改良早期预警评分与校正改良早期预警评分预测普外科术后患者去向的应用价值

目的探讨改良早期预警评分(MEWS)与校正MEWS预测普外科术后患者去向的应用价值。方法采用便利抽样法,选取2017年1月-2018年12月上海市浦东新区公利医院普外科术后1160例患者,收集患者转入病房72 h内的生命体征、神志、血氧饱和度及尿量数据,使用MEWS和校正MEWS分别评估。计算该期间两种评分的最高评分结果,观察患者的去向。比较两种评分预测患者去向的相关预测指标灵敏度、特异度、阳性预测值、阴性预测值、预测患者去向分辨度的受试者工作特征曲线(ROC)。结果转入ICU患者的校正MEWS高于MEWS。以收住ICU为预测目标时,MEWS的ROC曲线下面积为0.986(95%CI为0.973~0.998),最佳截断值为3分,此时Youden指数最大,为0.903;校正MEWS的ROC曲线下面积为0.991(95%CI为0.978~0.995),最佳截断值是5分,此时Youden指数最大,为0.943;校正MEWS的ROC曲线下面积大于MEWS,差异有统计学意义(P<0.05);校正MEWS评估患者转入ICU的特异度、阳性预测值高于MEWS,差异有统计学意义(P<0.05);校正MEWS评估患者转入ICU的灵敏度、阴性预测值高于MEWS,但差异无统计学意义(P>0.05)。结论校正MEWS比MEWS更能反映外科术后患者病情危重程度,能够准确预测患者的病情变化,值得在普外科病房中推广应用。     

超声引导下腹横肌平面阻滞用于≥70岁患者腹股沟疝修补术术后镇痛的临床观察

目的观察超声引导下腹横肌平面（TAP）阻滞对于≥70岁患者开放性腹股沟疝修补术术后镇痛的影响。 方法选择择期行开放性腹股沟疝无张力修补术患者60例,采用蛛网膜下腔阻滞麻醉,均为男性,年龄≥70岁,美国麻醉师协会分级Ⅰ~Ⅱ级,采用随机数字表法将患者分为对照组和试验组,每组30例。试验组于手术结束后于患侧行超声引导下TAP阻滞。观察2组患者术中、术后有无恶心、呕吐、心慌、胸闷、呼吸困难及头晕、嗜睡等不良反应;记录试验组术中、术后有无血管、神经及腹腔脏器损伤,局部麻醉药物中毒、穿刺部位感染等不良事件发生;记录2组患者术后4、6、8、12、24 h时静息状态下和咳嗽时视觉模拟量表（VAS）评分;记录术后下床时间、术后住院天数、总住院天数、麻醉费用以及住院总费用,记录2组术后非甾体类镇痛药的使用例数。 结果2组患者术中、术后均无恶心、呕吐、心慌、胸闷、呼吸困难及头晕、嗜睡等不良反应。试验组患者术中、术后无血管、神经及腹腔脏器损伤,无局部麻醉药物中毒及穿刺部位感染等不良事件。对照组在静息状态下［4 h：（3.8±1.2）分vs （1.6±0.5）分;6 h：（4.2±1.5）分vs （1.8±0.8）分;8 h：（4.8±1.5）分vs （2.0±0.7）分;12 h：（5.2±1.4）分vs （2.2±0.6）分;24 h：（3.2±?.?）分vs （1.6±0.6）分］和咳嗽时［4 h：（3.9±1.3）分vs （1.8±0.8）分;6 h：（4.6±1.5）分vs （2.0±0.8）分;8 h：（5.5±1.6）分vs （2.2±0.9）分;12 h:（5.8±1.8）分vs （2.4±0.8）分;24 h：（4.6±1.4）分vs （1.8±0.7）分］不同时间点的VAS评分均大于试验组（P<0.01）;2组住院总费用差异无统计学意义,试验组麻醉费用高于［（780.06±63.10）元vs （566.69±93.23）元］、下床活动时间早于［（5.26±1.43）天vs （8.62±1.62）天］、非甾体类药物使用例数少于（2 vs 28）对照组（P<0.01）。 结论超声引导下TAP阻滞因其镇痛效果确切,且操作简单,相关并发症少,对于≥70岁患者的开放性腹股沟疝修补术是一种安全有效的术后镇痛方法。     

体位和活动指导对腹腔镜胆囊结石患者术后胃肠功能及生活质量影响

目的探讨体位和活动指导对腹腔镜胆囊结石患者术后胃肠功能及生活质量影响。方法选取2018年1-12月我院收治的腹腔镜胆囊结石手术患者96例,根据随机数字表将患者分为观察组(n=48)及对照组(n=48),对照组给予围手术期常规护理,观察组在对照组的基础上给予体位及活动指导,比较干预后2组患者术后胃肠功能恢复情况、并发症发生率及生活质量。结果干预后,观察组首次下床活动时间、肛门排气时间、正常排便时间、恢复正常饮食时间及平均住院时间均短于对照组;术后并发症发生率低于对照组。观察组躯体功能、心理功能、社会关系、环境维度及生活质量总评分均高于对照组(χ^2=20.641,P<0.001)。结论体位和活动指导能有效促进腹腔镜胆囊结石患者术后胃肠功能恢复,减少术后并发症的发生,促进患者术后康复,提高患者生活质量。     

大承气汤加减治疗痔疮术后便秘临床应用效果观察及围手术期睡眠质量调查

目的:观察对痔疮术后便秘患者应用大承气汤加减治疗的临床效果及其对围术期患者睡眠质量的影响.方法:选取2017年9月至2019年4月在河池市人民医院接受治疗的痔疮术后便秘患者71例作为研究对象,以治疗方式为依据将患者分成对照组(n=35,常规西医治疗)与观察组(n=36,对照组+大承气汤加减).比较2组患者的治疗效果、排便情况、肛门疼痛情况与睡眠情况.结果:观察组患者的治疗总有效率与睡眠总时间均低于对照组;观察组患者的排便次数正常时间、大便性质正常时间与肛门疼痛评分均低于对照组;均有统计学意义(P<0.05).结论:对痔疮术后便秘患者使用大承气汤加减治疗的效果理想,可有效改善患者的便秘情况,减轻患者的肛门疼痛,并提高患者的睡眠质量,应积极推广.     

前列腺穿刺术后感染并发症的研究进展

前列腺癌,顾名思义是发生于前列腺的恶性肿瘤,美国2019年预计前列腺癌新发率20%,位居男性恶性肿瘤之首,死亡率居第二位10%[1]。近年来我国前列腺癌的发病率逐年增高,国内对于前列腺癌的认识以及科普工作的不足导致许多基层老龄人口对前列腺癌的认知程度几乎为零,因而早期确诊和治疗前列腺癌对于患者的生存就显得尤为重要。目前我国人口老龄化问题与世界上许多国家地区一样逐年升高,人口结构的巨大改变,前列腺癌的发病及诊出率越来越高,因此前列腺癌又被冠以"老年男性头号杀手"的称号,并且有资料统计我国的前列腺癌增长速度比欧美发达国家更为迅速[2]。症状出现较晚是前列腺癌的一个显著的临床特点,早期患者可无明显症状或者仅有一些前列腺增生的临床表现,部分患者疾病已进入了晚期才会出现如骨痛、血尿等明显症状,此时已经不能通过手术方法治愈肿瘤了,患者也已失去了最佳的治疗时机。因此前列腺癌如果不能被早期诊断,患者往往会遭受较大的痛苦,进而危及生命。     

Risk factors for postoperative sepsis in patients with gastrointestinal perforation

BACKGROUND Sepsis is fatal in patients with gastrointestinal perforation(GIP).However,few studies have focused on this issue.AIM To investigate the risk factors for postoperative sepsis in patients with GIP.METHODS This was a retrospective study performed at the Department of General Surgery in our treatment center.From January 2016 to December 2018,the medical records of patients with GIP who underwent emergency surgery were reviewed.Patients younger than 17 years or who did not undergo surgical treatment were excluded.The patients were divided into the postoperative sepsis group and the non-postoperative sepsis group.Clinical data for both groups were collected and compared,and the risk factors for postoperative sepsis were investigated.The institutional ethical committee of our hospital approved the study.RESULTS Two hundred twenty-six patients were admitted to our department with GIP.Fourteen patients were excluded:Four were under 17 years old,and 10 did not undergo emergency surgery due to high surgical risk and/or disagreement with the patients and their family members.Two hundred twelve patients were finally enrolled in the study;161 were men,and 51 were women.The average age was 62.98±15.65 years.Postoperative sepsis occurred in 48 cases.The prevalence of postoperative sepsis was 22.6%[95%confidence interval(CI):17.0%-28.3%].Twenty-eight patients(13.21%)died after emergency surgery.Multiple logistic regression analysis confirmed that the time interval from abdominal pain to emergency surgery[odds ratio(OR)=1.021,95%CI:1.005-1.038,P=0.006],colonic perforation(OR=2.761,CI:1.821–14.776,P=0.007),perforation diameter(OR=1.062,95%CI:1.007-1.121,P=0.027),and incidence of malignant tumorrelated perforation(OR=5.384,95%CI:1.762-32.844,P=0.021)were associated with postoperative sepsis.CONCLUSION The time interval from abdominal pain to surgery,colonic perforation,diameter of perforation,and the incidence of malignant tumor-related perforation were risk factors for postoperative sepsis in patients with GIP.     

Effectiveness of surgical resection for complicated liver cancer and its influencing factors: A retrospective study

BACKGROUND Surgical resection is the preferred method for patients with complex liver cancer.But the tumor is in a special position,the surgery is highly risky,postoperative complications can easily occur,and the prognosis is not ideal.AIM To investigate the effectiveness of surgical resection for complex liver cancer and its influencing factors.METHODS Fifty-seven patients who had complicated liver cancer and underwent surgical resection at our hospital from August 2015 to August 2016 were enrolled in this study.All patients were followed for three years,and their postoperative complications,survival,and factors that impacted their survival were analyzed.RESULTS The total incidence of postoperative complications was 45.61%,and the incidence of pleural effusion was the highest at 28.07%.There were no correlations between the 2-year and 3-year survival rates and sex,age,and HbsAg of the patients(P>0.05).In terms of pathological parameters,the 2-year and 3-year survival rates were significantly different according to the presence of a tumor capsule,degree of liver cirrhosis,satellite or focal lesions,hepatic vein thrombosis,portal vein tumor thrombus,and intraoperative blood loss(P<0.05).CONCLUSION be affected by factors such as the presence of a tumor capsule,cirrhosis degree,satellite or focal lesions,hepatic vein embolization,portal vein tumor thrombus,and intraoperative blood loss.Therefore,these factors should be controlled and prevented during surgery to help improve patient survival after surgery.     

Mid-term clinical and haemodynamic results after aortic valve replacement with the Trifecta bioprosthesis

 Open in a separate windowOBJECTIVESThe aim of this study was to evaluate the clinical and haemodynamic results after implantation of the Trifecta bioprosthesis.METHODSThis study is a retrospective analysis of all patients undergoing Trifecta aortic valve replacement between 01 January 2012 and 31 December 2017 at the Ghent University Hospital. Univariable and multivariable analyses were performed to identify predictors of valve- and procedure-related complications and mortality. The haemodynamic performance was analysed by longitudinal Doppler echocardiography.RESULTSThe mean age of the 182 patients was 77 [standard deviation (SD): 5.5] years; 54.9% were women. The mean follow-up was 39.8 (SD: 24.3) months. Overall survival at 1 and 5 years was 86% (SD: 3%) and 68% (SD: 4%), respectively, and overall freedom from structural valve deterioration was 100% and 98% at 1 and 5 years, respectively. There was no valve thrombosis nor early endocarditis. Urgent surgery was the only risk factor for early mortality in the multivariable analysis [P = 0.009, odds ratio 0.06, 95% confidence interval (CI) 0.01–0.5]. Preoperative atrial fibrillation was the most important predictor of late mortality (P = 0.001, hazard ratio 3.68, 95% CI 1.65–8.21). The average peak gradients were stable from discharge up to 1 and 5 years postoperatively [15 (SD: 6) and 17 (SD: 8) mmHg].CONCLUSIONSThese results confirm the excellent clinical performance of the Trifecta valve, particularly in an elderly age group. Through the 7-year follow-up period, low transvalvular gradients persisted, and only a few patients needed reoperation. Although structural valve degeneration occurred rarely, it was unrelated to valve size or age at implantation; therefore, further long-term follow-up remains mandatory.     

胃癌术后胆囊结石形成的危险因素及预防措施的研究进展

胃癌是常见的消化系统恶性肿瘤,治疗方式以手术为主。随着医疗水平的进步,胃癌患者的生存率有所提高,术后并发症也引起人们的关注,临床实践发现一些胃癌患者术后会发生胆囊结石或胆囊炎,有的甚至需二次手术治疗,严重影响了患者的生活质量。目前对于胃癌术后术后胆囊结石形成的危险因素尚无统一定论,较为明确的危险因素包括神经因素、胃切除范围、消化道激素、消化道重建及淋巴结清扫范围等。同样对于胃癌术后胆囊结石的预防尚无统一定论,其中是否需要进行预防性的胆囊切除仍存在很大的争议,也是临床医生关注的焦点。本文就胃癌术后胆囊结石形成的危险因素以及目前最新的预防措施做一综述,希望能对临床工作有所帮助。     

胃癌患者腹腔镜辅助全胃切除手术治疗的有效性及对患者预后的影响

目的 探讨胃癌患者腹腔镜辅助全胃切除手术治疗的有效性及对患者预后的影响.方法 选取78例胃癌患者,采用随机数字表法分为两组,每组各39例.对照组实施开腹全胃切除术,观察组实施腹腔镜辅助全胃切除术.比较两组临床治疗效果、应激指标水平[C反应蛋白(CRP)和皮质醇(COR)水平]以及并发症发生情况.结果 对照组手术时间为(...