ABSTRACT
Objective:To explore the application effect of clinical nursing pathway based on enhanced recovery after surgery (ERAS) concept in perioperative nursing of gastric cancer in the elderly, so as to provide basis for the selection of clinical nursing plan.Methods:A total of 92 patients with gastric cancer who underwent surgical treatment in Hefei Second People′s Hospital from January 2018 to July 2020 were enrolled. They were divided into the observation group and the control group by random number table method, 46 cases in each group. The control group was given routine nursing intervention, while the observation group was given clinical nursing pathway based on ERAS concept for intervention. The postoperative recovery, improvement of nutritional indexes, postoperative complications were compared between the two groups.Results:The first bowel sound time, first exhaust time, first defecation time, leaving bed time, indwelling time of urinary catheter, and postoperative hospitalization time were (18.43 ± 1.80) h, (43.67 ± 8.79) h, (53.06 ± 5.18) h, (22.65 ± 4.95) h, (29.08 ± 2.69) h, (13.93 ± 2.19) d in the observation group, while (22.96 ± 2.24) h, (47.98 ± 8.46) h, (57.97 ± 5.65) h, (31.30 ± 5.73) h, (35.40 ± 3.66) h, (15.48 ± 2.40) d in the control group, there were significant differences between the two groups ( t values were 2.40-10.69, all P<0.05). There was no significant difference in the nutritional indexes before intervention between the two groups( P>0.05). After intervention, the levels of serum total protein, serum albumin and hemoglobin were (64.43 ± 6.22), (35.43 ± 3.07), (125.88 ± 4.75) g/L in the observation group, while (55.97 ± 5.25), (29.96 ± 2.64), (120.05 ± 5.07) g/L in the control group, there were significant differences between the two groups ( t=7.05, 9.16, 5.69, all P<0.05). The incidence of postoperative complications was 4.35%(2/46) in the observation group, 19.57%(9/46) in the control group, there was significant difference between the two groups ( χ2=5.06, P<0.05). Conclusions:The clinical nursing pathway based on ERAS concept can effectively ensure the nutrition needed by patients with gastric cancer during postoperative rehabilitation, accelerate rehabilitation process, and reduce the incidence of postoperative complications.
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Objective To explore the correlation factors and clinical significance of lymph node metastasis in right recurrent laryngeal nerve of thyroid papillary carcinoma (PTC).Methods Ninty-eight consecutive patients with PTC who were underwent total thyroidectomy with routine central lymph node dissection in the Second People's Hospital of Hefei from January 2015 to August 2017 were analyzed.The right paratracheal lymph nodes in the central compartment lymph nodes were divided into the level Ⅵ-A (anterior) and level Ⅵ-B (posterior,that was lymph node posterior to recurrent laryngeal nerve) compartments by recurrent laryngeal nerve.The lymph node metastasis of Ⅵ-B area during central compartment lymph node dissection was analyzed.We drew the receiver-operating characteristic curve (ROC) for right neck Ⅵ-A number of lymph node metastasis,and calculated the area under the curve (AUC) and Youden index.Results Among 98 cases,16 cases occurred Ⅵ-B district lymph node metastasis (16.33％).Single factor analysis results showed that lymph node metastasis in Ⅵ-B area of PTC patients were related to the tumor size (x2 =12.864,P ＜0.001),tumor capsular invasion (x2 =16.354,P ＜ 0.001),the right neck Ⅵ-A area lymph node metastasis (x2 =16.065,P ＜ 0.001),tumor number (x2 =15.593,P ＜ 0.001) and neck lymph node metastasis (x2 =21.098,P ＜0.001),but they were not related to the patients' gender,age and lesion location (all P ＞ 0.05).Lymph node metastasis in Ⅵ-B area of PTC patients were related to the number of right neck Ⅵ-A area lymph node metastasis.When the number of right neck Ⅵ-A metastatic lymph nodes was 2.5,the sensitivity and specificity were 70.60％ and 70.00％ respectively,AUC was 0.754,and Youden index was 0.406.Conclusion For patients with PTC,primary tumor diameter ＞ 1 cm,tumor extracapsular invasion,Ⅵ-A area lymph node metastasis,multiple tumor and lateral cervical lymph node metastasis were the predictive factors for the lymph node metastasis in Ⅵ-B area.When the number of right neck Ⅵ-A area metastatic lymph nodes was greater than 3,we should dissect Ⅵ-B area.
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Objective To study the morbidity rule of community trauma and pre-hospital care mea-sures so as to improve the pre-hospital care performance. Methods 962 cases who received pre-hospital care by "120" commanding center in our hospital were retrospectively analyzed by means of self-designed questionnaires. Results The features of community trauma were mainly multiple trauma caused by traffic accidents, the main pre-hospital care measures included bandaging, hematischesis, pexia, aspiration of oxy-gen,intravenous injection, cardiopulmonary resuscitation,tracheal intubation and cricothyroid puncture,a-mong which bandaging, hematischesis and pexia accounted for 92.7 per cent. Conclusions Early and rapid treatments to the wounded patients, and correct medical rescue are very important. They are the two key factors to promote the success rate of rescue. At the same time, sound nursing management, correct medical treatment and nursing coordination are also critical aspects.