快速康复外科理念在食管癌治疗中的应用

目的探讨快速康复外科理念在食管癌患者围手术期的应用及对患者的临床结局的影响。方法收集2011年1-6月间南京医科大学附属淮安第一医院胸外科接受食管癌根治术的食管鳞癌患者117例,其中4-6月63例（研究组）,围手术期采用快速康复外科理念进行处理：1～3月接受手术54例（对照组）,围手术期按常规处理。结果研究组术后排气时间、术后拔除胸腔引流管时间、术后住院时间及住院总费用均显著低于对照组（P〈O．05）：手术时间两组差异无统计学意义（P〉0．05）。研究组和对照组总并发症的发生率分别为7．9％（5／63）和24．1％（13／54）,差异有统计学意义（P〈0．05）。结论食管癌患者围手术期应用快速康复外科理念,可促进术后肠功能恢复．减少术后并发症发生率．从而改善患者的临床结局．     

快速康复外科护理新路径在痔疮患者围手术期的应用研究

目的：探讨快速康复外科护理新路径在痔疮患者围手术期的应用。方法：将2013年－2014年我科室收治的200例痔疮手术患者随机分为观察组与对照组,每组各100例患者,对观察组痔疮患者采用快速康复护理新路径进行护理,对照组采用传统常规护理方案进行护理,对两组护理方式的康复结果进行对比。结果：两组患者在愈合时间、首次排便时间、健康教育知晓率、患者满意度、术后并发症发生率等方面的差异具有统计学意义（ P ＜0．05）。结论：快速康复外科护理新路径在痔疮患者围手术期的应用可缩短伤口愈合时间、减少术后并发症,有利于患者康复,具有良好的社会效益。     

中西医结合快速康复外科在妇科腹腔镜围手术期的应用

【目的】观察中西医结合快速康复外科（FTS）在妇科腹腔镜围手术期的作用。【方法】将226例行腹腔镜手术患者随机分为试验组（即中西医结合FTS组）和对照组（即传统治疗组）各113例。观察2组术后首次肛门排气时间、下床活动时间、住院时间及术后并发症的发生率。【结果】试验组术后首次肛门排气时间和下床活动时间较对照组早,住院时间较对照组显著缩短（P＜0.05）;试验组术后并发症发生率为0.9%,显著低于对照组的4.4%（P＜0.05）。【结论】中西医结合快速康复外科治疗能促进肠蠕动,缩短肛门排气时间,有效地促进妇科腹腔镜术后胃肠功能的恢复,减少患者术后并发症,加快术后康复进程。     

Fast-track surgery in elderly patients undergoing colorectal cancer radical resection

PurposeTo investigate the efficacy of applying fast-track surgery (FTS) to elderly patients undergoing radical resection of colorectal cancer.MethodsElderly patients undergoing radical resection of colorectal cancer received FTS (n = 31) or routine (n = 31) nursing care. The time to first anal exhaust, oral feeding and leaving the bed, duration of postoperative hospital stay and the incidence of complications were compared between the two groups.ResultsPatients receiving FTS nursing demonstrated significantly shorter times to exhaust, oral feeding and leaving the bed compared with those receiving routine nursing (all p < 0.01). Furthermore, there were significantly fewer incidences of postoperative pulmonary and urinary tract infections and intestinal adhesion in patients receiving FTS nursing (all p < 0.05).ConclusionApplication of FTS in elderly patients undergoing radical resection of colorectal cancer facilitates an early rehabilitation after surgery, but places higher demands on nursing care.     

快速康复外科护理对胸腔镜肺段切除术患者术后恢复与护理满意度的影响分析

目的 探讨快速康复外科（FTS）护理对胸腔镜肺段切除术患者术后恢复的影响。方法于2016年1月—2017年1月,选取复旦大学附属华山医院胸外科拟行胸腔镜肺段切除手术的患者126例为研究对象。采用随机数表法分为观察组（n=63）和对照组（n=63）。对照组采用传统的胸外科围手术期护理,观察组患者在围手术期给予FTS护理,比较两组患者术后恢复指标、并发症发生率、术后7d的世界卫生组织生存质量测定简表（WHOQOL-BREF）评分以及出院时患者的护理满意度。结果 观察组术后胸腔引流管放置时间、首次排便时间、术后住院天数与并发症的总发生率显著低于对照组,差异具有统计学意义（P＜0.05）。观察组术后7d WHOQOL-BREF量表的生理、心理、社会关系领域评分及总分显著高于对照组,护理满意度显著优于对照组,差异具有统计学意义（P＜0.05）。结论 FTS护理在胸腔镜肺段切除术的围手术期中的应用效果令人满意,能显著促进术后康复,减少术后并发症的发生风险,提高术后生活质量与护理满意度,值得临床推广应用。     

加速康复外科理念在腹腔镜直肠癌根治术围手术期的应用价值

目的:探讨加速康复外科理念在腹腔镜直肠癌根治术围手术期的应用价值.方法:2009年1月至2010年12月为30例腹腔镜直肠癌根治术患者施行加速康复外科(fast track surgery,FrS)处理,以同期30例未行FTN的患者为对照组,观察两组患者手术前后体重与电解质的变化、营养状况、术后排气时间、排便时间、首次...     

Rol de enfermería en los programas de recuperación intensificada (fast-track)

Rapid recovery (RR) or fast-track programmes are aimed at reducing surgical stress, leading to a reduction in nurse workload, costs and hospital stay, greater patient empowerment, early post-surgical recovery and reduced morbidity and mortality. These new protocols require the coordinated participation of a multidisciplinary team.Based on an integrative review of the literature, this paper aims to define the concept of a RR or fast track programme and show the existing evidence on the implementation of these programmes in nursing.The benefits and low incidence of damage of RR programmes in nursing justify their implementation. The programmes require greater support and diffusion in order to develop, as well as more research to increase the evidence on the effectiveness and efficiency of the protocols.     

A cohort study of results following elective colonic and rectal resection within an enhanced recovery programme

Objective  The use of laparoscopic surgery coupled with an enhanced recovery programme (ERP) has resulted in hospital stays of 4 or less days for colonic and 6 days following rectal resection, in previously reported small selected groups of patients. This report analyses an unselected cohort to determine if such benefits are reproducible.
Method   Consecutive patients undergoing elective colonic or rectal surgery at a single centre between January 2002 and January 2006 were followed. All were included in the ERP and underwent either laparoscopic or open surgery.
Results   The study group comprised 241 patients (mean age of 67 ± standard deviation 14 years and 49% male sex distribution) who underwent elective colorectal resection within the context of an ERP. One hundred and fifty-one (62.7%) patients had malignant disease. Overall, 191 (79.3%) patients underwent a laparoscopic procedure and the remaining underwent an open operation. Postoperative stay was shorter in patients undergoing laparoscopic vs open, colonic surgery (4 days vs 6 days, P  = 0.002). A nonsignificant trend towards reduced postoperative stay was observed for patients undergoing laparoscopic vs open, rectal surgery (6 days vs 9 days, P  = 0.088). Patients undergoing laparoscopic colectomy demonstrated significantly lower 30-day mortality rates than those undergoing traditional colectomy (3/131 vs 3/39, P  = 0.049).
Conclusion  Laparoscopic colonic surgery in the context of an ERP offers reduced hospital stay and may confer a survival advantage over traditional techniques. These results confirm that previously reported benefits of laparoscopic surgery are reproducible within an unselected population.     

Advanced Gynecologic Laparoscopy in a Fast-Track Ambulatory Surgery Center

Background/Objectives:

It has been shown that major gynecologic laparoscopy is safe in hospital ambulatory settings, but there is little data to suggest the same in freestanding ambulatory surgery centers. This study evaluates the safety and efficacy of advanced gynecologic laparoscopic surgery using a fast-track model in freestanding ambulatory surgery centers and discusses our institution protocols.

Methods:

Retrospective, multicenter review was conducted of major gynecologic surgeries from August 1^st 2010 to September 30^th 2011 in 3 surgical centers with one primary surgeon. All patients were treated for symptomatic uterine leiomyomas and/or endometriosis. Primary outcome measures were unplanned admissions and discharge within 23 hours.

Results:

One hundred and thirty-four patients underwent major laparoscopic gynecologic surgery with a total of 160 procedures: 77 stage IV endometriosis treatment including 7 disk excisions of endometriosis from the large bowel, 3 ureteroneocystostomies and 1 partial bladder resection, 38 myomectomies, and 34 hysterectomies including 12 modified radical hysterectomies. The overall unplanned admission rate was 4.5%. One hundred and thirty-one patients (97.7%) were discharged within 24 hours after surgery. Three patients (2.2%) were transferred to the hospital postoperatively: 1 patient for observation of postoperative anemia and 2 patients for postoperative fever. Three patients (2.2%) were admitted to the hospital after discharge: 1 patient for postoperative ileus, 1 patient for postoperative fever, and 1 patient with septic pelvic thrombophlebitis. These postoperative issues all resolved without complication, and all patients had an uneventful follow-up.

Conclusions:

With appropriate resources and an experienced surgeon, advanced laparoscopic surgery can be safely performed in a fast-track ambulatory surgery center with a high rate of discharge within 23 hours and low unplanned readmission rate.     

微创食管癌术后不留置胃肠减压管的安全性和可行性研究

目的：探讨微创食管癌根治术后不常规留置胃肠减压管的安全性和可行性。方法回顾性分析安徽医科大学第一附属医院普胸外科同一治疗组医师自2012年1月至2013年5月期间完成的90例胸腹腔镜联合食管癌根治术患者的临床资料,其中留置和未留置胃管患者各45例。对比两组患者的术后排气时间、恢复流质饮食时间、术后住院时间、胃管重置情况及术后并发症情况。结果与留置胃管组相比,未留置胃管组患者咽痛的发生率明显降低[44．4％（20/45）比100％（45/45）,P＜0．01],恢复流质饮食时间（中位2 d比9 d）、术后排气时间（中位3 d比6 d）及术后住院时间（中位7 d比12 d）均明显缩短（均P＜0．01）;而两组术后呕吐情况、并发症发生率及围手术期死亡率的差异均无统计学意义（均P＞0．05）。结论微创食管癌术后不常规留置胃肠减压管是安全的,可加快术后肠功能恢复,缩短术后住院时间。