急性ST段抬高型心肌梗死患者急诊PCI术后I期心脏康复护理研究

目的探讨I期心脏康复七步训练法用于急性ST段抬高型心肌梗死急诊PCI术后患者的效果。方法将100例急性ST段抬高型心肌梗死直接PCI术后患者随机分为观察组52例和对照组48例,对照组给予急性心肌梗死PCI术后常规护理,观察组在对照组的基础上实施I期心脏康复七步法护理。结果两组住院期间心律失常发生率比较,差异无统计学意义(均P0.05),观察组CCU监护时间、住院时间显著短于对照组,PCI术后首次排便时间显著早于对照组(均P0.01)。结论对急性ST段抬高型心肌梗死直接PCI术后患者实施个体化的I期心脏康复护理有利于缩短CCU监护时间及住院时间,预防便秘发生,促进患者安全。     

急性ST段抬高型心肌梗死患者急诊PCI术后Ⅰ期心脏康复护理研究

目的 探讨Ⅰ期心脏康复七步训练法用于急性ST段抬高型心肌梗死急诊PCI术后患者的效果.方法 将100例急性ST段抬高型心肌梗死直接PCI术后患者随机分为观察组52例和对照组48例,对照组给予急性心肌梗死PCI术后常规护理,观察组在对照组的基础上实施Ⅰ期心脏康复七步法护理.结果 两组住院期间心律失常发生率比较,差异无统计学意义(均P＞0.05),观察组CCU监护时间、住院时间显著短于对照组,PCI术后首次排便时间显著早于对照组(均P＜0.01).结论 对急性ST段抬高型心肌梗死直接PCI术后患者实施个体化的Ⅰ期心脏康复护理有利于缩短CCU监护时间及住院时间,预防便秘发生,促进患者安全.     

预防心肌梗死患者便秘的循证护理

目的 探讨循证护理(EBN)预防急性心肌梗死(AMI)患者便秘的效果.方法 将96例AMI患者随机分为观察组与对照组各48例,对照组给予常规护理,观察组行EBN,即循证后采取早期预防、促进排便训练、心理支持、首次排便监护等干预措施.结果 两组患者首次排便持续时间、排便时心率、心电图S-T段变化以及便秘、心律失常等并发症及再次梗死发生率比较,差异有显著性意义(均P＜0.01).结论采用EBN能显著降低AMI患者便秘发生率,从而降低由此引起的并发症.     

舒适护理预防骨折卧床患者便秘的效果观察

目的分析骨折后需卧床休息的患者住院期间行舒适护理以预防发生便秘的临床效果。方法选取骨折术后需卧床休息的患者共90例,按照入院时间分为观察组和对照组2组,每组各45例。对照组患者行常规护理,观察组患者在对照组基础上应用舒适护理,包括:心理护理、腹部按摩指导、饮食指导、疼痛护理及对患者的排便环境管理等。结果观察组2例患者(4.44%)术后发生便秘,对照组18例患者(40.00%)术后发生便秘,2组比较,差异有统计学意义(P0.05)。结论对骨折患者予舒适护理后可显著降低患者的便秘发生率。     

微波联合腹部按摩预防骨科术后便秘

目的观察微波联合腹部按摩预防骨科术后便秘的效果。方法将60例骨科术后患者随机分为对照组和观察组各30例,两组均予以常规护理,包括饮食指导、康复护理等,观察组在此基础上予以微波联合腹部按摩治疗。结果观察组便秘发生率显著低于对照组(P0.01)。结论微波联合腹部按摩可有效预防骨科术后患者便秘,促进术后康复。     

模块化膳食干预对急诊PCI患者便秘及血脂水平的影响

目的探讨模块化膳食营养干预对急性心肌梗死(AMI)行急诊PCI术患者便秘和血脂水平的影响。方法将在CCU住院接受急诊PCI术的166例AMI患者按时间段分为对照组和观察组各83例。对照组行常规低盐低脂饮食指导;观察组针对急诊PCI术患者设计模块化膳食清单管理患者日常饮食。结果观察组住院期间日摄入能量及便秘发生率显著少于和低于对照组(均P0.01),术后第7天、出院1个月时TG、LDL-C及HDL-C值显著优于对照组(P0.05,P0.01)。结论对AMI行急诊PCI术患者设计和应用模块化膳食营养干预可以有效改善其血脂水平,减少便秘发生。     

饮食量化指导对痔术后患者排便的影响

目的 探讨饮食量化指导对痔术后患者排便的影响.方法 将62例痔术后患者随机分为观察组与对照组各31例.对照组术后接受常规饮食教育,观察组于术后2 h后开始饮食量化指导,内容包括进食时间、可食食物的种类、食物的量等,同时将饮食量化制成表格,每人1份.结果 两组患者术后首次排便时间、大便性状、便秘发生率及首次排便疼痛程度比较,差异有显著性意义(P＜0.05,P＜0.01).结论 对痔术后患者进行饮食量化指导能有效地控制排便,避免发生便秘,有效缓解术后排便疼痛.     

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.     

系统化整体护理模式对肛裂患者术后疼痛及便秘的效果观察

为观察系统化整体护理模式对肛裂患者术后疼痛及便秘的效果,将肛裂手术患者184例随机分为对照组和观察组,每组92例。对照组患者术后采用常规护理,观察组患者术后采用系统化整体护理模式护理;比较2组患者术后疼痛及便秘效果。结果显示,观察组患者术后疼痛评分低于对照组(P <0.05),观察组患者3d未排便、用力排便、排便堵塞、粪便干硬比率低于对照组(P <0.05)。结果表明,系统化整体护理模式能有效缓解肛裂患者术后疼痛,改善肛裂术后患者便秘症状。     

中药电熨疗法预防脑卒中后便秘

目的 观察中药电熨疗法对脑卒中后便秘的预防作用.方法 将64例脑卒中患者随机分为对照组(n=30)与观察组(n=34).对照组接受常规治疗护理,观察组在此基础上采用中药电熨疗法,连续治疗14 d.结果 观察组首次排便时间显著缩短、便秘发生率显著低于对照组(P＜0.01,P＜0.05).结论 中药电熨疗法有较好的预防便秘作用,且患者感觉舒适,护理操作简便.     

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.