研究胃癌根治术后早期肠内营养联合肠外营养的临床效果

目的:探讨胃癌根治术后早期肠内营养联合肠外营养的临床效果。方法:选取我院2013年1月至2015年1月胃癌根治术后患者80例,随机分为研究组和对照组各40例,研究组为术后早期肠内营养联合肠外营养,对照组为术后早期完全肠外营养;记录并比较两组肛门排气/排便时间、术后7天营养指标、术后并发症发生率、术后住院时间、总住院时间、总住院费用。结果:术后24小时渐进式肠内营养联合肠外营养不耐受率低;与早期完全肠外营养相比,明显缩短了肛门排气/排便时间,研究组术后并发生症发生率低于对照组。结论:胃癌根治术后24小时实施渐进式早期肠内营养联合肠外营养耐受性与早期完全肠外营养相比效果好,还可有效地预防和降低术后感染性并发症的发生率和死亡率。     

胃癌术后鼻空肠营养管的护理分析

目的：探讨胃癌术后利用鼻空肠营养管给予肠内营养支持的具体护理体会。方法选取我院2013年8月-2014年7月胃癌患者14例。所有患者完成手术后,均应用鼻空肠营养管给予肠内营养。通过随机数表法将所有胃癌患者分为B1组（观察组7例）与B2组（对照组7例）。 B2组：胃癌术后实施常规护理;B1组：胃癌术后实施鼻空肠营养管护理;对比B1组与B2组胃癌患者在术后并发症出现概率以及住院时间等方面表现出的差异性。结果 B1组患者中,术后出现胃肠不适症状患者1例。在B2组患者中,出现胃肠不适症状患者4例,出现吻合口瘘症状患者3例。在术后并发症方面,B1组优于B2组胃癌患者明显（P〈0.05）;B1组患者住院时间为（10.2±1.2）d,B2组患者为（13.9±1.9）d,在患者住院时间方面,B1组短于B2组患者明显（P〈0.05）。结论针对胃癌术后患者,选择鼻空肠营养管给予肠内营养支持,并配合给予护理干预,能够显著促进患者胃肠功能的恢复,降低术后并发症出现概率,将住院时间有效缩短,有效凸显鼻空肠营养管护理的应用价值。     

胃癌术后空肠造口早期肠内营养患者中的护理体会分析

目的:探究胃癌术后空肠造口早期肠内营养患者中的护理体会分析。方法:抽取我院2017年1月-2018年2月收入的胃癌手术患者80例,按照护理方式不同分为两组,对照组40例予以全胃肠外营养护理,观察组40例予以早期空肠造口营养支持,对两组干预前后并发症发生率、营养支持效果进行比较。结果:观察组并发症发生率17.5%,低于对照组32.5%,两组差异有意义(P0.05),观察组体重增加量高于对照组,住院时间短于对照组,两组差异有意义(P0.05)。结论:早期肠内营养应用于胃癌术后空肠造口患者,能有效增加自身免疫力,降低并发症发生率,缩短住院时间,值得推广。     

研究肠内营养在胃癌患者术后早期应用的护理效果

目的：探究肠内营养在胃癌患者手术后的早期应用当中的护理效果。方法随机选取2013年4-9月在本院进行胃癌手术治疗的60例患者,对这60例胃癌手术患者的资料进行回顾性的分析,把这60例患者随机分成对照组和观察组两组,其中对照组患者在手术后的进行肠外营养的护理;而观察组的患者在手术后进行肠内营养的护理。对比肠内营养和肠外营养的护理效果。结果实施肠内营养护理的观察组患者的术后首次下床活动时间、首次进食的时间等各项术后康复指标的时间均明显对于对照组,两组患者术后的康复指标比较,P＜0.05,差异有统计学意义;同时观察组患者的营养指标明显优于对照组,两组患者的术后营养指标比较,P＜0.05,差异有统计学有意义。结论肠内营养在胃癌患者手术后的早期应用当中具有显著的效果,在胃癌患者手术后实施早期肠内营养的护理能够加快患者的康复,减少不良反应和并发症的发生,具有临床推广的意义。     

综合护理在行胃癌根治术的患者中的应用效果分析

目的:分析综合护理在行胃癌根治术的患者中的应用效果。方法:选择在本院行胃癌根治术治疗的84例患者作为研究对象,并随机划分为对照组与干预组,对照组42例给予常规护理,干预组42例实施综合护理。对比两组情绪状态、术后并发症发生率及胃肠功能恢复时间。结果:两组护理后焦虑及抑郁自评量表(SAS及SDS)评分均低于护理前(P0.05),且干预组均低于对照组(P0.05);干预组肠鸣音恢复、肛门排气与肛门排便时间均较对照组少(P0.05),并发症发生率较对照组低(P0.05)。结论:对行胃癌根治术治疗的患者实施综合护理,可大大降低焦虑、抑郁程度,明显减少术后并发症的发生,并有效促进胃肠功能恢复。     

观察食管癌患者术后早期实施肠内营养时应用综合护理干预的效果

目的 探讨综合护理干预对术后早期肠内营养患者的效果。方法 选取2018年5月-2021年5月东台市中医院普外科收治的78例食管癌患者作为研究对象,依照组间基线资料均衡可比的原则将患者分为对照组与观察组,每组各39例;对照组给予常规护理,观察组给予综合性护理。对比两组患者术后恢复情况、记录患者的住院时间,血浆白蛋白、前白蛋白、转铁蛋白水平、术后并发症情况。结果 综合护理干预后,观察组患者术后肠鸣音消失时间、肛门排气时间、首次排便时间及住院时间均短于对照组患者,差异具有统计学意义（P<0.05）;观察组患者术后7d的白蛋白、前白蛋白及转铁蛋白水平均优于对照组患者,差异具有统计学意义（P<0.05）;观察组术后并发症总发生率17.95%,低于对照组患者的38.46%,差异具有统计学意义（P<0.05）。结论 综合护理干预能够改善术后早期肠内营养患者的营养指标,促进患者术后康复,缩短患者住院时间,同时还能降低术后并发症发生率。     

胃癌患者术后早期肠内营养的护理

目的：探讨胃癌患者术后早期肠内营养的护理。方法：选取2013年1月至2013年12月期间中南大学湘雅二医院收治的以手术法治疗的胃癌患者60例，并将其随机分为观察组与对照组。其中对照组患者在术后实施常规护理；观察组患者在此基础上给予干预性护理。比较两组患者的肠道恢复情况。结果：治疗、护理后。两组患者均有不同程度的恢复，相比之下，观察组患者在肠鸣音恢复时间、排气、排便时间、术后进食时间及住院时间均明显短于对照组患者，两组数据差异显著，结果具有统计意义（p〈0．05）。结论：给予胃癌术后早期患者性干预性的营养护理，可促进患者胃肠道系统的恢复，帮助患者尽早回归正常的生活模式。     

胃癌根治术后早期肠内营养的应用探讨

目的:观察腹腔镜下胃癌根治术后早期肠内营养的安全性及耐受性,以期为胃癌根治术后营养治疗的开展提供参考.方法:前瞻性收集2019年1月至2020年12月在安徽省黄山首康医院普通外科接受腹腔镜下胃癌根治术的病人,随机分为观察组和对照组.2组在术后7d接受不同的营养治疗方式,观察组于术后24h内开始鼻饲肠内营养,逐步过渡至口服肠内营养;对照组则在术后早期接受肠外营养,待肠功能恢复后逐步过渡至口服肠内营养.比较2组并发症、进食耐受性、营养状况、肠功能恢复情况、住院时间及住院费用等,并随访至术后第6个月.结果:本研究共纳入60例胃癌病人(观察组30例,对照组30例),均治愈出院.2组病人的基线资料差异无统计学意义(P＞0.05).观察组发生肠梗阻2例(2/30,6.7％);对照组发生肺部感染1例、肠梗阻2例(3/30,10.0％),观察组总体并发症发生率与对照组比较差异无统计学意义(P＞0.05).观察组2例出现恶心伴呕吐、腹胀等进食不耐受情况,予以暂停肠内营养并经肠外营养及保守治疗后缓解.两组间进食不耐受的差异无统计学意义(P＞0.05).观察组术后第3天血清白蛋白、前白蛋白的水平明显高于对照组(P＜0.05).观察组术后首次排气时间短、留置引流管时间短、术后住院时间短、住院总费用少(P＜0.05).两组均随访6个月,无死亡病例,未发生远期并发症及肿瘤复发.结论:腹腔镜胃癌根治术后早期开展鼻饲肠内营养并逐步过渡至口服肠内营养不增加并发症发生率,且可促进术后胃肠功能的恢复,缩短住院时间,安全可行.     

胃癌术后合理使用营养输注泵对减少患者肠内营养并发症的作用

目的探讨胃癌术后合理使用营养输注泵对减少患者肠内营养并发症的作用。方法将40例胃癌根治术患者随机分为观察组及对照组,每组20例,所有患者均于术后20小时开始给予肠内营养,观察组采用营养输注泵及输液加热器途径,对照组则采用传统的重力滴注法,对比观察两组患者消化道并发症及导管并发症的发生情况。结果在早期给予肠内营养过程中,5例出现腹痛、腹泻,经减慢肠内营养速度好转。对照组中2例出现鼻肠管堵塞,经处理后再通。观察组患者腹痛、腹胀、腹泻等胃肠道障碍症状较对照组明显减少(χ2=4.362,P<0.05)。结论胃癌术后早期应用肠内营养输注泵及输液加热器持续滴注可减少胃肠道并发症及导管并发症,具备一定的可行性。     

热敏灸对胃癌病人根治术后早期肠内营养耐受性的影响

目的:探讨热敏灸对胃癌病人根治术后早期肠内营养耐受性的影响。方法:将60例行胃癌根治术的病人,按随机信封法随机分为对照组和观察组,每组30例。对照组采取肠内营养常规护理,观察组在肠内营养常规护理基础上在实施肠内营养前30 min给病人进行热敏灸。观察两组病人胃肠道不耐受症状发生率、肠内营养日需要量完成率、首次肛门排气时间、首次经口进食时间、术后住院时间。结果:观察组病人胃肠道不耐受症状发生率为20.69%,对照组为46.67%,两组比较差异有统计学意义(P 0.05)。两组病人肠内营养日需要量完成率比较差异有统计学意义(P0.05),术后首次肛门排气时间、首次经口进食时间和术后住院时间差异都有统计学意义(P0.01)。结论:热敏灸能降低胃癌病人术后早期肠内营养胃肠道不耐受症状的发生率,提高病人肠内营养日需要量完成率,热敏灸还能缩短术后首次排气时间和首次进食时间及术后住院时间。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.