50%),对照组为7例(8.75%),2组差异有统计学意义(P0.05)。结论对产妇实施综合护理干预,可有效消除和改善产妇的焦虑及抑郁等不良情绪,降低产后抑郁的发病率。     

孕晚期心身健康问题调查

为探讨孕晚期孕妇主要心身健康问题,随机抽取产前检查决定在本院分娩的孕妇１０５２例,采用自似２６项孕期常见健康问题问卷,进行孕晚期心身健康问题调查,以产后抑郁量表跟踪调查至产生后７ｄ。调查结果显示产后抑郁症的发生与孕晚期心身健康问题有关。提出了加强孕晚期心理护理,采用社区家庭护理干预和自我护理保健,并根据实际情况选择适当的干预方式,可促进孕产妇的身心健康。     

快乐母亲中医情志护理方案对初产妇孕期焦虑的影响

目的探讨"快乐母亲"情志护理对初产妇孕期妊娠相关焦虑的影响。方法将90例初产妇随机分为观察组和对照组各45例。对照组实施常规产科门诊护理及参加孕妇课堂学习,观察组实施"快乐母亲"的情志护理方案。比较两组初产妇妊娠相关焦虑、简易应对方式和分娩结局。结果干预后观察组初产妇妊娠相关焦虑评分及消积应对评分显著低于对照组,积极应对评分显著高于对照组(均P0.05);观察组自然分娩率显著高于对照组,总产程时间、产时出血量、产时疼痛评分显著低于对照组(均P0.05)。结论采用"快乐母亲"情志护理方案对焦虑初产妇进行孕期干预,能有效减轻焦虑情绪,改善孕期质量和分娩结局。     

子宫收缩乏力性产后出血的护理体会

目的总结实施综合护理干预对预防与降低子宫收缩乏力性产后大出血的体会。方法将52例子宫收缩乏力产妇随机分为观察组和对照组,各26例。对照组采用常规护理模式,观察组在对照组的基础上实施心理、产程观察等综合护理干预。观察两组患者子宫收缩乏力性产后大出血的发生率。结果观察组子宫收缩乏力性大出血发生率(2.5%)明显低于对照组(15%),差异有统计学意义(P0.05)。结论加强孕期保健,定期产前检查,注意高危妊娠的识别与筛查并采取心理、产程观察等综合护理干预措施,可有效降低子宫收缩乏力性大出血发生率,提高治疗效果。     

短期冥想干预对住院肺癌患者负性情绪的影响

目的探讨短期冥想干预对住院肺癌患者心理痛苦及焦虑、抑郁的影响。方法将肿瘤科存在心理痛苦的住院肺癌患者48例按病区分为干预组和对照组各24例。对照组按常规实施心理护理,干预组在常规心理护理基础上实施连续5d的短期冥想干预。结果干预后两组心理痛苦、焦虑评分比较,差异有统计学意义(P0.05,P0.01),两组抑郁评分比较,差异无统计学意义(P0.05)。结论对住院肺癌患者实施短期冥想干预,可使患者以放松的状态调节心理,减轻其心理痛苦及焦虑程度,缓解不良情绪。     

心肌梗死患者支架术前后生活质量及心理护理的探讨

目的:研究急性心肌梗死(AMI)患者冠状动脉介入术前后的抑郁障碍情况、心理干预的效果以及对生活质量的影响.方法:选择2009年1月至2010年9月于我科接受PCI治疗的AMI患者,随机分为对照组和心理干预组,两组均在患者手术前1～2d和手术后7～10d分别进行两次行汉密尔顿抑郁量表(HAMD)评分和生活质量(MIDAS)评分.结果:PCI术前两组患者抑郁发生率、HAMD评分、MIDAS评分无显著差异(P＞0.05).手术前后对照组抑郁发生率无明显变化(P＞0.05),HAMD评分无显著差异(P＞0.05);术后心理干预组的抑郁障碍较对照组有明显改善(P＜0.05),HAMD评分明显降低(P＜0.05);手术前后干预组抑郁发生率有明显变化,HAMD评分有显著差异(P＜0.05);手术前后两组患者的生活质量均有显著差异(P＜0.05),且干预组较对照组改善更明显(P＜0.05).结论:PCI术后患者抑郁发生率较高,因此有必要对PCI术后的患者进行联合心理干预的治疗,PCI术可以明显改善患者的生活质量,且PCI术后抑郁情绪与术后生活质量的改善呈负相关.     

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.