肾移植术前的心脏准备

肾移植术前的心脏准备曾国彬张创成黄玉林骆苗新杨露郑丽玉（武警福建总队医院福州３５００１９）关键词肾移植术心血管疾病术前准备１９９５年８月，我们成功完成了１例高龄肾移植手术，该例术前曾并发多种心血管疾病。本文报道其术前心脏准备的经验。１资料患者女性，５...     

肠内营养在结直肠癌术前肠道准备中的应用

目的探讨肠内营养在结直肠癌术前肠道准备中的应用价值。方法将61例结直肠癌术前肠道准备患者随机分为肠内营养组30例和对照组31例。肠内营养组在禁食的同时配合使用肠内营养混悬液,对照组按传统方法进行。结果两组肠道清洁效果无显著差异（P〉0.05）;肠内营养组术后血淋巴细胞、白蛋白、前白蛋白明显高于对照组（P〈0.05）,不良反应明显少于对照组（P均〈0.05）。结论肠内营养辅助用于术前肠道准备肠道清洁效果好,并可改善患者营养状态。     

盐酸达克罗宁胶浆在胃镜检查术前准备应用的临床观察

目的 探讨盐酸达克罗宁胶浆在胃镜检查中的祛泡作用.方法将受检于我院内镜中心的420例患者随机分成研究组(盐酸达克罗宁组),对照组(利多卡因组),两组分别于受检前10～15 min口服盐酸达克罗宁胶浆10 ml,盐酸利多卡因胶浆10 ml,观察胃镜视野的清晰度.结果 研究组的视野清晰度明显优于对照组.其中研究组A级清晰度...     

品管圈在降低非自愿住院精神病患者出走率中的应用

目的探讨品管圈活动对降低住院精神病患者出走率的作用。方法选择2012年10月至2013年3月在我院住院的精神病患者100例为观察组,采用品管圈小组的活动程序,分析患者出走的原因,制定改进措施并组织实施,并以实施品管圈活动前的100例住院患者为对照组。对比品管圈实施前后患者的出走率。结果开展品管圈活动后,患者出走发生率由活动前的10%下降到零,两组住院患者出走发生率组间比较差异具有统计学意义(P0.001)。结论开展品管圈活动不但可以提高病房管理质量,降低了患者出走率,保证住院患者的安全,而且还可提高圈成员的自主发现问题和解决问题的能力,增强了护理人员参与病区安全管理的意识及团队凝聚力,促进品管圈手法的运用及电脑相关知识的掌握。     

品管圈活动在降低静脉输液拒配率中的应用

目的 通过品管圈活动在老年病科的运用,提高科室医护人员药物管理的意识和医院静脉配置中心配制药物的质量,减少药物配伍差错及药品浪费,确保临床用药的安全.方法 根据静脉配制中心及信息科反馈的数据成立品管圈小组,采用柏拉图、鱼骨图、雷达图等方法,引导护士积极参与质量管理全过程,增强团队的合作能力、工作责任心,提高工作质量.结...     

部分脾栓塞术前准备对于防治术后并发症的意义

目的探讨部分脾栓塞术前准备的规范化内容和临床意义。方法行部分脾栓塞病人两组,A组行规范术前准备,B组无特殊术前准备,观察术后并发症。结果B组以感染为主的并发症发生率明显高于A组。结论部分脾栓塞术前规范肠道准备和预防性使用抗生素是减少术后并发症的必要措施。     

人工永久心脏起搏器安装的术前准备及术后护理

人工心脏起搏器是通过人工心脏起搏、按一定频率发放脉冲刺激心脏使之起搏,以维持生理循环功能。常用的心脏起搏器类型有单腔永久心脏起搏器和双腔埋藏式永久心脏起搏器。     

术前服用安素进行肠道准备的效果观察

2000年1月～9月，我院对30例结、直肠疾病患者术前3天予以安素口服，并与术前按常规进行肠道准备的30例患者比较，前者明显优于后者，现报告如下。     

阶梯给药法在甲亢术前准备中的应用效果观察

目的探讨阶梯给药法在甲状腺功能亢进症(简称甲亢)术前准备中的安全性。方法将90例行手术治疗的甲亢患者随机分为对照组和观察组各45例。对照组采用传统给药法,住院口服复方碘溶液;观察组采用阶梯给药法门诊服药。观察两组手术时间、术中失血量及术后并发症发生率情况。结果两组患者在手术时间、术中失血量、术后并发症发生率等方面比较差异无统计学意义(P0.05),两组患者的住院天数、住院费用比较差异有统计学意义(P0.05)。结论阶梯给药法行甲亢术前准备与传统服药法同样安全可靠,并缩短住院时间和减少住院费用,值得推广应用。     

腹腔镜抗反流手术术后并发症的处理

目的探讨腹腔镜抗反流手术术后并发症的评估及处理方法。 方法回顾性分析2005年9月至2014年4月,新疆维吾尔自治区人民医院施行腹腔镜抗反流手术725例患者的临床资料,并对并发症患者进行治疗分析。 结果725例患者均成功完成食管裂孔疝修补＋胃底折叠术。术后并发症患者45例,其中吞咽困难21例,食管裂孔疝复发(折叠的胃底疝入胸腔)4例,症状复发14例,胃肠胀气综合征6例。随访6个月至9年,平均36.6个月。 结论腹腔镜抗反流手术并发症的发生率及其后果主要与术前评估、术者经验、围手术期饮食指导和患者的依从性相关。     

Quality of life convergence of laparoscopic and open anti-reflux surgery for gastroesophageal reflux disease

Although laparoscopic anti-reflux surgery (LARS) has become the surgical treatment of choice for gastroesophageal reflux disease (GERD), it is unclear whether the quality of life (QoL) advantage of LARS over open anti-reflux surgery (OARS) persists in the long term. The purpose of this study was to compare long-term QoL between LARS and OARS patients. A prospectively gathered database of all patients who underwent either LARS or OARS for symptomatic GERD was reviewed. Preoperatively, patients completed the GERD- health-related quality of life (HRQL) symptom severity questionnaire (best score 0, worst score 50), and the Medical Outcome Short Form (36) (SF-36) generic bodily QoL instrument (eight domains, physical functioning, PF; role - physical, RP; role - emotional, RE; bodily pain, BP; vitality, mental health, social functioning, SF; general health, best score 100, worst score 0). Postoperatively, patients completed both questionnaires at 6 weeks and a least 1 year. Data are presented as medians and statistically analyzed using the Mann-Whitney U-test. A beta-error was determined to assess adequacy of sample size. A total of 289 patients underwent LARS and 124 OARS. At 6 weeks there were statistically significantly better scores for LARS in the domains of PF, RP, RE, BP and SF. However, after 1 year, there were no statistically significant differences. The beta-error for non-statistically significant differences were all < 0.2, which is considered an adequate sample size. Although LARS does produce better QoL scores in the early postoperative period, after 1 year, these scores converge.     

Complications associated with laparoscopic anti-reflux surgery: one multispecialty clinic''s experience

Background: The records of all patients with significant complications of laparoscopic anti-reflux surgery (LARS) seen at our institution between June 1993 and September 1996 were reviewed. Specifically excluded were patients who had mild perioperative complications or postoperative dysphagia that either did not require bougienage or responded to one to two dilations. Data collected included patient demographics; type of surgery; complication and its presentation; response to medical, endoscopic, and/or surgical therapy; and outcomes. Results: Nine patients (five men and four women, mean age 59 years) presented at a mean of 4 months post-LARS (seven Nissen fundoplications and two Hill posterior gastropexy repairs). Symptoms included refractory dysphagia (4), intractable gas bloat (5), various degrees of chest or abdominal pain (4), and incapacitating diarrhea (3). Findings included tight repair (4), vagal nerve injury with gastroparesis (4) and/or diarrhea (3), and esophageal or gastric perforation (3). Additional findings included proximal gastric ulcers (3), volvulus (1), and incarcerated intrathoracic hernia (1). Patients with dysphagia had moderate improvement after a mean of 3 ± 0.6 (standard error of the mean) additional dilations, whereas four patients required five reoperations to date. Seven of the nine patients had clinical improvement, whereas two had refractory symptoms at a mean follow-up of 10 months. Conclusions: Although LARS has supplanted open surgery in many centers, refractory complications occur in a subset of patients and require reoperation in approximately one half of those referred to a multispecialty clinic. (Gastrointest Endosc 1997;46:527-31.)     

腹腔镜抗反流手术联合胃大弯侧折叠术动物训练模型的建立

目的建立用猪腹腔镜下抗反流手术联合胃大弯侧折叠术的动物模型的经验与体会。 方法对6头健康猪做麻醉,用OLYMPUS公司的腹腔镜器械,分别行腹腔镜食管裂孔疝修补术＋ Nissen胃底折叠术＋胃大弯侧折叠术,腹腔镜食管裂孔疝修补术＋ Toupet胃底折叠术＋胃大弯侧折叠术,记录术中遇到的技术问题。 结果用6头猪开展的两种抗反流手术及胃大弯侧折叠术均成功,无术中大出血及脏器损伤等并发症。 结论经腹腔镜下食管裂孔疝修补＋胃底折叠术联合胃大弯侧折叠术的技术是安全可行的。     

术前内镜下自体血标记定位应用于腹腔镜结直肠肿瘤手术的临床效果分析

为评价内镜下自体血标记定位在腹腔镜结直肠肿瘤术前应用的临床价值,回顾分析2019年1月—2021年1月在同济大学附属东方医院行结肠镜下自体血定位并随后行腹腔镜手术的结直肠肿瘤患者资料30例。腹腔镜手术中根据结肠浆膜面局部红色标记判断病灶所在位置。术中探查评估染色清晰度,观察有无注射自体血泄漏情况。所有患者在结肠镜下顺利完成自体血定位,无出血、穿孔和发热等并发症。腹腔镜探查可见清晰的自体血染色部位,未见染色弥散、泄漏污染术野情况。术后病理证实标本切缘阴性。说明经结肠镜下注射自体血是一种理想的腹腔镜结直肠肿瘤手术前病灶定位方法,安全有效,值得临床推广。     

Reoperation following failure of anti-reflux surgery

Reoperation is the treatment of choice of failed antireflux procedures. Preoperative full-scale evaluation of both residual anatomy and function of the upper digestive tract is mandatory. Conservative surgery is almost always feasible. Success rate of reoperations is high with experienced teams.     

腹腔镜结直肠肿瘤手术术前定位方法的应用现状

腹腔镜微创手术是目前治疗结直肠肿瘤最常见的手术方式,由于其较好的短期疗效,越来越受到中青年医师的青睐.但腹腔镜手术缺乏传统开放手术的直接触感,往往不能对较小的肿瘤精确定位,进而导致手术难度增加,手术时间延长等不良后果,因此术前准确定位是选择腹腔镜结直肠肿瘤手术的前提条件.本文就临床常用的肠道肿瘤定位方法结合相关文献及本...