胃肠外科的围手术期处理

胃肠外科是普通外科领域中范围最广、病种最多的一门专业。胃肠外科手术的范围小如简单的阑尾切除术、大如胰十二指肠切除术、全盆腔脏器切除术等。近年来随着诊疗技术(如麻醉技术、重症监护、微创外科等)的飞速发展,使医务人员不但在术前对病情能够得到较为准确的评估,并对一些异常发现进行及时必要的处理;同时也为患者创造了较为有利的手术条件,使他们能更好地承受难度更大、更复杂的手术,并使高龄及伴有各种合并症的患者都能较顺利地得到治疗和康复。但是,围手术期处理是否得当仍然是直接影响疾病治疗预后的重要因素。一、术前对病情的评…     

眼科合并全身疾病患者围手术期的护理

随着眼科手术设备和技术的提高,眼科围手术期的治疗已经较以往简单了许多,全身疾病特别是心血管疾病及糖尿病,已不再是眼科患者的手术禁忌证。但是临床上合并有全身疾病患者的围手术期状况却直接影响手术时机及效果,甚至危及患者生命。所以对术前合并有全身疾病进行眼部手术的患者,其围手术期的诊治和护理是不能忽视的。     

胃癌合并糖尿病患者围手术期护理

针对18例胃癌合并糖尿病患者,在围手术期进行护理干预:术前加强心理护理,改进糖尿病饮食适应胃癌手术营养需求,输注胰岛素有效地控制血糖。加强术后并发症预防及护理措施。使全部病例安全渡过围手术期、术后并发症发生率为16.6％。     

骨折合并糖尿病患者的围手术期护理

<正>目前,糖尿病已成为仅次于肿瘤、心血管病等之后第3大危害人民健康的终身性疾病[1]。临床发现骨折合并糖尿病的发生率较前明显增多,该类病人易发生感染等并发症,而骨科手术一旦出现感染等常致手术失败,因此,加强围手术期护理对手术成功和并发症预防有重要意义。我科2008     

合并糖尿病食管癌贲门癌患者的围手术期护理

目的探讨合并糖尿病食管癌贲门癌患者的围手术期护理方法及效果。方法回顾性分析40例行食管癌贲门癌手术的合并有糖尿病患者的围手术期护理资料。结果经过围手术期优质护理,40例患者均成功实行手术,恢复良好。结论围手术期护理对食管癌门癌合并糖尿病患者的术后恢复有重要促进作用,值得推广。     

合并糖尿病食管癌患者的围手术期综合护理

目的探讨合并糖尿病食管癌患者的围手术期综合护理方法及效果。方法对32例接受食管癌根治术的糖尿病患者行围手术期综合护理,回顾性分析患者的临床资料。结果经过围手术期综合护理措施,本组36例患者未发生低血糖、糖尿病酮症酸中毒、高渗性非酮症糖尿病昏迷及严重感染等并发症。未发生与护理措施不当有关的并发症。术后发生切口感染1例,经更换敷料后切口Ⅱ期愈合。其余患者均顺利康复出院。结论食管癌大多发生在高龄人群,故合并糖尿病的患者较多,术后易发生较多并发症,增加了手术的风险。加强围手术期综合护理,尤其是对糖尿病的护理,对患者的术后康复有重要意义。     

妇科疾病合并糖尿病的围手术期护理体会

目的总结妇科疾病合并糖尿病患者的围手术期护理方法。方法对68例合并糖尿病的妇科手术患者,给予加强血糖监测、控制饮食、重视心理护理、加强切口管理等围手术期精心护理。结果所有患者均痊愈出院,切口愈合良好,无严重并发症。结论妇科疾病合并糖尿病患者的围手术期护理,有助于保持血糖正常水平,是保证手术成功的关键。     

食管癌伴糖尿病患者围手术期的护理

糖尿病是一种常见的内分泌疾病，病因复杂，其病理基础主要由于胰岛素绝对或相对分泌不足而引起以慢性高血糖为特征的代谢紊乱。手术时，创伤引起的应激反应加之糖尿病的病理生理改变，围手术期并发症发生的危险性及死亡率大大增加，因此必须重视对糖尿病患围手术期的治疗与护理。我科自2004年4月2005年1月共收治食管癌伴糖尿病患46例，占收治食管癌总患数2．3％，现将护理体会报告如下。     

股骨颈骨折合并糖尿病高龄患者围手术期护理

<正>随着社会人口老龄化的到来,股骨颈骨折合并糖尿病患者在临床上逐渐增多,而手术是治疗股骨颈骨折的主要手段之一。股骨颈骨折合并糖尿病高龄患者术后易引发各种并发症,可影响手术的成功率。笔者通过对41例股骨颈骨折合并糖尿病高龄患者的围手术期观察及护理,患者均顺利通过围手术期,疗效满意。现将护理体会总结如下。     

肛肠疾病合并HIV患者围手术期的心理护理

目的 评价心理护理在肛肠疾病合并HIV患者围手术期的应用效果。方法 对本院92例肛肠疾病合并HIV患者在常规护理基础上进行精心的围手术期心理护理,分别于入院当天、术前1天和术后第3天采用症状自评量表(SCL90)对患者心理状况进行评价。结果 本组92例患者术前1天和术后第3天SCL90测验的9个因子(躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执及精神病性)评分均低于入院当天,差异均具有统计学意义。出院当天,92例患者均对护理满意度打分,无“非常不满意”或“不满意”(即满意度≤2分),3分者25例(27.1%),≥4分者共67例(72.8%)。结论 对肛肠疾病合并HIV患者围手术期的心理护理能够明显改善患者的心理状态,病人对护理人员的满意率较高。     

糖尿病患者非心脏手术围术期心血管事件危险因素分析

目的 探讨糖尿病患者非心脏手术围术期心血管事件的危险因素.方法 择期行非心脏手术的糖尿病患者358例,记录术中、术后恶性心律失常、心肌缺血、不稳定性心绞痛、心肌梗死、心衰[射血分数(EF)＜50％]等心血管事件,根据有无发生心血管事件分为心血管事件组和无心血管事件组,比较两组年龄、血糖、血脂、血压等,并进行多因素非条件Logistic回归分析.结果 发生心血管事件组代谢紊乱情况明显,术前合并有冠心病、高血压,年龄、心衰、微量白蛋白尿增高、糖化血红蛋白增高的发生率均高于无心血管事件组,以上危险因素均与心血管事件发生呈正相关性(P＜0.05).结论 年龄、糖尿病合并症(冠心病、心衰、肾病)是非心脏手术围术期心血管事件的主要危险因素.     

Continuous perioperative insulin infusion therapy for patients with type 2 diabetes undergoing bariatric surgery

Background Continuous insulin infusion (CII) is proven to decrease morbidity and mortality in surgical critical care patients. This study compared standard insulin therapy with CII in type 2 diabetes patients undergoing elective bariatric surgical procedures in a community hospital. Methods A retrospective review investigated 350 bariatric surgical patients with type 2 diabetes who underwent perioperative treatment of hyperglycemia using either standard insulin therapy or CII. The 182 patients in group 1 underwent glucose monitoring and subcutaneous insulin treatment every 6 h, whereas the 168 patients in group 2 had CII treatment beginning in the preoperative holding area and monitored hourly for the next 24 h. The two groups were similar in demographic characteristics. Results There were no significant hypoglycemic episodes with perioperative CII. The mean perioperative insulin required was 5.8 U/h. The patients receiving CII had fewer postprocedure cholecystectomies, but a higher number of port-site infections. Conclusions Perioperative CII can be administered safely to diabetic patients undergoing bariatric surgery. The insulin requirements in this population are higher than expected. Our study showed a decrease in the number of postoperative cholecystectomies in the CII group, but no effect on the stricture rate and an increase in the number of patients with postoperative port-site infections.     

糖尿病患者非心脏手术围术期心血管事件的危险因素

目的 筛选糖尿病患者发生围术期心血管事件(PCE)的危险因素.方法 择期行非心脏手术的糖尿病患者500例,根据围术期是否发生PCE分为PCE组和非PCE组.记录患者一般资料和麻醉方式、麻醉时间、术中血糖、血流动力学波动情况.将组间差异有统计学意义的因素进行logis-tic回归分析,筛选PCE的危险因素.结果 79例患者发生PCE,发生率为15.8％.2组患者年龄、甘油三酯水平、高敏C反应蛋白(hs-CRP)水平、血流动力学波动情况、ECG异常比率比较差异有统计学意义(P＜0.05).logistic回归分析结果显示,甘油三酯≥1.7 mmol/L、年龄≥65岁、hs-CRP≥8mg/L和术中血流动力学异常波动≥基础值30％是非心脏手术糖尿病患者PCE的危险因素.结论 高甘油三酯、老龄、高hs-CRP水平和术中血流动力学异常波动(≥基础值30％)是糖尿病患者非心脏手术围术期PCE的危险因素.     

A perioperative care map improves outcomes in patients with morbid obesity undergoing major surgery

Background

The surgical management of patients with morbid obesity (body mass index?≥?40) is notable for a relatively high risk of complications. To address this problem, a perioperative care map was developed using precautions and best practices commonly employed in bariatric surgery. It requires additional medical assessments, sleep apnea surveillance, more stringent guidelines for anesthetic management, and readily available bariatric operating room equipment, among other items. This care map was implemented in 2013 at 4 major urban teaching hospitals for use in patients undergoing all types of nonambulatory surgery with a body mass index greater than 40?kg/m². The impact on patient outcomes was evaluated.

胸部手术成人患者围术期胸腔引流护理研究进展

胸腔引流是目前国内胸部手术术后常规治疗措施,胸腔引流管是重要导管之一。本文旨在对术前导管及装置选择、术中置管位置、术后优质护理各方面进行总结分析,为制订有效的胸腔引流管理及干预提供借鉴。     

Influence of perioperative blood glucose levels on outcome after infrainguinal bypass surgery in patients with diabetes

BACKGROUND: High glucose levels are associated with increased morbidity and mortality after coronary surgery and in intensive care. The influence of perioperative hyperglycaemia on the outcome after infrainguinal bypass surgery among diabetic patients is largely unknown. The aim was to determine whether high perioperative glucose levels were associated with increased morbidity after infrainguinal bypass surgery. METHODS: Ninety-one consecutive diabetic patients undergoing primary infrainguinal bypass surgery were identified from a prospective vascular registry. Risk factors, indication for surgery, operative details and outcome data were extracted from the medical records. Exposure to perioperative hyperglycaemia was measured using the area under the curve (AUC) method; the AUC was calculated using all blood glucose readings during the first 48 h after surgery. RESULTS: Multivariable analysis showed that the AUC for glucose (odds ratio (OR) 13.35, first versus fourth quartile), renal insufficiency (OR 4.77) and infected foot ulcer (OR 3.38) was significantly associated with poor outcome (death, major amputation or graft occlusion at 90 days). Similarly, the AUC for glucose (OR 14.45, first versus fourth quartile), female sex (OR 3.49) and tissue loss as indication (OR 3.30) was associated with surgical wound complications at 30 days. CONCLUSION: Poor perioperative glycaemic control was associated with an unfavourable outcome after infrainguinal bypass surgery in diabetic patients.     

腹股沟疝并存糖尿病患者的围手术期处理

目的探讨腹股沟疝患者并存糖尿病患者围手术期血糖控制的安全方法。方法分别对61例腹股沟疝患者并存糖尿病,83例无糖尿病腹股沟疝患者围手术期的诊断与治疗进行回顾性分析。结果两组手术时间差异无显著性（P〉0．05）。在术后下床活动时间、生活自理时间、住院天数、恢复日常工作天数方面,两组差异均无显著性（P〉0．05）。两组术后均无复发。结论围手术期控制好血糖是避免手术并发症的关键。     

糖尿病病人多发伤急诊围手术期处理

目的探讨糖尿病人多发伤急诊手术围手术期诊断和血糖控制的安全方法。方法对52例糖尿病发生多发伤需行急诊手术的术前诊断与围手术期处理进行回顾性分析。结果96.2%(50/52)为2型中老年人糖尿病,部分病情隐匿,术前漏诊6例;急诊手术时血糖控制在13.9mmol/L以下可安全渡过手术期;术后出现低血糖昏迷1例,感染15例,死亡7例。结论糖尿病病人发生多发伤时有其特殊性,术前必须常规监测血糖明确诊断,静脉应用胰岛素是围手术期控制血糖的安全有效方法。     

Addressing psychosocial aspects of care for patients with diabetes undergoing limb salvage surgery

Surgeons provide a key role in improving the life of patients with diabetes-related foot complications who undergo limb salvage surgery as an alternative to amputation. An integrated multidisciplinary approach is essential to improve the emotional well-being of these patients to avoid potential complications that may prolong their convalescence and further degrade their psychosocial welfare. The authors attempt to increase awareness of critical preoperative risk factors that should be obtained by a thorough comprehensive psychosocial evaluation. In addition, this article discusses how to interact with the patient and his or her family throughout the perioperative period, assisting the patient in managing psychosocially and increasing the likelihood of an optimal outcome.     

医护一体化营养管理在骨科糖尿病患者围手术期的应用

【摘要】 目的 探讨医护一体化营养管理在骨科糖尿病患者围手术期的应用。方法 运用医护一体化模式对78例糖尿病合并骨折患者进行系统评估,制定个性化营养管理策略,包括健康教育、控制血糖、运动处方、纠正和预防营养不足以及预防并发症等。结果〓78例患者均安全度过围手术期,76例切口愈合良好,2例切口延期5~9天愈合,无营养治疗并发症发生。结论〓骨科糖尿病患者围手术期通过医护一体化的营养管理,可更好地控制血糖,改善营养状况,增强抵抗力,降低并发症的发生,促进患者恢复。