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Objective:To search, evaluate and summarize the best evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy, and to provide reference for clinical practice in order to reduce the complications during labor, such as the proportion of instrument delivery, prolonged labor duration, uterine rupture, postpartum hemorrhage, etc. Standardize the management process of induction of labor with oxytocin, improve the satisfaction of pregnant women to participate in the decision of induction of labor, and improve the outcome of the newborn.Methods:Take the evidence-based nursing method, in view of the full-term pregnancy pregnant women oxytocin drip induced labor evidence-based labor management problems, nearly 10 years related literature retrieval from January 1st 2011 to April 9th, 2021, the Australian JBI evidence-based health care center of literature quality evaluation criteria and evidence classification system, all kinds of research evaluation and classification of retrieval.Results:Early detection to 340 articles, and eventually into 9 articles, including 1 clinical decision, 6 guides, 2 pieces of system evaluation. Totally 45 pieces evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy were sumarized, including induced labor time, oxytocin side effects, induced labor before evaluation, induced labor of guardianship, infusion solution, such as health education, and other seven aspects.Conclusions:The present study summarized 45 pieces of best evidence on the management of labor induced by oxytocin infusion during term pregnancy, which provided some evidence-based basis for midwives, obstetric nurses and managers. Through the application of the best evidence, it is beneficial to improve the outcome of pregnant women in the neonatal perinatal period, standardize the process of inducing labor with oxytocin, and improve the quality of obstetric care.
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Objective@#To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis.@*Methods@#The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability.@*Results@#Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×104 yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×104 yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P<0.05). (3) Postoperative complications: 1 of 30 patients in the observation group had postoperative biliary leakage, with a postoperative complication rate of 3.3%, and was cured after symptomatic support treatment. Six of 22 patients in the control group had postoperative complication, with a postoperative complication rate of 27.3%, including 2 of biliary leakage, 1 of hemorrhage, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, and they were cured after symptomatic support treatment. There was a significant difference between the two groups (χ2=4.358, P<0.05). (4) Postoperative pain scores: from postoperative 6 hours to 48 hours, the postoperative pain score changed from 2.4±0.7 to 1.9±0.9 in the observation group, and from 4.1±0.7 to 2.9±0.9 in the control group, respectively, showing a significant difference in the changing trend between the two groups (F=78.053, P<0.05). (5) Changes in hepatic function and blood routine during perioperative period: from preoperation to postoperative 3 days, levels of alamine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), total bilirubin (TBil), and count of white blood cells in the observation group changed from (77±20)U/L to (53±12)U/L, from (85±22)U/L to (61±17)U/L, from (166±39)U/L to (55±24)U/L, from (40±13)μmol/L to (29±12)μmol/L, from (7.0±2.0)×109/L to (6.8±1.9)×109/L, and changed from (79±23)U/L to (62±14)U/L, from (88±24)U/L to (64±17)U/L, from (179±34)U/L to (74±29)U/L, from (45±13)μmol/L to (35±12)μmol/L, from (7.9±2.4)×109/L to (7.5±1.9)×109/L in the control group, respectively. The levels of ALT, AST, GGT, TBiL, and count of WBC showed increasing at postoperative 1 day, and decreasing at postoperative 3 days. There was no significant difference in the changing trend between the two groups (F=0.058, 0.471, 3.021, 1.593, 2.172, P>0.05).@*Conclusion@#ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.
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Objective To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis.Methods The prospective study was conducted.The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected.Patients were divided into 2 groups by random number table:patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration +T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS),and patients in control group received traditional perioperative management.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) postoperative complications;(4) postoperative pain scores;(5) changes in hepatic function and blood routine during perioperative period.Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was analyzed using the paired t test or repeated ANOVA.Count data were described as absolute numbers and percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Results Fifty-two patients were screened for eligibility,including 20 males and 32 females,aged 25-68 years,with an average age of 53 years.There were 30 patients in the observation group and 22 in the control group.(1) Surgical situations:the operation time and volume of intraoperative blood loss were (133± 19) minutes and (47 ± 21) mL in the observation group,and (136±22) minutes and (49±23)mL in the control group,respectively,showing no significant difference between the two groups (t=-0.386,-0.211,P＞0.05).(2) Postoperative situations:time to out-of-bed activity,time to initial food intake,time to first anal flatus,duration of postoperative hospital stay,and hospital expenses were (18±4) hours,(19±5) hours,(28±2)hours,(4.0± 1.0)days,and (1.82±0.22) × 104 yuan in the observation group,and (29±7)hours,(46±9)hours,(37±4)hours,(6.6±1.6)days,and (2.25±0.29) ×104 yuan in the control group,respectively,showing significant differences between the two groups (t =-7.054,-14.169,-9.426,-6.582,-5.809,P＜0.05).(3) Postoperative complications:1 of 30 patients in the observation group had postoperative biliary leakage,with a postoperative complication rate of 3.3％,and was cured after symptomatic support treatment.Six of 22 patients in the control group had postoperative complication,with a postoperative complication rate of 27.3％,including 2 of biliary leakage,1 of hemorrhage,1 of abdominal infection,1 of pulmonary infection,1 of urinary infection,and they were cured after symptomatic support treatment.There was a significant difference between the two groups (x2 =4.358,P ＜ 0.05).(4) Postoperative pain scores:from postoperative 6 hours to 48 hours,the postoperative pain score changed from 2.4 ± 0.7 to 1.9± 0.9 in the observation group,and from 4.1 ± 0.7 to 2.9 ± 0.9 in the control group,respectively,showing a significant difference in the changing trend between the two groups (F=78.053,P＜0.05).(5) Changes in hepatic function and blood routine during perioperative period:from preoperation to postoperative 3 days,levels of alamine aminotransferase (ALT),aspartate transaminase (AST),gamma-glutamyltransferase (GGT),total bilirubin (TBil),and count of white blood cells in the observation group changed from (77±20)U/L to (53± 12)U/L,from (85±22)U/L to (61± 17) U/L,from (166±39) U/L to (55±24) U/L,from (40± 13) μmol/L to (29±12) μmol/L,from (7.0±2.0) × 109/L to (6.8± 1.9) × 109/L,and changed from (79±23) U/L to (62± 14) U/L,from (88±24)U/L to (64± 17) U/L,from (179±34) U/L to (74±29) U/L,from (45± 13) μmol/L to (35±12) μmol/L,from (7.9±2.4)× 109/L to (7.5± 1.9)× 109/L in the control group,respectively.The levels of ALT,AST,GGT,TBiL,and count of WBC showed increasing at postoperative 1 day,and decreasing at postoperative 3 days.There was no significant difference in the changing trend between the two groups (F=0.058,0.471,3.021,1.593,2.172,P＞0.05).Conclusion ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.
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Objective To evaluate the feasibility and effects of endoscopic thyroidectomy(ETE) for papillary thyroid carcinoma(PTC).Methods A total of 137 patients with PTC were enrolled from January 2013 to January 2016.The patients were divided into two groups depended on different surgical approaches.The patients'' characteristics,such as age,gender,pain,intraoperative blood loss,hospitalization,central lymph node metastasis etc were retrospectively analyzed in the two groups.Results In the study,78 patients performed ETE,and 58 performed COT.There was one case converted to open surgery from ETE due to intraoperative bleeding.The clinicopathological characteristics and operative complications between the two groups had no significant differences,such as gender,time of drainage,postoperative hospitalized days,positive lymph node metastasis,injury of recurrent laryngeal nerve,permanent injury of parathyroid glands.The age of patients was younger in ETE(t=-4.299,P=0.000).The drainage content(t=9.539,P=0.000),intraoperative blood loss(t=2.862,P=0.005) and subcutaneous ecchymosis (χ2=13.482,P=0.000) were found more in the ETE.ETE required a longer operative time(t=8.162,P=0.000).However,ETE provided better cosmetic outcomes than COT [(9.4±0.5)points vs.(5.4±1.0)points,t=30.142,P=0.000].No clinical recurrence and metastasis occurred for at least one-year follow-up.Conclusion With excellent cosmetic results,ETE is a feasible and safe operation for patients with PTC without metastasis to lateral cervical lymph nodes.