晚期肿瘤患者家属负性情绪及应对方式调查分析

目的 探讨晚期肿瘤患者家属的焦虑、抑郁情绪及采取的应对方式,以指导心理干预,提高其生活质量.方法 选用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS),简易应对方式量表(SCSQ)对236名晚期肿瘤患者家属(观察组)和236名慢性病患者家属(对照组)进行调查.结果 观察组SAS和SDS评分与对照组和国内常模比较,差异有显著性意义(均P＜0.01);观察组积极应对和消极应对总分与对照组比较,差异无显著性意义(均P＞0.05).观察组SDS评分与积极应对分呈负相关(P＜0.01).结论 晚期肿瘤患者家属多伴有焦虑和抑郁情绪,并受多种因素影响,帮助他们改善应对方式,可以提高生活质量.     

放松训练辅助治疗焦虑症效果观察

目的探讨放松训练辅助治疗焦虑症的效果。方法将132例焦虑症患者随机均分为观察组和对照组。两组均予常规药物治疗，对照组辅以简单的娱乐活动，观察组增加放松训练，2周（1个疗程）后采用焦虑自评量表（SAS）、抑郁自评量表（SDS）评定治疗效果。结果观察组放松训练前后SAS、SDS评分比较，差异有显著性意义（均P〈0．01）；治疗后SAS、SDS评分与对照组比较，差异有显著性意义（均P〈0．01）。结论放松训练能有效改善患者的焦虑、抑郁情绪，提高临床疗效。     

临终关怀降低老年临终患者家属心理应激及负性情绪的效果

目的 提高老年临终患者的生活质量，降低其家属心理应激及焦虑、抑郁情绪。方法 将76例老年临终患者及其家属（76名）随机分为研究组和对照组，每组38例患者和38名家属。对照组按常规进行护理，研究组在常规护理的基础上接受临终关怀护理干预。在干预前及干预1个月后采用家属应激量表（RSS）、焦虑自评量表（SAS）、抑郁自评量表（SDS）对两组患者家属进行评定。结果 干预后研究组患者家属RSS总分及心理痛苦和生活被扰乱2个维度评分显著低于对照组（均P〈0．01），SAS、SDS评分显著低于对照组（P〈0．05，P〈0．01）。结论 临终关怀护理在降低老年临终患者家属应激水平的同时，也降低了其焦虑、抑郁程度。     

护士对住院患儿家属的护理支持及家属满意度调查

目的探讨首次和多次住院肿瘤患者家属情绪障碍情况。方法将252例恶性肿瘤患者根据住院次数分为首次住院组（122例）和多次住院组（130例），采用简易应对方式量表（SCSQ）、焦虑自评量表（SAS）、抑郁自评量表（SDS）测评两组患者家属的情绪状态。结果两组患者家属SCSQ、SAS和SDS评分比较，差异有显著性意义（P〈0.05，P〈0.01），不同年龄、文化程度、居住状况，与患者关系及家庭月收入的患者家属情感障碍发生率比较，差异有显著性意义（均P〈0.01）。结论首次住院肿瘤患者家属比多次住院肿瘤惠者家属更易发生焦虑、抑郁情绪，其积极应,对多于后者，尤其高年龄、低收入、低文化程度、与患者同住及配偶关系的患者家属情绪障碍发生率高，应给予针对性护理措施。     

心理剧治疗对改善癫痫患者焦虑抑郁情绪及应对方式的作用

目的探讨心理剧治疗对改善癫痫患者焦虑、抑郁情绪及应对方式的作用。方法将60例癫痫患者随机均分为观察组和对照组，对照组按常规予抗癫痫药物治疗及一般健康教育；观察组在此基础上，辅以心理剧治疗，4周为1个疗程。采用抑郁自评量表（SDS）、焦虑自评量表（SAS）及应对方式问卷对患者进行治疗效果评定。结果干预后观察组SAS和SDS评分显著低于对照组（均P〈0．05）；不成熟的应对方式（自责、幻想、退避）的评分显著低于对照组（均P〈0．05）。结论心理剧治疗能使癫痫患者较多地使用成熟的应对方式，能改善癫痫患者的负性情绪，提高心理健康水平，是促进癫痫患者神经功能康复的有效方法。     

以家庭为中心的护理干预对酒依赖患者家属心理状况的影响

目的 探讨酒依赖患者家属的心理状况及护理干预方法。方法 将97例酒依赖住院患者随机分为观察组（49例）和对照组（48例）。均配对选择患者1名与其生活关系密切的家属。两组患者均接受常规治疗与护理。观察组在此基础上进行以家庭为中心的护理干预，1次／周。共6周。于入院第1周及第6周末．分别采用焦虑自评量表（SAS）、抑郁自评量表（SDS）及自行设计的感受描述问卷进行评定。结果 干预后观察组患者家属SAS、SDS评分显著低于对照组（均P〈0．01），主观感受描述显著优于对照组（P〈0．01）。结论 以家庭为中心的护理干预．对酒依赖患者家属的焦虑、抑郁情绪有显著的缓解作用，对增强家属对患者摆脱酒依赖的信心、减轻恐惧心理、增加与患者的感情有显著的促进作用。     

首次和多次住院肿瘤患者家属情绪障碍调查

目的 探讨首次和多次住院肿瘤患者家属情绪障碍情况.方法 将252例恶性肿瘤患者根据住院次数分为首次住院组(122例)和多次住院组(130例),采用简易应对方式量表(SCSQ)、焦虑自评量表(SAS)、抑郁自评量表(SDS)测评两组患者家属的情绪状态.结果 两组患者家属SCSQ、SAS和SDS评分比较,差异有显著性意义(P＜0.05,P＜0.01),不同年龄、文化程度、居住状况,与患者关系及家庭月收入的患者家属情感障碍发生率比较,差异有显著性意义(均P＜0.01).结论 首次住院肿瘤患者家属比多次住院肿瘤患者家属更易发生焦虑、抑郁情绪,其积极应对多于后者,尤其高年龄、低收入、低文化程度、与患者同住及配偶关系的患者家属情绪障碍发生率高,应给予针对性护理措施.     

心理干预对不同妇科疾病患者焦虑抑郁状态的影响

目的探讨心理干预对不同妇科疾病患者焦虑抑郁的影响。方法选取恶性组、切除组、核除组各50例共150例患者，住院期间在常规护理的基础上给予心理支持、松弛训练、内心意象等措施，入院及出院时采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评定患者情绪状态。结果干预后恶性组SAS、SDS较干预前显著降低（P〈0．05，P〈0．01）；切除组、核除组SAS较干预前显著降低（P〈0．05）。结论妇科疾病患者存在明显的焦虑、抑郁状态，针对性心理干预可有效缓解其焦虑、抑郁状态。     

脊柱结核患者家属焦虑、抑郁分析与护理干预研究

目的：调查脊柱结核患者家属焦虑、抑郁状态及影响因素,探讨相应护理干预措施。方法：81例脊柱结核患者家属应用焦虑自评量表（SAS）、抑郁自评量表（SDS）及一般情况调查表进行调查,并将其随机分为干预组和对照组,干预组予以护理干预措施,对照组按常规进行。结果：脊柱结核患者家属焦虑、抑郁发生率90％,性别、家庭关系,疾病程度是影响患者家属焦虑、抑郁主要因素。两组患者家属焦虑自评量表、抑郁自评量表评分结果比较,干预组心理干预后焦虑、抑郁自评量表评分低于对照组（P〈0．05）。结论：多种因素可导致脊柱结核患者家属焦虑、抑郁发生,护理干预能改善患者家属的负性情绪。     

集体心理干预在烧伤患者中的应用

目的 探讨在烧伤患者中实施心理干预的基本方法．了解不同心理干预方式对烧伤患者心理状态的影响。方法 将120例烧伤患者随机分为对照组（59例）和干预组（61例），对照组患者按常规进行治疗和护理，干预组在此基础上实施集体心理干预，由医务人员、患者度其家属一起座谈探讨烧伤有关问题，针对患者的心理问题度时给予干预。采用Zung焦虑量表（SAS）和抑郁量表（SDS）对患者入院后第1天、第7天、第14天的心理状态进行评定。结果 两组患者入院第1天SAS、SDS评分差异无显著性意义（均P〉0．05）；入院第7天、第14天两组SAS、SDS评分比较，差异有显著性意义（均P〈0．01）。结论 对烧伤患者实施集体心理干预可以改善其焦虑、抑郁情绪。     

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.     

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.     

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.     

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.     

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.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.