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Objective To evaluate the application value of perioperative interventional strategy guided by enhanced recovery after surgery (ERAS) in elderly recipients undergoing liver transplantation. Methods Clinical data of 405 liver transplant recipients were retrospectively analyzed. According to age, all recipients were divided into the elderly (≥60 years, n=122) and non-elderly groups (< 60 years, n=283). All patients received perioperative interventions under the guidance of ERAS. Intraoperative and postoperative indexes, incidence of postoperative complications and discharge were analyzed between two groups. Results There were no significant differences in the duration of anesthesia, operation time, anhepatic phase, hemorrhage volume, blood transfusion volume, lactic acid level before abdominal closure, ventilator-assisted time, the length of intensive care unit (ICU) stay, Caprini score, CHIPPS score, time of gastric tube, urinary tube and drainage tube removal, time to first drinking, time to first physical activity and time to first flatus between two groups (all P > 0.05). In the elderly group, the time to first feeding was later than that in the non-elderly group (P < 0.05). There were no significant differences in the incidence of fever, ascites, pulmonary infection, delayed gastric emptying, hemorrhage and inactive venous thrombosis between two groups (all P > 0.05). No significant differences were observed in the levels of aspartate aminotransferase, total bilirubin, direct bilirubin, serum creatinine before discharge and total length of hospital stay between two groups (all P > 0.05). The alanine aminotransferase level in elderly recipients was lower than that in non-elderly counterparts, and the difference was statistically significant (P < 0.05). No unplanned reoperation was performed within postoperative 30 d in two groups. There was no significant difference in the re-hospitalization rate within 30 d after discharge (P > 0.05). Conclusions ERAS-guided interventional strategy contributes to perioperative recovery of elderly recipients undergoing liver transplantation, and yields equivalent postoperative recovery between elderly and non-elderly recipients.
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Objective To summarize the experience in nursing patients with gut leak after liver transplantation. Methods Two patients with recurrent gut leakafter liver transplantation underwent surgical repair. The nursing measures included strict observation of postoperative disease, observation of drainage fluid and abdominal signs, early nutritional support, good psychological nursing and health education. Results Gut leak occurred in the two cases again after liver transplantation.One case was treated with repair again and the other with end-stage ileotomy and ileostomy. The patients were discharged after medication and nursing care. Conclusions The close postoperative observation of the disease, observation of drainage fluid and abdominal signs can prompt the discovery of intestinal re-perforation.The early nutritional support plays an important role in the rehabilitation of patients with gut leak after liver transplantation.Mental care and health education can enhance patient's confidence in treatment.
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Objective To investigate the characteristics of falls as an adverse event in the hospitalization of elderly patients taking sedatives and hypnotics drugs.Methods Data of elderly patients treated in Department of General Internal Medicine,Beijing Chaoyang Hospital from July 2011 to July 2015 were collected.All patients were divided into medicine-taking group and non-medicinetaking group according to the history of taking sedatives and hypnotics during the hospital stay.Different characteristics of fall as an adverse event were compared between the two groups,and fall related nursing interventions were presented.Results A total of 3 834 patients were collected for analysis in this study.Of these patients,the fall as an adverse event occurred in 12 cases,the total incidence was 3.1％,in whom 8/638 (12.5％) in medicine-taking group and 4/3196 (1.3％) in nonmedicine-taking group(x2=21.72,P＜0.01).Of 8 cases with the fall as an adverse event in medicinetaking group,the fall occurred in 6 cases(75％)during 24 ∶ 00-6 ∶ 00.However,of 4 cases with the falls in non-medicine-taking group,the fall in 3 cases(75 ％)occurred during 6 ∶ 00-18 ∶ 00.In medicinetaking group,the fall occurred beside their beds in 62.5 ％ (5 cases).And in 37.5 ％ (3 cases)did in their bathrooms.In non-medicine-taking group,the fall occurred in 2 cases (50.0％) beside their beds,in 1 case did in the bathroom,1 case did in the passage.Multiple Logistic regression analysis showed that age ＞ 75 years(OR=1.26,95 ％CI:1.07-1.48),elevated nutritional risk score(NRS-2002 ≥3 scores) (OR=10.92,95％CI:1.79-66.46)and elevated risk for fall or out of bed(risk score ≥18 scores) (OR =19.08,95％ CI:4.02-90.47)were the independent risk factors for falls as an adverse event among medicine-taking group.Conclusions A use of sedatives and hypnotics is related with the increase of fall as an adverse event in elderly patients during a hospital stay.With the aim of preventing or reducing the incidence of fall as an adverse event,nursing interventions should be carried out based on the characteristics of fall as an adverse event in elderly patients taking sedatives and hypnotics.
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Objective To summarize the experience of nursing the patients with liver transplantation complicated with early portal vein thrombosis treated with post-embolectomic anticoagulation. Method The clinical data of 5 cases of liver transplantation-induced portal vein thrombosis treated with post-embolectomic anticoagulation was reviewed to summarize the curative effect , key points for disease conditions and anticoagulative nursing. Results The anticoagulative effect was not good in only one case. 4 other cases were recovered by embolectomy and postoperative anticoagulation therapy as well as related nursing measures. Conclusion The nursing measures such as close observation of the disease processing, early reasonable anticoagulation, accurate medication, prevention of patent complication are critical for preventing the recurrence of portal vein thrombosis after liver transplantation.
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Objective To review the important points in the preoperative assessment and the surgical technique in precise hepatic pedicle dissection in anatomical hepatic segmentectomy.Methods 104 patients who underwent anatomical hepatic segmentectomy were divided into two groups according to the different surgical approaches adopted in a prospective and non-randomized manner:the precise hepatic pedicle dissection group (the precise group,n=44) and the conventional hepatectomy group (the conventional group,n=60).The perioperative and follow-up data were analyzed.Patients who had primary liver cancer,including hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma,were analyzed separately.Results (1) There was no perioperative death in the two groups.There was no significant differences in blood loss and transfusion between the 2 groups of patients (P=0.069,0.208; t=1.844,1.266).There was a significantly higher rate of vascular inflow occlusion (P=0.001).There were significantly longer periods of vascular inflow occlusion and operative time (P=0.001,0.001; t=3.849,3.574) in the precise group.There was no significant difference in postoperative complications (P=0.988) and the duration of postoperative hospital stay (P=0.509;t=0.662) between the two groups.(2) In patients with primary liver cancer,there were no significant differences between the precise group (n=29) and the conventional group (n=41) in tumor margin positivity,vascular invasion and pathological staging (P=0.985,0.630,0.769).(3) All patients were followed up for two years.When compared with the conventional group,the disease-free survival (P=0.012),overall survival (P =0.006),and median survival (16.5 ± 4.5mo vs.7.8 ± 3.8mo)were significantly longer in the precise group.Conclusion Precise hepatic pedicle dissection had the same safety and efficacy as conventional method in partial hepatectomy.For primary liver cancer,precise hepatic pedicle dissection had better survival compared to the conventional method when the surgical margin was negative.