Colonic Surgery With Accelerated Rehabilitation or Conventional Care

BACKGROUND For patients undergoing colonic surgery, the postoperative hospital stay is usually 6 to 10 days, and the morbidity rate is 15 to 20 percent. Fast-track rehabilitation programs have reduced the hospital stay to 2 to 3 days. The aim of this study was to evaluate the postoperative outcome after colonic resection with conventional care compared with fast-track multimodal rehabilitation.METHODS One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal, fast-track rehabilitation (group 2) in another hospital. Outcomes were time to first defecation after surgery, postoperative hospital stay, and morbidity during the first postoperative month.RESULTS Median age was 74 years (group 1) and 72 years (group 2). American Society of Anesthesiologists (ASA) score was significantly higher in group 2 (P < 0.05). Defecation occurred on day 4.5 in group 1 and day 2 in group 2 (P < 0.05). Median hospital stay was 8 days in group 1 and 2 days in group 2 (P < 0.05). The use of a nasogastric tube was longer in group 1 (P < 0.05). The overall complication rate (35 patients) was lower in group 2 (P < 0.05), especially cardiopulmonary complications (5 patients; P < 0.01). Readmission was necessary in 12 percent of cases for group 1 and 20 percent in group 2 (P > 0.05).CONCLUSIONS Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast-track multimodal rehabilitation.Reprints are not available.     

地震期间“双轨制”模式对非地震患者急诊滞留时间的影响

急诊室患者的滞留及由此导致的过度拥挤已经成为国内外医院面临的共同难题〔1-3〕。2013-04-20,四川雅安芦山的7.0级地震使成千上万人的生命受到严重伤害。突发事件对医院的影响主要包括两方面：一方面是医疗工作的正常运行被干扰,另一方面是患者的医疗需求剧增〔4〕。     

在加速康复外科理念指导下的腹腔镜胃癌根治术

目的: 重点观察在加速康复外科(FTS)新理念指导下行腹腔镜胃癌根治术的安全性和有效性. 方法: 将90例择期胃癌手术病人分为三组,每组30例.A组采取传统的围手术期处理方法;B组应用FTS理念行剖腹手术;C组应用FTS理念行腹腔镜手术.比较三组病人手术时间、出血量、淋巴结清扫数量、术后开始下床时间、肠功能恢复时间、术后住院时间、并发症和住院费用等. 结果: C组与A组和B组比,病人术中出血量明显减少(P<0.01),但手术时间明显延长(P<0.01),治疗费用显著增加(P<0.01).三组间淋巴结清扫数量无显著性差异.C组与A组相比,病人术后肠功能恢复时间显著提前(P<0.01),术后住院时间明显缩短(P<0.01).C组与B组病人肠功能恢复时间和术后住院时间无明显差异(P>0.05). 结论: 在FTS理念指导下应用腹腔镜行胃癌手术,可缩短术后住院时间,加快肠功能恢复.但与FTS剖腹手术相比,优势并不十分明显.     

C-reactive protein as a marker of serious bacterial infections in hospitalized febrile infants

Objective:  To determine the potential predictive power of C-reactive protein (CRP) as a marker of serious bacterial infection (SBI) in hospitalized febrile infants aged ≤3 months.
Patients and Methods:  Data on blood CRP levels were collected prospectively on admission for all infants aged ≤3 months who were hospitalized for fever from 2005 to 2008. The patients were divided into two groups by the presence or absence of findings of SBI.
Results:  A total of 892 infants met the inclusion criteria, of whom 102 had a SBI. Mean CRP level was significantly higher in the infants who had a bacterial infection than in those who did not (5.3 ± 6.3 mg/dL vs. 1.3 ± 2.2 mg/dL, p < 0.001). The area under the ROC curve (AUC) was 0.74 (95% CI: 0.67–0.80) for CRP compared to 0.70 (95% CI: 0.64–0.76) for white blood cell (WBC) count. When analyses were limited to predicting bacteremia or meningitis only, the AUCs for CRP and WBC were 0.81 (95% CI: 0.66–0.96) and 0.63 (95% CI: 0.42–0.83), respectively.
Conclusion:  C-reactive protein is a valuable laboratory test in the assessment of febrile infants aged ≤3 months old and may serve as a better diagnostic marker of SBI than total WBC count.     

加速康复外科对乳腺癌改良根治术患者应激及炎症反应的影响

目的 探讨快速康复外科对乳腺癌改良根治术患者术后应激及炎症反应的影响。方法 将99例择期行乳腺癌改良根治术的患者随机分为快速康复外科组(FTS)和对照组,采用放射免疫法检测上述患者术前、术后12h、24h及48h血清肾素、血管紧张素Ⅱ、醛固酮、皮质醇、IL-6、IL-8和TNF-α的浓度,比较二组患者手术时间、术中出血量、住院天数、术后皮下积液、皮瓣坏死及上肢血肿发生率的差异。结果 FTS组及对照组术前及术后48h血清肾素、血管紧张素Ⅱ、醛固酮、皮质醇、IL-6、IL-8和TNF-α的浓度差异无统计学意义(P＞0.05)。FTS组术后12h及24h血清肾素、血管紧张素Ⅱ、醛固酮、皮质醇、IL-6、IL-8及TNF-α的浓度较对照组降低,差异具有统计学意义(P＜0.05)。术中出血量在FTS组及对照组分别为(156.98±17.09)mL和(158.57±16.92)mL,差异无统计学意义(P＞0.05)。上肢水肿、皮下积液及皮瓣坏死发生率在FTS组及对照组无差异(P＞0.05)。FST组及对照组的平均住院天数分别为(8.37±1.89)d和(10.37±2.05)d,差异具有统计学意义(P＜0.05)。结论 快速康复外科可有效减轻乳腺癌改良根治术患者的应激及炎症反应,明显加速术后康复进程,在乳腺癌改良根治术中的应用是安全可行的。     

Impact of centralization of pancreaticoduodenec-tomy coupled with fast track recovery protocol:a comparative study from India

BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduodenectomy(PD) from an individual unit during transit from low to a high volume center.METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received conventional surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postoperative recovery, length of hospital stay and patient readmission requirement.RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally(7.8 vs 12.1 days). The intraoperative events like operative blood loss(417.9±83.8 vs 997.4 ±151.8 mL, P0.001), blood transfused(a median of 0 vs 1 unit, P0.001) and operative time taken(125 vs 245 minutes, P0.001) were significantly lower in the fast track group. The frequency of pancreatic fistula(4.9% vs 13.0%) and delayed gastric emptying(7.0% vs 17.4%) was also significantly reduced with fast track treatment. Nevertheless, the readmission rate(11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol.CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneficial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and significantly shortens their length of hospital stay.     

卒中绿色通道溶栓救治急性脑梗死的效果评估

目的探讨卒中绿色通道对急性脑梗死患者进行溶栓的效果。方法回顾性分析自2006年实施急诊绿色通道以来新疆自治区人民医院神经内科对急性脑梗死患者进行溶栓治疗的情况。结果发病时间小于6h的39例患者,进行动脉溶栓15例,静脉溶栓24例。其中36例痊愈或好转,3例死亡。结论卒中绿色通道的建立可以缩短急性脑梗死患者在诊断、治疗过程中的时间,使脑梗死患者得到更及时的救治。     

快速康复外科理念在右半结肠切除术中的应用与评估

 目的 探索快速康复的理念在右半结肠切除术中的应用,评估其康复效果.方法 行右半结肠切除术患者30例,被随机分为快速康复组15例、传统方法对照组15例.术后14 d对患者进行随访调查,比较其康复指标(胃肠道恢复情况、营养状况、并发症、住院费用、住院时间)的差异.结果 与对照组比较,快速康复组的胃肠道恢复时间缩短、营养状况改善、住院时间缩短、费用降低,不良反应和并发症发生率差异无统计学意义.结论 右半结肠切除术采用快速康复的理念进行治疗安全可行,可以在不增加不良反应及并发症的情况下加快患者的康复、降低花费和住院时间.     

手术器械跟踪管理系统的临床应用

手术器械跟踪管理系统通过对每件器械、每个环节及其人员行为进行编码、扫描等,完成对手术器械的申领、发放、使用、清洁、消毒灭菌处理全过程的数字化跟踪管理,是信息系统与条形码技术在手术器械供应链中的成功应用,是做好手术器械管理的重要保障。