目的 探讨快速康复外科(enhanced recovery after surgery, ERAS)理念在膀胱癌根治加回肠膀胱术后护理的有效性和安全性。方法 分析我院2012年1月—2016年12月行膀胱癌根治加回肠膀胱术的患者共98例,其中ERAS组47例,传统组51例。比较两组术后伤口感染率、出血率、吻合口瘘率、肺部感染率及术后住院日等指标。结果 两组患者的伤口感染率、出血率、吻合口瘘率无差异,ERAS组的肺部感染率4.26%低于传统组21.57%,差异有统计学意义(P＜0.05)。ERAS组的术后住院日短于对照组[(8.53±1.82)vs (13.21±2.16)],差异有统计学意义(P＜0.05)。ERAS组的30天内再入院率6.38%低于传统组19.61%,差异有统计学意义(P＜0.05)。两组的非计划再次手术率无统计学差异。结论 快速康复外科理念应用在膀胱癌根治加回肠膀胱术后护理是有效和安全的,ERAS能减少术后并发症及缩短术后住院日。
目的 探讨红外线照射联合中药穴位贴敷在骨外科术后护理工作中的应用。方法 选择2014年2月—2015年6月我院收治的120例骨外科手术治疗患者,随机分为对照组与观察组,每组各60例;两组患者均给予饮食、心理、排便训练等常规护理,观察组在常规护理基础上给予中药穴位贴敷联合红外线照射综合护理,比较两组患者术后自主排便功能恢复情况,采用汉密尔顿抑郁量表(HAMD)与汉密尔顿焦虑量表(HAMA)评估患者干预前后心理状态,于术后不同时间采用视觉模拟评分法(VAS)对患者的疼痛情况进行评定,记录患者住院时间及下肢深静脉血栓发生情况。结果 术后观察组自主排便恢复情况(88.3%)高于对照组(73.3%)(χ2=4.357,P＜0.05),观察组自主排便恢复时间低于对照组(t=5.422,P＜0.05);术后5、30 d两组患者HAMD和HAMA评分均性降低(P＜0.05),观察组低于对照组(P＜0.05);术后5、10、20 d观察组患者疼痛评分比对照组降低(P＜0.05);观察组患者住院时间少于对照组(P＜0.05),观察组下肢深静脉栓发生率1.7%低于对照组6.7%,但无统计学意义(P＞0.05)。结论 红外线照射联合中药穴位贴敷可改善骨外科手术术后患者自主排便功能,降低患者心理压力,促进手术后恢复。
目的 探索在神经外科护理教学中使用周期目标教学模式对学生理论知识、护理技能的作用与意义。方法 采用统一标准百分制操作与理论考核,比较周期目标教学模式和一对一带教模式下护理学生护理理论与技能掌握、应用的差异。结果 实验组学生理论考核和操作考核成绩比一对一带教学生成绩高。结论 周期目标教学模式使学生的实习思路清晰,提高了学生实习的积极主动性;实习目标明确,促进了护生在专科技能操作上的提高。对提高我科护理教学质量起到积极的促进作用。
目的 探索外科硕士研究生医患沟通培养教育方法。方法 通过对56位外科硕士研究生的医患沟通培养实践,研究医患沟通教育的培养模式和评估方法。结果 通过课程培养,56位外科硕士研究生有92.8%的外科硕士研究生认为课程“有很大帮助”;培养前后对“信息采集”、“尊重隐私”、“语言艺术”、“情感沟通”、“诊疗作用”等方面认知有差异(P＜0.05),而在“专业知识”方面培养前后无差异(P＞0.05)。结论 应当在外科硕士研究生中建立医患沟通培养课程和相应的评估体系。
Objective To explore graduates training and education methods of communicating between doctors and patients in surgery department. Methods 56 graduates of surgery were trained for communicating between doctors and patients as special education practice.Experiences of the training were summed up to identify educational methods for graduates. Results After the end of the training programs,52 graduates,92.8% of 56,considered the training “great help”. Around the training of “Information Gathering”,“Respect for Privacy”,“Language Arts”,“Emotional Communication”,“Treatment Effects ” cognition of the graduates were significantly different from the beginning(P＜0.05),while in the “Professional Knowledge” no significant difference(P＞0.05). Conclusion Patient communication training courses and the corresponding evaluation system should be established.
目的 比较腹腔镜阑尾切除术结合快速康外科(FTS)观念与传统开腹阑尾切除术的疗效差异。方法 回顾分析奉新县人民医院普通外科2001年2月—2003年4月和2010年7月—2013年6月收治的96例阑尾炎患者,随机分为两组,每组各48例,分别为传统开腹手术组(对照组)和腹腔镜阑尾切除术联合FTS组(实验组),检测术前1 d及术后第1 d、第3 d白细胞计数(White blood cell,,WBC)、C-反应蛋白(CRP)、白细胞介素-6(IL-6),同时比较两组术式的手术时间、住院时间、消化功能恢复时间及术后并发症的发生率。结果 实验组与对照组术后第1 d、第3 d外周血WBC、CRP、IL-6均显著高于术前,两组之间相比较差异有统计学意义(P＜0.05);实验组平均手术时间(62±18)min,对照组平均手术时间(55±21)min,两组相比差异无显著性(P＞0.05);实验组平均住院天数为(4.2±1.3)d,对照组平均住院天数为(7.6±1.5)d,两组相比差异有统计学意义(P＜0.05);实验组术后消化功能恢复时间为(23.3±9)h,对照组为(30.5±11)h,两组相比较差异有统计学意义(P＜0.05);实验组未出现术后并发症病例,对照组出现3例切口感染病例,2例粘连性肠梗阻病例,1例盆腔感染病例,两组手术并发症发生情况相比较差异有统计学意义(P＜0.05)。结论 腹腔镜阑尾切除术结合快速康复外科理念,可有效缩短病人住院天数及促进术后恢复,值得临床广泛应用。
Objective To compare laparoscopic appendectomy surgery combined with fast track surgery(FTS)concept and conventional open appendectomy difference in efficacy. Methods To retrospective analysis Fengxin country people's hospital of general surgery from February 2001 to April 2003 and July 2010 to June 2013,a total of 96 cases of appendicitis were randomly divided into two groups,each included 48 cases,namely conventional open appendectomy group(control group)and the laparoscopic appendectomy combined FTS group(experimental group). The changes of white blood cell count(White blood cell,WBC),C-reactive protein(CRP),interleukin-6(IL-6)were detected in the first day before surgery and the 1,3 day after surgery,while the surgical operative time,the length of hospital stay and digestive function recovery, surgical incision pain,and the rate of postoperative complications were compared between the two groups. Results The levels of WBC,CRP, IL-6 at day 1 and day 3 after surgery were significantly higher than before surgery,and there was significant difference between the experimental group and control group(P<0.05). The average operation time of the experimental group and the control group were respectively (62±18)min and (55±21)min,and there was no significant difference(P＞0.05). Meanwhile the average time of hospital stay and digestive function recovery were obviously shorter in the experimental group than in the control group(P＜0.05). There was no postoperative complications in experimental group. There were 3 cases of incision infection and 1 case of intestinal obstruction and 1 pelvic infection in control group. It showed significant difference between the two groups(P<0.05). Conclusion Laparoscopic Appendectomy Surgery combined with fast track surgery,which can effectively shorten patients average time of hospital stay,reduce postoperative complications and promote postoperative recovery. It is worthy in clinical use widely.
目的 探讨优质护理服务对促进心胸外科患者恢复和提高患者护理满意度的效果。方法 将478例患者按时段分为按常规护理的对照组和实施优质护理的实验组,观察患者住院天数、拔除胸腔引流管时间、早期离床活动时间、护患纠纷发生率及满意度。结果 实验组患者住院天数、拔除胸腔引流管时间、早期离床活动时间、护患纠纷发生率明显缩短/降低,满意度显著提高,与对照组比较均差异有统计学意义(P＜0.01)。结论 优质护理服务有利于心胸外科患者术后恢复、减少护患纠纷和提高护理满意度,值得推广。
目的 探讨快速康复外科理念在手术室护理中应用效果。方法 选取2012年2月—2014年10月我院手术室普外科择期手术治疗140例患者随机分为康复组和常规组,分别采用快速康复外科理念护理和常规护理,比较两组患者胃肠功能恢复时间、下床活动时间、住院时间及并发症发生情况。结果 康复组胃肠功能恢复时间、下床活动时间及住院时间均短于常规组,两组间各值比较有统计学意义(P＜0.05);康复组并发症总发生率为4.29%,低于常规组20.00%发生率,两组比较差异有统计学差异(P＜0.05)。结论 快速康复外科理念应用于手术室护理可缩短患者康复时间,降低并发症发生,有较高应用价值,值得在临床中推广应用。
目的 探讨泌尿外科达芬奇机器人手术患者术中低体温的影响因素。方法 选取我院2020年12月—2023年12月泌尿外科收治的90例采用达芬奇机器人辅助手术的患者进行回顾性分析。依照术中是否发生低体温分为低体温组（n=30）及非低体温组（n=60），对比其基本资料，术前相关基础指标及围术期相关资料，采用Logistics回归模型分析泌尿外科达芬奇机器人手术患者术中低体温的影响因素。结果 低体温组与非低体温组患者性别、疾病类型、美国麻醉师协会（ASA）分级对比无明显差异，低体温组年龄高于非低体温组，体质指数低于非低体温组（P＜0.05）；低体温组与非低体温组患者术前血红蛋白、舒张压、收缩压、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、总胆固醇、甘油三酯、空腹血糖、肌酐对比差异无统计学意义（P＞0.05），低体温组术前白蛋白水平低于非低体温组（P＜0.05）；低体温组与非低体温组患者麻醉方式、气腹时间、入室时体温、入室时平均动脉压、术中出血量对比无明显差异，低体温组麻醉总时间、手术时间、入室时心率、术中输液量高于非低体温组，术中保温措施持续时间低于非低体温组（P＜0.05）；术前白蛋白、麻醉总时间、手术时间、术中输液量、术中保温措施持续时间为泌尿外科达芬奇机器人手术患者术中低体温的影响因素（P＜0.05）。结论 泌尿外科达芬奇机器人手术患者术中低体温的发生可能受患者术前白蛋白水平、麻醉总时间、手术时间、术中输液量及术中保温措施持续时间影响，因此需针对上述术中低体温高风险患者增加干预评估，并制定针对性干预措施，预防患者术中低体温的发生。
Objective To explore the influencing factors of hypothermia in patients undergoing da Vinci robotic surgery in urology department．Methods A retrospective analysis was conducted on 90 patients who underwent da Vinci robot assisted surgery in the urology department of our hospital from December 2020 to December 2023．According to whether hypothermia occurred during surgery，patients were divided into a hypothermia group（n=30）and a non hypothermia group（n=60），and their basic data，preoperative related basic indicators，and perioperative related data were compared．A logistics regression model was used to analyze the influencing factors of hypothermia in patients undergoing da Vinci robotic surgery．Results There were no significant differences in gender，disease type，and ASA grading between the hypothermia group and the non hypothermia group．The age of the hypothermia group was higher than that of the non hypothermia group，and the body mass index was lower than that of the non hypothermia group（P＜0.05）．There was no significant difference in preoperative hemoglobin，diastolic blood pressure，systolic blood pressure，low-density lipoprotein，high-density lipoprotein，total cholesterol，triglycerides，fasting blood glucose，and creatinine between the hypothermia group and the non hypothermia group．The preoperative albumin level in the hypothermia group was lower than that in the non hypothermia group（P＜0.05）．There was no significant difference in anesthesia method，pneumoperitoneum time，temperature at entry，mean arterial pressure at entry，and intraoperative blood loss between the hypothermia group and the non hypothermia group．The total anesthesia time，surgical time，heart rate at entry，and intraoperative infusion volume were higher in the hypothermia group than in the non hypothermia group，and the duration of intraoperative insulation measures was lower in the hypothermia group than in the non hypothermia group（P＜0.05）．Preoperative albumin，total anesthesia time，surgery time，intraoperative infusion volume，and duration of intraoperative insulation measures were independent influencing factors of intraoperative hypothermia in patients undergoing da Vinci robotic surgery（P＜0.05）．Conclusions The occurrence of hypothermia in patients undergoing da Vinci robotic surgery in urology may be affected by preoperative albumin levels，total anesthesia time，surgery time，intraoperative infusion volume，and duration of intraoperative insulation measures．Therefore，it is necessary to increase nursing evaluation for high-risk patients with hypothermia during surgery and develop targeted intervention measures to prevent the occurrence of hypothermia in patients．
