腰椎术后以护士为主导的骨科康复一体化模式的康复效果

目的探讨腰椎术后以护士为主导的骨科康复一体化模式的康复效果。方法选择235例诊断为腰椎退行性变,行单节段腰椎后路植骨融合内固定术的患者,按住院先后顺序分为对照组118例和观察组117例,对照组实施传统康复模式,观察组实施以护士为主导的骨科康复一体化模式,于手术前和手术后7 d、1个月、3个月、6个月采用Oswestry功能障碍指数(ODI)和腰椎日本骨科学会(JOA)评分评估腰椎功能,数字疼痛评分法(NRS)评估疼痛程度。结果 2组患者术前及术后7 d的NRS评分、JOA评分、ODI评分无统计学差异(P 0. 05);观察组患者术后1、3、6个月NRS评分、ODI评分显著低于对照组(P 0. 05),术后3、6个月JOA评分改善率显著高于对照组(P 0. 05)。结论以护士为主导的骨科康复一体化模式可以缓解腰椎管减压植骨融合内固定术患者的术后疼痛,提高腰椎功能改善率。     

全程系统康复对老年患者单节段腰椎融合术后功能的影响

目的:观察全程系统康复对老年患者单节段腰椎融合术后功能的影响。方法:前瞻性收集2013年7月至2015年1月确诊为腰椎退行性疾病且符合纳入及排除标准的119例患者,随机分为观察组(n=60)和对照组(n=59)。两组患者术前、术后住院期间接受同样内容的康复治疗,出院后两组采用不同康复方案,观察组患者给予家庭康复手册,定期电话指导,康复期为12周;对照组患者行传统康复。于术前、术后12周、术后24周随访并比较两组患者腰腿疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科学会评分系统(Japanese orthopedic association scoring system,JOA)腰痛评分及改良的Oswestry功能障碍指数(Oswestry disability index,ODI)评分。结果:119例患者获得满意随访,随访时间为5.3~6.8个月,平均(5.9±0.3)个月。术后12周和24周观察组VAS评分显著低于对照组,提示疼痛得到了显著改善(P<0.01),JOA评分显著高于对照组,提示功能得到了明显改善(P<0.01),ODI评分显著低于对照组,提示功能得到了明显改善(P<0.001);与术前相比,两组患者术后12周及24周各指标有显著性改善(P<0.01),与术后12周相比,两组患者术后24周各指标有显著性改善(P<0.01)。结论:术后全程系统康复对老年患者单节段腰椎融合术后恢复有积极影响,可以有效减轻患者疼痛症状,改善其腰部功能,提高手术疗效。     

经骶前间隙轴向椎间融合联合显微内窥镜下后入路椎间盘摘除术的护理

目的探讨经骶前间隙轴向椎间融合联合显微内窥镜下后入路椎间盘摘除术治疗腰骶椎退行性疾病患者的术前及术后护理要点。方法对33例腰骶椎退行性疾病手术患者进行术前及术后护理,内容包括术前心理评估、术前训练、术后护理、早期并发症的预防及康复功能训练等,观察比较术前及末次随访时患者的VAS评分及JOA评分。结果 1例患者术后出现骶前血肿,予以伤口局部换药、引流1周后血肿吸收。其余患者术后恢复良好,未出现因护理不当而导致的各种并发症,取得了满意效果。术前患者的VAS评分及JOA评分结果均较末次随访时高,两者比较差异有统计学意义(P0.05)。结论经骶前间隙轴向椎间融合联合显微内窥镜下后入路椎间盘摘除术治疗腰骶椎退行性疾病并发症发生率低,手术效果好。加强患者术前及术后的护理,对于提高临床疗效,减少术后并发症发生率,促进患者康复具有重要的意义。     

微创通道经椎间孔椎间融合术与传统术式治疗单节段腰椎退行性疾病的疗效比较

目的探讨微创通道经椎间孔椎间融合术(MIS-TLIF)治疗单节段腰椎退行性疾病的疗效,并与传统开放经椎间孔椎体间融合术(TLIF)比较。方法收治的52例腰椎退行性疾病患者,随机分为对照组和观察组,每组26例,分别采用TLIF治疗和MIS-TLIF治疗。比较两组手术情况,术前、术后视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会评分(JOA)评分变化及椎间植骨融合率。结果观察组手术术中和术后出血量及住院时间显著低于对照组(P0.05);术后3个月观察组腰疼和腿痛VAS评分显著低于治疗前和对照组(P0.05);术后3个月ODI较治疗前均显著降低(P0.05),JOA评分较治疗前均显著提高(P0.05),且改善程度显著优于对照组(P0.05);观察组术后1年椎骨性融合率达到91.43%,显著高于对照组(P0.05)。结论微创通道经椎间孔椎间融合术治疗单节段腰椎退行性疾病在获得与传统开放经椎间孔椎体间融合术相同的疗效下,植骨融合率更高,出血量、引流量更少,术后恢复更快,综合疗效优于传统方法。     

经椎间孔腰椎椎体间融合术治疗退变性腰椎滑脱的效果观察

目的探讨单节段退变性腰椎滑脱行Wiltse入路微创经椎间孔腰椎椎体间融合术的治疗效果。方法选取收治的单节段退变性腰椎滑脱患者82例,按照手术入路不同分为研究组和参照组各41例。参照组行正中入路微创经椎间孔腰椎椎体间融合术,研究组行Wiltse入路微创经椎间孔腰椎椎体间融合术。术前、术后7d、术后随访12个月以视觉模拟疼痛评分(VAS)评估两组下肢痛、腰痛情况,以日本骨科协会评估治疗(JOA)评估腰椎功能,比较两组手术相关指标(术中出血量、手术时间、下地活动时间、住院时间)、术后随访12个月椎间融合情况。结果与参照组相比,研究组术中出血量较少,手术时间、下地活动时间、住院时间较短(P<0.05);术后7d,研究组JOA评分高于参照组,下肢痛、腰痛VAS评分低于参照组(P<0.05);研究组融合率(92.68%,38/41)与参照组(90.24%,37/41)比较,差异无统计学意义(P>0.05)。结论单节段退变性腰椎滑脱行Wiltse入路微创经椎间孔腰椎椎体间融合术治疗,能减少术中出血量,减轻术后下肢、腰痛,缩短手术时间及术后恢复时间,促进腰椎功能恢复,且椎间融合效果确切,值得推广。     

脊柱内镜下经腰椎间孔腰椎椎间融合术联合膨胀式椎间融合器治疗单节段腰椎退行性疾病的临床效果

目的 探讨脊柱内镜下经腰椎间孔腰椎椎间融合术（Endo-TLIF）联合膨胀式椎间融合器治疗单节段腰椎退行性疾病的临床效果。方法 收集2019年9月－2021年5月该院收治的单节段腰椎退行性疾病患者73例,根据不同手术方式,分为Endo-TLIF组（32例）和经椎间孔腰椎椎间融合术（TLIF）组（41例）,比较两组患者的围手术期资料和临床疗效。结果 Endo-TLIF组手术时间长于TLIF组,术中出血量和术后引流量少于TLIF组,术后卧床时间短于TLIF组（P < 0.05）。两组患者术后腰腿痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）明显低于术前,日本骨科学会（JOA）评分明显高于术前,出院时,Endo-TLIF组腰痛VAS明显低于TLIF组,差异均有统计学意义（P < 0.05）;术后1个月至末次随访时,两组患者腰腿痛VAS比较,差异无统计学意义（P > 0.05）;出院时和术后1个月,Endo-TLIF组JOA评分高于TLIF组,ODI低于TLIF组,差异均有统计学意义（P < 0.05）;术前、术后3个月至末次随访时,两组各时间点JOA评分和ODI比较,差异均无统计学意义（P > 0.05）。结论 传统TLIF和Endo-TLIF治疗单节段腰椎退行性疾病,两者近期临床疗效相当,Endo-TLIF具有出血少和术后恢复快的优势,但手术时间较长。     

多节段腰椎间盘突出症精准治疗的临床疗效观察

目的探讨多节段腰椎间盘突出症精准治疗的临床疗效。方法通过对2011年10月至2015年10月入选的78例多节段腰椎间盘突出症患者的临床资料进行回顾性分析,应用X线片、腰椎CT及三维重建、腰椎MRI、双下肢肌电图并综合患者的临床症状、体征,明确责任椎间隙及神经受压部位。所有患者均确诊为多节段椎间盘突出,并进行精确减压,对于合并腰椎不稳者予以单节段椎间融合内固定。术后参考腰腿痛目测类比评分系统(VAS)和日本骨科协会评分系统(JOA)对患者的临床恢复情况进行评估。结果所有患者均手术顺利,获得6~24个月随访,末次随访患者的VAS评分和JOA评分均较术前有明显改善,其中VAS评分改善率为79%,JOA评分改善率为91%。所有患者均得到良好的恢复锻炼,且无内固定松动、断裂或畸形,无腰椎矢状位失衡,无临椎退变,无感染等严重并发症的发生。结论术前根据患者具体病史和影像学检测,科学、有效地确定责任椎间隙及神经受压部位,并合理运用单节段椎弓根固定联合椎间融合,对责任椎间隙进行减压、融合、固定,可以有效治疗多节段腰椎间盘突出症,帮助患者有效地改善腰椎稳定性,减轻症状,为临床上治疗多节段腰椎间盘突出症提供一定的临床经验。     

跨学科合作联合康复外科理念在腰椎间盘突出症患者围术期的应用效果

目的探讨跨学科合作联合康复外科理念在腰椎间盘突出症患者围术期的应用效果。方法选取2018年1月至2019年3月上海长征医院收治的腰椎间盘突出症患者96例为对象。所有患者均行经皮椎间孔镜下椎间盘髓核摘除术。对照组予以常规围术期护理,观察组在此基础上予以跨学科合作联合快速康复外科理念护理。比较两组术后首次进食时间、首次下床活动时间、首次排气时间、首次排便时间、住院时间、术后并发症等,并在术前和术后3个月采用JOA腰椎功能评分和Roland Morris(RMQ)调查表进行腰椎功能和生活质量评价。结果观察组术后首次进食时间、首次下床活动时间、首次排气时间、首次排便时间、住院时间短于对照组,差异均有统计学意义(均P<0.05)。两组术后JOA评分和生活质量评分高于术前,差异均有统计学意义(均P<0.05)。观察组术后JOA评分和生活质量评分高于同时期对照组,差异均有统计学意义(均P<0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论在常规围术期护理的基础上,为腰椎间盘突出症患者提供跨学科合作联合快速康复外科理念护理,能够更好地改善患者围术期情况,降低围术期并发症,促进患者术后腰椎功能和生活质量的提高。     

经皮内镜下腰椎间盘切除术与微创经椎间孔入路腰椎融合术治疗单节段腰椎间盘突出症的临床效果

目的 比较经皮内镜下腰椎间盘切除术(PELD)与微创经椎间孔入路腰椎融合术(MIS-TLIF)治疗单节段腰椎间盘突出症的临床效果。方法 随机选取2018年9月至2020年12月该院收治的90例单节段腰椎间盘突出症患者为研究对象,根据手术方案的不同分为两组,其中行PELD共45例(PELD组),行MIS-TLIF共45例(MIS-TLIF组)。比较两组围术期指标、手术前后腰腿疼痛改善效果、腰椎影像学参数变化及腰椎功能。结果 PELD组的手术时长、住院时间、术中出血量均少于MIS-TLIF组(P<0.05)。术前,两组腰痛、腿痛评分比较,差异无统计意义(P>0.05);术后1个月,PELD组腰痛、腿痛评分低于MIS-TLIF组(P<0.05),但术后3个月,两组腰痛、腿痛评分比较,差异无统计意义(P>0.05)。术前,两组腰椎影像学参数(腰椎曲度指数、椎间隙高度、椎间盘后缘高度、Cobb角)及腰椎功能[Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分]比较,差异无统计意义(P>0.05);术后3个月,两组腰椎影像学参数及ODI、JOA评分均较...     

早期康复护理预防腰椎间盘突出症术后神经根粘连

目的总结防治腰椎间盘突出症术后神经根粘连的有效方法。方法将2005年3月-2008年4月收治的腰椎间盘突出症手术患者82例随机分为早期康复组(A组,44例)和常规对照组(B组,38例),两组患者一般资料比较差异无统计学意义(P>0.05),有可比性。A组采用康复护理功能锻炼,B组采用常规护理方法。疗效采用日本骨科学会(JOA)下腰痛功能评定表评分,并计算功能改善率。结果术后2周,两组各时间点JOA评分均较术前明显提高,差异有统计学意义(P<0.05);两组术前JOA评分比较差异无统计学意义(P>0.05);治疗后各时间点A组评分均高于B组(P<0.05)。治疗后2周A、B组JOA改善率比较差异无统计学意义(P>0.05);治疗后3、6、12、24个月A组改善率均高于B组(P<0.01)。结论早期康复护理预防腰椎间盘突出症术后粘连疗效显著、安全。     

两种不同止痛方案对二尖瓣置换术术后患者应激状态的影响

目的 探讨芬太尼经静脉自控止痛（PCA）对二尖瓣置换术（MVR）术后患者应激状态的缓解作用。方法 60名MVR患者随机分为2组,CAT组为常规止痛组,术后按需给予吗啡0．10-0.20mg/kg静脉注射;PCA组为术后使用PCA给药装置持续输入芬太尼50μg/ml,持续背景输入速度25μg/h,单次给药剂量25μg,锁定时间15min。术后48h内观察止痛效果,术后24h、术后24h,48h测定血糖水平和尿去甲肾上腺素水平。结果 PCA组术后止痛效果明显好于CAT组,术后24h血糖水平CAT组明显高于PCA组（P＜0．05）,术后24h,24-48h CAT组尿NA水平均明显高于PCA组（P＜0．05）。结论 芬太尼经静脉PCA用于MVR术后患者可以明显缓解术后应激状态,有利于术后康复。     

Postoperative spontaneous breathing with CPAP to normalize late postoperative oxygenation

After intubation for elective upper abdominal surgery 30 patients were randomized in group A or B. Both groups had the same anaesthetics and were ventilated with a tidal volume of 12 ml/kg the rate keeping P_aCO₂ near 40 mm Hg. Group A was ventilated with ZEEP and group B with PEEP 10 cm H₂O. Group A was extubated when VC reached 15 ml/kg and P_aCO₂ did not exceed 50 mm Hg breathing spontaneously. Group B was allowed to breathe spontaneously with CPAP and PEEP 5 cm H₂O (Basel PEEP-Weaner^R) for 3 hours before extubation. Measurements: BP, PAP, RAP, HR, Hb, arterial and mixed-venous blood gases with F_IO₂=0,21. Both groups were similar in age, sex, cigarette consumption, preoperative pulmonary pathology, surgical procedure pathology, surgical procedure and time of operation.Results: RAP, PAP, BP, HR, P_aCO₂, P_aH, P_v–O₂ did not show important differences. Mean P_aO₂ changed as follows: Postoperative chest X-rays showed in Group A a total of 56 negative scores, in Group B 25.Conclusion: After upper abdominal surgery the well known decrease of FRC with its increased venous admixture can be prevented if the patient is ventilated with PEEP during operation and is breathing spontaneously with CPAP and PEEP for 3 postoperative hours before extubation.Deceased 1976     

The Impact of Preoperative Patient Anxiety on Postoperative Anxiety and Quality of Recovery After Orthopaedic Surgery

PurposeTo study how preoperative anxiety affects postoperative recovery in orthopaedic surgery based on two specific issues: does preoperative anxiety affect postoperative anxiety, pain, and nausea in the postanesthesia care unit (PACU) and does preoperative anxiety affect the quality of recovery.DesignThis was a nonexperimental quantitative observational study.MethodsPatients (N = 37) were included through consecutive selection. Anxiety, pain, and nausea were measured preoperatively, 30 minutes after arrival at PACU and before discharge from PACU. Three days after discharge, participants completed the Quality of Recovery Questionnaire by telephone.FindingsThere was a significant correlation between preoperative anxiety and anxiety in PACU as well as anxiety, sadness, and depression 3 days after discharge from PACU.ConclusionsPatients who experience preoperative anxiety also experience anxiety in PACU. The quality of recovery 3 days after surgery is also affected by preoperative anxiety. Patients experience continued anxiety as well as sadness and depression.     

右美托咪啶预防儿童术后躁动的观察及护理

目的 探讨右美托咪啶预防儿童吸入七氟烷全身麻醉后躁动的疗效及护理.方法 选择60例5～8岁拟行全身麻醉的患儿,随机分为观察组和对照组,每组30例.观察组予手术结束前30min静脉推注右美托咪啶0.2μg/kg.对照组静脉推注生理盐水10 ml.记录苏醒时间、拔除气管导管时间及发生躁动、恶心、呕吐的例数.结果 两组苏醒时间、拔除气管导管时间比较无显著性差异（P＞0.05）.手术后躁动的发生率观察组2例（6.7％）比对照组12例（40.0％）低,有显著性差异（P＜0.05）;结论 右美托咪啶能降低七氟烷吸入全身麻醉患儿术后麻醉恢复期躁动,护理观察重点是保证患儿呼吸道的通畅、预防患儿外伤、坠床和脱管等.     

快速缓解术后口干症的方法

病人在手术过程中。     

The Use of Coffee to Decrease the Incidence of Postoperative Ileus: A Systematic Review and Meta-Analysis

PurposeTo investigate the efficacy of providing coffee to elective abdominal surgery patients, immediately postoperatively, to lessen postoperative ileus.DesignA systematic review with meta-analysis of six randomized controlled trials published since 2012.MethodsMethodological quality was evaluated using the Cochrane guidelines. The Grading of Recommendations, Assessment, Development, and Evaluations assessment tool evaluated the quality of the evidence. Subgroup analyses were completed if the I² statistic demonstrated heterogeneity (greater than 50%).FindingsCoffee was statistically significant in shortening the time between surgery and the first passage of stool (mean difference, −9.38; 95% confidence interval, −17.60 to −1.16; P = .03). Although not statistically significant (P = .20), the overall effect favored shorter hospital stays for those patients receiving coffee.ConclusionsThe current systematic review and meta-analysis suggests that coffee given as early as 2 hours postoperatively decreases time to first bowel movement. In addition, patients tolerated solid food faster and were discharged sooner when given coffee immediately postoperatively.     

术后营养护理对蛛网膜下腔出血术后功能康复的影响

目的探讨术后营养护理对蛛网膜下腔出血术后功能恢复的影响。方法选取80例蛛网膜下腔出血手术患者设为观察组,术后给予营养目标策略护理,另选取同期收治的40例蛛网膜下腔出血手术患者为对照组,术后给予常规营养护理。比较2组术后的营养状况、负氮平衡情况、康复情况等。结果观察组营养7 d时的白蛋白、前白蛋白高于对照组,负氮平衡情况好于对照组,差异有统计学意义(P0.05)。观察组的机械通气时间、住ICU时间短于对照组,并发症少于对照组,预后好于对照组,差异均有统计学意义(P0.05)。结论加强蛛网膜下腔出血术后营养护理能够使患者尽快达到营养治疗目标,促进机体康复,改善预后。     

Intermittent Wound Perfusion for Postoperative Pain Relief Following Upper Abdominal Surgery: A Surgeon's Perspective

Background: Although there are many methods for postoperative pain management, implementation may be limited in some settings due to practical or financial constraints. Simple, inexpensive and easily implemented analgesic methods may improve access to effective pain relief. Methods: Fifty patients undergoing truncal vagotomy and gastrojejunostomy for pyloric stenosis secondary to chronic duodenal ulceration were studied in this prospective randomized trial. Subjects were assigned to receive either wound perfusion with 8 mL of 0.25% bupivacaine every 5 hours through a catheter placed subcutaneously or intravenous pethidine 0.2 mg/kg on demand for postoperative pain relief. Postoperative pain scores at rest were measured by visual analog scale and the opioid requirement at 0–12 hours, at 12–24 hours and at 24–36 hours were compared. Changes in respiratory parameters were also compared between the two groups. Results: Pain scores at 0–12 hours were significantly lower in the wound perfusion group compared with the intravenous pethidine group (5.7 ± 1.3 vs. 4.3 ± 1.2, mean ± SD; P < 0.001). The number of doses of analgesic required in the wound perfusion group was significantly lower compared with the controls during the 36 hours of study (3.5 ± 1.3 vs. 1.4 ± 1.0, P < 0.001). There were no differences in respiratory parameters, vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate between the two groups. The FEV1 : FVC ratio, however, was significantly higher in the intravenous pethidine group. There were no wound complications due to catheter placement or systemic toxicity due to the anesthetic. Conclusion: Intermittent wound perfusion with 0.25% bupivacaine is a safe and efficient method to reduce pain scores and opioid requirement in the early postoperative period. Wound perfusion, however, had no beneficial effect on the postoperative respiratory function.     

右美托咪定对恶心呕吐高危患者术后恶心呕吐发生影响的随机对照

目的：探讨右美托咪定对术后恶心呕吐（PONV）高危患者PONV发生的作用。方法：采用随机双盲对照研究法。纳入2015年11月至2016年5月择期行泌尿外科腹腔镜手术、女性且不吸烟的患者100例,随机分为：右美托咪定组和对照组。右美托咪定组患者在诱导前泵注右美托咪定0.6 μg/kg,术后加用右美托咪定3 μg/kg,其他麻醉处理同对照组。评价术后48 h内两组患者PONV严重程度、疼痛VAS评分,记录术后抗呕吐药物和其他镇痛药物使用情况。结果：93例患者完成研究,其中右美托咪定组47例,对照组46例。术后0～6 h,右美托咪定组患者PONV 0级例数较对照组多（37 vs 27,P＜0.05）。右美托咪定组患者术后48 h内抗恶心呕吐药物使用比例较对照组降低（25.5% vs 47.8%,P＜0.05）。术后6～24 h、24～48 h,右美托咪定组患者VAS疼痛评分低于同时间段对照组（2.9±0.9 vs 3.4±0.7,2.7±0.6 vs 3.0±0.7,P＜0.05）。结论：围手术期使用右美托咪定能够降低PONV高危患者术后早期PONV严重程度,减少术后抗恶心呕吐药物使用,并有助于改善术后镇痛效果。