无鼻胃管减压胆道手术112例报告

腹部外科围手术期放置鼻胃管行胃肠减压已成为常规．主要是为了防治术后胃肠道麻痹引起的胃潴留和腹胀．并减少切口裂开和吻合口漏的危险。但这一常规正在受到挑战。1993年至1997年间．作者行胆道手术112例，无选择地均不放置鼻胃管减压．取得了满意结果，现回顾总结如下。临床资料一、一般资料本组112例．其中男78例．女：34例．年龄26～78岁。胆囊结石42例（其中急性胆囊炎28例）．胆囊息肉7例。胆总管结石35例，肝胆管结石22例（其中急性胆管炎15例），先天性胆总管囊肿4例，肝胆管结石并肝内胆管癌2例。二、手术方式单纯胆囊切除49例，…     

圆角鼻贴及扣环夹在胃肠减压双重固定中的应用

目的探讨圆角鼻贴及扣环夹在胃肠减压双重固定中的应用效果。方法将146例普外科胃肠减压患者随机分为观察组(73例)和对照组(73例),观察组使用圆角鼻贴+扣环夹法固定胃肠减压,对照组使用直角鼻贴+挂绳法固定胃肠减压。结果观察组鼻贴卷边率、胃管脱出率显著低于对照组,鼻贴更换间隔时间显著延长,胃肠减压器固定落实率显著提高,护士粘贴鼻贴的时间及固定胃肠减压器的时间显著短于对照组(P0.05,P0.01)。结论圆角鼻贴及扣环夹应用于普外科胃肠减压双重固定,增强了固定效果,提高了工作效率,有利于促进护理安全,提高护理质量。     

新生儿胃肠减压胃管固定新法

目的寻求一种保证新生儿胃肠减压效果的胃管固定方法。方法将60例需要持续胃肠减压的新生儿随机均分为对照组与观察组。对照组按传统方法固定胃管，观察组采用改进法固定胃管，观察两组胃肠减压情况并记录。结果观察组胃管移动发生率显著低于对照组（P〈0．01），腹胀缓解效果显著优于对照组（P〈0．01），胃管脱落、面部皮肤异常显著低于对照组（P〈0．05）。结论采用改进方法固定胃管可保证胃肠减压持续通畅，降低并发症发生率。     

新生儿胃肠减压胃管固定新法

目的 寻求一种保证新生儿胃肠减压效果的胃管固定方法.方法 将60例需要持续胃肠减压的新生儿随机均分为对照组与观察组.对照组按传统方法固定胃管,观察组采用改进法固定胃管,观察两组胃肠减压情况并记录.结果 观察组胃管移动发生率显著低于对照组(P＜0.01),腹胀缓解效果显著优于对照组(P＜0.01),胃管脱落、面部皮肤异常显著低于对照组(P＜0.05).结论 采用改进方法固定胃管可保证胃肠减压持续通畅,降低并发症发生率.     

胃手术后胃肠减压的研究

将１６０例择期胃手术病人随机分二组。Ｉ组为术后不插胃管组，Ⅱ组为术后插管胃肠减压组。结果表明两组病人术后肠功能恢复时间相近（Ｐ＞０．０５），无吻合口漏、急性胃扩张等并发症，－Ⅱ组病人肺部感染明显增多（Ｐ＜０．０５），且插胃管后病人均感鼻咽部不适、恶心、术后早期不便下床活动等缺点。因此我们认为，择期胃手术后无须常规行胃肠减压，安全可靠。     

胃肠减压患者胃管置入深度的研究进展

对国内胃肠减压患者．从小儿、成人角度总结胃管置入的深度。提出在临床护理实践过程中，护理人员需根据患者身高、体型、年龄等确定置入胃管最佳深度，达到护理操作个体化，减少操作的盲目性，以提高治疗效果。     

胃肠减压患者胃管置人深度的研究进展

对国内胃肠减压患者,从小儿、成人角度总结胃管置入的深度.提出在临床护理实践过程中,护理人员需根据患者身高、体型、年龄等确定置入胃管最佳深度,达到护理操作个体化,减少操作的盲目性,以提高治疗效果.     

择期腹部手术切口的护理体会

目的总结择期腹部手术切口的综合护理体会。方法对200例择期腹部手术患者的切口采取综合护理措施,回顾性分析患者的护理资料。结果 200例患者中,196例(98%)切口甲级愈合,切口感染2例,脂肪液化2例,经对症处理3～7 d后愈合,护理满意度100%。结论做好术前心理护理,术中严格无菌操作,术后加强体位、切口及生活健康指导等综合护理干预,可有效减少患者择期腹部手术切口并发症发生率,提升护理质量。     

无胃肠减压对择期肝脏手术患者恢复的影响

目的 探讨不置胃管行胃肠减压对择期肝脏手术患者恢复的影响.方法 将102例择期肝脏手术患者随机分成两组,其中观察组50例,患者术前不予留置胃管,无胃肠减压;对照组52例,患者术晨予留置胃管行胃肠减压.结果 两组术后恶心、呕吐和腹部胀痛不适及外科并发症发生率比较,差异无统计学意义(均P>0.05);观察组术后咽喉疼痛发生...     

腹部手术围术期胃肠减压术的护理体会

正胃肠减压术是腹部手术后常用的措施,通过胃管负压吸引及虹吸原理吸出积聚于胃肠道内的气体和液体[1],以降低胃肠道内压力和张力改善胃肠壁的血液循环,有利于减少并发症的发生,而促进胃肠道功能恢复和提高手术治疗效果。2015-10—2016-04间,我们对37例实施胃肠减压术患者给予精心护理,效果满意,现将护理体会报告如下。1资料与方法1.1一般资料本组37例患者,男21例,女16例;年     

Nasogastric intubation and elective abdominal surgery.

The use of nasogastric tubes after elective abdominal surgery remains standard practice for many surgeons. Such tubes, however, cause much discomfort and are associated with significant morbidity. This paper reviews the arguments for and against nasogastric intubation, and finds little evidence to support its continued routine use.     

胃肠道手术中不常规留置胃肠减压管并早期进食的临床应用研究

目的 探讨胃肠道手术快速康复外科中不常规留置胃肠减压管并早期进食的安全及可行性。方法 随机选取南京军区南京总医院2006年11月至2007年12月胃肠道手术病人62例为胃肠减压组（A组）,2008年1月至2008年6月病人58例为非胃肠减压并早期恢复进食组（B组）。比较两组病例术后肛门恢复排气时间,咽喉疼痛、恶心、急性胃扩张、切口感染、肺部感染、吻合口漏等术后并发症发生率。结果 与A组相比B组肛门恢复排气时间显著提前（P＜0.05）,两组病人出现急性胃扩张、切口感染、肺部感染、吻合口漏等并发症发生率差异无统计学意义,但A组病人诉咽喉疼痛、恶心呕吐明显较B组增多（P＜0.01）。两组均有发生急性胃扩张并发症而需重置胃肠减压管并禁食病例,但差异无统计学意义（P＞0.05）。结论 不常规放置胃肠减压管并早期恢复进食安全可行,有利于病人的术后康复。     

Nasogastric tubes after elective abdominal surgery is not justified

There is no need for systematic nasogastric tube after elective abdominal and digestive surgery. Expected benefits are comfort for the patient, reduction of pulmonary morbidity, and rapid oral feeding. Only 5% of the patients will need a subsequent placement of nasogastric tube, due to vomiting and abdominal distention, with no adverse effects.     

Antibiotic prophylaxis in elective colorectal surgery

Background : Antibiotics are often administered in elective colorectal surgery to prevent wound infection. The tendency for surgeons to prolong the administration of prophylactic antibiotic therapy in the postoperative period is a well‐known fact. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilization in elective colorectal surgery and to determine if evidence‐based medicine is employed in relation to this practice. Methods : A cross‐sectional study encompassing general surgeons performing elective colorectal surgery was performed. Questionnaires were distributed to 144 surgeons (national, academic and private health care). Questions pertaining to the type, timing and duration of antibiotic administration were asked. The prevalence of wound infection audit rate and whether or not there were specific guidelines related to antibiotic administration were also determined. Results : The response rate obtained was 67% (n = 96). Although evidence from the current medical literature and recommended national guidelines support the use of single‐dose prophylactic antibiotics, 72% of the respondents used more than a single dose. Forty surgeons (42%) claimed that their prescribing practice was supported by the medical literature, 31 respondents (32%) based their practice on hospital guidelines and personal preference was cited as a reason by 21 surgeons (22%). The remaining four respondents (4%) used a similar scheduling policy to that practiced by their colleagues in relation to antibiotic administration. There was no significant difference in antibiotic dose scheduling between national, private and university academic institutions (P = 0.85). Conclusions : These results suggest that a significant proportion of surgeons administer excessive and unnecessary doses of antibiotics in elective colorectal surgery. Further studies are required to uncover the reasons but lack of appropriate guidelines and failure to exercise evidence‐based medicine are major factors that account for this practice.     

Coronary stent management in elective genitourinary surgery

What's known on the subject? and What does the study add? Withdrawal of dual antiplatelet therapy before the recommended, 12 months for drug‐eluting stents and 1 month for bare‐metal stents increases the rate of major adverse coronary events and mortality. However, in those undergoing surgery the risk of bleeding is increased substantially for those on antiplatelet agents. Successful management in patients with coronary stents who must undergo elective or non‐elective urological surgery should be a multidisciplinary decision. This article reviews the literature and recommends a protocol for clinical management of patients undergoing urological procedures after coronary stent placement. To review the literature on coronary stents and genitourinary surgery and provide a protocol for perioperative. The keywords, ‘elective surgery’, ‘aspirin’, ‘clopidogrel’, ‘guidelines for percutaneous coronary intervention’, and ‘antiplatelet therapy after coronary stent placement’ were used to search PubMed for any relevant articles relating to coronary stents. Recommendations were made based on the whether the procedures patients were exposed to placed them at low‐, moderate‐ or high‐bleeding risk based on the extent of the procedure. All elective procedures should be delayed for 1 month after bare‐metal stent placement and 1 year after drug‐eluting stent placement. In patients classified as low risk (endoscopy and laser prostatectomy), aspirin should be continued throughout the perioperative period and dual antiplatelet therapy should continue 24–48 h postoperatively, if there is no concern for active bleeding. In those classified as moderate risk (scrotal procedures, transurethral resection of bladder tumours, transurethral resection of the prostate, urinary sphincter placement) dual antiplatelet therapy should be discontinued 5–7 days before the procedure and continued within 7 days after procedure, if there is no concern for active bleeding, in consultation with cardiology. In high‐risk procedures (cystectomy, nephrectomy, prostatectomy, penile prosthesis placement) dual antiplatelet therapy should be discontinued 10 days before the procedure and continued postoperatively within 7–10 days of the procedure, when there is no longer a concern for active bleeding with the assistance of a cardiologist. Coronary artery disease is becoming more prominent in our society, increasing the use of coronary stents and antiplatelet agents. With the proposed protocol, it is safe to proceed with surgical intervention in those that have adequate stent endothelialisation.     

腹部手术后是否应用鼻胃管?

在许多医疗中心,腹部手术后在胃肠(GI)功能尚未完全恢复前预防性使用鼻胃管(NGI)已是一个诊疗常规。在腹部手术中使用鼻胃管可使术野有更好显露也已成为广泛共识。但在二十世纪80～90年代,许     

Nasogastric suction after elective abdominal surgery: a randomised study.

The value of nasogastric tube decompression after elective abdominal operations was assessed in a randomised trial in which 97 patients were and 100 were not allocated postoperative nasogastric decompression. Only two patients in the latter group subsequently required decompression. There was no statistically significant difference in the incidence of mortality, complications (including vomiting) or time to return of intestinal motility between the two groups. There was a significantly higher incidence of sore throat (P less than 0.0001) and nausea (P less than 0.05) in patients who received nasogastric decompression. A postal questionnaire to 259 UK general surgeons (96% replied) revealed that postoperative nasogastric decompression was usually used by 92% of surgeons after a Polya gastrectomy, 72% after a small bowel anastomosis, 49% after a large bowel anastomosis and 20% after cholecystectomy. We conclude that such a routine is not justified and should be reserved for those patients developing specific complications.     

Nasogastric intubation after abdominal surgery: a meta-analysis of recent literature

OBJECTIVE: To determine whether refraining from nasogastric intubation (NGI) in patients after abdominal surgery will result in the same therapeutic effectiveness as using NGI.Data Source We identified randomized trials from the Cochrane Central Register of Controlled Trials published between January 1990 and January 2005. STUDY SELECTION: Two of us independently selected trials based on randomization, abdominal surgery in patients, early vs late removal of the NGI, and reporting at least 1 of the following end points: hospital stay, gastrointestinal function, and postoperative complications. DATA EXTRACTION: Two of us independently performed trial quality assessment and data extraction. Trials were judged using a structured list that included factors relating to internal and external validity. Data were entered and analyzed by means of dedicated software from the Cochrane Collaboration. DATA SYNTHESIS: Seventeen randomized trials met the inclusion criteria. Meta-analysis showed that NGI does not offer any clinically relevant benefits for patients after abdominal surgery, such as recovery of gastrointestinal function or reduction of postoperative complications (relative risk, 1.18; 95% confidence interval, 0.98-1.42). Moreover, NGI showed some undesired effects, such as discomfort (in 60% of the NGI patients) and a later return to a liquid diet (weighted mean difference, 0.65 days; 95% confidence interval, 0.38-0.92 days) or a regular diet, whereas hospital stay was not shortened. CONCLUSIONS: Routine NGI seems to serve no beneficial purpose and may even be harmful in patients after modern abdominal surgery; also, it is uncomfortable. Therefore, NGI is recommended only as a therapeutic approach.