11例糖尿病合并重型新冠肺炎患者的护理

回顾11例糖尿病合并重型新冠肺炎患者的护理经过与效果,3例因并发急性肾衰竭转重症监护室继续治疗,4例康复出院,4例由重型转为普通型.护理过程中重视病情观察、遵医服药,营养支持,肺康复训练和心理护理能减少并发症,提高糖尿病合并重型新冠肺炎治愈率.     

323例简化捆绑式胰肠吻合的临床疗效

目的 探讨简化捆绑式胰肠吻合的临床疗效.方法 回顾性分析2005年3月至2010年5月华中科技大学同济医学院附属同济医院实施根治性胰十二指肠切除术治疗323例壶腹部周围癌患者的临床资料.胰肠吻合均采用简化的捆绑式胰肠吻合:胰腺断端游离3～4 cm;将6号或8号硅胶导尿管插入胰管内4～5 cm,胰腺断端外硅胶管为6～8 cm,用可吸收缝线将其缝合固定在胰腺断端上;胰腺断端交锁缝合止血.将空肠断端外翻2～3 cm,电灼损伤黏膜1 cm;回复外翻空肠,在空肠断端的系膜及其对侧和两者的中点与胰腺的下缘、上缘及其之间的胰腺被膜各对称性地缝合1针;并将空肠套在胰腺断端后打结固定.在确定空肠完整地套在胰腺游离段上后,用1-0可吸收线将空肠断端捆绑在胰腺游离段上.消化道重建均采用Child法.结果 323例患者顺利完成了简化的捆绑式胰肠吻合;1例胰肠吻合口出血患者于缝扎出血点后第3天发生胰瘘,置管引流出院1个月后自行痊愈.2例胆总管下端癌和2例胰腺钩突部癌患者分别于术后3、6和8、11 d发生胰瘘,经引流等保守治疗后痊愈.胰瘘发生率为1.5%(5/323).结论 简化的捆绑式胰肠吻合简单易行、安全、可靠,可明显降低胰瘘的发生率.

Abstract：

Objective To investigate the methods and techniques of simplified binding pancreaticojejunostomy for patients with periampullary malignant tumor after radical pancreatoduodenectomy (RPD). Methods From March 2005 to May 2010, 323 patients with periampullary malignant tumor received RPD at the Tongji Hospital of Huazhong University of Science and Technology, and their clinical data were retrospectively analyzed.Simplified binding pancreaticojejunostomy was applied after RPD: the distal end of pancreas was freed for 3-4 cm;a No. 6 or No. 8 silicone urinary catheter was inserted into the pancreatic duct for 4-5 cm, and the remaining urinary catheter (6-8 cm) out of the pancreatic duct was sutured to the pancreatic stump with absorbable sutures.The cutting end of the jejunum (2-3 cm) was everted, and the everted mucosa of the jejunum ( 1 cm) was injured by electrocautery, then the everted jejunum was reverted to its normal position. The cutting end of the mesentery of jejunum and its opposite side, as well as the mid-point of these two parts were sutured symmetrically with the lower and upper edges of the pancreas, and with the capsule of pancreas between them. The everted jejunum was wrapped over the pancreatic stump and sutured it to the pancreas for fixation. The cutting end of the jejunum was bound to the pancreatic stump with 1-0 absorbable suture after confirming the jejunum was completely invaginated into the pancreas. The alimentary tract was reconstructed by using Child's method. Results Simplified binding pancreaticojejunostomy was successfully completed in all patients, Pancreatic fistula was detected in one patient who was complicated with anastomotic bleeding on the third day after secondary laparotomy. The patient was discharged with catheter and spontaneously recovered one month later. Pancreatic fistula was also detected in two patients with distal bile duct carcinoma and two patients with carcinoma in the uncinate process of pancreas at postoperative day 3, 6, 8 and 11, and they were cured by expectant treatment. The incidence of pancreatic fistula was 1.5% (5/323). Conclusion Simplified binding pancreaticojejunostomy is simple, safe and feasible, and it can significantly reduce the incidence of pancreatic fistula.     

323例简化捆绑式胰肠吻合的临床疗效

目的 探讨简化捆绑式胰肠吻合的临床疗效.方法 回顾性分析2005年3月至2010年5月华中科技大学同济医学院附属同济医院实施根治性胰十二指肠切除术治疗323例壶腹部周围癌患者的临床资料.胰肠吻合均采用简化的捆绑式胰肠吻合:胰腺断端游离3～4 cm;将6号或8号硅胶导尿管插入胰管内4～5 cm,胰腺断端外硅胶管为6～8 cm,用可吸收缝线将其缝合固定在胰腺断端上;胰腺断端交锁缝合止血.将空肠断端外翻2～3 cm,电灼损伤黏膜1 cm;回复外翻空肠,在空肠断端的系膜及其对侧和两者的中点与胰腺的下缘、上缘及其之间的胰腺被膜各对称性地缝合1针;并将空肠套在胰腺断端后打结固定.在确定空肠完整地套在胰腺游离段上后,用1-0可吸收线将空肠断端捆绑在胰腺游离段上.消化道重建均采用Child法.结果 323例患者顺利完成了简化的捆绑式胰肠吻合;1例胰肠吻合口出血患者于缝扎出血点后第3天发生胰瘘,置管引流出院1个月后自行痊愈.2例胆总管下端癌和2例胰腺钩突部癌患者分别于术后3、6和8、11 d发生胰瘘,经引流等保守治疗后痊愈.胰瘘发生率为1.5%(5/323).结论 简化的捆绑式胰肠吻合简单易行、安全、可靠,可明显降低胰瘘的发生率.     

格林模式在护理健康教育应用中的研究进展

综述格林模式的概念与发展情况、格林模式的特点、实施格林模式的注意事项及其在国内外护理工作的中应用效果,为相关工作者提供一定的帮助。提出将格林模式的应用与我国国情相结合,制订适合我国国民的健康教育模式是所有医学工作者未来的研究方向,此外格林模式与其他模式的结合应用也是护理人员今后可以深入探讨的课题。     

CBL联合线上教学平台在胆胰外科见习教学中的应用

目的 将病例教学法(case-based learning,CBL)与钉钉教学平台相结合,尝试构建新型胆胰外科见习医生教学模式.方法 将2019年1—12月在华中科技大学同济医学院附属同济医院胆胰外科见习的本科生60名作为教学对象,随机(随机数字表法)分为试验组(n=30)和对照组(n=30).试验组采用CBL联合钉钉...     

胆管癌合并肌少症患者术后营养及运动干预

目的 探讨营养及运动干预对胆管癌合并肌少症患者术后机体功能的影响。方法 将2018年收治的32例合并肌少症的胆管癌患者作为对照组,实施肝胆外科常规护理;2019年收治的32例同类患者作为干预组,给予每日补充优质蛋白联合运动干预。比较两组患者术后并发症发生率和住院时间,出院患者的握力、步速、骨骼肌量指数和ADL评分。结果 干预后,干预组术后腹腔感染发生率、住院时间、握力、步速、骨骼肌量指数和ADL评分显著优于对照组（P<0.05,P<0.01）。结论 营养及运动干预可改善胆管癌合并肌少症患者术后机体功能和日常生活能力,提高患者的生存质量。