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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 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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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 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 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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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 .