2型糖尿病患者自我管理误区的调查研究

目的了解2型糖尿病患者的自我管理误区,为针对性健康教育提供依据。方法采用2型糖尿病患者自我管理误区问卷对176例2型糖尿病患者进行调查。结果2型糖尿病患者自我管理误区得分(22.78±9.88)分;不同性别、年龄、文化程度、职业、人均月收入、医疗费用支付方式患者自我管理误区总分或维度得分比较,差异有统计学意义(P0.05,P0.01)。结论2型糖尿病患者普遍存在自我管理误区,自我管理误区与个人人口统计学资料存在一定的关系,护理人员应给予针对性健康教育。     

2型糖尿病患者自我管理误区的调查研究

目的了解2型糖尿病患者的自我管理误区,为针对性健康教育提供依据。方法采用2型糖尿病患者自我管理误区问卷对176例2型糖尿病患者进行调查。结果2型糖尿病患者自我管理误区得分（22．78±9．88）分;不同性别、年龄、文化程度、职业、人均月收入、医疗费用支付方式患者自我管理误区总分或雏度得分比较,差异有统计学意义（P〈0．05,P〈0．01）。结论2型糖尿病患者普遍存在自我管理误区,自我管理误区与个人人口统计学资料存在一定的关系,护理人员应给予针对性健康教育。     

2型糖尿病患者的风险感知及影响因素分析

目的了解2型糖尿病患者的风险感知水平及其影响因素。方法采用糖尿病相对性风险感知问卷对268名2型糖尿病患者进行调查。结果相对性风险感知总得分2.55±0.37,各维度得分由高到低依次为:担心3.39±0.51,相对性环境风险2.84±0.39,个人风险控制2.74±0.47,乐观性偏差2.52±0.67,个人疾病风险2.17±0.78。女性及文化程度高者感知的个人风险控制和乐观性偏差显著高于男性及文化程度低者(P0.05,P0.01),非在岗者的担心水平显著高于在岗者(P0.05)。相对性风险感知总分与病程呈正相关(P0.01),个人风险控制与空腹血糖呈负相关(P0.05),个人疾病风险与年龄、病程呈正相关(均P0.01)。乐观性偏差、病程、年龄、个人风险控制、担心、家庭月收入是个人感知的疾病风险的独立影响因素。结论 2型糖尿病患者的风险感知水平偏低,应根据不同人口学特征和疾病临床特征,采取有效的健康风险沟通和个性化健康干预。     

2型糖尿病伴骨质疏松患者健康素养状况及影响因素分析

目的了解2型糖尿病伴骨质疏松患者健康素养状况及影响因素,为制定提高2型糖尿病伴骨质疏松患者健康素养干预措施提供参考。方法采用自制的健康素养量表对268名2型糖尿病伴骨质疏松患者进行问卷调查,分析调查对象的健康素养状况及其影响因素。结果 268名2型糖尿病伴骨质疏松患者健康素养得分为144.68±62.81分,占满分的62.91%(满分230分),其中书面素养得分为124.82±58.74分,占该领域满分的75.65%(满分165分);运算能力得分为26.84±10.42分,占该领域满分的41.30%(满分65分)。其中有109例(40.71%)的患者得分150分,属于健康素养缺乏;有86例(32.10%)的患者得分为150~180分,属于临界健康素养;另有73例(27.20%)的患者得分180分,属于健康素养充足。多元线性回归分析结果显示,年龄、文化程度、病程、有无职业、月收入、住院次数、居住地是2型糖尿病伴骨质疏松患者健康素养的影响因素。结论 2型糖尿病伴骨质疏松患者存在较低健康素养现象,对其影响因素制定针对性的干预措施是提高患者健康素养的重要途径。     

癌症患者心理弹性水平及其影响因素研究

目的探讨癌症患者心理弹性水平及其影响因素。方法采用心理弹性量表(CD-RISC)、中文版健康促进策略量表(SUPPH)和一般资料调查问卷对山东省某2所三级医院376例癌症患者进行横断面调查。结果癌症患者的心理弹性得分为(59.17±8.93)分,自我管理效能感得分为(82.93±14.96)分;癌症患者的心理弹性与自我管理效能感呈正相关(P0.01);性别、家庭月收入、信仰、文化程度、自我管理效能感是癌症患者心理弹性水平的预测因子,其解释心理弹性总变异的65.8%。结论癌症患者心理弹性水平相对较低,其心理弹性与自我管理效能感相关,临床护理中应该高度重视癌症患者的心理弹性状况,尤其是女性、经济状况较差、无信仰、文化程度低、自我管理效能感较差的患者。     

胃癌术后化疗期患者心理痛苦度及其影响因素的纵向研究

目的调查胃癌患者术后化疗期间心理痛苦变化情况及影响因素,为改善其负性心理提供参考。方法采用一般资料调查问卷、心理痛苦温度计及综合医院焦虑抑郁量表,分别于化疗前1 d(T1)及第1、3、6次化疗(T2、T3、T4)进行问卷调查。结果共212例完成研究。4个时间段中重度心理痛苦检出率分别为62.74%、70.28%、47.17%、31.60%;4个时间段心理痛苦、焦虑抑郁得分差异有统计学意义(均P0.01);其中心理痛苦得分T2最高(4.84±1.27)、T4最低(2.67±1.23)。多元回归分析结果显示:性别、年龄、文化程度、焦虑4个变量进入4个时间段、抑郁进入3个时间段(T2未能进入)、个人月收入进入T1、T3时间段、肿瘤分期进入T1时间段心理痛苦影响因素预测模型(调整R~2:T1为0.836,T2为0.512,T3为0.683,T4为0.605;P0.05,P0.01)。结论胃癌患者术后化疗期间心理痛苦发生率高,不同阶段心理痛苦呈动态变化趋势。应采取针对性措施干预,尤其对女性、高龄、文化程度偏低、个人月收入较少,以及焦虑、抑郁情绪较重患者应强化干预,以减轻患者心理痛苦水平,促其完成全程化疗和提高生活质量。     

乳腺癌化疗患者预期性悲伤现状及影响因素分析

目的 了解乳腺癌化疗患者预期性悲伤现状,并分析其影响因素,为临床医护人员采取有效干预措施提供参考。方法 以便利抽样方法选取乳腺癌化疗患者196例,采用一般资料调查表及预期性悲伤评估量表进行调查。结果 乳腺癌化疗患者预期性悲伤得分为(35.26±16.97)分;单因素分析显示,不同居住地、文化程度、职业、人均月收入、自觉心理状况、疲乏、失眠、食欲减退、活动障碍和患病时长的乳腺癌化疗患者预期性悲伤得分比较,差异有统计学意义（P<0.05,P<0.01）;多因素分析显示,人均月收入、自觉心理状况、疲乏、活动障碍为乳腺癌化疗患者预期性悲伤的主要影响因素（P<0.05,P<0.01）,共解释总变异量的24.60%。结论 化疗期乳腺癌患者预期性悲伤处于中等水平,临床医务人员需关注其心理状态,评估并分析导致其预期性悲伤的影响因素,制定个体化的干预措施,以降低其预期性悲伤水平。     

首发脑卒中患者积极度现状及影响因素

目的探讨首发脑卒中患者积极度现状及其影响因素,为制定针对性的干预措施提供参考。方法采用一般情况调查表、患者积极度量表、脑卒中健康知识问卷、脑卒中康复自我效能问卷调查212例首发脑卒中患者。结果首发脑卒中患者积极度得分为(49.44±12.75)分。多元线性回归分析显示,自我效能、文化程度、生活自理程度、家庭人均月收入、健康知识为患者积极度的主要影响因素,可解释总变异的40.4%。结论首发脑卒中患者积极度水平偏低,尤其是文化程度低、家庭人均月收入低、生活自理程度差、健康知识水平低及自我效能低的首发脑卒中患者,应给予针对性干预,以提高积极度水平。     

新诊断2型糖尿病青年患者自我管理现状及影响因素研究

目的了解新诊断2型糖尿病(T2DM)青年患者自我管理现状并分析其影响因素。方法对169例新诊断T2DM青年患者采用糖尿病自我管理行为、知识、态度问卷,自我效能问卷,糖尿病痛苦量表及医学应对问卷、社会支持评定量表进行横断面调查及影响因素分析。结果自我管理行为总均分(3.58±1.37)分,其中饮食维度(4.43±1.50)分,运动维度中位数3.50分,血糖监测维度2.00分,足部护理维度0分,遵医用药维度(6.17±1.80)分。自我效能、参加糖尿病组织或微信群可解释饮食自我管理总变异的16.3%;自我效能、糖尿病知识、年龄、回避应对可解释运动自我管理总变异的32.4%;参加糖尿病组织或微信群、面对应对、文化程度、糖尿病确诊时间、并存疾病或并发症可解释血糖监测自我管理总变异的24.2%;参加糖尿病组织或微信群、面对应对、文化程度可解释足部护理自我管理总变异的10.7%;家庭人均月收入可解释遵医用药自我管理总变异的3.3%;女性和文化程度高是吸烟的保护因素(OR=0.037,0.423)。结论新诊断T2DM青年患者总体自我管理水平较低,其中遵医用药最好,足部护理最差。患者应对方式、是否参加糖尿病组织或微信群和文化程度是主要影响因素。     

老年良性前列腺增生患者生活质量及其影响因素分析

目的分析老年良性前列腺增生患者生活质量现状及其影响因素,以期为老年BPH患者进行有针对性的护理干预提供理论依据。方法采用整群抽样法,使用一般资料调查表、良性前列腺增生症患者生活质量量表和健康行为能力自评量表,对河南省11家三级综合医院住院的372名老年良性前列腺增生患者进行问卷调查。结果老年BPH患者生活质量的得分是(104.77±20.04)分,根据得分指标显示得分率是65.5%。年龄、文化程度、性生活次数、病程、婚姻状况、人均月收入和自我效能均是影响老年BPH患者生活质量的因素。结论老年BPH患者生活质量居中等水平,影响其生活质量的主要因素有年龄、文化程度、性生活次数、病程、婚姻状况、人均月收入及自我效能。     

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.