发育性髋关节脱位患儿家长心理与社会支持状况调查

目的 了解社会支持对发育性髋关节脱住(DDH)患儿家长心理反应症状的影响.方法 采用症状自评量表(SCL-90)和社会支持评定量表,对96例DDH患儿家长进行问卷调查.结果 DDH患儿家长SCL-90总分(130.80±0.24)分,9个因子得分(1.21±0.58)～(1.85±0.56)分;SCL-90总分及抑郁、焦虑、人际关系敏感3个因子得分与国内常模比较,差异有统计学意义(均P＜0.01);社会支持总分(36.73±7.26)分,3个维度得分为(9.29±1.32)～(16.52±4.87)分;社会支持总分与抑郁、焦虑、精神病性呈负相关,主观、客观支持维度与抑郁呈负相关,主观、客观支持及社会支持利用度与焦虑呈负相关,客观支持与精神病性呈负相关(均P＜0.05).结论 DDH患儿家长存在明显的焦虑和抑郁,获得中度社会支持;社会支持对DDH患儿家长心理有正性作用.在护理DDH患儿时要注重对患儿家长的心理疏导与支持,以使患儿家长密切配合治疗,促进患儿康复.     

民族地区留守老年人的社区护理服务需求调查

目的 了解民族地区留守老年人对社区护理服务的认知和需求情况.方法 随机抽取湘、鄂、渝、黔四省(市)边区留守老年人289名,采用自制问卷对其进行社区护理服务需求调查.结果 留守老年人对社区护理认知差者达63.32%,对社区护理服务项目开展状况不了解者达65.40%;社区健康体查、慢性病护理及急救意外事故处理是老年人主要需求的项目.年龄、性别、文化程度、留守时间、健康状况和民族构成因素对社区护理服务具有显著影响(P<0.05,P<0.01).结论 应加强社区护理知识的宣传,发挥社区护理特色与优势,针对留守老年人的需求特点,开展多种服务方式的社区护理.     

NICU早产儿母亲疾病不确定感与社会支持的相关性研究

目的了解NICU早产儿母亲疾病不确定感、社会支持状况及其相关性,为临床干预提供依据。方法运用疾病不确定感父母量表(PPUS-FM)和社会支持评定量表(SSRS)对180例NICU早产儿母亲进行调查。结果早产儿母亲疾病不确定感总分(98.71±11.50)分,社会支持总分(38.95±6.68)分,疾病不确定感总分、不可预测性、不明确性及复杂性与社会支持总分、客观支持、主观支持、支持利用度呈负相关(均P0.01)。结论 NICU早产儿母亲疾病不确定感与社会支持水平相关;临床护理人员在护理早产儿的同时,应该重视其母亲的心理需求,帮助她们寻求来自家庭和社会的可利用资源,以降低其疾病不确定感,促进身心健康。     

社区护士工作适应障碍与领悟社会支持相关性研究

目的了解社区护士工作适应情况及领悟社会支持现状,探讨二者相关性,为社区护理管理者实施有效的人力资源管理提供参考。方法采用工作适应障碍量表和领悟社会支持量表对290名社区护士进行问卷调查。结果社区护士工作适应障碍得分为20.85±5.18;领悟社会支持总分为64.25±10.32,其中家庭内支持20.01±3.58,家庭外支持42.57±6.86;社区护士工作适应障碍与领悟社会支持总分、家庭内支持、家庭外支持呈负相关(均P0.01)。结论社区护士工作适应情况普遍不良,领悟社会支持处于中等水平。社区护理管理者应采取有效措施提高社区护士的社会支持度,以改善其工作适应不良,防止护理人才流失,提高社区护理服务质量。     

三级医院护士“互联网+护理服务”核心知识技能培训需求调查

目的调查郑州市三级医院护士"互联网+护理服务"核心知识技能的培训需求状况,为护理管理者制定培训方案提供参考。方法采用自行设计的"互联网+护理服务"核心知识技能培训需求调查问卷对郑州市三级医院472名护士进行调查。结果护士"互联网+护理服务"培训需求总分为(4.39±0.03)分,其中执业基本知识、伦理与礼仪和项目技能操作3个维度得分分别为(4.51±0.71)分、(4.51±0.75)分、(4.36±0.71)分。84.32%的护士愿意提供"互联网+护理服务",95.55%认为有必要开展该项培训。单因素分析显示,年龄、提供"互联网+护理服务"意愿、开展"互联网+护理服务"培训必要性认知与护士培训需求得分有关(P0.05,P0.01)。结论三级医院护士"互联网+护理服务"核心知识技能的培训需求较高,护理管理者需制定切实可行的培训方案以满足其需求。     

社区老年人痴呆恐惧状况及影响因素研究

目的 了解社区老年人痴呆恐惧状况,并探讨其影响因素,为实施针对性护理干预提供参考.方法 采用一般资料调查表、痴呆恐惧量表、社会支持评定量表以及自尊量表对621名社区老年人进行调查.结果 社区老年人痴呆恐惧得分55.65±13.56,社会支持得分29.59±8.31,自尊得分27.18±4.99.社区老年人痴呆恐惧与社会...     

社区老年人生活质量及其社区护理需求调查分析

目的 了解社区老年人的生活质量和对社区护理服务的需求情况及其影响因素,并提出改进社区护理的对策,以提高老年人生活质量.方法 选择福州4个社区的363名老年人作为研究对象,使用自制的社区护理需求调查问卷以及生活质量综合评定量表(GQOLI-74),对其生活质量状况、社区护理需求情况及影响因素进行调查.结果 老年人生活质量得分为61.71±9.85;其对社区护理需求得分为2.52±1.03,其中对健康促进需求最高[(2.88±1.09)分].影响社区护理需求的主要因素是对社区护理的认识、患病数目、年龄等;影响老年人生活质量的主要因素是患病数目、经济状况、文化程度、职业、婚姻状况、年龄等.老年人对社区护理各领域需求与生活质量的躯体功能、心理功能呈负相关关系(P＜0.05,P＜0.01);对疾病护理方面和护理需求总分与社会功能呈负相关关系(P＜0.05,P＜0.01).结论 社区老年人生活质量偏低,对社区护理需求较高,其生活质量和社区护理需求呈负相关关系,需针对老年人需求特点开展社区护理工作,以提高其生活质量.     

我国临床护士创新能力现状调查

目的 了解我国临床护士创新能力现状,探讨其影响因素,为护士护理创新能力培训策略制订提供参考.方法 采用临床护士创新能力评价量表对全国877所不同级别医院的21535名护士进行调查.结果 临床护士创新能力总分为(137.96±21.16)分,维度得分:创新主体(58.53±9.09)分、创新过程40(36,46)分、创新环境和压力27(21,29)分、创新产品13(9,15)分.得分较高的3个条目均来自创新主体维度;得分较低的3个条目中1条来自创新主体维度,2条来自创新产品维度.多元线性回归分析结果显示,护士的年龄、性别、科室、技术职称、行政职务、专利获得数、论文发表数对其创新能力有影响(P＜0.05,P＜0.01).结论 临床护士创新能力处于一般水平,影响临床护士创新能力的因素较多,护理管理者需对临床护士进行创新意识培训,为护理创新实践与转化提供必要的条件和政策支持.     

湖北省三级综合医院住院患者护理服务需求分析与对策

目的分析湖北省三级综合医院住院患者对护理服务的需求现状,拟为改进护理服务质量,进一步满足患者需求提供参考。方法采用自制三级综合医院住院患者护理服务需求问卷,对1 971例三级综合医院住院患者进行问卷调查。结果综合医院住院患者对护理服务需求得分依次为安全需求(4.53±0.54)、尊重需求(4.38±0.51)、爱与归属需求(4.26±0.63)、自我实现需求(4.23±0.59)、生理需求(3.76±0.68)。16个2级条目中,排在前3位的条目为护士能力(4.77±0.50)、预防感染(4.64±0.62)和健康宣教(4.59±0.46),均属于安全需求维度;排在后3位的条目为生活起居(2.57±0.77)、睡眠(3.79±0.69)和探视与陪护(3.99±0.68),分别属于生理需求和爱与归属维度。结论住院患者对护理服务中安全的需求较高,对生理需求相对较低,护理管理者应根据患者的实际需求制定护理服务措施,以最大限度地满足患者需求。     

民族地区留守老年人的社区护理服务需求调查

目的了解民族地区留守老年人对社区护理服务的认知和需求情况。方法随机抽取湘、鄂、渝、黔四省（市）边区留守老年人289名，采用自制问卷对其进行社区护理服务需求调查。结果留守老年人对社区护理认知差者迭63．32％，对社区护理服务项目开展状况不了解者达65．40％；社区健康体查、慢性病护理及急救意外事故处理是老年人主要需求的项目。年龄、性别、文化程度、留守时间、健康状况和民族构成因素对社区护理服务具有显著影响（P〈0．05，P〈0．01）。结论应加强社区护理知识的宣传，发挥社区护理特色与优势，针对留守老年人的需求特点，开展多种服务方式的社区护理。     

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.     

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.     

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.     

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.