加速康复外科理念下的日间手术麻醉管理

加速康复外科（enhanced recovery after surgery, ERAS）旨在通过多学科参与的循证干预措施改善围手术期结果,ERAS理念的实施已被证明可减少术后并发症与住院时长。ERAS理念下的麻醉管理是日间手术安全与平稳进行的基础。该文总结了国内外最新临床研究证据,从术前优化、麻醉方式选择、通气策略、液体管理、体温支持、疼痛管理、术后恶心呕吐预防、术后营养支持、改善术后睡眠等方面对ERAS理念下的日间手术麻醉管理进行综述,旨在为日间手术的麻醉管理提供参考。     

日间手术患者术后镇痛进展

越来越多的复杂手术在门诊完成,足够的术后镇痛决定患者是否可以早期安全离开医院。术后镇痛技术已由传统的阿片类药物静脉自控镇痛和椎管内镇痛向多模式镇痛转变。多模式镇痛技术运用更小量的阿片类药物,联合非阿片类药物,如非甾体类抗炎药、对乙酰氨基酚、局麻药、糖皮质激素、NMDA受体拮抗剂、α2肾上腺素能激动剂等,在术后镇痛的同时减少阿片类药物副作用,便于患者早期活动和康复。     

集束化策略对日间腹腔镜胆囊手术患者术后恶心呕吐的影响

目的 探讨集束化麻醉管理策略是否能降低术后恶心呕吐(postoperative nausea and vomiting,PONV)风险。方法 回顾性收集2021年7月—11月四川大学华西医院日间手术中心收治的腹腔镜胆囊切除术患者的病例资料。根据是否按照集束化策略实施麻醉管理分为集束化策略组及对照组。分析比较两组患者的一般资料、术中麻醉管理方式、术后情况与PONV发生率。结果 共纳入患者314例。其中,集束化策略组124例,对照组190例;发生术后恶心呕吐52例,PONV发生率为16.6%(52/314)。除手术时间、术毕切口浸润外(P>0.05),两组患者的年龄、性别、体质量指数、麻醉时间、建立气道方式及术毕镇痛药使用比较,差异均有统计学意义(P<0.05)。集束化策略组和对照组发生PONV比较(17 vs. 35例),差异无统计学意义(χ²=1.205,P>0.05)。Logistic回归分析结果显示,PONV与性别[比值比=0.107,95%置信区间(0.030,0.375),P<0.001]、采用集束化策略[比值比=0.388,95%...     

小儿全麻术后突发屏气的应急护理

我院自1988年1月至1995年1月间，在全麻下行小儿手术523例，术毕苏醒期突发屏气12例(占2．29％)，我们对12例突发屏气小儿的急救护理做如下探讨。     

小儿日间腹腔镜下腹股沟疝修补术后的近期随访分析

目的探讨小儿日间腹腔镜下腹股沟疝修补术后健康宣教近期随访的效果与作用。方法对2012年1月-8月收治的803例行腹腔镜下腹股沟疝修补日间手术术后患儿进行分组研究,对照组实施常规护理,试验组在常规护理基础上增加出院后专人电话随访及再次健康指导,并针对患儿出现的护理问题及家长的疑问进行护理干预及解答。同时就两组患儿出院后家长带患儿返回病房、来电咨询、健康知识的知晓率、对护理工作的满意率及术后不适的发生率进行比较分析。结果试验组返回病房、来电咨询及术后不适少于对照组（P〈0．05）;试验组的满意度、健康知识知晓率高于对照组（P〈0．05）。结论术后随访可及时解决日间手术患儿术后出现的护理问题及家长的疑惑、顾虑,降低家长带患儿返回病房咨询的发生率,确保医疗工作的持续有序进行。     

小儿腹股沟疝日间手术的围手术期护理

目的:分析并评价日间手术应用于小儿腹股沟疝的围术期护理模式。方法:对我院2013年1~6月收治的200例日间手术的腹股沟疝患儿的围术期护理模式进行分析。结果:200例患儿均顺利完成日间手术,其中197例当日下午如期完成手术,3例由于禁食时间短而转为次日上午手术,并留院观察1 d。苏醒期间有3例恶心呕吐,1例呛咳,3例体温超过38℃,未发生严重并发症。结论:只有不断完善并规范日间手术的围术期护理模式,才能确保日间手术取得令人满意的疗效。     

多模式疼痛管理下日间手术患者术后疼痛的影响因素分析

目的 了解日间手术患者术后急性疼痛发生率及疼痛程度,探讨术后中重度疼痛的影响因素,为日间手术疼痛管理提供参考。方法 采用便利抽样法,选取2020年4月-8月四川大学华西医院多模式疼痛管理下的日间手术患者,调查患者的一般情况、手术情况及术后疼痛情况等。按患者术后疼痛程度分为轻微疼痛组和中重度疼痛组,采用logistic回归分析探讨两组患者术后疼痛的影响因素。结果 最终纳入509例患者,其中69例患者出现中重度疼痛。Logistic回归分析显示,患者年龄[比值比（odds ratio,OR）=0.970,95%置信区间（confidence interval,CI）(0.946,0.993),P=0.012]、疼痛阈值[OR=1.348,95%CI(1.048,1.734),P=0.020]和术后有无引流管[OR=2.752,95%CI(1.090,6.938),P=0.017]是术后中重度疼痛的影响因素。结论 在多模式疼痛管理下,日间手术患者的中重度疼痛发生率较低,医护人员应从疼痛影响因素着手进一步加强疼痛管理,减少患者术后中重度疼痛的发生率。     

Postoperative Voiding Criteria for Ambulatory Surgery Patients

The number and types of surgeries being performed in ambulatory surgery facilities have increased during the past several years. Many surgeries that were once performed on an inpatient basis routinely occur in outpatient settings today.Patients are required to meet certain discharge requirements and, occasionally, voiding is included in this criteria. Requiring patients to void postoperatively, however, can unnecessarily delay a patient's discharge and contribute to increased anxiety for the patient.This article provides a case study with discussion, a literature review regarding postoperative voiding and urinary retention in ambulatory surgery, and recommendations for future research regarding postoperative voiding criteria for low-risk outpatients. AORN J 89 (May 2009) 871-874. © AORN, Inc, 2009.     

Aromatherapy Blend for Postoperative Nausea in Ambulatory Surgery Patients

PurposePostoperative nausea (PON) is one of the most common undesirable outcomes after surgery and increases patient dissatisfaction, hospital costs, and risk for postoperative complications. This quality-improvement project implemented and evaluated the effect of aromatherapy on nausea in adult postoperative patients.DesignQuality improvement project evaluating the inhalation of a blend of essential oils through an individual stick via an aroma stick.MethodsThis quality-improvement project was implemented in a postanesthesia care unit (PACU) in the Northeastern United States that averages 300 adult patients per month. Over the course of 12 weeks in the Fall of 2019, the project sample included all PACU registered nurses and patients with PON without allergies to inhalation agents or nasal surgery.FindingsOne hundred percent of PACU registered nurses (n = 20) were educated and demonstrated competence in the aromatherapy intervention; 70.6% (n = 36) of patients with PON used an aroma stick for PON treatment. Of the patients receiving the aroma stick for PON, 94.4% (n = 34) had improved PON scores.ConclusionsAromatherapy is an effective nonpharmacological treatment in reducing PON score for patients recovering from surgery. These results offer support for nursing practice to use aromatherapy as an additional method to enhance patient experience, improve outcomes, and reduce cost in recovery rooms.     

Prediction of Postoperative Ambulatory Status 1 Year After Hip Fracture Surgery

Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery.

Objectives

To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status.

Design

Cohort study.

Setting

Twelve hospitals belonging to the regional network for hip fracture in Japan.

Participants

The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers.

Interventions

Not applicable.

Main Outcome Measures

We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status.

Results

In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (ρ=0.6, P<.001).

Conclusions

In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery.     

日间手术病房管理护理模式实践

日间手术病房能使手术后病人在短期内得到有效的治疗、护理和健康教育。本文结合日间手术病房的流程特点,报道了日间手术病房患者接待、治疗、护理、医疗安全、健康教育、术后随访等环节的病房管理护理模式实践。临床实践结果显示,日间手术病房能有效保障病人医疗安全,降低病人住院天数,减少病人医疗费用,病人满意度达98%以上。     

膈肌膨升症患儿的术后护理

小儿膈肌膨升症属膈肌无力类疾病 ,是由于膈肌肌纤维发育不全或膈神经麻痹而造成某部分或某侧膈肌不正常的升高 ,临床上较为少见。该病常伴有呼吸、消化系统功能障碍、营养不良及其他并发症 ,且病情隐匿 ,变化迅速。我院自 1990年—2 0 0 1年共收治 2 2例 ,均行手术治疗 ,效果满意。现将术后护理体会总结如下。1　临床资料本组 2 2例中男 12例 ,女 10例。年龄最小出生后 8h ,最大8岁 ,其中 1岁以内 18例。 2 1例为先天性膈肌膨升 ,1例婴儿为产伤所致 ,同时伴有双侧斜颈。 2 2例均伴有反复发作性咳嗽、气促或复发性肺炎。 3例有呼吸困难、发…     

Management of Dilutional Coagulopathy during Pediatric Major Surgery

Perioperative dilutional coagulopathy is a major coagulation disorder during adult and pediatric surgery. Although the main underlying mechanisms are comparable, data of the development and management of dilutional coagulopathy in children are scarce. Observational data showed that intraoperative coagulation disorders mainly based on complex disturbances of clot firmness including acquired fibrinogen as well as factor XIII deficiencies, while clotting time and platelet counts remained fairly stable. A fast and reliable monitoring of the entire coagulation process (e.g. thrombelastometry) might be of extreme value for detection and guidance of effective coagulation management. Although the transfusion of fresh frozen plasma was recommended in several guidelines, the use of coagulation factors might offer an alternative and potentially superior approach in managing perioperative coagulation disorders. Further studies are urgently needed to determine the efficacy of modern coagulation management.