结肠造口的并发症及防治

现将我院９年来５４例结肠造口病例发生１３例并发症进行分析,并对并发症的预防和治疗作一探讨。 资料和方法 本组５４例,男３０例,女２４例,年龄２４～７５岁,平均年龄５４．４岁,病因为结直肠癌５０例,横结肠脂肪瘤引起全横结肠套叠坏死１例,乙状结肠损伤１例,乙状结肠扭转２例。行择期手术４２例,急诊手术１２例。乙状结肠单腔造口４０例,乙状结肠襟式造口９例,横结肠襟式造口３例,阑尾切除经阑尾残端盲肠插管造口２例。结果 本组５４例结肠造口发生并发症１３例表１,发生率２４％,其中造口旁疝１例,内疝１例,造口肠胃…     

永久性结肠造瘘术后结肠造瘘口并发症的临床分析

目的探讨结肠造瘘口并发症发生的原因、特点、预防以及处理。方法回顾分析我院2005年1月至2011年1月收治的136例直肠癌永久性结肠造瘘（Miles）术后结肠造瘘口患者的临床资料，分析结肠造瘘口并发症发生的原因、特点以及防治措施。结果结肠造瘘口术后并发症发生率为22．1％（30／136），其中66．7％（20／30）的并发症发生在术后1年内。经统计分析发现：结肠造瘘口术后并发症与腹壁外段造口肠管长度〈2cm（P=0．016）、腹壁切口直径〈3cm（P=0．017）、年龄≥60岁（P=0．084）、体型肥胖／消瘦（P=0．030）、伴发疾病（P=0．021）相关。结论结肠造瘘口并发症有较高的发生率，与手术方式、患者年龄、体形及有无伴发疾病有密切关系。     

蕈状管二期开放法结肠造口36例分析

目的：探讨蕈状管二期开放法结肠造口的临床效果。方法：总结分析36例m ile′s手术行结肠造口临床资料。结果：通过腹膜外结肠内置蕈状管二期开放法可有效减少造口并发症。结论：该手术方法操作简单,并发症低,造口易于管理,术后生活质量高。     

直肠癌术后结肠造瘘口26例的护理

目的探讨直肠癌术后结肠造瘘口的临床护理方法。方法对北京市良乡医院2008-01-2010-06 26例直肠癌术后结肠造瘘患者的临床资料进行回顾性分析。结果所有患者均手术成功,术后造瘘口坏死1例,行肠段切除及造瘘口重建手术后痊愈,造瘘口周围皮炎2例,经过局部皮肤的护理和换药痊愈。结论术后高质量的临床护理对于造口患者心理、生理和社会适应能力的恢复起着至关重要的作用。     

51例Miles术后造口并发症的原因分析与护理

总结了Miles术后永久性结肠造口患者并发症发生的原因及护理对策。在84例门诊随访的永久性结肠造口患者中,51例发生并发症,包括造口周围皮肤炎症21例,造口旁疝20例,肉芽增生8例,造口脱垂2例。对每例患者发生并发症的原因进行分析,实施相应的护理对策,经积极的治疗和护理,患者并发症均治愈。     

直肠癌结肠造口29例的综合护理

目的 总结直肠癌结肠造口患者的手术治疗护理体会.方法 回顾性分析2005-03-2009-03直肠癌结肠造口患者29例行手术治疗的临床资料.结果 全组无死亡病例,29例经手术治疗肠造口均无狭窄、无梗阻,生命体征均平稳出院.24个月内回访均无死亡病例.结论 综合护理及有效的术后康复指导是提高治愈率的关键.     

永久性结肠造口患者生存质量的调查分析

目的描述直肠癌永久性结肠造口患者术后6个月内生存质量状况及其变化。方法采用欧洲癌症研究与治疗组织的生存质量核心问卷和直结肠癌专用问卷,对49例结肠造口患者进行追踪调查,分别在术后1个月、3个月、6个月时收集患者生存质量资料。结果3次调查均参加的患者有33例。直肠癌结肠造口患者总的生存质量及功能量表中生理功能、角色功能、认知功能、情感功能和社会功能等与术后1个月时的状况相比,在术后3个月时有了明显改善,术后3个月到6个月期间变化不明显。在术后6个月内直肠癌结肠造口患者的疲乏、疼痛、呼吸困难、睡眠紊乱、食欲减退等症状逐渐加重;而泌尿症状、胃肠道症状、与造口有关的问题、体重下降、化疗不良反应在术后6个月内症状逐渐减轻。结论结肠造口患者的生存质量是动态变化的,护理工作者应该根据患者的实际情况给予有针对性的指导和帮助。     

直肠癌根治术结肠造口并发症的防治及护理

直肠癌根治术结肠造口是挽救直肠癌患者生命,提高其生活质量的有效措施,但术后并发症需予以重视.     

永久性结肠造口病人对造口知识需求情况的调查分析

目的了解院外永久性结肠造口病人对造口知识的需求情况,为帮助造口病人掌握造口知识提供方法。方法采用自制问卷调查表,对参加造口联谊会68例永久性结肠造口病人进行问卷调查,收集资料进行分析。结果所有的病人都希望有良好的社会支持,97.1%的病人希望能定期参加造口联谊会,对工作和生活、造口用品的选择、造口周围皮肤护理、并发症的观察与处理、训练规律排便等方面是病人渴望了解的知识。结论开展多元化的院外教育,充分发挥造口治疗师及造口专科护士的作用,定期召开造口联谊会,帮助病人学习和掌握造口知识,提高院外造口病人的生活质量。     

The calm after the cytokine storm: lessons from the TGN1412 trial

In March 2006, a phase I study of the superagonistic anti-CD28 antibody TGN1412 caused a massive cytokine storm and multiorgan failure in six healthy human volunteers. Such a profound impact on the immune system was not predicted by preclinical animal studies. In a study from this issue of the JCI, Müller et al. treated rats with the superagonistic anti-CD28 antibody JJ316 and found that it rapidly induced a marked T cell lymphopenia by trapping T cells in the spleen and lymph nodes (see the related article beginning on page 1405). This dramatic redistribution of T cells simulated the profound T cell lymphopenia observed in human recipients of TGN1412. In contrast, JJ316 treatment in the rats did not reproduce the massive cytokine storm observed following TGN1412 administration to the human volunteers. These results point to similarities as well as differences between rodents and humans in the immunological effects of superagonistic anti-CD28 antibody treatment and raise further questions about how best to design preclinical studies that can better predict the risks of novel immunotherapeutics in humans.     

非血缘关系异基因造血干细胞移植66例分析

目的对66例血液病患者进行非血缘关系异基因造血干细胞移植（allo-HSCT），探索提高移植疗效的措施。方法慢性粒细胞白血病（CML）患者24例，急性白血病（AL）患者40例，其他血液病患者2例，经预处理治疗后，进行人类白细胞抗原（HLA）基本相合的非血缘关系骨髓移植（BMT）48例，外周血干细胞移植（PBSCT）18例：部分患者采用长程加强的移植物抗宿主病（GVHD）的预防方案（将环孢菌素A提前至预处理开始时使用，同时加用霉酚酸酯）。结果64例患者达到完全稳定的供者植入，WBC植活中位时间15d（BMT组16d；PBSCT组12d，P〈0．01）。45例患者发生急性GVHD（aGVHD），累积发生率为71．16％，其中28例患者发生Ⅰ～Ⅱ度GVHD，累积发生率57．15％；17例患者发生Ⅲ～Ⅳ度GVHD，累积发生率32．25％；COX模型分析得出HLA配型及移植方式是影响aGVHD发生的因素，HLA配型相合、采用G-CSF动员的PBSCT可以降低aGVHD，尤其是重度GVHD的发生。可供分析的36例患者中有21例发生慢性GVHD。66例接受移植的患者中复发6例，死亡27例，5年的预期生存率为52．91％。用COX模型分析得出aGVHD以及aGVHD与GVHD的预防方案的交互冈素是影响生存率的惟一因素，其相对危险度分别为1.517和1.255。结论提高非血缘关系allo-HSCT疗效的关键是控制aGVHD，而选择HLA配型相合的供者，加强移植早期的免疫抑制，可以减少aGVHD的发生     

Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade

The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post‐ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting.     

1例结肠癌术后伤口裂开合并肠造口皮肤黏膜分离的护理体会

造口皮肤黏膜分离是造口术后并发症之一,指造口与其周边皮肤部分或完全分离。皮肤黏膜分离后形成的开放性伤口,可浅可深,通常到皮下层。我院于2012年6月收治1例老年结肠癌患者,行手术切除后．出现肠瘘、肠梗阻,即行第2次手术,     

Case Report: Dealing with a Ventilation Complication after Successful Cricothyrotomy

Background

Cricothyrotomy is a rare procedure in the Emergency Department, but necessary in cases where endotracheal intubation has failed and the patient cannot be ventilated. After establishing a cricothyrotomy, ventilation may be difficult, depending on the etiology of the patient’s respiratory failure.

Objectives

This case highlights a successful cricothyrotomy that needed further direct intervention to correct an air leak from the patient’s mouth.

Case Report

A novel double-bag technique (DBT), where an Ambu^® bag (Ambu Inc., Glen Burnie, MD) was connected to the cricothyrotomy catheter and another Ambu bag placed over the mouth and nose, was employed to help solve the post-cricothyrotomy air leak problem.

Conclusion

It was only after this DBT technique was initiated that we were able to properly ventilate and oxygenate the patient.