不同频次唤醒护理对全身麻醉胸科腔镜手术后患者苏醒效果的影响

目的探讨不同频次的唤醒护理对全身麻醉胸科腔镜手术后带气管导管转入麻醉后监测治疗室(PACU)患者苏醒效果的影响。方法采用便利抽样法,选取全身麻醉胸科腔镜手术后带气管导管转入气管导管观察的116例患者为研究对象,探讨不同频次(试验组A每5分钟、试验组B每10分钟、对照组等待患者自然苏醒)的唤醒护理对气管导管拔管时间、拔管后苏醒时间、总苏醒时间、拔管时呛咳反应、苏醒期躁动、拔管成功率、拔管后低氧血症和平均动脉压波动发生率的影响。结果气管导管拔管时间三组比较差异有统计学意义,试验组A和试验组B显著短于对照组(均P<0.05);试验组A与试验组B差异无统计学意义(P>0.05)。拔管后苏醒时间三组比较差异有统计学意义,试验组A显著长于对照组(P<0.05)。总苏醒时间三组比较差异无统计学意义(P>0.05)。三组气管导管拔管成功率和拔管后低氧血症发生率比较,差异无统计学意义(均P>0.05)。与对照组相比,试验组A和试验组B拔管时呛咳反应、苏醒期躁动程度和拔管后平均动脉压波动发生率明显降低(均P<0.05)。结论5 min和10 min频次的唤醒护理均能有效减少全身麻醉胸科腔镜手术后患者在气管导管机械通气时间,降低拔管时呛咳反应和苏醒期躁动严重度,有利于维持拔管时血流动力学稳定,提高苏醒质量。

不同频次唤醒护理对全身麻醉胸科腔镜手术后患者苏醒效果的影响

分析不同频次唤醒护理对全身麻醉胸科腔镜手术后患者苏醒效果应用效果。方法 收集我院2022.2-2023.2间行全身麻醉胸科腔镜手术后带气管导管转入PACU观察的患者资料作为对照组(在常规护理基础上实行患者自然苏醒),及2023.2-2024.3间收治的50例全身麻醉胸科腔镜手术后转入PACU观察的患者资料作为观察组(在常规护理基础上实行5min/次唤醒护理),记录并研究两组的护理结果。结果 观察组的拔管和苏醒时间均短于对照组;观察组的心率和血压指标比观察组更低、更趋近正常范围;观察组术后1h的认知功能比对照组更高,同时MAP波动程度较小;观察组的并发症发生情况比对照组更低,以上几组数据的差异较大,(P<0.05),含可比性。说明比起患者自然苏醒,5min/次的唤醒护理可以明显改善苏醒质量,降低并发症发生率。结论 比起患者自然苏醒,5min/次的唤醒护理对全身麻醉胸科腔镜手术后患者苏醒效果影响更佳,可以提升苏醒质量,值得推广。

保温护理措施对泌尿外科腔镜手术患者的效果观察

目的探讨保温护理措施在泌尿外科腔镜手术中的应用效果。方法选取我院2015年1月~2016年1月行泌尿外科腔镜手术治疗的患者92例,按随机数字表法分为对照组和观察组,各46例。对照组行常规护理干预。观察组行保温护理干预。比较两组术中低温、寒战发生情况,同时观察两组手术过程体温变化及术后并发症发生率。结果观察组术中低温、寒战发生率均低于对照组(P<0.05);观察组术中、术后体温均高于对照组(P<0.05);观察组术后并发症总发生率低于对照组(P<0.05)。结论对泌尿外科腔镜手术患者开展保温护理干预,可降低术中低温、寒战发生率。

羟考酮于妇科腔镜手术术后镇痛的效果观察

目的:研究妇科腔镜手术后患者给予羟考酮进行镇痛的临床疗效。方法:将我院2016年12月至2017年2月收治的60例进行妇科腔镜手术患者,按照入院顺序分为两组,其中30例给予羟考酮进行镇痛作为研究组,另30例患者给予舒芬太尼作为对照组,比较两组患者的临床疗效。结果:给予两组患者术后不同时间段进行视觉模拟评分法(VAS)评分,看出研究组术后6小时VAS评分(1.8±0.5)分明显比对照组(2.7±0.8)分低,且术后12小时、24小时以及48小时VAS评分均低于对照组,差别有统计学意义(P<0.05)。结论:妇科腔镜手术后给予患者羟考酮进行镇痛,可快速控制患者疼痛感,且效果明显,具有临床应用的价值。

集束化心理护理对胸科腔镜手术病人术前心理应激干预效果

探究接受胸科腔镜手术治疗的患者术前应用集束化心理护理模式对其心理应激产生的影响。方法:观察对象为随机抽取的100例接受胸科腔镜手术治疗的患者,将100例患者分为研究组和对比组,分别采取集束化心理护理模式和常规护理模式。评价标准包括并发症、护理满意度、应激反应指标和心理状态以及疼痛评分。结果:在并发症发生率方面,研究组和对比组比较存在较大的差异,研究组低于对比组;在护理满意度方面,研究组和对比组比较存在较大的差异,研究组高于对比组;在应激反应指标改善方面,研究组和对比组比较存在显著差异,研究组好于对比组;在心理状态和疼痛程度改善方面,研究组和对比组比较存在显著差异,研究组好于对比组,(P<0.05)。结论:对接受胸科腔镜手术治疗的患者在术前应用集束化心理护理模式有利于减轻患者的心理负担,而且还能够减少并发症的发生率,有助于营造良好的护患关系氛围,缓解患者的疼痛感,因此,集束化心理护理术前应激心理应激干预效果较为理想。

舒芬太尼复合罗哌卡因在超声引导下胸椎旁神经阻滞麻醉中的镇痛效果

目的 观察舒芬太尼复合罗哌卡因超声引导胸椎旁神经阻滞麻醉的镇痛效果。方法 回顾性分析74例胸腔镜手术患者的临床资料,依照镇痛方式分为对照组和观察组,每组37例。对照组实施全身麻醉镇痛方案,观察组实施舒芬太尼复合罗哌卡因超声引导胸椎旁神经阻滞麻醉方案。比较2组手术基本情况(手术时间、术中出血量和术中补液量),观察麻醉前、切片前、切皮后10 min和术毕时2组平均动脉压及心率变化情况,比较2组术后镇痛效果以及术后恢复情况(术后苏醒时间、下床活动时间和住院时间),统计2组麻醉不良反应的发生情况。结果 2组手术时间、术中出血量和术中补液量比较差异均无统计学意义(P>0.05)。2组切片前、切皮后10 min及术毕时平均动脉压和心率变化比较差异均无统计学意义(P>0.05)。术后2、4、8 h观察组的视觉模拟评分(visual analogue score,VAS)均低于对照组(P<0.05)。观察组术后苏醒时间、下床活动时间和住院时间均短于对照组(P<0.05)。观察组的麻醉不良反应发生率低于对照组(P<0.05)。结论 对胸腔镜手术患者实施舒芬太尼复合罗哌卡因超声引导胸椎旁神经阻滞麻醉具有较好的术后镇痛效果,能加快患者术后恢复,且麻醉不良反应发生率也较低。

COMPLICATIONS IN LAPAROSCOPIC GYNECOLOGIC SURGERY

Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies. Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department. The procedures included 1421 surgeries of ovary and tube, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy (176%). Results. Complications occured in 34 cases, the overall complication rate was 192%. Unintended laparotomies occured in 6 cases(034%). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 353% of all complications of this series. Five intraoperative complications (147%) occured during the laparoscopic surgery (3 severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was required in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities. Conlusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.

Ultrasound-guided Transversus Abdominis Plane Block Improves Postoperative Analgesia and Early Recovery in Patients Undergoing Retroperitoneoscopic Urologic Surgeries:A Randomized Controlled Double-blinded Trial

Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.

Application of Laparoscopy in Gynecological Surgery

Laparoscopic surgery is a recent minimally invasive technological innovation that conforms to the idea of endoscopic surgery. With the rapid development of science and technology, gynecological surgery has been widely used laparoscopic technology, greatly improved the gynecological problems. The survey found that China＇s laparoscopic technology and foreign laparoscopic technology were the same leveL Laparoscopic technology has become more and more mature in recent years, laparoscopic technology in the field of gynecology has been applied year after year, after many clinical trials, gets some experience and progress. This article explores the development of laparoscopic surgery in the field of gynecology and the limitations and solutions to discuss, promoting gynecological development, so that the majority of patients benefit from it.

Venous hemodynamic changes of lower extremity during gynecological laparoscopy

Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameter and blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volume was calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the femoral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down position could increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30 minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after the establishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0. 05). Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflation of the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may predispose deep venous thrombosis after laparoscopy.

Centers of excellence in minimally invasive gynecology: Raising the bar for quality in women's health

The ＂Center of Excellence＂ concept has been employed in healthcare for several decades. This concept has been adopted in several disciplines; such as bariatric surgery, orthopedic surgery, diabetes and stroke. The most successful model in surgery thus far has been the bariatric program, with a very extensive network and a large prospective database. Recently, the American As-sociation of Gynecologic Laparoscopists has introduced this concept in gynecologic surgery. The ＂Center Of Excellence in Minimally Invasive Gynecology＂ （COEMIG） designation program has been introduced with the goals of increasing safety and efficiency, cutting cost and increasing patient awareness and access to mini-mally invasive surgical options for women. The program may harbor challenges as well, such as human and fnancial resources, and diffculties with implementation and maintenance of such designation. This commen-tary describes the COEMIG designation process, along with its potential benefits and possible challenges. Though no studies have been published to date on the value of this concept in the feld of gynecologic surgery, we envision this commentary to provoke such studies to examine the relative value of this new program.

The Use of 3D laparoscopy in Surgical Operation

Purpose： studying and analyzing the application effect of three dimensional （3D） laparoscopy m surgical operation. Method： We select 126 patients who were diagnosed celiac disease in our hospital between May 2015 and April 2016 as our research subjects. All of these patients have indications for laparoscopic surgery, and we divide them into two groups randomly （observation and control group）. While the observation group is treated by 3D laparoscopic operation system, and the control group is treated by 2D laparoscopic system. During the treatment ,we observe the operation time, intra-operative bleeding and hospitalization time between the two different methods. Result： During the operation, the operation time of observation is （135.5±23.84） minutes and intra-operative bleeding time is （130.2±20. 11） milliliters, which both them are significantly lower than control group （163.8±25.22）min, （146.3±27.42）ml. This difference is statistically significant （P 〈0.05）. On the other hand, there is no obvious difference between observation and conlrol about indwelling catheter time, postoperative hospitalization time and postoperative exhaust time. For the observation, the datum were （2.3±0.31） d, （8.1±1. 32） d, （3.2±0.58） d and they were no statistical significance. Conclusion： Compared with traditional laparoscopic surgery, the image of 3D laparoscopic surgery is more clear and stereoscopic. What＇s more, operators can have a good command of it easily to shorten operation time, which avoid surgery vascular damage and reduce bleeding amounts to some extent. It is a good assistant for clinical use.

Application of Laparoscopy in Gastrointestinal Surgery

As a result of minimally invasive surgery in a comprehensive clinical application, Laparoscopic technology gets by the majority of patients favor in the actual operation. In the gastrointestinal surgery and hepatobiliary effect is significant, and the technology is constantly mature development. The authors combined with domestic and foreign related literature reports, as well as personal experience, the application oflaparoscopic techniques in gastrointestinal surgery to explore.

About Laparoscopic Surgery Teaching Methods Discussed in this Paper

Surgery as one of the backbone of the clinical medical disciplines, it is a practical subject and the surgery teaching is an important component part of the surgery, is also a medical student to study the surgical aseptic technique and basic knowledge of the surgery and surgical basic skills, the students learned an important part of the theory is applied to clinical practice. Laparoscopy is a new technology, how to apply this new medical technology in surgery, to help students in the limited class hours quickly mastering their own knowledge, this is at present our country facing the most important subject in medical teaching. In view of the present of laparoscopic surgery in school teaching method were discussed and analyzed, and on how to have a purpose, systematic training students to master this skill, and to lay a good foundation of surgical basic skills of students, set up a bridge from slowly towards the classroom teaching of clinical practice.

为什么要做肿瘤病理检查?

肿瘤是很常见的疾病,重者危及生命,早发现、早诊断、早治疗是获得较好疗效及提高患者生存率的基本原则。肿瘤的确诊是个复杂的多步骤过程,涉及诸多临床科室的通力协作。包括临床医生触诊、检验科抽血化验肿瘤标志物、腔镜科及影像科定位肿瘤并取材送检病理,由病理医生在显微镜下观察明辨病变本质、发出病理报告。病理学诊断的级别最高,尤其对于鉴别肿瘤良、恶性具有指导意义。

Application of ultrasonic scalpel in gynecologic operative laparoscopy

Objective To investigate the applied value of the ultrasonic scalpel in gynecologic operative laparoscopy. Methods Gynecologic operations were performed using the ultrasonic scalpel under laparoscopy. Operative bleeding and time, perioperative body temperature and hemogram, and tissue damage were observed.Results Forty-two cases of benign gynecologic diseases were treated with the ultrasonic scalpel under laparoscopy. Among them, there were 4 hysterectomies, 9 ovarian cystectomies, 18 salpingotomies, 4 ectopic pregnancies, 3 myomectomies, 3 adhesiolysis and 1 adnexectomy. The amount of operative bleeding, operating time and the tissue injury were related to the type of operation. The minimual operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 24.77±4.71ml, 23.39±3.01 min, 0.22±0.10mm, 0.98±0.21 and 0.38±0.26, respectively. The maximal operative bleeding amount, operating time, depth of tissue necrosis, tissue injury score and fibrin deposition score were 166.7±47.18ml, 127.2±16.99 min, 0.35±0.20mm, 1.25±0.20 and 0.81±0.29, respectively. The levels of body temperature, white blood cells and hemoglobin before and after the operations were not statistically different (P>0.05) except for hysterectomy (P<0.05). Conclusion The ultrasonic scalpel can be safely applied for gynecologic operative laparoscopy and should be used widely.

Incidence of deep venous thrombosis after gynaecological laparoscopy

Objective To evaluate the incidence of deep venous thrombosis (DVT) after gynaecological laparoscopy.Methods The incidence of DVT was studied in 72 consecutive patients who underwent gynaecological laparoscopy in the Liverpool Health Service between May and September 1997. B-mode ultrasound supplemented by Doppler was used to examine venous patency and intraluminal echoes to diagnose DVT. Sixty-one patients who had pneumoperitoneum less than 60 minutes were classified a minor procedure and 11 who had pneumoperitoneum more than 60 minutes were classified as major procedure. Two Doppler ultrasound scans were planned for every patient. The first one was done within 24 hours and the second was performed on day 7 post-surgery. All 72 patients had the first scan and 40 out of 61 in the minor procedure group and 9 out of 11 in the major procedure had the second scan. Twenty-three patients who did not come for the second scan were followed up by phone.Results No DVT was found in our study.Conclusion This study confirms an impression that gynaecological laparoscopic procedure has a very low incidence of DVT. If it occurs, the diagnosis and treatment must be made as soon as possible so that the fatal complications such as pulmonary embolus can be avoided.

Gasless laparoscopy for benign gynecological diseases using an abdominal wall-lifting system

Objectives: The use of gasless laparoscopy with an abdominal wall-lifting device for benign gynecological diseases was compared to conventional laparoscopy with CO2 pneumoperitoneum. Methods: From February 2007 to July 2007,76 women with uterine and/or adnexal benign diseases and candidates for laparoscopic surgery were recruited in this study. Thirty-two women underwent gasless laparoscopic surgery and 44 women underwent pneumoperitoneum laparoscopic surgery. Results: Diverse pathologies,including adnexal cyst,uterine myoma and ectopic pregnancy,were treated successfully with gasless laparoscopic surgery. Compared with the patients in the pneumoperitoneum group,the similar hospital stay (P=0.353) and intraoperative blood loss (P=0.157) were observed. However,the mean operative time in the gasless group was significantly longer than that in the pneumoperitoneum group (P=0.003). No severe intraoperative or postoperative complications were found in either group,except for one case of laparotomic conversion in the pneumoperitoneum group due to dense pelvic adhesions. The total hospital charges were significantly less in the gasless group than in the pneumoperitoneum group (P=0.001). In 38 cases of ovarian cyst resection,the mean operative time in the gasless group remained longer than that in the pneumoperitoneum group (P=0.017). The total hospital charges were also significantly less in the gasless group than in the pneumoperitoneum group (P<0.001). Conclusion: Our preliminary results demonstrated that the laparoscopic procedure using the gasless technique was a safe,effective method to treat benign gynecological diseases. Moreover,it was easy to master. As a minimally invasive treatment,gasless laparoscopic surgery provides a good choice to patients in the undeveloped regions in China without increasing the patients’ and the government’s burden significantly.

The impact of surgeon choices on costs associated with uncomplicated minimally invasive colectomy:you are not as important as you think

Background:There is increasing public discussion about the escalating cost of healthcare in America.There are no published data regarding the contribution of individual surgeons’choices on the cost of uncomplicated minimally invasive colectomy.Methods:A review of a hospital cost-accounting database of the direct costs related to the index operation and postoperative care of all patients who underwent elective minimally invasive segmental colectomy over a 1-year period was performed.Results:A total of 111 cases were enrolled in this study,18 of which were performed robotically.The average direct cost after minimally invasive colectomy was$5536.The cost of robotic colectomy was 53%greater than laparoscopic($7806 vs$5096,p<0.001).There was no statistically significant difference in overall costs among laparoscopic cases performed by three surgeons($5099 vs$5108 vs$5055,p¼0.987).Average operating room supply costs among the three surgeons were$1236,$1105 and$1030,respectively(p¼0.067),with a standard deviation of$328(6.4%of overall cost).Conclusions:No significant difference in overall costs between surgeons was demonstrated despite varied training,experience levels and operative techniques.Total costs are relatively institutionally fixed and minimally influenced by variations in individual surgeon preferences.