Optimal dose and duration of glucose administration during fasting period preceding surgery in rabbits

Purpose. We examined preoperative glucose administration to establish what dose and cutoff point were optimal for suppression of lipolysis and prevention of hypo- or hyperglycemia. Methods. Rabbits were preoperatively fasted and simultaneously received glucose at a constant rate of 0, 0.1, 0.2, 0.3, or 0.4 g·kg⁻¹·h⁻¹ in fluid infusion for 3 h. Plasma glucose, immunoreactive insulin activity, nonesterified fatty acids, and ketone bodies were measured 0, 1.5, 3 and 4 h after the start of infusion, and hepatic glycogen content was assessed 1 h after cessation of infusion. Results. Fluid infusion without glucose decreased plasma glucose. Glucose administration at more than 0.2 g·kg⁻¹·h⁻¹ caused hyperglycemia (>200 mg·dl⁻¹) in the infusion period; the differences were significant compared with the value at zero time or in the 0 g·kg⁻¹·h⁻¹ group (P < 0.01). The highest dose also raised plasma immunoreactive insulin activity, which was significantly higher than in the 0 g·kg⁻¹·h⁻¹ group (P < 0.01) at the midpoint of the infusion period. Plasma nonesterified fatty acids increased in all groups. The changes were, however, significantly reduced in both the 0.3 and 0.4 g·kg⁻¹·h⁻¹ groups (P < 0.05 and P < 0.01, respectively) by the end of infusion. All these effects of glucose supply, including suppression of lipolysis, disappeared regardless of dose within 1 h after the cessation of infusion. Conclusion. These results suggest that the optimal dose for preoperative glucose infusion, in order to preserve carbohydrate or fat metabolism, is 0.1–0.2 or 0.3 g·kg⁻¹·h⁻¹, respectively, and indicate that administration should not be discontinued until the start of surgery. Received for publication on July 16, 1998; accepted on August 23, 1999     

术前超声预测腹腔胆囊切除手术难度的意义

目的：探讨Ｂ超诊断对腹腔镜胆囊切除术的意义。方法 ：从２４８例欲施行ＬＣ手术患者中筛选出２００例胆囊结石并慢性胆囊炎及胆囊息肉患者,比较术前超声检查与ＬＣ的关系。结果;筛选出的２００例患者中,ＬＣ成功切除１９０例,１０例中转开腹手术。另４８例行开腹手术,术后结果与术前超声所见符合率１００％。     

手术前患儿心理状态评估方法的比较研究

目的：通过主观评定法和量表评定法对手术前患儿的心理状态进行评估，比较两种方法的差异及患儿年龄与心理状态的关系，以便临床选择一种科学可行的心理状态评估方法．并对易发生心理障碍年龄段的患儿进行早期干预：方法：对采用主观评定法评估为焦虑、抑郁、正常的120例患儿，同时采用量表评定法（SAS＋SDS）进行了心理测验。结果：主观评定法及量表评定法的阳性率比较，有显著性差异。结论：临床护士需要将主观评定法与量表评定法结合起来进行心理状态的评估．并对婴幼儿及学龄期儿童进行有预见性地护理和心理干预．制定相应的护理措施，保证心理护理的科学性。     

Prospective randomized,double-blinded,placebo-controlled trial of preoperative rofecoxib for pain relief in uterine curettage

Objective: To evaluate the analgesic efficacy of preoperative rofecoxib in patients who underwent uterine curettage. Materials and methods: This double-blinded, randomized, placebo-controlled trial included 80 women who underwent uterine curettage. Forty women were randomly assigned to rofecoxib 50 mg and 40 women to the placebo. The main outcome measure was the intensity of pain measured by the visual analog scale and categorical pain scores during and after the procedure. Chi-squared, Fisher exact, Student t test, and Mann-Whitney U tests were used for statistical analysis. Results: The intensity of pain was not found to be different between groups over the course of procedure (P>0.05). There were no serious adverse effects in this study. Conclusion: The preoperative administration of rofecoxib was not effective in reducing pain in uterine curettage.     

老年病人手术前焦虑相关因素的调查及干预

目的:探讨老年病人手术前焦虑水平及其影响因素,为术前实施心理干预提供依据.方法:采取问卷调查形式,包括自制基本资料调查表和采用Zung焦虑自评量表(SAS),对我院外科100例60岁及以上的老年腹部手术病人术前2 d进行焦虑水平调查,并采用描述性研究方法分析焦虑水平及其影响因素,将获得资料进行对比分析.结果:老年病人术前SAS总分高于国内常模,焦虑平均得分为(45.90±11.67)分,与我国常模(29.78±0.46)比较有显著性差异(P＜0.01＝;焦虑水平与手术方式、有无合并症、儿女的支持程度、对手术的感知程度等因素相关.结论:老年病人手术前普遍存在焦虑状态,焦虑状态与手术方式、有无合并病、儿女的支持程度、对手术的感知程度等因素有关,于术前1 d对病人实施切实可行的心理干预,具有显著的临床指导意义.     

老年上腹部手术患者术前预防性使用沐舒坦的临床效果观察

目的观察老年上腹部手术患者术前预防性使用沐舒坦的临床效果,探讨老年上腹部手术患者改善术后肺通气、促进排痰的方法。方法选择老年上腹部手术患者112例,随机均分为对照组和观察组,对照组给予常规外科治疗及术前术后处理,观察组在常规治疗的基础上,术前预防性静脉滴注沐舒坦,分别比较两组患者术后第1、3、5、7天的PaO2、PaCO2及术后排痰情况。结果观察组临床效果好于对照组,两组在上述方面比较,差异均具有统计学意义（P〈0.05）。结论老年上腹部手术患者术前预防性使用沐舒坦,可改善术后肺通气并促进排痰。     

先天性心脏病患儿父母术前需求及满足情况的调查

目的探讨先天性心脏病患儿父母术前需求状况及满足情况。方法选取105名先天性心脏病患儿父母为研究对象,采用急危重症患者家属需求量表（CCFNI）和急危重症患者家属需求满足程度量表（NMI）在术前1d对其进行问卷调查,统计其需求状况和满足状况并分析相关因素。结果回收有效问卷100份,有效回收率为95．2％;术前先天性心脏病患儿父母总体需求平均得分（3．24±0．46）分,总体满足程度平均得分（2．26±0．41）分;需求重要程度最高的3个维度分别是“增强信心和减轻焦虑需求”（3．70±0．29）分、“获取信息需求”（3．58±0．45）分和“接近患儿需求”（3．48±0．67）分,其中“获取信息需求”和“接近患儿需求”的满足程度平均得分较低,分别为（2．24±0．47）分和（2．28±0．46）分;多元逐步回归分析结果显示,患儿父母的年龄和文化程度是患儿父母术前需求的主要影响因素（r分别为0．196,0．248;P〈0．05）。结论先天性心脏病患儿父母术前需求程度较高,满足程度偏低。护理人员应了解先天性心脏病患儿父母术前需求情况,通过有效沟通和个体化的护理,及时满足患儿父母的需求,以提高护理质量。     

心理沟通对老年择期手术患者术前心理状态的影响

目的 探讨术前心理沟通对老年择期手术患者心理状态的影响.方法 将136例接受择期手术的老年患者随机分为观察组和对照组各68例,其中对照组患者的护理均采取常规普通外科手术护理,观察组患者在常规普通外科手术护理的基础上术前连续3d进行有针对性的心理沟通.比较2组患者的焦虑、抑郁及恐惧心理状态.结果 观察组经心理沟通后,焦虑、抑郁及恐惧状况较对照组明显改善.结论 在术前与择期手术的老年患者进行适当、有针对性的心理沟通,可以缓解老年患者术前的焦虑、抑郁及恐惧的心理,有助于手术顺利进行.     

不同病种外科病人术前血浆量、红细胞量和血容量的测定

目的 研究不同外科疾病病人术前血浆量、红细胞量和血容量变化情况。方法 ５１例外科住院病人参加了本研究,术前分别测定其血浆量和红细胞量,二者相加得病人血容量值,与百科全书及生理教科书介绍的正常人资料对比。结果 （１）胆道疾病病人及胃、结肠癌病人每千克体重血浆量、红细胞量和血容量的测定值较正常人资料显著增高。结论 门静脉高压症病人的血浆量、红细胞量和血容量均较正常人资料显著增高,其它疾病病人则和正常人资料相近。     

胰腺癌的影像学表现与病理对照研究

目的探讨胰腺癌的影像学表现及各种影像学方法的临床应用价值。方法回顾性分析我院１９８９年至１９９９年４６例经手术病理证实的胰腺癌,对照研究影像学表现（ＵＳ,ＣＴ,ＭＲＩ,ＧＩ）与手术及病所见,比较各种影学检查方法的优缺点。结果胰腺癌的影像学主要表现以下几个方面;①胰腺外形的变化,表现为胰腺增大和局部膨隆;②胰腺内肿块;③伴发胰,胆管扩张;④血管受侵;⑤邻近脏器受侵;⑥肝转移;⑦淋巴结转移。结论影像学