老年妇科恶性肿瘤手术患者术前合并症与术后并发症的观察及护理

目的 根据老年妇科恶性肿瘤手术患者的临床特点,探讨患者术前合并症与术后并发症的护理方法.方法 将我院2011年2月～2012年2月收治的86例老年妇科恶性肿瘤患者随机分为两组:对照组和观察组各43例.对照组:给予围手术期常规护理;观察组根据老年妇科恶性肿瘤患者术前合并症特点,进行综合护理.比较2组术后并发症、术中出血量、住院时间.结果 观察组术后并发症发生率、术中出血量及住院时间均明显少于对照组,差异有显著意义(P＜0.05).结论 针对老年妇科恶性肿瘤患者术前合并症特点,开展优质护理,有利于患者安全度过围手术期.     

老年妇科恶性肿瘤33例围术期护理

目的:探讨老年妇科恶性肿瘤患者围术期护理方法.方法:回顾性总结33例老年妇科恶性肿瘤患者围术期护理方法.结果:33例老年妇科恶性肿瘤患者术后恢复良好,无严重并发症发生.结论:对老年妇科恶性肿瘤患者做好术前、术中及术后护理,密切观察病情变化,能够预防感染等并发症的发生.     

老年妇科手术104例临床分析

目的：探讨60岁以上老年妇女行妇科手术的病程特点、合并症的防治及围手术期的处理。方法：对104例60岁以上妇科手术患者的资料进行回顾性分析。结果：资料显示老年妇科手术中的生殖道肿瘤占68.27%,其次为生殖道陈旧创伤性疾病占26.92%。术中可出现低血压,术后可并发肺部感染、切口裂开等并发症。结论：术前充分准备,术中、术后加强监护,老年妇科患者可以安全渡过围手术期。     

妇科老年患者围术期的护理

探讨60岁以上患者妇科疾病的临床特点、病种类型及围手术期相关问题与护理对策.对81例60岁以上妇科住院患者进行回顾分析.资料显示老年妇科疾病中以生殖器恶性肿瘤(39.6%)和子宫脱垂伴阴道壁膨出(23.78%)最常见.阴道流血、白带异常为最常见临床症状.81例手术治疗患者安全渡过围手术期.根据老年妇科疾病的临床特征进行早期诊断,早期治疗、手术方式选择恰当,术前准备充分,加强术中、术后护理,绝大多数老年妇科患者能顺利渡过围手术期,健康生活.     

高龄妇科恶性肿瘤43例围术期护理

目的:探讨高龄妇科恶性肿瘤患者的围术期护理方法.方法:对43例高龄妇科恶性肿瘤患者实施手术治疗,术前做好心理护理、合并症护理及各项准备工作,术后密切观察病情变化,做好并发症预防及护理.结果:本组手术顺利,术后并发尿潴留1例、肠梗阻1例,经治疗均痊愈出院.结论:加强围术期护理可有效提高手术成功率,减少并发症的发生.     

老年妇科患者围手术期的特点及护理

目的:探讨老年妇科患者围手术期的特点及护理经验,提高老年妇女手术治疗护理水平以及术后生活质量。方法:将2007年10月～2008年12月我院收治72例老年妇科患者(60～89岁)作为研究组,并随机抽取同期72例中年妇女患者(40～59岁)为对照组,分析两组患者围手术期的特点并进行统计学分析。结果:数据显示研究组中61.1%的患者有高血压、冠心病、糖尿病等合并症,明显高于对照组(P0.05)。两组患者术后在心力衰竭、肺部感染、血栓、切口愈合不良等并发症方面的比较无显著性差异(P0.05)。结论:只要掌握老年妇科患者围手术期的特点,在围手术期做好充分的准备及术后认真监护,加强护理,老年妇女患者可以安全渡过围手术期。     

老年患者妇科手术74例临床分析

目的探讨老年妇科患者手术的可行性、安全性。方法对74例75岁以上的妇科手术患者进行了回顾性统计学分析结果本组老年妇女罹患妇科疾病以卵巢肿瘤，子宫脱垂、子宫肌瘤为主。术前有各种合并症者58例(78．3％)，以心血管疾病为最多(51．4％)，其中高血压病居首位(31．1％)，74例手术患者均安全度过围手术期。结论对老年妇科疾患，只要手术选择适宜，术前准备充分，术中、术后加强监护，患者是可以安全渡过围手术期的．     

老年妇科手术围术期合并症与并发症的护理管理

目的根据妇科手术临床特点、手术合并症与并发症及老年女性自身生理特点,探讨提高其围手术期护理管理的方法。方法对168例≥60岁妇科手术患者的合并症和术后出现并发症的16例,进行护理管理,并做回顾性总结。结果患者均安全完成即定手术,术中未出现并发症,术后并发症16例,均经对症治疗治愈或好转出院,无一例围手术期死亡。结论针对老年患者的特点,加强围手术期的合并症、并发症护理管理,就可以提高护理质量及安全性,促进康复和治愈。     

老年妇科病人42例分析

目的：探讨老年妇科病人的围术期经验，提高老年妇女手术治疗水平，方法：对1996年1月2至2000年12月本院收治的60岁以上老年妇产科病人42例围术期资料分析。结果：资料显示老年妇科手术患者中83．3％病人合并合心血管方面的疾病和糖尿病等疾患，老年妇女疾病中恶性肿瘤占第一位42．8％，子宫脱垂占第二位33．3％，良性肿瘤23．8％，术后有发生心衰，切口愈合不全，肺感染及下肢静脉等并发症，结论：只要充分术前准备积极控制合并症，选择适当术式及麻醉方式，术中术后严格监护，大多数老年病人能安全渡过围术期。     

老年妇科恶性肿瘤221例分析

目的：探讨60岁以上老年妇科恶性肿瘤的临床特点及手术相关问题。方法：对221例老年妇科恶性肿瘤手术治疗患者的临床资料进行回顾性分析。结果：643例老年妇科疾病以生殖道肿瘤（65．9％）和子宫脱垂（19．9％）为主，221例恶性肿瘤中，卵巢癌124例（包括交界性），子宫内膜癌52例，子宫肉瘤3例，宫颈癌33例，外阴癌7例，输卵管癌2例。术前合并症182例，占82％，容易合并心血管、糖尿病和呼吸系统疾病，术后并发症38例（17．4％）。结论：老年妇科恶性肿瘤以卵巢癌和子宫内膜癌为主，加强围手术期的处理，手术安全性较高。     

结直肠癌手术并发症及其影响因素分析

目的：探索结直肠癌患者手术并发症发生情况及其影响因素。方法选取2012年1月至2013年5月间在我院进行手术治疗的结直肠癌患者274例为研究对象,收集他们的临床资料,运用 SPSS 16.0统计软件对数据进行单因素和Logistic回归分析找出对结直肠癌手术并发症有影响的因素。结果结直肠癌患者手术并发症的总发生率为22.23%,肺部感染、伤口感染是最常见的并发症。单因素分析显示内科合并症（P＝0.000）、手术时间（P＝0.022）和Dukes分期（P＝0.012）会影响术后并发症发生。Logistic回归分析显示内科合并症（P＝0.001,OR＝5.213,95%CI 1.124～15.323）和手术时间（P＝0.002,OR＝16.231,95%CI 2.313～16.930）是术后并发症发生的危险因素。结论性别、年龄、烟酒史、肥胖情况、手术方法、麻醉方式、术中失血情况和中转手术并非结直肠癌患者术后并发症的危险因素,而治疗术前内科合并症,缩短手术时间,尽早治疗能够有效地减少术后并发症发生。     

老年恶性胃肠肿瘤临床病理特征及术后并发症相关因素分析

[目的]分析老年恶性胃肠肿瘤患者临床病理特征及术后并发症发生情况.[方法]本院进行手术治疗的80例老年(年龄＞65岁)恶性胃肠肿瘤患者按术后有无并发症分为并发症组(n =26)与无并发症组(n=54),比较分析患者临床病理特点及术后并发症相关影响因素.[结果]①80患者中,26例术后出现并发症,并发症发生率为32.50％(26/80),以切口感染、肺部感染、心血管病发生率最高,其次为肝肾功能异常、吻合口瘘;②术后发生并发症组男性所占病例高于无并发症组,且其手术时间、年龄均大于无并发症组,两组合并症、TNM分期、病理分化程度、淋巴结清扫情况、淋巴结转移发生率等相比较差异均有显著性(P＜0.05);③多因素回归分析显示:年龄、手术时间、术前合并症、淋巴结清扫类型、病理分化程度是影响胃肠道恶性肿瘤患者术后并发症发生的独立危险因素(P＜0.05).[结论]年龄、性别、病理分化程度、淋巴结清扫、术前合并症均为影响老年胃肠道恶性肿瘤患者术后并发症发生率的独立危险因素,临床应积极控制相关危险因素.     

Preparing the medically compromised patient for surgery

Preparing the medically compromised patient for surgery requires identifying and treating preoperative risk factors and anticipating postoperative complications. Preoperative evaluation of all patients should include careful screening for bleeding disorders and prior anesthetic complications and assessment of nutritional status. In addition, patients with preexisting cardiac, pulmonary, and endocrine problems must be identified, since these problems represent the greatest risk factors for postoperative complications. Perioperative care is more effective when directed at specific organ systems. Communication among internists, anesthesiologists, and surgeons promotes optimal treatment for surgical patients with medical illness.     

Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy

BACKGROUND Pancreaticoduodenectomy(PD) is a complex surgical procedure with a high morbidity rate. The serious complications are major risk factors for poor longterm surgical outcome. Studies have reported an association between early postoperative prognostic nutritional index(PNI) and prediction of severe complications after abdominal surgery. However, there have been no studies on the use of early postoperative PNI for predicting serious complications following PD.AIM To analyze the risk factors and early postoperative PNI for predicting severe complications following PD.METHODS We retrospectively analyzed 238 patients who underwent PD at our hospital between January 2007 and December 2017. The postoperative complications were classified according to the Dindo-Clavien classification. Grade Ⅲ-Ⅴ postoperative complications were classified as serious. The risk factors for serious complications were analyzed by univariate analysis and multivariate logistic regression analysis.RESULTS Overall complications were detected in 157 of 238 patients(65.9%) who underwent PD. The grade Ⅲ-Ⅴ complication rate was 26.47%(63/238 patients).The mortality rate was 3.7%(9/238 patients). Multivariate logistic regression analysis revealed that preoperative serum albumin [odds ratio(OR): 0.883, 95%confidence interval(CI): 0.80-0.96; P < 0.01] and PNI on postoperative day 3 <40.5(OR: 2.77, 95%CI: 1.21-6.38, P < 0.05) were independent factors associated with grade Ⅲ-Ⅴ postoperative complications.CONCLUSION Perioperative albumin is an important factor associated with serious complications following PD. Low early postoperative PNI(< 40.5) is a predictor for serious complications.     

Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly

Although chest physical therapy (PT) immediately after surgery lowers the risk of postoperative pulmonary complications, several reports indicate preoperative chest PT results in further improvement. This study compares the effects of initiating chest PT either before and/or after chest surgery in patients over age 65. We studied two groups: 130 patients (the PRE group) undergoing both pre- and postoperative therapy and 150 patients (the POST group) undergoing only postoperative therapy, dividing them into four surgical subgroups: lung, cardiac and other thoracic surgery, upper abdominal, and lower abdominal (considered low risk compared with the other three). Overall complication rates and atelectasis rates were significantly lower in the PRE high-risk subgroups. PRE and POST pneumonia rates, however, were statistically equivalent in all surgical subgroups. Since the low rate of pulmonary complications for PRE-group patients undergoing thoracic or upper abdominal procedures is comparable to that for PRE-group therapy in much younger populations, advanced age alone does not appear to be a significant risk factor. The lack of effect on incidence of pneumonia indicates that preoperative chest PT only counters the altered pulmonary mechanics responsible for atelectasis, but has no effect on pulmonary complications due to infection.     

A preoperative scoring system to identify patients requiring postoperative high dependency care.

INTRODUCTION: The incidence of postoperative complications is reduced with early identification of at risk patients and improved postoperative monitoring. OBJECTIVE: A nursing preoperative assessment tool was developed to identify patients at risk of postoperative complications and to reduce the number of acute admissions to ICU/HDU. METHOD: All surgical patients admitted to a surgical ward for an elective surgical procedure (n=7832) over a 23-month period were concurrently scored on admission using the preoperative assessment tool. RESULTS: During the time period studied, acute admissions to ICU/HDU reduced from 40.37 to 19.11%. DISCUSSION: Only 24.04% of patients who had a PAS >4 were identified by the surgeon and/or anesthetist as being at risk of a postoperative complication, or if identified, no provision was made for improved postoperative monitoring. This supports the need for nurses to be involved in identifying preoperatively patients at risk of a postoperative complication and in need of improved postoperative monitoring. The postoperative monitoring requirements for the PAS >4 patients were relatively low technology interventions. CONCLUSION: The preoperative assessment tool is a simple and effective tool for nurses to identify patients at risk of postoperative complications and reduces the number of acute admissions to ICU/HDU.     

食管癌术后并发肺部感染的危险因素分析

目的分析影响食管癌术后并发肺部感染的危险因素。方法选取本院2018年3月至2019年12月收治的100例接受手术治疗的食管癌患者。统计食管癌患者术后并发肺部感染的发生情况,并分析食管癌术后并发肺部感染的相关危险因素。结果手术治疗后,共19例患者发生肺部感染,肺部感染发生率为19.00%(19/100)。并发肺部感染的患者中,年龄≥65岁、体质量≥25 kg/m2、有长期吸烟史、术前合并肺部感染、手术路径2~3个、有喉返神经损伤、合并糖尿病、术前血清白蛋白<35 g/L、单肺通气的患者占比显著高于未并发肺部感染患者(P<0.05)。多元回归性分析显示,长期吸烟史、喉返神经损伤、糖尿病、术前血清白蛋白水平及通气方式为食管癌患者术后并发肺部感染的危险因素(P<0.05)。结论导致食管癌术后并发肺部感染的危险因素较多,临床医务人员需分析患者的身体状况于围手术期开展合理的预防措施,以促进预后改善。     

Preoperative medical consultation and evaluation of surgical risk

Internists are frequently asked to assess the surgical risk of patients with various medical problems. Numerous recent prospective studies have defined specific risk factors for increased morbidity and mortality in the preoperative evaluation of surgical patients. Careful attention to such factors as age, type of operation and anesthesia, underlying pulmonary, hypertensive, cardiac, renal, hepatic, endocrine, and hematologic diseases, and nutritional status can reduce the complication rate and death rate in surgical patients if specific preoperative, operative, and postoperative therapeutic maneuvers are instituted. A comprehensive comparative analysis by the internist, surgeon, and anesthesiologist should be made on all high-risk surgical patients to improve their medical care.     

胆囊切除术病人实施临床路径的影响因素分析

[目的]探讨可能影响胆囊切除术临床路径的因素,分析影响胆囊切除术住院天数和住院费用的主要因素,识别临床路径中的变异。[方法]调取2003年6月—2004年6月胆囊切除手术病历206份资料信息,对病人年龄、性别、诊断、术前合并症、手术时机、术式、输液量、术后并发症、住院天数、住院费用等进行单因素及多元回归分析,筛选出影响住院天数和住院费用的主要因素。[结果]单因素分析显示:手术时机、术前合并症对住院天数的影响存在统计学差异;年龄、诊断、术前合并症、术式、手术时机对住院费用的影响存在统计学差异。多元逐步回归分析显示:对住院天数有影响的4个主要因素是术后并发症、术前合并症、手术时机、术式,其中术后并发症影响最大;对住院费用有影响的4个主要因素是术式、输液天数、术后并发症、住院天数,其中术式影响最大。[结论]年龄、诊断、手术时机、术前合并症、输液天数、术前住院天数、术后住院天数、术式等是单纯胆囊切除术临床路径中影响住院天数和住院费用的变异因素。     

风险护理与集束化护理在腹腔镜妇科手术患者中的应用价值

目的 探讨对腹腔镜妇科手术患者实施风险护理与集束化护理的临床价值。方法 选择2021年8月-2022年2月100例妇科患者,均在本院行腹腔镜手术治疗。根据随机数字表法将患者分为参考组、护理组,均50例。参考组实施基础性护理模式,将风险管理、集束化护理联合应用于护理组。借助量表评价两组患者心理弹性水平,统计两组临床指标、术后康复指标,比较并发症发生情况。结果 护理组护理后心理弹性量表评分高于参考组,差异有统计学意义(P<0.05)。护理组手术时间、术后首次下床时间、胃肠功能恢复时间、住院时间均短于参考组,术中出血量低于参考组,差异有统计学意义(P<0.05)。护理组并发症发生率略低于参考组,但两组差异未见统计学意义(P>0.05)。结论 风险护理与集束化护理能够提升腹腔镜妇科手术患者心理弹性水平,提高手术效率并促进术后康复进程,有利于避免此类手术并发症的发生,确保其治疗安全性。