生活方式干预对单纯肥胖性脂肪肝预后的影响

目的探讨生活方式干预对单纯肥胖性脂肪肝患者预后的影响。方法将124例单纯肥胖性脂肪肝患者随机分为观察组（66例）和对照组（58例）。对照组予常规降脂治疗，观察组在此基础上进行生活方式干预，包括健康教育、饮食与运动行为干预、记生活日记等，干预3个月后进行效果评价。结果观察组干预后减重效果、脂肪肝程度、肝功能恢复及血脂下降程度显著优于对照组（均P〈0．01）。结论生活方式干预能使患者建立良好的饮食与运动行为习惯，全面降低对患者预后不利的影响。     

中药膳食配合运动干预对肥胖性脂肪肝的影响

目的探讨中药膳食配合运动干预对肥胖性脂肪肝的影响.方法将68例脂肪肝患者随机分为对照组和观察组各34例.对照组常规给予低脂饮食和易善复、大黄庶虫丸等降酶保肝治疗;观察组按常规方法治疗外,采用中医辨证施食予以活血化淤、健脾利湿的中药膳食疗法配合运动干预,疗程均为1年.结果治疗后观察组体重、甘油三酯、总胆固醇、谷丙转氨酶等显著低于对照组(均P<0.01).结论中药膳食配合运动干预对肥胖性脂肪肝疗效显著.     

非酒精性脂肪肝患者的行为干预

目的 探讨对非酒精性脂肪肝患者进行以饮食干预及有氧运动为主的行为干预的效果.方法 选择非酒精性脂肪肝患者87例,将其随机分为对照组(51例)和干预组(36例).对照组进行常规健康教育,干预组进行以饮食及运动干预为主的行为干预.结果 干预1年后,干预组体重、体重指数(BMI)、胆固醇(TC)、三酰甘油(TG)、舒张压显著低于干预前(P＜0.05,P＜0.01),其中体重、BMI、TC、TG显著低于同时期对照组(P＜0.05,P＜0.01),干预组治疗有效率72.22%,对照组31.37%,两组比较,差异有显著性意义(P＜0.01).结论 采取饮食加有氧运动为主的行为干预能改善非酒精性脂肪肝患者的临床指标,提高治疗效果.     

特需病房代谢综合征患者的综合护理干预

目的 探讨综合护理干预对特需病房代谢综合征患者的生活方式及各项代谢指标的影响.方法 将50例代谢综合征患者随机分为观察组和对照组各25例,对照组患者按医嘱服药和常规护理,出院后不适随诊;观察组患者在此基础上进行综合护理干预,包括健康教育、运动及饮食干预、出院指导等.连续6个月后比较两组干预效果.结果 干预后观察组患者的生活方式(除外戒烟、坚持服药项)较对照组显著改善(均P<0.05).三酰甘油、体重、体重指数、空腹血糖、收缩压、舒张压的下降程度显著优于对照组(均P<0.05).结论 对代谢综合征患者实施有计划、有跟踪的综合护理干预措施,对改善患者的生活方式,提高代谢综合征的控制率有积极作用.     

中药膳食配合运动干预对肥胖性脂肪肝的影响

目的 探讨中药膳食配合运动干预对肥胖性脂肪肝的影响。方法 将68例脂肪肝患者随机分为对照组和观察组各34例。对照组常规给予低脂饮食和易善复、大黄庶虫丸等降酶保肝治疗；观察组按常规方法治疗外，采用中医辨证施食予以活血化淤、健脾利湿的中药膳食疗法配合运动干预．疗程均为1年。结果 治疗后观察组体重、甘油三酯、总胆固醇、谷丙转氨酶等显著低于对照组（均P〈0．01）。结论 中药膳食配合运动干预对肥胖性脂肪肝疗效显著。     

杞荷饮辅助治疗脂肪肝患者的持续性护理干预

目的 探讨口服杞荷饮辅助治疗脂肪肝患者的效果及护理方法.方法 将80例脂肪肝患者随机分为干预组和对照组各40例,两组均予杞荷饮治疗,每天1剂,3个月为1个疗程;对照组按照常规进行护理,包括指导遵医嘱服药、戒酒、饮食干预、嘱出院后遵医嘱复查;干预组在此基础上,建立患者护理日志,对患者进行持续性护理干预至出院后1年.结果 治疗1年后,干预组治疗效果及患者不良生活方式改善情况显著优于对照组(均P<0.01).结论 对脂肪肝患者进行持续性护理干预,可以提高患者对痰病的认知水平,改善其不良生活行为,提高治疗效果.     

饮食与运动行为干预用于非酒精性脂肪肝的效果观察

目的:观察饮食与运动行为干预对酒精性脂肪肝患者的治疗效果,共同探讨非酒精性脂肪肝患者饮食与运动的干预策略,使患者建立良好的饮食与运动习惯,从而降低预后的不利因素.方法:对患者实施生活方法干预,制定膳食干预原则,编制食谱,给与饮食和运动指导,共6个月并定期随访.结果:90例非酒精性脂肪肝患者通过6个月的干预,干预前饮食控制和运动不合格者分别占93.3％与90％,高热量与高脂肪的摄入分别占100％与92.7％;干预后高热量与高脂肪摄入减少,运动量增加,体重减轻,血糖,血脂值降低,健康意识增强.结论:合理的饮食干预结合恰当的有氧运动,对于脂肪肝具有良好的治疗效果.     

老年糖尿病患者失眠的综合护理干预

目的 探讨老年糖尿病失眠患者的护理干预方法.方法 将96例老年糖尿病患者随机分为对照组(46例)和干预组(50例),采用自制问卷调查影响患者睡眠的因素;对照组采用常规护理,观察组针对影响因素进行综合干预,4周为1个干预周期,2个周期后比较两组睡眠及糖尿病改善效果.结果 观察组睡眠环境、睡眠质量、药物辅助睡眠及饮食分配,运动与血糖值显著优于对照组(均P＜0.01).结论 综合护理干预能提高老年糖尿病失眠患者对疾病相关知识的认知和自我管理能力,改变不良的行为和生活习惯,改善睡眠,提高生活质量.     

循经刮痧与微信运动用于痰湿体质单纯性肥胖人群的干预效果

目的分析循经刮痧结合微信运动对痰湿体质单纯性肥胖人群的干预效果,为临床单纯性肥胖患者的健康管理提供思路。方法将80例痰湿体质单纯性肥胖患者随机分为两组各40例。对照组采用微信运动配合饮食调整及常规健康宣教进行干预,观察组在此基础上施以循经刮痧。分别在干预前,干预12周后比较两组的体质量、腰围、体重指数、中医痰湿体质评分、总胆固醇、甘油三酯、低密度脂蛋白。结果干预12周后,观察组体质量、腰围、体重指数、总胆固醇、中医痰湿体质评分显著优于对照组(P 0. 05,P 0. 01)。结论循经刮痧结合微信运动更能降低痰湿体质单纯性肥胖患者的体质量、腰围、体重指数、中医痰湿体质评分。     

补益肝肾药膳联合轻断食疗法对围绝经期肥胖的改善效果

目的 探讨补益肝肾药膳联合轻断食疗法对围绝经期肥胖的改善效果.方法 将72例围绝经期肥胖患者随机分为对照组和干预组各36例.对照组采取线上、线下相结合模式对患者进行营养与饮食健康教育;干预组在对照组基础上实施补益肝肾药膳联合轻断食疗法,连续干预8周.结果 干预后干预组体质量、腰围测量值显著低于对照组(均P＜0.05);围绝经期生活质量4个维度评分显著优于对照组(均P＜0.01);蛋白质、脂肪、碳水化合物三大营养素供能比改善效果显著优于对照组(均P＜0.01).结论 补益肝肾药膳联合轻断食疗法用于围绝经期肥胖患者,不仅规范营养素摄入情况,有效降低体质量,且对生活质量的改善有积极作用.     

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.