中西医结合疗法改善低位直肠癌完全经肛门括约肌间切除术后患者肛门功能的临床研究

目的:探讨中西医结合疗法在加速低位直肠癌完全经肛门括约肌间切除术(ISR)切除术后肛门功能恢复中的作用。方法:回顾性分析2016年1月—2019年1月大连大学附属中山医院胃肠外科收治的43例低位直肠癌接受完全ISR切除手术患者的临床资料,对照组21例,治疗组22例。所有患者严格遵守直肠全系膜切除术(TME)原则行完全ISR手术。对照组术后予生活方式干预(戒烟、运动)、饮食因素调整、提肛运动,口服洛哌丁胺治疗;治疗组在对照组的基础上,增加针刺治疗、口服中药汤剂及中药坐浴治疗。采用Williams标准及Wexner评分系统评估术后肛门功能恢复情况。动态跟踪观察随访两组患者肛门功能至术后12个月。结果:Williams肛门功能评估:治疗组患者术后3个月的肛门功能良好率均优于对照组,差异有统计学意义(P=0.044),术后1、6、12个月时差异无统计学意义(P>0.05)。肛门失禁Wexner评分:治疗组患者术后1、3、6个月肛门失禁Wexner评分明显低于对照组,差异有统计学意义(P<0.05),术后12个月,两组差异无统计学意义(P>0.05)。结论:中西医结合疗法能够加速低位直肠癌完全ISR切除患者术后肛门功能的恢复,降低术后肛门失禁发生率,在前期(术后3~6个月)时效果显著。     

中医活血补骨汤用于骨质疏松性肱骨近端骨折患者临床价值研究

目的:探讨骨质疏松性肱骨近端骨折术,给予患者中医活血补骨汤+阿仑膦酸钠治疗对患者术后康复效果产生的影响。方法:选取2019年1月—2020年1月本院收治66例骨质疏松性肱骨近端骨折患者通过随机数字表分作两组。对照组(33例)术后给予阿仑膦酸钠片进行治疗,观察组(33例)给予阿仑膦酸钠片+活血补骨汤治疗。观察患者治疗后病情恢复时间、疼痛程度、肩关节功能恢复及骨代谢改善情况及并发症发生情况。结果:治疗后与对照组相比,观察肿胀消退、住院天数及骨痂出现、骨折愈合天数均显著更短(t=6.153、5.861、14.163、17.958,均P0.05);对比对照组,治疗后1、3、6、12个月观察组NPIS评分均显著更低(t=4.335、10.673、21.542、30.315,均P0.05);治疗后观察组肩关节功能恢复优良率为93.94%(31/33),相比对照组的75.76%(25/33)显著更高,并发症总发生率为3.03%(1/33),相比对照组的18.18%(6/33)显著更低(χ~2=4.243、3.995,均P0.05);治疗后相比对照组,观察组PTH、BALP、β-CTX水平均显著更低,OC则显著更高(t=9.897、3.858、8.942、26.732,均P0.05)。结论:骨质疏松性肱骨近端骨折患者接受术后治疗后再使用阿仑膦酸钠+活血补骨汤进行辅助治疗,术后恢复速度更快,减轻患者术后疼痛,提高肩关节功能恢复效果,促进患者骨代谢获得良好改善,减少术后并发症,有助于患者术后获得更理想总体康复效果。     

加味薏苡附子败酱散对复杂性肛瘘患者术后的疗效观察

目的:探讨加味薏苡附子败酱散联合常规换药在复杂性肛瘘术后患者中的疗效观察及对视觉模拟疼痛(VAS)评分的影响。方法:选择复杂性肛瘘患者106例作为对象,电脑抽取随机数法分为两组,各53例。两组均采用手术治疗,对照组术后常规换药干预,观察组在对照组基础上联合加味薏苡附子败酱散干预,术后14 d对患者效果进行评估,并完成6个月随访,比较两组术后肛门功能、VAS评分、术后创面愈合评分及术后并发症、复发率。结果:观察组术后14 d排便干燥(0.68±0.14)分、不自主气体(0.70±0.16)分、需要衬垫(0.69±0.15)分、生活方式(0.72±0.18)分及稀便评分(0.63±0.12)分均低于对照组[排便干燥(1.69±0.45)分、不自主气体(2.10±0.46)分、需要衬垫(1.84±0.42)分、生活方式(1.67±0.36)分及稀便评分(2.16±0.39)分,差异有统计学意义(t=7.591、5.434、6.316、6.019、5.693,P0.001);观察组手术后14 d VAS评分(1.15±0.32)分、渗液(0.56±0.09)分及肉芽生长评分(1.72±0.16)分均低于对照组[VAS评分(3.24±0.41)分、渗液(1.69±0.11)分及肉芽生长评分(2.15±0.23)分],差异有统计学意义(t=7.493、5.671、6.434,P0.001);两组术后尿潴留、切口感染及肛门失禁发生率、术后1、3个月复发率差异均无统计意义(χ~2=0.343、1.101、1.039、1.101、0.343,P=0.558、0.315、0.308、0.315、0.558);观察组术后6个月复发率低于对照组(χ~2=4.970,P=0.026)。结论:加味薏苡附子败酱散联合常规换药用于复杂性肛瘘术后患者能提高患者肛门功能,减轻疼痛,能促进创面愈合,可降低术后复发率,且未增加手术并发症发生率。     

中医外治技术联合快速康复外科理念对肝胆外科术后患者的临床疗效

目的:探讨中医外治技术联合快速康复外科(ERAS)理念促进肝胆外科患者康复的临床疗效。方法:选择于2018 年8 月—2020 年10 月在我科行腹腔镜手术的患者308 例,随机分为外治组156 例,对照组152 例。对照组行腹腔镜手术+ERAS 理念,外治组在前者基础上加用中医外治技术,比较两组患者在术后肠鸣音恢复、肛门首次排气及排便时间、疼痛评分、住院天数、相关并发症等方面的差异。结果:外治组术后肠鸣音恢复、肛门首次排气排便时间均短于对照组(P <0.05),术后疼痛评分低于对照组(P <0.05),行肝脏手术及胰腺手术患者的住院时间均短于对照组(P <0.05)。但两组相关并发症发生率差异无统计学意义(P <0.05)。结论:中医外治技术联合ERAS 理念在肝胆外科围手术期的应用能减轻术后患者的疼痛,促进胃肠道功能的恢复,缩短住院时间,值得临床推广应用。     

快速康复外科理念在股骨粗隆间骨折患者中应用观察

目的 探讨加速康复外科（ERAS）对股骨近端抗旋髓内钉（PFNA）固定的粗隆间骨折患者的影响。方法 回顾性研究纳入100例粗隆间骨折患者,分为ERAS组（50例）和对照组（50例）,记录两组的住院天数、Harris髋关节评分（HHS）、视觉模拟量表（VAS）、日常生活活动量表（ADL）。结果 ERAS 手术与较短的住院时间、较低的术后VAS评分、较早的活动和术后3个月的平均HHS评分显著改善相关,平均住院时间从6.3±2.8减少到4.9±2.6天。结论 股骨粗隆间骨折患者围手术期接受ERAS处理能够减少住院时间而不增加术后并发症和再入院率。     

Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019

BackgroundSevere acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) are closely related. The effect of AKI on the clinical outcomes of these two conditions is unclear.MethodsThis retrospective, territory-wide cohort study used an electronic public healthcare database in Hong Kong to identify patients with SARS or COVID-19 by diagnosis codes, virologic results, or both. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death.ResultsWe identified 1670 patients with SARS and 1040 patients with COVID-19 (median ages, 41 versus 35 years, respectively). Among patients with SARS, 26% met the primary endpoint versus 5.3% of those with COVID-19. Diabetes mellitus, abnormal liver function, and AKI were factors significantly associated with the primary endpoint among patients with either SARS or COVID-19. Among patients with SARS, 7.9%, 2.1%, and 3.7% developed stage 1, stage 2, and stage 3 AKI, respectively; among those with COVID-19, 6.6%, 0.4%, and 1.1% developed stage 1, stage 2, and stage 3 AKI, respectively. In both groups, factors significantly associated with AKI included diabetes mellitus and hypertension. Among patients with AKI, those with COVID-19 had a lower rate of major adverse clinical outcomes versus patients with SARS. Renal function recovery usually occurred within 30 days after an initial AKI event.ConclusionsAKI rates were higher among patients with SARS than those with COVID-19. AKI was associated with major adverse clinical outcomes for both diseases. Patients with diabetes mellitus and abnormal liver function were also at risk of developing severe consequences after SARS and COVID-19 infection.     

The Effect of Minimally Invasive Thoracoscopic Left Atrial Appendage Excision on Cardiac Dynamic and Endocrine Function

Purpose: Left atrial appendage (LAA) isolation is an effective surgical treatment for decreasing thromboembolic risk. We sought to evaluate the short-term effect of minimally invasive surgery with LAA excision on left atrial dynamic and endocrine function in atrial fibrillation (AF) patients.Methods: A total of 52 patients with paroxysmal AF undergoing minimally invasive surgery with LAA excision in Anzhen Hospital from October 2012 to June 2014 were enrolled in the study. The natriuretic peptide plasma level was determined by enzyme-linked immunosorbent assay (ELISA), and left atrial dynamic function was measured preprocedure by real-time three-dimensional echocardiography and postprocedure after 7 days and 3 months.Results: With the exception of six recurrences, 88.5% (46/52) of the patients were prospectively followed over 3 months in terms of their sinus rhythm postprocedure. No severe operative complications or embolism events occurred within those 3 months. Echocardiography showed a 3–6% decrease in left atrial volume postprocedure, and dynamic function was largely restored by 3 months. There was no significant change in natriuretic peptide levels, although a slight decrease was detected 7 days postprocedure, which gradually recovered by 3 months (P = 0.350).Conclusions: There are no significant differences in left atrial dynamics and natriuretic peptide secretion in AF patients after minimally invasive surgery with LAA excision.     

Principles of preoperative assessment and enhanced recovery optimization for thoracic anaesthesia

A comprehensive preoperative assessment is imperative for patients undergoing lung surgery, ideally by way of a multidisciplinary team approach. This not only allows for clinicians to risk stratify patients and gain informed consent, but also to explore avenues in optimizing patients prior to surgery and plan for the delivery of the most appropriate postoperative care. A tripartite risk assessment combining risks of operative mortality, perioperative adverse cardiac events and postoperative dyspnoea should be assessed and discussed with patients. Those patients who continue towards surgical management may then be optimized with patient education addressing nutritional status, smoking cessation and alcohol dependency as well as the management of anaemia and physiological prehabilitation. This article aims to review existing guidelines for preoperative assessment in thoracic surgery as well as the latest preoperative guidance for enhanced recovery specific to thoracic surgery.     

Laboratory tests of renal function

The kidneys are vital organs in the management of fluid balance, waste product removal, electrolyte homeostasis, acid–base balance and endocrine function. Waste products removed by the kidney are urea, uric acid and creatinine; other foreign products with similar physiochemical properties are also excreted. Urea and uric acid are by products of protein metabolism and creatinine is generated by the metabolism of creatine compounds from muscle. The kidney regulates fluid and electrolyte balance through controlling the composition and volume of urine. In the proximal convoluted tubule and the loop of Henle, 90% of sodium, potassium, calcium and magnesium are reabsorbed. Acid–base balance is achieved by regulating the excretion of hydrogen ions and bicarbonate buffering. The kidney also has a number of endocrine functions including the production of renin and erythropoietin as well as hydroxylation of vitamin D. The kidneys receive 25% of cardiac output, generating 170–200 litres of ultrafiltrate per day. Urine output is approximately 1.5 litres per day, which is concentrated ultrafiltrate through selective reabsorption of solutes and water. In this article we will discuss tests frequently used to assess renal function.