RESUMEN
Cardiotoxicity caused by postoperative radiotherapy can increase the risk of cardiovascular adverse events in patients with breast cancer, especially those with left breast cancer, which is proportional to the dose of radiation to the heart. It has been proved that deep inspiration breath-hold (DIBH) technique can significantly reduce the cardiac dose in patients with left breast cancer, but the benefits of this technique vary greatly among different patients, and its implementation requires additional equipment, time, manpower and other resources. Hence, it is necessary to select patients who are suitable for this technique in advance. In addition to comprehensive analysis of general factors before simulation positioning that affect DIBH selection, this review also systematically summarized relevant indicators of CT simulation positioning images. These anatomical indicators included the measurement of the cardiac contact distances in parasagittal (CCD ps) plane, the lateral heart-to-chest distance (HCD), the product of maximum heart width (HW max) and the maximum heart depth (HD max) during CT simulation positioning, and the maximum heart distance, heart volume in the irradiation field (HVIF), the difference of lung volume and heart volume between free breathing (FB) and DIBH measured after CT localization. All of them showed some instructive significance for evaluating whether DIBH should be applied in tangent field based radiotherapy planning. The automatic planning (rapid plan) function in the treatment planning system could quickly predict the benefit of DIBH for breast cancer patients. The purpose of this article is to help clinicians select patients who are suitable for DIBH technique, guaranteeing that DIBH technique resources can be used reasonably.
RESUMEN
Objective:To explore the effects of Xiao's double-C nursing mode based on enhanced recovery after surgery (ERAS) on perioperative related indexes and pain in patients undergoing mixed hemorrhoid surgery.Methods:From August 2019 to August 2020, 60 patients undergoing mixed hemorrhoid surgery who were admitted to anorectal surgery department of Anqing Municipal Hospital were enrolled as the research objects by single center, random, single blind and parallel control methods. They were divided into control group (routine perioperative nursing) and observation group (ERAS-based Xiao's double-C nursing mode) by random number table method, 30 cases in each group. The perioperative indexes, scores of postoperative Visual Analogue Scale (VAS) and wound healing, postoperative complications and nursing satisfaction were compared between the two groups.Results:The first urination time, defecation time, hospitalization time and hospitalization cost were (5.78±1.38) h, (13.37±2.38) h, (7.32±0.72) d and (7 337.84±524.99) yuan in the observation group, and (6.48±1.26) h, (16.72±2.33) h, (8.85±0.93) d, (8 689.54±688.34) yuan in the control group, and the differences were statistically significant ( t values were 2.052-8.552, P<0.01 or 0.05). There were between-group, time and interaction differences in the scores of VAS and postoperative wound healing between the two groups ( Fbetween-group values were 36.24, 42.36, Ftime values were 256.71, 377.42, Finteraction values were 88.62,90.62, P<0.01). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). The scores of nursing satisfaction with health education and services accessibility were (94.37±2.92), (95.11±3.85) points in the observation group, and (92.38±3.01), (91.72±4.31) points in the control group, and the differences were statistically significant ( t values were 2.599, 3.213, P<0.05). Conclusions:ERAS-based Xiao's double-C nursing mode is beneficial to shorten first defecation time, incision healing time and hospitalization time of patients undergoing mixed hemorrhoid surgery, accelerate wound healing and alleviate pain, with higher nursing satisfaction.