红霉素促进腹部手术后胃肠运动功能恢复的临床研究

目的：观察红霉素对腹部手术后胃肠蠕动功能恢复的作用.方法：随机选择96例腹部手术的病人,术后按红霉素的常规用量静脉滴注3～5 d,与同期不使用红霉素及其他促胃肠蠕动药的90例术后第1次肠鸣音恢复和肛门排气时间进行比较.结果：治疗组术后肠鸣音恢复及肛门排气分别为（30.5±13.5）h和（46.3±16.2）h,明显快于对照组的（46.8±15.9）h和（68.5±19.7）h,差别有显著意义（P＜0.01）.结论：红霉素对腹部手术后的胃肠蠕动能力有显著的促进作用,不失为一种治疗或促进腹部手术后或腹膜炎所致的肠麻痹的促动力药.     

下肢屈曲活动和腹部按摩促进胃肠蠕动的临床观察

选择 132例粘连性肠梗阻再手术病人 ,随机分为观察组 (除常规护理外 ,采用下肢主动或被动屈曲活动和腹部按摩 )和对照组 (采用常规护理方式 )。观察两组病人术后肠鸣音恢复时间、肛门排气时间和炎性肠梗阻的发生率。结果表明 :观察组病人术后肠鸣音恢复时间和肛门排气时间较对照组明显提前 (P<0 .0 1) ;炎性肠梗阻的发生率明显降低 (P<0 .0 5 )。提示 :下肢屈曲活动和腹部按摩可阻止肠间袢的粘连 ,促进胃肠蠕动 ,减少粘连性肠梗阻的发生 ,从而提高护理服务质量。     

穴位电刺激对腹部术后胃肠功能恢复的疗效观察

腹部手术后尽快恢复胃肠道功能,尽早排气排便,是减少术后肠粘连等并发症、促进病人早日进食、早日康复的有效措施。连续硬膜外麻醉下施行腹部手术,术后胃肠蠕动的恢复一般需要数日时间。作者利用胃肠治疗仪对３０例腹部手术病人术后进行穴位电刺激治疗,促进胃肠蠕动的...     

急性弥漫性腹膜炎术后早期应用体表胃肠起搏器的临床观察

目的:探讨体表胃肠起搏器在急性弥漫性腹膜炎术后患者的早期应用价值.方法:将我院2008年1月至2009年6月收治的50例急性弥漫性腹膜炎术后患者随机分成治疗组和对照组(各25例),治疗组术后6h起予以体表胃肠起搏器治疗,对照组予以常规治疗,比较两组的术后肠鸣音恢复时间(h)、肛门排气时间(h)、术后腹腔内压(cm H2O)、术后症状积分等指标.结果:治疗组和对照组的术后肠鸣音恢复时间、肛门排气时间、术后腹腔内压、术后症状积分分别是(39.7±6.6)h与(52.4±8.7)h、(53.2±8.1)h与(76.6±7.5)h、(4.7±2.1)cm H2O与(7.4±1.8)cm H2O、(10.3±5.2)分与(19.1±6.2)分,两组各项之间的比较差异有统计学意义(P＜0.05).结论:急性弥漫性腹膜炎术后早期应用体表胃肠起搏器可能有效促进患者胃肠动力的恢复.     

姜片虫致肠梗阻一例

患者 女性，46岁，因腹胀、腹痛，肛门停止排便和排气约60h，于2004年6月入院。患者50h前服用月见草油胶囊后，出现阵发性腹痛，腹胀，呕吐。入院查体：体温37．5℃，脉搏90次／min，呼吸21次／min，血压13．8／9．2kPa（1mmHg=0．133kPa）。腹部膨胀，可见肠型和蠕动波，有轻度压痛和反跳痛，在腹中部可触及团块。绞痛发作时，肠鸣音亢进。     

超声药物透入治疗在结直肠癌术后胃肠功能恢复中的护理研究

[摘要]目的探讨超声药物透入治疗技术对结直肠癌手术患者术后胃肠功能恢复的影响及护理策略。方法将180例结直肠癌手术患者随机分为观察组、安慰剂组和对照组,每组各60例,进行前瞻性对比研究。在常规治疗、基础护理相同的情况下,观察组使用超声药物（胃肠宁片）透入治疗,安慰剂组采用不加入药物的超声治疗,对照组未使用超声治疗,观察3组患者术后肠鸣音恢复、肛门排气排便等胃肠功能恢复情况。结果观察组、安慰剂组和对照组的肠鸣音恢复时间、肛门首次排气、排便时间比较差异有统计学意义（P〈0．001）,其中观察组恢复最快,安慰剂组次之,对照组最慢。结论术后使用超声药物透入治疗可促进患者肠鸣音恢复及排气排便,加快肠功能恢复,加速患者康复。     

聚乙二醇电解质散对腹部手术后排气的影响

腹部手术后病人胃肠蠕动明显减弱或停止，是术后胃肠道处于保护性的抑制状态所致，通常经48～72h后大部分病人可自然排气，24h内排气者很少川，如不及早恢复病人腹部手术后的消化道功能，则术后发生肠粘连梗阻的概率很高．且与排气时间成正相关。本研究旨在探讨腹部手术后促进胃肠功能早期恢复及防止肠粘连的新途径。     

温水足浴促进腹部非胃肠手术后肛门排气效果观察

目的观察温水足浴对腹部非胃肠手术后患者肛门排气时间的效果。方法将500例腹部非胃肠手术惠者随机分为观察组和对照组，各250例。两组均采用术后常规护理；观察组在此基础上采取温水足浴，即术后6h患者生命体征稳定后用42C温水浸泡双足。结果观察组不同术式患者术后肛门排气时间均较对照组明显提前（P〈0．05，P〈0．01）。结论温水足浴可使腹部非胃肠手术后患者肛门排气时间提前，有利早期恢复正常饮食，促进机体康复。     

免气腹与气腹腹腔镜下子宫肌瘤剔除术的临床比较研究

目的探讨免气腹腹腔镜子宫肌瘤剔除术的临床应用价值。方法选取2007年5月～2008年5月在我院行免气腹腹腔镜下子宫肌瘤剔除术（免气腹组）的子宫肌壁间肌瘤43例,及同期气腹腹腔镜下子宫肌瘤剔除术（气腹组）40例进行回顾性对照研究,比较2组手术时间、术中出血量、术后腹腔引流量、术后胃肠功能恢复时间及术后半年的复发情况。结果2组手术均在腹腔镜下顺利完成,无术中、术后并发症。与气腹组相比,免气腹组手术时间短[（46．2±17．2）min vs （59．4±20．8）min,t=-3．160,P=0．002],术中出血量少[（235．3±83．1）ml vs （310．5±99．4）ml,t=-3．749,P=0．000],术后24h腹腔引流量少[108．4±23．4）ml vs （125．9±35．1）ml,t=-2．690,P=0．010],术后胃肠功能恢复快[肛门首次排气时间（17．4±7．2）h vs （21．6±9．8）h,t=-2．236,P=0．023;首次排便时间（23．5±8．1）h vs （31．0±9．4）h,t=-3．902,P=0．001]。2组术后2个月阴道B超均未发现肌瘤,术后6个月阴道B超提示气腹组1例子宫后壁肌层内见一直径12mm的小肌瘤,2组复发率差异无显著性（0／43 vs 1／40,P=0．482）。结论与气腹腹腔镜子宫肌瘤剔除比较,免气腹法具有手术时间短、术中出血少、手术操作简便、术后病人恢复快等优点,对于拟施行子宫肌瘤剔除术的患者是一种较好的手术方式。     

快速康复技术在腹腔镜胆囊切除术围术期的应用

目的探讨快速康复技术（fast-track surgery,FTS）在腹腔镜胆囊切除术（1aparoscopic cholecystectomy,LC）围术期的应用价值。方法选取我院2012年1-12月LC200例,住院号单号为传统组,双号为快速康复组（FTS组）,各100例,比较手术时间、出血量、术后下床活动时间、进半流食时间、肛门排气时间、排便时间及住院时间。结果与传统组比较,FTS组进半流食早[（11．34±2．0）hvs．（50．24±8．7）h,f=-43．976,P=0．000],下床活动早[（6．24±1．5）h vs．（14．34±1．7）h,t=-35．728,P=0．000],排气早[（12．04±4．4）h vs．（24．94±5．4）h,t=-18．519,P=0．000],排便早[（15．84±5．3）h vs．（25．24±4．3）h,t=-13．773,P=0．000],术后住院时间短[（3．24±1．3）d VS．（4．24±2．1）d,t=-4．048,P=0．000]。结论快速康复方法安全可行,有利于患者的术后康复。     

生物胶体液对腹部手术后粘连性肠梗阻的预防作用

目的探讨生物胶体液对预防术后粘连眭肠梗阻及促进术后胃肠功能恢复的作用。方法140例腹部手术患者随机分为研究组71例和对照组凹例，研究组术中使用生物胶体液冲洗手术区域并保留部分于腹腔内，对照组未使用，比较2组术后粘连性肠梗阻发生率和对术后胃肠功能恢复的影响。结果研究组术后粘连性肠梗阻发生率明显低于对照组，差异有统计学意义（P〈0．05），并且可促进术后胃肠功能恢复，缩短患者的住院时间（P〈0．05）。结论腹部手术中应用生物胶体液安全有效，对预防粘连性肠梗阻、促进术后胃肠功能恢复有显著作用，可作为术中的常规操作推广应用。     

Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin

No standard effective treatment exists for peritoneal carcinomatosis of gastrointestinal origin. The pharmacokinetic advantage of intraperitoneal chemotherapy and the synergy of heat and certain anticancer agents have prompted researchers to investigate intraperitoneal hyperthermic chemotherapy in treating disseminated peritoneal cancers. We have conducted a large Phase II trial to determine the safety and efficacy of aggressive cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) in treating peritoneal carcinomatosis of gastrointestinal origin. Patients with disseminated peritoneal carcinomatosis of gastrointestinal origin with or without malignant ascites were eligible. After aggressive surgical debulking, patients were administered a 2-hour heated (40.5 degrees C) intraperitoneal perfusion with mitomycin C. The major response variable monitored was overall survival. Patients were assessed for toxicity after IPHC administration using the National Cancer Institute Common Toxicity Criteria. Eighty-four patients with peritoneal carcinomatosis of gastrointestinal origin were evaluated for survival and toxicity (colon, n = 38; appendix, n = 22; stomach, n = 19; other gastrointestinal, n = 5). Thirty-nine (46%) patients had malignant ascites at the time of therapy. The operative mortality (30-day) was 6 per cent. Hematologic toxicity was the most common toxicity but was of mild to moderate severity (7 and 4% of patients had grade 3/4 white blood cell or platelet toxicity, respectively). The overall median survival was 14.3 months. The median survival of patients with peritoneal carcinomatosis of appendiceal, colorectal, and gastric origins were 31.1+, 14.6, and 10.1 months, respectively. Significant differences in median survival were seen in patients without and with malignant ascites (27.7 vs 7.6 months; P = 0.0004) and R0/R1 (complete gross tumor resection) versus R2 (gross residual tumor) surgical resection status (28.5+ vs 10.8 months, P = 0.0002). These data suggest that aggressive cytoreductive surgery with IPHC using mitomycin C is safe and effective in treating peritoneal carcinomatosis of gastrointestinal origin. Additional studies and broader applications of this treatment are encouraged.     

中药热疗腹带"康腹帝"对腹部手术后胃肠道功能恢复的促进作用研究

目的探讨中药热疗腹带"康腹帝"对腹部手术后胃肠道功能恢复的促进作用.方法 术后8 h开始将研制的"康腹帝"捆于病人腹部,与同期随机入选的腹部手术病人为对照,观察胃肠道功能恢复情况.结果 187例经观察(治疗组93例,对照组94例),肠鸣恢复时间治疗组为8～112h,中位时间为28 h,对照组为16～124 h,中位时间46 h,有显著统计学意义(P=0.0001);肛门排气时间治疗组为22～116 h,中位时间56 h,对照组为24～147 h,中位时间82 h,有显著统计学意义(P=0.0001);肠电图显示治疗组各检测肠段的电控制活动(ECA)、连续反应电活动波(CERA)、收缩电综合波(CEC)均显著增强.结论本中药热疗腹带有助于促进腹部手术后胃肠道功能的恢复.     

抗炎灵对腹部外科SIRS/MODS患者免疫功能的影响

目的：动态研究观察抗炎灵对腹部外科SIRS／MODS患者免疫功能的影响。方法：以腹部外科手术SIRS／MODS52例患者为研究对象,按入院时间分为对照组21例和抗炎灵治疗组31例,分别于术后1、3、7d观察血清I gA,IgG,IgM,C3,C4水平。结果：血清IgG,IgM,IgA和补体C3、C4后逐渐上升,于第3d时IgG,IgM,IgA两组有显著差别（P＜0．05）,于第7d时,C3、C4两组有差异（P＜0．05）,治疗组上升较快,结论：抗炎灵能提高机体免疫能力,对SIRS／MODS有一定的治疗作用。     

Emergency hospital admissions and three-year survival of adults with and without cardiovascular surgery for congenital cardiac disease

OBJECTIVE: This study determined the quantity and nature of emergencies leading to unscheduled hospital admissions of adults with congenital cardiac disease and their mid-term survival. RESULTS: During 1 year, 429 adults with congenital cardiac diseases were admitted 571 times, and 124 admissions (22%) of 95 patients (22%) were emergency admissions. Fifteen of the 95 patients were seen for the first time in 1 of the participating centers. The underlying anomalies were Fallot's tetralogy and pulmonary atresia (n = 26/7), univentricular heart after Fontan procedure (n = 25), atrial septal defect (n = 18), Eisenmenger syndrome (n = 12), complete transposition (n = 11), and others (n = 25). Indications for admission were cardiovascular complications (n = 103; 83%) (arrhythmia, cardiac failure, syncope, pacemaker problems, pericardial tamponade, and sudden death), infections (n = 8, 6%) (endocarditis, pacemaker infection, pneumonia, and cerebral abscess), acute chest pain (n = 7; 6%), and acute abdominal pain (n = 4; 3%). All patients required immediate emergency care, and 16 patients (17%) required urgent cardiovascular or abdominal surgery. Six patients died during the hospital stay. During a follow-up of 2.9 years (SD 0.8), 16 (18%) of the discharged patients died, and 2 additional patients underwent heart or heart-lung transplantation. CONCLUSION: Adults with congenital cardiac disease often experience serious emergency situations with a high in-hospital and mid-term post-hospital mortality. Care given by physicians with special expertise is important in this specific group of patients.     

Changes in respiratory physiological dead space and compliance during non-abdominal, upper abdominal and lower abdominal surgery under general anaesthesia

BACKGROUND AND OBJECTIVE: To evaluate the temporal changes in respiratory physiological dead space and dynamic compliance of the respiratory system during non-abdominal, upper abdominal and lower abdominal surgery under general anaesthesia with intermittent positive pressure ventilation. METHODS: Thirty-four adult patients were studied (non-abdominal surgery, n = 8; upper abdominal surgery, n = 13 and lower abdominal surgery in lithotomy position, n = 13). Physiological dead space was measured using the single breath carbon dioxide test. The physiological dead space to tidal volume ratio (VD/VT), dynamic compliance of respiratory system, expiratory tidal volume and respiratory rate were measured 10 min after tracheal intubation, and 30, 60 and 120 min later. RESULTS: In lower abdominal surgery group, VD/VT was significantly increased at 120 min compared with 0 min (P = 0.005) and 30 min (P = 0.009). There were no significant differences in VD/VT between the three groups at any time point. Compliance decreased significantly in patients with upper abdominal (120 min) and lower abdominal surgery (60 and 120 min), but there were no significant changes during non-abdominal surgery. CONCLUSIONS: We found that the VD/VT increased in patients undergoing lower abdominal surgery in lithotomy and head down tilt, and compliance decreased in those undergoing upper abdominal and lower abdominal surgery over time.     

Mininvasive abdominal aortic surgery. Early recovery and reduced hospitalization after multidisciplinary approach

AIM: Clinical experience in gastrointestinal surgery demonstrated that a multimodal approach can improve the outcome and reduce the length of hospital stay. In this paper we investigate the impact of a multimodal clinical program, based on mininvasive surgery, epidural anesthesia and early feeding and mobilization, on postoperative morbidity and hospitalization after abdominal aortic surgery. METHODS: A 2-armed study was designed. All patients undergoing abdominal aortic surgery between May 2000 and April 2001 were enrolled in a multidisciplinary clinical program including thoracic epidural anesthesia and analgesia, left sub-costal minilaparotomy without evisceration, encouragement to feed and mobilize soon after surgery (Multidisciplinary group: n=82). For comparison purposes, a retrospective analysis was conducted using the data of all patients operated on between January and December 1997, receiving standard anesthesia care and a standard surgical and nursing program (Standard group: n=64). RESULTS: In the Multidisciplinary group we observed significantly better pain relief (p<0.01), earlier restoration of ambulation (p<0.01), earlier feeding (p<0.01) and passage of stools (p<0.01). The incidence of complications was significantly lower in the Multidisciplinary group: pulmonary (0% vs 14.1%), cardiac (2.4% vs 9.4% ) and gastrointestinal (0% vs 10.9%). None of the patients in the Multidisciplinary group required admission to Intensive Care. Median postoperative hospitalization was 3 days in the Multidisciplinary group compared to 9 days in the Standard group (p<0.01). CONCLUSION: These results suggest that a multidisciplinary intervention with review of the traditional surgical care program would enhance recovery, decrease morbidity and hospitalization after abdominal aortic surgery.     

妇产科腹部手术后增生性瘢痕形成情况和影响因素

目的 分析妇产科腹部手术后增生性瘢痕形成情况和影响因素。 方法 选择2020年1月-2022年1月 于我院妇产科行腹部手术治疗的60例患者为研究对象,根据患者术后增生性瘢痕形成情况分为增生性瘢痕 组（n=30）与非增生性瘢痕组（n=30）,比较两组术后情况,并借助多因素Logistic回归对术后增生性瘢痕 形成的因素展开分析。 结果 增生性瘢痕组术后感染发生率、美容修复率及色素沉着发生率均高于非增生 性瘢痕组（P＜0.05）;多因素Logistic回归分析显示,妊娠、切口类型、内分泌疾病、瘢痕体质是妇产科腹 部手术后增生性瘢痕形成的影响因素（P＜0.05）。 结论 导致妇产科腹部手术患者增生性瘢痕形成的因素 较多,需根据患者自身情况,结合其临床表现,积极采取针对性的防治措施。     

腹腔镜手术与传统开放手术治疗老年残余胆囊胆管结石的疗效对比

目的对比分析腹腔镜手术与传统开放手术治疗老年残余胆囊胆管结石的疗效。方法回顾性选取我院2013年5月至2017年5月期间收治的50例经肝胆超声、上腹部磁共振胰胆道成像(MRCP)检查明确为残余胆囊胆管结石患者的临床资料,根据不同手术治疗方法分为腹腔镜组(n=25)和开放组(n=25),统计两组手术基本情况,术前、术后腹痛、腹胀改善情况及术后胃肠道恢复效果。结果腹腔镜组手术时间明显较开放组短,术中失血量显著低于开放组(P0.05),结石清除率为100.00%略高于开放组的92.00%,但差异无统计学意义(P0.05),术后并发症发生率8.00%显著低于开放组的32.00%(P0.05)。术前两组腹痛、腹胀评分比较无明显差异(P0.05),术后12h腹痛、腹胀评分均明显降低,与术前相比差异有统计学意义(PO.05),且腹腔镜组腹痛评分、腹胀评分均明显低于对照组(P0.05)。腹腔镜组术后肠鸣音恢复时间、肛门排气时间、排便时间及固体食物进食时间均显著较开放组短(P0.05)。结论与传统开放手术相比,腹腔镜手术治疗老年残余胆囊胆管结石可一定程度降低机体因手术操作、老年患者免疫力低导致的术后并发症,显著缓解腹痛、腹胀症状和促进术后胃肠功能恢复。     

疼痛对上腹部术后呼吸肌功能不全的影响

目的　观察疼痛在上腹部手术后呼吸肌功能不全中所起的作用。方法　ASAⅠ～Ⅱ级择期腹腔镜胆囊切除术患者 30例 ,随机分为病人自控镇痛 (PCA)组与对照组 ,每组 15例。用最大吸气压 (MIP)和最大呼气压 (MEP)来评估呼吸肌功能。两组于术前 ,术后 2 4、4 8h分别测定MIP、MEP ,并用视觉模拟疼痛评分法 (VAS)评估疼痛程度。结果　术后对照组的MIP与MEP比术前显著下降 (P <0 0 5 )。VAS评分两组均增加 ,与术前相比 ,对照组有显著差异 (P <0 0 5 )。两组相比 ,PCA组的VAS增加明显少于对照组 (P <0 0 5 )。MIP、MEP和疼痛在统计学上有显著相关 (P <0 0 1)。结论　疼痛是导致上腹部术后呼吸肌功能不全的一个重要因素 ,而PCA则能部分地改善术后呼吸肌功能不全