妇科腹腔镜手术及其并发症的护理体会

腹腔镜技术是借助摄像系统及器械进行的微创手术方式，兼有诊断和治疗双重作用，因其具有创伤小、痛苦轻、术后恢复快、住院时间短等优点，在妇科领域广泛运用。然而，随着腹腔镜手术应用范围的拓宽，操作难度的增加，腹腔镜手术的并发症不容忽视。术前充分的准备和术后精心的护理对预防和及时处理腹腔镜手术并发症，促进患者术后尽快恢复具有重要作用。     

妇科腹腔镜术后并发症及护理进展

随着医学的不断发展,高科技微创手术的诞生,腹腔镜已经越来越广泛地应用于临床.妇科腹腔镜手术因其微创、手术效果好、术后痛苦少、恢复快、住院时间短、美观、治疗后生活质量高等优点,成为妇科最常见的操作技术之一.但由于应用范围不断扩大,腹腔镜手术适应证不断调整,手术难度逐渐增加,腹腔镜术后并发症发生的种类日益增多.本文从与穿刺及气腹有关的并发症、与手术体位有关的并发症、与手术相关并发症综述腹腔镜术后并发症及护理新进展.旨在认识有高危因素的患者和复杂手术本身特有的并发症,早期发现,正确处理,有效预防.     

妇科腹腔镜术后并发症及护理进展

随着医学的不断发展,高科技微创手术的诞生,腹腔镜已经越来越广泛地应用于临床.妇科腹腔镜手术因其微创、手术效果好、术后痛苦少、恢复快、住院时间短、美观、治疗后生活质量高等[1]优点,已为越来越多的患者所接受,成为妇科最常见的操作技术之一.但由于应用范围不断扩大,腹腔镜手术适应证不断调整, 手术的复杂性及操作视野的限制,手术医生的经验[2]、手术难度的逐渐提高[3],由此引起的并发症日益增多[4],护理工作也随之不断发展和更新,现将近年来妇科腹腔镜术后并发症及护理进展综述如下.     

妇科腹腔镜手术围手术期的护理新进展

近年来,腹腔镜技术已广泛应用于临床,且应用范围渐渐扩展,临床妇科中主要应用于异位妊娠、急性盆腔炎、不孕症和子宫手术等［1］。与传统手术相比,妇科腹腔镜手术因其微创、手术效果好、术后痛苦少、恢复快、住院时间短、美观、治疗后生活质量高等优点［2］,已被越来越多的患者接受,成为妇科许多良性疾病最常见的手术方式。但是腹腔镜手术毕竟是一种手术,切实做好围手术期的护理、提高患者对手术的耐受性、预防术后并发症、促进患者早日康复十分重要。由于腹腔镜应用范围不断扩大,其围手术期的护理措施也不断发展和更新。现将妇科腹腔镜手术围手术期护理新进展综述如下。     

妇科腹腔镜手术80例围术期护理与观察

目的：探讨妇科腹腔镜手术围术期的护理体会。方法回顾性分析我院收治行腹腔镜手术治疗的妇科患者80例，对于护理措施和效果进行总结分析。结果80例妇科患者经过腹腔镜手术治疗后，均获得痊愈并出院；住院期间未发生感染等严重并发症。结论对行腹腔镜手术治疗的妇科患者实施细致、完善的护理干预，有助于提高护理效果，降低并发症，对于患者和医院均具有积极意义。     

妇科疾病腹腔镜手术的护理体会

妇科微创手术是利用宫腔镜、腹腔镜等技术,以最小的创伤、最佳的治疗手段达到治愈妇科疾病的目的。随着微创手术的不断发展,腔镜技术、设备日臻成熟,大部分妇科经典的开腹手术已被腹腔镜手术所替代。妇科微创手术与开腹手术相比具有切口小、出血少、术后恢复快、治疗效果好、便于护理等优点。目前,妇科腹腔镜手术是治疗妇科良性肿瘤的首选术式［1］。国内已普遍将腹腔镜技术应用于早期宫颈癌、子宫内膜癌和卵巢癌,保留生育的经阴道广泛手术（宫颈切除,保留宫体）及淋巴结切除术［2］。现将我院2009年1月-2012年12月应用腹腔镜手术治疗妇科疾病的护理体会汇报如下。     

妇科腹腔镜围手术护理研究进展

随着医学科学的不断发展,妇科许多传统的开腹手术逐步被腹腔镜手术取代。近年来,我国妇科专家学者们在微创手术领域不断实践和探索,积累了宝贵的工作经验,微创手术技术日趋成熟。目前,微创手术已成为妇科疾病的重要治疗方法,在妇科疾病治疗方法中的应用占有较高的比例;世界妇产科联盟提出,在本世纪应有60%以上的妇科手术在内镜下完成。妇科微创技术是利用腹腔镜、宫腔镜等技术取代传统开腹技术治疗疾病。腹腔镜手术作为微创手术,尽管有其独特的优点,但其穿刺、气腹及电烫等操作对呼吸、循环、内分泌的影响不容忽视。术后并发症不仅会影响手术疗效,严重者将威胁患者生命。因此应加强腹腔镜手术前后的护理,严格观察病情变化是防治并发症的关键。     

129例腹腔镜下卵巢肿瘤剥除术的护理体会

随着微创手术的开展,腹腔镜在妇科的应用已很广泛。与传统的开腹手术相比,腹腔镜手术具有许多优点:(1)创伤小,切口小,出血少;(2)并发症少;(3)手术效果确定,可以达到开腹手术相同的效果;(4)术后疼痛轻,恢复快,不留疤痕,住院时间短等。我院于2009年1月至2011年1月对卵巢肿瘤患者129例进行腹腔镜下卵巢肿瘤剥除,术后患者均痊愈出院。现将护理体会总结如下。     

妇科腹腔镜手术的护理

腹腔镜手术是近年来发展迅速的微创治疗,其代替开腹手术已经称为明显的趋势。与普通开腹手术相比腹腔镜手术具有许多优点,临床护理也有许多不同之处,认真做好腹腔镜术后护理以及并发症的观察和处理是进一步体现腹腔镜治疗模式优势的重要环节。通过对本院92例妇科腹腔镜手术的研究分析,探讨妇科腹腔镜手术前后的护理工作,从而制定一系列切实可行的护理操作程序。对妇科腹腔镜手术患者,完善术前准备工作,注重心理护理,采用科学合理的护理操作程序有利于手术和麻醉的顺利实施,有效地促进了患者的身心康复。     

妇科腹腔镜手术的护理

腹腔镜手术是近年来发展迅速的微创治疗,其代替开腹手术已经称为明显的趋势。与普通开腹手术相比腹腔镜手术具有许多优点,临床护理也有许多不同之处,认真做好腹腔镜术后护理以及并发症的观察和处理是进一步体现腹腔镜治疗模式优势的重要环节。通过对本院92例妇科腹腔镜手术的研究分析,探讨妇科腹腔镜手术前后的护理工作,从而制定一系列切实可行的护理操作程序。对妇科腹腔镜手术患者,完善术前准备工作,注重心理护理,采用科学合理的护理操作程序有利于手术和麻醉的顺利实施,有效地促进了患者的身心康复。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.