全麻复合硬膜外在高龄患者腹腔镜直肠癌根治术中的应用

目的:研究全麻复合硬膜外在高龄患者腹腔镜直肠癌根治术中的应用效果。方法:选择60岁以上择期行腹腔镜直肠癌根治术患者60例,随机分为G组和GA组,每组各30例。G组患者为单纯全麻组,GA组患者为硬膜外复合全麻组。GA组患者在诱导前取L1~2硬膜外穿刺置管,予0.5%罗哌卡因5 ml,术中每小时追加5~7 ml。两组患者诱导方法相同:即,咪哒唑仑0.04 mg/kg、舒芬太尼0.3~0.4μg/kg、顺阿曲库铵0.15~0.20 mg/kg、依托咪酯0.2~0.3 mg/kg。监测并记录患者血压(BP),心率(HR),心电图(ECG),术中全麻药用量及术后患者苏醒情况。结果:GA组患者气腹后、拔管前BP、HR明显低于G组(P<0.05),且全麻药用量明显低于G组(P<0.05)。结论:全麻复合硬膜外应用于老年腹腔镜直肠癌手术较单纯全麻用药量减少,术中循环更加稳定,是腹腔镜直肠癌根治术比较安全可行的麻醉方法。     

Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease

Objective

The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.

Les bouchées enrichies adaptées,un outil à la portée des établissements sanitaires et médico-sociaux ainsi que des aidants familiaux : retour d’expérience

IntroductionFor many years, nutrition of the elderly is of a special attention. The food policies wants to value the regional initiatives that can be slowed down, and new techniques of adapted food are in development. Following a tracking of malnutrition in an establishment for dependent elderly, a program of nutritional improvement was set up. It was decided to transform the dishes of the daily menu into small enriched, mixed, prehensile mouthfuls, with for objective to use the remaining capacities of the patients, to adapt the care to their rhythm, to answer their expectations and their nutritional needs.MethodThe agents of texture of the mouthfuls were adapted. Their enrichment and their presentation were specified, as well as the modalities of distribution, in order to allow an easy access as well by the patients, the nursing and the families. Cooled cupboards were used.ResultsThe residents found again the pleasure to eat by themselves, their self-respect and consequently covered better their needs. A decrease of the malnutrition prevalence was observed. Times of exchange with other establishments and a formation were set up to share this tool. Levers were identified to develop this concept under good conditions.ConclusionThe adapted enriched mouthfuls tool seems to be useful. Its application is inseparable of a voluntary multidisciplinary approach, anchored in the knowledge of the accompanied person and in the analysis of her global situation. This tool is adaptable not only in any structure welcoming dependent, old people or not, but also at home.