护理干预预防脑卒中吞咽障碍患者吸入性肺炎效果观察

目的探讨护理干预预防脑卒中吞咽障碍患者吸入性肺炎的效果.方法将180例脑卒中吞咽障碍患者随机分为对照组(84例)和干预组(96例),两组均予神经内科常规治疗及护理,干预组在此基础上给予吞咽功能训练及进食功能训练.入院及住院30 d时比较两组患者吸入性肺炎的发生情况及吞咽康复效果.结果干预组吸入性肺炎发生率显著低于对照组(P<0.05),而吞咽康复总有效率显著高于对照组(P<0.01).结论吞咽功能训练及进食功能训练可有效预防患者吸入性肺炎的发生,明显改善其吞咽障碍.     

脑卒中后吞咽障碍患者病耻感现状及影响因素研究

目的了解脑卒中后吞咽障碍患者病耻感水平及影响因素,为制定干预措施提供参考。方法采用一般资料调查问卷、社会影响量表和进食评估问卷调查工具-10中文版,对74例脑卒中后吞咽障碍患者进行调查。结果患者病耻感得分(63.84±4.04)分,95.95%处于中等水平。医保类型、吞咽障碍等级、是否留置胃管为脑卒中后吞咽障碍患者病耻感的影响因素(调整R2=0.539)。结论脑卒中后吞咽障碍患者具有一定的病耻感,可通过改善患者吞咽功能减轻其病耻感。     

脑卒中后中度吞咽障碍患者饮食护理干预效果观察

目的 评价脑卒中后中度吞咽障碍患者置胃管进食和经口进食两种护理方法的效果.方法 将中度吞咽障碍的脑卒中患者随机分为对照组35例和观察组45例,两组均在康复护理干预的基础上进行经鼻胃管鼻饲(对照组)和经口进食(现察组)2周,观察评估两组吞咽功能、营养状况、并发症情况.结果 两组吞咽功能改善、营养状况、并发症发生率比较,差异无显著性意义(均P＞0.05).结论 对中度吞咽功能障碍的急性期脑卒中患者决定进食方式时,可根据实际情况选择经口进食或经鼻胃管进食.     

脑卒中后吞咽障碍患者吞咽肌群的康复训练

目的观察吞咽肌群康复训练对脑卒中吞咽障碍的疗效。方法采用随机区组法将80例脑卒中后吞咽障碍患者分为观察组和对照组各40例。对照组采用吞咽治疗仪常规治疗及一般的口腔护理,观察组在此基础上增加吞咽肌群的功能训练。结果观察组临床疗效显著优于对照组(P<0.01)。结论吞咽治疗仪治疗的基础上增加吞咽肌群的康复训练能明显改善脑卒中患者的吞咽障碍。     

吞咽训练及穴位按摩治疗脑卒中吞咽障碍的研究进展

介绍脑卒中吞咽障碍的发病机制和评估方法,从吞咽训练治疗方案、穴位按摩治疗方案、吞咽训练联合穴位按摩治疗的优势3个方面对吞咽训练及穴位按摩治疗脑卒中吞咽障碍的临床使用情况及研究进展进行综述,旨在为脑卒中吞咽障碍患者探索最佳治疗方法提供参考。     

吞咽障碍筛查对降低急性脑卒中患者吸入性肺炎的作用

目的探讨吞咽障碍筛查对预防急性脑卒中患者发生吸入性肺炎的效果。方法将514例急性脑卒中患者按入院时间顺序分为对照组177例和观察组337例。对照组根据患者主诉是否有呛咳、吞咽困难界定是否存在吞咽障碍,护士遵医嘱执行饮食护理。观察组由专门接受过培训的护士采用床边吞咽试验(包括吞水试验及吞糊试验)联合监测脉冲氧饱和度评估患者吞咽功能,根据患者吞咽功能采取不同的摄食护理干预。结果观察组吞咽障碍检出率35.9%,显著高于对照组(P<0.05);吸入性肺炎的发生率为2.4%,显著低于对照组(P<0.01)。结论对急性脑卒中患者及早采用床边吞咽试验联合脉冲氧饱和度监测进行吞咽功能评估,能较客观地指导饮食护理,降低患者吸入性肺炎发生率,促进患者的整体康复。     

老年脑卒中吞咽障碍患者的护理干预效果

目的:探讨对老年脑卒中吞咽障碍患者实施护理干预效果。方法:选取神经内科2011年3月～2012年3月收治的68例伴随不同程度的吞咽障碍老年脑卒中患者,按随机分组表随机分为对照组与干预组,对照组接受常规护理,干预组全面性护理。患者的吞咽障碍程度分为1到5级,级别越高则障碍越大,观察护理前后,两组患者吞咽障碍程度的变化,进行比较分析。结果:在护理后,干预组与对照组1-5级吞咽障碍对应的患者数目均出现了显著变化,且干预组患者吞咽障碍的康复情况明显优于对照组(P<0.05)。结论:针对老年脑卒中吞咽障碍患者进行心理疏导、基础训练、饮食指导与训练的护理,患者的吞咽能力显著增强,生活质量得到了明显的改善。     

酸刺激法改善脑卒中患者吞咽障碍效果观察

目的 探讨对脑卒中吞咽障碍患者早期实施酸刺激法康复护理训练的效果.方法 将80例脑卒中吞咽障碍患者随机分为酸刺激组和对照组各40例.对照组采用常规康复训练方法,酸刺激组在此基础上加用酸梅粉、醋或维生素C进行酸刺激的吞咽功能训练.结果 酸刺激组治疗效果显著优于对照组(P＜0.01).结论 对脑卒中吞咽障碍患者进行以酸刺激为主的早期吞咽功能训练,有助于患者吞咽功能的恢复.     

脑卒中吞咽障碍患者的摄食管理临床研究

目的提高脑卒中吞咽障碍患者吞咽功能训练效果,降低卒中相关性肺炎发生率。方法将136例脑卒中吞咽障碍(洼田饮水试验Ⅱ～Ⅴ级)患者随机分为两组各68例。对照组行脑卒中吞咽障碍常规饮食护理;观察组采取食物稠度及一口量精细评估,制订个体化进食方案,动态评价与方案调整等措施进行摄食管理。结果观察组吞咽功能恢复程度显著优于对照组,卒中相关性肺炎发生率显著低于对照组(P0.05,P0.01)。结论精细评估、个体化护理及全程追踪可提高脑卒中吞咽障碍训练效果,降低相关并发症。     

程序化管理模式在脑卒中患者饮食护理中的应用

目的观察程序化管理模式在脑卒中患者饮食护理中的应用效果。方法对654例脑卒中患者按照程序实施饮食管理,包括吞咽功能评估、正确选择食物、制作个体化饮食提示卡以及执行喂食程序。结果早期筛查出吞咽障碍患者265例,无一例因饮食不足而发生脱水、营养不良现象和误吸窒息意外事件;患者对饮食护理的满意度为98.0%。结论实施程序化管理模式能及早筛查吞咽障碍患者,制定个性化饮食护理方案,使患者安全进食。     

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.