快速康复外科在老年结肠癌围手术期护理中的应用

目的:探讨快速康复外科(fast-track surgery,FTS)在老年结肠癌围手术期护理中应用的临床效果。方法:将92例年龄大于65岁的结肠癌患者随机分为FTS组与对照组,分别给予FTS护理措施和传统护理措施,比较2组患者术后恢复情况、营养状况、并发症发生情况等。结果:与传统护理措施相比较,FTS护理组术后患者胃肠道功能恢复时间明显缩短,术后营养状况恢复较快,术后并发症发生率明显降低。FTS护理组老年患者的住院时间和住院费用均较对照组显著降低。结论:FTS应用于老年患者结肠癌围手术期的护理是安全、有效的。其加快了老年患者的术后康复、减轻了患者的痛苦,降低术后并发症的发生,值得推广应用。     

FTS理念在腹腔镜肾上腺肿瘤切除术围手术期护理中的应用

目的探讨FTS理念在腹腔镜肾上腺肿瘤切除术围手术期护理中的应用。方法选择我科2018年4月～2019年4月收治的泌尿外科腹腔镜肾上腺肿瘤切除术患者100例,按数字表法随机分为对照组50例,FTS组50例,其中FTS组采用FTS理念进行护理干预,对照组采用常规护理。观察比较两组患者首次下床活动时间、首次进食时间、术后输液时间、术后住院时间、住院费用、术后并发症发生情况。结果 FTS组患者首次进食时间、首次下床活动时间、术后输液时间、术后住院时间、住院费用均明显低于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论 FTS理念在腹腔镜肾上腺肿瘤切除术围手术期护理中的应用是安全可行的,能缩短住院时间,降低住院费用,减少并发症的发生,促进患者康复,临床上值得推广及应用。     

一例桥小脑角占位围手术期患者护理病例讨论

目的:通过对一例1例桥小脑角肿瘤患者的护理病例讨论,探讨围手术期护理措施。方法:对我科收治的1例桥小脑角肿瘤患者进行护理经验总结。结果:通过精心的护理和治疗,病人恢复良好。结论:加强桥小脑角占位围手术期的护理,是患者康复的关键。     

营养风险筛查在结直肠癌快速康复外科治疗中的作用

目的:探讨营养风险筛查在结直肠癌快速康复外科治疗中的作用,提高结直肠癌患者术后的营养状况和胃肠道免疫功能,促进胃肠道功能的恢复。方法:收集60例结直肠癌择期手术患者,并将其随机分为快速康复组(FTS)和传统治疗组,分别用快速康复措施和传统方法进行围手术期的处理,其中引入术前营养风险筛查和预防性营养干预,比较两组患者的术后营养状况与胃肠道免疫功能及术后肛门排气时间、术后住院日、住院总费用的差异。结果:与传统组相比,FTS组术后血清白蛋白(ABL)水平明显升高(P0.01),C反应蛋白(CRP)水平明显降低(P0.01),术后胃肠功能恢复更早,术后住院日更短(P0.05),但两组的住院总费用和并发症的发生率比较无明显差异(P0.05)。结论:术前营养风险筛查并营养干有助于结直肠癌的快速康复外科治疗。     

神经内镜下经鼻蝶垂体瘤切除术患者围术期加速康复护理研究现状

垂体瘤是一种神经内分泌肿瘤,发生在人体的颅内鞍区,是一种常见的颅内良性肿瘤。目前,神经内镜垂体腺瘤治疗方法是一种有效替代传统显微手术的方法。临床研究指出,经鼻蝶垂体瘤切除术治疗的成功与否与护理人员的规范化操作配合息息相关。加速康复外科理念是通过多模式的协作,在围手术期采用一系列的优化措施减少应激反应和并发症的发生,加速患者康复。本文对近年来各类护理干预在神经内镜下经鼻蝶垂体瘤切除术患者围术期的应用进行回顾分析,总结其在加速康复标准护理方案构建中的价值。     

围手术期焦虑及护理干预研究进展

围手术期是一个很特殊的时期,在这段时间之内,病人往往要承受比正常人更大的精神压力,因此围手术期患者比正常人更容易产生焦虑情绪与焦虑问题,如果得不到疏通和缓解将导致严重的心理问题与心理疾病。由此对围手术期患者的焦虑问题和护理干预工作进行研究就是有意义的,目前我国的围手术期焦虑及护理干预研究工作已经经历了几个时期,并取得了相当大的进展和成果,值得庆贺,为了总结我国围手术期焦虑及护理干预研究所取得的成果,本文作者特地对我国围手术期焦虑及护理干预研究的研究时期、进展和已经取得的成果进行了一番疏理,希望这能对我国广大的相关研究者提供一些帮助。     

快速康复外科理念对胸腔镜纵隔肿瘤手术患者围术期VAS评分及生活质量的影响

目的探讨快速康复外科理念(FTS)在胸腔镜纵隔肿瘤围术期护理中的应用效果。方法选取2017年1月～2018年1月在我院行胸腔镜下纵隔肿瘤切除术患者70例,随机抽签分为对照组37例和观察组33例。对照组给予常规护理,观察组实施快速康复外科护理理念,比较两组患者视觉模拟评分(VAS)及生活质量量表(SF-36)评分、拔管时间、抗生素使用时间、下床活动时间及住院时间。结果观察组患者的VAS评分显著低于对照组(P0.05),且SF-36评分显著高于对照组(P0.05);观察组患者的拔管时间、抗生素使用时间及住院时间、下床活动时间均短于对照组(均P0.05)。结论对胸腔镜纵隔肿瘤手术患者围术期实施快速康复外科理念,能显著缩短患者住院时间、拔管时间以及下床活动时间,有效缓解患者疼痛,提高生活质量,该护理理念具有积极推广意义。     

小议外科围术期患者的护理措施

目的:讨论围术期患者的护理。方法:采用观察、交谈、体检、参阅各种相关文字资料等方法对3个阶段的主客观资料进行动态的分析判断。结果:护理作为现代护理模式的重要组成,应贯彻临床护理全过程,遍及护理实践的每一个角落。特别是做好外科围手术期患者的护理,对患者的肢体康复有着非常重要的意义。结论:做好围术期护理是非常重要的。     

子宫肌瘤围手术期舒适护理的观察

随着现代护理学的发展。护理工作不再是单纯简单的技术操作,更应注重“以人为本”的护理理念。舒适护理模式是使人在生理、心理、灵性、社会上达到最愉快的状态。或缩短、降低其不愉快的程度。根据这一模式,我院从2006～2008年对38例子宫肌瘤手术患者实施舒适护理,并与整体护理相结合运用于整个围手术期,取得良好效果。现介绍如下。     

腹腔镜治疗结肠癌患者围术期护理体会

目的观察腹腔镜下行结肠癌根治术临床效果及围术期护理体会。方法对32例实施腹腔镜结肠癌根治术患者围术期给予针对性护理,常规开腹手术根治治疗结肠癌患者38例,围术期予以常规护理,收集两组患者的围手术期资料,并进行统计学分析。结果两组患者一般情况包括性别比、年龄等无统计学差异,手术时间、术后镇痛时间、住院时间有统计学差异(P0.05)。结论腹腔镜治疗结肠癌患者疗效确切,围术期进行有针对性护理可减少并发症及住院时间,有利于患者身体康复。     

Application of fast track surgery in routine nursing for patient with colorectal cancer

Objective: To investigate the clinical effect of fast track surgery (FTS) in perioperative nursing of colorectal cancer surgery. Background: In recent years, many complicated surgery began to develop in the direction of low invasion and short hospital time, which provides an unprecedented opportunity for the development of fast track surgery (FTS). Methods: According to different nursing measures, 156 cases of colorectal cancer patients treated in our hospital were divided into FTS nursing group (86 cases) and traditional nursing group (70 cases). FTS nursing care and traditional nursing care were respectively employed to analyze and compare postoperative recovery and complications of the two groups. Results: FTS nursing group was significantly shorter than the traditional care group in terms of the first postoperative exhaust time, the first defecation time, the first eating time, ambulation time and postoperative hospital time, with statistical significance (P < .05); compared with the conventional nursing group, FTS group significantly had lower incidence of postoperative intestinal obstruction, lower limb vein thrombus formation and gastrointestinal discomfort, with statistical significance (P < .05); FTS group has less situations of nausea and vomiting, incision infection, pulmonary infection, urinary tract infection and anastomotic leakage compared to the conventional nursing group. Conclusion: FTS nursing can effectively promote the postoperative recovery of intestinal function for patients with colorectal cancer and reduce the occurrence of postoperative complications, which will relieve postoperative pain and shorten the length of stay, giving patients increased rehabilitation quality.     

脑胶质瘤术后口服替莫唑胺的护理体会

目的:探讨脑胶质瘤术后患者定期口服化疗药物的护理要点。方法:对31胶质瘤患者口服替莫唑胺胶囊化疗,全程观察治疗过程中所出现的护理问题,包括胃肠道反应和血液学反应,并采取相应的护理措施。结果:本组病例均能顺利完成化疗全程,无一例口服替莫唑胺出现的毒性反应影响化疗。结论:良好的护理可预防或减轻口服替莫唑胺胶囊的副作用,确保口服化疗顺利进行。     

American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Management of Acromegaly Patients: What is the Role of Pre-Operative Medical Therapy?

Objective: Acromegaly is a complex disease characterized by growth hormone (GH) excess originating in most cases from a pituitary tumor. The goals of treatment include removing the tumor or reducing tumor burden, normalizing GH secretion and insulin-like growth factor 1 levels, and preserving normal pituitary function if possible. Surgery by an experienced neurosurgeon is still considered first-line therapy, especially in cases with small tumors. In the last few decades, significant progress in the development of selective pharmacologic agents has greatly facilitated the management of active acromegaly, with agents such as somatostatin-receptor ligands (SRLs), GH-receptor antagonists, and dopamine agonists. In addition to adjuvant treatment, pre-operative medical therapy and primary therapy in de novo patients are increasingly employed.Methods: A United States National Library of Medicine PubMed search (through July 2014) was conducted for the following terms: acromegaly, pre-operative medical therapy, somatostatin-receptor ligands, and somatostatin analogs. Articles not in English and those not in peer-reviewed journals were excluded. In reviewing pertinent articles, focus was placed on biochemical and other postoperative outcomes of medical therapy.Results: An analysis of the full effect of pre-operative use of SRLs on surgical outcomes (remission rates and peri-operative complications) is limited by heterogeneity of methodology, low overall surgical cure rates, and different study designs. The assumption that SRL use prior to surgery reduces peri-operative surgical risk has yet to be proven. A variable degree of tumor shrinkage with preoperative SRLs is observed. Likewise, SRL treatment 3 months before surgery may improve surgical remission rates in the short term; however, positive results do not persist in the long term.Conclusion: We consider that medical therapy before surgery could play a role in carefully selected patients, but treatment should be individualized. Primary medical therapy with a SRL may be considered in patients with macroadenomas without local mass effects on the optic chiasm, as SRLs have been shown to reduce tumor size and control GH hypersecretion. However, the data are insufficient to support general use of a SRL prior to surgery in order to improve post-surgery biochemical outcomes. Theoretically, patients with severe cardiac and respiratory complications due to acromegaly could potentially benefit from pre-operative SRLs in order to reduce peri-operative morbidity. Further investigation and investment in large randomized long-term clinical trials are needed to define the precise role and duration of pre-surgical medical treatment in acromegaly patients.Abbreviations: GH = growth hormone IGF-1 = insulin-like growth factor 1 MRI = magnetic resonance imaging SRL = somatostatin-receptor ligand     

经脐单孔腹腔镜手术患者的围手术期护理

目的:探讨经脐单孔腹腔镜手术的临床可行性及护理要点。方法:对我院2010年6月～2011年6月实施的6例经脐单孔腹腔镜手术患者的临床资料进行回顾性分析。结果:经脐单孔腹腔镜手术除常规治疗作用外,患者恢复快,花费少,同时美容效果也大大提高。结论:经脐单孔腹腔镜手术安全可行,腹部无明显瘢痕,美容效果明显;系统的围手术期护理,更有利于促进患者康复;随着相关技术不断成熟,必然会得到广泛应用。     

快速康复配合腹腔穿刺减压治疗胃粘膜下肿瘤术后气腹的效果观察

目的:探讨快速康复护理模式对行腹腔穿刺放气结合胃肠减压处理胃黏膜下肿瘤患者的术后气腹症状,为临床护理工作提供参考。方法:对我院2010年7月至2013年1月收治的43例的胃黏膜下肿瘤患者行EFR手术,对术中及术后各临床资料进行分析。结果:两组患者手术的基本情况无显著性差异(P0.05)。快速康复组患者术后恢复情况优于常规护理组,且术后并发症的发生率低,差异具有统计学意义(P0.05)。快速康复组护理工作的落实率和患者治疗的依从性均明显优于常规护理组,差异具有统计学意义(P0.05)。结论:通过胃肠减压和腹腔穿刺放气能有效改善患者因术中胃壁全层切除产生胃壁穿孔而导致的术后气腹症状,全套操作及护理能够减少患者术后并发症、平均住院时间和平均住院花费,是一种安全有效的处理胃粘膜下肿瘤EFR术后气腹方法。     

不同麻醉方法对胃肠道肿瘤手术病人细胞免疫功能的影响

目的:探讨不同麻醉方法对胃肠道肿瘤患者围术期外周血T细胞亚群以及白细胞介素-2(IL-2)的影响.方法:选择胃肠道肿瘤手术患者40例,随机分为两组.采用单纯全麻者为对照组,采用全麻复合硬膜外麻醉者为治疗组.分别于麻醉前、麻醉后不同时间点抽取静脉血,流式细胞术测定CD4+T及CD8+T细胞亚群数量,ELISA法测定血清IL-2的浓度.结果:麻醉后两组患者的CD4+T细胞、CD4+/CD8+比值和血清IL-2浓度均有所下降,与麻醉前比较差异有统计学意义(P＜0.05),治疗组患者的CD4+T细胞及IL-2下降程度不如对照组患者明显,且恢复较快,两组间差异有统计学意义(P＜0.05).结论:胃肠道肿瘤患者在麻醉手术后其细胞免疫功能受到不同程度的抑制,但复合麻醉较单纯全麻的免疫抑制效应低且恢复较快.     

Le traitement chirurgical des tumeurs endocrines digestives

Surgery is the only curative treatment for localized gastrointestinal endocrine tumors. It plays a major role in therapeutic strategy. It meets the oncological principles of treatment. It must take into consideration the site of the tumor, its extension and its secretory nature. In well-differentiated endocrine tumors according to WHO classification, surgery must be indicated, not only for the primary tumor but also for the metastasis, particularly liver metastasis. The primary gastrointestinal endocrine tumors (functional or non functional) are mainly pancreatic in origin but also can be situated in small bowel, appendix, colon, or rectum. Surgery is part of a comprehensive approach discussed in multidisciplinary meeting.     

Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis.

OBJECTIVE--To evaluate the impact of a fast track triage system for patients with acute myocardial infarction. DESIGN--Comparison of delays in admission to hospital and in receiving thrombolytic treatment before and after introducing fast track system with delays recorded in 1987-8. Patients fulfilling clinical and electrocardiographic criteria for myocardial infarction were selected for rapid access to the cardiac care team, bypassing evaluation by the medical registrar. SETTING--Major accident and emergency, cardiac and trauma centre. SUBJECTS--359 patients admitted to the cardiac care unit during 1 February to 31 July 1990 with suspected acute infarction. MAIN OUTCOME MEASURES--Accuracy of diagnosis and delay from arrival at hospital to thrombolytic treatment. RESULTS--248 of the 359 patients had myocardial infarction confirmed, of whom 127 received thrombolytic treatment. The fast track system correctly identified 79 out of 127 (62%) patients who subsequently required thrombolytic treatment. 95% (79/83) of patients treated with thrombolysis after fast track admission had the diagnosis confirmed by electrocardiography and enzyme analysis. The median delay from hospital admission to thrombolytic treatment fell from 93 minutes in 1987-8 to 49 minutes in fast track patients (p less than 0.001). Delay in admission to the cardiac care unit was reduced by 47% for fast tract patients (median 60 minutes in 1987-8 v 32 minutes in 1990, p less than 0.001) and by 25% for all patients (60 minutes v 45 minutes, p less than 0.001). CONCLUSION--This fast track system requires no additional staff or equipment, and it halves inhospital delay to thrombolytic treatment without affecting the accuracy of diagnosis among patients requiring thrombolysis.     

腹腔镜探查并治疗腹部恶性肿瘤术后肠梗阻的临床研究

目的:探讨腹腔镜辅助探查并治疗腹部恶性肿瘤术后肠梗阻患者的可行性及安全性。方法:应用腹腔镜技术对我院42例腹部恶性肿瘤术后患者行手术治疗,其中包括良性粘连性肠梗阻14例、肿瘤复发16例、原发性结肠癌1例、恶性肠粘连11例。结果:42例患者均在腹腔镜下明确诊断,其中18例患者在完全腹腔镜下手术治疗,13例患者在腹腔镜辅助下行手术治疗,6例患者腹腔严重粘连中转开腹手术治疗,5例患者腹腔广泛转移行保守治疗。腹腔镜手术时间为35~290min,平均住院日9.2±1.7d。患者术后疼痛较轻、下床活动时间及肠道功能恢复时间短、术后并发症少。结论:恶性肿瘤术后肠梗阻患者仍需手术治疗,在严格掌握手术适应症下,应用腹腔镜技术对恶性肿瘤术后肠梗阻病人的治疗是安全、可行的。