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Objective:To evaluate the effect of accelerated rehabilitation surgery (ERAS) under diagnosis-intervention packet (DIP) in patients with early cancer of digestive tract undergoing endoscopic submucosal dissection (ESD).Methods:The 64 patients with early cancer of digestive tract treated with ESD in the Gastroenterology Department of the Second People′s Hospital of Jiaozuo were selected by randomized controlled trial and convenient sampling method. According to random number table method, they were divided into routine group and observation group, 32 patients in each group. All patients in the 2 groups paid their medical expenses by DIP method, the routine group was treated with traditional perioperative nursing, and the observation group was treated with ERAS perioperative management mode. The postoperative complication rate, length of hospital stay, DIP allocation ratio, and patient satisfaction with nursing were compared between the two groups.Results:There were 16 men and women in the routine group, 14 men and 18 women in the observation group.After intervention, the incidence of postoperative complications was 21.88% (7/32) in the routine group and 3.12% (1/32) in the observation group, and the difference between the two groups was statistically significant ( χ2=5.14, P<0.05). The length of stay was (10.93 ± 2.87) d in the routine group and (9.01 ± 1.53) d in the observation group, and the difference between the two groups was statistically significant ( t=4.13, P<0.05). The average hospitalization expenses per case was (20 108.23 ± 6 495.49) yuan in the routine group and (18 589.03 ± 4 439.46) yuan in the observation group, and the difference between the two groups was statistically significant ( t=20.57, P<0.05). The DIP allocation ratio of the observation group was 87.98% (303 419.26/344 872.99), and that of the routine group was 69.33% (244 864.99/353 187.65), and the difference between the two groups was statistically significant ( χ2=4.81, P<0.05). The satisfaction of the observation group was 96.88% (31/32) and the routine group was 78.13% (25/32), and the difference between the two groups was statistically significant ( χ2=5.14, P<0.05). Conclusions:The accelerated rehabilitation surgical nursing can effectively reduce the postoperative complications, the average length of stay, the average hospitalization expenses per case under DIP in patients with early cancer of digestive tract treated by ESD, improve the DIP allocation ratio of ESD diseases and the patient′s nursing satisfaction, which reflects the value of nursing work and can be applied to the nursing management of other surgical diseases.
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BACKGROUND:If quadriceps femoris muscle is not effectively rehabilitated,the strength of quadriceps femoris muscle in patients with intertrochanteric fractures will gradually decline,even causing lower limb muscle atrophy.As a result,postoperative complications such as pain in the affected thigh and inflexibility of the hip and knee joints will occur. OBJECTIVE:To evaluate the effect of universal stepwise rehabilitation training of quadriceps femoris muscle on the postoperative rehabilitation of intertrochanteric fracture of the femur,and to investigate the efficacy of quadriceps femoris rehabilitation in the postoperative rehabilitation of intertrochanteric fractures of the femur. METHODS:A retrospective analysis was performed to analyze the data of 48 patients operated for intertrochanteric fracture of the femur who were rehabbed by applying a quadriceps femoris rehabilitation program between October 2016 and February 2022.Rehabilitation training included isotonic and isometric contraction training of quadriceps femoris muscle,and the time of exercise was from the 1st to the 12th week of the postoperative period.Patient's Hip function was evaluated using hip joint mobility score in Merle D'Aubigne and Postel evaluation system,WOMAC lower extremity function score,and Harris hip joint function score.The Visual Analog Scale was used to assess patients'pain.The Hospital Anxiety and Depression Scale was used to assess the patient's psychological status.Changes in quadriceps muscle strength were also measured. RESULTS AND CONCLUSION:The average healing time of the fracture was(9.78±1.65)weeks.At 4 weeks postoperatively,the patient's hip function significantly improved compared with that at the preoperative period(P＜0.01),the Visual Analog Scale scores for pain evaluation decreased(P＜0.01),quadriceps femoris muscle strength increased(P＜0.01),and the Hospital Anxiety and Depression Scale scores decreased(P＜0.05).At 12 weeks postoperatively,as the rehabilitation training continued,the patient's hip function and pain symptoms further improved compared with those at 4 weeks postoperatively(P＜0.05),quadriceps femoris muscle strength further recovered(P＜0.05),and the Hospital Anxiety and Depression Scale scores further decreased(P＜0.01).At 24 weeks postoperatively,the rehabilitation training had been stopped,the patient's hip joint function and muscle strength were well maintained,and no obvious amyotrophy occurred in the quadriceps femoris muscle,and there were no significant differences between 12 and 24 weeks postoerpatively(P＞0.05).No complications and adverse events occurred during postoperative rehabilitation.To conclude,the application of universal stepwise functional rehabilitation model of quadriceps femoris muscle in the early postoperative period of intertrochanteric formal fracture is helpful for the recovery of hip joint function,increasing muscle strength,and promoting fracture healing to a certain extent.
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OBJECTIVE: The perioperative optimization measures of accelerated rehabilitation surgery run through the whole hospitalization period of patients with open spinal surgery. The clinical efficacy and safety of tranexamic acid in open spinal surgery were evaluated using meta-analysis. METHODS: Databases of PubMed, Embase, Ovid, Cochrane Library, CNKI, CBM, Wanfang, and VIP were searched. According to the inclusion and exclusion criteria, ten prospective randomized controlled trials were obtained. Endnote software was utilized to manage the literature. The extracted data were analyzed using Revman 5.3 software for meta-analysis, mainly analyzing the intraoperative blood loss, postoperative blood loss, total perioperative blood loss, postoperative hemoglobin, operation time, length of hospital stay, blood transfusion rate, and thrombotic complications by using tranexamic acid in open spinal surgery. RESULTS: (1) A total of 10 high-quality prospective randomized controlled studies were included in 802 patients. (2) Meta-analysis results showed that tranexamic acid significantly reduced intraoperative blood loss (MD=-210.38, 95%CI:-267.31 to-153.45, P < 0.000 01), postoperative drainage (MD=-113.40, 95%CI:-126.97 to-99.83, P < 0.000 01), total perioperative blood loss (MD=-266.85, 95%CI:-351.18 to-182.52, P < 0.000 01), and postoperative hemoglobin loss (SMD=0.20, 95%CI: 0.02-0.38, P=0.03) compared with the control group, with significant difference. Moreover, the length of hospital stay (MD=-1.09, 95%CI:-1.86 to-0.32, P=0.006) significantly reduced, and blood transfusion rate (RR=0.61, 95%CI: 0.48 to 0.79, P=0.000 1) significantly reduced. Operation time (MD=-7.75, 95%CI:-16.65 to 1.15, P=0.09) did not shorten. (3) There was no significant difference in the incidence of thrombotic complications between the tranexamic acid group and the control group (RR=0.92, 95%CI: 0.47 to 1.82, P=0.81). CONCLUSION: Tranexamic acid can significantly reduce the perioperative blood loss of open spine surgery, shorten hospital stay, lower blood transfusion rate, and is safe and reliable. The use of tranexamic acid in open spinal surgery can promote enhanced recovery of patients after surgery; the initial dose of tranexamic acid is 10-15 mg/kg, maintenance dose 1.0-2.0 mg/kg per hour. It may be the best solution for intravenous tranexamic acid in open spine surgery.
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Objective To investigate the application effect of selective cyclooxygenase-2 (COX-2) inhibitor in perioperative preemptive on-demand analgesia of the patients with laparoscopic cholecystectomy under enhanced recovery after surgery(ERAS).Methods The clinical data in 206 cases of gallstones undergoing selective COX-2 inhibitor for preemptive analgesia (new type analgesic group) from June to December 2015 and 198 cases of gallstones undergoing tramadol postoperative analgesia (traditional analgesia group) in the biliary surgery department of West China Hospital of Sichuan University were retrospectively analyzed.The intraoperative anesthesia schemes in the two groups were consistent.The same pain resolution scheme was adopted after operation.Then the VAS pain score,pain relief drug use rate,adverse reactions,analgesic satisfaction and hospitalization time were compared between the two groups.Results The VAS scores at postoperative 2,6,12,24 h in the new type analgesia group were lower than those in the traditional analgesia group,the difference was statistically significant (P＜0.05);the analgesic drug use rate in the new type analgesia group was lower than that in the traditional analgesia group (14.56％ vs.44.95％,P＜0.05),and the use rate of tramadol hydrochloride and pethidine hydrochloride was lower than that in the traditional analgesia group (P＜0.05).The incidence rate of adverse reactions in the new type analgesia group was lower (2.43％ vs.36.36％,P＜0.05).The incidence rate of nausea and vomiting in the new type analgesia group was lower than that in the traditional analgesia group (P＜0.05),and the incidence rate of other complications had no statistically signifiwas higher than that in the traditional analgesia group (P＜0.05);the average hospital stay and postoperative hospital stay had no statistical difference between the two groups (P＞0.05).Conclusion COX-2 inhibitors can effectively reduce perioperative pain degree in the patients with laparoscopic cholecystectomy,reduces the use frequency of analgesic drugs,shortens the hospital stay time and increases the patient satisfaction.cant difference (P＞0.05).The perioperative patient analgesia satisfaction the in the new type analgesia group
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Objective Compare the effect of thoracic and abdominal mediastinal tube placement on pain and comfort in patients with minimally invasive esophageal cancer and nursing care. Methods 108 patients with squamous cell carcinoma of the thoracic esophagus were selected from December 2016 to May 2017. The patients were divided into chest group and abdominal group according to the random number comparison table, each with 54 cases. All patients underwent minimally invasive radical resection of esophageal carcinoma. The mediastinum drainage tube was placed at different locations of the chest and abdomen after operation. The duration of intubation, total drainage volume, number of dressing change before and after extubation, degree of pain and comfort after surgery were recorded, drainage tube failure and the incidence of related complication were compared between the two groups. Results There was no significant difference in duration of intubation, total drainage volume, drainage tube failure and the incidence of related complication between Patients with mediastinal tubes placed through the chest and abdomen(P>0.05). The times of dressing change before and after extubation in the abdominal group were (2.8 ± 1.0), (1.9 ± 0.6) times, those in the chest group were (4.5 ± 1.2), (3.6 ± 1.1) times, there were significant difference between the two groups (t=7.841, 9.377, P<0.01). The NRS and VAS score at 1-4 days and extubation in the abdominal group were significantly lower than those in the chest group, the abdominal group were (3.2±1.0), (2.7±0.8), (2.3±0.7), (1.9±0.7), (1.5±0.6) points and (3.7±0.8), (3.4±1.4), (3.0± 0.7), (2.6±1.0), (2.6±1.0) points, the chest group were (3.7±1.3), (3.3±1.1), (2.8±0.8), (2.3±0.8), (2.3±0.7) points and (5.0±0.9), (4.3±1.4), (4.1±1.3), (3.3±1.2), (3.6±1.0) points, there were significant difference between the two groups (t=2.443-7.247, P<0.01 or 0.05). Conclusions Intraoperative abdominal minimally invasive radical mediastinal tube placed esophageal cancer, can significantly relieve pain and improve patient comfort, reduce the frequency of dressing change before and after extubation, not only quickly improve the rehabilitation of patients, but also can avoid the waste of medical resources, it is worthy of clinical promotion.
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Objective To explore the effect of accelerated rehabilitation surgical nursing on perioperative period of laparoscopic radical nephrectomy. Methods A total of 78 patients with laparoscopic radical nephrectomy in Heze City Hospital in Shandong Province from December 2015 to December 2017 were divided into research group and control group with 39 cases each by random digits table method. The control group was received traditional perioperative nursing intervention, the research group was given accelerate rehabilitation surgical nursing in addition to the traditional perioperative nursing. The indicators related to the operation, postoperative complications and postoperative Visual Analogue Scale (VAS) score were compared. In addition, the scores of Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) before and after nursing in the two groups were compared, and the nursing satisfaction rates of the two groups were compared. Results The first time to go out of bed, anus exhaust time, eating time, length of hospital stay, postoperative hospitalization expenses respectively was (4.82±0.43) h, (6.45±1.93) h, (2.53±0.41) h, (3.59±0.23) d, (3.12±0.15) ten thousand yuan in the research group, and (7.57±0.62) h, (32.67±14.59) h, (27.63±10.64) h, (8.54±0.52) d, (4.57±0.26) ten thousand yuan in the control group, with statistically significant differences between the two groups (t=-54.367--11.126, all P<0.01). The VAS score was (3.63 ± 0.29) points in the research group, and (7.52 ± 0.34) points in the control group, with statistically significant differences between the two groups (t=-54.362, P<0.01). The incidence of postoperative complications was 2.56％ (1/39) in the research group, and 10.26％ (4/39) in the control group, with statistically significant differences between the two groups (χ2=4.942, P<0.05). Before and after nursing, SAS and SDS scores was respectively (56.37±5.59), (42.35±2.89), (57.30±5.74), (43.09±3.25) points in the research group, and (56.49±5.70), (50.46±4.25), (57.23±5.68), (50.71±5.20) points in the control group, with statistically significant differences between the two groups (t=-9.854,-7.760, all P<0.01). The satisfaction rate of patients was 97.44％(38/39) in the research group, and 84.62％(33/39) in the control group, with statistically significant differences between the two groups (χ2=10.064, P<0.01). Conclusions For patients with laparoscopic radical renal resection, accelerate rehabilitation the use of surgical nursing is of great significance, to reduce the incidence of complications, shorten patients with postoperative hospital stay, reduce pain, eliminate the adverse psychological aspects and so on all play a positive role, further improve nursing satisfaction, promote the postoperative rehabilitation, clinical significance and application value.
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Objective The clinical benefits of carbohydrate intake 2-3 h before surgery in patients with digestive tract malignant tumor without diabetes mellitus have been confirmed by foreign experts,the"High level evidence" for perioperative nutrition support were also written in China"Guidelines for perioperative nutritional support in adults".However,there are few hospitals in China that prefer preoperative glucose pretreatment,taking into account the differences between domestic and foreign data.In this paper,the clinical randomly controlled experimental data about the effect of preoperative glucose pretreatment on the prognosis of patients with malignant tumor of digestive tract was analyzed by Meta analysis,in order to evaluate the efficacy and safety of preoperative glucose pretreatment in Chinese patients,and to achieve the clinical significance.Methods Retrieving the database from establishment to March 2017,the related literatures about preoperative glucose pretreatment and prognosis of patients with digestive tract malignant tumor were collected.Revman5.3 software was used to perform Meta analysis of 10 randomized controlled trials(606 patients)who met the inclusion criteria.Results Compared with the traditional fasting and non drinking group,the preoperative subjective discomfort of the preoperative group was significantly reduced(SMD = -1.29,95%CI = -2.00--0.59,P = 0.000 3), postoperative insulin resistance was significantly reduced(SMD=-1.92,95%CI=-2.68--1.16,P<0.01), postoperative blood glucose concentration,insulin concentration increased,and no vomiting and aspiration occur in any patient as shown by the literature.Conclusion In the patients with malignant tumor of digestive tract, perioperative nutrition support and pretreatment show significant clinical benefits,preoperative subjective comfort improves,the risk of aspiration does not increase significantly,postoperative insulin resistance decreases.It is proved that preoperative carbohydrate pretreatment is effective and safe in the operation of domestic digestive tract cancer.
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Interdisciplinary research is one of the focus of sci-entific method discussion .In recent years a large number of interdiscipli-nary methods or engaged in interdisciplinary research and collaboration between scientists have won the Nobel prize , once again proved this point.Its profound, interdisciplinary research in the field of medicine it-self also embodies a new paradigm of modern medical science and explo-ration the cross disciplinary research applied to medical postdoctoral training work, aims to cultivate a group of clinicians is an excellent ex-perimental research and know the innovative medical amphibious expert.With the development of modern medicine and the current actual situation , the development of a single subject is far from enough .This article from the interdisciplinary talents cultivation idea or-igin, development of surgery and anatomy , informatics, imaging, such as the development of other disciplines and the close connection between the hot research in twenty-first century To expound the progress of medicine , the need for mutual cooperation between families , and by their respective areas of strengths together to carry out interdisciplinary research .
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Patella infera (baja) is a rare condition that can result from several etiologies including trauma around the knee. Risk factors include scar tissue formation in the retropatella fat pad, extensor mechanism dysfunction, immobilization in extension position of the knee joint, etc. Unawareness and delayed recognition are known to be associated with long-term disability. In this condition, arthroscopic treatment is generally recommended only for early cases. In this report, we present a case with reasonable outcome of delayed patella infera treated by arthroscopic treatment. Prudent arthroscopic debridement of the responsible scar tissue and accelerated rehabilitation therapy is necessary for achievement of a successful outcome.
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Adipose Tissue , Cicatrix , Debridement , Immobilization , Knee , Knee Joint , Patella , Rehabilitation , Risk FactorsABSTRACT
We studied 30 patients who participated in accelerated rehabilitation program after ACL reconstruction to evaluate the effects on knee joint function prospectively. This program emphasizes early full hyperextension, early weight bearing as tolerated, and closed-chain quadriceps functional activities with rapid return to sports. Timing of the return to occupation, activity level, manual knee test, range of motion, thigh circumference, Lysholm knee score and KT-2000 arthrometer measurement were checked at the latest follow-up which is at least more than 1 year. The result were as follows: 1. The mean time for patients to return to occupation was 7.5 weeks (2 weeks-6 months). 2. Range of motion of the knee were not limited in 25 cases (83%) at 1 year after reconstruction. 3. The mean Lysholm score was 92.7. 4. The mean manual maximum KT-2000 arthrometer score was 2.0mm. The results of this study show that patients who had an ACL reconstruction with an autogenous central 1/3 patellar tendon graft and followed an accelerated rehabilitation program obtained longterm stability, achieved full range of motion, had a low complication rate, and were able to return to full sporting activities predictably.