中药膳食及营养指导与脑卒中不同预后、并发症的相关性研究

目的依据急性期脑卒中患者不同中医证候进行营养护理及中药膳食搭配指导,观察预后及并发症的发生率。方法分别对220例急性脑卒中患者随机分组护理,对照组按一般饮食护理,治疗组采取辨证饮食方案指导。结果治疗组及对照组营养不良的发生率分别为7.27%、3.64%,并发症分别为20.91%、43.63%。结论通过及时、合理的中药膳食指导,对中风急性期患者的预后及并发症的预防具有重要的意义。

老年慢性肾衰治疗及预后的若干问题探讨

老年慢性肾衰治疗及预后的若干问题探讨陈天善华西医大附属第一医院肾脏科随着科学的进步，人类寿命的延长，如何提高老年慢性肾功能衰竭（ＣＲＦ）的防治水平，已成为当今研究的重要课题。本文对我院１９８９年至１９９３年期间住院的７５例老年ＣＲＦ患者的临床资料进行...

ICU护理风险管理对重症肺炎呼吸机辅助治疗患者预后及并发症的影响分析

探究重症肺炎使用呼吸机治疗期应用监护室(ICU)护理风险管理的效果。方法 试验受试者共54名,筛选自我院患者统一病历系统,时间2021年6月至2022年6月,在院内伦理部门见证下利用数字奇偶随机法对受试者进行均分,分为两组,每组重症肺炎病人27例,其中管理组予全程ICU护理风险管理,对照组依旧沿用传统护理管理,随访患者各项检测指标,使用问卷表调查患者生活状况,分析对病人预后的影响。结果 管理组治疗期重症肺炎病人出现并发症的几率更低,发生率比对照组低P<0.05;管理组干预后除PCO2指标,余下指标如PO2和FEV1等数值均比对照组高,P<0.05;管理组肺炎患者呼吸及治疗时间、监护和住院时间少于另一组,ICU病人急慢性生理健康状况得分更低,P<0.05;干预后管理组肺炎患者躯体疼痛、功能及职能等方面分值均上升,P<0.05。结论 重症肺炎呼吸机辅助治疗期应积极开展ICU护理风险管控,规避长期辅助呼吸引起的并发症,纠正患者缺氧症状,改善整体健康状况。

中西医结合治疗慢性重型肝炎38例回顾性分析

近年来,我们以中西医结合的方法治疗慢性重型肝炎(以下简称慢重肝)38例,总结分析如下。 1 临床资料 1.1 病例选择 38例慢重肝为我科住院病人。其中男31例,女7例;年龄最小者23岁,最大者82岁,20～50岁者29例,占76.32％。

Endoscopic mucosal resection of early gastric cancer: Experiences in Korea

Endoscopic mucosal resection （EMR） has been established as one of the treatment options for early gastric cancer （EGC）. However, there are many uncertain areas such as indications of EIR, best treatment methods, management of complications and follow-up methods after the procedure. Host studies on this topic have been carried out by researchers in Japan. In Korea, gastric cancer is the most common malignant disease, and the second leading cause of cancer death. In these days, EIR for EGC is widely performed in many centers in Korea. In this review, we will provide an overview of the bechniques and outcomes of EIR in Korea.

Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer

AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease stage.RESULTSSixty-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, P < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, P < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative complications.CONCLUSIONThe preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

AIM To evaluate the impact of glycemic control and nutritional status after total pancreatectomy(TP) on complications, tumor recurrence and overall survival.METHODS Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified.RESULTS High early postoperative fasting blood glucose(FBG) levels(OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels(OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative Hb A1 c levels over 7%(HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative Hb A1 c levels over 7% had much poorer overall survival than those with Hb A1 c levels less than 7%(9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus(HR = 15.019, 95%CI: 1.278-176.211, P= 0.031) and alcohol history(B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively.CONCLUSION At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on longterm outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

日本透析医疗的现状

自1972年日本的透析医疗被纳入医疗保险后得到了广泛普及,透析人数急剧增多。目前有25万(每500人中有1人)终末期肾衰竭患者接受持续性透析治疗。透析患者增多的主要原因包括①生活习惯的变化造成糖尿病患者增多;②透析患者生存率提高;③日本移植治疗进展缓慢。随着糖尿病治疗水平的提高,患者生存率得到改善,糖尿病肾病向慢性肾衰竭(CRF)进展的概率也相应增高。另外,生活习惯改变所引发的高血压导致了肾动脉硬化症患者不断增多。透析技术的改良和辅助医疗的进步使透析患者的生命预后得到改善,另外,每年仅有900例肾移植,肾移植进展缓慢导致了持续性透析患者人数的增多。近年来,受全球化浪潮的影响,在世界范围内开展以改善持续性透析患者生命预后为宗旨的大规模前瞻性研究(Dialysis Outcomes and Practice Patterns Study,DOPPS),这样就可以比较各国透析患者预后和并发症的相关因素。

有创动态颅内压监测在重度颅脑损伤治疗中的应用价值探究

目的探讨有创动态颅内压监测在重度颅脑损伤治疗中的应用价值。方法选择阳江市人民医院2018年1月-2020年12月收治的接受血肿清除去骨瓣减压术患者43例为研究对象,回顾性分析患者的临床资料,根据患者术后颅内压监测方式将其分为观察组(n=22,接受有创动态颅内压监测)和对照组(n=21,接受常规监测)。比较2组患者用药时间、甘露醇日用量、并发症发生率和预后效果。结果观察组用药时间显著短于对照组,甘露醇日用量显著低于对照组(P<0.05)。观察组并发症发生率为45.45%,低于对照组的100.00%,差异有统计学意义(P<0.05)。观察组患者预后良好率为72.73%,显著高于对照组的47.62%(P<0.05)。结论将有创动态颅内压监测应用于重度颅脑损伤患者术后治疗可提供准确的颅内压数值依据,并为后续针对性的治疗争取时间,降低并发症发生率,改善预后效果,具有显著的临床推广应用价值。

护理干预用于急性出血性坏死性胰腺炎的效果观察

目的观察护理干预用于急性出血性坏死性胰腺炎的效果。方法 2010年6月—2012年6月期间,我院诊治的20例急性出血性坏死性胰腺炎患者,在心理护理、一般护理、药物护理、营养支持护理以及引流管观察及其并发症观察方面进行相应的护理干预。结果 20例急性出血性坏死性胰腺炎患者经过有效的治疗和护理干预后,治愈19例,死亡1例,治愈率达到95.0%。结论根据急性出血性坏死性胰腺炎患者的具体情况,及时进行针对性的护理干预,可有效降低并发症的发生率,提高患者的预后,值得临床推广。

Prognostic factors for 5-year survival after local excision of rectal cancer

AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively analyzed.Survival analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, respectively.The rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, respectively.Univariate analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(P<0.05).Multivariate analysis showed that T stage[P=0.011,95% confidence interval(CI)=1.194-3.878]and local recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:Local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal cancer.Prevention of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

腰大池引流术VS多次腰椎穿刺在动脉瘤破裂出血术后预防并发症及疗效对比

观察腰大池引流术和多次腰椎穿刺术在动脉瘤破裂出血术后预防并发症及治疗效果比较。方法:选择我院2020年——2022年我院颅内动脉瘤破裂致使蛛网膜下腔出血的86例动脉瘤栓塞患者,根据栓塞术后释放血性脑脊液的方式不同,使其分为观察组43例、对照组43例,观察组患者选择腰大池引流术释放脑脊液,对照组患者选择多次腰椎穿刺术释放脑脊液。观察两组不同手术方式释放血性脑脊液患者的并发症(脑积水、脑梗死、癫痫发作、脑血管痉挛)发生率,对比两组治疗效果(术后意识清醒时间、头痛减轻时间、颅内出血清除时间、脑脊液红细胞数目),观察两不同术式预后。结果:观察组脑积水、脑梗死、癫痫、血管痉挛发生率小于对照组(P<0.05),观察组意识清醒时间、头痛减轻时间、颅内出血清除时间均小于对照组。术后第1天两组脑脊液红细胞数目无明显变化,术后第3--7天脑脊液中红细胞数目较前显著降低,第10脑脊液中的红细胞数目恢复到正常范围,但对比两组血性脑脊液中红细胞变化程度,观察组1周内脑脊液中红细胞数目降低速度优于对照组(P<0.05)。结论:腰大池引流术可预防动脉瘤破裂出血并发症发生率,同时还缓解患者头痛,促进患者意识状态恢复,其临床疗效显著。

论癫痫持续状态的抢救与治疗

论癫痫持续状态的抢救与治疗王传立（河南省台前县人民医院台前县４５７６００）癫痫是门诊工作中的常见病，而癫痫持续状态则是临床上常见的急、危重病症，且发病率高，如不及时而正确的抢救，可导致死亡或永久性的大脑损害。我院自１９８６年５月～１９９６年５月共收治...

切开复位治疗跟骨骨折伴跟骰关节脱位的临床疗效及并发症的预测

目的:探究切开复位治疗跟骨骨折合并跟骰关节脱位的临床疗效及预后并发症预测模型的构建。方法:选取2014年6月至2023年6月收治的跟骨骨折合并跟骰关节脱位患者96例为研究对象,患者均采取切开复位治疗,分析其临床疗效,随访1年观察预后并发症发生情况。根据随访1年并发症情况分为并发症组(26例)和无并发症组(70例),通过单因素方差分析两组一般资料,并将有统计学差异的指标纳入二元Logistic回归模型,分析预后并发症发生相关影响因素。结果:96例患者均顺利完成手术,术后1年患者Gissane角低于术前,而跟骨结节关节角高于术前,差异有统计学意义(P<0.05)。96例患者中切口感染8例(8.3%),关节疼痛2例(2.1%),骨折移位1例(1.0%),深静脉血栓5例(5.2%),皮缘坏死7例(7.3%),距下关节炎1例(1.0%),软组织损伤2例(2.1%),预后并发症共发生26例(27.1%)。二元Logistic回归分析显示,吸烟、糖尿病、受伤至就诊时间(≥5 d)是预后并发症发生的危险因素,差异有统计学意义(P<0.05)。纳入上述因素建立研究模型的整体预测准确率为76.0%,通过Hosmer-Lemeshow拟合度检验显示模型拟合值和观测值的吻合程度一致(χ2=1.224,P=0.943)。利用Bootstrap法对模型进行验证曲线下面积(AUC)为0.787,95%CI为0.687~0.886,提示模型数据预测预后并发症发生准确性较好。结论:吸烟、糖尿病、受伤至就诊时间(≥5 d)是预后并发症发生的危险因素,基于上述相关因素建立风险预测模型具有较好预测价值。

胃癌术后早期腹腔内化疗的临床观察

目的 探讨胃癌术后早期腹腔内化疗（ＥＰＩＣ）与术后并发症的关系以及对预后的影响。方法 对８５例胃癌患者于根治术后行ＥＰＩＣ后的情况进行总结分析。结果 ＥＰＩＣ组术后５年生存率显著高于单纯手术组（Ｐ＜０．０５）；ＥＰＩＣ组术后各血液学指标与单纯手术组比较差异无显著性（Ｐ均＞０．０５）；ＥＰＩＣ组术后并发症发生率为１１. ８％（１０／８５），单纯手术组为９．０％（８／８９），两者差异无显著性（Ｐ＞００５）；ＥＰＩＣ组术后肛门排气和开始进食时间明显长于单纯手术组（Ｐ＜０．０５）。８５例ＥＰＩＣ患者中的腹腔普通化疗组（５３例）和温热化疗组（３２例）间术后生存率、并发症发生率差异均无显著性（Ｐ均＞０.０５）；温热化疗组与普通化疗组比较，术后白细胞明显下降、肛门排气和开始进食时间延长（Ｐ＜０ ０５）。结论ＥＰＩＣ能提高胃癌患者术后生存率，不增加术后并发症的发生率。

内脏脂肪面积及体质量指数对结直肠癌根治术患者疗效的影响及其预测价值分析

目的:探讨内脏脂肪面积及体质量指数(BMI)对结直肠癌根治术患者疗效的影响,并分析其对术后并发症、预后的预测价值。方法:前瞻性选取我院2017年5月~2019年12月收治的结直肠癌根治术患者126例,所有患者术前均进行体格检查,记录内脏脂肪面积(VFA)与BMI。根据VFA将其分成高脂肪组(VFA≥100cm^(2),n=43)、低脂肪组(VFA<100cm^(2),n=83),根据BMI分成未超重组(BMI<24kg/m^(2),n=78)、超重组(BMI≥24kg/m^(2),n=48),比较不同VFA、BMI患者的围手术期疗效指标及并发症发生率。术后随访1年,比较不同VFA、BMI患者的预后情况,绘制受试者工作特征(ROC)曲线分析VFA、BMI预测并发症、预后的曲线下面积(AUC)。结果:高脂肪组手术时间、术后排气时间较低脂肪组延长,术中出血量高于低脂肪组,淋巴结清扫数目低于低脂肪组(P<0.05)。超重组手术时间、术后排气时间较未超重组延长,术中出血量高于未超重组(P<0.05)。高脂肪组总并发症发生率和预后不良率高于低脂肪组(P<0.05)。超重组的总并发症发生率为18.75%,高于未超重组的6.41%(P<0.05),但是两组预后比较无差异(P>0.05)。ROC曲线提示,VFA、BMI预测术后并发症的AUC分别为0.784(P=0.001,95%CI:0.683-0.885)、0.740(P=0.004,95%CI:0.608-0.872)。VFA、BMI预测预后的AUC分别为0.776(P=0.002,95%CI:0.667-0.885)、0.667(P=0.058,95%CI:0.517-0.817)。结论:VFA、BMI过高均会影响结直肠癌根治术患者的疗效,并增加并发症发生率,其中VFA过高还会增加预后不良风险,VFA预测术后并发症及预后的效果优于BMI。

脑外伤早期颅骨修补临床治疗分析

分析脑外伤患者采用早期颅骨修补术治疗的临床疗效。方法:选择我院2017年10月—2020年10月收治的去骨瓣减压术后脑颅骨缺损患者96例,根据颅骨修补术与骨瓣减压术间隔时间分为早期组和常规组,各48例。早期组于脑外伤后4~6周实施颅骨修补术,常规组于脑外伤后3~6个月实施颅骨修补术。对比两组脑灌注水平[脑血流量(rCBF)和达峰值时间(TTP)]、生活质量[卡氏功能状态(KPS)]、预后情况[格拉斯哥预后评分(GOS)]及并发症发生情况。结果:早期组术后10d的rCBF及随访1年的KPS、GOS评分均高于常规组,术后10d的TTP短于常规组,且随访1年的并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论:脑外伤患者早期行颅骨修补术可增加脑血流量,加快血流速度,降低并发症发生率,对提高生活质量、改善预后具有积极的意义,值得推广应用。