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Objective:To investigate the status quo and influencing factors of unsatisfied needs of patients after radical gastrectomy for gastric cancer through quantitative and qualitative mixed research methods, and to provide reference for the development of effective health management programs in the future.Methods:A total of 297 patients who were hospitalized in Tianjin Medical University Cancer Hospital from January to December 2021 after radical gastretomy were selected as subjects by convenient sampling method. The general data questionnaire and Short-Form Survivor Unmet Needs Survey (SF-SUNS) were used to investigate. Selected 12 patients with gastric cancer by objective sampling method for semi-structured in-depth interview and collate data by Colaizzi 7-step analysis method.Results:The total average score of 297 subjects who did not meet the requirements was (60.91 ± 16.00), which was in the middle level. The average score of each dimension from high to low was: continuous care unmet needs (2.37 ± 0.75) points, work economy unmet needs (2.22 ± 0.65) points, information unmet needs (2.20 ± 0.92) points, emotion unmet needs (1.72 ± 0.60) points. Educational background, main economic source of family and working state were the influencing factors of unmet demand ( t=5.32, -3.59, -3.28, all P<0.05). Qualitative research had extracted four themes: unmet needs for symptom network recognition and accurate symptom management, unmet needs for shared decision participation and disease perception trajectory, unmet needs for dignity maintenance and reconstruction of psychological stress mechanism, and unmet needs for "Internet plus" mobile medical continuous care. Conclusions:The problem of unmet needs of patients after radical gastritis is still prevalent and affected by a variety of factors. It is suggested that medical workers build an effective supportive care system based on the status quo of unmet needs of patients, promote the whole process of multidimensional health management services for patients with gastric cancer, and improve the quality of life.
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Objective To evaluate the accuracy of respiratory variations of internal jugular vein (IJV) in monitoring fluid responsiveness in patients undergoing radical gastrectomy for gastric cancer.Methods Fifty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,scheduled for elective radical gastrectomy for gastric cancer,were enrolled in this study.Before induction of anesthesia,the hemodynamic parameters such as heart rate,central venous pressure,cardiac index,stroke volume index (SVI),stroke volume variation and respiratory variation of IJV were recorded after haemodynamics was stable and were recorded again at 10 min after endotracheal intubation,and a loading dose of 6％ 130/0.4 hydroxyethyl starch 7 ml/kg was infused over 15 min.The parameters mentioned above were recorded within 5 min after loading dose.Patients were divided into 2 groups according to the percentage of increase in SVI (△SVI) after volume expansion:△SVI≥ 15％ was considered to be a positive response (responder group) and △SVI＜15％ was considered to be a negative response after volume expansion (non-responder group).Results The area under the receiver operating characteristic curve of respiratory variations of IJV in monitoring fluid responsiveness and 95％ confidence interval were 0.852 (0.744-0.961).Respiratory variation of IJV 24.6％ was considered as the cut-off value and used to monitor fluid responsiveness,and the sensitivity and specificity were 67.6％ and 92.3％,respectively.Conclusion Respiratory variation of IJV can be considered as an effective index in monitoring fluid responsiveness in the patients undergoing radical gastrectomy for gastric cancer.
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Fast track surgery(FTS) can reduce the patients' surgery stress response, maintain the physiological state of the patients, decrease the risk of postoperative complications and then accelerate recovery after surgery.At present, the FTS protocol in laparoscopic radical gastrectomy for gastric cancer is still in a preliminary stage, and its safety and validity remains to be verified.This systemic and comprehensive review focused on the concept of rapid rehabilitation surgery, the program of perioperative treatment, the economic benefit and its future outlook.
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Objective To observe the analgesic effect of abdominis plane block under bilateral costal margin in patients undergoing radical gastrectomy for gastric cancer.Methods Sixty patients with gastric cancer,35 males and 25 females,ASA physical status Ⅰ or Ⅱ,were randomly divided into local anesthetic group (group R) and saline group (group C).After induction of general anesthesia,ultrasound-guided flat knitting machine on bilateral rib fiat knitting machine,the patients were injected 40 ml of 0.5％ ropivacaine or saline.At the end of the operation,patients were pushed into the anesthesia recovery room after extubation,and patients were connected to the venous self-control analgesia pump before leaving the anesthesia room.The VAS pain scores 2,6,12,24,48 h after extubation,the total dosage of sufentanil,remifentanil and vasoactive drugs were recorded.Results The VAS scores of group R 6,12 and 24 h after operation were less than group C (P＜0.05),but there was no statistical difference between the two groups at 2 h and 48 h after operation.The total dosage of sufentanil,remifentanil and vasoactive drugs in group R were less than group C (P＜0.05).The frequency of active pressure reduction in group R was significantly decreased after operation,and the consumption of sufentanil in group R was less than in group C (P＜0.05).Conclusion Transversus abdominis plane block through the block anterior abdominal wall abdominis plane around the nerve provides open abdominal cancer surgery effective postoperative analgesia.
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Objective To analyze the effect of laparoscopic minimally invasive surgery on the immune function of patients with gastric cancer and its clinical efficacy.Methods A total of eighty patients with gastric cancer treated in the First Affiliated Hospital of Hainan Medical University from February 2012 to February 2017 were retrospectively selected.According to the different surgical methods the patients were divided into laparoscopic group and laparotomy group.The laparotomy group was treated with open radical gastrectomy,and the laparoscopic group was treated with laparoscopic radical gastrectomy.The operation and postoperative condition,complications,immune indexes and changes of gastrointestinal hormone levels in the two groups were observed.Results The operation time of the endoscopic group was(198.64±43.89)min,longer than that in the laparotomy group((152.01 ± 42.11)min),the incision size((5.79 ± 1.54)cm),blood loss((75.20 ±11.36)ml)and hospitalization time((8.12±1.58)d)were less than those in the control group((15.96 ±1.55)cm,(129.21±12.03)ml,(12.33±1.85)d)(t=4.849,29.428,20.645,10.944; P<0.05).There was no significant difference in the number of lymph node dissection between the two groups(P>0.05).The CD3,CD4,CD8 and CD4 /CD8 in the laparotomy group three days after the treatment were lower than those after treatment in the endoscopic group((51.90 ± 3.66)% vs.(62.01 ± 3.02)%;(30.25 ± 3.98)% vs.(41.13 ±4.79)%;(23.01±4.02)% vs.(28.20 ± 4.15)%;(0.93 ± 0.21)% vs.(1.19 ± 0.20)%)(t=13.475, 11.049,5.681,5.670,P<0.05).No significant difference was showed between the levels of immune indexes before and after treatment in the endoscopic group(P>0.05).The VIP in the laparotomy group 3d after the treatment was higher than those before treatment and in the laparoscopic group after treatment,MTL and SS were lower than those before treatment and in the endoscopic group after treatment(t=1.707,2.713,4.409,1.756, 2.488,3.969;P<0.05).There was no significant difference in the levels of gastrointestinal hormones before and after treatment in the endoscopic group(P>0.05).The complication rate in the endoscopic group was 10% and 27.50% in the laparotomy group,and the complication rate in the endoscopic group was lower than that in the laparotomy group(χ2=4.021;P<0.05).Conclusion Laparoscopic radical gastrectomy has the advantages of less trauma,less bleeding loss and less complications.It also has little effect on the immune function and gastrointestinal hormones,which is beneficial to the recovery of postoperative patients.
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OBJECTIVE:To investigate the effect of flurbiprofen on morphine doses and intestinal function recovery after radi-cal gastrectomy for gastric cancer. METHODS:102 patients underwent radical gastrectomy of gastric cancer were randomly divided into control group and observation group,with 51 cases in each group. Control group was treated with routine morphine analgesia pump,and observation group was additionally given intravenous injection of flurbiprofen 50 mg before operation and 24 h after op-eration on the basis of control group. VAS,comfort score(BCS),the amount of morphine and intestinal function recovery were ob-served and recorded in 2 groups. RESULTS:48 h after operation,there was no statistical significance in VAS and BCS scores be-tween both groups(P>0.05),but the dose of morphine in observation group was significantly less than in control group,with sta-tistical significance (P<0.05);the postoperative recovery time of bowel sounds and the first anal exhaust time in observation group were significantly shorter than control group,and the incidence of nausea and vomiting in observation group was significant-ly lower than control group,with statistical significance (P<0.05). CONCLUSIONS:The application of flurbiprofen combined with morphine in gastrectomy can reduce the dose and ADR of morphine based on the same analgesic effect,and it is good for the recovery of intestinal function.
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OBJECTIVE:To observe the haemostasis outcome of treating radical gastrectomy for gastric cancer with Rep-tilase.METHODS:A total of30patients underwent radical gastrectomy for gastric cancer were randomly divided into reptilase group and control group,the preoperative and postoperative blood clotting functional parameter changes of the2groups were observed and the volumes of intraoperative blood loss and blood infusion were recorded.RESULTS:There was no significant difference in the blood clotting functional parameters before and after operation in the reptilase group,the intraoperative blood loss volume and blood infusion volume in this group were all lower than in the control group(P