Objective:In order to explore the application effect of blood glucose management mode of multiteam cooperation in perioperative period of general surgery patients.Methods:The perioperative blood glucose control of 94 ...Objective:In order to explore the application effect of blood glucose management mode of multiteam cooperation in perioperative period of general surgery patients.Methods:The perioperative blood glucose control of 94 patients undergoing surgical treatment in general surgery from January 2016 to March 2019 was reviewed by Non-synchronous.According to the perioperative blood glucose management model of multi-team cooperation,the patients were divided into intervention group and control group.From January 2016 to January 2018,64 patients who did not implemented the multi-team blood glucose management model were the control group and from February 2018 to March 2019,30 patients who implemented the multi-team blood glucose management model were the intervention group,compared with two group about the differences in perioperative blood glucose.Results:It is no statistically significant about two group in highest and lowest blood sugar levels under fasting stats;during the fluid diet the blood sugar level of the intervention group was lower than control group(P<0.05),and when the patients was in the semifluid or food-feeding period,the highest and lowest blood sugar level is that the intervention group was lower than control group(P<0.05).The time of the blood sugar reaching the standard,the coincidence of complications rate and average hospitalization days in the intervention group were particularly lower than control group(P<0.05).Conclusion:If we adopt multiteam blood glucose management model can better control the perioperative blood glucose of patients undergoing general sugar.展开更多
Anemia,usually due to iron deficiency,is highly prevalent among patients with colorectal cancer.Inflammatory cytokines lead to iron restricted erythropoiesis further decreasing iron availability and impairing iron uti...Anemia,usually due to iron deficiency,is highly prevalent among patients with colorectal cancer.Inflammatory cytokines lead to iron restricted erythropoiesis further decreasing iron availability and impairing iron utilization.Preoperative anemia predicts for decreased survival.Allogeneic blood transfusion is widely used to correct anemia and is associated with poorer surgical outcomes,increased post-operative nosocomial infections,longer hospital stays,increased rates of cancer recurrence and perioperative venous thromboembolism.Infections are more likely to occur in those with low preoperative serum ferritin level compared to those with normal levels.A multidisciplinary,multimodal,individualized strategy,collectively termed Patient Blood Management,minimizes or eliminates allogeneic blood transfusion.This includes restrictive transfusion policy,thromboprophylaxis and anemia management to improve outcomes.Normalization of preoperative hemoglobin levels is a World Health Organization recommendation.Iron repletion should be routinely ordered when indicated.Oral iron is poorly tolerated with low adherence based on published evidence.Intravenous iron is safe and effective but is frequently avoided due to misinformation and misinterpretation concerning the incidence and clinical nature of minor infusion reactions.Serious adverse events with intravenous iron are extremely rare.Newer formulations allow complete replacement dosing in 15-60 min markedly facilitating care.Erythropoiesis stimulating agents may improve response rates.A multidisciplinary,multimodal,individualized strategy,collectively termed Patient Blood Management used to minimize or eliminate allogeneic blood transfusion is indicated to improve outcomes.展开更多
There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take plac...There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently. Allogenic blood products have been shown to increase morbidity and mortality. Primary haemostasis, coagulation and fibrinolysis are altered by liver disease. This, combined with intraoperative disturbances of coagulation, increases the risk of bleeding. Meanwhile, the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis. The application of the principles of patient blood management to transplantation can reduce the risk of transfusion. This includes: preoperative recognition and treatment of anaemia, reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers. The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management. Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis, and rarely, the use of recombinant factor VIIa. Factor concentrates are increasingly used; fibrinogen concentrates to improve clot strength and stability, and prothrombin complex concentrates to improve thrombin generation. Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure. The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion. Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation.展开更多
Cardiologic assessment was conducted on a 78-year-old male patient scheduled for elective aortic valve surgery who complained of angina and dyspnea that had arisen over the previous few months. Evaluation showed stabl...Cardiologic assessment was conducted on a 78-year-old male patient scheduled for elective aortic valve surgery who complained of angina and dyspnea that had arisen over the previous few months. Evaluation showed stable coronary artery disease and iron deficiency anemia (hemoglobin, 7.7 g/dL). Colonoscopy revealed a non-stenosing carcinoma of the right colonic flexure that was causing chronic blood loss. The interdisciplinary tumor board of the hospital decided that his need for an extended right hemicolectomy followed by resection of two pulmonary nodules that were suspicious of metastatic lesions had priority over his cardiac surgery. Prior to abdominal surgery, the patient received 4 × 500 mg intravenous iron (Ferric-Carboxymaltose) over 2 weeks, for correction of iron deficiency and optimization of hemoglobin concentration. This treatment led to rapid improvement of his angina and exertion-induced dyspnea. His hemoglobin concentration continued to rise even after completion of the iron supplementation, and reached normal levels before thoracoscopic removal of the lung nodules, which took place 1 month after resection of the colon tumor. The patient remained in good clinical condition without any need for blood transfusions. As follow-up visits showed persistent abatement of angina and dyspnea, aortic valve surgery and other cardiac interventions were no longer deemed necessary.展开更多
目的探讨基于护患互动达标理论的护理措施在妊娠期糖尿病(gestational diabetes mellitus,GDM)患者中的应用效果。方法选取2023年4月—2024年3月曹县人民医院收治的94例GDM患者为研究对象,按照不同护理方法分为两组,各47例。对照组采取...目的探讨基于护患互动达标理论的护理措施在妊娠期糖尿病(gestational diabetes mellitus,GDM)患者中的应用效果。方法选取2023年4月—2024年3月曹县人民医院收治的94例GDM患者为研究对象,按照不同护理方法分为两组,各47例。对照组采取常规护理,研究组采取基于护患互动达标理论的护理措施。比较两组血糖水平、糖尿病自我管理行为量表(Summary of Diabetes Self-care Activities,SDSCA)与糖尿病生活质量特异性表(Diabetes Specific Quality of Life,DSQL)评分。结果护理前,两组餐后2 h血糖与空腹血糖、SDSCA、DSQL评分比较,差异无统计学意义(P均>0.05)。护理后,研究组餐后2 h与空腹血糖均低于对照组,差异有统计学意义(P均<0.05)。护理后,研究组SDSCA、DSQL评分均低于对照组,差异有统计学意义(P均<0.05)。结论基于护患互动达标理论的护理措施能够有效提高GDM患者的自我管理行为能力,保障血糖的控制效果与生活质量。展开更多
基金Establishment of nursing scientific research of Guangdong nursing in 2018(Construction and Application of Core Competence of Insulin Pumpers:No.gdhlxueh 2019zx336)。
文摘Objective:In order to explore the application effect of blood glucose management mode of multiteam cooperation in perioperative period of general surgery patients.Methods:The perioperative blood glucose control of 94 patients undergoing surgical treatment in general surgery from January 2016 to March 2019 was reviewed by Non-synchronous.According to the perioperative blood glucose management model of multi-team cooperation,the patients were divided into intervention group and control group.From January 2016 to January 2018,64 patients who did not implemented the multi-team blood glucose management model were the control group and from February 2018 to March 2019,30 patients who implemented the multi-team blood glucose management model were the intervention group,compared with two group about the differences in perioperative blood glucose.Results:It is no statistically significant about two group in highest and lowest blood sugar levels under fasting stats;during the fluid diet the blood sugar level of the intervention group was lower than control group(P<0.05),and when the patients was in the semifluid or food-feeding period,the highest and lowest blood sugar level is that the intervention group was lower than control group(P<0.05).The time of the blood sugar reaching the standard,the coincidence of complications rate and average hospitalization days in the intervention group were particularly lower than control group(P<0.05).Conclusion:If we adopt multiteam blood glucose management model can better control the perioperative blood glucose of patients undergoing general sugar.
文摘Anemia,usually due to iron deficiency,is highly prevalent among patients with colorectal cancer.Inflammatory cytokines lead to iron restricted erythropoiesis further decreasing iron availability and impairing iron utilization.Preoperative anemia predicts for decreased survival.Allogeneic blood transfusion is widely used to correct anemia and is associated with poorer surgical outcomes,increased post-operative nosocomial infections,longer hospital stays,increased rates of cancer recurrence and perioperative venous thromboembolism.Infections are more likely to occur in those with low preoperative serum ferritin level compared to those with normal levels.A multidisciplinary,multimodal,individualized strategy,collectively termed Patient Blood Management,minimizes or eliminates allogeneic blood transfusion.This includes restrictive transfusion policy,thromboprophylaxis and anemia management to improve outcomes.Normalization of preoperative hemoglobin levels is a World Health Organization recommendation.Iron repletion should be routinely ordered when indicated.Oral iron is poorly tolerated with low adherence based on published evidence.Intravenous iron is safe and effective but is frequently avoided due to misinformation and misinterpretation concerning the incidence and clinical nature of minor infusion reactions.Serious adverse events with intravenous iron are extremely rare.Newer formulations allow complete replacement dosing in 15-60 min markedly facilitating care.Erythropoiesis stimulating agents may improve response rates.A multidisciplinary,multimodal,individualized strategy,collectively termed Patient Blood Management used to minimize or eliminate allogeneic blood transfusion is indicated to improve outcomes.
文摘There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently. Allogenic blood products have been shown to increase morbidity and mortality. Primary haemostasis, coagulation and fibrinolysis are altered by liver disease. This, combined with intraoperative disturbances of coagulation, increases the risk of bleeding. Meanwhile, the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis. The application of the principles of patient blood management to transplantation can reduce the risk of transfusion. This includes: preoperative recognition and treatment of anaemia, reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers. The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management. Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis, and rarely, the use of recombinant factor VIIa. Factor concentrates are increasingly used; fibrinogen concentrates to improve clot strength and stability, and prothrombin complex concentrates to improve thrombin generation. Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure. The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion. Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation.
文摘Cardiologic assessment was conducted on a 78-year-old male patient scheduled for elective aortic valve surgery who complained of angina and dyspnea that had arisen over the previous few months. Evaluation showed stable coronary artery disease and iron deficiency anemia (hemoglobin, 7.7 g/dL). Colonoscopy revealed a non-stenosing carcinoma of the right colonic flexure that was causing chronic blood loss. The interdisciplinary tumor board of the hospital decided that his need for an extended right hemicolectomy followed by resection of two pulmonary nodules that were suspicious of metastatic lesions had priority over his cardiac surgery. Prior to abdominal surgery, the patient received 4 × 500 mg intravenous iron (Ferric-Carboxymaltose) over 2 weeks, for correction of iron deficiency and optimization of hemoglobin concentration. This treatment led to rapid improvement of his angina and exertion-induced dyspnea. His hemoglobin concentration continued to rise even after completion of the iron supplementation, and reached normal levels before thoracoscopic removal of the lung nodules, which took place 1 month after resection of the colon tumor. The patient remained in good clinical condition without any need for blood transfusions. As follow-up visits showed persistent abatement of angina and dyspnea, aortic valve surgery and other cardiac interventions were no longer deemed necessary.
文摘目的探讨基于护患互动达标理论的护理措施在妊娠期糖尿病(gestational diabetes mellitus,GDM)患者中的应用效果。方法选取2023年4月—2024年3月曹县人民医院收治的94例GDM患者为研究对象,按照不同护理方法分为两组,各47例。对照组采取常规护理,研究组采取基于护患互动达标理论的护理措施。比较两组血糖水平、糖尿病自我管理行为量表(Summary of Diabetes Self-care Activities,SDSCA)与糖尿病生活质量特异性表(Diabetes Specific Quality of Life,DSQL)评分。结果护理前,两组餐后2 h血糖与空腹血糖、SDSCA、DSQL评分比较,差异无统计学意义(P均>0.05)。护理后,研究组餐后2 h与空腹血糖均低于对照组,差异有统计学意义(P均<0.05)。护理后,研究组SDSCA、DSQL评分均低于对照组,差异有统计学意义(P均<0.05)。结论基于护患互动达标理论的护理措施能够有效提高GDM患者的自我管理行为能力,保障血糖的控制效果与生活质量。
