叙事护理对晚期癌症主要照顾者预期性悲伤的影响

目的观察叙事护理缓解晚期癌症患者主要照顾者预期性悲伤的效果。方法采用便利抽样法抽取晚期癌症患者主要照顾者60人,随机分为干预组和对照组各30人。对照组进行常规心理护理,干预组在此基础上进行叙事护理干预,干预前后应用预期性悲伤调查问卷评价主要照顾者的预期性悲伤水平。结果干预后干预组预期性悲伤总分及内疚、悲伤、焦虑3个维度得分显著低于对照组(均P<0.01)。结论叙事护理干预能够缓解晚期癌症主要照顾者预期性悲伤水平。     

乳腺癌术后化疗患者自我表露干预

目的 探讨基于积极心理学理论的自我表露干预对乳腺癌术后化疗患者情绪的影响。方法将乳腺癌术后化疗患者按入住病区分为对照组（n=45）和观察组（n=43）。对照组实施乳腺癌术后化疗常规护理，观察组在常规护理的基础上进行基于积极心理学理论的自我表露干预。比较两组患者干预前后自我表露水平、负性情绪及癌症复发恐惧情况。结果干预后观察组自我表露得分显著高于对照组，内向刺激、外向刺激、抑郁、焦虑、癌症复发恐惧得分显著低于对照组(均P<0.05)。结论乳腺癌术后化疗患者实施基于积极心理学理论的自我表露干预能够有效提高患者的自我表露水平，缓解负性情绪，降低癌症复发恐惧。     

尊严护理干预对晚期住院癌症患者尊严水平及焦虑抑郁的影响

目的探讨尊严护理干预对晚期住院癌症患者尊严水平及焦虑抑郁的影响。方法将2所三级甲等医院肿瘤科的100例住院晚期癌症患者分为干预组和对照组各50例。对照组接受常规护理,干预组在此基础上接受4周尊严护理干预。结果干预后两组尊严及焦虑抑郁评分比较,差异有统计学意义(P0.05,P0.01)。结论尊严护理干预能有效改善住院晚期癌症患者尊严水平,减轻焦虑抑郁情绪。     

四子散热熨对压力性尿失禁患者盆底功能康复的影响

目的 探讨四子散热熨对轻中度压力性尿失禁患者盆底功能的康复作用。方法 将女性轻中度压力性尿失禁患者随机分为对照组(n=39)和观察组(n=38)。对照组采用常规康复护理,观察组在对照组基础上采用四子散热熨,每次20 min, 3次/周,连续干预4周。干预前后评估患者盆底肌肉功能、盆底组织形态和尿失禁总体情况,干预1个月后随访时评估患者尿失禁总体情况和尿失禁疗效。结果 干预后观察组盆底表面肌电值前静息阶段、快速收缩阶段和后静息阶段康复效果和肛提肌裂孔面积显著优于对照组;干预后与随访时,观察组尿失禁总体评分显著优于对照组,干预后观察组尿失禁疗效显著优于对照组(P<0.05,P<0.01)。结论 四子散热熨能促进轻中度压力性尿失禁患者盆底功能康复,改善尿失禁。     

可敏索码熵家棋疗法对儿科护士负性情绪及职业倦怠的影响

目的 探讨可敏索码熵家棋疗法对儿科护士焦虑、抑郁情绪及职业倦怠的干预效果.方法 将77名儿科护士按照随机数字表法分为干预组(n=39)与对照组(n=38),干预组采用可敏索码熵家棋疗法进行干预,对照组采用支持性心理疗法进行干预,两组均干预5周,每周1次,每次40～60 min.分别于干预前、干预5周后及干预结束12周后采用汉密尔顿焦虑量袁、汉密尔顿抑郁量表及护士职业倦怠量表对两组护士进行测评.结果 不同时间干预组焦虑、抑郁及职业倦怠总分与对照组比较,差异有统计学意义(P＜0.05,P＜0.01).结论 可敏索码熵家棋疗法可明显改善儿科护士的焦虑、抑郁情绪,降低职业倦怠感,提高其心理健康水平.     

情绪释放疗法对糖尿病周围神经病理性疼痛患者的影响

目的 探讨缓解糖尿病周围神经病理性疼痛、提高生活质量的有效干预方法.方法 将90例糖尿病周围神经病理性疼痛患者随机分成对照组和观察组各45例,对照组给予常规护理,观察组在对照组基础上增加情绪释放疗法,每次10～15 min,2次/d,连续8周.结果 干预后观察组疼痛灾难化、疼痛恐惧、疼痛程度得分显著低于对照组,生活质量得分显著高于对照组(均P＜0.01).结论 情绪释放疗法能有效缓解糖尿病周围神经病理性疼痛患者疼痛状况,提高患者生活质量.     

阶梯式心理护理对头颈肿瘤患者焦虑抑郁和生活质量的影响

目的探讨阶梯式心理护理对头颈肿瘤患者焦虑与抑郁情绪和生活质量的影响。方法将86例有焦虑或抑郁情绪的头颈肿瘤住院患者随机分为干预组和对照组各43例,两组均给予常规健康教育和出院后随访,干预组在此基础上实施4步阶梯式心理护理方案,包括2周观察等待、4周指导性自助、6周面对面问题解决疗法、4周专业心理干预和(或)药物疗法,干预前后评估患者焦虑抑郁状况和生活质量。结果干预后干预组焦虑抑郁评分显著低于对照组,干预有效率显著高于对照组(均P 0. 01),干预组在疼痛、吞咽、感觉、发声和进食等生活质量方面有显著改善,与对照组比较,差异有统计学意义(P 0. 05,P 0. 01)。结论以阶梯式护理为指导的心理护理可有效改善头颈肿瘤患者的焦虑、抑郁状况,在一定程度上提升患者生活质量。     

5E护理对日间腹腔镜胆囊切除术患者医从性及负性情绪的影响

目的:探讨"5E"模式下的个案护理管理对日间腹腔镜胆囊切除术患者医从性及负性情绪的影响.方法:选取2018年10月至2019年9月因胆囊良性疾病行日间腹腔镜胆囊切除术治疗的患者.采用非同期对照方法将患者纳入对照组(n=89)与观察组(n=89).对照组采用常规护理干预,观察组在此基础上加用"5E"个案护理.对比两组患者...     

Effects of rational-emotive therapy on family function among patients with heterosexual transmission of HIV

目的 探讨理性情绪疗法对经异性性途径感染艾滋病患者家庭功能的影响.方法 采用整群随机抽样方法抽取湖南省3个艾滋病治疗点39例经异性性途径感染艾滋病患者及其配偶作为研究对象,随机分为干预组(19例)和对照组(20例).干预组给予为期6周的基于理性情绪疗法的干预,对照组接受常规治疗和护理.采用家庭关怀度指数问卷进行效果评价.结果 两组家庭功能总分及适应度、合作度、情感度干预主效应有统计学意义(均P＜0.01)；干预后干预组家庭功能障碍程度显著轻于对照组(P＜0.05).结论 理性情绪疗法是改善经异性性途径感染艾滋病患者家庭功能的有效方法.     

六步癌症告知模型在前列腺癌患者病情告知中的应用

目的评价六步癌症告知模型在前列腺癌穿刺活检阳性患者告知中的应用效果。方法将98例前列腺癌穿刺活检阳性患者随机分为干预组和对照组各49例,对照组采用常规病情告知方式,干预组采用六步癌症告知模型进行病情告知。结果病情告知后干预组自我接纳总分显著高于对照组,患者负性情绪及死亡焦虑总分显著低于对照组(均P0.01)。结论将六步癌症告知模型应用于前列腺癌穿刺活检阳性患者,可提高患者的自我接纳水平,降低其负性情绪和死亡焦虑,对患者而言具有正性意义。     

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.     

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.     

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.