快速康复外科理念在胃癌患者中的临床研究

【摘要】 目的 探讨快速康复外科理念在胃癌患者中临床应用的安全性和有效性。方法 回顾性研究184例胃癌患者临床资料,一组为快速康复外科组,另一组为传统治疗组,每组92例。比较两组患者的手术及术后恢复相关评价指标。结果 快速康复外科组与传统治疗组相比,在手术时间(182±43 min vs 190±46 min,P=0.68)、术中出血量(179±64 mL vs 182.59±74.65 mL,P=0.52)、淋巴结清扫数(21.2±7.2个vs 20.8±8.7个, P=0.59)、术后并发症(8.70% vs 10.87%,P=0.17)比较无显著性差异。而术后首次排气时间(3.6±0.6 d vs 5.0±0.8 d,P<0.01)、术后住院天数(7.1±1.4 d vs 11.5±2.0 d,P<0.001)和住院总费用(40583±3693元 vs 46438±6311元,P<0.001)比较有显著性差异。结论 快速康复外科理念应用于胃癌患者安全有效,可明显加快胃癌患者术后康复进程。     

Various Surfaces Benefited Functional Outcomes and Fall Incidence in Individuals With Spinal Cord Injury: A Randomized Controlled Trial With Prospective Data Follow-up

ObjectivesTo compare effects of walking training on a walking track with different surfaces (WTDS), including artificial grass, soft, and pebbles, as compared to overground walking training on the functional ability necessary for independence and incidence of falls of ambulatory individuals with spinal cord injury (SCI).DesignA randomized controlled trial (single-blinded design) with 6-month prospective fall data follow-up.SettingTertiary rehabilitation centers and several communities.ParticipantsIndependent ambulatory individuals (N=54) with SCI who walked with or without a walking device.InterventionParticipants were randomly arranged into a control group (overground walking training, n=26) or experimental group (walking training over a WTDS, n=28) for 30 min/d, 5 d/wk over 4 weeks.Main Outcome MeasuresThe 10-m walk test, timed Up and Go test, five times sit-to-stand test, and 6-minute walk test were repeatedly measured 4 times, including before training, and after 2 and 4 weeks, and 6 months. In addition, participants were prospectively monitored for the fall data over 6 months.ResultsParticipants who walked with an average speed of 0.52 m/s and postinjury time >7 years could safely walk over a WTDS. They demonstrated significant improvement at 2 and 4 weeks after experimental training (P<.001), but not after control training. During the 6-month follow-up, participants in the experimental group also had the number of those who fell (n=5, 18%) fewer than those in the control group (n=12, 46%).ConclusionsBeing at a chronic SCI with ability of independent walking, participants needed a challenging task to promote their functional outcomes and minimize fall risk. The findings suggest the use of various surfaces as an alternative rehabilitation strategy for these individuals.     

Thermal control of drug release by a responsive ion track membrane observed by radio tracer flow dialysis

The combination of a responsive hydrogel with a rigid porous supporting structure yields a membrane with high mechanical strength and high on-off-permeability ratio. A membrane consisting of an ion track filter with a thermally responsive lining was prepared by penetrating a 19 μm thick foil of poly(ethylene terephthalate) (PET) with swift heavy ions at a fluence of 5·10⁵ ions/cm², followed by etching of the ion tracks to generate an ion track filter with 2.9 μm pore diameter, onto which a thin layer of poly(N-isopropylacrylamide) (NIPAAm) hydrogel was grafted. It was revealed that the mass flow of various molecules (water, chloride⁻, choline⁺, insulin, and albumin) through the membrane could be thermally controlled. The on-off-permeability ratio ranged between 3 and 10 increasing with molecular weight. Over a storage time of 5 months the permeabilities varied up to a factor of 2.6, while the on-off-permeability ratio and temperature sensitivity remained practically constant.     

Improving Patients' Experiences Communicating With Nurses and Providers in the Emergency Department

IntroductionAs health care becomes increasingly patient centered, organizations strive to improve patients’ ratings of satisfaction with care. Communication with nurses and providers drives overall satisfaction, yet little evidence exists to guide them in ensuring effective communication in the emergency department.MethodsA semistructured interview guide based on the Hospital Consumer Assessment of Healthcare Providers survey was used to elicit qualitative data from 30 patients seen in the emergency department and fast track regarding communication with nurses and providers. Data were analyzed using content analysis methodology.ResultsTwo types of overarching themes emerged. Foundational themes include behaviors that convey courtesy and respect and are required for participants to view their interactions with nurses and providers as positive. Interactive themes describe humanistic ways in which nurses and providers conveyed courtesy and respect, reassurance through careful listening, attentiveness, and explaining things in an understandable way.DiscussionThe findings underscore existing evidence regarding patients’ perceptions of being treated with courtesy and respect via nurses’ and providers’ use of positive verbal phrasing and nonverbal body language. They reveal new insights into the importance of specific communication behaviors used by nurses and providers during interactions. Treating patients as individuals amidst a fast-paced care environment, proactively recognizing and responding to patients’ fears and concerns, and explaining information clearly to ensure understanding were critical.     

用加速康复外科理念治疗胃癌患者的临床应用探讨

目的探讨加速康复外科理念在胃癌患者围手术期治疗过程中的应用。方法将80例胃癌患者随机分为传统方法组(n=40)和加速康复组(n=40),比较2组患者术前1 d、术后第1、3天的外周血总淋巴细胞计数(TLC)、C反应蛋白(CRP)、IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平,记录2组患者术后发热持续时间、首次排气时间,住院时间以及术后并发症情况。结果加速康复组术后首次排气时间提前,术后发热持续时间及住院时间均较传统方法组短(P<0.05),2组患者术后并发症发生率差异无统计学意义(P>0.05);2组患者术后第1天TLC与术前1 d相比降低,而CRP与术前1 d相比增高,差异均有统计学意义(P<0.01)。术后第3天加速康复组CRP较传统方法组明显降低(P<0.05),IgG、IgM、IgA、CD3+、CD4+、CD8+和CD4+/CD8+水平均比传统方法组升高(P<0.05)。结论胃癌患者行加速康复外科理念治疗是安全有效的,且能减轻手术创伤对患者免疫功能的打击,促进患者康复。     

加速康复外科指导下腹腔镜结直肠癌根治术后营养指标的变化分析

目的:观察加速康复外科(fast track surgery,FTS)联合腹腔镜技术对结直肠癌根治术后患者营养指标的影响。方法:将92例结直肠癌患者随机分为3组,Ⅰ组(n=31)应用传统围手术期处理行开腹手术,Ⅱ组(n=31)在FTS理念指导下行开腹手术,Ⅲ组(n=30)在FTS理念指导下行腹腔镜手术。3组患者分别于术前、术后第3天、术后第7天抽取外周血测定C反应蛋白(CRP)、白蛋白(ALB)、前白蛋白(PRE)、转铁蛋白(TRF)、视黄醇结合蛋白(RbP)、血红蛋白(Hb)等。结果:3组患者术后第3天、第7天CRP较术前均明显升高(P<0.01),与Ⅱ组、Ⅲ组相比,Ⅰ组患者术后第3天、第7天CRP升高更明显(P<0.01),与Ⅲ组相比,Ⅱ组升高明显(P<0.05)。术后第3天3组患者ALB、PRE、TRF、RbP、Hb水平均较术前明显减低,与Ⅱ组、Ⅲ组相比,Ⅰ组减低更明显;与Ⅲ组相比,Ⅱ组PRE、TRF、Hb降低更明显(P<0.05)。术后第7天,Ⅰ组各项指标仍低于术前(P<0.05),较第3天升高(P<0.05);Ⅱ组各项指标较术后第3天有所升高(P<0.05),且较Ⅰ组升高明显(P<0.05);Ⅲ组患者PRE、TRF、Hb恢复至术前水平,其他指标较术后第3天升高明显(P<0.05)。结论:应用FTS理念行腹腔镜结直肠手术,可更有效缓解术后炎症反应,维持患者术后营养状态,对术后患者康复具有积极作用。     

快速康复外科对食管癌手术患者胰岛素抵抗指标的影响

目的探讨快速康复外科（FTS）方案对食管癌手术患者胰岛素抵抗指标的影响。方法选取2009年11月至2011年3月在我院胸外科行根治外科治疗的食管癌患者,采用信封法随机分为FTS组（n=34）和对照组（n=34）。记录两组患者术后肛门首次排气、排便时间,术后住院时间,住院总费用及手术并发症。于术前,术后第1、3、7天监测两组患者的胰岛素抵抗相关指标,包括空腹血糖（FBG）、空腹胰岛素（FINS）、白细胞介素-6（IL-6）和C反应蛋白（CRP）,计算胰岛素抵抗指数（HOMA-IR）。结果FTS组患者术后肛门首次排气时间[（1．91±1．13）d比（2．95±1．25）d,P=0．000]、排便时间[（3．75±1．54）d比（4．84±1．76）d,P=0．007]显著短于对照组,住院总费用显著低于对照组[（3．19±0．42）万元比（3．98±0．36）万元,P=0．000]。术前两组患者胰岛素抵抗的相关指标差异均无统计学意义（P均＞0．05）。术后第1天,FTS组患者log-HOMA-IR值[（0．97±0．52）比（1．54±O．57）,P=0．000]、FINS[（11．87±4．55）μU／ml比（17．16±6．90）μU／ml,P=0．000]、IL-6[（124．15±21．39）ng／L比（138．78±23．60）ng／L,P=0．009]和CRP[（62．92±14．78）mg／L比（71．07±14．51）mg／L,P=0．025]水平显著低于于对照组;术后第3天,FTS组患者log-HOMA-IR值[（0．86±0．47）比（1．27±0．58）,P=0．002]、FINS[（9．56±4．37）μU／ml比（14．91±6．54）μU／ml,P=0．000]、IL-6[（140．94±25．12）ng／L比（153．89±24．06）ng／L,P=0．035]和CRP[（138．59±21．61）mg／L比（153．17±25．20）mg／L,P=0．019]水平显著低于于对照组;术后第7天,vrs组患者CRP水平显著低于对照组[（53．074-15．84）mg／L比（61．59±16．28）mg／L,P=0．032]。结论FTS方案用于食管癌患者可促进早期胃肠道功能恢复,减轻应激反应,降低术后胰岛素抵抗,有效加速术后患者的康复,具有一定的可行性。     

快速康复理念下腹腔镜直结肠癌根治手术的手术配合

目的探讨快速康复理念腹腔镜直结肠癌根治手术的配合。方法选取我院肛肠外科学于2009年6月至2011年9月成功开展快速康复理念下腹腔镜直结肠癌根治手术45例,总结例快速康复理念腹腔镜直结肠癌根治手术的配合体会。结果手术顺利开展,无一例需术中改开腹,无一例病人发生术后应激反应。结论护士掌握手术的配合要求有助于减少术后应激反应及并发症的发生。     

自助爬楼轮椅的稳定性分析

目的:分析本研究设计的自助爬楼轮椅的稳定性。方法:计算链条极限拉伸载荷,针对轮椅容易在楼梯上倾翻这一问题,从两个角度着重分析轮椅的稳定性:①分析履带的长度和宽度对轮椅在爬楼梯时重心位置变化的影响。②分析轮椅在楼梯上的受力。结果:链条的极限拉伸载荷为201.6kN。轮椅爬楼时重心位置可前后移动260mm。左右最大倾角可达32°。轮椅爬楼时沿楼梯方向最小总反力大于重力沿楼梯方向向下的分力。结论:自助爬楼轮椅设计时采用的32A型滚子链条能够满足链条的抗拉载荷要求,链条的结构稳定可靠。爬楼时重心位置可前后移动260mm,左右最大倾角可达32°,足够保证轮椅爬楼时不发生侧翻。轮椅在楼梯上受楼梯的总反力大于重力沿楼梯向下的分力,能够保证轮椅不下滑,自助爬楼轮椅结构设计安全可靠。     

Viral pathogens among elderly people with acute respiratory infections in Shanghai,China: Preliminary results from a laboratory‐based surveillance, 2012‐2015

Acute respiratory infections (ARIs), with viral pathogens as the major contributors, are the most common illnesses worldwide, and increase the morbidity and mortality among the elderly population. The clinical and pathological features of elderly people with ARIs need to be identified for disease intervention. From January 1, 2012 through December 31, 2015, respiratory specimens from patients above 60 years old with ARIs were collected from the outpatient and inpatient settings of six sentinel hospitals in Pudong New Area. Each specimen was tested via multiplex polymerase chain reaction (PCR) for eight target viral etiologies including influenza, human rhinovirus (HRV), human para‐influenza virus (PIV), adenovirus (ADV), respiratory syncytial virus (RSV), human metapneumovirus (hMPV), human coronavirus (hCoVs), and human bocavirus (hBoV). A total of 967 elderly patients with ARIs were enrolled, including 589 (60.91%) males, and the median age was 73 years old. 306 (31.64%) patients were tested positive for any one of the eight viruses, including 276 single infections and 30 co‐infections. Influenza was the predominant virus (14.17%, 137/967), detected from 21.35% (76/356) of the outpatients and 9.98% (61/611) of the inpatients. Influenza infections presented two annual seasonal peaks during winter and summer. Compared with non‐influenza patients, those with influenza were more likely to have fever, cough, sore throat, and fatigue. This study identified influenza as the leading viral pathogen among elderly with ARIs, and two seasonal epidemic peaks were observed in Shanghai. An influenza vaccination strategy needs to be advocated for the elderly population.