老年2型糖尿病患者害怕跌倒现状及影响因素分析

目的了解老年2型糖尿病患者害怕跌倒情况及相关影响因素,为开展针对性护理干预以预防跌倒发生提供参考。方法选取老年2型糖尿病患者128例,采用一般资料调查表、害怕跌倒评估、简易精神状态检查量表、简易虚弱问卷、老年焦虑量表、简版老年抑郁量表进行调查。结果 63例(49.22%)老年2型糖尿病患者存在害怕跌倒心理;患者害怕跌倒心理与焦虑、抑郁水平呈正相关(均P0.01);多因素Logistic回归分析结果显示,年龄、过去1年内有跌倒史、抑郁是害怕跌倒的独立危险因素(均P0.01)。结论老年2型糖尿病患者害怕跌倒心理存在的比例较高,患者年龄、抑郁水平及过去1年内跌倒史与害怕跌倒密切相关。加强防跌倒健康教育及改善情绪状态有助于缓解其害怕跌倒心理,降低患者再次跌倒的风险。     

住院患者跌倒的相关因素分析

目的 了解住院患者跌倒情形和跌倒后的伤害程度,并分析其影响因素.方法 采用回顾性调查研究法,依据跌倒意外事件报告单和不安全事件管理系统对住院患者跌倒事件进行比较分析.结果 287例住院跌倒的患者,以男性、发生在5:00～6:00居多.54.7％跌倒发生在患者房间内,39.3％在如厕／沐浴过程中跌倒,35.9％患者跌倒后发生不同程度的损伤.生活自理能力差、高龄、虚弱、服用抗高血压药物等是跌倒的危险因素.结论 护理人员应针对跌倒的危险因素,制定防护措施,避免住院患者跌倒事件发生,从而提高以患者安全为中心的护理质量.     

两表一书联用预防内科老年住院患者跌倒

目的减少老年患者住院期间意外跌倒的发生。方法自行设计跌倒危险因素评分表、预防跌倒告知书、预防跌倒宣教表（两表一书）于2007年8月至2008年9月用于441例经评估有潜在跌倒风险的内科老年住院患者：对有跌倒潜在风险的患者进行评分→告知家属或患者→签名→健康教育→签名,并根据患者的实际情况,住院时、住院期间循环不断地重复以上流程,患者出院时将两表一书保存在病历中留档。结果441例元1例发生跌倒意外。结论对患者进行动态防跌倒危险评估利于对跌倒危险患者重点防范,加强预防跌倒知识教育可降低患者跌倒发生,确保患者住院期间的安全,减少医疗纠纷。     

两表一书联用预防内科老年住院患者跌倒

目的 减少老年患者住院期间意外跌倒的发生.方法 自行设计跌倒危险因素评分表、预防跌倒告知书、预防跌倒宣教表(两表一书)于2007年8月至2008年9月用于441例经评估有潜在跌倒风险的内科老年住院患者:对有跌倒潜在风险的患者进行评分→告知家属或患者→签名→健康教育→签名,并根据患者的实际情况,住院时、住院期间循环不断地重复以上流程,患者出院时将两表一书保存在病历中留档.结果 441例无1例发生跌倒意外.结论 对患者进行动态防跌倒危险评估利于对跌倒危险患者重点防范,加强预防跌倒知识教育可降低患者跌倒发生,确保患者住院期间的安全,减少医疗纠纷.     

老年住院患者陪护预防跌倒知信行调查

目的调查老年住院患者陪护对预防跌倒的认知情况,以便有针对性地对陪护者实施护理对策,预防住院老年患者跌倒的发生。方法采用自行设计的老年住院患者陪护预防跌倒问卷,对100名老年住院患者的陪护者进行调查。结果陪护者对患者跌倒相关风险的认识为36.00%~65.00%;不同年龄、不同陪护角色、不同陪护时间的陪护者知识、态度和行为得分不同(P0.05,P0.01)。结论陪护人员对老年住院患者的预防跌倒认知上存在差异,护理人员应重视并加强老年住院患者陪护人员预防跌倒相关知识持续专业性的个体化教育,以减少老年患者跌倒的发生。     

严重膝关节炎患者跌倒情况分析

目的调查年龄65岁的严重膝关节炎患者跌倒的频率、机制、地点、跌倒时正在做的活动、受伤的情况以及测试身体状况,其次是研究年龄、性别、慢性疾病、社交活动、身体其他部位疼痛以及和生活质量相关的指标(如疼痛、僵硬、机体功能和动态稳定性)对跌倒概率的影响。方法纳入自2011-05—2012-05行全膝关节置换术的75例重度膝关节炎患者,当面询问过去一年的跌倒史,采用SF-36简易健康调查表评估患者生活质量,WOMAC评分评估术后效果,来回试验评估患者的机动性以及静态和动态稳定性。结果本研究中46例(61.3%)在过去的一年中发生过跌倒,跌倒的主要原因是被绊倒。75例的SF-36生理因素评分(34.39±6.97)分,SF-36精神因素评分(37.16±8.84)分;WOMAC总分(825.74±307.33)分,疼痛(223.10±86.43)分,僵硬(57.52±42.46)分,生理功能(538.93±257.18)分;来回试验(13.27±4.31)s。单因素分析发现,跌倒组和未跌倒组的年龄、性别、BMI、合并其他部位疼痛、合并慢性疾病、社交活动、其他部位关节置换、SF-36简易健康量表、WOMAC评分、来回试验比较差异无统计学意义(P0.05)。结论严重膝关节炎患者发生跌倒的风险较大,应尽早接受膝关节置换手术治疗,以改善膝关节功能,降低跌倒受伤的风险。     

住院老年患者跌倒警觉度现状及影响因素研究

目的 了解住院老年患者跌倒警觉度状况，并分析其影响因素，为制定针对性跌倒预防措施提供借鉴。方法 采用便利抽样法选取782例住院老年患者为调查对象，使用一般资料调查表、Morse跌倒评估表、Barthel指数、跌倒警觉度量表进行调查。结果 有效调查住院老年患者695例，住院老年患者跌倒警觉度得分为(62.67±12.34)分。多元线性回归结果显示，自理能力、是否害怕跌倒及知晓治疗用药易致跌倒是患者跌倒警觉度的影响因素(均P<0.05)。结论 住院老年患者跌倒警觉度较高，护理人员应结合患者跌倒警觉程度及影响因素，进行个性化的健康教育和安全指导，预防跌倒发生。     

应用护理干预措施预防住院患者跌倒的研究

目的:探讨住院患者跌倒危险因素及规律,提高住院患者跌倒预防的实效.方法:建立住院患者跌倒评估表、预防措施表、宣教单、警示标志和使用流程,共同组成住院病人跌倒预防方案运用于临床,并对22600例住院患者进行回顾性调查分析.结果:经过对两年213例住院高危跌倒患者应用跌倒预防方案进行护理干预前后对比,全院住院患者跌倒发生率明显下降.结论:运用综合预防方案,采取必要护理干预措施,可以有效地预防住院患者跌倒的发生.     

三级甲等综合性医院住院患者跌倒发生的高危因素与管理策略

目的 降低住院患者跌倒发生率.方法 分析住院患者跌倒发生的病区环境、患者原因、护士原因、陪护等高危因素;实施改善病区环境,加强预防跌倒知识培训,畅通护理不良事件上报系统,实施患者跌倒防范管理制度及伤情认定制度,合理配置护士人力等管理策略.结果 实施管理策略前全院跌倒发生率为0.047％,实施后降至0021％,实施前后比较,差异有统计学意义(P＜0.05).结论 分析住院患者跌倒发生的高危因素,采取统一的住院患者跌倒管理策略,可有效控制和降低住院患者跌倒发生率.     

两种健康教育方式防止老年住院患者跌倒的效果观察

目的探讨老年住院患者防跌倒健康教育的效果。方法将356例65岁以上的老年住院患者随机分为两组各178例,对照组采用说教式的集体教育,观察组采用以人为本、因人施教的健康教育。结果观察组对防跌倒相关知识了解程度明显高于对照组(均P<0.01),随访期间观察组跌倒发生率明显低于对照组(P<0.01)。结论对老年住院患者实施以人为本、因人施教的防跌倒健康教育,能提高老年患者对跌倒危险因素的认知,采取预防跌倒措施,降低跌倒发生率。     

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.