目的构建加速康复理念下腹腔镜口腔黏膜输尿管成形术围手术期的护理方案,为临床护理实践和科研提供理论依据。方法系统检索加速康复外科(enhanced recovery after surgery,ERAS)腹腔镜口腔黏膜输尿管成形术相关文献,通过文献筛选和质量...目的构建加速康复理念下腹腔镜口腔黏膜输尿管成形术围手术期的护理方案,为临床护理实践和科研提供理论依据。方法系统检索加速康复外科(enhanced recovery after surgery,ERAS)腹腔镜口腔黏膜输尿管成形术相关文献,通过文献筛选和质量评价,初步拟定加速康复理念下腹腔镜口腔黏膜输尿管成形术围手术期的护理方案。采用德尔菲专家函询法,对方案条目进一步完善,形成最终护理方案。结果共进行2轮专家函询,2轮函询问卷有效回收率分别为95.24%、100.00%,专家权威系数分别为0.87、0.87,肯德尔和谐系数分别为0.18、0.21(均P<0.001)。第2轮函询,各条目变异系数为0~0.20,重要性评分为3.95~5.00分,最终形成包含4个一级条目,27个二级条目,60个三级条目的加速康复理念下腹腔镜口腔黏膜输尿管成形术围手术期护理方案。结论该研究构建的护理方案具有可靠性、实用性和针对性,应用该方案能缓解手术为患者带来的不适,促进患者术后恢复。展开更多
BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to...BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day(POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery(ERAS) program.METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA.Demographic data, anesthesia data, and ambulatory outcomes were compared.RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.展开更多
AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwen...AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel( TPN ) support during the first threepostoperational days. From the 4thpostoperational day, animals were randomlyassigned to receive 7 different treatments for 8days: TPNcon group, receiving TPN and enteral20 g.L- 1 glycine perfusion; TPN + Gin group,receiving TPN and enteral 20 g.L-1 glutamineperfusion; ENcon group, receiving enteralnutrition (EN) fortified with 20 g@L-1 glycine; EN+ Gin group, enteral nutrition fortified with20g. L-1 glutamine; EN + Fib group, enteralnutrition and 2 g. d- 1 oral soybean fiber; EN + GHgroup, enteral nutrition and subcutaneousgrowth hormone (GH) (0.31U) injection twicedaily; and ENint group, glutamine-enriched EN.oral soybean fiber, and subcutaneous GHinjection.RESULTS Enteral glutamine perfusion duringTPN increased the small intestinal villus height(jejunal villus height 250 μm ±29 μm in TPNconvs 330 μm ± 54 μm in TPN + Gin, ileal villus height260μm±28μm in TPNcon vs 330 μm±22μm inTPN + Gin, P＜0.05) and mucosa thickness( jejunal mucosa thickness 360 μm ± 32 μm inTPNcon vs 460 μm ± 65 μm in TPN + Gin, ilealmucosa thickness 400 μm ± 25 μm in TPNcon vs490μm ± 11 μm in TPN + Gin, P＜0.05) incomparison with the TPNcon group. Either fibersupplementation or GH administration improvedbody mass gain (end body weight 270 g ± 3.6 g inEN+Fib, 265.7 g ± 3.3 g in EN+GH, vs 257g±3.3g in ENcon, P＜0.05), elevated plasmainsulin-like growth factor ( IGF-Ⅰ ) level(880 μg. L-1 ± 52 μg. L-1 in EN + Fib, 1200 μg. L-1± 96 μg. L- 1 in EN ± GH, vs 620 μg. L-1 ±43 μg. L-1 in ENcon, P＜0.05), and increased thevillus height (jejunum 560 μm ± 44 μm in EN ± Fib,530 μm± 30 μm in EN ± GH, vs 450 μm ± 44 μm inENcon, ileum 400 μm ± 30 μm in EN + Fib, 380 μm±49 μm in EN± GH, vs 320 μm± 16 μm in ENcon,P＜0.05) and the mucosa thickness (jejunum740 μm ± 66 μm in EN ± Fib, 705 μm ± 27 μm in EN ±GH, vs 608 μm ± 58 μm in ENcon, ileum 570 μm ±27 μm in EN ± Fib, 560 μm ± 56 μm in EN ± GH, vs480μm ± 40 μm in ENcon, P＜0.05) in remnantjejunum and ileum. Glutamine-enriched ENproduced little effect in body mass, plasma IGF-Ⅰ level, and remnant small bowel mucosalstructure. The ENint group had greater bodymass (280g ± 2.2g), plasma IGF-Ⅰ level(1450g@L-1 ± 137g. L 1), and villus height(jejunum 620 μm ± 56 μm, ileum 450 um ± 31 μm)and mucosal thickness (jejunum 800 μm ± 52 μm,ileum 633 μm± 33 μm) than those in ENcon, EN +Gin (jejunum villus height and mucosa thickness450 μm ± 47 μm and 610 μm ± 63 μm, ileum villusheight and mucosa thickness 330 μm ± 39 μm and500 μm± 52 μm), EN + GH groups (P＜0.05), andthan those in EN + Fib group although nostatistical significance was attained.CONCLUSION Both dietary fiber and GH whenused separately can enhance the postresectionalsmall bowel structural adaptation. Simultaneoususe of these two gut-trophic factors can producesynergistic effects on small bowel structuraladaptation. Enteral glutamine perfusion isbeneficial in preserving small bowel mucosalstructure during TPN, but has little beneficialeffect during EN.展开更多
文摘目的构建加速康复理念下腹腔镜口腔黏膜输尿管成形术围手术期的护理方案,为临床护理实践和科研提供理论依据。方法系统检索加速康复外科(enhanced recovery after surgery,ERAS)腹腔镜口腔黏膜输尿管成形术相关文献,通过文献筛选和质量评价,初步拟定加速康复理念下腹腔镜口腔黏膜输尿管成形术围手术期的护理方案。采用德尔菲专家函询法,对方案条目进一步完善,形成最终护理方案。结果共进行2轮专家函询,2轮函询问卷有效回收率分别为95.24%、100.00%,专家权威系数分别为0.87、0.87,肯德尔和谐系数分别为0.18、0.21(均P<0.001)。第2轮函询,各条目变异系数为0~0.20,重要性评分为3.95~5.00分,最终形成包含4个一级条目,27个二级条目,60个三级条目的加速康复理念下腹腔镜口腔黏膜输尿管成形术围手术期护理方案。结论该研究构建的护理方案具有可靠性、实用性和针对性,应用该方案能缓解手术为患者带来的不适,促进患者术后恢复。
文摘BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day(POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery(ERAS) program.METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA.Demographic data, anesthesia data, and ambulatory outcomes were compared.RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.
基金Supported partially by the MedicalHealth Research Foundation of PLA, No. 980015
文摘AIM To investigate the individual and thecombined effects of glutamine, dietary fiber,and growth hormone on the structural adaptationof the remnant small bowel.METHODS Forty-two adult male Sprague-Dawley rats underwent 85% mid-small bowel( TPN ) support during the first threepostoperational days. From the 4thpostoperational day, animals were randomlyassigned to receive 7 different treatments for 8days: TPNcon group, receiving TPN and enteral20 g.L- 1 glycine perfusion; TPN + Gin group,receiving TPN and enteral 20 g.L-1 glutamineperfusion; ENcon group, receiving enteralnutrition (EN) fortified with 20 g@L-1 glycine; EN+ Gin group, enteral nutrition fortified with20g. L-1 glutamine; EN + Fib group, enteralnutrition and 2 g. d- 1 oral soybean fiber; EN + GHgroup, enteral nutrition and subcutaneousgrowth hormone (GH) (0.31U) injection twicedaily; and ENint group, glutamine-enriched EN.oral soybean fiber, and subcutaneous GHinjection.RESULTS Enteral glutamine perfusion duringTPN increased the small intestinal villus height(jejunal villus height 250 μm ±29 μm in TPNconvs 330 μm ± 54 μm in TPN + Gin, ileal villus height260μm±28μm in TPNcon vs 330 μm±22μm inTPN + Gin, P＜0.05) and mucosa thickness( jejunal mucosa thickness 360 μm ± 32 μm inTPNcon vs 460 μm ± 65 μm in TPN + Gin, ilealmucosa thickness 400 μm ± 25 μm in TPNcon vs490μm ± 11 μm in TPN + Gin, P＜0.05) incomparison with the TPNcon group. Either fibersupplementation or GH administration improvedbody mass gain (end body weight 270 g ± 3.6 g inEN+Fib, 265.7 g ± 3.3 g in EN+GH, vs 257g±3.3g in ENcon, P＜0.05), elevated plasmainsulin-like growth factor ( IGF-Ⅰ ) level(880 μg. L-1 ± 52 μg. L-1 in EN + Fib, 1200 μg. L-1± 96 μg. L- 1 in EN ± GH, vs 620 μg. L-1 ±43 μg. L-1 in ENcon, P＜0.05), and increased thevillus height (jejunum 560 μm ± 44 μm in EN ± Fib,530 μm± 30 μm in EN ± GH, vs 450 μm ± 44 μm inENcon, ileum 400 μm ± 30 μm in EN + Fib, 380 μm±49 μm in EN± GH, vs 320 μm± 16 μm in ENcon,P＜0.05) and the mucosa thickness (jejunum740 μm ± 66 μm in EN ± Fib, 705 μm ± 27 μm in EN ±GH, vs 608 μm ± 58 μm in ENcon, ileum 570 μm ±27 μm in EN ± Fib, 560 μm ± 56 μm in EN ± GH, vs480μm ± 40 μm in ENcon, P＜0.05) in remnantjejunum and ileum. Glutamine-enriched ENproduced little effect in body mass, plasma IGF-Ⅰ level, and remnant small bowel mucosalstructure. The ENint group had greater bodymass (280g ± 2.2g), plasma IGF-Ⅰ level(1450g@L-1 ± 137g. L 1), and villus height(jejunum 620 μm ± 56 μm, ileum 450 um ± 31 μm)and mucosal thickness (jejunum 800 μm ± 52 μm,ileum 633 μm± 33 μm) than those in ENcon, EN +Gin (jejunum villus height and mucosa thickness450 μm ± 47 μm and 610 μm ± 63 μm, ileum villusheight and mucosa thickness 330 μm ± 39 μm and500 μm± 52 μm), EN + GH groups (P＜0.05), andthan those in EN + Fib group although nostatistical significance was attained.CONCLUSION Both dietary fiber and GH whenused separately can enhance the postresectionalsmall bowel structural adaptation. Simultaneoususe of these two gut-trophic factors can producesynergistic effects on small bowel structuraladaptation. Enteral glutamine perfusion isbeneficial in preserving small bowel mucosalstructure during TPN, but has little beneficialeffect during EN.
