目的 对比观察海桐皮汤熏洗应用于膝骨性关节炎关节镜清理术后的临床疗效。方法 于2012年1月—2014年1月,从我院骨科住院患者中选取因膝骨性关节炎行关节镜清理术病例60例,随机分为两组,对照组术后给予常规康复治疗措施,治疗组在常规康复治疗的基础上于术后2周拆线后配合海桐皮汤熏洗治疗,治疗周期4周。对比两组患者治疗前后的WOMAC评分,分析其疗效差异。结果 两组患者WOMAC评分术后2周比较无差异P＞0.5;治疗4周后,两组患者较术后2周有所降低(P＜0.5),但治疗组疗效优于对照组(P＜0.5)。结论 海桐皮汤熏洗疗法可改善膝骨性关节炎关节镜清理术后膝关节功能,操作简便,成本低廉,无副作用,值得临床推广应用。

目的 通过对比观察常规西药和当归芍药散加减治疗哺乳期子宫上环术后子宫异常出血的临床效果,探讨其安全有效的治疗方法。方法 选取在哺乳期行子宫上环术的妇女96例,随机分为两组,西药组采用常规西药治疗,中药组采用当归芍药散加减方剂治疗。观察术前、术后及治疗后月经量的变化,并对实验结果进行分析和评价。结果 所有96例患者在行子宫上环术后均出现月经量较术前增多(P<0.05),在经过药物治疗后,所有患者月经量较治疗前减少(P<0.05),并治疗后月经量与术前月经量相比波动较小,差异无统计学意义(P>0.05)。中药组与西药组比较,治疗后月经量稍增多,差异无统计学意义(P>0.05)。西药组有5例患者出现头痛、头晕、恶心、呕吐等不适,对症处理或减量后好转,中药组无不良反应病例。结论 西药及中药治疗哺乳期子宫上环术后子宫异常出血效果相当,当归芍药散加减方剂副作用小,具有较高的可靠性和安全性,值得借鉴与推广。

目的 研究探讨适合基层医院开展白内障复明手术的手术方式。方法 随机抽取我院2010年4月—2014年4月收治的白内障患者1560例为研究对象。所有患者的患眼有2460只。并将其随机分成观察组和对照组,每组患者患眼分别有1230只。对照组采用大切口(巩膜隧道)有缝线白内障(囊外)摘除并人工晶状体植入手术,观察组患者采用小切口(巩膜隧道) 无缝线白内障(囊外)摘除并人工晶状体植入手术治疗的方法,并对两组的疗效进行分析。观察患者手术后的视力、术中以及术后并发症、住院费用等。结果 治疗结果显示,观察组患者的视力术后7天在0.4以上的患者占有89.7%,对照组患者视力在0.4以上的患者占有87.3%。差异无统计学意义(P＞0.05)。手术时间对照组长于观察组,手术费用对照组略高于观察组,差异有统计学意义(P<0.05)。两组在术中后囊膜破裂的发生率、前房型人工晶体植入的比例、上袢缝合固定后房型人工晶体植入比例比较,差异有统计学意义(P<0.05),观察组上述情况少于对照组。结论 在基层医院进行白内障复明活动,采用小切口(巩膜隧道) 无缝线白内障(囊外)摘除并人工晶状体植入手术治疗的方法疗效可靠,并发症少,手术时间短,住院总费用较低,有利于我们在资金、设备有限的情况下在限定的时间内完成较多的白内障复明手术。因此,在基层医院开展的白内障扶贫复明活动中小切口白内障(囊外)摘除并人工晶状体植入手术方法值得推广。

目的 观察术前宣教对支撑喉镜喉肿物摘除患者全麻苏醒期的影响。方法 选择择期支撑喉镜喉肿物摘除全身麻醉手术的患者72例。随机分成两组进行效果对比,一组为接受常规护理的对照组,另一组为本次接受术前宣教观察组。分别对两组患者术后苏醒期躁动发生情况、心血管变化及配合性进行对比。结果 观察组患者通过术前宣教,有效减少全麻苏醒期患者躁动相关情况的发生,其心率、血压水平也较稳定,与对照组相比较差异有统计学意义(P<0.05);两组患者配合性相比较,差异有统计学意义(P<0.05)。结论 对支撑喉镜喉肿物摘除行全麻手术的患者进行术前宣教护理,可以有效减少苏醒期患者躁动的发生率,减轻气管拔管对心血管影响。提高整体治疗护理效率,达到更高的满意度,该方法切实可行,值得临床广泛运用。

Objective To obeserve the effect of preoperative education on the recovery period of general anesthesia after suspension laryngoscopic surgery. Methods Seventy-two adult patients undergoing suspension laryngoscopic surgery were randomly divided for the effect contrast.Routine nursing were adopted for control-group while the only difference for the observation group was the preoperative education. The occurrence of emergence agitation, hemodynamic, and compliance degree were compared between the two groups. Results Through preoperative education,observation group can significantly reduce the occurrence of agitation effectively and keep hemodynamics more stable than control group.Moreover,the compliance degree in two groups also has statistical significance (P<0.05). Conclusion Preoperative education can succeed in reducing the incidence of emergence agitation,inhibiting the responses to endotracheal extubation after suspension laryngoscopic surgery. Thus, preoperative education is feasible to enhance the overall effectiveness of treatment and nursing care. It is worth in popularization and application in clinical practice.

目的 探讨生长抑素对腹部手术后早期肠内营养支持顺应性的影响。方法 选择在本院接受中等以上腹部手术的住院病人60例,随机分成实验组和对照组各30例,手术后12 h开始给予早期肠内营养支持,连续5 d,实验组按常规使用生长抑素5 d,而对照组未使用生长抑素;比较两组在术后5 d内胃肠道不适的发生与否,胃肠减压的引流量,肠蠕动功能恢复情况,以及术后7 d的血液常规、肝、肾功能及血糖等血液生化指标。结果 与对照组比较,实验组在手术后胃肠道不适的发生,鼻胃管(胃肠减压)引流量,肠蠕动功能恢复时间等差异有统计学意义;术后7 d的血液常规、肝、肾功能及血糖等指标比较差异无统计学意义。结论 生长抑素有助于机体对腹部手术后肠内营养支持的顺应性,并安全可行。

Objective To study the clinical effects of somatostatin on compliance of early enteral nutrition after abdominal surgery. Methods 60 cases who accepted above medium abdominal operations were randomized into two groups including 30 cases of treatment group with somatostatin on the bases of early enteral nutrition and 30 cases of control group with early enteral nutrition, continued for 5 days after abdominal surgery. The promotion of clinical manifestations and signs, gastrointestinal decompression, blood routine examination, liver and renal function, blood glucose and so on were compared between the two groups. Results As for clinical manifestations and signs promotion, there were statistically significance in the alleviation of pain and distension of the abdominal and the average volume gastrointestinal decompression and the time of recovering peristalsis and passing flatus (P<0.05).As for blood routine examination, liver and renal function, blood glucose there were no statistically significance between the two groups. Conclusion Somatostatin can effected on compliance of early enteral nutrition after abdominal surgery.

目的 探讨体外循环手术前后患者血清HMGB₁、CK、CK-MB、LDH、LD₁、AST水平变化及意义。方法 采用ELISA法检测57例体外循环患者手术前后血清HMGB₁表达水平,采用临床常规方法检测血清中CK、CK-MB、LDH、LD₁、AST水平。对体外循环手术前后血清HMGB1表达水平与CK、CK-MB、LDH、LD₁、AST的水平进行比较与相关分析。结果 体外循环手术患者HMGB₁、CK、CK-MB、LDH、LD₁、AST水平在手术后0.5小时、24小时、48小时、72小时均高于手术前(P<0.05);HMGB₁、CK、CK-MB、LD₁、AST水平在手术后24小时达高峰,LDH水平高峰出现于手术后48小时,其他各指标渐渐下降。体外循环手术阻断时间延长,则HMGB₁、CK、CK-MB、LDH、LD₁、AST水平升高。体外循环手术后患者血清中HMGB₁表达水平与CK、CK-MB、LDH、AST指标呈正相关关系(P<0.05)。结论 体外循环手术后患者血清HMGB₁、CK、CK-MB、LDH、LD₁、AST水平升高,HMGB1参与了心肌的缺血再灌注损伤过程。

Objective To investigate before extracorporeal circulation and after HMGB₁, CK, CK-MB, LDH, LD₁, AST levels and significance in serum of patients. Methods 57 cases before extracorporeal circulation surgery and after, the levels of HMGB₁ were detected by ELISA,while the levels of CK and CK-MB and LDH and LD₁ and AST were detected by using conventional methods of clinical. Difference of HMGB₁ and CK, CK-MB, LDH, LD₁ and AST levels were compared. The relationship were been analyzed on the patients before extracorporeal circulation surgery and after. Results In extracorporeal circulation surgery, HMGB₁, CK, CK-MB, LDH, LD₁, AST levels after surgery in 0.5 hours, 24 hours, 48 hours,72 hours were higher than before surgery (P<0.05); HMGB₁, CK, CK-MB, LD₁, AST levels peaked at 24 hours aftersurgery, LDH levels was peaked at 48 hours after surgery, and then gradually declined. Extracorporeal circulation blocking was prolonged, the levels of HMGB₁ and CK and CK-MB and LDH and LD₁ and AST were elevated. After extracorporeal circulation surgery in serum the levels of HMGB₁ expression and CK,CK-MB,LDH, AST indicators showed a positive correlation(P<0.05). Conclusion The levels of HMGB₁, CK, CK-MB, LDH, LD₁ and AST were elevated after extracorporeal circulation surgery. HMGB₁ was involved in myocardial ischemia and reperfusion injury.

目的 研究比较低流量异氟烷与七氟烷麻醉在小儿腹腔镜手术中的麻醉效果。方法 选取在我院进行腹腔镜手术治疗的小儿患者120例作为研究对象,随机分为异氟烷和七氟烷两组,每组各60例,分别采用低流量异氟烷和七氟烷进行麻醉,比较两组患儿的相关麻醉参数,以及入睡、苏醒、拔管时间和不良反应情况。结果 两组患儿的不同时期脉搏氧饱和度、心率、呼气末二氧化碳浓度比较无差异(P＞0.05);七氟烷组患儿的不同时期的平均动脉压具有较强的稳定性,而异氟烷组患儿在诱导期间、手术过程中平均动脉压降低,差异有统计学意义(P＜0.05)。结论 在小儿腹腔镜手术过程,采用低流量七氟烷进行麻醉,可以使手术过程中血流动力学更加稳定,缩短术后拔管时间,减少术后不良反应发生,更易满足小儿腹腔镜手术的麻醉要求。

Objective To investigate efficacy between low flow isoflurane and sevoflurane in pediatric laparoscopic surgery. Methods 120 cases of children underwent laparoscopic surgery in our hospital were randomly divided into two groups. 60 patients in isoflurane group were given low-flow isoflurane anesthesia; 60 patients in sevoflurane group were given low-flow isoflurane anesthesia. Heart rate (HR), mean arterial blood pressure (MAP), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) at different period, sleep and awakening time, extubation time, and adverse reactions of two groups were observed. Results Heart rate (HR), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) of two groups at different period had no significantly difference (P>0.05). Mean arterial blood pressure (MAP) of two groups at different period had significantly difference (P<0.05). The sleep time and recovery time of two groups had no significant difference (P>0.05). The extubation time of sevoflurane was significantly lower than isoflurane group (P<0.05). The adverse reaction rate of sevoflurane was significantly lower than isoflurane group (P<0.05). Conclusion Low flow isoflurane and sevoflurane can be used in pediatric laparoscopic surgery, and the efficacy of sevoflurane is better.

目的 探讨肝脏脂肪变性对肝脏切除手术安全性及预后的影响。方法 选取2012年1月—2014年12月在我院接受肝切除术治疗的肝癌患者172例,根据HE染色结果,172例患者中无脂肪变性106例(对照组),轻度脂肪变性42例(轻度组),中重度脂肪 24例(中重度组),比较各组患者基本资料(性别、年龄等)、手术情况、生化指标、术后并发症、住院时间等。结果 三组患者体重指数(BMI)差异有统计学意义(P＜0.05),中重度组BMI最高,为(26.94±3.14)kg/m²;中重度组患者手术时间、术中出血量、输注红细胞和肝门阻断时间分别为(182.39±42.17)min、(553.07±50.22)mL、(1.18±0.34)U和(20.15±6.07)min,均高于其他两组(P＜0.05);中重度组患者重度并发症发生率为45.83%,高于对照组和轻度组的9.43%和9.52%(P＜0.05);中重度组住院时间和ICU时间分别为(23.06±7.30)d和(3.71±1.03)d,高于其他两组(P＜0.05)。结论 轻度肝脏脂肪变性对手术基本无影响,而中重度脂肪变性会增加手术时间和出血、重度并发症发生较多,不利于手术的安全性以及预后。

Objective To explore the effect of liver steatosis on liver resection safety and the prognosis. Methods Selected from January 2012 to December 2014 in our hospital liver resection of 172 cases of liver cancer patients, according to the results of HE staining, 172 patients without fatty degeneration in 106 cases (control group), 42 cases of mild steatosis (mild steatosis group), 24 cases of severe fatty (moderate and severe steatosis group),observed each group patients the clinical characteristics, surgery situation, biochemical index, postoperative complications, hospitalization time, etc. Results Body mass index(BMI)of patients in the three groups difference was statistically significant (P<0.05), moderate and severe steatosis group had the highest BMI (26.94±3.14)kg/m²; in moderate and severe steatosis group, surgery time, intraoperative bleeding volume, infusion of red blood cells and hepatic portal occlusion time were (182.39±42.17) min, (553.07±50.22) ml, (1.18±0.34) U and (20.15±6.07) min. They were significantly higher than that of the control group and mild steatosis group (P<0.05); moderate and severe steatosis patients with severe complication rate was 45.83%,significantly higher than that in the control group and the mild steatosis 9.43% and 9.52%. The difference was statistically significant (P<0.05); In moderate and severe steatosis group, hospitalization time and ICU were (23.06±7.30) d and(3.71±1.03) d, significantly higher than that in the control group and the mild steatosis group(P<0.05). Conclusion Mild liver steatosis have no effect on the surgery, severe liver steatosis may increase the surgery time and bleeding, severe complications occurred more, is not conducive to the safety of the surgery and prognosis.

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。