肿瘤化疗患者癌性厌食现状及影响因素研究

目的 调查肿瘤化疗患者癌性厌食现状并分析其影响因素,为实施针对性干预提供参考。方法 采用便利抽样法,选取286例肿瘤化疗患者为调查对象,采用一般资料调查表、癌性厌食量表、化疗相关性味觉改变量表、医院焦虑抑郁量表、家庭功能问卷进行调查。结果 患者癌性厌食得分为(18.50±5.88)分,癌性厌食与化疗相关性味觉改变、负性情绪呈负相关,与家庭功能呈正相关(均P<0.05)。多元回归分析显示,性别、化疗相关性味觉改变、焦虑、家庭功能是化疗患者癌性厌食的影响因素(均P<0.05),可解释总变异的31.2%。结论 肿瘤患者在化疗期间普遍存在癌性厌食,医护人员应关注并识别发生厌食的患者,制定个体化干预措施,缓解患者癌性厌食症状。     

鼻咽癌放化疗致慢性鼻窦炎患者症状困扰分析

目的 探讨鼻咽癌放化疗致慢性鼻窦炎患者症状困扰现状并分析其影响因素,为临床制定护理方案提供参考。方法 以便利抽样法收集广西某三级甲等综合医院放疗科门诊复查的鼻咽癌放化疗致慢性鼻窦炎患者193例为研究对象,采用一般资料调查表、鼻腔鼻窦结局测试22特异性量表、公众健康积极指数量表、中文版预后和治疗认知问卷进行横断面调查,采用多元线性回归分析患者症状困扰的相关影响因素。结果 鼻咽癌放化疗致慢性鼻窦炎患者症状困扰得分为（27.05±6.37）分。多元线性回归分析显示,鼻咽冲洗依从性、健康积极度得分、预后关注度得分为鼻咽癌放化疗致慢性鼻窦炎患者症状困扰的预测因素（均P＜0.05）。结论 鼻咽癌放化疗致慢性鼻窦炎患者症状困扰处于轻度水平,且普遍存在。医疗人员亟需对鼻咽癌放化疗致慢性鼻窦炎患者制定针对性护理干预措施,以减轻症状负担,提高生存质量。     

150例急性肠套叠患儿家属焦虑抑郁情绪的相关因素分析及护理干预

目的:调查分析住院解肠套叠住院患儿家属焦虑与抑郁患病情况及其相关的影响因素.方法:收集中国医科大学附属盛京医院小儿外科病房肠套叠住院患儿的直系家属150例,应用焦虑自评量表(SAS)及抑郁自评量表(SDS)进行测评并对结果进行分析.结果:肠套叠家属的焦虑、抑郁自评量表的焦虑得分(61.30±14.21)分,抑郁评分(54.00±14.89)分,与正常人群国内常模比较有显著性差异(P＜0.01);文化程度和年龄在焦虑和抑郁得分上的差异均具有统计学意义(P＜0.01;P＜0.01);性别对焦虑和抑郁得分的影响不显著(P＞0.05).结论:肠套叠患者家属的焦虑和抑郁状况受到多种因素不同程度的影响,而文化程度和年龄对焦虑和抑郁的程度影响较大,临床上应采用不同的措施来降低肠套叠家属的焦虑和抑郁情绪.     

原发性肝细胞癌患者术前焦虑抑郁状况及相关因素研究

目的研究原发性肝细胞癌患者术前焦虑抑郁状况及相关因素。方法采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对2014年1月至2014年12月142例原发性肝细胞癌患者术前的焦虑、抑郁状况进行调查,并分析影响焦虑和抑郁发生的相关因素。结果 142例肝细胞癌患者术前SAS平均标准分为(55.41±10.13)分,69.01%(98/142)的患者伴有焦虑情绪,术前SDS平均标准分为(54.59±12.22)分,59.86%(85/142)的患者伴有抑郁情绪。教育程度、婚姻状况、医疗费用来源、经济状况等因素影响焦虑、抑郁情绪的发生。结论肝细胞癌患者术前焦虑抑郁情绪发生率较高,应充分认识此现象并给予合理干预。     

1164例早泄患者心理障碍调查分析

目的 了解早泄( premature ejaculation,PE)患者心理障碍的患病情况及相关因素,探讨心理障碍与PE的关系. 方法 2009年9月至2010年10月我们应用焦虑自评量表(SAS)和抑郁自评量表(SDS)、中国早泄患者性功能评价表(C1PE-5)、国际前列腺炎症状指数表(NIH-CPSI)、国际勃起功能指数表(IIEF-5)及自制相关因素调查表对1164例PE患者心理状况进行调查.分析SAS、SDS评分及焦虑抑郁症状检出率与NIH-CPSI评分、CIPE-5评分、勃起功能、年龄、病程、职业、文化程度、性格特点等因素的相关性. 结果 1164例PE患者SAS、SDS评分分别为(43.87 ±10.53)分、(44.05 ±9.81)分,按SAS≥50分、SDS≥53分判定,有焦虑症状者341例(29.3％),有抑郁症状者217例(18.6％).SAS、SDS评分和焦虑抑郁症状检出率与CIPE-5评分、NIH-CPSI评分、勃起功能、病程、性格特点等有相关性(P＜0.05),与年龄、职业、文化程度等无相关性(P＞0.05). 结论 PE患者普遍存在焦虑、抑郁情绪,并与前列腺炎症状、勃起功能障碍、病程、性格特点等因素有关.     

脑卒中患者偏瘫肩痛的症状体验及影响因素研究

目的探讨脑卒中患者偏瘫肩痛的症状体验及其强度的影响因素,为临床症状管理提供参考。方法采用一般资料调查表、脑卒中后偏瘫肩痛症状评估问卷、简易疲乏量表、医院焦虑抑郁量表对153例脑卒中后偏瘫肩痛患者进行调查。结果脑卒中患者偏瘫肩痛症状强度得分为(5.99±2.04)分,为中等疼痛;症状困扰总分为(11.98±5.20)分,属于中等困扰;肩痛症状强度的影响因素包括脑卒中疾病分期、肩痛频度和疲乏水平(均P0.05)。结论脑卒中患者的偏瘫肩痛症状体验呈多样性,临床护理人员应对不同肩痛频度、疾病分期、疲乏水平的患者给予针对性的症状管理干预措施,促进其康复。     

新型冠状病毒肺炎流行期武汉某社区居民心理状况及影响因素研究

目的了解新型冠状病毒肺炎流行期社区居民的心理状况及其影响因素,为实施针对性心理干预提供参考。方法采用便利抽样法抽取武汉市某社区居民333人,应用患者健康问卷和广泛性焦虑量表进行调查。结果社区居民抑郁评分为(6.89±2.12)分,焦虑评分(7.10±2.14)分。社区居民中201人(60.36%)同时存在抑郁、焦虑情绪。多因素分析显示,性别、文化程度、有亲人为医护人员是影响社区居民抑郁、焦虑情绪的因素(P0.05,P0.01)。结论新型冠状病毒肺炎流行期,社区居民存在不同程度的抑郁、焦虑情绪,应针对影响因素对社区居民加强心理疏导,提高其心理健康水平。     

食管癌术后化疗患者症状困扰与焦虑抑郁的相关性研究

目的探讨食管癌术后化疗患者的症状困扰、生活受干扰程度及焦虑抑郁程度,并探讨前二者与焦虑抑郁的相关关系。方法采用M.D.Anderson症状调查量表、医院焦虑抑郁量表对84例食管癌术后化疗患者进行调查。结果患者的症状困扰及生活受干扰评分分别为3.18、2.81分,前者与其焦虑呈正相关,后者与焦虑、抑郁呈正相关(均P<0.01);患者的主要症状为脱发、胃口差、体质量减轻、反流等。结论食管癌术后化疗患者普遍存在症状困扰,且症状困扰与焦虑抑郁相互影响。护理人员在缓解患者躯体症状的同时应关注其心理状况,指导其合理宣泄情绪。     

中青年经皮冠状动脉介入治疗术后患者个人掌控感现状及影响因素研究

目的 探讨中青年经皮冠状动脉介入治疗(PCI)术后患者个人掌控感现状及其影响因素.方法 采用一般资料调查表、个人掌控感量表、医院焦虑抑郁量表、一般自我效能量表对163例中青年PCI术后患者进行问卷调查.结果 中青年PCI术后患者个人掌控感得分(20.61±3.08)分,焦虑得分(8.69士1.91)分,抑郁得分(8.06±1.85)分,自我效能感得分为(2.55±0.34)分.多元逐步回归分析显示,文化程度、家庭人均月收入、冠心病病程、焦虑、抑郁及自我效能是中青年PCI术后患者个人掌控感的影响因素(P＜0.05,P＜0.01).结论 中青年PC1术后患者个人掌控感处于中等水平,应多关注文化程度低、家庭收入低及冠心病病程短的患者,临床医护人员可以通过加强对疾病的宣教指导,促进疾病二级预防和康复,提高自我效能,促进个人掌控感水平的提高.     

鼻咽癌同步放化疗患者孤独感现状及影响因素分析

目的 了解鼻咽癌同步放化疗患者孤独感现状及影响因素,为针对性干预提供参考.方法 对252例鼻咽癌同步放化疗患者,采用一般资料调查表、癌症孤独感量表、恐惧疾病进展简化量表、癌症疲乏量表进行调查,分析孤独感影响因素.结果 患者癌症孤独感得分为19.82±3.03,多元线性回归分析结果显示,年龄、居住状态、症状数量、癌症疲乏、恐惧疾病进展为患者癌症孤独感的影响因素(调整R2 =0.552;P＜0.05,P＜0.01).结论 患者癌症孤独感处于中等水平,护理人员应予以重视,重点关注年龄较大、独居,存在多种并发症、疲乏、恐惧疾病进展患者,早评估、早干预,以缓解其癌症孤独感.     

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.