Application value of paper towel combined with 360° horizontal turning over method in preoperative preparation of gastroscopy / 中国实用护理杂志

Objective:To investigate the effect of paper towel combined with 360° horizontal turning over method on the field of vision, operation time and detection of small lesions before gastroscopy, so as to improve the detection rate of early gastrointestinal cancer.Methods:The outpatients and inpatients who voluntarily accepted gastroscopy in the First Affiliated Hospital of Shandong First Medical University from May to October 2020 were enrolled. A prospective randomized controlled study was used. They were divided into the experimental group (paper towel group combined with 360° horizontal turning over) and the control group (routine) according to the random number table. Finally, a total of 948 patients were included, including 487 cases in the experimental group and 461 cases in the control group. The visual field clarity, operation time, rinse times, detection of micro lesions and detection of early cancer of the two groups were compared.Results:The scores of gastric mucosa clarity (fundus, body, antrum and whole stomach) in experimental group were (1.61 ± 0.79), (1.18 ± 0.56), (1.01 ± 0.36), (3.20 ± 0.51) points, which were significantly lower than (2.56 ± 0.82), (2.01 ± 0.65), (1.98 ± 1.10), (5.05 ± 0.89) points in control group. The difference was statistically significant ( t values were 0.02-0.07, all P<0.05). The operation time of the experimental group was (5.91 ± 0.41) min, which was significantly shorter than (6.80 ± 0.72) min of the control group, and the difference was statistically significant ( t=-7.46, P<0.05). The number of flushing in the experimental group was 67 times, accounting for 13.8%, which was significantly lower than 144 times in the control group, accounting for 31.2%, and the difference was statistically significant ( χ2=54.78, P<0.05). The number of microlesions in the experimental group was 398 cases, which was higher than 245 cases in the control group. The difference was statistically significant ( χ2=8.43, P<0.05). For biopsy pathology, the detection of precancerous lesions or early carcinomas in the experimental group (56 cases) was significantly higher than that in the control group (24 cases), and the difference was statistically significant ( χ2=6.45, P<0.05). Conclusions:The application of paper towel combined with 360° horizontal turning over method before gastroscopy can significantly improve the clarity of gastroscope field of vision, shorten the operation time, increase the detection rate of small lesions, and effectively improve the detection rate of early gastrointestinal cancer, which is a simple and practical preoperative preparation method.

Preoperative enema in patients with pelvic or acetabular fracture: a cross sectional survey / 中华创伤骨科杂志

Objective:To investigate the current situation of preoperative enema in patients with pelvic or acetabular fracture and how orthopedists think about enema as a preoperative preparation so as to provide clinical guidance.Methods:In a cross-sectional survey conducted in September 2019 in the form of Wechat Questionnaire Star, a questionnaire was sent to 1,000 orthopedists all over the country. The items surveyed included the professional title and the hospital level of the participants. The questions asked included: 1. Will enema be performed for a patient with pelvic or acetabular fracture before surgery? 2. If enema is given to a patient before surgery, what method will you choose? 3. What is your purpose of preoperative enema for patients? 4. What are your reasons for not giving a patient enema before surgery? Stratified analysis was conducted by the hospital levels of the participants.Results:A total of 704 orthopedists from all over the country completed the present survey. The questionnaires finished came from 506 (71.88%, 506/704) tertiary hospitals and 198 (28.13%, 198/704) secondary hospitals. The survey showed that 41.90% of the orthopedists (295/704) would give their patients enema before surgery, 26.99% (190/704) would not and 31.11% (219/704) would not necessarily. The main purpose of enema in the orthopedists who advocated enema was to eliminate intestinal gas so as to make intraoperative fluoroscopy more clearly (77.04%, 396/514); the main reason against this measure in those who did not support enema was that it would increase the pain of patients (76.84%, 146/190). Compared with the tertiary hospitals, a higher proportion of orthopedists in the secondary hospitals would perform preoperative enema and choose mechanical enema. Moreover, a higher proportion of orthopedists in the secondary hospitals believed that enema could reduce complications and make intraoperative fluoroscopy clearer.Conclusion:At present, a number of orthopedists in China, especially those in a tertiary hospital, do not give their patients enema before surgery of pelvic or acetabular fracture.

Possibility of blood transfusion in obstetric surgery and its effect on preoperative blood preparation / 中国输血杂志

Objective Preoperative preparation of blood is common.The preoperative blood ordering and transfusion practices for elective obstetric surgery were evaluated in our Renji hospital in order to develop a reasonable preoperative blood preparation schedule for those procedures where a cross-match appears necessary.Methods We evaluated blood ordering practices in total 16 232 elective obstetric surgeries in our hospital from January 1,2013 to June 30,2017 retrospectively.The age of patients,preoperative diagnosis,surgical procedures type,preparation volume of blood,intra-operative transfusion volume of blood,and excessive usage ratio of blood were calculated and analyzed.Results 455 patients transfused intraoperatively total 1 610 U red blood cells.The usage ratio of blood was 2.80％ for patients and 4.87％ for blood preparation volumes respectively.Placenta previa,ectopic pregnancy,twin pregnancy accounted for the first three of the possibility of intraoperative blood transfusion in obstetric surgeries.Conclusion The relationship between preoperative diagnosis and the risk of blood transfusion in obstetric surgery should be take attention to.Preoperative blood typing,antibody screening and appropriate cross-matching could ensure the safety of obstetric surgery.

The design and application of electronic preoperative preparation checklist / 中国实用护理杂志

Objective To design and formulate a electronic preoperative preparation checklist for applying in the preoperative preparation,to reduce missing rate in preoperative preparation and transfer,to improve patient satisfaction,to avoid operation delay and medical accident caused by inappropriate preparation.Methods A total of 145 patients with surgery from March 2013 to February 2013 were as experimental group,and 158 patients with surgery from March 2012 to February 2012 were as control group.The experimental group was used electronic preoperative preparation checklist for preoperative preparation and transition,and the control group was used conventional methods.The incidence of mistake for preoperative preparation and transfer and both surgeon's and patient's satisfactory were compared between two groups.Results After applying the electronic preoperative preparation checklist,the incidence of mistake for preoperative preparation and transfer in experimental group reduced significandy to 1.37％(2/145) and 4.83％ (7/145),compared with the incidence of control group 6.33％(10/158),11.39％(18/158),and the differences between two groups were statistically different (x2=4.870,4.305,P ＜ 0.05).Both surgeon's and patient's satisfactory were improved dramatically,the satisfactory in experimental group improved to 100.00％(50/50)and 97.93％(142/145),compared with the satisfactory of control group 90.00％(45/50) and 90.51％(143/158),and the differences between two groups were statistically different(x2=5.263,7.459,P ＜ 0.05).Conclusions Implementing the electronic preoperative preparation checklist can reduce the incidence of mistake before operation and ensure patient operation schedule.Therefore,it could improve nursing care quality and efficiency.

Application of preoperative evaluation checklist in the preoperative preparation of laparoscopic cholecystectomy / 重庆医学

Objective To explore the effect of preoperative evaluation checklist in the preoperative preparation of laparoscop‐ic cholecystectomy .Methods Based on whether the preoperative evaluation checklist was used or not ,664 cases of patients were di‐vided into control group (n=350) and experimental group (n=314) .Routine preparation was used in the control group ,while the preoperative evaluation checklist made by department of hepatobiliary surgery in the second affiliated hospital of Chongqing medical university was added to the experimental group .The case histories of patients in both groups were retrospectively reviewed ,so as to make comparisons of the defect of preoperative preparation ,influence to operation (delay or cancel) ,comprehension of preoperative knowledge ,and score of degree of satisfaction .Results The incidence rate of the defect of preoperative preparation in the experi‐mental group (1 .59% ) was lower than that in the control group (6 .86% ) with a statistical difference (P<0 .05) .The influence to operation (delay or cancel) in the experimental group was lower than that in the control group with a statistical difference (P<0 .05) .The comprehension of preoperative knowledge and score of degree of satisfaction in the experimental groups were obviously superior to those in the control groups ,which both had a statistical difference (P<0 .05) .Conclusion The application of preopera‐tive evaluation checklist in laparoscopic cholecystectomy could benefit for sufficient preoperative preparation ,conducting surgery as scheduled ,patients′comprehension of preoperative knowledge and patients′satisfaction of medical treatment ,which deserved widely clinical generalization .

The perioperative use of steroids including dexamethasone in hyperthyroidism / 中华内分泌外科杂志

ObjectiveTo explore the effects of steroids for hyperthyroidism management during the perioperative period. Methods198 cases were analyzed in terms of the perioperative use of steroids such as dexamethasone for hyperthyroidism. ResultsFT3 and FT4 decreased gradually to the nomal level after use of dexamethasone. 15 cases had hypokalemic limb paralysis, 2 cases had hyperthyroidism crises, 9 cases had transient numbness of mouth, lip and limb, and the rest resumed normal. ConclusionsThe use of steroids such as dexamethasone for hyperthyroidism can shorten the preoperative preparation time, improve the success rate, and reduce postoperative complications.

Preoperative preparation for thyroid nodular disease concomitant with hyperthyroxinemia / 中华内分泌外科杂志

Objective To explore the feasibility of individualized preoperative preparation for thyroid nodular disease concomitant with hyperthyroxinemia. Methods According to different clinical manifestations,traditional preoperative medical preparation, impulse preoperative medical preparation and propranolol preoperative medical preparation were respectively made on 43 cases of thyroid nodular disease concomitant with hyperthyroxinemia and without eye proptosis. Preoperative medical preparation wasn't performed on 12 eases of hyperthyroxinemia without apparent hypermetabolism and basal metabolic rate less than 20%. Hospitalization time and incidence of intraoperative and postoperative complication were observed and recorded. Results Intraoperative and postoperative thyroid crisis or serious complications didn't occur in all 43 cases of thyroid nodular disease concomitant with hyperthyroxinemia and without eye proptosis. Hospitalization time differs for patients with different preoperative preparation. Conclusion It was feasible to make individualized preoperative preparation for thyroid nodular disease concomitant with hyperthyroxinemia.

Fast track surgery preoperative preparation / 肠外与肠内营养

Recovery after surgery can be substantially facilitated by taking fast track surgery.Preoperative patient preparation is the beginning of the fast-track surgery,and it will influence the course of patient care after the operation.Preoperative patient preparation of the fast-track surgery was reviewed.

Method and effect of scar prepared for surgery / 医学研究生学报

Objective: To survey the condition of bacteria on the scar area; to improve the method and outcome of skin with scar prepared for plastic surgery. Methods: 49 patients were divided into group A and B randomly. 24 patients in group A were enrolled in control group and 25 patients in group B were designed for investigation group. Each scar was taken 3 samples to be cultured and submitted for sensitive test on admission day, before and after the skin with scar prepared. Each case was observed on the types and the condition of bacteria distribution on the scar. The outcome of cleaning and disinfection from the area was recorded. The relationship between the bacteria reproduction and types of scar was analyzed, and the observation of the postoperative temperature was made and the duration of antibiotics used and surgical site healing were recorded. Results: The positive rate of bacterial culture was reached 83.33% -88.00%. Two methods of skin prepared can diminish the bacteria reproduction. The outcomes of Group B was better than Group A. The temperature and wound healing days had no significant difference between the two groups. The days used of antibiotics in group B were significantly shorter than group A. Conclusion: The more effective method can improve the clean ingress of the skin than with usual method. 60% bacteria on the area removed was benefit to prevent wound infection and healing.

Clinical experience with preoperative preparation for pheochromocytoma (report of 286 cases) / 中华泌尿外科杂志

Objective To investigate the preoperative preparation for pheochromocytoma. Methods The data of 286 cases of pheochromocytoma, who were treated in our hospital from 1980 to 2002,were collected and reviewed on the preoperative preparation.Phenoxybenzamine was given to 207 cases and urapidil to 78 during preoperative period, lasting for 2～9 weeks with a mean of 6 weeks.The remaining 1 underwent emergent surgery without use of ?-adrenergic blockers.In 28% of the cases,?-adrenergic blocker was given for control of heart rate. Results In 254 cases,blood pressure remained stable at the level of 120/80 mm Hg (1 mm Hg=0.133 kPa) or so.No paroxysmal hypertension,palpitation and sweating occurred after use of ?-blockade.The heart rate remained 80～85 times/min.No arrhythmia occurred.Peri-microcirculation was obviously improved.The tumor size (range,3～12 cm in diameter;mean,5.2 cm) was not related to the function and length of preoperative use of the medications.Hypertensive crisis occurred in 32 cases 2 weeks before operation. In most cases (96%), blood pressure fluctuated (reaching up to 280/180 mm Hg) when they experienced anesthesia induction and tumor crush during operation.However,it was easy to control.Postoperative blood pressure remained stable. Conclusions The full preoperative preparation for patients with pheochromocytoma is essential for the safety and success of anesthesia and operation.

Application of immune-enhanced enteral nutrition in preoperative preparation for patients with colorectal carcinoma / 肠外与肠内营养

Objective:The aim of this study was to explore the applicative effects of immune-enhanced enteral nutrition(Supportan) in preoperative preparation for patients with colorectal carcinoma.Methods:56 colorectal carcinoma patients with mid-severe malnutrition were randomly divided into two groups,experiment group and control group,each of 23.Experiment group was administrated with immune-enhanced enteral nutrition(Supportan).Control group was administrated with common enteral nutrition(Nutrison Fibre).Nutritional status,immunological function,inflammatory factor and the satisfaction of colon were observed.Results:After enteral nutrition,the plasma albumin,prealbumin,IgG,IgM,CD4+ T cells and the ratio of CD4+/ CD8+ were higher in experiment group than in control group and TNF-?,IL-6 and PGE2 were lower in experiment group than in control group.Conclusions:Immune-enhanced enteral nutrition(supportan) can improve nutritional status,strengthen immunological function,and decrease inflammatory reaction in the colorectal carcinoma patients with mid-severe malnutrition.

Dexamethasone applied before operation as preoperative preparation for primary hyperthyroidism / 中国普通外科杂志

Objective To study new preoperative preparation for primary hyperthyroidism. Methods Before operation, Lugol solution was used(5～10 getts/time, 3 times/d) for 10 days. On the 7th day, dexamethasone 20?mg was added to 5%～10% glucose solution 500?ml was consecutively used for 3 days before the operation. Results FT 3 fell to normal value after dexamethasone 20?mg was used once, and FT 4 fell to normalvalue after dexamethasone used 3 days. There was no any complication, such as thyroid crisis occurring in this series. Conclusions Dexamelhasone applied before operation as the preoperative preoparation for primary hyperthyroidism is testified a safe and effective method.

Anesthetia for Pheochromocytoma Resection / 대한마취과학회지

Two patients underwent anesthesia for pheochromocytoma involving adrenal gland and extra- adrenal space. Patient 1 was not diagnosed as pheochromocytoma before surgery and thus proper preoperative evaluation and care was not possible. During surgery and anesthesia, the patient showed a marked blood pressure variation, arrythmia and tachycardia. Pulmonary edema occurred intraoperatively, but subsided with positive end expiratory pressure and the use of diuretics and morphine. Patient 2 was preoperatively diagnosed as pheochromocytoma and was thus given prazosin and nifedipine (for 11 days) preoperatively. Blood pressure and pulse rate throughout the surgery and anesthesia were stable and no intra- and postoperative complication occured. We believe that careful preoperative preparation is essential to minimize intraoperative hemo- dynamic disturbance and their sequelae.

Clinical Evaluation of Anesthetic Management for Pheochromocytoma Following Prazosin Pre-treament / 대한마취과학회지

Perioperative management of patients with pheochromocytoma is challenging. Accordingly, proper preoperative preparation is important. Prazosin, a selective alpha I blocker, may offer a potential advantage. This 54-year-old woman was treated with prazosin 2 mg, b.i.d. for 15 days and also with propranolol 20 mg, b.i.d. for a few days intermittently before the proposed surgery. Both symptoms and blood pressure were well controlled effectively. Induction of anesthesia was accomplished with nitrolingual spray, fentanyl 100 ug, 1% idocaine 50 mg, 2.5% thiopental sodium 200 mg, vecuronium 6 mg and 100% O2-enflurane. During the surgical and anesthetic procedure, the patient showed a reduced incidence of excessive blood-pressure variations and no arrhythmia was present except for supraventricular ectopic beats. Conclusively, we believe that careful preoperative preparation is recommended to minimize intraoperative hemodynamic dieturbances and their sequelae.