腹部择期手术患者舒适护理模式的应用

目的减轻腹部择期手术患者术后切口疼痛,改善患者舒适度。方法按病例入选标准分别在外科普通病房(对照组)和优质护理病房(观察组)选择腹部择期手术患者各63例,对照组术后实施外科护理常规,观察组以萧氏舒适护理模式为理论框架,术后2h评估患者舒适需求,实施术后舒适护理,给予疼痛控制、卧位、环境、心理等舒适护理干预。结果两组患者术后疼痛程度、术后48h舒适度比较,差异有统计学意义(均P<0.01)。结论对腹部择期手术患者实施优质、高效的生理、心理舒适护理服务,对减轻患者痛苦,促进疾病康复有重要的临床意义。     

Anaesthesia and critical care for scheduled infrarenal abdominal aortic aneurysm surgery

OBJECTIVES: Patient scheduled for infrarenal abdominal aortic aneurysm surgery carries a high risk of cardiac or respiratory comorbidity. To outline the perioperative management for these patients. METHODS: Review of the literature using MesH Terms "abdominal aortic aneurysm", "anesthesia", "analgesia" "critical care" and/or "surgery" in Medline database. RESULTS: Cardiac preoperative evaluation and management have recently been reviewed. Intermediate and high-risk patients should undergo non-invasive cardiac testing to decide between a preoperative medical strategy (using betablocker+/-statin and aspirin) and an interventional strategy (coronary angioplasty or cardiac surgery). Perioperative myocardial ischaemia should also be investigated by clinical, electrocardiographic and biologic monitoring such as plasmatic troponin Ic dosage. Specific score could also assess the respiratory failure risk preoperatively. Epidural analgesia decreases this risk. There is no evidence that a pharmacological treatment decreases the incidence of acute renal failure after aortic surgery. Endovascular repair is actually recommended for older, higher-risk patients or patients with a hostile abdomen or other technical factors that may complicate standard open repair.     

术前预康复护理在日间膝关节镜手术患者中的应用

目的 探讨术前预康复护理在日间膝关节镜手术患者中的应用效果.方法 将预约日间膝关节镜手术的1 220例患者按时间段分为对照组620例,观察组600例.对照组采用常规术前护理模式,观察组采用术前预康复护理模式.结果 观察组日间手术临时取消率、术前等待时间和患者满意度显著优于对照组(均P＜0.01).结论 对膝关节镜日间手...     

全麻诱导期快速输液对腹部手术病人血液动力学的影响

目的比较晶体液和胶体液快速扩容对全麻诱导期腹部手术病人血液动力学的影响。方法ASAⅠ-Ⅱ级择期行腹部手术病人60例,随机分为3组(n=20)。A组于诱导开始时。以15ml·kg1·h-1匀速输入乳酸钠林格氏液;B和C组于诱导前20min内开始分别输入7ml·kg-1乳酸钠林格氏液和6％羟乙基淀粉,诱导开始时加快输液速度,20min内分别输入13ml·kg-1乳酸钠林格氏液和6％羟乙基淀粉。结果麻醉诱导后及插管后A组收缩压低于B组和C组(P<0.01)。中心静脉压随输液量的增加而渐升高,升高幅度C组>B组>A组(P<0.05)。麻醉诱导后,A组心脏指数(CI)开始下降,气管插管后仍低于基础值;B和C组诱导后CI稍增加,气管插管后B组渐降至低于基础值,但下降幅度小于A组,而C组无明显变化。外周血管阻力(SVR)变化与CI相反,A和B组麻醉诱导及气管插管后SVR较基础值增加或变化不明显,而C组下降(P<0.05))。升主动脉血液加速度指数麻醉诱导及气管插管后A组无明显变化,B组诱导后增加,气管插管后降至基础值水平,而C组诱导及气管插管后均较基础值升高(P<0.05或0.01)。结论晶体液和胶体液快速扩容对全麻诱导期低血压有相似的预防作用,但预防CI下降的作用胶体液优于晶体液。     

Tape-recorded hypnosis instructions as adjuvant in the care of patients scheduled for third molar surgery

As medical costs continue to escalate, there is willingness to consider the role played by nontraditional factors in health. We investigated the usefulness of tape-recorded hypnosis instruction on perioperative outcome in surgical patients in a prospective, randomized, and partially blinded study. Sixty patients scheduled for third molar surgery were studied. Patients were allocated to either an experimental group (E) or a control group (C). Group E received an audio tape to listen to daily for the immediate preoperative week, which guided the patients through a hypnotic induction and included suggestions on enhancement of perioperative well-being. Group C did not receive any tapes. The same surgeon administered local anesthesia and a standard regimen of sedation and performed the operation for all patients. The following variables were assessed 1 wk before surgery, immediately before and after surgery, and for 3 days after surgery by the indicated measurements: State anxiety by a Spielberger scale; nausea and pain by visual analog scales; number of tablets of the analgesics that were used; number of episodes of vomiting; and complications. In addition, the surgeon's assessment of ease of surgery was recorded. Two variables showed differences between the groups. First, Group C exhibited a mean increase of 11.7 points on the Spielberger scale from the screening to the presurgery period, while Group E showed only a mean increase of 5.5 points during the same period, P = 0.01. Second, the mean number of vomiting episodes was more in Group E, 1.3, than in Group C, 0.3, P = 0.02. In conclusion, anxiety was reduced before surgery by means of an audio tape containing hypnotic instructions; however, for no apparent reason, there was also an increase in the incidence of vomiting. IMPLICATIONS: We administered hypnosis instructions to patients before third molar surgery. Anxiety was reduced, but there was an increase in the incidence of vomiting. Although an easy and cost-effective method, the value of this approach remains to be established.     

Glucose tolerance testing in patients scheduled for cardiovascular surgery

Diabetes and impaired glucose tolerance are largely underdiagnosed in patients with acute atherosclerotic events. This glucose-unawareness is an obstacle for aggressive treatment in these patients. It is suggested to check fasting glucose levels in patients scheduled for cardiovascular surgery and to give intensive insulin therapy perioperatively if fasting glucose levels are greater than 7.0 mmol/L (126 mg/dL). If fasting glucose levels are not elevated an oral glucose tolerance test should be considered so that unknown diabetes can be detected and treated.     

择期腹部手术前应用B型钠利尿肽筛选慢性心力衰竭

目的 探讨通过监测腹部手术病人术前血浆B型钠利尿肽(B-type natriuretic peptide,BNP)来诊断慢性心力衰竭,并甄选无明显症状的慢性心力衰竭病人.方法 对70例接受择期腹部手术病人应用化学发光法检测术前BNP水平.结果 术前BNP值与NYHA心功能分级明显正相关(r=0.912,P:0.0048...     

Psychosocial stress factors among patients with lumbar disc herniation,scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery

Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly inter-related to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this sub-group of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for first-time disc surgery, than among knee patients awaiting arthroscopy. It was notable that the disc patients had high expectations in terms of improved job satisfaction after treatment by surgery.     

改性几丁质喷雾剂用于经闭孔无张力尿道中段悬吊术患者阴道准备

目的探讨女性压力性尿失禁经闭孔无张力尿道中段悬吊术患者适宜的阴道准备方法,提高其阴道准备效果及患者舒适度。方法将42例经闭孔无张力尿道中段悬吊术患者按入院时间单双号分为观察组和对照组各21例,对照组术前应用聚维酮碘擦洗阴道,观察组采用改性几丁质喷雾剂喷洗阴道。结果观察组患者舒适度显著优于对照组(P0.01),护理操作时间短于对照组;两组阴道分泌物细菌培养阴性率、术后体温及白细胞计数比较,差异无统计学意义(均P0.05)。结论经闭孔无张力尿道中段悬吊术患者术前选择改性几丁质喷雾剂阴道喷洗法可提高患者舒适度,患者耐受性好,是一种安全舒适的阴道准备方式。     

上腹部手术史患者腹腔镜胆囊切除术的应用探讨

[摘 要] 目的 探讨既往有上腹部手术史患者行腹腔镜胆囊切除术（LC）的可行性、安全性及应用价值。方法 回顾性分析扬州市中医院2010年6月至2016年6月55例有上腹部手术史患者行LC的临床资料。结果 成功完成LC 53 例,中转开腹2 例,手术时间平均（69.6±22.5）min,术中出血量平均（26.6±12.8）mL,平均住院（4.2±0.8）d。术后无胆管损伤、胆漏、腹腔出血等并发症发生,所有患者均治愈出院。结论 上腹部手术史不是LC的禁忌证,既往有上腹部手术史患者行LC是安全可行的。     

Preoperative evaluation of intubation conditions in patients scheduled for elective surgery

Prediction of a difficult airway is a continuing problem. Several tests have been developed in order to overcome this problem. It has been proposed that using more than one test could increase the degree of predictability. One hundred patients scheduled for general surgery were successfully evaluated using three methods: 1. The size of the tongue in relation to the oral cavity (Mallampati gradation). 2. The thyromental and the mandibular length. 3. The atlanto-occipital angle. Seven patients had a difficult laryngoscopy and were difficult to intubate. It was possible to predict differenties in all seven patients, but it was found that only the Mallampati gradation and the atlanto-occipital angle contributed significantly to predictability. The cost of predicting further difficulties in all patients with a difficult laryngoscopy was a false positive prediction in a further 13 patients who had no problems with laryngoscopy or intubation. By increasing the specificity of the tests the number of false positive classifications could be reduced to 10 patients, but this would have led to the missing of one patient with a difficult laryngoscopy.     

The self-reporting of psychiatric medications in patients scheduled for elective surgery

Study Objective: To determine by survey the percentage of patients, over the age of 21 years, reporting for elective surgery who also are taking psychotropic medications.

Design: Institution-approved, anonymous survey.

Setting: Teaching hospital.

Patients: 169 patients who were scheduled for elective surgery.

Interventions: After completion of the preoperative evaluation by members of the anesthesia care team, all patients were given an institution-approved survey of medications they were taking in addition to their nonpsychiatric medications. The survey listed 33 drugs known to affect central nervous system neurotransmitters, and included the most commonly prescribed antidepressants, antipsychotics, benzodiazapines, and lithium. Over-the-counter drugs known to affect mood, such as melatonin, also were included in the survey. Patients were not asked the indications for the medications, and no psychiatric questions were asked of the patients.

Measurements and Main Results: 300 surveys were distributed, and 169 patients completed the survey for a response rate of 53%. Forty-three percent of all patients who completed the survey admitted to taking one or more of the psychotropic medications. Of these patients, 35% were taking antidepressants, 34% were taking benzodiazapines, 19% were taking combination therapies, and 11% took antipsychotics, lithium, or over-the-counter drugs such as melatonin.

Conclusion: The number of patients taking psychotropic medications and who present for elective surgery is high. The anesthetic implications of this drug usage are essentially unknown. Additional study of these medications and their impact on anesthetic care is warranted.     

Oral health of patients scheduled for elective abdominal aortic correction with prosthesis.

OBJECTIVE: to evaluate the frequency of potential oral foci of infection in patients scheduled for elective abdominal aortic surgery. Design: prospective clinical study. MATERIALS: oral health and dentures of 50 patients (33 males and 17 females, mean age 65 years) were examined before aortic surgery. Chief outcome measures: radiographic and clinical examination with special emphasis on identifying acute and chronic oral and ontogenic conditions which may contribute to aortic prosthesis infection. RESULTS: eighty-two per cent of the patients had some oral infection foci. The mean number of remaining teeth in the cohort was 9.3, and 21% of these were potential infectious foci (62% in the patients). Twenty-six per cent of the patients suffered from oral Candida infection. Seventy-four per cent of the patients had total or partial dentures, 45% of which were ill-fitting and needed repair. CONCLUSIONS: oral infectious foci occur frequently in patients needing aortic surgery. Untreated foci may contribute to aortic prosthesis infection. Preoperative oral evaluation and elimination of intraoral infection is recommended for patients scheduled for abdominal aortic repair.     

维持性血液透析患者的舒适护理实践

目的探讨舒适护理在慢性肾衰竭患者维持性血液透析护理中的应用效果。方法便利抽取维持性血液透析患者70例,随机分为对照组和观察组各35例。对照组给予常规护理,观察组在对照组的基础上给予生理、心理、社会和环境的整体舒适护理干预。采用自制舒适度评分和护理满意度问卷于干预前和干预3个月后对患者进行评估。结果干预后观察组舒适度评分和护理满意度与对照组比较,差异有统计学意义(P<0.05,P<0.01)。结论舒适护理模式的应用可提高血液透析患者的舒适度,充分体现了以人为本的护理内涵。     

Low-dose aspirin and clopidogrel: how to act in patients scheduled for day surgery

PURPOSE OF REVIEW: With the increasing use of antiplatelet drug treatment, complications resulting from its interference with invasive procedures (surgery or regional anaesthesia) have become an everyday challenge to the surgical team. The purpose of this review is to examine the most recent findings and integrate them into the ambulatory surgery setting. RECENT FINDINGS: Recent studies have outlined the risks of withholding antiplatelet drug treatment, but it is now generally considered to be preferable to withhold treatment than to maintain it. The role of low molecular weight heparins or short-life NSAIDs as bridge drugs is now discussed and their usefulness challenged. SUMMARY: Most ambulatory surgical procedures present low bleeding risk. The current attitude in this setting is to maintain aspirin therapy and possible antiplatelet drug inhibitors throughout the perioperative period. High-risk patients proposed for high-risk surgery should not be treated as outpatients.     

腹部外科术后患者无负压拔管法的应用

目的探讨在腹部外科术后置有橡胶引流管的患者中运用无负压拔管法的可行性和效果。方法选取腹部外科术后置有橡胶引流管的患者167例,采用传统拔管法的82例设为对照组,采用无负压拔管法的85例设为观察组。比较两组患者拔管时疼痛程度及拔第2根引流管前焦虑水平。结果观察组拔管时疼痛程度及拔第2根引流管前焦虑评分显著低于对照组(均P0.01)。结论无负压拔管法能减轻拔管时患者疼痛不适,降低其焦虑水平。     

Experience with the preoperative invasive measurement of haemodynamic, respiratory and renal function in 100 elderly patients scheduled for major abdominal surgery

The extent of physiological disturbance in a preoperative population of 100 elderly patients scheduled for elective major surgery was measured. Haemodynamic, respiratory and renal function were evaluated preoperatively in the intensive care unit. Of these patients 13% had serious problems requiring either postponement of the operation (7%) or its cancellation (6%). Cardiac index was 2.2 l/min/m2 or less in 11% of patients; creatinine clearance 50 ml/min or less in 19% of patients; mean blood pressure was equal to or exceeded 120 mmHg in 15% of patients and intrapulmonary shunt equalled or exceeded 15% in 10% of patients. The mean duration of stay in the intensive care unit was four days, including the preoperative day. The logistics of preoperative admission were implemented without undue difficulty.