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Objective:To explore the effectiveness of Acute Care of the Elderly(ACE)model and its existing problems in the clinical practice for older adults with acute clinical conditions.Methods:Using the random number table method, a random number sequence was generated, and the patients admitted to the Department of Geriatrics of Shenzhen Nanshan Hospital due to acute diseases From January 2019 to September 2021 were enrolled in the ACE model intervention group(160 cases)and the control group(77 cases)in a 2: 1 ratio.The inclusion criteria were based on disease severity, frailty assessment, and activity of daily living(ADL)assessment.The intervention time was 1-3 weeks.Outcomes of the patients include ADL, hospitalization days, hospitalization expenses, drug proportion, human resource investments, adverse events, 30-day readmission rate, and 1-year mortality.Results:There were no significant difference in baseline indicators such as frailty index and ADL score between the two groups at admission.The ADL score(Barthel index)of the ACE group was significantly improved compared with the control group at discharge(81.71±14.23 vs.70.9±23.89, P<0.001)and at 30 days after discharge(85.84±15.25 vs.68.29±30.91, P<0.001). The hospital cost[(12 735.81±6 541.41)￥ vs.(16 391.54±12 962.34)￥, P=0.002], drug proportion(21.34% vs.28.93 %, P=0.036)and 30-day readmission rate(13.1% vs.23.4%, P=0.037)of the ACE group were significantly lower compared to the control group.The human resource input(32.97±6.72 vs.25.03±5.31, P=0.008)and patient satisfaction(98.23% vs.90.66%, P=0.031)in the ACE group were significantly higher than those of the control group.(4)The incidence of adverse events during hospitalization was significantly lower in the ACE group than in the control group in terms of aspiration(0.63% vs.20.8%, P<0.001), falls(0 vs.10.4%, P<0.001), incontinence dermatitis(0 vs.3.9%, P=0.033), and 1-year mortality(6.3% vs.24.7%, P<0.001). There was no significant difference in the average length of stay(8.98±4.25 vs.10.03±5.32, P=0.101), pressure sores(13.01±4.77 vs.13.27±4.89, P=0.364), DVT risk score(8.53±2.79 vs.8.89±2.76, P=0.340)and medical staff satisfaction(73% vs.80%, P=0.240)between the two groups. Conclusions:The ACE model helps to reduce the disability rate of elderly patients with frailty, adverse events during hospitalization, save drug costs, and improve patient satisfaction.It is worth promoting in geriatric practice, but its localization management details and processes still face many challenges.
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OBJECTIVE@#To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with electroacupuncture (EA) on rehabilitation after abdominal surgery.@*METHODS@#A total of 320 patients undergoing abdominal surgery were randomly divided into a combination group (80 cases), a TEAS group (80 cases, 1 case discontinued), an EA group (80 cases, 1 case discontinued) and a control group (80 cases, 1 case discontinued). The patients in the control group received enhance recovery after surgery (ERAS) standardized perioperative management. On the basis of the treatment in the control group, the TEAS group was treated with TEAS at Liangmen (ST 21) and Daheng (SP 15); the EA group was treated with EA at Neiguan (PC 6), Hegu (LI 4), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39); the combination group was treated with TEAS combined with EA, with continuous wave, 2-5 Hz in frequency, and the intensity was tolerable to the patients, 30 min each time, once a day, from the first day after surgery, until the anus resumed spontaneous defecation and the oral intake of solid food was tolerated. The gastrointestinal-2 (GI-2) time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time, time of first get out of bed and hospital stay were observed in all the groups; the pain visual analogue scale (VAS) score and incidence rates of nausea and vomiting 1, 2, 3 days after surgery were compared in all the groups; after treatment, the acceptability of each treatment was evaluated by patients in each group.@*RESULTS@#Compared with the control group, the GI-2 time, first exhaust time, first defecation time, first tolerance of oral intake of solid food time were shortened (P<0.05), the VAS scores 2, 3 days after surgery were decreased (P<0.05) in the combination group, the TEAS group and the EA group; those in the combination group were shorter and lower than the TEAS group and the EA group (P<0.05). Compared with the control group, the time of hospital stay in the combination group, the TEAS group and the EA group were shortened (P<0.05), and that in the combination group was shorter than the TEAS group (P<0.05).@*CONCLUSION@#TEAS combined with EA can accelerate the recovery of gastrointestinal function in patients after abdominal surgery, relieve postoperative pain, and shorten hospital stay.
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Humans , Electroacupuncture , Transcutaneous Electric Nerve Stimulation , Acupuncture Points , Gastrointestinal Tract , Pain, PostoperativeABSTRACT
Objective:To explore the postoperative analgesic effect of Dexmedetomidine on elderly patients with colorectal cancer under the guidance of the concept of rapid recovery after surgery.Methods:A total of 230 elderly patients with colorectal cancer who underwent laparoscopic surgery in our hospital from March 2018 to September 2020 were randomly divided into an observation group(receiving Dexmedetomidine auxiliary general anesthesia, n=115)with aged(66.6±4.6)years, male 59, and control group(receiving normal saline auxiliary general anesthesia, n=115), with aged(67.0±4.6)years, male 61.The analgesic effect, hemodyna mic index, postoperativeout of bed activity time, gastrointestinal fuction recovery time postoperative hospital stay and adverse reactions were observed.Results:The pain scores at 4, 8, 12, 24 and 48 h after operation were lower in the observation group than in control group(all P<0.05). The recovery rate of postoperative analgesic drugs was 13.9% in the observation group and 24.3% in the control group( χ2=4.047, P<0.05). Ramesay scores were higher in the observation group than in the control group( P<0.05). Fluctuations of postoperative heart rate and blood pressure were lower in the observation group than in the control group( P<0.05). The total incidence of adverse reactions was lower in the observation group(11.3%)than in the control group(24.3%)( χ2=6.678, P<0.05). Conclusions:Under the guidance of the concept of rapid recovery after surgery, Dexmedetomidine can improve the postoperative analgesic effect in elderly patients with colorectal cancer, reduce the incidence of adverse reactions, and have stable hemodynamics.
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Objective:To explore the clinical application effect of early removal of drainage tube in rapid postoperative recovery of patients with thyroid cancer.Methods:A total of 90 thyroid cancer patients admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from June 2018 to June 2019 were selected and divided into a control group and a study group according to the order of operation time. Patients in the control group were given routine extubation, and patients in the study group were removed early during rapid recovery after surgery. The complication rate, postoperative hospital stay, satisfaction, extubation time distribution, and drainage port healing rate 3 days after surgery were compared between the two groups of patients.Results:In the study group, the incidence of complications after drainage tube removal during rapid recovery after surgery was 6.7% (3/45), which was significantly lower than that of the control group, 26.7% (12/45), and the difference was statistically significant ( χ2 value was 6.48, P <0.05). The postoperative hospital stay in the study group was (3.25±0.89) days, and the satisfaction score was (97.83±7.25), which was significantly shorter than the control group's (5.68±0.96) days and (92.36±12.19). The difference was statistically significant ( t value was 12.45, 2.59, P <0.05). Conclusions:Early removal of the drainage tube during rapid postoperative recovery of patients with thyroid cancer can effectively reduce the trauma of the drainage tube orifice, shorten the hospital stay, and improve patient satisfaction.
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Modern military actions and non-military operations characterized by high-intensity, sudden emergencies and long continuous working inevitably lead to sleep deprivation of military personnel. High-intensity actions require military personnel to maintain excellent action abilities all the times; sudden emergencies need them to maintain alert; and the continuous work need them to maintain a healthy mental state. Therefore, how to effectively combat sleep deprivation, keep alert and have high stress ability have become the focus of modern military medical research. This article reviews the research progress of central nervous system stimulants, preventive sleep medications, sleep induction and rapid recovery drugs, and non-drug measures to combat sleep deprivation.
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BACKGROUND: Postoperative pain is a common clinical problem in unicompartmental knee arthroplasty, and severe pain can affect postoperative efficacy. Hormone is a common and effective anti-inflammatory drug, and there is some controversy over whether to add hormone to the local injection of cocktail in unicompartmental knee arthroplasty. OBJECTIVE: To evaluate the effectiveness of adding hormones to the cocktail to promote rapid recovery after unicompartmental knee arthroplasty. METHODS: Osteoarthritis patients receiving unilateral unicompartmental knee arthroplasty from October 2017 to March 2019 were randomly divided into a hormone group (local injection of cocktail + 40 mg triamcinolone acetonide) and a control group (local injection of cocktail + equivalent normal saline). Visual analogue scale score, fentanyl consumption, knee function, inflammatory indicators, adverse reactions and complications were observed in both groups after surgery. RESULTS AND CONCLUSION: (1) Finally, 80 patients were included in the study (n=40 in each group). There was comparability between the two groups (P > 0.05). (2) The static and dynamic visual analogue scale scores of patients in the hormone group at 1, 2 and 3 days after surgery were significantly lower than those in the control group (P 0.05). (6) C-reactive protein levels at 3 days and interleukin-6 levels at 24 hours after surgery in the hormone group were significantly lower than those in the control group (P < 0.05). (7) The incidence of complications in the hormone group was significantly lower than that in the control group (P < 0.05). (8) Addition of hormones in the cocktail can effectively promote the rapid recovery after unicompartmental knee arthroplasty..
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As one of the four major types of organ transplantation, lung transplantation has been developed rapidly in recent years. With the establishment of Quality Management and Control Center for Lung Transplantation of National Health Commission, the formulation of Technical Management Specifications for Lung Transplantation and Standard Procedures and Technical Specifications for Lung Transplantation and the implementation of a series of measures, the quality and quantity of lung transplantation have been steadily increased in China. It will provide a guarantee for further promoting the development of lung transplantation in China by the establishment and improvement of scientific quality control parameters for clinical application of lung transplantation technology, the formulation of standard procedures and technical specifications for lung transplantation, strengthening the management of standardized training bases for lung transplantation, building up a multidisciplinary lung transplantation team and constructing a complete lung transplantation database.
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Needle-embedding therapy is characterized by shallow puncture and long retention of needle, which can reduce the pain during acupuncture and prolong the time of acupuncture effect to improve the effect, especially suitable for perioperative patients. The study shows that the clinical application of needle-embedding therapy has the effects of sedation, analgesia, reducing stress response, protecting gastrointestinal function and promoting postoperative recovery. The paper shows the advantages of traditional Chinese medicine (TCM) treatment in the field of rapid recovery during perioperative period and provides a new method for perioperative patients.
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Objective:To research the quality of postoperative recovery of patients with lung cancer through the(PQRS),and compare the recovery quality after video-assisted thoracoscopic surgery (VATS) or traditional open lobectomy.Method:PQRS scale was used to evaluate the recovery of 140 patients with lung lesions preoperatively and postoperative 1 day,3 days,7 days,14 days and 1 month.95 patients who met the set standard and complete the PQRS scales were enrolled and divided into video-assisted thoracoscope group or traditional thoracotomy group.This article mainly compared and analysied the quality of postoperative recovery of patients in both groups.Result:Except the anesthesia time,other general datum showed no statistical difference.In total recovery rate,the video-assisted thoracoscope group has significant difference when compared with the traditional thoracotomy group(P ＜ 0.05).The recovery rates of VATS group in feeling of the harmful factors,emotional factors and the daily life are higher than that of the traditional thoracotomy group,with statistically significant differences(P ＜0.05).However,the recovery rates in the physiological factors and cognitive factors had no statistical difference between two groups(P＞ 0.05).Conclusion:PQRS can effectively evaluate the quality of postoperative recovery in patients with lung cancer,and VATS is helpful to quick recovery postoperatively.
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BACKGROUND: Although lidocaine seems to be one of the most suitable spinal anesthetics for ambulatory surgery, the safety of lidocaine for spinal anesthesia has been called into question by report of transient neurologic toxicity. So diluted bupivacaine with opioids or adrenergic receptor agonist can replace spinal lidocaine, but delayed awakening, pruritis, intraoperative weak motor block are unsolved problems. This study explored the possibility of solving the unmerited problem to mix bupivacaine and plain lidocaine in spinal anesthesia for transurethral surgery. METHODS: Fifty patients presented for transurethral resection of bladder or prostate. The duration was expected to less one hour. All patients were randomized to two groups receiving the following spinal anesthetics: Group I (7.5 mg bupivacaine), 1.5 ml of 0.5% spinal bupivacaine in 8% dextrose + 0.6 ml saline; Group II (7.5 mg bupivacaine + 6 mg lidocaine), 1.5 ml of 0.5% spinal bupivacaine in 8% dextrose + 0.6 ml 1% plain lidocaine. The sensory and motor block level were checked via pinprick test and modified Bromage score. RESULTS: The highest level of sensory block was not different in group I and group II [median (range): T8 (T5-T9) vs. T8 (T5-T10)]. Onset time to peak block was similar in both groups (11+/-2 vs. 11+/-4 min). Time to two-segment regression (49+/-10 vs. 42+/-10 min; P < 0.05), L1 regression (139+/-27 vs. 113+/-24 min; P < 0.01), S2 regression (200+/-41 vs. 158+/-38 min; P < 0.01) were significantly reduced in group II. No clinical evidence of transient neurologic toxicity was found. Modified Bromage score to evaluate for motor block was not different at the same sensory block level. CONCLUSIONS: Bupivacaine and lidocaine mixture as spinal anesthetics provided the combination of adequate depth of anesthesia and rapid recovery.