加速康复外科理念在日间病房胆囊切除术的应用

目的 探讨融合加速康复外科理念的日间病房护理对腹腔镜下胆囊切除术患者术后康复的影响。方法 将102行腹腔镜胆囊切除术的患者随机分为两组,即对照组51例,开展围术期常规护理;观察组51例,开展融合加速康复外科理念的日间病房护理,评估两组术后康复效果。结果 观察组术后3 h、6 h、24 h的VAS评分比对照组低（P<0.05）;术后肠鸣音恢复时间（10.90±1.98） h、首次肛门排气时间（15.30±2.30） h,进食时间（19.09±3.10） h及下床活动时间（7.99±1.34） h均比对照组短（P<0.05）;并发症发生率为1.96%,略低于对照组9.80%(P>0.05)。结论 给予腔镜下胆囊切除术患者融合加速康复外科理念的日间病房护理,既能减轻患者疼痛,又能促进患者康复。     

加速康复外科在腹腔镜胆囊切除术中的应用

目的应用围手术期加速康复外科理念,观察腹腔镜胆囊切除术患者临床应用的安全性及优势。方法250例腹腔镜胆囊切除术患者随机分成两组:采用围手术期加速康复外科治疗126例,传统方法治疗124例。分析比较两组患者术后住院时间、停止输液时间、住院费用和术后并发症发生情况。结果加速康复组与传统方法组比较,可更好地促进患者恢复,缩短住院时间、降低住院费用,减少患者因医源性操作引起的不适及手术相关并发症的发生。结论加速康复外科治疗措施在腹腔镜胆囊切除术患者中应用是安全、经济、有效和可靠的围手术期处理方案。     

加速康复外科理念在老年患者腹腔镜胆囊切除围手术期中的应用体会

目的:评价加速康复外科理念应用于老年患者腹腔镜胆囊切除围手术期的临床价值。方法:收集2014年10月至2016年11月行腹腔镜胆囊切除术的173例老年患者的临床资料,对照组采用传统围手术期处理;实验组采用加速康复外科措施。比较两组患者术前禁饮禁食时间、术后持续心电监护时间、首次下床时间、首次排气时间、术后阿片类药物使用率、术后并发症、住院时间、住院费用、出院30 d再入院率及死亡率。结果:实验组下床活动时间[(6.99±2.57)h vs.(28.14±4.13)h]、首次排气时间[(20.34±11.75)h vs.(29.74±4.07)h]、术后住院时间[(2.00±1.58)d vs.(5.08±2.58)d]、阿片类药物使用率(1/100 vs.5/73)、住院费用[(12 700.71±1 680.4)元vs.(15 034.09±6 147.0)元]明显优于对照组(P0.05)。结论:老年患者腹腔镜胆囊切除围手术期应用加速康复外科措施可降低创伤应激,术后胃肠功能恢复快,住院时间明显缩短,住院费用明显下降,临床效果明显。     

快速康复外科理念在老年患者急诊胆囊切除术中的应用

目的探讨快速康复外科理念在老年患者急诊胆囊切除术中应用的效果。方法比较传统方法与快速康复外科理念治疗急诊行胆囊切除术对老年患者的疗效,观察比较两组患者的肠道排气时间、住院时间及术后心肺、手术切口并发症、C-反应蛋白、前降钙素原等指标有无差异。结果所有患者均治愈,未发生胆瘘、黄疸、腹腔出血及腹腔感染等并发症。与快速康复治疗组比较,传统治疗组C-反应蛋白、前降钙素原、排气时间及住院时间明显延长,而心肺并发症、手术切口并发症两组则无明显差异。结论应用快速康复外科理念采取适当治疗措施,能减少患的应激反应,缩短住院时间,加速患者的康复。     

快速康复外科在老年腹腔镜胆囊切除术围术期护理中的应用

目的 探讨快速康复外科(FTS)应用于老年腹腔镜胆囊切除术(LC)围手术期护理的效果.方法 将行LC治疗的94例老年患者随机分为2组,各47例.对照组围术期予以常规护理,FTS组在常规护理的基础上实施FTS理念指导下的护理干预.比较2组患者术后胃肠功能恢复时间、离床活动时间、住院时间、并发症发生率,以及视觉模拟评分(V...     

加速康复外科理念在小切口胆囊切除术中的应用

目的 探讨加速康复外科理念在小切口胆囊切除术(MC)中的应用价值.方法 自2000年1月至今,我院实施MC手术1 575例,遵循加速康复外理理念,优化围手术期医疗护理措施,减轻应激反应.结果 本组1 575例中发生胆管损伤2例,术中出血1例,术后胆漏1例.平均住院5.6 d.结论 贯彻加速康复外科理念实施MC手术,更好地促进患者早日康复.     

腹腔镜胆囊切除术在老年患者中的应用

目的 探讨腹腔镜胆囊切除术在老年患者中的应用.方法 回顾性分析60例老年急性胆囊炎患者应用腹腔镜治疗的临床资料.结果 本组60例均在腹腔镜下完整切除病变胆囊,住院时间5～19 d,无手术并发症.60例均痊愈出院,无死亡病例.结论 术前仔细评估患者具体手术适应证,规范操作,及时处理术中、术后各项并发症,是老年急性胆囊炎腹...     

腹腔镜胆囊切除术快速康复外科护理效果观察

目的探讨腹腔镜胆囊切除术(LC)快速康复外科护理的效果。方法随机将2016-05—2018-06间在新野县人民医院接受LC的84例患者分为2组,各42例。观察组实施快速康复外科护理。对照组行常规护理。结果观察组术后恢复效果、疼痛评分、并发症发生率均优于对照组,差异有统计学意义(P0.05)。结论对LC患者采取快速康复外科护理,可减轻患者疼痛,降低术后并发症发生率,缩短住院时间,促进术后恢复,提高患者的生活质量。     

Predictors of cardiac events in high-risk patients undergoing emergency surgery

Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high-risk patients undergoing non-elective surgery.
Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included.
Troponin I (TnI) was measured pre-operatively, 12 and 48 h post-operatively. Pre-operative N-terminal fragment of B-type natriuretic peptide (NT-proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI >0.06 μg/l and NT-proBNP >1800 pg/ml, respectively. Post-operative major adverse cardiac events (MACE), 30-day and 3-months mortality were recorded.
Results: Elevated TnI levels were detected in 33% of the patients post-operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, P <0.001) and 30-day mortality (23% vs. 7%, P =0.003). Increased concentrations of NT-proBNP were seen in 59% of the patients. Elevated NT-proBNP was an independent predictor of myocardial damage post-operatively, odds ratio, 6.2 [95% confidence interval (CI) 2.1–18.0] and resulted in an increased risk of MACE (21% vs. 2.5% in patients with NT-proBNP ≤1800 pg/ml, P <0.001).
Conclusion: Myocardial damage is common in a high-risk population undergoing unscheduled surgery. These results suggest a close correlation between myocardial damage in the post-operative period and increased concentration of NT-proBNP before surgery. The combinations of TnI and NT-proBNP are reliable markers for monitoring patients at risk in the peri-operative period as well as useful tools in our risk assessment pre-operatively in emergency surgery.     

快速康复外科理念在行急诊无张力疝修补术的腹股沟嵌顿疝患者中的应用

目的探讨快速康复外科（fast track surgery，FTS）理念在行急诊无张力疝修补术腹股沟嵌顿疝患者中的应用效果。 方法选取2016年2月至2017年10月，丹阳市人民医院收治的132例腹股沟嵌顿疝患者为研究对象，随机分为研究组（66例）与对照组（66例）。2组均行急诊无张力疝修补术，对照组给予围手术期常规干预，研究组给予FTS理念的系统干预，术后均随访6个月。比较2组术后胃肠道功能恢复时间、急慢性疼痛、并发症及应激反应方面的差异。 结果研究组术后肠鸣音恢复时间、肛门排气时间、进食时间、下床活动时间和住院时间较对照组缩短，差异有统计学意义（P<0.01）。与对照组比较，研究组术后第2天NRS评分及术后1个月IPQ评分均降低，差异有统计学意义（P<0.01）。术后随访期间，研究组并发症总发生率及腹股沟不适感发生率低于对照组，差异有统计学意义（P<0.05）。 结论FTS理念的系统干预可加速行急诊无张力疝修补术的腹股沟嵌顿疝患者预后，促进其胃肠功能恢复，减轻患者疼痛程度，降低患者术后并发症及腹股沟不适感的发生率。     

经自然腔道内镜下胆囊切除术患者的围术期护理

对38例胆囊疾病患者经自然腔道内镜下行胆囊切除术,手术均顺利完成,无1例术中转开腹手术;术后住院2.5d出院。提出术前消除患者对新术式的恐惧和抵制心理,做好脐部皮肤准备;术后密切观察生命体征,及时处理疼痛,保持敷料干燥,预防切口感染是其护理重点。     

急性胆囊炎腹腔镜胆囊切除术中转开腹危险因素分析

目的:探讨急性胆囊炎行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的危险因素。方法:回顾分析我科401例急性胆囊炎患者行LC的临床指标,并进行多因素分析。结果:391例成功完成LC,10例中转开腹。结论:急性胆囊炎LC失败的危险因素有上腹部手术史,白细胞、总胆红素、碱性磷酸酶增高,胆囊管结石嵌顿,发病超过72h。急性胆囊炎患者行LC的危险因素有助于外科医师在术前对患者进行全面评估,以提高LC的成功率,减少并发症的发生。     

Postoperative morbidity and mortality in patients undergoing additional cholecystectomy during digestive surgery]

A retrospective case-control study was carried out to assess whether additional cholecystectomy in patients undergoing digestive surgery caused increased postoperative morbidity and mortality. During the period 1983-90, 70 patients underwent cholecystectomy at the same time as other surgery (25 gastric resections, 23 colon resections, 17 total gastrectomies, 2 fundoplicatio using Nissen's technique, 2 cases of Heller's operation, 1 truncular vagotomy and pyloroplasty). These cases were matched for sex, age (+/- 5 years) and type of primary operation with 70 controls (patients without additional cholecystectomy). Complications were significantly more frequent among the former group compared to controls (28.6% vs 11.4%, p = 0.02), in particular in the group of patients undergoing colon resection (34.8% vs 8.7%, p = 0.04). The frequencies of reoperation and mortality were also higher in patients undergoing additional cholecystectomy than in controls (10% vs 1.4%), but the difference was not statistically significant (p = 0.06). In conclusion, additional cholecystectomy during digestive surgery increases the risk of postoperative complications, in particular in colorectal surgery.     

External validation of prognostic models among cancer patients undergoing emergency colorectal surgery

BACKGROUND: The aim of this study was to evaluate the predictive accuracy of different scoring systems on patients undergoing emergency colorectal surgery. METHODS: The Acute Physiology and Chronic Health Evaluation II or III, the Simplified Acute Physiology Score II, the Mortality Probability Model II, and the Colo-rectal POSSUM scoring systems were applied to 102 patients who underwent colorectal resection for cancer. Validation of scoring systems was tested by assessing calibration and discrimination. Calibration was assessed using Hosmer-Lemeshow goodness-of-fit test and the corresponding calibration curves. Evaluation of the discriminative capability of both models was performed using receiver-operating characteristic curve analysis. RESULTS: Overall, 17 deaths occurred. The Simplified Acute Physiology Score II showed good calibration (x(2) = 1.079, P = .982) and discrimination (areas under the receiver-operating characteristic curve .83). CONCLUSIONS: These data suggest that the SAPS II scoring system was accurate in predicting outcome for patients undergoing emergency colorectal surgery.     

Outcomes of patients older than 55 years undergoing abdominoplasty after bariatric surgery

BackgroundBariatric surgery has become widely performed for treating patients with morbid obesity, and the age limits are being pushed further and further as the procedure proves safe. After massive weight loss, many of those patients seek body-contouring surgery for excess skin and fat.ObjectivesTo analyze the feasibility and the safety of abdominoplasty in patients older than 55 years old after bariatric surgery.SettingUniversity hospital medical center.MethodsWe performed a retrospective review of prospectively collected data from patients aged older than 55 years who had undergone abdominoplasty following massive weight loss due to a bariatric surgery at a single institution from 2004 to 2017. The data analyzed included age, gender, preoperative body mass index, associated interventions, co-morbidities, and postoperative complications.ResultsWe retrieved records for 104 patients; 85.6% percent of them were female, and the mean age was 60.1 ± 3.9 years old. Of the 104 patients, 21 (20.2%) underwent a sleeve gastrectomy and 77 (74%) underwent a Roux-en-Y gastric bypass. The mean interval between the bariatric surgery and the abdominoplasty was 33.6 ± 26.9 months. The mean preoperative weight and body mass index were 76.1 ± 14.5 kg and 28.9 ± 4.5 kg/m², respectively. A total complication rate of 20% was observed. The only factor significantly associated with postoperative morbidity was the associated procedure (P = .03), when we performed another procedure at the same time as the abdominoplasty. Complications included postoperative bleeding in 5 patients (4.8%), seromas in 5 patients (4.8%), surgical site infections in 12 patients (11.5%), and wound dehiscence or ischemia in 2 patients (1.9%). No mortality occurred.ConclusionAbdominoplasty can be safely performed in carefully selected patients older than 55 years old after weight loss surgery, and does not present increased morbidity or mortality. We recommend that surgeons avoid adding concomitant procedures when possible, to decrease the risk of complications. It is also important to look at the patient’s previous maximum BMI levels, as a higher maximum BMI can predict higher postoperative risks and longer hospital stays.