对NICU出院早产儿母亲实施网络支持干预的研究

目的探讨网络支持干预对新生儿重症监护室(NICU)出院早产儿母婴的影响。方法将符合入组条件的早产儿母亲77人按时间分组,2013年6~9月入组的早产儿母亲38人设为对照组,2013年12月至2014年3月入组的早产儿母亲39人设为观察组。对照组接受早产儿常规出院指导,观察组在此基础上实施网络支持干预,持续12周。结果观察组母亲在早产儿出院后4周、12周角色适应评分及育儿胜任感评分显著高于对照组(均P0.01);观察组早产儿出院后12周体质量、身长、头围显著高于对照组(均P0.01),再入院率显著低于对照组(P0.01)。结论网络支持干预能帮助NICU出院早产儿母亲适应母亲角色,提升育儿胜任感,有利于早产儿体格生长发育,降低早产儿再入院率。     

吊床体位减轻早产儿足底采血疼痛的效果观察

目的 探讨吊床体位减轻早产儿足底采血疼痛的效果。方法 将66例早产儿随机分为观察组与对照组各33例。足底采血过程中对照组采用传统鸟巢体位干预,观察组给予吊床体位干预。比较两组早产儿足底采血前后心率、血氧饱和度和疼痛评分。结果 针刺后2 s、采血后1 min观察组心率显著低于对照组,血氧饱和度显著高于对照组（均P<0.05）;针刺后2 s、采血后1 min和5 min观察组疼痛评分显著低于对照组（均P<0.05）。结论 早产儿足底采血过程中给予吊床体位,可维持操作过程中的心率和血氧饱和度稳定,且可降低早产儿疼痛程度。     

护理干预对急诊科低钾血症患者焦虑的影响

目的 探讨减轻低钾血症患者焦虑水平的护理干预方法.方法 将79例急诊低钾血症患者随机分为观察组(40例)和对照组(39例),对照组行常规治疗及护理,观察组在此基础上行针对性的心理干预、认知干预、行为干预.分别于患者刚进急诊科、护理3 h后采用状态-特质焦虑问卷(STAI)及分量表SAI进行问卷调查.结果 两组患者刚进急诊科时SAI及TAI评分比较,差异无显著性意义(均P＞0.05);但SAI评分显著高于TAI(均P＜0.01).护理3 h后观察组SAI评分显著低于对照组(P＜0.01).结论 急诊低钾血症患者就诊初期呈高焦虑水平,针对性的心理干预、认知干预、行为干预可有效缓解其焦虑情绪.     

音乐疗法在早产儿护理中的应用

目的探讨音乐疗法在早产儿护理中的应用效果.方法将50例出生体重1000～2000 g早产儿随机分为观察组和对照组各25例.对照组予以常规护理,观察组在此基础上于出生后72 h内实施音乐干预,3次/d,15 min/次,直至出院前.其他治疗两组相同.观察比较两组体重增长、对疼痛刺激即针刺足跟采血前后心率、呼吸、血氧饱和度的变化恢复时间及住院时间.结果观察组每日体重增长显著高于对照组(P＜0.05);针刺足跟采血后心率、呼吸及血氧饱和度恢复至刺激前的时间显著短于对照组(均P＜0.01);住院时间短于对照组(P＜0.05).结论音乐疗法能促进早产儿体重的增长,缩短机体疼痛刺激阈及住院时间,有利于早产儿的生长发育.     

早产儿不同脐带结扎时机对母婴结局的影响

目的探索不同脐带结扎时机对母亲和早产儿分娩结局及生长发育的影响,明确早产儿脐带结扎的最佳时机。方法将经阴道自然分娩的115对产妇及其早产儿随机分为对照组(常规即刻断脐处理)40对、干预A组(延迟断脐30～60 s)39对和干预B组(延迟断脐60～120 s)36对,比较各组产妇产后2 h出血量及早产儿出生1 min、5 min Apgar评分、产后24～48 h血红蛋白、红细胞比容及产后1 d、2 d、3 d经皮胆红素浓度。结果干预A、B组产妇产后2 h出血量显著少于对照组,干预A、B组早产儿产后24～48 h血红蛋白显著高于对照组,且干预B组红细胞比容显著高于干预A组(均P0.05),各组早产儿出生1 min、5 min Apgar评分及产后1 d、2 d、3 d经皮胆红素浓度差异无统计学意义(均P0.05)。结论延迟结扎脐带对早产儿及产妇是安全的。延迟结扎脐带30～120 s为早产儿提供额外的胎盘血,有利于降低早产儿贫血发生率,且减少产妇产后2 h出血量。     

护理干预小儿疝囊高位结扎患儿对手术后疼痛评分的影响

目的探讨护理干预小儿疝囊高位结扎患儿对手术后疼痛评分的影响。方法选取2015年3月至2016年3月在首都医科大学附属北京朝阳医院接受手术治疗的腹股沟斜疝患儿及其监护人各100例,随机分为干预组(50例)和对照组(50例)。对对照组的患儿采取常规的疼痛护理模式,对干预组的患儿采取综合疼痛干预护理措施。比较两组患儿在手术返回后(T0)、手术返回后2 h(T1)和手术返回后4 h(T2)时刻的观察疼痛评分(FLACC评分)、心率、血压。比较两组患儿监护人术前1 d、手术当天和出院时的S-AI状态焦虑量表评分。结果在T0时刻,两组患儿的疼痛评分差异无统计学意义(P0.05),在T1和T2时刻,干预组患儿的疼痛评分显著低于对照组(P0.05)。干预组患儿的在T0、T1、T2时刻的心率、血压值均显著低于对照组(P0.05)。干预组患儿的监护人在术前1 d、手术当天和出院时的S-AI状态焦虑量表评分显著低于对照组(P0.05)。结论综合疼痛护理干预措施能够显著改善小儿腹股沟斜疝患儿的疼痛状态,减轻患儿监护人的焦虑状态,值得推广应用。     

梯度压力弹力袜干预对透析低血压的预防作用

目的探索梯度压力弹力袜干预对血液透析患者透析低血压的预防效果。方法采用交叉配对设计,将18例维持性血液透析患者交叉分组到对照组(常规护理干预)和干预组(梯度压力弹力袜干预)进行干预,测量患者透析前即刻,透析1 h、2 h、3 h,下机前,下机后15 min的血压、心率,透析结束后患者的剩余超滤量和补液量。结果干预组发生透析低血压29例次,对照组为37例次。干预组透析1 h、2 h收缩压显著高于对照组,心率显著低于对照组(均P0.05);透析后3 h、下机前和下机后15 min,两组血压比较,差异无统计学意义(均P0.05);干预组剩余超滤量、补液量显著低于对照组(均P0.05)。结论血液透析患者于透析时采用梯度压力弹力袜干预对透析低血压有一定的预防作用,能够减少透析剩余超滤量和透析中补液量,可保证血液透析治疗效果。     

三阶梯俯卧位对早产儿心率呼吸及血氧饱和度的影响

目的评价头部抬高15°俯卧位和三阶梯俯卧位对早产儿心率、呼吸频率及血氧饱和度(SpO2)的影响。方法将132例早产儿随机分为三阶梯组(65例)和头部抬高组(67例)。三阶梯组接受三阶梯俯卧位,头部抬高组接受头部抬高15°俯卧位,均干预1周。记录俯卧位干预前及俯卧位即刻、5min、10min、15min、30min、60min、120min 8个时间点早产儿心率、呼吸频率及SpO2。结果俯卧位不同时间点两组心率、呼吸频率及SpO2比较,干预主效应均P0.01,两组心率的时间效应P0.01;两组皮肤压红发生率比较,差异无统计学意义(P0.05)。结论三阶梯俯卧位有助于稳定早产儿心率、呼吸频率和SpO2,可维持早产儿更好的生理状态。     

口部刺激联合健康教育对孤独症患儿口腔健康行为的影响

目的探讨口部刺激联合健康教育对孤独症患儿口腔健康行为的影响。方法将72例孤独症患儿随机分为对照组(37例)和干预组(35例)。对照组对患儿照顾者行口腔保健知信行健康教育,干预组在对照组的基础上实施口部触觉刺激干预,连续干预2个月。比较干预前后两组患儿口腔健康行为及照顾者口腔保健知信行评分的差异。结果干预后两组照顾者口腔保健知信行评分显著高于干预前,干预组显著高于对照组(均P0.01)。干预后两组患儿口腔保健行为评分显著高于干预前,干预组显著高于对照组(P0.05,P0.01)。结论将口部触觉刺激技术结合口腔健康知信行健康教育,用于孤独症患儿口腔健康行为干预和照顾者指导,能提高孤独症患儿口腔健康行为及照顾者口腔保健知信行程度。     

母亲心音联合背景音乐播放对早产儿睡眠及体质量的影响

目的探讨母亲心音与背景音乐合成的乐曲对早产儿睡眠时间及体质量的影响。方法选择符合纳入和排除标准的早产儿90例,采用随机数字表法分为乐律组、音乐组和对照组各30例。对照组按早产儿护理常规护理;音乐组在对照组基础上每天播放背景音乐;乐律组在对照组基础上每天播放早产儿母亲心率音与背景音乐合成的音律。干预15d后比较三组患儿睡眠时间及体质量增长情况。结果三组睡眠时间及体质量增长情况比较,差异有统计学意义(均P0.01);乐律组患儿睡眠时间及体质量增长显著优于其他两组(P0.05,P0.01);音乐组睡眠时间及体质量增长显著优于对照组(P0.05,P0.01)。结论倾听母亲心音与背景音乐合成的乐曲更能稳定早产儿的情绪,增加睡眠时间,加快体质量的增长。     

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.     

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.     

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.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.