Ocena bólu u pacjentów po operacji w obrębie jelita grubego

Wprowadzenie: Każdy pacjent ma prawo do skutecznego leczenia bólu pooperacyjnego. Ból pooperacyjny warunkują różnorakie czynniki. Cel pracy: Ocena natężenia bólu u pacjentów po operacji w obrębie jelita grubego oraz zależności pomiędzy natężeniem bólu a czynnikami demograficznymi i klinicznymi. Metoda i materiał: Badanie przeprowadzono w Szpitalu Uniwersyteckim w Krakowie na Oddziale Chirurgii Ogólnej, Onkologicznej i Gastroenterologicznej wśród 143 pacjentów w wieku od 22 do 90 lat, którzy zakwalifikowani zostali do zabiegu operacyjnego w obrębie jelita grubego. Natężenie bólu przed- i pooperacyjnego oraz satysfakcję z analgezji pooperacyjnej oceniano skalą numeryczną (zakres: 0-10), a natężenie lęku przedoperacyjnego Zmodyfikowaną Skalą HADS (zakres: 0-21). Badano zależność pomiędzy natężeniem bólu pooperacyjnego, a wiekiem, płcią, rodzajem dostępu operacyjnego, rodzajem analgezji pooperacyjnej, liczbą interwencji podjętych przez pielęgniarki w celu uśmierzenia bólu. Analizę statystyczną przeprowadzono z użyciem testów: Szapiro-Wilka, U Manna-Whitneya, Kruskala-Wallisa, współczynnika korelacji lub rang Spearmana. Wyniki: Najsilniejsze dolegliwości bólowe w spoczynku chorzy zgłaszali w 1. godzinie po operacji - 69,2% badanych oceniło ból jako umiarkowany, a 14% chorych odczuwało ból silny. W 4. godzinie po operacji ból umiarkowany domi-nował tylko przy pomiarze w ruchu. Ponad 85% badanych odczuwało ból słaby w 24. godzinie po operacji zarówno w spoczynku jak i w ruchu. Satysfakcja z analgezji była wysoka (mediana 7/10). Większe dolegliwości bólowe odczu-wali mężczyźni niż kobiety (p<0,05) oraz pacjenci po operacji metodą laparoskopową niż laparotomii (p<0,05), otrzy-mujący analgezję dożylną + regionalną niż tylko dożylną (p<0,05). Stosowanie znieczulenia regionalnego jako dodat-kowego znieczulenia do znieczulenia ogólnego wykazało odczuwanie mniejszych dolegliwości bólowych (p<0,05). Odnotowano dodatnią korelację pomiędzy natężeniem bólu pooperacyjnego i natężeniem lęku przedoperacyjnego (p<0,05) oraz liczbą interwencji podjętych przez pielęgniarki w celu uśmierzenia bólu (p<0,05). Wnioski: Najsilniejsze dolegliwości bólowe chorzy odczuwali w pierwszych czterech godzinach po operacji, a najsłab-sze 24. godziny po operacji. Satysfakcja z analgezji była wysoka. Natężenie bólu pooperacyjnego warunkowały płeć, poziom lęku przedoperacyjnego, rodzaj dostępu operacyjnego, rodzaj analgezji pooperacyjnej oraz liczba interwencji podjętych przez pielęgniarki w celu uśmierzenia bólu.Introduction: Every patient has a right to effective post-operative pain treatment. Post-operative pain is conditioned by various factors. Purpose of the work: The assessment of pain intensity among patients after the surgery within large intestine and rela-tion between pain intensity and clinical and demographic factors. Method and material: The studies were conducted at The University Hospital in Cracow, in the Department of General, Oncological and Gastroenterological Surgery among 143 patients at the age from 22 to 90 years who were classified to surgery within the large intestine. Pain intensity, both pre-operative and post-operative and the satisfaction of the post-operative analgesia were accessed with a numeric scale (scope: 0-10) and the dose of the pre-operative drug by the Modified HADS Scale (scope: 0-21). The relation between post-operative pain and age, sex, the type of surgical access, the type of post-operative analgesia, the number of interventions taken by nurses to relieve pain were studied. The statistical analysis was conducted with the use of the following tests: Szapiro-Wilk test, U Manna-Whitney test, Kruskal-Wallis test, correlation rate or Spearmana ranks. Results: The strongest pain complaints at rest were reported by patients in the first hour after surgery - 69.2% of sub-jects rated pain as medium and 14% suffered from severe pain. 4 hours after surgery, medium pain dominated only when measured in motion. Over 85% of respondents felt weak pain 24 hours after surgery both at rest and in motion. Satisfaction with analgesia was high (median 7/10). More pain was experienced by men than women (p <0.05) and patients after laparoscopic surgery than laparotomy (p <0.05), and patients receiving intravenous analgesia + regional than only intravenous analgesia (p <0.05). The use of regional anesthesia (TAP block, an injection of the wound) as an additional anesthetic for general anesthesia showed the feeling of minor pain (p <0.05). There was a positive correlation between the intensity of post-operative pain and pre-operative anxiety (p <0.05) and the number of interventions taken by nurses to relieve pain (p <0.05). Conclusions: Patients experienced the strongest pain in the first four hours after surgery and the weakest 24 hours after surgery. Satisfaction with analgesia was high. The intensity of post-operative pain was determined by gender, pre-operative anxiety level, type of surgical access, type of post-operative analgesia and number of interventions taken by nurses to relieve pain

5-HT_{7} receptor modulates GABAergic transmission in the rat dorsal raphe nucleus and controls cortical release of serotonin

The 5-HT7 receptor is one of the several serotonin (5-HT) receptor subtypes that are expressed in the dorsal raphe nucleus (DRN). Some earlier findings suggested that 5-HT7 receptors in the DRN were localized on GABAergic interneurons modulating the activity of 5-HT projection neurons. The aim of the present study was to find out how the 5-HT7 receptor modulates the GABAergic synaptic input to putative 5-HT DRN neurons, and whether blockade of the 5-HT7 receptor would affect the release of 5-HT in the target structure. Male Wistar rats with microdialysis probes implanted in the prefrontal cortex (PFC) received injections of the 5-HT7 receptor antagonist (2R)-1-[(3-hydroxyphenyl)sulfonyl]-2-[2-(4-methyl-1-piperidinyl)ethyl]pyrrolidine hydrochloride (SB 269970), which induced an increase in the levels of 5-HT and its metabolite, 5-hydroxyindoleacetic acid (5-HIAA) in the PFC. In another set of experiments whole-cell recordings from presumed projection neurons were carried out using DRN slices. SB 269970 application resulted in depolarization and in an increase in the firing frequency of the cells. In order to activate 5-HT7 receptors, 5-carboxamidotryptamine (5-CT) was applied in the presence of N-[2-[4-(2-methoxyphenyl)-1piperazinyl]ethyl]-N-2-pyridinylcyclohexanecarboxamide (WAY100635). Hyperpolarization of cells and a decrease in the firing frequency were observed after activation of the 5-HT7 receptor. Blockade of 5-HT7 receptors caused a decrease in the mean frequency of spontaneous inhibitory postsynaptic currents (sIPSCs), while its activation induced an increase. The mechanism of these effects appears to involve tonically-active 5-HT7 receptors modulating firing and/or GABA release from inhibitory interneurons which regulate the activity of DRN serotonergic projection neurons

Nitric oxide synthase inhibitor attenuates the effects of repeated restraint stress on synaptic transmission in the paraventricular nucleus of the rat hypothalamus

Corticotropin-releasing hormone (CRH)-synthesizing parvocellular neuroendocrine cells (PNCs) of the hypothalamic paraventricular nucleus (PVN) play a key role in the activation of the hypothalamic-pituitary-adrenocortical (HPA) axis. Several studies have demonstrated that synaptic inputs to these cells may undergo stress-related enhancement but, on the other hand, it has been reported that exposition to the same stressor for prolonged time periods may induce a progressive reduction in the response of the HPA axis to homotypic stressors. In the present study rats were subjected to 10 min restraint sessions, repeated twice daily for 3 or 7 days. Miniature excitatory and inhibitory postsynaptic currents (mEPSCs and mIPSCs) were then recorded from PNCs in ex vivo hypothalamic slice preparations obtained 24 h after the last restraint. Restraint stress repeated over 3 days resulted in increased mean frequency and decreased rise time and decay time constant of mEPSCs, accompanied by a decrease in the excitability of PNCs, however, no such changes were evident in slices obtained from rats subjected to restraint over 7 days. There were no changes in mIPSCs after repeated restraint. Administration of the unspecific nitric oxide synthase (NOS) blocker Nω-Nitro-L-arginine (L-NNA) before each restraint, repeated over 3 days, prevented the occurrence of an increase in mEPSC frequency. However, animals receiving L-NNA and subjected to repeated restraint had similar changes in PNCs membrane excitability and mEPSC kinetics as stressed rats not receiving L-NNA. Comparison of the effects of a single 10 min restraint session followed by either an immediate or delayed (24 h) decapitation revealed an increase in the mean mEPSC frequency and a decrease in the mean mIPSC frequency in slices prepared immediately after restraint, with no apparent effects when slice preparation was delayed by 24 h. These results demonstrate that restraint, lasting 10 min and repeated twice daily for 3 days, induces a selective and long-lasting enhancement of excitatory synaptic input onto PNCs, partially by a NOS-dependent mechanism, and reduces PNC excitability, whereas prolongation of repeated stress for up to 7 days results in an adaptation

The influence of interleukin-6 and tumor necrosis factor α gene polymorphisms on bone mineral density in postmenopausal women

Summary Proinflammatory cytokines, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), involved into osteoclastogenesis and responsible for bone resorption process, participate in the pathogenesis of the osteoporosis. In vitro studies have shown that single nucleotide polymorphisms of IL-6 and TNF-α genes could influence the transcription process of the genes and the cytokines level. Aim: Assessment of the influence of IL-6 and TNF-α gene polymorphisms on bone mineral density (BMD) and evaluation of their connection with osteoporosis prevalence in women from Wielkopolska region. Material and methods: In the group of 267 postmenopausal women (average age 58,5+/-5,9 years, average age of last period 49,8+/-3,9 years) bone mineral density in lumbar spine (L2-L4) was performed using dual energy X-ray absorptiometry (DXA). Genotypes frequencies were determined by polymerase chain reaction with restriction fragment length polymorphism (PCR/RFLP) using restriction enzymes Lwe I and Faq I, respectively. The connection between the polymorphisms of investigated genes and body mass index, age of menarche and menopause and length of reproductive age had been analyzed as well. Results: No statistically significant association was found between examined genetic factors and the value of bone mineral density in the investigated group of postmenopausal women. The frequencies of investigated genotypes were in compliance with Hardy-Weinberg equilibrium. The correspondence between evaluated clinical parameters and IL-6 i TNF-α genotypes frequencies has not been proven. Conclusions: The -174G/C polymorphism in the IL-6 and -308G/A polymorphism in TNF-α genes have no influence on bone mineral density value (BMD) in the investigated population of women from Wielkopolska region

Nursing care for the mechanically ventilated patient with the influenza A/H1N1 virus in the Intensive Care Unit

Celem pracy było przedstawienie wirusa grypy A/H1N1 wirusa grypy pandemicznej, który najbardziej zdominował sezon zachorowań w roku 2009/2010. Pandemia została odwołana, jednak co roku występują pojedyncze zachorowania na ten wariant grypy. Wirus ten jest niebezpieczny dla człowieka, ponieważ objawami przypomina zwykłą sezonową grypę. Późno zdiagnozowany, nieleczony, a co gorsze powikłany może doprowadzić do zgonu chorego. Pacjenci z rozpoznaną ciężką postacią zakażenia lub z występującymi powikłaniami po zakażeniu tym wirusem wymagają leczenia szpitalnego. Leczenie to najczęściej obejmuje specjalistyczną opiekę na Oddziale Intensywnej Terapii. W oparciu o analizę literatury wyłoniono 9 diagnoz pielęgniarskich, które stanowią najważniejsze problemy chorego poddanego leczeniu w Oddziale Intensywnej Terapii. W pracy opisano także epidemiologię grypy A/H1N1, objawy kliniczne, diagnostykę wirusa oraz leczenie i zapobieganie zakażeniu.The aim of the thesis was to present the influenza A/H1N1 virus, the most prevalent pandemic influenza virus in 2009/2010. The pandemia has been reversed, but each year there are single cases of influenza. This virus is dangerous to humans because the symptoms resemble ordinary seasonal flu. Late diagnosis, untreated, and worse complications can lead to the death of the patient. Patients with known severe infection or complications after infection with this virus require hospital treatment. This treatment usually includes specialist care in Intensive Care Unit. Based on the review of literature, 9 nursing diagnoses have been identified, which are the most important problems of the patient being treated in the Intensive Care Unit. The work also describes the epidemiology of influenza A/H1N1, clinical symptoms, virus diagnosis and treatment and prevention of infection

Repeated blockade of 5-HT7 receptors depresses glutamatergic transmission in the rat frontal cortex

The effects of the intraperitoneal administration of the 5-HT7 receptor antagonist SB 269970 were studied in the rat frontal cortex. In ex vivo slices prepared from rats receiving 14 daily doses of the drug (1.25 mg/kg) the mean frequency and the mean amplitude of glutamate-mediated, spontaneous excitatory postsynaptic currents (sEPSCs) recorded from layer II/III pyramidal neurons, were decreased. In contrast, single administration of SB 269970 affected neither the frequency nor the amplitude of sEPSCs. Treatment with SB 269970 did not affect membrane excitability of pyramidal cells. These data indicate that repeated, but not single, treatment with SB 269970 results in an attenuation of glutamatergic transmission in the frontal cortex, most likely due to a combination of pre- and postsynaptic mechanisms