奥曲肽在胰腺术后腹腔并发症预防中的作用

胰腺手术(包括胰十二指肠切除、胰体尾切除等)后使用奥曲肽是否能够降低腹腔并发症的发生目前仍有一定的争议。本文通过单盲随机对照方法,选择1 993～1 998年多中心2 30例行胰十二指肠切除、胰体尾切除及其扩大手术病例作为研究对象。原发病包括胰腺、壶腹部恶性肿瘤和胰腺、十二指肠良性肿瘤及慢性胰腺炎等。根据术后是否使用奥曲肽将所有病例分为奥曲肽组1 2 2例和对照组(不使用奥曲肽) 1 0 8例,两组患者在性别、年龄、原发病、手术方式等临床资料方面均无统计学差异。奥曲肽使用一般是术后连续8天以上,每天3次,每次1 0 0μg。统计的腹腔…     

奥曲肽在胰腺疾病中应用的新进展

奥曲肽(octreotide)为首个人工合成的生长抑素(somatostatin,SST)类似物,具有抑制腺体分泌、抑制细胞增殖、抗肿瘤等作用.随着对奥曲肽的深入研究和认识,它在胰腺疾病中的应用逐渐广泛.本文就奥曲肽近年来在胰腺疾病中应用的新进展做一综述.     

耐高压注射型双腔PICC置管患者皮肤的集束化管理

目的探讨集束化管理对耐高压注射型双腔PICC置入患者皮肤相关并发症的干预效果。方法将85例耐高压注射型双腔PICC置入患者随机分为干预组41例、对照组44例,干预组应用集束化护理措施,包括进行专项培训,换药手法标准化等;对照组实施常规护理。结果对照组非张力性机械性损伤发生率为9.09%,张力性机械性损伤4.55%,干预组发生率均为0;对照组过敏反应发生率显著高于干预组,差异有统计学意义(P0.05)。结论集束化管理可有效降低耐高压注射型双腔PICC置入患者皮肤相关并发症的发生。     

项目导向教学法在老年科护士耐高压双腔PICC维护培训中的应用

目的探讨项目导向教学法在老年科护士耐高压双腔PICC维护培训中的应用效果,提高患者导管护理质量。方法采取项目导向教学法,以提高老年科护士维护耐高压双腔PICC导管技能为项目,对全科护士进行耐高压双腔PICC导管维护技能培训,培训后(2015年4~6月)观察耐高压双腔PICC置管的48例患者(观察组)导管相关并发症发生情况,并与培训前(2014年6~12月)的45例患者(对照组)进行比较。结果项目实施后护士双腔PICC导管维护知识和操作水平显著高于实施前(均P0.01)。观察组PICC导管相关并发症发生率显著低于对照组,患者满意率显著高于对照组(均P0.01)。结论项目导向教学法有利于护士将理论知识迁移至实践,提高培训效果,从而提高双腔PICC导管维护质量。     

奥曲肽联合激素治疗术后早期炎性肠梗阻

术后早期炎性肠梗阻(early postoperative inflammatory ileus,EPⅡ)是腹部大手术后常见的并发症之一,通常在手术后1～3周内发生,处理不当可能引起肠瘘、重症感染、短肠综合征等严重并发症,甚至死亡.近年来应用奥曲肽联合激素治疗术后早期炎性肠梗阻,取得了较满意的临床效果,报道如下.     

奥曲肽对大鼠胰腺移植缺血再灌注损伤的保护机制

目的 探讨奥曲肽在胰腺移植缺血再灌注损伤中的作用以及可能机制。方法 应用大鼠全胰十二指肠同种异体移植动物模型,监测再灌注3、6 h血清中一氧化氮(NO)水平和超氧化物歧化酶(SOD)活性的变化,同时对移植胰进行组织学观察和诱导性一氧化氮合酶(iNOS)的免疫组织化学分析,以及应用奥曲肽和硝酸甘油(NTG)后上述指标的变化。结果 再灌注3、6 h血清NO水平、SOD活性分别为(77.13±5.29)、(103.92±11.17)μmol/L和(64.46±7.03)、(56.54±7.82)Nu/ml,与同时点假移植组差异有显著性(P均<0.01),且两指标变化呈显著负相关。应用奥曲肽后能显著降低NO水平,提高SOD活性接近至假移植组水平,与移植组相比差异有显著性(P均<0.01),并明显改善移植组织病变和降低iNOS表达强度。加用NTG后,又能在奥曲肽组基础上部分扭转上述变化,但这种现象仅在再灌注3 h时见到。结论 奥曲肽能显著下调移植胰iNOS的表达,降低血清NO水平并提高SOD活力,从而干扰NO/cGMP途径,减轻组织炎症反应,对再灌注组织起到保护作用。     

奥曲肽预防术后腹腔粘连的实验研究

目的:评估奥曲肽在腹腔术后粘连中的作用.方法:选用120只Wistar大鼠,在同一标准下刮伤其盲肠浆膜,制成损伤性腹腔粘连模型.将动物随机分成6组.1组为对照组,于首次剖腹术后给予生理盐水作为安慰剂0.5ml/12h皮下注射.2、3组分别给予奥曲肽0.5ml 2.5μg/(kg·12h)和氢化可的松2mg/(kg·12h)皮下注射,应用2周;a、b、c组不给予任何干预,而于2周后,实施粘连松解术,术后同1、2、3组方法分别给予生理盐水、奥曲肽和氢化可的松皮下注射,应用2周.1、2、3组和a、b、c组分别于首次剖腹术和粘连松解术后2周观察腹腔粘连程度.结果:同对照组相比,奥曲肽无论在首次开腹术后还是在粘连松解术后均能显著减轻腹腔粘连(P＜0.01).而氢化可的松只在首次术后具有预防腹膜粘连的作用.结论:奥曲肽具有预防腹腔粘连形成的作用.     

奥曲肽对肝硬变门静脉高压症病人门静脉,肝静脉血流动力学的 …

食管静脉曲张破裂出血是肝硬变门脉高压症致命的并发症之一,死亡率高达30%～50%,治疗较为困难。近年来应用有效药物降低门脉压力取得了较大进展,其中奥曲肽(Ｏｃｔｒｅｉｔｉｄｅ),又称善宁(Ｓａｎｄｏｓｔａｔｉｎ),能有效降低门静脉压力。并且副作用小而广泛用于临床。彩色多普勒超声的出现为我们提供了一种安全,无创性研究门脉血流动力学的手段。本文对18例肝硬变病人静脉注射奥曲肽前后进行彩色多普勒超声检查门静脉血流动力学的改变,探讨善宁的降压止血机理,现报道如下。材料与方法1病例资料:本组18例门脉高压症病人,经病理确诊为结节…     

Effect of octreotide acetate on pancreatic exocrine function

Somatostatin and its analogs have been shown to inhibit both pancreatic endocrine and exocrine function. We hypothesized that octreotide acetate (Sandostatin), a somatostatin analog, decreases the pancreatic flow rate through a peptide-mediated mechanism and alters pancreatic fluid composition by inhibiting carbonic anhydrase action and circulating peptide levels. To test this hypothesis, we collected pancreatic fluid from six patients (four with pancreatic fistulas and two with pancreatic drains after pancreatic resection). Pancreatic fluid volume and chloride, sodium, potassium, amylase, lipase, and bicarbonate levels were measured before and after octreotide acetate therapy. Octreotide acetate reduced pancreatic fluid output by a mean of 75 percent (p less than 0.05), increased chloride concentration by 21 percent (p less than 0.05), and reduced bicarbonate content by 45 percent (p less than 0.05). Sodium levels were unchanged, but the potassium concentration was increased by 14 percent (p less than 0.05). Total amylase and lipase production per 24 hours was decreased by 63 percent and 27 percent, respectively (differences not significant). Somatostatin may be useful in the treatment of established pancreatic fistulas and may be a useful prophylactic tool to prevent postoperative fistula formation.     

双腔耐高压PICC使用方法的改进

目的对双腔耐高压PICC的使用方法进行改进并评价其效果。方法将100例置入5Fr双腔耐高压PICC患者按住院时间分为对照组和观察组各50例。对照组行常规方法置管、维护,观察组在常规方法基础上增加冲管频率,并交替使用管腔。结果观察组仅1例发生导管完全堵塞,堵管程度显著低于对照组(P0.01),两组导管相关性感染率比较,差异无统计学意义(P0.05)。结论双腔耐高压PICC使用方法的改进,能有效降低堵管率,在严格遵守操作规程的基础上并不会增加导管相关性感染率。     

Effects of octreotide acetate on intractable chylothorax after surgery for congenital heart diseases

We experienced 2 infants in whom octreotide acetate was effective on intractable chylothorax after surgery for congenital heart diseases. They were 8- and 5-month-old. They were diagnosed as having corrected transposition of the great arteries (TGA) and tetralogy of Fallot respectively, and underwent bidirectional Glenn anastomosis and right modified Blalock Taussig shunt. Chylothorax was revealed on the 11th and the 1st postoperative day, and was not improved by any conventional therapy in either case. Then octreotide acetate was infused continuously with 0.1-0.6 micorg/kg/hour for 24 and 7 days. Chylothorax disappeared completely without any complications such as disturbance of blood sugar level or growth retardation. Octreotide acetate was effective and safe even in infants in intractable chylothorax after surgery for congenital heart diseases, as long as used for short period.     

肿瘤患者PICC留置期健康促进行为与心理一致感及抑郁的关系

目的了解肿瘤患者PICC留置期间健康促进行为情况,探讨其健康促进行为与心理一致感、抑郁的关系。方法采用健康促进生活方式量表、心理一致感量表、抑郁自评量表对130例留置PICC肿瘤患者进行调查。结果肿瘤患者PICC留置期间健康促进行为得分为135.7±15.7;健康促进行为总分与心理一致感总分呈正相关,与抑郁呈负相关(均P0.01)。结论肿瘤患者PICC留置期间健康促进行为处于中等水平,健康促进行为与心理一致感和抑郁密切相关。医护人员应帮助肿瘤患者获得有效的社会支持,提高患者心理一致感水平,同时密切关注患者情绪变化,以改善和提高肿瘤患者PICC留置期间健康促进行为水平。     

Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis

Objective

To assess the effectiveness of octreotide in preventing postoperative pancreatic fistula. Pancreatic fistula is one of the most common complications after elective pancreatic surgery. Several clinical trials have evaluated the use of octreotide to prevent the development of pancreatic fistula after pancreatic surgery with conflicting recommendations.

Methods

We undertook a meta-analysis of 7 identified randomized controlled trials, reporting comparisons between octreotide and a control. The primary outcome was the incidence of postoperative pancreatic fistula, and the secondary outcome was the postoperative mortality.

Results

Seven studies, involving 1359 patients, met the inclusion criteria for this review. In these studies, sample sizes ranged from 75 to 252 patients. In total, 679 patients were given octreotide and 680 patients formed the control group. Perioperative octreotide is associated with a significant reduction in the incidence of pancreatic fistula after elective pancreatic surgery, with a relative risk of 0.59 (95% confidence interval 0.41–0.85, p = 0.004). However, this risk reduction was not associated with a significant difference in postoperative mortality (p > 0.05).

Conclusions

The review revealed that perioperative octreotide is associated with a significant reduction in the incidence of pancreatic fistula after elective pancreatic surgery. However, this risk reduction was not associated with a significant difference in postoperative mortality; further studies are warranted to confirm the results of this metaanalysis and to define which patient subgroups might benefit the most from prophylactic octreotide administration.     

应用5A护理模式提高肺癌术后化疗患者自我效能

目的探讨应用5A护理模式提高肺癌术后化疗患者自我效能的作用。方法选取肺癌术后进行化疗的112例患者为研究对象,随机分为对照组和干预组各56例,对照组采用常规治疗和护理方法,干预组在常规治疗和护理的基础上,应用5A护理模式对患者进行干预,运用一般自我效能感量表比较两组患者自我效能的情况。结果采用5A护理模式干预3个月和6个月的肺癌术后化疗患者自我效能得分显著高于采用常规护理方法的患者(均P0.05)。结论基于5A护理模式的护理干预方法能提高肺癌术后化疗患者的自我效能。     

经近心端静脉PICC置管在超低出生体重儿中的应用

目的探讨经近心端静脉PICC置管在超低出生体重儿的应用效果。方法将超低出生体重儿57例根据置管部位不同分为观察组(n=26)和对照组(n=31),对照组经外周静脉PICC置管,观察组经近心端静脉PICC置管。结果观察组一次置管成功率显著高于对照组,导管异位发生率显著低于对照组(均P0.05)。结论对超低出生体重儿行近心端静脉PICC置管,能安全、迅速地为超低出生体重儿建立有效的静脉通路。     

制作核查标识提高手术患者Time-out核查执行率

目的探讨核查标识提高手术安全核查的效果。方法对照组1 000例患者按常规方法执行Time-out程序实施安全核查,观察组1 000例患者在此基础上在无影灯开关按钮粘贴自制的安全核查标识,提醒手术团队执行Time-out程序。结果麻醉前两组手术患者的安全核查执行率均为100%;手术开始前、患者离开手术间前安全核查执行率观察组显著高于对照组(均P0.01)。结论核查标识可提高手术前及手术结束后手术患者的安全核查执行率。     

PICC置管患者医护协同全程管理效果探讨

目的探讨医护一体化管理模式在PICC置管及规范化维护全程管理中的应用效果。方法采用非同期对照实验将164例患者分为对照组与观察组各82例,对照组给予PICC置管常规护理,观察组给予医护一体化管理模式干预。比较两组非计划性拔管、患者对护理工作的满意度以及导管相关并发症的发生率。结果观察组非计划拔管率显著低于对照组;对护理工作满意度显著高于对照组(P0.05,P0.01);两组导管相关并发症比较,差异无统计学意义(均P0.05)。结论对PICC置管患者实施医护一体化管理模式能有效降低非计划拔管率,从而提高患者满意度。