肝硬化患者自我护理能力与健康行为的相关性分析

目的 探讨肝硬化患者的自我护理能力与健康行为状况及其相互关系.方法 应用自我护理能力测定量表(ESCA)、健康行为量表(HPL)对80例肝硬化患者进行调查.结果 肝硬化患者自我护理能力和健康行为自评得分分别为102.75±19.74和124.25±21.86,80例中63例均处于中等水平;患者自我护理能力总分及其各项评分与健康行为呈显著正相关(均P＜0.01).结论对肝硬化患者实施针对性护理干预应重视增加肝硬化患者的压力调解、人际关系、躯体活动和心理健康,促使其采取健康行为,提高自我护理能力.     

我国护理本科生临床实习表现的调查

目的了解我国护理本科生临床实习表现,为提高临床实习质量提供依据。方法按比例分层从全国142所护理本科高校中抽取22所毕业实习的护理本科生（实习初期1074名,实习中期935名）,采用护理本科生毕业实习临床实践行为表现自评量表进行调查。结果我国护理本科生实习初期和中期临床实习表现总分分别为（3.70±0.43）和（3.68±0.47）,两者比较,差异无统计学意义（P〉0.05）;实习初期和中期各维度得分顺序一致,得分最高的维度是专业和自我发展（4.07±0.48,3.95±0.50）,得分较低的是教学指导（3.63±0.51,3.62±0.53）、临床护理（3.58±0.55,3.59±0.58）和科研（3.19±0.74,3.25±0.72）;仅专业和自我发展维度得分实习初期显著高于中期（P〈0.01）。结论我国护理本科生在实习初期和中期临床实习表现一般;护生在遵守医院规章制度、法律法规及保护患者隐私方面表现较好,但在教学指导、整体化护理和科研方面表现相对较差,临床护理教育者要加强护理本科生这三方面的培养。     

实习护生健康教育能力与自主学习能力及自我效能的相关性

目的 了解实习护生（护生）的健康教育能力与自主学习能力、自我效能的现状及其相关性,为护理教育者提高护生健康教育能力提供参考。 方法 采用护理人员健康教育能力测评量表、护理专业大学生自主学习能力测评量表及一般自我效能量表对409名护生进行问卷调查。 结果 护生健康教育能力得分为74.40±16.82,自主学习能力得分为65.77±11.42,一般自我效能感得分为22.21±15.26,护生健康教育能力与自主学习能力、一般自我效能呈正相关（均P＜0.01）。 结论 护生健康教育能力有待提高,增强自主学习能力及自我效能感可提高护生的健康教育能力。     

体态语言机的设制及在机械通气患者护理中的应用

目的探讨护士长变革型领导行为与领导有效性的关系。方法采用变革型领导行为问卷、团体内合作量表、团体绩效量表、团体满意度量表、团体凝聚力量表、自我效能感量表及自行设计的下属对领导的信任问卷对重庆市万州区1094名护士进行问卷调查．对研究涉及的121名护士长进行专题分析。结果护士长变革型领导行为总均分为4．66±1．04．其德行垂范、领导魅力、愿景激励、个性化关怀维度评分分别为4．72±1．02、4．75±1．02、4．62±1．01、4．54±1．08。护士长变革型领导行为与领导有效性显著相关（均P〈0．01）．可有效预测领导有效性；在下属对领导的信任方面．变革型领导行为的4个维度均是其预测变量（P〈0．05．P〈0．01）。结论护士长在德行垂范、领导魅力方面做得较好．但愿号激励、个性化关怀方面有待抽强。对护士长进行变革型领导行为培养．将有助于提高团队层面和个体层面的领导有效性。     

老年病房护士关怀照护行为调查分析

目的了解老年病房护士关怀照护行为的表现。方法以立意取样方式选取4所医院老年病房工作护士100名,采用改编的关怀行为量表进行调查。结果老年病房护士关怀照护行为得分（63．12±12．01）分,低于中位数,属于中等偏下程度;3个雏度中帮助患者渡过疾病不平顺的过程得分（28．26±6．81）分,患者权益的维护（16．50±4．67）分,了解患者（20．38±4．29）分。结论老年病房护士的护理关怀行为属中等程度,偏重于操作性活动,表达性活动较少,护理关怀理念及知识亟待提高。     

护士对住院患儿家属的护理支持及家属满意度调查

目的了解护士对患儿家属的护理支持情况及家属对护理支持行为的满意度。方法采用护士对患儿家属的支持量表（NPST）及满意度调查量表对125名患儿家属进行问卷调查。结果护士对患儿家属的总体支持评分为（3．32±0．45）分，家属对护理支持行为的总体满意度评分为（3．06±0．26）分，其中优质护理支持及其满意度得分最高，而情感支持、尊重支持及其满意度得分偏低。结论护士对患儿家属的支持情况总体较好，患儿家属基本满意。但在注重疾病护理的同时，需加强对患儿家属的情感支持和尊重支持。     

智力障碍者家庭功能与日常生活能力现状调查

目的了解智力障碍（下称智障）者家庭功能与日常生活能力的现状,为改善其家庭功能和提高智障者日常生活能力提供参考。方法采用日常生活能力量表（ADL）、家庭关怀度指数问卷（APGAR量表）和自设的一般资料调查问卷对104名智障者进行调查。结果智障者APGAR评分为（7.8±2.4）分,其中适应度（1.7±0.6）分,合作度（1.3±0.9）分,成长度（1.5±0.6）分,情感度（1.6±0.6）分,亲密度（1.7±0.5）分。家庭功能良好者81名（77.9%）,中度障碍者17名（16.3%）,严重障碍者6名（5.8%）。ADL评分为（23.1±8.5）分,其中躯体生活自理能力评分为（7.2±2.7）分,工具性生活自理能力评分为（15.9±6.5）分。家庭功能良好与下降者ADL、躯体生活自理能力、工具性生活自理能力比较,差异无显著性意义（均P〉0.05）。结论智障者家庭功能较好,合作度有待提高;日常生活自理能力尤其是工具性生活自理能力偏低。社会、家庭和学校需注意培养智障者各方面的能力,政府应加大对智障家庭的扶持力度,帮助智障者提高生存能力,回归社会。     

导乐护理在非全麻手术患者围术期的实施

目的探讨2型糖尿病患者自我管理行为与积极度现状及其相关性,提高糖尿病患者自我管理能力。方法采用糖尿病自我管理行为量表和患者积极度量表对102例2型糖尿病患者进行问卷调查。结果2型糖尿病患者总体自我管理行为得分为（71．52±11．94）分,良好者占24．5％;总体积极度得分为（54．56±11．54）分,其中第1水平占25．5％,第2水平占26．5％,第3水平占31．4％,第4水平占16．6％;总体自我管理行为及其6个维度与积极度呈正相关（P〈0．05,P〈0．01）。结论2型糖尿病患者自我管理行为有待提高,积极度不理想。护理人员评估患者的自我管理行为时应注意其积极水平,根据其积极水平来制定针对性的干预措施,帮助患者提高自我管理能力。     

护理本科实习生沟通技能态度及行为评估

目的了解护理本科实习生沟通技能态度及沟通行为现状。方法采用方便抽样方法抽取104名护理本科实习生,使用沟通技能态度问卷、沟通行为自我评价量表对其进行调查。结果护理本科实习生的沟通技能正性态度得分为3．81±0．61,负性态度得分为2．65±0．85,中性态度得分为3．44±0．65;沟通行为总分为42～90（59．79±10．29）分。得分排前5位的是接受其他同事的反馈、提供有关生活方式的咨询、团队建设、病情评估、对其他同事进行反馈,后5位的是与受虐待或暴力患者的沟通、与酒精成瘾或吸毒成瘾患者沟通、与愤怒或敌对患者沟通、与艾滋病患者沟通、与少数民族或国外患者的沟通。其沟通行为与正性态度及中性态度呈正相关,与负性态度呈负相关（均P〈0．05）。结论护理本科实习生的沟通技能态度较积极,但需加强护理本科实习生与受虐待或暴力患者的沟通、与酒精成瘾或吸毒成瘾患者沟通、与愤怒或敌对患者沟通、与艾滋病患者沟通、与少数民族或国外患者的沟通技能培训;在沟通技能培训中．须重视护理本科生的沟通态度的转变,并将其作为教学效果的重要评价指标之一。     

控烟干预对骨折患者吸烟知识、态度和行为的影响

目的探讨控烟护理干预对骨折患者吸咽知识、态度和行为的影响。方法对40例吸烟的男性骨折住院患者在建立护理干预的基础上，实施吸烟与健康知识的认知干预，对其错误的认知进行分析，树立正确的认知观念，加强健康教育，给予行为干预，使其主动戒烟，养成不吸烟的良好生活习惯，并采用交谈及问卷调查相结合的方式评定干预前后患者吸烟知识、态度和行为的差异。结果干预前患者吸烟与健康知识测试得分15．97±7．7，干预后26．97±2．64，干预前后比较，差异有显著性意义（P〈0．01）；吸烟态度和行为干预前后比较，差异有显著性意义（均P〈0．05）。结论对骨折患者实施控烟护理干预是必要的，也是可行的。     

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.