全麻术后成人患者麻醉后监护室转出标准的构建

目的 构建全麻术后成人患者麻醉后监护室（PACU）转出标准,为麻醉苏醒室护士转出患者提供参考。方法 采用文献研究和德尔菲专家咨询法,确定PACU转出标准条目,构建转出标准指标体系。结果 形成的全麻术后成人患者转出标准为呼吸、循环、活动与肌力、舒适及潜在风险5个方面共22个条目。2轮专家积极性分别为100%、94.74%,专家权威系数分别为0.95和0.94,肯德尔和谐系数分别为0.385、0.392。结论 构建的麻醉后苏醒室成人转出标准评估内容较为全面、贴近临床,适用于护士对苏醒室患者的转出评估。     

成人有创机械通气患者误吸危险因素评估量表的条目筛选

目的筛选及优化成人有创机械通气患者误吸危险因素评估量表条目。方法采用Delphi法对17名专家进行2轮专家咨询,并对其结果进行统计分析。结果 2轮专家咨询的积极系数分别为92.86%和100%;专家权威系数分别为0.848和0.852;第2轮重要性和准确性专家意见的协调系数分别为0.594和0.561。最终研制的成人有创机械通气患者误吸危险因素评估量表由2个维度、12个条目和30个等级条目构成。结论本研究的专家积极程度和权威程度均较高,专家意见的集中程度和协调程度均较好,采用Delphi法筛选出的条目具有较高的可靠性。     

脊柱外科手术后切口感染风险预测评估体系的构建

目的构建脊柱外科手术后切口感染风险预测评估体系。方法以失效模式与效应分析(FMEA)为基础, 通过文献检索整理出脊柱手术后切口感染的危险因素和评估项目, 采用德尔菲专家咨询法进行专家咨询。根据项目的重要性, 结合专家意见进行筛选, 建立三级评估指标并进行赋分, 最终制定术后切口感染风险评估体系。结果经2轮专家咨询问卷, 有效回复率为100%。专家咨询权威程度为0.85, 可靠性高;专家咨询的肯德尔协调系数为0.525～0.686, 协调程度良好(P<0.05)。三级评估指标包括3个一级指标, 18个二级指标, 54个三级指标。选择的重要风险条目包括术前评估条目6项, 术后评估条目18项, 经过统计分析, 得出6个术前预测指标和12个术后预测指标, 按照半定量的方法得出高、中、低风险的风险优先系数范围值。结论本研究依据专家咨询和FMEA的方法, 建立了一套脊柱外科手术后切口感染风险因素和评估预测工具。     

基于德尔菲法研制住院患者社会适应能力评估量表

目的研制适用于住院患者的社会适应能力评估量表,为住院患者社会适应能力评估提供良好的工具。方法在文献研究的基础上编制专家咨询问卷,应用德尔菲法,选取20名专家进行2轮专家咨询确定量表的条目。结果专家的积极性较高,2轮问卷的有效回收率均为100%;第1轮和第2轮专家权威系数分别为0.85和0.89,两轮专家意见的协调系数分别为0.265和0.335(均P0.01)。最终形成了包含环境适应、角色适应、生活方式适应、规章制度适应、人际关系适应5个维度28个条目的住院患者社会适应能力评估量表。结论应用德尔菲法编制的住院患者社会适应能力评估量表具有较高的可靠性,该量表可作为住院患者社会适应能力的评估工具。     

妇科患者手术期静脉血栓风险评估量表的构建

目的 构建妇科患者手术期静脉血栓风险评估量表,为临床提供有效评估工具.方法 以Virchow血栓形成三要素为理论基础,广泛查阅文献,参考相关指南及临床常用量表形成初始量表条目池,运用Delphi法对15名专家进行2轮咨询.结果 2轮专家咨询问卷有效回收率均为100％,专家权威系数为0.81,专家意见的协调系数分别为0....     

华西医院心脏死亡器官捐献供体新型冠状病毒感染快速筛查工具的初步构建

目的初步构建在新型冠状病毒感染疫情背景下心脏死亡器官捐献(donation after circulatory death,DCD)肝移植供体的快速筛查工具。方法通过文献分析法和核心小组讨论法构建理论基础,采用德尔菲法进行两轮专家咨询确立维度和指标,最后采用层次分析法计算各维度和指标的权重系数。结果筛查工具包含流行病学史、医院暴露史、临床表现3个维度,15个条目。两轮专家权威系数均值为0.757和0.768,专家咨询问卷有效回收率分别为88%和100%。第2轮维度和指标协调系数分别为0.417和0.319。问卷内容效度为0.91。结论德尔菲法构建的DCD肝移植供体新型冠状病毒感染快速筛查工具科学性和可靠性较高,疫情期间,DCD肝移植供体风险筛查工具对肝移植风险防控具有重要意义。     

基于德尔菲专家法构建观察等待期良性前列腺增生患者下尿路症状的干预方案

目的探讨基于德尔菲专家法构建观察等待期良性前列腺增生(BPH)患者下尿路症状(LUTS)的干预方案的可行性。方法通过检索文献、质性访谈、8名相关领域专家进行2轮德尔菲法咨询构建形成干预方案, 对2021年5月1日至2021年6月1日在大庆市人民医院随机招募10例≥50岁的BPH患者实施预实验来验证干预方案的可行性。结果 2轮德尔菲专家法咨询问卷回收率为100%(8/8), 第一轮与第二轮的专家权威系数(Cr)分别为0.8438和0.9589, 肯德尔协调系数(Kendall′s W)分别为0.216(χ2=63.918, P<0.01)和0.280(χ2=42.567, P<0.001);第一轮专家协调程度优于第二轮。第1轮咨询38个条目, 各条目重要性评分均数为3.00～4.75分, 变异系数0.10～0.35分, ;第2轮咨询20个条目, 各条目重要性评分均数为3.50～4.75分, 变异系数为0.10～0.31分, 经咨询后形成3个维度, 18个条目。最终形成观察等待期BPH患者LUTS的干预方案。干预后的国际前列腺症状评分(IPSS)低于干预前, 差异无统计学意义(...     

早产儿经口喂养能力评估量表的编制

目的建立早产儿经口喂养能力评估量表,以指导医护人员正确评估早产儿喂养能力。方法在文献回顾、理论研究的基础上,拟定早产儿经口喂养能力评估量表,对15名专家采用Delphi法进行3轮咨询。结果3轮咨询的有效问卷回收率分别为78.95%、76.00%、100.00%,专家权威系数分别为0.93、0.89、0.91,可行性评分的协调系数为0.18、0.26、0.22(均P0.01),重要性评分的协调系数为0.18、0.23、0.26(均P0.01)。建立的初始量表包含喂养前早产儿状态、吸吮能力、吞咽能力、喂养过程中维持生理稳定的能力4个维度共23个条目。结论参与咨询的专家积极性高、权威性好,量表条目设计合理,量表的编制为早产儿经口喂养能力评估提供了实用的工具,但还需要进一步的实证研究。     

本科实习护生多元文化护理能力评估量表的初步研制

目的研制本科实习护生多元文化护理能力评估量表。方法在Campinha-Bacote多元文化护理理论和国内外已有文献的基础上,通过小组讨论拟定量表的维度和条目,运用德尔菲法对20名资深专家进行2轮函询筛选条目。结果 2轮函询问卷的回收率均为100%,专家权威系数为0.79,2轮咨询的协调系数分别为0.48、0.49(均P0.01)。初步确立了5个维度、63个条目的本科实习护生多元文化护理能力评估量表。结论编制的本科实习护生多元文化护理能力评估量表具有较高的可靠性和科学性,可为医院提升本科实习护生的多元文化护理能力针对性培训提供依据。     

全膝关节置换术患者居家康复训练依从性量表的编制及信效度检验

目的构建全膝关节置换术患者居家康复训练依从性评估工具。方法参考相关文献联合讨论法形成初始全膝关节置换术患者居家康复训练依从性量表(依从性量表),进行2轮专家咨询,发放给176例全膝关节置换术患者检验其信效度。结果专家积极性为84.62%、81.82%,专家协调系数为0.332,专家权威系数为0.839;依从性量表含3个维度11个条目,累积方差贡献率为69.855%;I-CVI为0.889～1.000,S-CVI为0.978,3个维度及量表总的Cronbach′sα系数为0.747～0.885及0.850,各维度与总分的相关系数r为0.622～0.865。结论全膝关节置换术患者居家康复训练依从性量表编制合理,信度效度较好,可作为全膝关节置换术患者居家康复训练依从性评估工具。     

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.