全麻手术前不同时间留置尿管对患者术后尿管耐受性的影响

目的 探讨全麻手术术前不同时间留置尿管对患者术后尿管耐受性的影响.方法 将307例全麻开胸手术患者随机分成A组(102例)、B组(104例)、C组(101例),分别在病室(A组)、手术室全麻诱导前(B组)、手术室全麻诱导后(C组)留置尿管,观察置管时及术后(拔除气管导管时,术后3 h,术后6 h)4个时段患者对尿管的耐受情况.结果 置管时,C组尿管耐受率100%,显著优于B组(59.61%)和A组(23.53%),而B组耐受率显著优于A组(均P＜0.01).术后,C组拔除气管导管时、术后3 h尿管耐受率与A、B组比较,差异有显著性意义(P＜0.05,P＜0.01),而A、B组比较,差异无显著性意义(均P＞0.05);术后6 h,3组间比较,差异无显著性意义(均P＞0.05).结论 麻醉诱导前留置尿管,患者不适反应轻,术后苏醒期对尿管的耐受性好,是术前留置尿管的最佳时机.     

男性昏迷病人拔除尿管时机的探讨

将200例留置导尿的男性昏迷病人随机分成A、B、C、D四组,各50例。A组在夹闭尿管2～3 h或进行膀胱冲洗有溢尿并在膀胱充盈时拔管;B组同A组,但在膀胱不充盈时拔管;C组在病情稳定但无溢尿时拔尿管;D纽拔管时机与A组相同,但同时使用冬眠合剂(氯丙嗪、异丙嗪及哌替啶)。结果A组病人拔管后顺利排尿率较高,与B、C、D组比较,差异有显著性意义(P<0.05,P<0.01);且留置尿管时间较短。提示男性昏迷留置导尿病人在膀胱充盈且有溢尿时是拔管的最佳时机。     

护患纠纷后护理人员心理状况调查分析

目的 探讨全麻手术术前不同时间留置尿管对患者术后尿管耐受性的影响。方法 将307例全麻开胸手术患者随机分成A组（102例）、B组（104例）、C组（101例），分别在病室（A组）、手术室全麻诱导前（B组）、手术室全麻诱导后（C组）留置尿管，观察置管时及术后（拔除气管导管时，术后3h，术后6h）4个时段患者对尿管的耐受情况。结果 置管时，C组尿管耐受率100％，显著优于B组（59．61％）和A组（23．53％），而B组耐受率显著优于A组（均P〈0．01）。术后，C组拔除气管导管时、术后3h尿管耐受率与A、B组比较，差异有显著性意义（P〈0．05，P〈0．01），而A、B组比较，差异无显著性意义（均P〉0．05）；术后6h，3组间比较，差异无显著性意义（均P〉0．05）。结论 麻醉诱导前留置尿管，患者不适反应轻，术后苏醒期对尿管的耐受性好，是术前留置尿管的最佳时机。     

成年男性全麻患者术前不同时机留置尿管疼痛等级的观察

目的观察成年男性全麻患者术前不同时机留置尿管的疼痛等级,探讨其留置尿管的最佳时机。方法采用随机数字表将189例全麻胸腰椎手术患者随机分成A组(63例)、B组(62例)、C组(64例),分别在进入手术室后即刻(A组)、手术室静脉给镇静药后麻醉诱导前(B组)、手术室全麻成功后手术开刀前(C组)留置尿管,观察留置尿管时及术后(患者苏醒期、术后3 h和术后6 h)4个时段成年男性患者全麻后留置尿管疼痛情况。结果置管时,C组尿管无痛率100%,显著优于B组(27.4%)和A组(12.7%),而B组无痛率显著优于A组(P0.01)。术后苏醒期,C组尿管无痛率(6.3%)与B组(48.4%)、A组(19.1%)比较,差异有统计学意义(P0.01),而A、B组比较,B组无痛率显著优于A组,差异有统计学意义(P0.05);术后3 h,C组尿管无痛率与A、B组比较,差异有统计学意义(P0.01),而A、B组比较,差异无统计学意义(P0.05);术后6 h,3组间比较,差异无统计学意义(P0.05)。结论成年男性全麻患者于手术室静脉给镇静药后及麻醉诱导前留置尿管是术前留置尿管的最佳时机,值得推广。     

探讨小儿体外术后拔尿管时机对排尿的影响

目的:比较小儿体外术后两个不同时间段拔尿管对排尿困难的程度、发生次数及持续时间的影响。方法:对符合实验条件的病人随机分为先拔尿管组(A组)和后拔尿管组(B组) ,观察其尿道刺激症状消失时间和排尿困难程度。结果:发现用速尿前拔尿管组(既A组)明显优于用速尿等排尿后再拔尿管组(既B组)。结论:小儿体外术后用速尿前拔尿管可缩短尿道刺激症状持续时间,减轻排尿困难程度。     

男性脑膜瘤患者麻醉前留置尿管时机的选择

目的 探讨男性脑膜瘤患者术前留置尿管的最佳时机,以提高其开颅术后对留置尿管的耐受性.方法 将102例男性脑膜瘤手术患者随机分为对照组和观察组各51例.对照组全麻前15 min留置导尿管,观察组全麻前2 h留置导尿管.观察两组患者术后对尿管的耐受性及麻醉前、术后24 h平均血压、心率变化.结果 观察组术后尿管耐受程度显著优于对照组(P＜0.01);观察组术后24 h平均血压、心率无显著变化(均P＞0.05);对照组术后24 h平均血压、心率显著高于麻醉前及观察组(均P＜0.01).结论 男性脑膜瘤手术患者麻醉前2 h留置导尿管,可有效减轻患者的不适,降低术后血压、心率波动,有利于患者安全地渡过术后出血期和水肿期.     

男性脑膜瘤患者麻醉前留置尿管时机的选择

目的探讨男性脑膜瘤患者术前留置尿管的最佳时机,以提高其开颅术后对留置尿管的耐受性。方法将102例男性脑膜瘤手术患者随机分为对照组和观察组各51例。对照组全麻前15min留置导尿管,观察组全麻前2h留置导尿管。观察两组患者术后对尿管的耐受性及麻醉前、术后24h平均血压、心率变化。结果观察组术后尿管耐受程度显著优于对照组（P〈0.01）;观察组术后24h平均血压、心率无显著变化（均P〉0.05）;对照组术后24h平均血压、心率显著高于麻醉前及观察组（均P〈0.01）。结论男性脑膜瘤手术患者麻醉前2h留置导尿管,可有效减轻患者的不适,降低术后血压、心率波动,有利于患者安全地渡过术后出血期和水肿期。     

长时间留置尿管拔管时注入药物对排尿的影响

目的 探讨长时间留置尿管患者拔尿管时注入药物对排尿功能的影响.方法 将84例长时间留置尿管患者按入院时间分组,单号分为常规组(40例),双号为注药组(44例).常规组患者拔尿管时按常规操作拔除尿管;注药组拔尿管前注入甲泼尼龙、利多卡因、丁胺卡那.比较两组患者拔尿管后第1次排尿时尿痛、排尿困难及排尿障碍发生率.结果 拔尿管后两组第1次排尿时尿痛、排尿困难及排尿障碍发生率比较,差异有显著性意义(P<0.05,P<0.01).结论 长时间留置尿管患者拔管时注入甲泼尼龙、利多卡因、丁胺卡那能改善拔管后排尿自觉症状,减轻患者痛苦.     

截瘫病人留置尿管及膀胱训练的护理体会

目的 :截瘫病人大部分对排尿无感觉 ,进行膀胱训练后能自主排尿。方法 :通过对 6 0例截瘫病人心理护理、置管护理、膀胱功能训练等环节的观察 ,并与既往 32例病人比较 ,对比两组病人膀胱训练的情况。结果 :训练自主膀胱的成功率两组无显著性差异 ,治疗组尿路感染率降低 ,与对照组比较 (P <0 .0 5) ;治疗组留置尿管的时间比对照组明显缩短 (P <0 .0 1 )。结论 :病人在尿常规检验正常时进行膀胱自主排尿训练 ,可减少尿路感染及缩短尿管留置时间。     

胸腔镜肺切除术围术期不放置导尿管的可行性研究

目的探讨胸腔镜肺切除术围术期不放置导尿管的可行性。方法选取2018年6～12月胸腔镜肺切除术220例,随机分为无尿管留置组及尿管留置组各110例。比较2组术后尿路感染、尿潴留发生率,术后舒适度(Kolcaba舒适状况量表)、首次下床时间、术后住院时间及住院费用;比较男性患者术后国际前列腺症状评分(IPSS)严重程度。结果与尿管留置组相比,无尿管留置组术后尿路感染发生率低[21. 8%(24/110) vs. 34. 5%(38/110),χ2=4. 402,P=0. 036],Kolcaba舒适状况量表的生理、心理精神、社会文化以及环境等舒适度得分高,首次下床早,术后住院时间短,住院费用低,均有统计学差异(P 0. 05),2组尿潴留发生率差异无显著性(P 0. 05)。无尿管留置组男性患者术后24 h IPSS评分轻、中、重度分别为33、28、7例,尿管留置组分别为20例、27例、22例,差异有显著性(Z=-2. 469,P=0. 014)。结论胸腔镜肺切除术不留置尿管能够降低尿路感染发生率,提高术后患者舒适度,缩短首次下床时间及住院时间,降低术后IPSS评分严重程度,促进患者快速康复。     

骨科择期术后患者进食时间的研究

目的 探讨骨科择期术后患者早期进食的安全性和可行性.方法 将116例骨科行择期手术的患者随机分为两组,观察组(57例)先进行健康教育,于术后2 h开始由责任护士对患者麻醉情况、胃肠功能恢复情况、进食意愿进行评估,合格后即鼓励进食;对照组(59例)严格按照医嘱要求进食.结果 观察组术后进食时间(3.71 士3.35)h,其中80.70%患者在术后2～4 h进食;对照组(8.63±6.32)h,两组进食时间比较,差异有显著性意义(P<0.01).现察组术后口渴、饥饿、便秘评分显著低于对照组,术后下床时间和出院时间显著短于对照组(均P<0.01);而两组术后呕吐发生率比较,差异无显著性意叉(P>0.05).结论 骨科择期手术患者术后2～4 h进食可行,先评估后进食方法是确保患者安全的必要措施.     

Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

Background and Objectives:

Combining laparoscopy and enhanced recovery provides benefit to short-term outcomes after colorectal surgery. Advances in training and techniques have allowed surgeons to operate on cases that are technically challenging and associated with prolonged operative time. Laparoscopic techniques improve the outcome of enhanced recovery after colorectal surgery; however, there are no specifications on the effect of prolonged operations on the outcome. The objective was to elucidate the impact of prolonged surgery and blood loss on the outcome of enhanced recovery after surgery after laparoscopic colorectal surgery.

Methods:

Four-hundred patients who underwent elective colorectal resection on enhanced recovery after surgery in Yeovil District Hospital between 2002 and 2009 were retrospectively reviewed. Delayed discharge was defined as a prolonged length of stay beyond the mean in this series (≥8 days).

Results:

Three-hundred eighty-five patients were included. Median operative time was 180 minutes with a median blood loss of 100 mL. Conversion was not associated with a prolonged length of stay. Operative time and blood loss correlated with length of stay in a stepwise fashion. There were 2 cutoff points of operative time at 160 minutes and 300 minutes (5 hours), where risk of prolonged stay increased significantly (odds ratio [OR] = 2.02; 95% confidence interval [CI], 1.05–3.90; P = .027), and blood loss of >500 mL (OR = 3.114; 95% CI, 1.501–6.462, P = .002).

Conclusions:

Total operative timing impacts negatively on the outcome of enhanced recovery after laparoscopic colorectal resections with increased risk of delayed discharge seen after ∼2.5 hours and 5-hour duration.     

Colonic Transit Time After Spinal Cord Injury

Abstract

Colonic transit time (CTT) was measured with abdominal radiographs using Chaussade’s technique in 30 spinal cord injured patients (ASIA A and B) following ingestion of 20 radiomarkers per day for three days . A significant increase in total CTT (p=0.0001) and segmental CTT of the right colon (p=0.0004) and of the left colon (p=0.0001) was shown. While using on the average only 2.3 films of the abdomen per patient, we obtained results comparable with other radiologic techniques which use radiomarkers to measure CTT. The clinical relevance of these results is not clear and their correlation with intestinal symptoms remains to be investigated. (J Spinal Cord Med 1997;20:416-421)     

经皮冠状动脉介入术后患者卧位及其时间的研究

目的 探讨经皮冠状动脉腔介入术(PCI)后患者的卧位及卧床时间对患者舒适度及并发症的影响.方法 将140例患者按时问先后分为A组(60例)和B组(80例),A组术后采用常规护理,穿刺点弹性绷带包扎并用1 kg沙袋压迫8 h,保持术侧肢体制动、平卧24 h后下床活动;B组术后床头抬高30°,穿刺点弹性绷带包扎,术肢伸直,平卧2 h后改术侧卧位、坐位或半坐位,12 h后下床活动.结果 B组术后烦躁、腰酸背痛、排尿困难、睡眠差、无食欲等不舒适发生率显著低于A组(P＜0.05,P＜0.01);两组患者术后并发症发生率比较,差异无显著性意义(均P＞0.05).结论 改进PCI术后患者卧位及其时间可提高患者舒适度.     

深静脉导管拔管后按压时间的临床研究

目的 探讨深静脉导管拔管后最佳按压时间.方法 将250例单腔深静脉导管留置患者随机分为A、B、C、D、E五组.患者取平卧位拔管后,穿刺点置2块纱布,操作者左手示指贴于皮肤进针点,中指、无名指,沿血管走向以0.5 kg的力量依次按压3、4、5、6、7 min.结果 五组按压效果比较,差异有显著性意义(P＜0.01).其中A组效果显著差于B、C、D、E组(均P＜0.005).组效果显著差于C、D、E组(均P＜0.005);C、D、E组比较.差异无显著性意义(均P＞0.005).结论 深静脉导管拔管后按压血管时间以5 min为宜.超过5 min作用不大.     

深静脉导管拔管后按压时间的临床研究

目的探讨深静脉导管拔管后最佳按压时间。方法将250例单腔深静脉导管留置患者随机分为A、B、C、D、E五组。患者取平卧位拔管后．穿刺点置2块纱布．操作者左手示指贴于皮肤进针点，中指、无名指，沿血管走向以0．5kg的力量依次按压3、4、5、6、7min。结果五组按压效果比较．差异有显著性意义（P〈0．01）。其中A组效果显著差于B、C、D、E组（均P〈0．005）．B组效果显著差于C、D、E组（均P〈0．005）；C、D、E组比较．差异无显著性意义（均P〉0．005）。结论深静脉导管拔管后按压血管时间以5min为宜，超过5min作用不大。     

Surgical Antibiotic Prophylaxis After Renal Transplantation: Time to Reconsider

The optimal regimen for perioperative antibiotic prophylaxis after renal transplantation remains to be determined. Worldwide, it seems there is a trend toward decreased use of prophylaxis from the first 48 hours to several days after surgery. However, bacterial strains resistant to common antibiotic agents arise even if only a single dose of a molecule is administered at any time. Inasmuch as infections currently are the primary cause of hospitalization after renal transplantation, it is desirable to not favor selection of resistant strains that may not be treated appropriately in the event of onset of infection. Therefore, antibiotic therapy, whether for therapeutic or prophylactic purposes, should be administered based exclusively on clinical evidence. Because systemic antibiotic prophylaxis is not effective against infections of the urinary tract, the objective of perioperative antibiotic prophylaxis should be to prevent infection of the surgical wound. In this case, administration of a single dose of an antibiotic agent (1-shot regimen) at the induction of anesthesia is effective and safe. For these reasons, it is urgent that new guidelines be defined for perioperative antibiotic prophylaxis. Multicenter prospective randomized trials comparing 1-shot vs multiple-dose regimens should be performed to establish the optimal regimen.