腹腔镜下胃减容减重术治疗病态性肥胖症5例围术期护理

目的:探讨腹腔镜下胃减容减重术治疗病态性肥胖症患者的围术期护理方法。方法:对5例患者行腹腔镜下胃减容减重术,观察患者术后并发症情况及BMI变化,总结有效临床护理经验。结果:5例手术均顺利进行,手术时间70～150 min,出血量30～50 ml;患者术后半年平均减重27.84 kg,无体重反弹及营养不良症状,4例合并睡眠呼吸暂停综合征患者不同程度好转。结论:通过积极的围术期护理、并发症观察及出院指导,对提高腹腔镜下胃减容减重术治疗病态性肥胖症的疗效十分重要。     

减重代谢术后患者居家自我管理障碍因素的质性研究

目的:探讨减重代谢术后患者居家自我管理的障碍因素,为构建减重代谢术后患者居家自我管理方案提供参考依据。方法:采用目的抽样法,于2021年2—3月选取上海市第十人民医院减重代谢中心的16例术后随访患者为研究对象,采用半结构化访谈对其进行访谈,并运用Colaizzi 7步分析法对文本资料进行分析和整理。结果:共提炼出8个主...     

减重代谢术后患者饮食体验的系统评价

目的 系统评价肥胖症患者减重代谢术后的饮食体验的研究,全面了解其存在的饮食问题与管理需求,为更好地开展临床医疗工作提供依据。 方法 计算机检索Cochrane Library、乔安娜布里格斯研究所循证卫生保健中心数据库、PubMed、Embase、Web of Science、CINAHL、PsycINFO、中国知网、万方数据库、中国生物医学文献数据库。搜集有关肥胖症患者减重代谢术后饮食体验的质性研究,检索年限为建库至2021年1月。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准评价文献质量,采用汇集性整合的方法进行结果整合。 结果 共纳入18项研究,提炼39个结果,归纳为7个类别,综合为4个整合结果。①减重代谢术后患者进食状态的变化:饮食方式的变化、饮食管理阶段的变化;②减重代谢术后积极的进食策略;③减重代谢术后消极的进食体验和不良饮食行为:消极的进食体验、不良饮食行为及原因;④减重代谢术后患者寻求多方面的饮食管理支持:医护人员的饮食管理支持、家人和朋友的饮食管理支持、社会组织的饮食管理支持。 结论 医护人员应重视患者在减重代谢术后已出现的或可能会出现的饮食问题,根据相关原因,有针对性的提供支持与帮助以应对术后饮食挑战,指导患者建立正确的饮食行为,实现并维持最佳的减重效果,提高生活质量。     

肥胖症行腹腔镜胃减容术的围手术期护理

目的　总结肥胖症行胃减容术围手术期的经验体会。方法　2013年至2014年之间,对我院胃肠外科收治的10名行胃减容术的肥胖症患者进行围手术期的综合护理,包括心理护理,内科疾病的相关多学科护理,胃肠外科专科护理及术中护理等。结果　10位患者减重效果满意,围手术期护理效果良好,无术后并发症,术后患者满意度高。结论　腹腔镜下胃减容术对重度肥胖症患者减重效果满意,配合积极系统的围手术期护理,创伤小,并发症少。     

老年髋关节置换术患者居家护理的研究进展

髋关节置换术作为髋部骨折患者外科治疗的主要方式，近些年得到广泛应用，而当前国内医疗行业的主要关注在手术过程和术后短期内的快速康复方面，对于出院后的居家护理康复内容研究较少，而居家治疗的依从性对于术后患肢的康复效果具有重要作用。本文主要对目前国内外对于老年髋关节置换术患者居家护理的现状进行总结，内容包括居家护理的定义、患者居家护理需求的影响因素以及国内外对于此类患者居家护理的研究现状，以帮助相关护理学者了解当前的干预措施和效果，总结其中的不足，为今后相关研究的开展提供参考。     

腹腔镜减重代谢手术治疗效果及过程护理

通过回顾性分析2015年1月-2016年12月于本科行减重代谢手术100例,总结护理经验。认为腹腔镜减重代谢手术对于治疗肥胖病以及减重手术具有较好的治疗效果,通过有效的护理后,术后患者的生活质量和水平得到了显著的改善。     

肥胖症患者减重代谢术后心理体验质性研究的Meta整合

目的 系统评价肥胖症减重代谢术后患者心理体验的质性研究。方法 检索The Cochrane Library、Embase、PubMed、PsycINFO、Web of Science、CINAHL、Scopus、中国生物医学文献数据库、中国知网、万方、维普数据库中相关的质性研究及混合性研究,检索时限均为建库至2021年12月5日,采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准评价文献质量,采用汇集性整合方法归纳整合结果。结果 共纳入14项研究,提炼出93个研究结果,归纳形成11个新类别,综合得到3个整合结果：（1）减重代谢术后患者的积极心理体验;（2）减重代谢术后患者面临的多重挑战;（3）减重代谢术后患者的心理支持需求。结论 在减重代谢术后康复过程中,正性心理体验与负性情绪感受共存。减重团队应重视阻碍术后康复的心理社会因素,加强随访筛查力度,及时为患者提供减重相关心理健康教育及心理调适技能支持。同时,发挥患者积极心理效应,帮助其强化社会支持系统,以更好地应对术后挑战。     

病态性肥胖症行腹腔镜胃袖套状切除术的护理

总结了13例病态性肥胖症患者行腹腔镜袖套式胃减容术的护理措施.包括术前周详的身体状况和并发症评估,精心的心理护理;术后密切观察和预防并发症的发生,正确的饮食宣教和出院指导.认为术前、术后积极有效的护理有助于患者术后恢复和有效减重.     

个案管理结合快速康复模式在减重代谢手术患者中的应用

目的:探讨个案管理结合快速康复模式在减重代谢手术患者中的应用效果。方法:选取2017年3月1日～2019年8月31日实施减重代谢手术的42例患者为研究对象,将2018年5月1日前采用常规护理模式的20例患者分为对照组,将2018年5月1日后采用个案管理结合快速康复模式的22例患者分为实验组;比较两组术后恢复情况、体质指数变化情况。结果:实验组术后恢复情况及体质指数变化情况均优于对照组(P0.05)。结论:将个案管理结合快速康复护理模式应用于减重代谢手术患者中,能促进患者术后恢复,更有利于长期巩固减重术后效果。     

乳腺癌术后留置伤口引流管患者居家康复需求的质性研究

目的：探讨乳腺癌术后留置伤口引流管患者居家康复的需求及真实体验,为有效开展延续性护理提供参考。方法：采用目的性抽样法,对14例乳腺癌术后留置伤口引流管的居家康复患者进行半结构式访谈,通过Colaizzi 7步分析法进行资料的编码、分类、提炼主题。结果：乳腺癌术后患者留置伤口引流管居家康复的需求可归纳为4个主题,分别为提高居家自我管理能力的需求、多维度支持的需求、心理情感需求及康复环境需求。结论：随着住院时间的缩短,乳腺癌术后伤口留置引流管出院患者的数量将会继续增加。医护人员应根据乳腺癌术后患者留置伤口引流管居家康复的需求及真实体验,提供针对性的延续性护理,为患者提供优质护理服务,促进其恢复健康。     

Obesity: a rapidly expanding challenge

: Explore the health implications of obesity, commonly performed surgical procedures, and postoperative care needs of bariatric surgery patients.     

Primary care perspective on bariatric surgery

The role of primary care physicians in identifying potential candidates for bariatric surgery and providing them with long-term postoperative care is gaining rapidly in importance. With the increased use of surgical procedures as treatment options for obesity, a knowledge of bariatric surgery is essential for providing optimal care. During the past decade, the number of bariatric procedures has increased, and refinements of these procedures have made them safer and more effective. Primary care physicians should know how to Identify appropriate surgical candidates and be familiar with available procedures, aware of potential complications and benefits, and able to provide lifelong monitoring and follow-up care. Thus, the primary care physician must be informed about surgical criteria, types of procedures, outcomes, complications, and the long-term monitoring needs of these patients.     

Endoscopy unit considerations in the care of obese patients

The dramatic increase in obesity in the general population is accompanied by a concomitant increase in bariatric surgical programs. Gastrointestinal endoscopy has an important role in patient evaluation, postoperative management, and emerging endoscopic bariatric therapies. Endoscopy units must address special design and equipment needs of obese patients in short- and long-range planning. Obese people require more health care resources than nonobese people, with increased physical challenges for staff in administering that care. This article details endoscopy unit considerations pertaining to the bariatric patient, which may apply to pretreatment endoscopic evaluation, managing postoperative bariatric surgical complications, and emerging endoluminal bariatric therapies.     

The frequency of respiratory failure in patients with morbid obesity undergoing gastric bypass

Morbid obesity is associated with multiple metabolic and mechanical abnormalities that increase morbidity and mortality after major abdominal surgery. It is unclear whether patients undergoing bariatric surgery have increased pulmonary complications postoperatively. We performed a retrospective chart review of 207 patients who underwent elective gastric bypass surgery during a recent 2-year period. Body mass index (BMI = kg/m2) of more than 35 was used to define morbid obesity. The purpose of this study was to determine the frequency of respiratory failure, defined as intubation for 24 hours or more and/or reintubation, in these patients. We also evaluated differences in the frequency of respiratory failure between patients with a BMI of 43 or less and those with a BMI of more than 43. Patients with morbid obesity undergoing elective weight loss surgery had few respiratory or other perioperative complications with our experienced team. The rates of respiratory failure and total postoperative complications were 8% in the group with a BMI of 43 or less and 14% in the group with a BMI of more than 43. Skillful anesthetic care allows patients with significant comorbid conditions to benefit from bariatric surgery with reasonable risk in terms of postoperative complications.     

减重代谢手术后患者生活质量的研究现状

本文主要介绍国内外减重代谢手术后患者的生活质量现状,包括不同测评工具、术后生活质量水平的变化及相关影响因素,旨在为我国医护人员提高患者减重代谢手术后生活质量及建立特异性测评工具提供参考依据。     

Current knowledge and perception of bariatric surgery among Greek doctors living in Thessaly

Introduction

The purpose of this study was to assess doctors’ knowledge, current conceptions, and clinical practice regarding obesity and bariatric surgery.

Methods

A self‐administered survey was administered to 500 doctors with varying medical specialties in public and private practice.

Results

The response rate was 60%. Most participants (77.3%) were in private practice. Although almost half of the participants could define morbid obesity and obesity‐related comorbidities, only 8.7% felt educated about bariatric surgery. Participants had little knowledge of various types of bariatric procedures. A minority of doctors (24.7%) knew of the existence of a bariatric center in their area. Only 21.3% of doctors had referred a patient to a bariatric center. Reasons for non‐referral included lack of interest in bariatric surgery (37.3%), patient refusal (35.3%), increased operative fees (17.3%), lack of confidence in bariatric surgery (6.3%), and lack of access to a nearby bariatric center (3.7%). The majority of doctors were interested in learning more about bariatric surgery and related guidelines, but they remained reluctant to conduct patients’ postoperative follow‐ups.

Conclusion

The penetration of bariatric surgery in the medical community remains limited, despite its proven effectiveness in facilitating sustained weight loss and resolving several obesity‐related comorbidities. A great effort should be made to inform health‐care providers about the evolution of bariatric procedures, the potential benefits they offer, and the existence of certified bariatric centers. This will allow doctors to provide optimum health care to patients who could benefit from bariatric surgery.     

Critical care of the bariatric patient

OBJECTIVE: To synthesize the current literature on care of obese, critically ill, and bariatric surgical patients. DATA SOURCE: A MEDLINE/PubMed search from 1966 to August 2005 was conducted using the search terms obesity, bariatric surgery, and critical illness, and a search of the Cochrane Library was also conducted. DATA EXTRACTION AND SYNTHESIS: An increase in both the prevalence of obesity and the number of bariatric procedures performed has resulted in an increased number of obese and, specifically, bariatric surgical patients who require intensive care unit care. Obesity is a chronic inflammatory state with resultant effects on immune, metabolic, respiratory, cardiovascular, gastrointestinal, hematologic, and renal function. Principles of care of the critically ill obese patient are reviewed and then applied to critically ill bariatric surgical patients. Pharmacotherapy, vascular access, and the presentation and management of both pressure-induced rhabdomyolysis and anastomotic failure after bariatric surgery are also reviewed. CONCLUSIONS: Obesity causes a range of pathologic effects on all major organ systems. Knowledge of these effects and issues specific to the intensive care unit care of bariatric patients can help to predict and manage complications in this population.     

Association of Bariatric Surgery With Cancer Incidence in Patients With Obesity and Diabetes: Long-term Results From the Swedish Obese Subjects Study

OBJECTIVEObesity and type 2 diabetes are associated with serious adverse health effects, including cancer. Although bariatric surgery has been shown to reduce cancer risk in patients with obesity, the effect of bariatric surgery on cancer risk in patients with obesity and diabetes is less studied. We therefore examined the long-term incidence of cancer after bariatric surgery and usual care in patients with obesity and diabetes in the matched prospective Swedish Obese Subjects (SOS) study.RESEARCH DESIGN AND METHODSThe SOS study examines long-term outcomes following bariatric surgery or usual care. The current analysis includes 701 patients with obesity and type 2 diabetes at baseline, 393 of whom underwent bariatric surgery and 308 who received conventional obesity treatment. Information on cancer events was obtained from the Swedish National Cancer Register. Median follow-up time was 21.3 years (interquartile range 17.6–24.8 years, maximum 30.7 years).RESULTSDuring follow-up, the incidence rate for first-time cancer was 9.1 per 1,000 person-years (95% CI 7.2–11.5) in patients with obesity and diabetes treated with bariatric surgery and 14.1 per 1,000 person-years (95% CI 11.2–17.7) in patients treated with usual obesity care (adjusted hazard ratio 0.63 [95% CI 0.44–0.89], P = 0.008). Moreover, surgery was associated with reduced cancer incidence in women (0.58 [0.38–0.90], P = 0.016), although the sex-treatment interaction was nonsignificant (P = 0.630). In addition, diabetes remission at the 10-year follow-up was associated with reduced cancer incidence (0.40 [0.22–0.74], P = 0.003).CONCLUSIONSThese results suggest that bariatric surgery prevents cancer in patients with obesity and diabetes and that durable diabetes remission is associated with reduced cancer risk.