甲状腺手术患者术前访视方法的改进

目的探讨改进甲状腺手术患者术前访视的方法及效果。方法将240例行手术治疗的甲状腺患者随机分为观察组和对照组各120例，对照组按照常规进行术前访视．观察组由巡回护士与病房护士共同进行术前访视、心理干预及放松训练．并于术后回访。结果两组患者入手术室20rain后焦虑评分及收缩压、心率比较．差异有显著性意义（均P〈0．01）；观察组因高度紧张需延迟手术及术中增加麻醉辅助用药者显著低于对照组。患者满意度显著高于对照组（P〈0．05．P〈0．01）。结论改进后的访视方法，能有效缓解甲状腺手术患者的术前焦虑，减少血压、心率的波动，使患者以最佳状态接受手术．提高了患者对手术室护理工作的满意度。     

标准化术前访视在神经电生理监测下听神经瘤手术中的应用

目的探讨标准化术前访视在神经电生理监测下听神经瘤手术患者中的应用效果。方法将50例神经电生理监测下听神经瘤手术患者按照手术时间分为对照组与观察组各25例。观察组按术前标准访视表,结合访视图册与视频实施标准化术前访视;对照组采用常规术前访视。比较两组患者访视前、入室后5min焦虑评分、心率、血压,调查两组访视满意度。结果入室后5min观察组焦虑评分及血压、心率显著低于对照组,患者满意度显著高于对照组(P0.05,P0.01)。结论采用标准化术前访视,使术前宣教更加规范,可有效降低患者的负性心理及生理应激。     

乳癌手术患者术前访视方法的改进

目的 提高术前访视效果.方法 将112例行手术治疗的乳癌患者随机分为观察组(58例)和对照组(54例),对照组行常规访视,观察组由手术室巡回护士及病区管床护士共同进行术前访视和心理支持,并于术后回访.结果 术后1 d观察组焦虑评分显著低于对照组(P＜0.01);术后3 d观察组心理状态评分及患者满意度显著优于对照组(均P＜0.01).结论 改进后的访视方法能有效降低乳癌患者心理应激水平及焦虑水平,提高手术室护理满意度.     

甲状腺手术患者术前访视方法的改进

目的 探讨改进甲状腺手术患者术前访视的方法及效果.方法 将240例行手术治疗的甲状腺惠者随机分为观察组和对照组各120例,对照组按照常规进行术前访视,观察组由巡回护士与病房护士共同进行术前访视、心理干预及放松训练,并于术后回访.结果 两组患者入手术室20 min后焦虑评分及收缩压、心率比较,差异有显著性意义(均P<0.01);观察组因高度紧张需延迟手术及术中增加麻醉辅助用药者显著低于对照组,患者满意度显著高于对照组(P<0.05,P<0.01).结论 改进后的访视方法,能有效缓解甲状腺手术患者的术前焦虑,减少血压、心率的波动,使患者以最佳状态接受手术,提高了患者对手术室护理工作的满意度.     

回压静脉法在静脉穿刺困难患者中的应用

目的：提高术前访视效果。方法：将112例行手术治疗的乳癌患者随机分为观察组（58例）和对照组（54例），对照组行常规访视，观察组由手术室巡回护士及病区管床护士共同进行术前访视和心理支持，并于术后回访。结果：术后1d观察组焦虑评分显著低于对照组（P＜0．01）；术后3d观察组心理状态评分及患者满意度显著优于对照组（均P＜0．01）。结论：改进后的访视方法能有效降低乳癌患者心理应激水平及焦虑水平，提高手术室护理满意度。     

术前访视对白内障手术患者焦虑状态的影响

目的 探讨术前访视对白内障手术患者焦虑的影响.方法 将101例白内障手术患者随机分为观察组(53例)和对照组(48例),观察组接受术前访视,对照组行常规术前准备及宣教,手术前1 d及术晨采用状态-特质焦虑量表(STAI)测量两组患者焦虑状况,同时测量其血压、心率.结果 观察组术晨焦虑评分、收缩压、心率显著低于对照组(P＜0.05,P＜0.01),且血压及心率波动小.结论 术前访视能有效缓解白内障手术患者术前焦虑,减少血压、心率的波动,使患者以最佳状态接受手术.     

微信公众平台服务在术前访视中的应用效果评价

目的探讨微信公众平台服务在术前访视中的应用效果。方法将择期手术患者60例按手术日期分为对照组与观察组各30例,对照组于术前1d由巡回护士按常规进行术前访视,观察组术前1d访视方法及内容与对照组相同,同时加推手术室微信公众平台服务。比较两组术前访视时间、手术患者对访视内容知晓度、术前准备质量、患者手术配合度和术前访视满意度。结果两组术前访视每例患者所需时间比较,差异无统计学意义(P0.05);对照组术前访视满意率及术前访视内容知晓度、术前准备质量、手术配合度评分显著低于观察组(均P0.05)。结论微信公众平台服务提高了术前访视的实施效果,进一步提升了手术室优质护理服务质量。     

iPad访视软件在手术室术前访视中的应用

目的探讨iPad访视软件在手术室择期手术患者中的应用效果。方法选取行择期手术的神经外科患者209例,按随机数字表法分为观察组(n=106)和对照组(n=103),对照组按常规实施术前访视;观察组采用iPad访视软件实施术前访视。比较两组患者术前访视时间、手术相关知识掌握情况、术前准备质量和术前访视满意度。结果观察组术前访视时间显著短于对照组(P0.01),手术相关知识掌握情况、术前准备质量及满意度得分显著高于对照组(均P0.01)。结论iPad访视软件使手术室术前访视内容丰富、形式多样,能够有效缩短术前访视时间,提高择期手术患者手术相关知识知晓情况和术前访视满意度,保障手术顺利进行。     

术前访视对白内障手术患者焦虑状态的影响

目的 探讨术前访视对白内障手术患者焦虑的影响。方法 将101例白内障手术患者随机分为观察组（53例）和对照组（48例），观察组接受术前访视，对照组行常规术前准备及宣教，手术前1d及术晨采用状态-特质焦虑量表（STAI）测量两组患者焦虑状况，同时测量其血压、心率。结果 观察组术晨焦虑评分、收缩压、心率显著低于对照组（P〈0．05，P〈0．01），且血压及心率波动小。结论 术前访视能有效缓解白内障手术患者术前焦虑，减少血压、心率的波动，使患者以最佳状态接受手术。     

多学科团队协作的个案管理对甲状腺相关眼病手术患者的影响

目的 探讨基于多学科团队协作的个案管理在甲状腺相关眼病手术患者中的应用效果.方法 将99例甲状腺相关眼病手术患者按照入院时间分为对照组50例,观察组49例.对照组实施传统诊疗和护理;观察组实施基于多学科团队协作的个案管理.比较两组患者生活质量、焦虑抑郁评分、住院时间和护理满意度.结果 干预后观察组患者焦虑评分、住院时间显著低于或短于对照组,生活质量、对护理工作满意度得分显著高于对照组(P<0.05,P<0.01).结论 实施基于多学科团队协作的个案管理可改善甲状腺相关眼病患者生活质量,缓解其焦虑情绪,减少住院时间,提高患者护理满意度.     

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 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.     

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.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

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.     

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.     

Intrathecal administration of sameridine to patients subjected to arthroscopic knee joint surgery

Background: Sameridine, a new substance with both local anesthetic and opioid effects, was administered intrathecally for the first time to humans, i. e. in patients subjected to arthroscopic knee joint surgery.
Method: A dose-escalating (10, 15, 20 and 25 mg), open study was performed in 33 patients. Only two patients were included in the 25 mg group.
Results: Sameridine provided good quality of surgical anesthesia in all patients except those receiving 10 mg. The maximum level of sensory block, Th5–Th7, was reached within 30 min with a median duration of 3.6–3.9 h. The motor block was more profound with increasing dose, but never lasted longer than the sensory block. The influence on heart rate and blood pressure was minor and atropine and ephedrine were needed in four patients. No clinically significant ECG-changes were detected and no arrhythmias were recorded. Oxygen saturation and respiratory rate did not decrease in a clinically significant way and were not affected by concomitant morphine given i. v. postoperatively. There were few side-effects, the most frequent being mild pruritus (10/33).
Conclusion: Sameridine provided clinically adequate anesthesia for the patients receiving the doses of 15, 20 and 25 mg. Further studies are needed to evaluate the substance and it is of great interest to clinically investigate the opioid component with respect to postoperative analgesia.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.