同期放化疗鼻咽癌患者的集束化营养管理

目的 探讨同期放化疗鼻咽癌患者行集束化营养管理的效果。方法 便利选取接受同期放化疗的初治鼻咽癌患者134例,将患者随机分为对照组(66例)和观察组(68例)。对照组行常规营养管理;观察组行集束化营养管理,包括营养知识教育、营养评估筛查、保证营养摄入、治疗相关症状的预防及处理、康复运动指导、心理支持。干预前后评价两组营养摄入达标情况、营养不良与疗程延后发生率,体重指数、血红蛋白、血清白蛋白和前白蛋白值。结果 干预后,观察组营养不良与疗程延后发生率显著低于对照组,体重指数、白蛋白、血红蛋白、前白蛋白、75%能量摄入达标率和75%蛋白质摄入达标率显著高于对照组(P<0.05,P<0.01)。结论 集束化营养干预可显著改善同期放化疗鼻咽癌患者营养状况,降低患者营养不良发生率。     

袋鼠肠内营养电子泵在鼻饲患者中的应用

目的观察袋鼠肠内营养电子泵在鼻饲患者中的应用效果。方法将120例老年鼻饲患者随机分为两组各60例。对照组应用普通肠内营养泵鼻饲,观察组应用袋鼠肠内营养电子泵,鼻饲3个月后对两组鼻饲效果进行比较。结果观察组鼻饲期间胃潴留、腹泻发生率显著低于对照组(P<0.05,P<0.01);其营养支持效果显著优于对照组(P<0.01)。结论应用袋鼠肠内营养电子泵控制鼻饲液输注,能有效预防鼻饲并发症发生,提高肠内营养支持的效果,促进胃肠功能恢复。     

集束化管理在ICU肠内营养患者的应用

目的 探讨集束化管理用于ICU肠内营养(EN)患者降低EN并发症的效果.方法 将ICU300例行EN患者按入院时序分为常规组和集束化组各150例.常规组按EN护理常规施护;集束化组在此基础上进行集束化护理.结果 两组患者ICU住院时间、并发症(胃肠道、代谢、感染、心理)发生率及病死率比较,差异有统计学意义(均P＜0.01).结论 对ICU行EN患者实施集束化管理,可减少并发症发生率,对患者预后有积极作用.     

新型布尼亚病毒感染患者预防医院感染的集束化护理

目的探讨运用循证研究的方法构建集束化护理方案对预防新型布尼亚病毒感染患者医院感染的效果,为临床防治提供参考。方法将2013年3月至2014年12月27例新型布尼亚病毒感染患者作为对照组,采取常规护理;将2015年1月至2016年11月收治的51例作为集束化组,采取基于循证的集束化护理方案,观察实施集束化护理的临床效果。结果集束化组医院感染发生率相对低于对照组,但两组比较,差异无统计学意义(P>0.05);集束化组健康知识知晓合格率显著高于对照组(均P<0.05)。结论新型布尼亚病毒感染致发热伴血小板减少综合征是近年新发的感染性疾病,起病急,病情重,运用循证研究的方法构建和应用集束化护理方案,可预防患者医院感染的发生,促进早日康复。     

ICU患者肠内营养加入少量食醋预防腹泻

目的预防ICU患者早期肠内营养腹泻并发症。方法将ICU 100例实施早期肠内营养的患者随机分为观察组和对照组各50例,对照组常规肠内营养,观察组常规肠内营养后鼻饲食醋20mL,连续10d后评价效果。结果观察组并发腹泻11例,对照组34例,两组比较,差异有统计学意义(P<0.01)。结论肠内营养加入少量食醋可降低腹泻发生率。     

基于肠内营养耐受性评分的俯卧位通气患者早期肠内营养实施

目的 探讨肠内营养耐受评估表在急性呼吸窘迫综合征（ARDS）行俯卧位通气患者早期肠内营养（EN）中的应用效果。方法 将2014年12月至2019年12月收治的ARDS行俯卧位通气患者30例，按入科时间分为对照组（n=12）和观察组（n=18）。对照组按常规护理方法实施早期肠内营养，观察组在常规护理基础上应用肠内营养耐受评估表指导早期肠内营养的实施。比较两组俯卧位通气治疗期间EN耐受情况、72 h内70%目标热量达标率、达70%目标热量时间，机械通气时间、俯卧位通气时间、俯卧位通气前后前白蛋白指标及ICU住院时间等。结果 观察组达70%目标热量的时间显著短于对照组（P<0.05）,且观察组喂养量及72 h内70%目标热量达标率显著高于对照组（P<0.05，P<0.01）。两组胃肠道并发症发生率及预后指标方面比较，差异无统计学意义（均P＞0.05）。结论 肠内营养耐受性评估表在指导行俯卧位通气治疗患者早期肠内营养的护理中具有重要的价值，能规范早期肠内营养方案，及早发现并积极防治肠内营养不耐受情况，对提高俯卧位通气患者早期肠内营养支持成功率有重要的意义。     

集束化管理对静脉留置针预防静脉炎的护理研究

目的 探讨应用集束化管理（Bundles of Care）对静脉留置针的ICU患者预防静脉炎的临床实践和护理研究。方法 将2012-01-2013-12 ICU222例应用静脉留置针的患者作为研究对象,随机分为对照组和集束化组,对照组采用常规的静脉留置针护理方法;集束化组采用集束化管理方法进行静脉留置针的护理;比较2组静脉炎的发生率。结果 集束化组静脉炎发生率为8.11%,对照组为28.83%,2组比较有显著差异（P〈0.05）;集束化组在应用静脉留置针的ICU患者中预防静脉炎发生率方面明显低于对照组。结论 集束化管理措施能有效预防应用静脉留置针ICU患者静脉炎的发生率。     

集束化护理预防ICU患者导尿管相关性尿路感染(CAUTI)的效果

目的探讨集束化护理预防ICU患者导尿管相关性尿路感染(CAUTI)的效果。方法选取2016-12-2019-01间入住ICU留置导尿管的60例患者作为研究对象。将2016-12-2017-12间入住ICU的28例患者作为对照组,予以常规护理。将2018-01-2019-01间入住ICU的32例患者作为观察组,采用集束化护理。比较2组ICU入住时间、CAUTI发生率、导尿管留置时间及护理工作满意度。结果观察组患者ICU入住时间短于对照组,差异有统计学意义(P<0.05)。入住ICU期间观察组患者的CAUTI发生率均低于对照组,导尿管留置时间短于对照组,患者及家属对护理工作满意度高于对照组,差异均有统计学意义(P<0.05)。结论对入住ICU留置导尿管的患者采取集束化护理,能降低CAUTI的发生率,缩短康复时间,提高患者及家属对临床护理工作的满意度。     

集束化鼻饲护理预防喉切除患者胃部不适

目的探讨集束化鼻饲护理预防喉切除患者胃部不适的效果。方法将117例喉切除患者随机分为观察组59例和对照组58例。对照组给予常规鼻饲护理,观察组给予集束化鼻饲护理,包括胃管的选择、鼻饲液的选择、鼻饲体位、鼻饲方式与鼻饲速度、胃残留量监测。结果观察组恶心呕吐、胃胀气、烧灼感发生率显著低于对照组,且留置胃管时间显著短于对照组(P0.05,P0.01)。结论采用集束化鼻饲护理措施能有效预防喉切除患者术后胃部不适,缩短胃管留置时间,促进患者舒适。     

腹内压监测在危重患者早期肠内营养中的应用效果

【摘要】〓目的〓探讨腹内压监测技术在指导危重患者实施早期肠内营养支持中的应用效果。方法〓将重症监护病房(ICU)95例实施早期肠内营养支持患者分为实验组48例和对照组47例,实验组采用腹内压监测+常规肠内营养护理策略,对照组采用常规肠内营养护理策略。比较两组患者早期肠内营养并发症的发生情况、肠内营养实施天数、ICU住院天数、MODS发生率和死亡率。结果〓实验组胃潴留、腹胀、反流等并发症的发生率均明显低于对照组,肠内营养实施天数及ICU住院天数均少于对照组,差异均具有统计学意义(P<0.05)。实验组中3例发展为MODS,2例死亡;对照组有10例MODS,8例死亡。结论〓腹内压水平可作为指导危重患者合理开展早期肠内营养的有效指标,对降低肠内营养并发症和改善患者预后起积极作用。     

Meeting the Challenge of Managed Care Through Clinical Pathways for Bariatric Surgery

Background: The 1990s will bring sweeping changes in managed care and capitation. Health care providers are continually searching for new ways to improve the quality of patient-care outcomes in the obese. Improving clinical care by promoting the use of processes that have been proved to yield optimal outcomes has become a powerful strategy for measuring the value of services provided. Methods: To address this cost/quality paradox, an optimal care path (OCP) was developed as a guideline for all patients undergoing gastric bypass or laparoscopic adjustable gastric banding. A transdisciplinary team developed the OCP, preprinted orders, discharge home instruction sheet, and daily guidelines for patients. All patients were provided with OCPs from July 1995 to September 1997. Results: Length of stay decreased from 6.5 days to 5.4 days (16.9%); the average total charges decreased 17.6%, or $2,683; the percentage of wound infections decreased; and communication between, and collaboration of, interdisciplinary team members increased across the continuum of care. Conclusions: The study suggests that the use of OCP does not impair quality of care and can produce significant cost savings to a health care facility.     

Extensive preoperative testing is not necessary in morbidly obese patients undergoing gastric bypass

Morbidly obese patients are considered at high risk for perioperative complications and often undergo extensive testing for preoperative clearance. We analyzed prospectively collected data from 193 patients undergoing weight loss surgery between November 2000 and November 2002. Preoperative chest x-ray examination, pulmonary function tests, noninvasive cardiac testing, and blood work were performed routinely. Preoperative testing identified abnormalities on eight chest x-ray films (4%) and 29 electrocardiograms (15%), none of which required preoperative intervention. Spirometry was abnormal in 41 patients (21%); logistic regression identified preexisting asthma as predictive of obstructive physiology (odds ratio [OR] 3.3; 95% confidence interval [CI] 1.2 to 8.9), and body mass index as predictive of restrictive physiology (OR 1.1; 95% CI 1.01 to 1.2). Arterial blood gases identified only one case of severe hypoxemia requiring intervention. Mild hypoxemia was associated with increasing age (OR 14.5; 95% CI 1.8 to 114). Echocardiography demonstrated four abnormalities (2%); previous history of cardiac disease was the only risk factor (OR 14.5; 95% CI 1.8 to 114). Complete blood count did not identify 84% and 50% of the patients with iron (n = 31) and vitamin B12 (n = 12) deficiencies, respectively. Age, body mass index, and history of asthma were associated with abnormal pulmonary function tests and previous cardiac disease with abnormal cardiac testing. These tests are not mandatory as a routine preoperative evaluation and can be used selectively on the basis of medical history. Presented at the Forty-Fourth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Florida, May 18–21, 2003 (oral presentation).     

胃癌胃大部分切除术后患者的综合性饮食护理

目的探讨综合性饮食护理的可行性．促进胃癌患者康复。方法将171例进展期胃癌行毕Ⅱ式胃大部分切除术患者随机分为观察组（85例）与对照组（86例），观察组采用综合性饮食护理，根据平衡营养和色、香、味、形俱佳的饮食理念提供合理膳食，由专人负责其全过程的饮食护理。对照组采用常规饮食护理。结果两组术后6个月及12个月体重、皮褶厚度、血红蛋白测定及精神状况4项指标测定值比较．差异有显著性意义（P〈0．05，P〈0．01）。结论综合性饮食护理能改善患者的营养牡况，有利于患者康复，不失为一种安全可行的饮食护理方法。     

“互联网+”居家医疗服务平台应用效果分析

目的 分析“互联网+”居家医疗服平台的应用效果，为优化服务模式提供参考。 方法 对三级医院居家医疗服务平台数据库中2020~2021年服务对象的一般资料、平台使用情况、服务项目等数据，进行回顾性分析。 结果 纳入研究的1 780例次服务中，患者通过医护上门服务App端口获取服务1 683例次，通过互联网医院线上问诊端口获取服务67例次,通过互联网医院医联体服务端口获取服务30例次；提供服务者多为护士（1 451例次），其次为医生（245例次）；服务量排在前3位的项目分别是尿管护理（39.04%）、伤口护理（18.15%）及胃管护理（12.08%）；居家医疗服务比自行前往医院就医更加实惠便捷。 结论 “互联网+”居家医疗服务平台构建了医院-社区-家庭多元联动、医护技药等多学科团队相互协作的新型医疗服务模式，可以为患者提供专业、高效、便捷的医疗服务。但还需进一步完善服务模式，使更多需求者受益。     

Waking up the Gastric Bypass Patient

Waking up the gastric bypass patient in the post-anesthesia care unit (PACU) is a continual challenge. From January 1992 to November 1996, 961 gastric bypasses (GBP) have been performed at Columbia St Mark's Hospital. Of the 961 patients, 957 came to the PACU. Four patients went directly to ICU because of respiratory status requiring mechanical ventilation. There have been no deaths and no respiratory arrests in PACU. Continuous bedside monitoring of the patient's respiratory status coupled with pain management contributed to positive care of the GBP patient. Methods of care for the GBP patient include the use of O₂ masks and cannulas, coughing and deep breathing, administering i.v. narcotics until patient controlled analgesia pumps are initiated, encouragement and emotional support, ongoing assessment of patients' status, and treating problems/needs appropriately.     

Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal

This study aimed to reappraise short-term and long-term results of palliative biliary and gastric bypass surgery in patients with unresectable pancreatic head carcinoma found at explorative laparotomy. We retrospectively analyzed 83 consecutive patients whose pancreatic head carcinoma appeared unresectable at laparotomy (vascular involvement [57%], liver metastases [24%], distant metastatic lymph nodes [11%], peritoneal implants [8%]) and who underwent palliative surgical concomitant biliary and gastric bypass. Postoperative mortality and morbidity rates were 4.8% and 26.5%, respectively. Postoperativedelayed gastric emptying occurred in 9 patients (10%). Antecolic (46%) and retrocolic (54%) gastrojejunostomies did not differ for the duration of nasogastric suction, the delay of oral intake, and the incidence of delayed gastric emptying. Mean hospital stay was 16 +- 8 days. Median survival was 9 months (range 1–44). Late cholangitis occurred in 2 patients (2.4%) treated medically. One recurrent jaundice required transhepatic stenting 9 months from surgery. Four late gastric outlet obstructions occurred (4.8%) with a mean delay of 8 months from surgery. These data demonstrate that, in patients with unresectable pancreatic head carcinoma at laparotomy, palliative concomitant biliary and gastric bypass in a single procedure is safe and long-term efficient. This strategy remains to be compared to endoscopic palliation in this setting.     

History and Technical Aspects of Bariatric Surgery in the Czech Republic

Background: Central Europe and the Czech Republic are specific in the prevalence of obesity which has increased by 10-40% during the last 10 years. Methods: In the Czech republic there is 30 years of experience of a comprehensive approach to obesity treatment which includes: dietary treatment; exercise; behavioral modification; drug treatment; and bariatric surgery. Each of these approaches has its place in complex obesity management. Since 1983 bariatric surgery has been established in the Czech Republic for the treatment of morbid obesity. Vertical banded gastroplasty (VBG), gastric banding, laparoscopic nonadjustable and adjustable gastric bandings have been used over the years. Since 1993 laparoscopic gastric banding has been the only method used in our department. Results: The comprehensive approach for obesity treatment in the Czech Republic has resulted in the development of obesity management and research centers, regional obesity units, obesity out-patients clinics and weight reduction clubs. The surgical treatment is a well-established part of this system and the long-term results of surgical treatment are acceptable both in terms of weight loss and complication rate. There has been no statistical difference in weight loss results following VBG and laparoscopic gastric banding, but there is a significant decrease in morbidity, and shorter hospital stay associated with laparoscopic gastric banding. Conclusions: The surgical approach in obesity treatment has an important place in the comprehensive care of obese patients. Laparoscopic gastric banding in the hands of an experienced surgeon is a method with low morbidity, short hospital stay and long-term weight loss results which are fully comparable with the results of other surgical approaches.     

American Society of Metabolic and Bariatric Surgery consensus statement on laparoscopic adjustable gastric band management

BackgroundLaparoscopic adjustable gastric band (LAGB) management continues to be an important part of many metabolic and bariatric surgery practices.ObjectivesTo replace the existing American Society for Metabolic and Bariatric Surgery (ASMBS) LAGB adjustment credentialing guidelines for physician extenders with consensus statements that reflect the current state of LAGB management.SettingASMBS Integrated Health Clinical Issues Committee.MethodsA modified Delphi process using a 2-stage consensus approach was conducted on LAGB management. Thirty-four consensus statements were developed following a literature search on a wide range of LAGB topics. A 5-point Likert scale was implemented to measure consensus agreement with a Delphi panel of 39 expert participants who were invited and agreed to participate in 2 rounds of Delphi questionnaires. Consensus was set a priori at 75% agreement, defined as the proportion of participants responding with agreement (i.e., 4 or 5) or disagreement (i.e., 1 or 2) on the Likert scale.ResultsConsensus was reached on 74% (25 of 34) of the LAGB management statements. In Delphi round 1, 95% (37 of 39) of the participants responded to 34 consensus statements; 21 of the statements (62%) met the 75% criteria for consensus. Thirty-one participants (80%) responded in round 2, shifting the agreement on 4 more statements to the 75% threshold.ConclusionThe ASMBS consensus statement on LAGB management is intended to guide practice with current evidence-based knowledge and professional experience. The ASMBS is not a credentialing body and does not seek to guide credentialing with this document.     

老年胃癌病人术后促进肠功能恢复措施的探讨

目的：探讨老年胃癌病人术后肠功能恢复的措施。方法：将79例病人分为观察Ⅰ组、观察Ⅱ组和对照组，对照组采用常规护理；观察Ⅰ组在常规护基础上注意早期活动；观察Ⅱ组在观察Ⅰ组基础上，施行早期肠内营养。结果：观察Ⅰ、Ⅱ组病人排便时间及观察Ⅱ组排气时间与对照组比较，差异有极显著性意义（P＜0．01），观察Ⅰ组排气时间与对照组比较，差异有显著性意义（P＜0．05）；观察Ⅱ组排气，排便时间均较观察Ⅰ组明显缩短（P＜0．01）。结论：术后早期活动并施行早期肠内营养能有效促进老年胃癌病人肠功能恢复。     

Allowing pre-operative patients to drink: effects on patients'' safety and comfort of unlimited oral water until 2 hours before anaesthesia

The effect of allowing patients unlimited access to oral water in the time up until 2 h pre-operatively was the subject of a randomised, blind, controlled trial. No effect was seen on gastric volume or pH, or on plasma osmolality, and allowing water pre-operatively was associated with a reduction in anxiety in the anaesthetic room.