加速康复外科术前肠道准备对电解质及血糖的影响

目的观察加速康复外科术前肠道准备方法和常规术前肠道准备方法对电解质及血糖的影响。方法将我科拟实施胃肠道手术的患者62例随机均分为实验组和对照组各31例,实验组术前口服10%的葡萄糖液体;对照组术前生理盐水清洁灌肠;比较两种肠道准备方法对电解质及血糖的影响及两组患者肠道准备后的舒适程度。结果实验组和对照组血清电解质钾、钠、钙浓度均有所下降,氯浓度均有所上升,但差异无统计学意义（P〉0.05）;两组血糖均有所升高,差异有统计学意义（P＜0.05）。结论加速康复外科术前肠道准备方法和常规肠道准备方法均能导致血清钾、钠、钙浓度下降及氯浓度上升,但使其下降和上升的程度无差异。两种均可安全用于临床。但实验组增加患者的舒适度,肠道准备后对血糖的影响较对照组小,更值得临床推广和应用。     

加速康复外科理念在先天性巨结肠症患儿术前肠道准备中的应用效果

目的探讨加速康复外科理念在先天性巨结肠症患儿术前肠道准备中的应用效果。方法将2019年1月—2019年12月在本院行巨结肠根治手术的127例患儿作为对照组,将2020年5月—2021年5月在本院行巨结肠根治手术的112例患儿作为观察组,对照组患儿采用常规措施进行术前肠道准备,观察组患儿采取加速康复外科理念进行术前肠道准备。观察并比较两组患儿的术前灌肠天数、每日灌肠平均耗时、每日平均灌洗量、术中肠道清洁度以及术后1个月内并发症的发生率。结果干预后,观察组患儿的术前灌洗天数和每日灌肠平均耗时短于对照组,每日平均灌洗量少于对照组,患儿的术中肠道清洁度优于对照组,差异均有统计学意义(P<0.05)。同时,两组患儿术后1个月内并发症发生率比较,差异无统计学意义(P>0.05)。结论加速康复外科理念可以提高先天性巨结肠症患儿术前肠道准备的效果,缩短患儿的术前灌肠天数及每日灌肠平均耗时,减少每日平均灌洗量,提高术中肠道清洁度。     

基于加速康复外科理念禁食禁饮与肠道准备国内外应用现状

加速康复外科（enhanced recovery after surgery,ERAS）是基于循证医学证据的多模式围术期优化措施,旨在促进患者早日康复。根据患者个体化需求,ERAS提倡通过缩短禁食禁饮时间、取消机械性肠道准备、改良手术技术、优化麻醉方案、减少阿片类止痛药的使用等围术期优化措施减轻患者手术应激反应,降低术后并发症发生率。其中术前胃肠道准备方案的变革是ERAS的焦点问题,该理念提倡术前6h禁食,术前2h禁饮,非肠道手术取消机械性肠道准备,这与多年来的传统观念相悖,在临床实践中遇到一定阻碍。文章现对近几年ERAS术前胃肠道准备方案在国内外的应用现状,以及临床实践中遇到的问题与对策进行综述。     

无肠道准备对食管切除术后并发症及康复速度的影响

目的 ：研究食管切除术前无肠道准备的安全性及其对患者康复速度的影响。方法 ：2021年6月—10月,便利选取3所三级甲等医院的236例食管切除患者为研究对象,随机分为实验组和对照组,其中实验组117例,对照组119例。实验组术前不进行肠道准备,只禁食水,对照组术前1天口服复方聚乙二醇电解质散进行肠道准备。比较术后14天内两组患者的吻合口瘘发生率和综合并发症指数,围手术期感染相关血液指标和血清电解质平衡情况,以及术后恢复指标。结果 ：实验组发生吻合口瘘6例（5.1%）,对照组发生9例（7.6%）,差异无统计学意义（P>0.05）。实验组综合并发症指数为5.47±9.73,对照组为7.67±12.17,差异无统计学意义（P>0.05）。实验组进食时间、下床活动时间及术后住院时长均优于对照组（P<0.05）。结论 ：食管癌患者食管切除术前不进行肠道准备是安全的,能够加速患者术后康复。     

回肠膀胱术前机械性肠道准备的研究进展

<正>针对目前关于外科手术中肠道准备的争议,探讨回肠膀胱术是否有必要进行机械性肠道准备。笔者采用文献回顾法,检索以回肠膀胱术是否应机械性肠道准备为主题的文章并对其进行综述。1相关概念1.1回肠膀胱术膀胱癌是我国泌尿系统临床常见肿瘤之一,世界范围内,膀胱癌发病率居恶性肿瘤第11位,在我国男性当中,膀胱癌居全身恶性肿瘤第7位,女性为第10位[1]。浸润性膀胱癌及复发性膀胱癌患者往往需行全膀胱切除术。回肠代膀胱术     

84家医院泌尿外科手术前肠道准备现况调查

目的 ：调查我国泌尿外科手术前肠道准备现状,为促进加速康复外科护理中肠道准备管理工作的进一步优化提供方向和参考依据。方法：2022年11月1日至2023年3月1日,采用便利抽样法,选取全国84家医院作为研究对象,采用自行设计的泌尿外科手术患者术前肠道准备现状调查问卷进行调查。结果 ：采用机械性肠道准备比例较高的泌尿系统手术为前列腺穿刺术（81.0%）,膀胱肿瘤根治术（78.6%）,前列腺癌根治术（70.2%）,最低的是输尿管结石手术（35.7%）。对于大部分泌尿外科手术,三级甲等医院采取机械性肠道准备的比例显著高于非三级甲等医院（P<0.05）。肠道准备不良反应排名前3位的是腹胀（31.1%）、睡眠影响（27.4%）、恶心（14.7%）。结论 ：泌尿外科手术前肠道准备仍以机械性肠道准备为主,不同泌尿外科手术、不同等级医院对于术前肠道准备方式的选择存在差异,未来应在患者安全的前提下,进一步推广非机械性肠道准备在泌尿外科手术中的应用,以促进患者的快速康复。     

加速康复外科理念在食管癌术前准备应用与护理

目的:探讨加速康复外科理念在食管癌术前准备中的应用效果。方法:对80例同期住院食管癌病人按随机分组法分为观察组和对照组各40例,对照组按常规护理方法,观察组遵循加速康复外科理念,具体包括术前健康教育、术前食管准备、术前不常规肠道准备及禁食、基础麻醉下放置鼻胃管等。结果:两组病人首次排气时间、排便时间、术后体质下降情况、住院费用及并发症等指标,差异有统计学意义(P0.01)。结论:加速康复外科理念在食管癌术前准备中的应用,可提高病人的手术耐受力,促进病人早日康复,且安全可靠。     

加速康复外科理念对老年胃癌患者术后临床指标及免疫功能的影响

目的探讨加速康复外科理念对老年胃癌患者术后临床指标及免疫功能的影响。方法选取本院收治的82例老年胃癌患者作为研究对象,按照是否愿意接受加速康复外科手术方案治疗分为FTS组42例和对照组40例,对照组患者采取围术期常规护理干预,FTS组给予加速康复外科护理干预,比较2组患者首次排气和排便时间、术后并发症发生率、住院时间、住院总体费用以及术前1 d、术后8 d的免疫功能状况。结果 FTS组在首次排气和排便时间、术后并发症发生率、住院时间、住院总体费用方面显著优于对照组,差异有统计学意义(P0.05);在CD4+、CD8+以及CD4+/CD8+细胞水平方面,术后8 d组间比较,FTS组显著优于对照组,差异有统计学意义(P0.05)。结论加速康复外科理念有利于提高老年胃癌患者术后免疫功能,加速患者的术后康复,减少并发症的发生,节省医疗费用,值得推广应用。     

加速康复外科理念在胃癌围术期中应用研究进展

加速康复外科是在循证医学证据的支撑下,优化围术期管理,减少患者生理和心理创伤应激,实现快速康复的一种外科新理念.近年,加速康复外科理念在胃癌领域迅速发展,可减少胃癌患者围术期应激,加快患者机体恢复.目前,我国不同地区、不同级别医院、不同学科专家对其重视程度和理解有较大差异,整体发展较缓慢.本文就加速康复外科的内涵及其在...     

加速康复外科模式下乳腺癌患者胰岛素抵抗的研究进展

从围术期胰岛素抵抗发生的原因和相关机制、对乳腺癌患者的危害及加速康复外科模式下胰岛素抵抗的防范措施进行综述,以期为更好地管理乳腺癌患者围术期胰岛素抵抗提供参考。     

耳穴贴压对胃癌术后患者胃肠功能恢复的效果研究

目的探讨耳穴贴压对胃癌术后患者胃肠功能恢复的效果。方法将200例胃癌手术患者分为观察组和对照组各100例,对照组采用常规治疗护理方法,观察组在对照组的基础上对患者采取耳穴贴压。观察患者肠鸣音恢复时间、肛门排气时间、首次排便时间、住院时间及血浆血管活性肠肽含量。结果观察组肠鸣音恢复时间、肛门排气时间、首次排便时间、住院时间、术后腹胀发生率均低于对照组(P0.01或P0.05);观察组术后3d血浆血管活性肠肽高于对照组(P0.05),且无过敏、皮肤损伤等并发症发生。结论耳穴贴压有助于促进胃癌术后患者肠蠕动的恢复,并减少术后腹胀的发生率,利于患者早日康复。     

耳穴贴压对胃癌病人术后胃肠功能恢复影响的Meta分析

目的:系统评价耳穴贴压对胃癌病人术后胃肠功能恢复的干预效果。方法:计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据知识服务平台(WanFang Data)、中文科技期刊数据库(VIP)、PubMed、EMbase、Web of Science、CINAHL(EBSCO Host)和Cochrane临床对照实验中心注册数据库(Cochrane Central Register of Controlled Trials,CENTRAL)中关于耳穴贴压对胃癌病人术后胃肠功能恢复的随机对照试验及半随机对照试验。检索时间为建库至2020年5月31日。依据文献纳入及排除标准进行筛查、提取资料,利用Cochrane手册5.1.0推荐的随机对照试验偏倚风险评估工具评价文献质量,采用RevMan 5.2软件进行Meta分析。结果:最终纳入12项研究,包括1370例研究对象。Meta分析结果显示,术前对干预组病人采用耳穴贴压,肛门首次排气时间短于对照组接受常规护理的病人[MD=-34.52,95%CI(-48.24,-20.81),P<0.00001],术后干预组肛门首次排气时间短于对照组病人[MD=-11.92,95%CI(-14.39,-9.44),P<0.00001],术前干预组首次排便时间短于对照组病人[MD=-34.98,95%CI(-47.69,-22.26),P<0.00001],术后干预组首次排便时间短于对照组病人[MD=-10.62,95%CI(-15.86,-5.37),P<0.0001],术后干预组肠鸣音恢复时间短于对照组病人[MD=-7.58,95%CI(-10.25,-4.92),P<0.00001],术后干预组腹胀消失时间短于对照组病人[MD=-3.46,95%CI(-4.76,-2.16),P<0.00001]。结论:现有证据表明,耳穴贴压能够有效改善胃癌病人术后的胃肠功能情况。由于本研究评价指标间存在异质性,因此,需要更多临床多中心、大样本、高质量的研究进一步评价耳穴贴压对胃癌术后病人胃肠功能恢复的综合效果。     

Effects of Cassia alata Linn on bowel function recovery following surgery for gynecological cancer: A randomized controlled trial

BackgroundPostoperative ileus is a common complication following abdominal surgery. This study was undertaken to determine the effectiveness and safety of Cassia alata Linn in stimulating gastrointestinal function recovery among women with gynecologic cancer who had undergone laparotomy for surgical staging or cytoreductive surgery.MethodsA total of 90 participants were randomly allocated to postoperative consumption of either Cassia alata Linn tea (n = 45) or warm water (N = 45). Outcomes of interest included time to first passage of flatus, time to first defecation, time to toleration of solid food, and ileus symptoms. Differences between the groups were measured as mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI).ResultsWomen allocated to the Cassia alata Linn group had shorter times to first passage of flatus (MD −8.53; 95% CI −3.69, −13.38 h) and first defecation (MD −19.83; 95% CI −11.18, −28.48 h) compared with controls. There were no differences in terms of time to toleration of solid food (MD 0.26; 95% CI −2.13, 1.61 h) or ileus symptoms (OR 0.10; 95% CI 0.01, 1.94) between the two groups.ConclusionPostoperative consumption of Cassia alata Linn hastens gastrointestinal function recovery after laparotomy in women with gynecologic cancer.     

术前外周血血小板/淋巴细胞比值相关列线图模型预测胃癌患者术后无病生存期：一项双中心回顾性研究

目的 探讨外周血血小板/淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）对胃癌患者术后无病生存期（disease-free survival, DFS）的影响，并构建列线图模型预测胃癌患者术后DFS。方法 回顾性纳入2011年12月至2019年12月在复旦大学附属肿瘤医院行胃癌根治术的3 112例患者，随机分为训练组（n=2 178）和内部验证组（n=934）。选择2010年至2018年广西医科大学附属肿瘤医院诊治的280例胃癌患者作为外部验证组。采用单因素和多因素Cox回归分析筛选影响训练组患者术后DFS的危险因素，建立预测胃癌患者术后1、3、5年DFS的列线图模型。采用C指数和校准曲线评估模型的辨别和校准能力，通过内部验证组和外部验证组检验模型的准确性。结果 多因素Cox回归分析显示，TNM分期Ⅱ～Ⅲ期（Ⅱ期：HR=1.64, 95%CI 1.29～1.97, P<0.001;Ⅲ期：HR=2.52, 95%CI 2.20～2.82, P<0.001）、癌胚抗原（carcinoembryonic antigen, CEA）>5.2μ...     

Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial

Objective

To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer (NSCLC).

Design

Randomised controlled trial.

Setting

Teaching hospital.

Participants

One hundred and thirty-one subjects with NSCLC admitted for curative surgery.

Interventions

Participants were randomised to usual care or a hospital plus home exercise programme.

Outcomes

The primary outcome was the between-group difference in physical activity 4 weeks after surgery. Secondary outcomes were the difference in quadriceps strength, exercise tolerance and quality of life [Short Form-36 (SF-36) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-LC13] from pre-operatively (baseline) to 4 weeks after surgery.

Results

The participants (n = 131) had a mean age of 68 [standard deviation (SD) 11] years and mean forced expiratory volume in 1 second of 2.4 (SD 1.1) l. There were no significant differences in physical activity between the groups 4 weeks after surgery [mean difference adjusted for baseline 12 minutes/day, 95% confidence interval (CI) −20.2 to 44.1]. In addition, there were no significant differences in total SF-36 or EORTC QLQ-LC13 scores from baseline to 4 weeks after surgery. Both groups had recovered their pre-operative walking distance 4 weeks after surgery, and there were no differences between the groups (mean difference in Incremental Shuttle Walk Test from baseline to 4 weeks after surgery (−26 m, 95% CI −94.2 to 42.3).

Conclusions

A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery. Regardless of group allocation, the patients had recovered their pre-operative exercise tolerance levels by 4 weeks after surgery.     

Effects of a postoperative strength-training program on the walking ability of children with cerebral palsy: a randomized controlled trial

OBJECTIVE: To investigate the effect of a postoperative strength-training program on the walking of children with cerebral palsy (CP). DESIGN: Randomized controlled trial. SETTING: Hospital rehabilitation department. PARTICIPANTS: Thirty-nine children with CP (age range, 6-16 y). After orthopedic surgery, the control group (n=20) followed a conventional physiotherapy (PT) program, and the strength-training group (n=19) followed a strength-training program in addition to the conventional PT. Twenty-nine age-matched healthy children were used as references. INTERVENTION: A 9-month strength-training program. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and kinetic parameters during gait analysis were analyzed before (E0) and 1 year after (E1) the surgery. For 22 children, a 2-year postoperative gait analysis (E2) took place as well. RESULTS: At E1, several kinematic and kinetic parameters improved, although there was no significant difference between the groups. Spatiotemporal parameters showed a worsening at E1 and a recovery to preoperative values at E2. CONCLUSIONS: The examined parameters may be more substantially influenced by factors such as the surgery outcome and the variability of pathologic characteristics than by the strength-training program per se. However, a more significant effect of the strength-training may appear if more intense and short-term training protocols are used, considering factors such as patients' motivations, ages, and postoperative statuses.     

The effects of preoperative education of cardiac patients on haemodynamic parameters,comfort, anxiety and patient-ventilator synchrony: A randomised,controlled trial

BackgroundPatients on mechanical ventilation are likely to suffer stress, which may lead to problems of patient-ventilator synchrony, anxiety, haemodynamic instability and decrease in comfort levels.ObjectivesThe aim of this study is to evaluate the effects of preoperative education regarding haemodynamic parameters, patient comfort and anxiety, and patient-ventilator synchrony provided to patients before they undergo cardiac surgery.MethodsThe study is a randomised, controlled clinical study, it was conducted at the cardiovascular surgery clinic of a teaching hospital in Turkey. The study was conducted on 200 patients who underwent cardiac surgery and received mechanical ventilation. Using the block randomisation method, the patients were grouped into intervention and control groups, with 100 patients in each group. The patients in the intervention group received preoperative education on mechanical ventilation and the usage of the communication panel that patients under mechanical ventilation use to communicate with health personnel, the control group received no education. Data was collected while the patients were on mechanical ventilation support in the intensive care unit on their second postoperative day.ResultsThe difference between the patient-ventilator synchrony levels of the patients to the mechanical ventilation treatment in the intervention and control groups was found statistically significant (p < 0.05). The differences between the haemodynamic measurements of the patients in both groups, which were measured after the patients woke up and before extubation, were also statistically significant (p < 0.05). Median scores obtained by the patients in the intervention group on the Perianaesthesia Comfort Questionnaire and the Tension-Anxiety subscale of the Profile of Mood Scale were 5.7 and 2.0, respectively. The median scores obtained by the patients in the control group on the same scales were 4.1 and 24.0, respectively.ConclusionsCompared to the participants in the control group, the participants in the intervention group who received education had higher patient-ventilator synchrony, comfort and haemodynamic stability levels, as well as lower anxiety levels when they were under mechanical ventilation, showing that results were better in the intervention group than the control group.     

The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: A randomized controlled trial with 6-month follow up

Background

Colorectal cancer is a major public health problem. There is growing support for colorectal cancer survivors who are experiencing problems after cancer treatment to engage in self-management programs to reduce symptom distress. However, there is inconclusive evidence as to the effectiveness of such program especially in Asian region.

Objectives

This study tested the effects of a six-month nurse-led self-efficacy-enhancing intervention for patients with colorectal cancer, compared with routine care over a six-month follow up.

Design

A randomized controlled trial with repeated measures, two-group design.

Setting

Three teaching hospitals in Guangzhou, China.

Participants:

One hundred and fifty-two Chinese adult patients with a diagnosis of colorectal cancer were recruited. The intervention group (n = 76) received self-efficacy-enhancing intervention and the control group (n = 76) received standard care.

Method

The participants were randomized into either intervention or control group after baseline measures. The outcomes of the study (self-efficacy, symptom distress, anxiety, depression and quality of life) were compared at baseline, three and six months after the intervention.

Results

Sixty-eight participants in the intervention group and 53 in the control group completed the study. Their mean age was 53 (SD = 11.3). Repeated measure MANOVA found that the patients in the intervention group had significant improvement in their self-efficacy (F = 7.26, p = 0.003) and a reduction of symptom severity (F = 5.30, p = 0.01), symptom interference (F = 4.06, p = 0.025), anxiety (F = 6.04, p = 0.006) and depression (F = 6.96, p = 0.003) at three and six months, compared with the control group. However, no statistically significant main effect was observed in quality of life perception between the two groups.

Conclusions

The nurse-led self-efficacy enhancing intervention was effective in promoting self-efficacy and psychological well-being in patients with colorectal cancer, compared with standard care. The intervention can be incorporated into routine care. Future empirical work is required to determine the longer term effects of the intervention.     

Effect of recombinant human erythropoietin on quality of life in cancer patients receiving chemotherapy: results of a randomized,controlled trial

The purpose of this study was to assess whether the administration of recombinant human erythropoietin (rHuEPO) would correct anemia and improve the quality of life (QOL) in cancer patients receiving chemotherapy. One hundred twenty-two patients with hemoglobin ≤11.0 g/dl were randomized to receive rHuEPO 10,000 U three times weekly (n = 61) or no additional treatment (n = 61). Response was assessed by measuring changes in hemoglobin level and QOL. QOL was evaluated before each cycle of chemotherapy at baseline, Week 4, and Week 12 using two separate self-report questionnaires. The analyses indicated that the rHuEPO-treated patients experienced significantly less fatigue (P < 0.05) than their control group counterparts, and reported significantly higher scores on energy level (P < 0.05), ability to perform daily activities (P < 0.01), and overall QOL (P< 0.05). The overall change in hemoglobin level was significantly greater in the rHuEPO group than in the control group (1.7 g/dl versus 0.3 g/dl, P < 0.001). rHuEPO effectively corrects anemia and significantly improves QOL in patients with solid tumors receiving chemotherapy.