优质护理服务模式在股骨颈骨折围手术期护理中的作用效果分析

目的分析优质护理服务模式在股骨颈骨折围手术期护理中的效果。方法资料选自2013年1月~2014年1月我院收治的股骨颈骨折患者68例,均分为研究组和对照组,给予对照组常规护理,研究组实施优质护理服务模式,对比两组护理效果。结果护理后,研究组护理满意度97.06%,高于对照组79.41%,比较差异有统计学意义(P0.05)。结论给予股骨颈骨折患者围手术期优质护理服务,对改善护患关系有积极意义。     

Multidisciplinary treatment strategy for locally advanced gastric cancer: A systematic review

BackgroundMultidisciplinary management of patients with locally advanced gastric cancer (LAGC) remains unstandardized worldwide. We performed a systemic review to summarize the advancements, regional differences, and current recommended multidisciplinary treatment strategies for LAGC.MethodsEligible studies were identified through a comprehensive search of PubMed, Web of Science, Cochrane Library databases and Embase. Phase 3 randomized controlled trials which investigated survival of patients with LAGC who underwent gastrectomy with pre-/perioperative, postoperative chemotherapy, or chemoradiotherapy were included.ResultsIn total, we identified 11 studies of pre-/perioperative chemotherapy, 38 of postoperative chemotherapy, and 14 of chemoradiotherapy. In Europe and the USA, the current standard of care is perioperative chemotherapy for patients with LAGC using the regimen of 5-FU, folinic acid, oxaliplatin and docetaxel (FLOT). In Eastern Asia, upfront gastrectomy and postoperative chemotherapy is commonly used. The S-1 monotherapy or a regimen of capecitabine and oxaliplatin (CapOx) are used for patients with stage II disease, and the CapOx regimen or the S-1 plus docetaxel regimen are recommended for those with stage III Gastric cancer (GC). The addition of postoperative radiotherapy to peri- or postoperative chemotherapy is currently not recommended. Additionally, clinical trials testing targeted therapy and immunotherapy are increasingly performed worldwide.ConclusionsRecent clinical trials showed a survival benefit of peri-over postoperative chemotherapy and chemoradiotherapy. As such, this strategy may have a potential as a global standard for patients with LAGC. Outcome of the ongoing clinical trials is expected to establish the global standard of multidisciplinary treatment strategy in patients with LAGC.     

A nationwide surveillance of surgical site infection after mid-urethral slings in Japan

We performed a questionnaire-based, retrospective, nationwide survey on perioperative management and antimicrobial prophylaxis for mid-urethral sling surgery for stress urinary incontinence in Japan to realize the clinical practice and risk factors for SSI.Records of women receiving transobturator tape (TOT) and tension-free vaginal tape (TVT) surgeries from 2010 to 2012 were obtained from hospitals belonging to the Japanese Society of Pelvic Organ Prolapse Surgery. The questionnaire addressed hospital volume, perioperative management, and SSI. Risk factors for SSI were investigated by comparing cases with and without SSI.The data from 97 hospitals and a total 1627 TOT and 1045 TVT surgeries were analyzed. Mean case volumes of TOT and TVT surgeries were 7.3 ± 14.9 and 7.1 ± 17.8 cases per year, respectively. Preoperative hair removal, bowel preparation, and urine culture were routinely performed at 44 (45.3%), 31 (32.0%), and 22 (22.7%) hospitals, respectively. First-generation (51.5%) or second-generation (34.0%) cephalosporin was mostly used for antimicrobial prophylaxis. SSI was reported only in 6 patients (0.22%) and none of them developed abscesses. None of the factors we could evaluate from the questionnaire were found to be significantly associated with SSI.SSI after mid-urethral slings rarely occurred in Japan (0.22%) and no parameters about perioperative managements significantly increased SSI. However, further studies with more detail information of each patient and operation are required to confirm their appropriate perioperative managements for mid-urethral slings.     

改良纤维板剥脱术对慢性结核性脓胸患者围手术期临床指标、肺功能及术后并发症的影响

目的探讨改良纤维板剥脱术对慢性结核性脓胸患者围手术期临床指标、肺功能及术后并发症的影响。方法选取慢性结核性脓胸患者140例,采用随机数字表法分为对照组(70例)和试验组(70例),分别常规纤维板剥脱术和改良纤维板剥脱术治疗。比较两组患者围手术期临床指标,术后肺活量(VC)和最大通气量(MVV)增加量及术后胸腔再次感染率等。结果两组患者手术时间、术中出血量、术后24 h引流量、引流管放置时间及住院时间等围手术期临床指标比较差异无统计学意义(P0.05);试验组患者治疗后VC和MVV增加量均高于对照组,差异有统计学意义(P0.05);两组患者术后胸腔再次感染率比较差异无统计学意义(P0.05)。结论改良纤维板剥脱术治疗慢性结核性脓胸患者可有效改善肺功能,且未对围手术期临床指标及术后并发症产生明显影响,具有临床应用价值。     

Increased risk of hip fracture mortality associated with intraoperative hypotension in elderly hip fracture patients is related to under resuscitation

BackgroundAs the US and world population ages, hip fractures are increasingly more common. The mortality associated with these fractures remains high both in the immediate postoperative period and at one year. Perioperative resuscitation in this population is of key interest to prevent organ injury and mortality. Our objectives were to evaluate the effect of fluid resuscitation and hemodynamic status in the form of mean arterial pressure (MAP) on inpatient mortality of hip fracture patients.MethodsAn institutional database was queried to compare elderly hip fracture patients that sustained in-hospital mortality to a matched control cohort. Pre-, intra-, and post-operative intravenous fluid (IVF) administration and MAP were extracted from the electronic medical record. Time from hospital presentation to the OR was also recorded.Results1,114 total hip fractures were identified during the two-year study period, 16 of which suffered inpatient mortalities. The mortality cohort was then matched with a control of 394 hip fracture patients for the same period based on age, sex, and Charlson Comorbidity Index (CCI). Conditional logistical regression analysis found odds ratios (OR) indicating that longer time between presentation and surgery (OR per additional hour: 1.05; 95% CI: 1.01–1.08) and lower intraoperative minimum MAP (OR per 5 mmHg decrease: 0.77; 95% CI: 0.61–0.97) were associated with significantly increased odds of mortality. There was also a marginal relationship between greater intraoperative IVF administration and reduced odds of mortality (OR per 500 cc additional fluid: 0.61; 95% CI: 0.37–1.00).ConclusionExtended time from presentation to surgery and intraoperative hypotension were associated with increased likelihood of inpatient mortality in an elderly hip fracture cohort, with a possible additional effect of under-resuscitation. Further investigation into a safe intraoperative minimum MAP should be pursued.Level of evidenceLevel III.     

优质护理在混合痔围手术期患者中的应用价值分析

目的：探讨分析优质的护理在混合痔围手术期患者中的应用价值。方法：选取2013年1月～2014年1月我院接受治疗的68例混合痔患者，随机分为试验组（优质护理组，试验例数为34）和对照组（常规护理组，试验例数为34），利用统计学方法对此两种护理方式下患者的术前精神状态和术后并发症发生率等进行比较分析。结果：试验组通过优质精心的护理，试验组混合痔患者的术前精神状态和并发症发生率明显优于对照组，且术后住院时间也低于对照组，两组对比具有显著差异性（P〈0．05），具有统计学意义。结论：通过优质精心的护理，可有效地促进手术创面的愈合，有利于患者的旱日康复，避免各种并发症的发生，值得在临床上应用和推广。     

Perioperative high-dose-rate brachytherapy in locally advanced and recurrent gynecological cancer: Final results of a Phase II trial

PurposeTo determine the long-term results of a Phase II trial of perioperative high-dose-rate brachytherapy (PHDRB) in primary advanced or recurrent gynecological cancer.Methods and MaterialsFifty patients with locally advanced and recurrent gynecological cancer suitable for salvage surgery were included. Unirradiated patients (n = 25) received preoperative chemoradiation followed by surgery and PHDRB (16–24 Gy). Previously irradiated patients (n = 25) received surgery and PHDRB alone (32–40 Gy).ResultsMedian followup was 11.5 years. Eight unirradiated patients (32%) developed Grade ≥3 toxic events including two fatal events. Local and locoregional control rates at 16 years were 87.3% and 78.9%, respectively. Sixteen-year disease-free and overall survival rates were 42.9% and 46.4%, respectively. Ten previously irradiated patients (40.0%) developed Grade ≥3 adverse events, including four fatal events. Local and locoregional control rates at 14 years were 59.6% and 42.6%, respectively. Fourteen-year disease-free and overall survival rates were 16.0% and 19.2%, respectively.ConclusionsPHDRB allows effective salvage of a subset of unfavorable gynecological tumors with high-risk surgical margins. Toxicity was unacceptable at the initial dose levels but deescalation resulted in the absence of severe toxicity without a negative impact on locoregional control. A substantial percentage of patients remain alive and controlled at >10 years including a few previously irradiated cases with positive margins.