Search

系统呼吸训练在食管癌患者围术期的应用

目的　探讨系统呼吸训练在食管癌患者围术期应用的意义。 方法　将2009年6月收治的73例行食管癌切除术的患者作为对照组，在围术期行常规健康教育；将2010年6月收治的59例行食管癌切除术的患者作为试验组，在围术期行常规健康教育的同时，采用集体健康教育的方法进行系统呼吸训练。 结果　试验组术后肺部并发症的发生率（27.11%）低于对照组（43.83%），差异有统计学意义（P＜0.05）；试验组平均住院日15.75 d，低于对照组平均住院日16.87 d；试验组健康教育满意度达到99.49%，高于对照组的95.01%，差异有统计学意义（P＜0.05）。 结论　在食管癌患者围术期应用系统呼吸训练能降低肺部并发症，缩短平均住院日；同时，系统呼吸训练的开展，整合了护士的人力资源、提高工作效率，促进了护士自身素质的提高，也提高了患者对护士健康教育的满意度。

非HIV感染者肺孢子菌定植及临床意义研究进展

Comparison of airspace consolidation in thoracic CT between organizing pneumonia and community acquired pneumonia

ObjectiveTo explore the differential diagnosis value of airspace consolidation in thoracic CT between organizing pneumonia (OP) and acquired community pneumonia (CAP).MethodsA retrospective study was taken by retrieving the patients CT database from October 2010 to August 2016. Fifty-six consecutive patients with OP and 99 consecutive patients with CAP whose CT showed airspace consolidation were enrolled and their clinical characteristics and radiological characteristics were analyzed.ResultsThe percentage of patients whose CT image showed various amount of air bronchogram (ABG) with different shapes is higher in OP group than that in CAP group (87.5% and 72.7% respectively, χ2=4.558, P=0.033). The median and interquartile range amount of ABG in the OP patients were significantly higher than those in CAP group [4 (ranged from 2 to 8) and 2 (ranged from 0 to 4) respectively, z=3.640, P=0.000]. Morphologically, 58.9% of the OP patients showed entire air bronchogram (EABG) on the thoracic CT, significantly higher than that in CAP group (21.2%) (χ2=22.413, P=0.000). Interrupted ABG was found in 26.3% of CAP patients, while 16.1% of OP patients shared same features and the difference was not statistically significant (χ2=2.125, P=0.148). Traction bronchiectasis and ground glass opacity (GGO) were more likely to be found in the OP patients rather than CAP patients with 26.8% and 39.3% respectively, while they were found in 1.0% and 11.1% in the CAP patients (P<0.05). Reversed halo sign was found only 1.0% of the CAP patients, significantly lower than that in OP group, 26.8% (χ2=25.671, P=0.000). Pleural effusion and bronchial wall thickening were more commonly found in the CAP group with 56.6% and 35.4% respectively. By multivariate logistic analysis, EABG (OR=5.526, P=0.000), traction bronchiectasis (OR=21.564, P=0.010), GGO (OR=4.657, P=0.007) and reversed halo sign (OR=13.304, P=0.023) were significantly associated with OP, while pleural effusion (OR=0.380, P=0.049) and bronchial wall thickening (OR=0.073, P=0.008) were significantly associated with CAP. Other features in thoracic CT coexisting with ABG all reach significance statistically between the OP and CAP group (all P<0.05).ConclusionsAirspace consolidation in thoracic CT may be valuable for the differential diagnosis between OP and CAP. EABG is more commonly found in OP patients than in CAP patients. When EABG exists or ABG coexists with traction bronchiectasis, GGO and reversed halo sign, a diagnose of OP should be considered.

口服普罗帕酮与胺碘酮联合电复律转复持续性房颤的随机对照试验

目的　比较普罗帕酮与胺碘酮联合电复律转复持续性心房颤动及维持窦性心律的疗效与安全性。方法　将60例基础疾病治疗良好的持续性房颤患者随机分为两组，每组各30例。普罗帕酮组：普罗帕酮600 mg顿服后观察6 h，未转复者予电复律，并以最低有效量口服维持窦律；胺碘酮组：胺碘酮600 mg分3次口服，连服7天，未转复者电复律，以最低有效量维持窦律。结果　单纯药物复律，普罗帕酮组4例，胺电酮组3例，联合电复律两组分别转复25例和22例，两组早期有效率分别为90.0%和80.0%，晚期有效率分别为73.3%和70.0%，两组比较差异无统计学意义。住院时间普罗帕酮组短于胺碘酮组（Plt;0.001）。普罗帕酮组1例服药后出现一过性低血压，放弃复律，经对症治疗后好转；胺碘酮组4例服药后恶心、呕吐，未能坚持负荷量连服7天；但两组副反应发生率差异无统计学意义。结论　普罗帕酮与胺碘酮联合电复律治疗持续心房颤动安全而有效，但普罗帕酮起效快，可相对减少患者的住院时间。

Solve Several Difficult Problems in General Surgery Teaching by Dialectics

The status quo of postoperative pain management in patients with pulmonary disease after discharge

ObjectiveTo investigate the current status of outpatient pain management in patients with pulmonary disease after surgery by WeChat and to provide a basis for postoperative pain management.MethodsA total of 449 patients who underwent thoracic surgery in our hospital from December 2017 to May 2018 were enrolled, including 156 males and 293 females with an average age of 22-83 (55.54±11.17) years. Brief Pain Inventory was adopted for pain assessment in 24-48 hours after discharge and 24 hours after removal of from the wound.ResultsTotally 98.22% of the patients reported that they suffered from pain in 24-48 h after discharge, most pain position was still at drainage port (45.21%), the overall pain score was 2.75 (2.00, 3.25) points, and 82.85% of patients adopted physical methods to relieve pain. After removal of stitches at the drainage port, 79.29% of the patients suffered from pain, the pain site was mainly at the drainage port (47.88%), and the overall pain score was 1.75 (1.25, 2.25) points, and 73.94% of patients adopted physical methods to relieve pain. The score of the overall influence degree of pain on patients was 2.29 (1.86, 2.86) points and 1.86 (1.29, 2.43) points, while pain had the greatest influence on sleep and mood. The scores were 4.00 (3.00, 5.00) points, 3.00 (2.00, 4.00) points and 2.00 (1.00, 4.00) points, 3.00 (2.00, 4.00) points, respectively.ConclusionUnder the concept of enhanced recovery after surgery, the overall pain level of patients with pulmonary disease after discharge is mild pain, but the application rate of drug analgesia in patients is low. The overall effect of pain on postoperative patients with lung cancer is low, but it has a great impact on sleep and mood. Medical staff should strengthen the pain education for patients in order to improve their pain self-management ability.

Application of Linear Cutting Stapler in Subtotal Gastrectomy

目的 探讨胃大部切除术中应用直线型切割缝合器的临床经验及优点。方法 总结直线型切割缝合器的使用方法，并比较分析传统胃大部切除术和采用直线型切割缝合器行胃大部切除术的手术时间和术后并发症。结果 使用直线型切割缝合器使手术时间缩短60～120 min (P=0.000)，术后出血并发症明显减少(P=0.024)。结论 应用直线型切割缝合器行胃大部切除术可以缩短手术时间和减少术后出血的发生。

Clinical Analysis of 40 Cases of Radical Resection of Colon Carcinoma under Hand-Assisted Laparoscopic Surgery

目的　总结手助式腹腔镜结肠癌根治术的临床经验。方法　回顾性分析我科2002年7月至2007年5月期间40例采用手助式腹腔镜结肠癌根治术治疗的结肠癌患者的临床资料。结果　40例手术均获成功，无中转开腹手术，无死亡病例。全部患者均未发生切口感染、吻合口漏、肠梗阻等并发症。随访0.5~4.0年，平均2.8年，未见肿瘤复发。结论　对于肿块直径大于5 cm的结肠癌患者采用手助式腹腔镜实施结肠癌根治术，可以保证手术的安全性和有效性。

改良式多头腹带的临床应用

急腹症腹腔镜探查术120例报道

我科自2002年9月至2007年7月期间运用腹腔镜行腹腔探查术120例，疗效满意。其中男70例，女50例，年龄18～76岁，平均44.9岁。全部患者均以急腹症入院，发病时间4～72 h，平均7.3 h。 除14例有腹部既往手术史外，其余均为首次发病。所有患者均在入院后2 h内在全麻下行腹腔镜腹腔探查术。44例(37%)急性阑尾炎行腹腔镜阑尾切除术； 24例(20%)消化道穿孔（胃小弯前壁10例、十二指肠球部前壁8例、胃后壁6例），其中4例穿孔小于1 cm，于腹腔镜下行穿孔修补术，其余患者则中转开腹行胃大部切除术； 18例(15%)腹腔肿瘤发现病变后即用活检钳取活检，明确诊断后16例中转开腹行相应根治性手术，2例因肿瘤广泛转移于腔镜下行单纯造瘘姑息性手术； 16例(13%)腹腔粘连均在腔镜下行粘连分解术； 11例(9%)妇科疾病，术中请妇科会诊做相应妇科处理； 急性肠系膜淋巴结炎2例(2%)及原发性腹膜炎2例(2%)探查明确后行保守治疗； 急性坏死性小肠炎1例(1%)探查明确后即转开腹行坏死小肠切除、肠吻合术； 结核性腹膜炎2例(2%)利用腹腔镜抽取腹水明确诊断后行保守抗结核治疗。除2例晚期肿瘤腹腔广泛转移外，其余患者手术后均顺利康复，临床治愈率达98%。　　讨论　利用腹腔镜行腹腔探查与传统的开腹探查手术在实际操作中有着很大不同，方法不当易漏诊。 腹腔镜行急腹症腹腔探查术，探查的顺序极其重要。首先应进行全腹腔探查，根据术中所见如腹腔积液、积脓、积血或消化液外溢、纤维素附着等情况，多可发现病变来源。 在外伤或未发现明确病变而行全面探查时,应先探查实质性脏器再探查空腔脏器，肠管等空腔脏器游离性较大,可在最后探查。 本组120例探查术中无一例漏诊，与正确的探查顺序和方法有关。 采用腹腔镜行粘连分解术，应首先探查粘连的部位。 由于屈氏韧带位于横结肠系膜根部,在腹腔镜下很难确切寻找到,故用腹腔镜探查肠管应从腹腔镜较易发现的回盲部开始。 在探查肠管时应注意以下几点： ①应用无损伤抓钳抓持肠管探查,避免肠管副损伤； ②掌握探查进度，抓钳移动距离应大致相等，这样既可随时明确病变部位，又可防止漏诊； ③发现肠管病变要及时标记,若病情允许，可探查完全程肠管后再作相应处理； ④在探查肠管同时应观察系膜可能存在的病变。 我们从本组病例发现，对常见腹腔粘连而导致的急腹症，采用腹腔镜行粘连分解术确实是一种行之有效的治疗方法。 另外，愈来愈多的急腹症是由腹腔肿瘤所导致的并发症引起，采用腔镜探查时，除可以明确这些病灶的准确位置、大小等基本情况外，最大的优势是可以获取少量病灶组织以明确病变的性质。