Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.Th...Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.The patients were divided into observation group(n=15)and control group(n=40)according to received perioperative cranial ultrasound or not.The general data and surgical data were compared between groups,and ultrasonic data of observation group were analyzed.Results The proportions of good prognosis 1 and 6 months after operation in observation group were both higher than those in control group,while the incidence of cerebral infarction in observation group was lower than that in control group(all P<0.05).No significant difference of general data nor other surgical data was found between groups(all P>0.05).Acute encephalocele occurred in 1 case in observation group during operation,and cranial ultrasound accurately showed the contralateral secondary epidural hematoma.Increased intracranial pressure in different degrees were found in all 15 cases(15/15,100%)in observation group after operation with transcranial color coded Doppler(TCCD)or transcranial Doppler(TCD),while cerebral vascular spasm was observed in 5 cases(5/15,33.33%),among them 4 cases(4/5,80.00%)were diagnosed cerebral infarction based on CT examination.Conclusion Cranial ultrasound could be used to evaluate changes of sTBI in perioperative period and guide adjusting treatment strategy in time,being valuable for reducing risk of postoperative cerebral infarction and improving prognosis.展开更多
Liver cancer represents a grave hepatic condition and constitutes a significant global health concern.Surgical resection remains the principal therapeutic modality for liver cancer.Nevertheless,perioperative malnutrit...Liver cancer represents a grave hepatic condition and constitutes a significant global health concern.Surgical resection remains the principal therapeutic modality for liver cancer.Nevertheless,perioperative malnutrition exerts a notable impact on patients with liver cancer,emerging as an independent risk factor for disease mortality and adverse outcomes.Hence,precise nutritional diagnosis and timely nutritional support hold the potential to enhance therapeutic efficacy and quality of life for liver cancer patients.This study represents a meticulous foray into the literature,extracting data from PubMed,Web of Science,and EMBASE databases,with a focus on the past 5 years.It scrutinizes the impact of malnutrition on patients undergoing liver cancer surgery,the etiological underpinnings of malnutrition within this patient cohort,the critical assessment of perioperative nutritional status,and the strategic approaches to nutritional support.Utilizing rigorous inclusion and exclusion criteria,the amassed scholarly works are meticulously synthesized,methodically organized,and categorically elaborated upon.Ultimately,the authors propose the incorporation of a multidisciplinary nutrition management team during the perioperative period,comprising nutritionists,pharmacists,physicians,nurses,psychologists,and rehabilitation therapists,among other specialized professionals.Together,they collaborate to devise and implement personalized nutritional support plans,monitor patients’nutritional status,and make necessary adjustments as required.Through comprehensive management and intervention,improvements in the nutritional status of liver cancer patients can be achieved,thereby enhancing surgical success rates and facilitating postoperative recovery.It is believed that this manuscript will offer valuable insights to advance the nutritional management during the perioperative phase of liver cancer,aiding in ameliorating patients'nutritional status and treatment outcomes.展开更多
Objective:To investigate the clinical effect of perioperative intensive nursing on patients who underwent severed finger reimplantation and its influence on sleep quality.Methods:62 patients who underwent severed fing...Objective:To investigate the clinical effect of perioperative intensive nursing on patients who underwent severed finger reimplantation and its influence on sleep quality.Methods:62 patients who underwent severed finger reimplantation between January 2023 and December 2023 were included.They were divided into two groups:the observation group(n=31)and the control group(n=31).The control group received basic nursing interventions,while the observation group received intensive nursing care.The comparison parameters included visual analog pain score(VAS),incidence of vascular crises,length of hospitalization,Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Score(HAM-D),Hamilton Anxiety Score(HAM-A),and patient satisfaction.Results:Postoperative VAS score,incidence of vascular crisis,hospitalization time,PSQI score,and HAM-A and HAM-D scores of the observation group were lower than those of the control group(P<0.05).Meanwhile,the patient satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Perioperative intensive nursing care for patients undergoing severed finger reimplantation demonstrates significant benefits.It reduces postoperative pain,lowers the incidence of vascular crises,shortens hospitalization durations,enhances sleep quality,alleviates negative emotions,and improves nursing satisfaction.These findings underscore the importance and applicability of such care practices.展开更多
Myasthenia gravis(MG)is an autoimmune disorder that affects the neuromuscular junction.The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors(AChRs),which results in qualitative...Myasthenia gravis(MG)is an autoimmune disorder that affects the neuromuscular junction.The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors(AChRs),which results in qualitative and quantitative reductions in the availability of functional AChRs.Cardiac muscles are also affected,resulting in various perioperative cardiac complications.Antistriational antibodies are commonly reported in MG cases with cardiac involvement.In the presence of thymoma,the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%.Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia,myocarditis,conduction disorders,heart failure,and sudden death.Increased incidence of atrial fibrillation,ventricular and supraventricular extra systoles,and prolonged QTc have also been reported in patients with MG.Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.展开更多
BACKGROUND The incidence of cholecystolithiasis is on the rise.Use of information,motivation,and behavioral skills can play a positive role in promoting changes in individual health behaviors.However,reports on the ef...BACKGROUND The incidence of cholecystolithiasis is on the rise.Use of information,motivation,and behavioral skills can play a positive role in promoting changes in individual health behaviors.However,reports on the effects of information-motivationbehavioral(IMB)skills model based high-quality nursing as a perioperative nursing intervention for patients with gallstones are nonexistent.AIM To explore the application of IMB skills model based high-quality nursing in patients with gallstones.METHODS Two hundred and sixteen patients with cholecystolithiasis treated at our hospital from January 2022 to January 2023 were enrolled and divided into a control,highquality,and combined nursing groups,with 72 patients in each group.The control,high-quality,and combination groups received conventional,high-quality,and IMB skills model based perioperative nursing services,respectively.Differences in clinical indicators,stress levels,degree of pain,emotional state,and quality of life were observed,and complications and nursing satisfaction among the three groups were evaluated.RESULTS After nursing,the time to recovery of gastrointestinal function in the high-quality and combined nursing groups was significantly shorter than that of the control group,with the recovery of gastrointestinal function being the fastest in the combined nursing group(P<0.05).After nursing intervention,cortisol and norepinephrine levels in the high-quality and combined nursing groups were closer to normal than those of the control group 24 h after surgery,with the combined nursing group having the closest to normal levels(P<0.05).After 3 and 7 d of intervention,the patients’pain significantly improved,which was more prominent in the highquality and combination groups.Meanwhile,the pain score in the combination group was significantly lower than those of the control and high-quality nursing groups(P<0.05).After nursing intervention,the emotional states of all patients improved,and the scores of patients in the combination group were significantly lower than those of the control and high-quality nursing groups.The quality of life of patients in the high-quality and combined nursing groups significantly improved after nursing intervention compared to that of the control group,with the combined nursing group having the highest quality of life score.After intervention,the incidence of complications in the high-quality and combination groups was significantly lower than that of the control group(P<0.05),but the difference between the combination and high-quality nursing groups was not significant.Nursing satisfaction of patients in the high-quality and combination groups was significantly higher than that of the control group,with the nursing satisfaction being the highest in the combination group(P<0.05).CONCLUSION IMB skills model based nursing can improve surgical stress levels,degrees of pain,emotional state,quality of life,and nursing satisfaction of patients with gallstones and reduce the incidence of complications.展开更多
BACKGROUND Surgery is an effective method for treating certain diseases.Factors such as disease,preoperative fear and tension,surgical stress,postoperative pain,and related complications directly affect the smooth pro...BACKGROUND Surgery is an effective method for treating certain diseases.Factors such as disease,preoperative fear and tension,surgical stress,postoperative pain,and related complications directly affect the smooth progression and outcome of surgery.Patients may experience a series of psychological and physiological changes during the perioperative period,resulting in anxiety and depression,which may reduce the pain threshold and worsen their prognosis.METHODS We enrolled 200 patients who underwent surgical care at The First People’s Hospital of Lin’an District,Hangzhou between January and December 2023.They were categorized into a routine intervention group(n=103)and a psychological intervention group(n=97),based on the intervention strategies used.Various assessment tools,including the self-rating anxiety scale(SAS),the self-rating depression scale(SDS),and the Connor–Davidson Resilience scale,were used to measure patients’negative states and emotions.The pre-and post-intervention scores for these metrics in the two groups were then analyzed.RESULTS In the psychological intervention group,the SAS and SDS scores(31.56±5.18 and 31.46±4.57,respectively)were significantly reduced compared to the routine intervention group(P<0.05).The visual analog scale pain scores at 12 and 24 hours after intervention(6.85±1.21,4.24±0.72)were notably higher than those in the routine intervention group(P<0.05).The psychological intervention group also demonstrated superior scores in perseverance(36.08±3.29),self-reliance(22.63±2.91),optimism(11.42±1.98),and resilience(70.13±5.37),compared to the routine intervention group(P<0.05).Additionally,the psychological intervention group’s confrontation score(23.16±4.29)was higher(P<0.05).This group also reported lower scores in avoidance(9.28±1.94)and yielding(6.19±1.92)(P<0.05).Lastly,the Short Form 36 Health Survey scores were significantly higher in the psychological intervention group,indicating a better quality of life(P<0.05).CONCLUSION Psychological intervention measures based on SCT can effectively alleviate pain,anxiety,and depression in periop-erative patients.展开更多
BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fist...BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.展开更多
[Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and ...[Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and the new mode of rational drug use control was established by using fine pharmaceutical technology intervention,and the intervention effect was evaluated by the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs.[Results]After adopting drug pathway in departments,the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs decreased significantly,and the effect of rational drug use control was remarkable.[Conclusions]The drug pathway provides a new management and control mode for the rational use of perioperative antibacterial drugs in surgical departments of hospitals.Thus,it is worthy of popularization and application.展开更多
Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE)....Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .展开更多
Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were g...Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling.The patients were divided into a control group and an observation group,with 35 cases in each group.The control group underwent basic nursing intervention,and the observation group was given precise patient education.The nursing effects of both groups were observed.Results:After the intervention,all compliance indicators of the observation group were better than those of the control group(P<0.05).Besides,the incidence of complications in the observation group(2.86%)was lower than that of the control group(17.14%)with P<0.05.Furthermore,the patient satisfaction of the observation group(97.14%)was higher than that of the control group(82.86%),with P<0.05.Conclusion:A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room.Therefore,this practice should be popularized.展开更多
[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from Jul...[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.展开更多
Nursing models at home and abroad for breast cancer patients during the perioperative period were screened, including eight types of models: the nursing model guided by self-care theory, the plan-do-check-a...Nursing models at home and abroad for breast cancer patients during the perioperative period were screened, including eight types of models: the nursing model guided by self-care theory, the plan-do-check-act cycle combined with the four-in-one model, the peer support nursing model, the nursing model guided by transcultural theory, the multidisciplinary cooperative nursing model, the knowledge-attitude-practice nursing model, the safe nursing management model, and the case nursing model. These models were analyzed and described with the aim of providing a reference for the clinical breast surgery nursing staff in China and for promoting the development of nursing in China for breast cancer the perioperative period.展开更多
Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia...Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia.Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed,Web of Science,the Cochrane Library,China National Knowledge Infrastructure(CNKI),and Wanfang Data were searched for randomized-controlled trials(RCTs)on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September,2021.The standardized mean differences(SMD)with 95%confidence interval(CI)were employed to analyze the data.The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients(dexmedetomidine group,546 patients;control group,287 patients)were included.There was no significant increase in perioperative heart rate(HR),mean arterial pressure(MAP),and diastolic blood pressure(DBP)in the dexmedetomidine group before and during the operation.In addition,the variations of hemodynamic indexes including HR,MAP,SBP(systolic blood pressure),and DBP were significantly lower in the dexmedetomidine group compared with the control group(HR:SMD=-0.87,95%CI:-1.13 to-0.62;MAP:SMD=-1.12,95%CI:-1.60 to-0.63;SBP:SMD=-1.27,95%CI:-2.26 to-0.27;DBP:SMD=-0.96,95%CI:-1.33 to-0.59).Subgroup analysis found that with the prolongation of 1.0μg/kg dexmedetomidine infusion,the patient’s heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients.However,further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.展开更多
Objective:To investigate the clinical value of using preoperative nutritional risk screening and support in gastric cancer patients.Methods:In this paper,70 gastric cancer patients selected from July 2017 to July 2020...Objective:To investigate the clinical value of using preoperative nutritional risk screening and support in gastric cancer patients.Methods:In this paper,70 gastric cancer patients selected from July 2017 to July 2020 treated in our hospital were grouped concerning the lottery method,and the reference group(n=35)used conventional nutritional support,while the experimental group(n=35)used preoperative dietary risk screening and support,comparing the clinical treatment differences between gastric cancer patients in the experimental group and the reference group.Results:After the intervention,IgA,IgM,IgG,serum albumin,complication rate,NRS score,hospitalization time and anal exhaust time of gastric cancer patients in the experimental group were compared with those in the reference group,P<0.05,and there was statistical validation analysis significance between the data indicators.P<0.05 for the comparison of IgA,IgM,IgG,serum albumin after the intervention and pre-intervention for gastric cancer patients in the experimental group and the reference group,with statistical validation analysis significance between the data indicators.Conclusion:Preoperative nutritional risk screening and support is of significant value in gastric cancer patients and can improve patients’nutritional status.展开更多
The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive...The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive care unit (ICU).Cancer surgery is characterized by large trauma,long duration,and wide operation scope;and there are many inflammatory factors in the tumor.Common manifestations of systermic inflammatory response syndrome(SIRS)。such as fever,elevated white blood cells,and elevated infammatory indicators,frequently occur in patients during the penioperative period as a result of the above factors.These factors are diverse and complex;additionally,advanced cancer and the trauma of major surgery are important factors that influence PCT blood levels.Because all of the aforementioned factors make it dificult to distinguish the postoperative inflammatory response fom the true infection in clinical practice,conventional methods cannot prediet disease sevenity or disease course.Methods:A total of 53 patients with endotracheal intubation admitted to the ICU of Tianjin Medical University Cancer Institute and Hospital from January 2020 to May 2020,were retrospectively selected.According to the patient source,35 cases were assigned to ORIG(Operating Room to ICU Group),and 18 cases were assigned to General Ward to ICU group(GWO).At the ICU admission,the patient's age,sex,surgical site of tumor,reason for ICU and other data were recorded to form a database;PCT,B-type natiuretic peptide(BNP),high sensitivity toponin I(hsTni),serumn creatinine(Cr),serum cystatin C(Cys-c)and other laboratory indicators were detected;scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)were marked 24 h after ICU admission;Proportion of Antibiotics,Time Antibiotic Application,and Time Indicators(Ventilator support Time,Endotracheal Intubation Time,ICU Stay Time)were recorded during the period from ICU admission to ICU discharge.Results:APAHCE Ⅱ score and SOFA score increased significantly in the GWIG,compared with the ORIG,and the differences were statistically significant(P<0.01);the GWIG had a significantly longer Time Antibiotic Application than the ORIG,and the difference was statistically significant(P<0.01);in tems of blood indicators,the PCT,BNP,and hsTNi levels were elevated in the GWIG compared with the ORIG,and the differences were statistically significant(p<0.01);no statistical differences were found in Cr and Cys-C levels(P>0.05).In terms of time indicators,the Ventilator support Time,Endotracheal Intubation Time,and ICU Stay Time were prolonged in the GWIG compared with the ORIG,and the differences were statistically significant(P<0.01).The PCT level was statistically signifcant(P<0.01)when correlated with the Ventilator Supporting Time and Endotracheal Intubation Time;however,the PCT level was negatively correlated with the ICU Stay Time,with a small r(correlation cofficient)value and no statistical significance(P>0.05)when correlated with the ICU Stay Time.Conclusion:The initial PCT level can predict the disease severity in critically ill cancer patients treated with mechanical ventilation during the perioperative period.展开更多
Objective To observe the changes of thrombelastography (TEG) and color Doppler flow imaging (CDFI) in the perioperative period after closed lower limb fracture.Methods Fasting venous blood samples in the morning from ...Objective To observe the changes of thrombelastography (TEG) and color Doppler flow imaging (CDFI) in the perioperative period after closed lower limb fracture.Methods Fasting venous blood samples in the morning from 11 healthy adults were used展开更多
Objective To investigate current surgical site infection and perioperative antibiotics in inpatients and explore the controlling aim and methods. Methods The infection rates of surgical sites of 287 operated cases fro...Objective To investigate current surgical site infection and perioperative antibiotics in inpatients and explore the controlling aim and methods. Methods The infection rates of surgical sites of 287 operated cases from May to Dec 31,2007 were studied and compared with展开更多
BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IP...BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).展开更多
Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surge...Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.展开更多
文摘Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.The patients were divided into observation group(n=15)and control group(n=40)according to received perioperative cranial ultrasound or not.The general data and surgical data were compared between groups,and ultrasonic data of observation group were analyzed.Results The proportions of good prognosis 1 and 6 months after operation in observation group were both higher than those in control group,while the incidence of cerebral infarction in observation group was lower than that in control group(all P<0.05).No significant difference of general data nor other surgical data was found between groups(all P>0.05).Acute encephalocele occurred in 1 case in observation group during operation,and cranial ultrasound accurately showed the contralateral secondary epidural hematoma.Increased intracranial pressure in different degrees were found in all 15 cases(15/15,100%)in observation group after operation with transcranial color coded Doppler(TCCD)or transcranial Doppler(TCD),while cerebral vascular spasm was observed in 5 cases(5/15,33.33%),among them 4 cases(4/5,80.00%)were diagnosed cerebral infarction based on CT examination.Conclusion Cranial ultrasound could be used to evaluate changes of sTBI in perioperative period and guide adjusting treatment strategy in time,being valuable for reducing risk of postoperative cerebral infarction and improving prognosis.
基金National Natural Science Foundation of China,No 81701888Science and Technology Program of Sichuan Province,No.2023YFS0206Scientific Research Project of Sichuan Cadre Health Committee,No.2022-211.
文摘Liver cancer represents a grave hepatic condition and constitutes a significant global health concern.Surgical resection remains the principal therapeutic modality for liver cancer.Nevertheless,perioperative malnutrition exerts a notable impact on patients with liver cancer,emerging as an independent risk factor for disease mortality and adverse outcomes.Hence,precise nutritional diagnosis and timely nutritional support hold the potential to enhance therapeutic efficacy and quality of life for liver cancer patients.This study represents a meticulous foray into the literature,extracting data from PubMed,Web of Science,and EMBASE databases,with a focus on the past 5 years.It scrutinizes the impact of malnutrition on patients undergoing liver cancer surgery,the etiological underpinnings of malnutrition within this patient cohort,the critical assessment of perioperative nutritional status,and the strategic approaches to nutritional support.Utilizing rigorous inclusion and exclusion criteria,the amassed scholarly works are meticulously synthesized,methodically organized,and categorically elaborated upon.Ultimately,the authors propose the incorporation of a multidisciplinary nutrition management team during the perioperative period,comprising nutritionists,pharmacists,physicians,nurses,psychologists,and rehabilitation therapists,among other specialized professionals.Together,they collaborate to devise and implement personalized nutritional support plans,monitor patients’nutritional status,and make necessary adjustments as required.Through comprehensive management and intervention,improvements in the nutritional status of liver cancer patients can be achieved,thereby enhancing surgical success rates and facilitating postoperative recovery.It is believed that this manuscript will offer valuable insights to advance the nutritional management during the perioperative phase of liver cancer,aiding in ameliorating patients'nutritional status and treatment outcomes.
文摘Objective:To investigate the clinical effect of perioperative intensive nursing on patients who underwent severed finger reimplantation and its influence on sleep quality.Methods:62 patients who underwent severed finger reimplantation between January 2023 and December 2023 were included.They were divided into two groups:the observation group(n=31)and the control group(n=31).The control group received basic nursing interventions,while the observation group received intensive nursing care.The comparison parameters included visual analog pain score(VAS),incidence of vascular crises,length of hospitalization,Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Score(HAM-D),Hamilton Anxiety Score(HAM-A),and patient satisfaction.Results:Postoperative VAS score,incidence of vascular crisis,hospitalization time,PSQI score,and HAM-A and HAM-D scores of the observation group were lower than those of the control group(P<0.05).Meanwhile,the patient satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Perioperative intensive nursing care for patients undergoing severed finger reimplantation demonstrates significant benefits.It reduces postoperative pain,lowers the incidence of vascular crises,shortens hospitalization durations,enhances sleep quality,alleviates negative emotions,and improves nursing satisfaction.These findings underscore the importance and applicability of such care practices.
文摘Myasthenia gravis(MG)is an autoimmune disorder that affects the neuromuscular junction.The primary pathology in MG involves the presence of autoantibodies to acetylcholine receptors(AChRs),which results in qualitative and quantitative reductions in the availability of functional AChRs.Cardiac muscles are also affected,resulting in various perioperative cardiac complications.Antistriational antibodies are commonly reported in MG cases with cardiac involvement.In the presence of thymoma,the prevalence of cardiac manifestations in patients with MG increases to approximately 10%-15%.Cardiac involvement in MG may range from asymptomatic electrocardiogram changes to ventricular tachycardia,myocarditis,conduction disorders,heart failure,and sudden death.Increased incidence of atrial fibrillation,ventricular and supraventricular extra systoles,and prolonged QTc have also been reported in patients with MG.Clinicians should consider the evaluation of autonomic dysfunction and risk of cardiovascular disease in patients with MG.
文摘BACKGROUND The incidence of cholecystolithiasis is on the rise.Use of information,motivation,and behavioral skills can play a positive role in promoting changes in individual health behaviors.However,reports on the effects of information-motivationbehavioral(IMB)skills model based high-quality nursing as a perioperative nursing intervention for patients with gallstones are nonexistent.AIM To explore the application of IMB skills model based high-quality nursing in patients with gallstones.METHODS Two hundred and sixteen patients with cholecystolithiasis treated at our hospital from January 2022 to January 2023 were enrolled and divided into a control,highquality,and combined nursing groups,with 72 patients in each group.The control,high-quality,and combination groups received conventional,high-quality,and IMB skills model based perioperative nursing services,respectively.Differences in clinical indicators,stress levels,degree of pain,emotional state,and quality of life were observed,and complications and nursing satisfaction among the three groups were evaluated.RESULTS After nursing,the time to recovery of gastrointestinal function in the high-quality and combined nursing groups was significantly shorter than that of the control group,with the recovery of gastrointestinal function being the fastest in the combined nursing group(P<0.05).After nursing intervention,cortisol and norepinephrine levels in the high-quality and combined nursing groups were closer to normal than those of the control group 24 h after surgery,with the combined nursing group having the closest to normal levels(P<0.05).After 3 and 7 d of intervention,the patients’pain significantly improved,which was more prominent in the highquality and combination groups.Meanwhile,the pain score in the combination group was significantly lower than those of the control and high-quality nursing groups(P<0.05).After nursing intervention,the emotional states of all patients improved,and the scores of patients in the combination group were significantly lower than those of the control and high-quality nursing groups.The quality of life of patients in the high-quality and combined nursing groups significantly improved after nursing intervention compared to that of the control group,with the combined nursing group having the highest quality of life score.After intervention,the incidence of complications in the high-quality and combination groups was significantly lower than that of the control group(P<0.05),but the difference between the combination and high-quality nursing groups was not significant.Nursing satisfaction of patients in the high-quality and combination groups was significantly higher than that of the control group,with the nursing satisfaction being the highest in the combination group(P<0.05).CONCLUSION IMB skills model based nursing can improve surgical stress levels,degrees of pain,emotional state,quality of life,and nursing satisfaction of patients with gallstones and reduce the incidence of complications.
文摘BACKGROUND Surgery is an effective method for treating certain diseases.Factors such as disease,preoperative fear and tension,surgical stress,postoperative pain,and related complications directly affect the smooth progression and outcome of surgery.Patients may experience a series of psychological and physiological changes during the perioperative period,resulting in anxiety and depression,which may reduce the pain threshold and worsen their prognosis.METHODS We enrolled 200 patients who underwent surgical care at The First People’s Hospital of Lin’an District,Hangzhou between January and December 2023.They were categorized into a routine intervention group(n=103)and a psychological intervention group(n=97),based on the intervention strategies used.Various assessment tools,including the self-rating anxiety scale(SAS),the self-rating depression scale(SDS),and the Connor–Davidson Resilience scale,were used to measure patients’negative states and emotions.The pre-and post-intervention scores for these metrics in the two groups were then analyzed.RESULTS In the psychological intervention group,the SAS and SDS scores(31.56±5.18 and 31.46±4.57,respectively)were significantly reduced compared to the routine intervention group(P<0.05).The visual analog scale pain scores at 12 and 24 hours after intervention(6.85±1.21,4.24±0.72)were notably higher than those in the routine intervention group(P<0.05).The psychological intervention group also demonstrated superior scores in perseverance(36.08±3.29),self-reliance(22.63±2.91),optimism(11.42±1.98),and resilience(70.13±5.37),compared to the routine intervention group(P<0.05).Additionally,the psychological intervention group’s confrontation score(23.16±4.29)was higher(P<0.05).This group also reported lower scores in avoidance(9.28±1.94)and yielding(6.19±1.92)(P<0.05).Lastly,the Short Form 36 Health Survey scores were significantly higher in the psychological intervention group,indicating a better quality of life(P<0.05).CONCLUSION Psychological intervention measures based on SCT can effectively alleviate pain,anxiety,and depression in periop-erative patients.
基金Supported by Youth Project of Anhui Provincial Health Commission T,No.AHWJ2023A30225.
文摘BACKGROUND Large abdominal wall defect(LAWD)measures>20 cm in width.LAWD can easily lead to intestinal necrosis,peritonitis,other complications,and even mul-tiple organ dysfunction syndrome.Multiple intestinal fistulas are high-flow fis-tulas that can cause severe water–electrolyte imbalance and malnutrition,as well as inflammation,high metabolic status,and chronic intestinal failure caused by intestinal fluid corrosion in tissues around the orifice fistulas.CASE SUMMARY This article summarizes the nursing experience of a patient with sigmoid carci-noma who has LAWD with multiple intestinal fistula due to repeated operations for postoperative complications.The key points of care:Scientific assessment of nutritional status,dynamic adjustment of nutritional support programmes,com-prehensive adoption of enteral nutrition,parenteral nutrition and combined nut-rition of enteral and parenteral;taking good care of abdominal wall defects and intestinal fistulas;continuous flushing of the abdominal drainage tube and low negative pressure drainage;prevention of venous thrombosis;strengthening of physical exercise;implementation of positive psychological interventions.CONCLUSION After more than 7 months of careful care,the patient's physical fitness has been well recovered,local inflammation is well controlled,which wins the opportunity for the operation,and the postoperative recovery is good.
基金Supported by Science and Technology Innovation Plan for Medical Workers in Shandong Province(SDYWZGKCJH2023095)Clinical Pharmacy Research Project of Shandong Provincial Medical Association(YXH2022ZX010)+1 种基金Traditional Chinese Medicine Science and Technology Development Project of Shandong Province(2019-0400&2021Q097)Traditional Chinese Medicine Research Program of Qingdao City(2020-zyy031)Medical Research Guidance Plan of Qingdao City(2020-WJZD087).
文摘[Objectives]To establish a new management model for rational use of perioperative antibacterial drugs in surgical departments.[Methods]Based on evidence-based medicine,the department s drug pathway was formulated,and the new mode of rational drug use control was established by using fine pharmaceutical technology intervention,and the intervention effect was evaluated by the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs.[Results]After adopting drug pathway in departments,the intensity of antibacterial drug use,per capita drug costs and the proportion of drugs decreased significantly,and the effect of rational drug use control was remarkable.[Conclusions]The drug pathway provides a new management and control mode for the rational use of perioperative antibacterial drugs in surgical departments of hospitals.Thus,it is worthy of popularization and application.
文摘Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .
文摘Objective:To explore and analyze the effect of implementing a precise education model on the nursing care of perioperative patients in the interventional catheterization room.Methods:We selected 70 patients who were going to undergo surgical intervention in our hospital from August 2020 to December 2022 as the subjects for this study through random sampling.The patients were divided into a control group and an observation group,with 35 cases in each group.The control group underwent basic nursing intervention,and the observation group was given precise patient education.The nursing effects of both groups were observed.Results:After the intervention,all compliance indicators of the observation group were better than those of the control group(P<0.05).Besides,the incidence of complications in the observation group(2.86%)was lower than that of the control group(17.14%)with P<0.05.Furthermore,the patient satisfaction of the observation group(97.14%)was higher than that of the control group(82.86%),with P<0.05.Conclusion:A precise propaganda and education model facilitates the nursing of perioperative patients in the interventional catheterization room.Therefore,this practice should be popularized.
文摘[Objective] To explore the effect of clinical care pathways in perioperative patients with autologous arteriovenous fistula balloon expansion. [Method] 202 patients undergoing autologous arteriovenous fistula from July 2021 to June 2022 were randomly divided into a control group (101 cases) and an observation group (101 cases) to compare the incidence rates of postoperative complications, hospitalization days, hospitalization expenses, knowledge of self-management of arteriovenous fistula and nursing satisfaction. [Results] In the observation group, the incidence of arteriovenous fistula was higher than that of the control group, and the hospitalization days and hospitalization costs were lower than that of the control group. The difference between the two groups was statistically significant (P < 0.05). [Conclusion] The application of the clinical nursing path to intervene in patients with autologous arteriovenous fistula balloon dilation can reduce the incidence of postoperative complications, shorten the hospital length of time, reduce hospitalization costs and improve patient satisfaction, which is clinical promotion significance.
基金supported by a scientific research project of the Hubei Province Health and Family Planning Commission,China(No.WJ2017M100)
文摘Nursing models at home and abroad for breast cancer patients during the perioperative period were screened, including eight types of models: the nursing model guided by self-care theory, the plan-do-check-act cycle combined with the four-in-one model, the peer support nursing model, the nursing model guided by transcultural theory, the multidisciplinary cooperative nursing model, the knowledge-attitude-practice nursing model, the safe nursing management model, and the case nursing model. These models were analyzed and described with the aim of providing a reference for the clinical breast surgery nursing staff in China and for promoting the development of nursing in China for breast cancer the perioperative period.
基金Supported by National High Level Hospital Clinical Research Funding(2022 GSP-QN-16)Yunnan Provincial Cardiovascular Disease Clinical Medical Center Project(FZX2019-06-01).
文摘Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia.Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed,Web of Science,the Cochrane Library,China National Knowledge Infrastructure(CNKI),and Wanfang Data were searched for randomized-controlled trials(RCTs)on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September,2021.The standardized mean differences(SMD)with 95%confidence interval(CI)were employed to analyze the data.The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients(dexmedetomidine group,546 patients;control group,287 patients)were included.There was no significant increase in perioperative heart rate(HR),mean arterial pressure(MAP),and diastolic blood pressure(DBP)in the dexmedetomidine group before and during the operation.In addition,the variations of hemodynamic indexes including HR,MAP,SBP(systolic blood pressure),and DBP were significantly lower in the dexmedetomidine group compared with the control group(HR:SMD=-0.87,95%CI:-1.13 to-0.62;MAP:SMD=-1.12,95%CI:-1.60 to-0.63;SBP:SMD=-1.27,95%CI:-2.26 to-0.27;DBP:SMD=-0.96,95%CI:-1.33 to-0.59).Subgroup analysis found that with the prolongation of 1.0μg/kg dexmedetomidine infusion,the patient’s heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients.However,further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.
文摘Objective:To investigate the clinical value of using preoperative nutritional risk screening and support in gastric cancer patients.Methods:In this paper,70 gastric cancer patients selected from July 2017 to July 2020 treated in our hospital were grouped concerning the lottery method,and the reference group(n=35)used conventional nutritional support,while the experimental group(n=35)used preoperative dietary risk screening and support,comparing the clinical treatment differences between gastric cancer patients in the experimental group and the reference group.Results:After the intervention,IgA,IgM,IgG,serum albumin,complication rate,NRS score,hospitalization time and anal exhaust time of gastric cancer patients in the experimental group were compared with those in the reference group,P<0.05,and there was statistical validation analysis significance between the data indicators.P<0.05 for the comparison of IgA,IgM,IgG,serum albumin after the intervention and pre-intervention for gastric cancer patients in the experimental group and the reference group,with statistical validation analysis significance between the data indicators.Conclusion:Preoperative nutritional risk screening and support is of significant value in gastric cancer patients and can improve patients’nutritional status.
基金supported by the Oncology Translational Medicine Seed Fund Project of Tianjin Medical University Cancer Institute and Hospital(No.1910).
文摘The predictive value of the initial procalcitonin(PCT)level was explored in the perioperative peniod of citically ill cancer patients.Background:It is quite important to predict infections in patients in the intensive care unit (ICU).Cancer surgery is characterized by large trauma,long duration,and wide operation scope;and there are many inflammatory factors in the tumor.Common manifestations of systermic inflammatory response syndrome(SIRS)。such as fever,elevated white blood cells,and elevated infammatory indicators,frequently occur in patients during the penioperative period as a result of the above factors.These factors are diverse and complex;additionally,advanced cancer and the trauma of major surgery are important factors that influence PCT blood levels.Because all of the aforementioned factors make it dificult to distinguish the postoperative inflammatory response fom the true infection in clinical practice,conventional methods cannot prediet disease sevenity or disease course.Methods:A total of 53 patients with endotracheal intubation admitted to the ICU of Tianjin Medical University Cancer Institute and Hospital from January 2020 to May 2020,were retrospectively selected.According to the patient source,35 cases were assigned to ORIG(Operating Room to ICU Group),and 18 cases were assigned to General Ward to ICU group(GWO).At the ICU admission,the patient's age,sex,surgical site of tumor,reason for ICU and other data were recorded to form a database;PCT,B-type natiuretic peptide(BNP),high sensitivity toponin I(hsTni),serumn creatinine(Cr),serum cystatin C(Cys-c)and other laboratory indicators were detected;scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and sequential organ failure assessment(SOFA)were marked 24 h after ICU admission;Proportion of Antibiotics,Time Antibiotic Application,and Time Indicators(Ventilator support Time,Endotracheal Intubation Time,ICU Stay Time)were recorded during the period from ICU admission to ICU discharge.Results:APAHCE Ⅱ score and SOFA score increased significantly in the GWIG,compared with the ORIG,and the differences were statistically significant(P<0.01);the GWIG had a significantly longer Time Antibiotic Application than the ORIG,and the difference was statistically significant(P<0.01);in tems of blood indicators,the PCT,BNP,and hsTNi levels were elevated in the GWIG compared with the ORIG,and the differences were statistically significant(p<0.01);no statistical differences were found in Cr and Cys-C levels(P>0.05).In terms of time indicators,the Ventilator support Time,Endotracheal Intubation Time,and ICU Stay Time were prolonged in the GWIG compared with the ORIG,and the differences were statistically significant(P<0.01).The PCT level was statistically signifcant(P<0.01)when correlated with the Ventilator Supporting Time and Endotracheal Intubation Time;however,the PCT level was negatively correlated with the ICU Stay Time,with a small r(correlation cofficient)value and no statistical significance(P>0.05)when correlated with the ICU Stay Time.Conclusion:The initial PCT level can predict the disease severity in critically ill cancer patients treated with mechanical ventilation during the perioperative period.
文摘Objective To observe the changes of thrombelastography (TEG) and color Doppler flow imaging (CDFI) in the perioperative period after closed lower limb fracture.Methods Fasting venous blood samples in the morning from 11 healthy adults were used
文摘Objective To investigate current surgical site infection and perioperative antibiotics in inpatients and explore the controlling aim and methods. Methods The infection rates of surgical sites of 287 operated cases from May to Dec 31,2007 were studied and compared with
文摘BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).
文摘Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.