目的 观察手术前静滴不同剂量复方麝香注射液对老年患者全麻术后早期轻度认知障碍(MCI)发生的影响。方法 选择下肢与下腹部手术全麻患者120例(ASA Ⅰ-Ⅱ级),将其随机分为4组,组Ⅰ(n=30,对照),采用质量浓度为9 g/L的生理盐水100 mL静脉滴注;组II(n=30):应用低剂量复方麝香注射液(0.1 mL/kg,加入质量浓度为9 g/L的生理盐水100 mL)手术开始前0.5 h静脉滴注,其速率为200 mL/h;组Ⅲ(n=30): 应用中剂量复方麝香注射液(0.2 mL/kg), 药物配伍、治疗时间和注射速度与组Ⅱ相同;组Ⅳ(n=30):高剂量复方麝香注射液(0.3 mL/kg),用药方法同组Ⅱ。各组术前用药、麻醉诱导、术中麻醉深度、麻醉苏醒等用药与方法相同;观察各组患者术前、术后第1天、3天、7天的CCSE、FAQ、MMSE评分等。结果 4组患者手术时间、麻醉时间、术中出血量、苏醒时间基本相同(P>0.05),4组手术后第1天、3天及7天CCSE、FAQ、MMSE认知功能评分均减少, 组Ⅱ、组Ⅲ、组Ⅳ下降的变化幅度较小,得分高于组Ⅰ(P<0.05),组Ⅱ、组Ⅲ、组Ⅳ组间比较差异无统计学意义(P﹥0.05);术后第1天、3天、7天MCI发生率,组Ⅰ分别为66.7%、33.3%和16.7%;组Ⅱ为50.0%、16.7%和6.7%;组Ⅲ为50.0%、16.7%和6.7%。组Ⅳ为46.7%、20.0%和10.0%,用药组比组Ⅰ降低(P<0.05),但组Ⅱ、组Ⅲ、组Ⅳ之间无明显差异(P﹥0.05);4组术后不良反应组间比较差异无统计学意义。结论 术前静脉滴注复方麝香注射液0.1 mL/kg可有效降低老年患者全麻术后MCI的发生,增加麝香注射液剂量(0.2 mL/kg、0.3 mL/kg)对于老年手术患者MCI未见增效作用,临床选用静滴的剂量0.1 mL/kg即可。

Objective To observe the effect of different doses of compound musk injection before operation on early mild cognitive impairment (MCI) in elderly patients after general anesthesia. Methods We selected 120 cases of lower limb and lower abdominal surgery general anesthesia (ASA level Ⅰ-Ⅱ),and divided them randomly into 4 groups: Group Ⅰ (n=30,control): 0.9% saline 100mL intravenous infusion; Group Ⅱ (n=30): low dose compound musk injection (0.1 mL/kg,add 0.9% saline 100 mL), 0.5h before the start of surgery, intravenous drip, the rate was 200 mL/h; Group Ⅲ (n=30): medium dose compound musk injection (0.2 mL/kg), the same as group Ⅱ in drug compatibility,treatment time and injection rate; Group Ⅳ (n=30): high dose compound musk injection (0.3 mL/kg), the same as group Ⅱ in drug compatibility, treatment time and injection rate. Each premedication, induction of anesthesia, anesthesia depth,intraoperative awake and anesthesia medication were the same. And we observed each group about preoperative and postoperative CCSE,FAQ and MMSE(mini-mental state examination) score of the 1st days,3rd days and 7th days. Results In the 4 groups of patients,the operation time,anesthesia time,intraoperative blood loss,recovery time were basically the same (P>0.05); CCSE,FAQ,MMSE cognitive function scores of 4 groups were reduced after operation on the first day,the third day and the seventh day; group Ⅱ,group Ⅲ,group Ⅳ decreased slightly.The scores were higher than group Ⅰ (P<0.05),and there were no significant differences between group Ⅱ,group Ⅲ and group Ⅳ (P>0.05); The incidence of MCI in first days, third day and seventh day after operation respectively was: group Ⅰ 66.7%,33.3% and 16.7%; group Ⅱ 50%,16.7% and 6.7%; group Ⅲ 50%,16.7% and 6.7%; group Ⅳ 46.7%,20% and 10%.Those of the drug groups were lower than group Ⅰ (P<0.05), but there was no significant difference between group Ⅱ, group Ⅲ and group Ⅳ (P>0.05).There were no significant differences in the 4 groups in postoperative adverse reactions. Conclusion Preoperative intravenous infusion of compound musk injection 0.1 ml/kg, may effectively reduce the incidence of MCI in elderly patients after general anesthesia. Increasing musk injection dose (0.2 ml/kg,0.3 ml/kg and 0.4 mg/kg) was no synergistic effect on MCI in elderly patients,0.1ml/kg is enough.

目的 探讨早期康复护理干预对胸腰椎骨折内固定术后患者的临床护理效果。方法 2014年6月—2016年12月,将94例胸腰椎骨折内固定术后患者按数字随机法,分为实验组51例和对照组43例,分别实进行早期康复护理和常规性护理。比较两组患者胸腰背部功能状况、胸腰背部疼痛情况、术后抑郁水平,以及护理满意度等相关指标,以评价早期康复护理的效果。结果 94例患者均获得3个月随访。与对照组比较,实验组患者平均住院天数减少4.1 d,差异有统计学意义(P<0.05);平均住院费用也有所下降;实验组和对照组总并发症发生率分别为7.84%和20.9%,两组间比较差异有统计学意义;实验组的护理工作满意度高达90.20%,高于对照组的67.44%,差异具有统计学意义(P<0.05)。术后3个月随访时,Oswestry功能障碍评分实验组为(14.74±3.25),低于对照组的(20.04±5.32)(P<0.05); SDS评分实验组的为42.35±3.68,低于对照组的(47.28±3.49)(P<0.05);胸腰背痛VAS评分实验组的为(1.07±0.67),低于对照组的(2.62±1.86)(P<0.05)。结论 早期康复护理干预是促进胸腰椎骨折内固定术后患者快速康复的有效方法,提高患者对护理工作的满意度,值得推广应用。

Objective To evaluate and compare the outcomes of early rehabilitation nursing and routine nursing care for patients with thoracolumbar bursting fracture after internal fixation. Methods From June 2014 to December 2016, this study enrolled ninety-four subjects who were randomly divided into observe group with fifty-one cases and control group with forty-three cases according to the digital random method. Patients in the control group were treated with routine nursing care, and early rehabilitation nursing care were used in the observe group. The physical function of thoracolumbar spine, psychological condition, pain of thoracolumbar spine, nursing satisfaction and soon. were compared between the two groups. Results The average days of hospital stay in the observation group was 4.10 days, it was less than that of control group, and the difference was statistically significant(P<0.05). Average hospital costs were also declined. The total complication rate were 7.84% in observe group and 20.9% in control group, there was significant difference between the two groups (P<0.05). The nursing satisfaction was 90.20% in observe group, which was higher than 67.44% in that in control group (P<0.05). When follow-up three months after operation, the ODI score in experiment group was(14.74±3.25), which was lower than that (20.04±5.32)in control group (P<0.05). The SDS score in experiment group was (42.35±3.68), which was lower than that (47.28±3.49)in control group(P<0.05). And the VAS score in experiment group was (1.07±0.67), which was lower than that(2.62 ±1.86)in control group (P<0.05). Conclusion Early rehabilitation nursing care is effective to the rapid functional recovery for patients with thoracolumbar bursting fracture after internal fixation, and improves the nursing satisfaction.

目的 探讨快速康复外科理念对降低子宫全切术后患者下肢深静脉血栓形成的应用效果。方法 采用方便抽样的方法,将185例子宫全切术后患者分为观察组(95例)和对照组(90例)。观察组实施快速康复外科护理路径,对照组实施常规护理路径。结果 两组患者术后的下肢深静脉血栓发生率、D-二聚体水平、日常生活活动能力评分的比较差异均有统计学意义(P<0.05);观察组下肢深静脉血栓形成的发生率和D-二聚体水平低于对照组(P<0. 01),观察组日常生活活动能力评分低于对照组(P<0.05)。结论 快速康复外科理念应用于子宫全切术后患者,可降低患者下肢深静脉血栓的发生率,提高患者自理能力,使患者尽快恢复健康水平。

Objective To explore the effect of fast-track surgery on the treatment of lower extremity deep venous thrombosis in patients after total hysterectomy. Methods A total of 185 patients with hysterectomy were divided into observation group(n=95) and control group (n=90) randomly. The observation group implemented a rapid rehabilitation surgical care path, and the control group implemented routine nursing path. Results There were significant differences in the incidence of deep venous thrombosis, D-dimer level and daily living activity score between the two groups (P<0.05). The incidence of deep venous thrombosis and the level of D-dimer in the lower extremity of the observation group were significantly lower than those in the control group (P<0.01). The score of the daily living activity was lower in the observation group than that of control group (P<0.05). Conclusion Fast-track surgery for patients after total hysterectomy could reduce the incidence of postoperative deep venous thrombosis and improve the self-care abilities of patients, so that patients may return to health as soon as possible.

飞秒激光辅助的SMILE因其微创、准确性、安全性、可预测性、稳定性好的特点越来越受患者和术者的欢迎,随着大家对手术的期望值增加,视觉质量成为反应手术效果极其重要的因素之一,而高阶像差又是评定视觉质量尤为重要的指标。本文对飞秒激光SMILE的眼高阶像差及其影响因素进行综述。

Femtosecond laser-assisted SMILE is more and more popular with patients and the operators because of the minimal invasion, efficacy, safety, predictability and stability. But with the increase of people's expectations of the surgery, visual quality become one of the important factors which reacts operation effect extremely, and higher-order aberration is an especially important index when evaluate the visual quality. In this paper, the higher-order aberration and its influence factors of femtosecond laser-assisted SMILE were summarized.

目的 探讨断指再植术后血管危象发生情况及危险因素。方法 收集2015年8月—2016年12月我院行断指再植术患者66例临床资料行回顾性分析,根据患者术后是否发生血管危象分为A组(发生血管危象)和B组(未发生血管危象),收集两组患者一般临床资料,采用单因素和多因素Logistic 回归分析影响断指再植术患者术后血管危象发生的危险因素。结果 单因素分析得出,性别、年龄、吸烟史、指别、外伤原因、末端断离及缺血时间在A、B两组间比较有统计学意义(P＜0.05)。多因素分析得出,性别、年龄、吸烟史、指别、外伤类型、末端断离、缺血时间均为影响断指再植术术后血管危象发生危险因素。结论 血管危象为断指再植术常见并发症,影响发生血管危象危险因素较多,临床中应针对性进行预防和干预,以降低断指再植术患者术后血管危象发生率,提高断指存活率。

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 探讨腔镜手术治疗老年肺癌的疗效及对肺功能的影响。方法 我们纳入90例老年肺癌患者作为研究对象,随机抽签分为2组,各45例。观察组45例行胸腔镜肺癌切除术,对照组45例行传统开胸肺癌切除术。比较两组患者手术时间、术中出血量、胸腔引流时间、淋巴结清扫数量、术后住院时间、疼痛评分、肺功能及术后并发症情况。结果 两组手术时间、淋巴结清扫数量无差异(P>0.05);观察组术后胸腔引流时间、术中出血量、疼痛评分、住院时间少于对照组(P＜0.05)。观察组术后并发症总发生率低于对照组(P＜0.05)。观察组术后一秒用力呼气容积、用力肺活量、肺活量、一秒用力呼气容积与用力肺活量比值恢复情况优于对照组(P＜0.05)。结论 腔镜微创手术用于老年肺癌患者能够显著降低围术期并发症,缩短患者术后恢复时间,且有助于改善肺功能。

Objective To investigate the efficacy and safety of endoscopic surgery in the treatment of elderly patients with lung cancer. Methods 90 elderly patients with lung cancer in our hospital were divided into two groups,45 cases in each group. The observation group was treated with thoracoscopic lung resection in 45 cases, the control group of 45 cases received conventional open lung cancer resection. The operation time, intraoperative blood loss, thoracic drainage time, lymph node dissection, postoperative hospital stay, pain score, pulmonary function assessment and postoperative complications were compared. Results There were no significant differences in the operation time and lymph node dissection between the two groups (P>0.05). The thoracic drainage time,intraoperative blood loss pain score and hospitalization time in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). The forced expiratory volume, forced vital capacity, vital capacity, one-second forced expiratory volume and forced vital capacity of the observation group were better than those in the control group after operation(P<0.05). Conclusion Endoscopic minimally invasive surgery may significantly reduce perioperative complications in elderly patients with lung cancer, shorten the postoperative recovery time and improve lung function.

目的 比较不同浓度罗哌卡因横纹肌阻滞应用于剖宫产术后镇痛的临床效果。方法 选取2015年3月—2016年3月于我院剖宫产的孕妇300例,随机分为A组、B组、C组,每组100例,A组产妇给予质量浓度为1.5 g/L的罗哌卡因1.5 mg/kg,B组产妇给予质量浓度为2 g/L的罗哌卡因1.5 mg/kg,C组产妇给予质量浓度为2.5 g/L的罗哌卡因1.5 mg/kg,同时给予所有产妇镇痛泵辅助镇痛。记录观察所有产妇术后6 h、12 h、24 h、36 h、48 h的疼痛视觉模拟评分(VAS)、镇痛泵按压次数、产妇对镇痛效果的满意程度以及腹横肌平面阻滞(TAP)不良反应发生情况。结果 B、C组产妇的VAS评分均低于A组产妇(P＜0.05),24 h后C组产妇的VAS评分低于B组产妇(P＜0.05);与B、C组产妇相比,A组产妇的镇痛泵按压次数更多,镇痛效果满意度较低(P＜0.05),同时B组产妇的镇痛泵按压次数多于C组产妇(P＜0.05);3组产妇均未出现术后不良反应。结论 使用质量浓度为2.5 g/L的罗哌卡因横纹肌阻滞进行剖宫产术后镇痛,效果显著、安全性较高,临床中可推广使用。

Objective To compare the clinical effects of different concentrations of ropivacaine for postoperative analgesia after cesarean section. Methods 300 cases of pregnant women undergoing cesarean section in our hospital from March 2015 to March 2016 were selected and were randomly divided into group A, group B and group C with 100 cases in each group. The patients in group A were given 0.15% ropivacaine 1.5 mg/kg, 0.20% ropivacaine 1.5 mg/kg in group B and 0.25% ropivacaine 1.5 mg/kg in group C, and at the same time all the pregnant women were given analgesic pump assisting analgesia. The pain visual analogue scales (VAS) of the pregnant women were recorded at 6 hours, 12 hours, 24 hours and 36 hours after cesarean section and the number of times of analgesia pressing pump were also recorded. The satisfaction degree of analgesic effect and the TAP occurrence of adverse reactions of the patients were also recorded. Results The VAS scores of group B and group C were lower than that of group A(P<0.05). 24 hours after cesarean section, the VAS score of group C was lower than that of group B (P<0.05). Compared with group B and C, the number of times of analgesia pressing pump in group A were more but the analgesic effect of satisfaction was lower (P<0.05), and at the same time the number of times of analgesia pressing pump in group B were more than those in group C (P<0.05). No adverse reactions were found in the three groups. Conclusion The treatment of using of 0.25% of ropivacaine for muscle block for postoperative analgesia after cesarean section is effective and safe, which may be widely used in clinical practice.

目的 比较胆总管切开探查术后留置T管和胆总管切开探查并一期缝合术后胆管内支架引流这两种模式治疗胆管疾病的手术疗效。方法 对2012年—2014年期间收治的90例需择期行胆总管探查的患者进行前瞻性随机对照研究。按照实验方式分为T管组40例和单管内支架组50例。对比分析两组胆总管置管缝合手术时间、住院时间、治疗总费用、生活质量指数值以及并发症发生率,包括引流失败率(T管滑脱、内支架管滑脱、移位)、胆漏、胆道感染、胰腺炎和残石率。结果 开腹胆总管探查术术后内支架引流患者的出院前生存质量评价高于T管引流患者,住院时间少于T管引流患者,置管及胆管缝合时间长于T管引流患者(均为P＜0.05);术后两组患者间的治疗总费用和非计划脱管、胆漏、胆道感染、胰腺炎、残石率和不能拔/脱管等术后并发症发生率的差异无统计学意义(P＞0.05)。结论 内镜下胆道支架内引流术(Endoscopic retrograde biliary drainage,ERBD)移植于胆总管切开探查并一期缝合术具有可行性、安全性及治疗效果确切,显著缩短患者住院时间、加快患者康复提高患者出院前的生存质量,并放宽胆总管一期缝合指征。

Objective To compare the clinic research between biliary stent insertion drainage and T-tube drainage after choledochotomy. Methods The clinical data of 90 cases from 2012 to 2014 were analyzed in a prospectively randomized trial, and they were divided into two groups by T-tube drainage and biliary stent insertion drainage. Cathetering and suture time, length of stay, hospital costs, life quality and incidence of complications were compared, respectively. Results After open common bile duct exploration (OCBDE), the life quality of stent group was significantly higher than that of T-tube group, the length of stay in stent group was shorter, and cathetering and suture time of bile duct in stent group was longer than that of T-tube group (P＜0.05); There were no significant differences between the two groups in the hospital costs and incidences of postoperative complications including bile leakage, early stent dislodgement, biliary infection, pancreatitis and residual stone (P＞0.05). Conclusion Endoscopic retrograde biliary drainage (ERBD) with primary closure after choledochotomy is a safe, effective and feasible procedure for the management of choledocholithiasis, it can significantly reduce the postoperative hospital stay and improve the life quality of patients and expand the indications for primary closure of CBD incision.

目的 探讨分析品管圈在提高腔镜肾癌术后护理流程管理中的应用,以提高肾癌术后患者的存活率也避免术后并发症出现。方法 对我院肾癌术后护理流程管理的现状进行分析,并将目前我院在肾癌术后护理流程管理当中出现的问题进行分析探讨和总结,并制定出详细的工作目标拟定可行的工作计划,并组织人员进行实施,并将实施之后的结果与预期的结果进行对比分析总结。结果 在实施了品管圈活动之后,我院对腔镜肾癌术后护理流程的管理得到了显著的提升,其中人员操作不规范的发生率由实施活动之前的13.2%(5/38)减低到了5.3%(2/38),同时患者发生术后并发症的例数也由之前的7例降低到了3例,结果对比较之前的差异有统计学意义。结论 使用品管圈活动不仅能够有效的提高对腔镜肾癌术后护理流程管理中的效力,而且还能够减少患者术后并发症的发生几率。