Observation of the Effectiveness of Rapid Recovery Nursing on Lung Cancer Surgery Patients and Its Impact on Sleep Quality

Objective: To investigate the nursing effects of rapid recovery care measures on lung cancer surgery patients. Methods: 42 cases of lung cancer surgery patients were divided into control group and study group, with 21 cases in each group. The sleep quality and postoperative recovery indicators were compared between the two groups. Results: The study group showed better results than the control group in terms of PSQI scores, venting time, extubation time, time to getting out of bed, and duration of antibiotic use, with P Conclusion: Rapid recovery nursing has a positive impact on improving sleep quality and promoting postoperative recovery in lung cancer surgery patients.

Research on the prognostic value of adjusting intraperitoneal threedimensional quality evaluation mode in laparoscopic cholecystectomy patients

BACKGROUND Benign gallbladder diseases have become a high-prevalence condition not only in China but also worldwide.The main types of benign gallbladder diseases include gallbladder polyps,acute and chronic cholecystitis,and gallstones,with gallstones being the most common,accounting for over 70%of cases.Although the mortality rate of benign gallbladder diseases is low,they carry obvious potential risks.Studies have shown that an increased incidence of benign gallbladder diseases can increase the risk of cardiovascular diseases and gallbladder cancer,resulting in a substantial disease burden on patients and their families.AIM To assess the medical utility of the Configuration-Procedure-Consequence(CPC)three-dimensional quality evaluation model in modulating the prognosis of laparoscopic cholecystectomy patients.METHODS A total of 98 patients who underwent laparoscopic cholecystectomy in our hospital from February 2020 to January 2022 were selected as the subjects.According to the random number table method,they were divided into a study group and a control group,with 49 patients in each group.The control group received routine perioperative care,while the study group had the addition of the CPC three-dimensional quality evaluation.The postoperative recovery-related indicators(time to first flatus,time to oral intake,time to ambulation,hospital stay),stress indicators(cortisol and adrenaline levels),distinctions in anxiety and RESULTS The time to first flatus,time to oral intake,time to ambulation,and hospital stay of the study group patients were obviously lower than those of the control group patients,with statistical significance(P<0.05).On the 1st day after admission,there were no obvious distinctions in cortisol and adrenaline levels in blood samples,as well as in the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores between the study group and the control group(P>0.05).However,on the 3rd day after surgery,the cortisol and adrenaline levels,as well as SAS and SDS scores of the study group patients,were obviously lower than those of the control group patients(P<0.05).The study group had 2 cases of incisional infection and 1 case of pulmonary infection,with a total incidence of complications of 6.12%(3/49),which was obviously lower than the 20.41%(10/49)in the control group(P<0.05).CONCLUSION Implementing the CPC three-dimensional quality evaluation model for patients undergoing laparoscopic cholecystectomy can help accelerate their perioperative recovery process,alleviate perioperative stress symptoms,mitigate anxiety,depression,and other adverse emotions,and to some extent,reduce the incidence of perioperative complications.

地塞米松用于LQLB对妇科腹腔镜患者术后QoR的影响

目的探讨地塞米松作为佐剂行LQLB对妇科腹腔镜患者术后QoR的影响。方法选取2022年10月-2023年1月本院择期行妇科腹腔镜良性肿瘤手术患者70例,随机分为LD组(地塞米松复合罗哌卡因,n=35)和L组(罗哌卡因,n=35)行LQLB,对比2组术后QoR、VAS评分、镇痛补救情况、PONV发生率及严重程度、镇吐补救次数、术后首次肛门排气时间。结果与L组相比,LD组患者术后1d QoR-40评分更高、术后24h及48h VAS评分更低、镇痛补救次数减少、首次镇痛药物使用时间更长、术后48h内PONV发生率和严重程度更低、术后首次肛门排气时间更短,差异有统计学意义(P<0.05)。结论地塞米松作为佐剂行LQLB镇痛效果更完善、PONV发生率及严重程度降低、胃肠功能恢复快,有效提高妇科腹腔镜手术患者的术后QoR。

Ultrasound-Guided Continuous Thoracic Paravertebral Block Improves Patientʼs Quality of Recovery After Open Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy.We hypothesize that these effects may improve the quality of recovery(QoR)after open hepatectomy.Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine(CTPVB group)or normal saline(control group).All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours.The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7,which was statistically analyzed using Student’s t-test.Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study.Compared to the control group,the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores(133.14±12.97 vs.122.62±14.89,P=0.002)on postoperative day 7.Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours(P<0.05;P=0.002),respectively,in the CTPVB group.Conclusion Perioperative CTPVB markably promotes patient’s QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.

Exploring the Experiences of Personal Recovery among Mental Health Consumers and Their Caregivers Receiving Strength- Based Family Interventions

Background:This study explored the personal recovery of consumers and their caregivers receiving the strength-based family intervention.Method:A three-year project was implemented with 43 dyads from 5 community psychiatric rehabilitation agencies in northern,central,and Southern Taiwan.This paper presents qualitative analysis with a focus on describing the experiences of personal recovery.To gain a deeper understanding of the participants’personal experiences and perspectives,semi-structured in-depth interviews were conducted on three occasions(six months after the inception of the experiment,18 months after,and when the participants left the services of this study).Over the three occasions,a total of 27 consumers and 28 caregivers were interviewed.Data analysis was conducted based on grounded theory.Results:Consumers expressed positive experiences in the domain of the recovery process(positive sense of self,taking responsibility,and better coping)and on the objective indicators of recovery(functioning,interpersonal interaction,and family relationship).Caregivers experienced lessened psychological burdens.They also revealed improvements to their sense of self(recovery process)and subjective indicators of recovery outcomes,including feeling empowered and having a better quality of life.Moreover,they had better interaction with consumers(objective domain of recovery).Conclusion:These findings suggest that the strength-based perspective is an acceptable,culturally-compatible approach among Chinese mental health consumers and their caregivers.The investigators suggest that additional resources would be necessary to support a change in the service system in Taiwan so that family-based services can be provided to promote the recovery of mental health consumers and their family caregivers.

Enhanced recovery after surgery-based nursing in older patients with postoperative intestinal obstruction after gastric cancer surgery:A retrospective study

BACKGROUND Gastric cancer-related morbidity and mortality rates are high in China.Patients who have undergone gastric cancer surgery should receive six cycles of chemotherapy according to their condition.During this period,intestinal obstruction is likely to occur.Electrolyte balance disorders,peritonitis,intestinal necrosis,and even hypovolemic shock and septic shock can seriously affect the physical and mental recovery of patients and threaten their health and quality of life(QoL).AIM To quantitatively explore the effects of enhanced recovery after surgery(ERAS)-based nursing on anxiety,depression,and QoL of elderly patients with postoperative intestinal obstruction after gastric cancer.METHODS The clinical data of 129 older patients with intestinal obstruction after gastric cancer surgery who were treated and cared for in our hospital between January 2019 and December 2021 were examined retrospectively.Nine patients dropped out because of transfer,relocation,or death.According to the order of admissions,the patients were categorized into either a comparison group or an observation group according to the random number table,with 60 cases in each group.RESULTS After nursing care,the observation group required significantly less time to eat for the first time,recover bowel sounds,pass gas,and defecate than the comparison group(P<0.05).No significant difference was noted in nutrition-related indicators between the two groups before care.Before care,the Symptom Check List-90 scores between the two groups were comparable,whereas anxiety,depression,paranoia,fear,hostility,obsession,somatization,interpersonal sensitivity,and psychotic scores were significantly lower in the observation group after care(P<0.05).The QoL scores between the two groups before care did not differ significantly.After care,the physical,social,physiological,and emotional function scores;mental health score;vitality score;and general health score were significantly higher in the observation group,whereas the somatic pain score was significantly lower in the observation group(P<0.05).CONCLUSION ERAS-based nursing combined with conventional nursing interventions can effectively improve patient’s QoL,negative emotions,and nutritional status;accelerate the time to first ventilation;and promote intestinal function recovery in elderly patients with postoperative intestinal obstruction after gastric cancer surgery.

Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study

Background: After functional endoscopic nasal surgery, emergence agitation is not uncommon. The aim of this trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality and incidence of emergence agitation in patient undergoing functional endoscopic sinus surgery. Study Design: Prospective, randomized, double-blinded, placebo-controlled trial. Methods: 100 patients of ASA I and II, aged 18 - 50 years, of both sexes scheduled for FEES, were assigned into two groups. In Group L;patients received an intravenous bolus infusion of 1.5 mg/kg lidocaine just before induction of anesthesia followed by a continuous infusion of 2 mg/kg/h during the operation and until the end of the surgery. In Group C;patients received normal saline infusion with the same volume as group L according to the same protocol. The primary endpoints were incidence of emergence agitation and postoperative recovery quality (QoR-40) score on first postoperative day (POD1). Results: Incidence of emergence agitation was significantly lower in group L (P < 0.05) compared with group C. Global QoR-40 scores on POD1 were significantly lower in both groups compared with preoperative assessment, it was significantly higher in group L on POD1 (P < 0.05) than in group C. Among the five dimensions of QoR-40, the scores for physical comfort and pain were superior in group L compared to group C (P < 0.05) at POD1. Conclusion: Systemic lidocaine infusion can improve QoR-40 scores and decrease incidence of emergence agitation in patients scheduled for FEES, also it reduces the duration of stay in PACU after surgery.

Approach of service recovery decision-making based on Bellman dynamic programming

Based on service-oriented architecture（SOA）,a Bellman-dynamic-programming-based approach of service recovery decision-making is proposed to make valid recovery decisions.Both the attribute and the process of services in the controllable distributed information system are analyzed as the preparatory work.Using the idea of service composition as a reference,the approach translates the recovery decision-making into a planning problem regarding artificial intelligence （AI） through two steps.The first is the self-organization based on a logical view of the network,and the second is the definition of evaluation standards.Applying Bellman dynamic programming to solve the planning problem,the approach offers timely emergency response and optimal recovery source selection,meeting multiple QoS （quality of service）requirements.Experimental results demonstrate the rationality and optimality of the approach,and the theoretical analysis of its computational complexity and the comparison with conventional methods exhibit its high efficiency.

Influence of Moisture Content,Variety and Parboiling on Milling Quality of Rice Grains

The effects of moisture content （8%, 10%and 12%）, variety （Tarom and Fajr） and parboiling on milling quality of rice as a function of milling recovery （MR）, head rice yield （HRY）, degree of milling （DOM） and whiteness were investigated. The parboiled grains was prepared with three soaking temperatures of 25 oC, 50 oC and 75 oC and three steaming times of 10, 15 and 20 min. As a result of parboiling, the increasing rates of MR and HRY values were 7.8%and 14.3%for Tarom and 9.8%and 10.0%for Fajr, respectively, and the decreasing rates for DOM and whiteness were 6.6%and 10.8%for Tarom and 6.8% and 10.5% for Fajr, respectively. Moreover, decreasing moisture content to 8%maximized MR （75.8% for Tarom and 74.3% for Fajr） and HRY （65.8% for Tarom and 57.0% for Fajr） while increasing that to 12%revealed maximum values of DOM （6.1%for Tarom and 6.2%for Fajr） and whiteness （24.8%for Tarom and 28.2%for Fajr）.

Analyzing the effect of steam quality and injection temperature on the performance of steam flooding

The heavy oil reservoirs are currently mainly targeted by thermal enhanced oil recovery technologies,particularly,steam flooding.Steam flooding is carried out by introducing heat into the reservoir to unlock the recovery of heavy oil by reducing oil viscosity.Several investigations were carried out to improve oil recovery by steam flooding.Most recently,high steam flooding is reported as an effective approach to improve recovery in high pressure heavy oil reservoirs.The oil recovery from steam flooding is sub-stantially affected by the steam quality and injection temperature.In this study,an attempt was made to look into the integration of parameters,i.e.steam quality and injection temperature upon steam flooding on oil recovery by using a simulation approach via ECLIPSE.The results obtained indicated that high temperature along with the moderate value of steam quality gives the best result regarding oil recovery for steam flooding in an economical way.

Safety and effectiveness of electromyography-induced rehabilitation treatment after epidural electrical stimulation for spinal cord injury:study protocol for a prospective,randomized,controlled trial

Epidural electrical stimulation is a new treatment method for spinal cord injury(SCI).Its efficacy and safety have previously been reported.Rehabilitation treatment after epidural electrical stimulation is important to ensure and improve the postoperative efficacy of epidural electrical stimulation in patients with SCI.Considering that electromyography(EMG)-induced rehabilitation treatment can accurately match the muscle contraction of patients with SCI,we designed a study protocol for a prospective,randomized controlled trial.In this trial,on the premise of adjusting the spinal cord electrical stimulator to obtain the maximum EMG signal of the target muscle,patients with SCI receiving epidural electrical stimulation will undergo EMG-induced rehabilitation treatment.Recovery of muscle strength of key muscles,quality of life,safety and therapeutic effects will be monitored.Twenty patients with SCI who are scheduled to undergo epidural electrical stimulation in Shanghai Ruijin Rehabilitation Hospital will be randomly divided into two groups with 10 patients per group.The control group will receive conventional rehabilitation treatment.The EMG-induced rehabilitation group will receive EMG-induced rehabilitation treatment of the target muscles of the upper and lower limbs based on conventional rehabilitation treatment.After rehabilitation treatment,follow up for all patients will occur at 2 weeks and 1,3 and 6 months.The primary outcome measure of this trial will be evaluation of target muscle recovery using the Manual Muscle Testing grading scale.Secondary outcome measures will include modified Barthel Index scores,integrated EMG values,the visual analogue scale,Spinal Cord Independence Measure scores,and modified Ashworth scale scores.The safety indicator will be the incidence of adverse events.This trial will collect data regarding the therapeutic effects of EMG-induced rehabilitation in patients with SCI receiving epidural electrical stimulation for 6 months after rehabilitation treatment.Findings from this trial will help develop rehabilitation methods in patients with SCI after epidural electrical stimulation.This study protocol was approved by Ethics Committee of Shanghai Ruijin Rehabilitation Hospital(Approval No.RKIRB2022-12)on February 15,2022 and was registered with Chinese Clinical Trial Registry(registration number:ChiCTR2200061674;date:June 30,2022).Study protocol version:1.0.

Psychometric properties of the interRAI subjective quality of life Instrument for mental health

A new Subjective Quality of Life (SQoL) Instrument for inpatient and community mental health settings was developed by the interRAI research collaborative to support evaluation of quality in mental health settings from the person’s perspective. Ratings of SQoL provide important information about the quality of service and patient experience with the care they receive. This information can help staff to improve approaches to each person’s plan of care in a manner that is meaningful to the individual. This study examined the reliability of the SQoL-MH. 83 inpatients from several clinical departments in a mental health center in South Western Ontario, Canada were randomly assigned to either be interviewed or complete the assessment on his or her own. Reliability was tested using Cronbach’s Alpha. A preliminary factor analysis points to four SQoL-MH subscales with very good internal consistency, ranging from 0.83 to 0.90. Once finalized, the Subjective Quality of Life instrument will be integral to the interRAI suite of instruments used to assess persons with mental health needs. A reliable and valid SQoL-MH instrument will allow mental health service providers to shape or modify care environments in order to enhance quality of life. In addition, the SQoL-MH instrument could also benefit advocacy groups who use reports on quality of life to influence social policy development and funding decisions.

Symptoms, Illness Perceptions, Self-Efficacy and Health-Related Quality of Life Following Colorectal Cancer Treatment

Introduction: Lower health-related quality of life (HRQoL) is associated with fatigue, poor mental and poor gastrointestinal health during the first three months after colorectal cancer (CRC) treatment. Research indicates that maintaining usual activities has a positive impact on HRQoL after treatment for CRC. Illness perceptions have been associated with HRQoL in other cancer diseases, and self-efficacy has been associated with HRQoL in gastrointestinal cancer survivors. Our knowledge about illness perceptions and self-efficacy in relation to maintaining everyday activities and HRQoL following CRC treatment is incomplete. Aim: To explore associations between HRQoL, fatigue, mental health, gastrointestinal health, illness perceptions and self-efficacy in relation to maintaining everyday activities, three months after surgical CRC treatment. A further aim was to test the Maintain Function Scale in a CRC population. Method: The study was cross-sectional. Forty-six persons participated. Data were collected using questionnaires. Descriptive and analytical statistics were used. Results: Persons who were more fatigued, depressed, worried, and had more diarrhea were more likely to report lower HRQoL. Increased fatigue and diarrhea were associated with decreased HRQoL. Concerning illness perceptions, persons who reported negative emotions and negative consequences of CRC were more likely to report lower HRQoL. Persons scoring higher on self-efficacy were more likely to report higher HRQoL. Increased self-efficacy was associated with increased HRQoL. The Maintain Function Scale was suitable for assessing self-efficacy in relation to maintaining everyday activities. Conclusions: Nursing support to improve self-efficacy and illness perceptions and to minimize symptoms during recovery should have a favorable impact on HRQoL.

TIP睡眠调控技术联合耳穴磁疗对乳腺癌患者围手术期睡眠质量的影响

目的观察低阻抗意念导入疗法(thought induction psychotherapy,TIP)睡眠调控技术联合耳穴磁疗对乳腺癌患者围术期睡眠质量、情绪状态和恢复质量的影响。方法将60例行乳腺癌手术的心肾不交证型失眠患者随机分为研究组和对照组,每组30例。对照组接受围手术期常规护理和耳穴磁疗,研究组在对照组基础上辅助TIP睡眠调控技术,每天1次,从术前1 d开始治疗至术后3 d。观察两组术前和术后3 d的匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、中医证候积分、临床疗效、焦虑自评量表(self-rating anxiety scale,SAS)评分和抑郁自评量表(self-rating depression scale,SDS)评分,以及15项恢复质量评分(quality of recovery-15,QoR-15)。结果治疗后,两组患者的PSQI各因子评分,SAS、SDS评分,中医证候积分均低于治疗前(P<0.05),且研究组睡眠质量、入睡时间、睡眠效率、睡眠障碍及日间功能障碍评分,SAS、SDS评分,中医证候积分下降幅度显著大于对照组(P<0.05)。治疗后,研究组总有效率为93.3%,明显高于对照组的66.7%。与对照组比较,研究组术后1、3 d QoR-15评分升高(P<0.05);与术前1 d比较,研究组术后1 d、3 d QoR-15评分降低(P<0.05);与术后1 d比较,研究组术后3 d QoR-15评分升高(P<0.05)。结论TIP睡眠调控技术联合耳穴磁疗可以减轻乳腺癌患者围手术期睡眠障碍,降低焦虑和抑郁水平,有助于提高患者的睡眠质量和术后恢复质量。

日间鼻科手术患者围术期出院准备度干预的效果观察

目的探讨日间鼻科手术患者围术期出院准备度干预的效果。方法选取2023年7月至2024年1月首都医科大学附属北京同仁医院接受日间鼻窦开放术的患者76例。采用随机数字表法将患者随机分为对照组及观察组,每组38例,对照组给予常规护理,观察组在常规护理的基础上实施以互联网为载体的智能平台和场景模拟的宣教、优化日间流程的关键环节,给予从院前-院中-院后全过程的信息支持等出院准备度干预措施。比较两组患者出院准备度、围术期焦虑评分、术后恢复质量(quality of recovery,QoR)及护理满意度。结果76例患者中,男43例、女33例,年龄21~65岁,平均(44.0±10.0)岁。观察组出院准备度评分中自身状况[(56.0±8.0)分比(49.8±10.0)分]、疾病认识[(65.6±14.0)分比(54.7±18.8)分]、出院后应对能力[(26.3±6.0)分比(22.9±4.7)分]及总分[(184.1±27.9)分比(167.5±29.6)分]均高于对照组;术前状态焦虑评分[(41.7±5.1)分比(46.2±4.6)分]和特质焦虑评分[(39.5±4.2)分比(45.3±3.4)分]、术后状态焦虑评分[(36.4±4.5)分比(41.3±3.8)分]及特质焦虑评分[(32.3±4.9)分比(41.8±4.1)分]均低于对照组;术后1 d的QoR[(116.9±4.7)分比(94.0±4.1)分]、术后7 d的QoR[(121.1±3.9)分比(103.1±4.4)分]及护理满意度[(94.2±1.6)分比(86.7±2.5)分]均高于对照组,差异均有统计学意义(P<0.05)。结论出院准备度干预能有效降低日间鼻科手术患者围术期焦虑,提升术后QoR及护理满意度。

快速康复外科理念下日间手术的麻醉与围术期质量控制

日间手术模式是一种加速康复理念下的手术诊疗康复体系,我国的日间手术正处于高速发展状态中,日间手术医疗质量管理也越来越受到重视。本文围绕日间手术的围术期管理进行了阐述,从患者选择、手术麻醉选择、术中管理、术后镇痛、术后恶心呕吐管理和出院随访等方面探讨了日间手术的管理细节,旨在建立统一的日间手术麻醉质量管理模式、进行全面的质量改进,为临床日间手术管理提供更恰当的日间手术管理方法,才能更好地促进日间手术的健康、快速、高效的发展。

高含水老油田化学驱综合治理新方法及工程实践路径

针对胜利高含水老油田化学驱在科学、技术、管理、工程四个角度面临的开发矛盾,以渤76块为典型单元,在工程实践中进行具体对策分析,构建了“适、专、快、集”的老油田化学驱综合治理新方法。“适”指在老油田科学开发方式转化上,构建不同油藏类型老油田化学驱最佳介入时机模型,提出了在含水率相对较低的阶段,是适合化学驱的有利时机,高效开发方式需“适”介入。“专”指在老油田开发技术应用上,改变传统聚合物先溶解后注入的开发思路,研制可控相转化聚合物,使聚合物先注入后溶解,解决炮眼剪切降解的难题,提高油水流度控制能力,老油田开发矛盾需“专”治理。“快”指在老油田综合管理模式上,改变传统方式,即矿场提问题、研究院设计方案、化工厂生产驱油剂的“串联”管理模式,提出充分发挥矿场、研究院、生产厂三方优势的“并联”管理模式,形成针对单一油藏的产品工业化工艺包以及产业化落地方案,老油田开发技术实现“快”转化。“集”指在老油田工程应用实践上,打破老油田化学驱地面大规模建站的工程工艺模式,采用集约化撬装配注设备,实现老油田化学驱的集约快速配注,老油田工程工艺实现“集”应用。运用上述方法,在胜利油田渤76块综合含水率上升初期,实施由水驱转为可控相转化聚合物驱,实施后一年即见到明显的降水增油效果,单井日产油水平增加8.6t/d,综合含水率降低3.1%,验证了综合治理模式的可行性,为高含水老油田化学驱高效开发提供了有效路径。

行为研究法视角下的快速康复护理在腹腔镜胆囊结石手术病人中的应用

目的:探讨基于行为研究法的快速康复干预在腹腔镜胆囊结石手术病人中的应用效果。方法:2021年8月—2022年8月选取腹腔镜胆囊结石手术病人104例为研究对象,采用随机数字表法将病人分为观察组(n=52)和对照组(n=52),对照组行常规护理,观察组实施基于行为研究法的快速康复干预,比较两组干预前后健康管理行为、术后康复情况及生活质量。结果:两组干预后健康行为量表(HPLP)评分、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分比较差异有统计学意义(P<0.001)。观察组首次下床活动时间、术后首次排气时间、恢复正常饮食时间、拔除腹腔引流管时间及住院时间均较对照组缩短,差异有统计学意义(P<0.001),观察组术后12 h疼痛视觉模拟评分(VAS)、并发症发生率及术后6个月结石复发率低于对照组,差异有统计学意义(P<0.05)。结论:基于行为研究法的快速康复干预能有效提升腹腔镜胆囊结石手术病人健康管理行为,促进病人术后康复,并能预防结石复发,改善病人生活质量。

不同性别对日间关节镜手术患者瑞马唑仑使用剂量及术后恢复质量的影响

目的 探讨性别对日间关节镜手术患者瑞马唑仑使用剂量以及术后24 h恢复质量(QoR)的影响。方法 选择预约在日间手术中心进行关节镜半月板修复术的患者50例,按照性别分为两组,其中男25例(M组),女25例(F组)。本研究主要观察两组在麻醉诱导失去意识和术中维持瑞马唑仑剂量的区别,以及采用QoR-15量表、阿森斯失眠(AIS)量表观察性别对术后睡眠和24 h恢复质量的影响。结果M组患者失去意识时瑞马唑仑剂量为0.14(0.13,0.15) mg/kg,麻醉维持剂量为0.80(0.60,0.96)mg/(kg·h);F组患者失去意识时瑞马唑仑剂量为0.14(0.12,0.16) mg/kg,麻醉维持剂量为0.90(0.79,1.12)mg/(kg·h),两组患者失去意识与麻醉维持的瑞马唑仑剂量差异均无统计学意义(P> 0.05)。两组对术后第1天睡眠的AIS总分影响差异无统计学意义(P> 0.05),但女性患者较男性患者更易发生低血压和PONV,术后比期望中更早醒及QoR-15总分、生理舒适度分数降低,差异有统计学意义(P <0.05)。结论 性别对日间关节镜患者瑞马唑仑麻醉诱导剂量及麻醉维持剂量影响较小,但女性患者术后睡眠清醒时间更早,男性患者术后24 h恢复质量较高。

胸肋间筋膜阻滞对心脏瓣膜置换术后早期恢复质量的影响

目的探讨胸肋间筋膜阻滞(PIFB)对心脏瓣膜置换术后早期恢复质量的影响。方法选择择期行正中切口心脏瓣膜置换术患者80例,男45例,女35例,年龄44~75岁,BMI 18~30 kg/m 2,ASAⅡ或Ⅲ级,随机分为两组:全麻联合PIFB组(P组)和全麻组(C组),每组40例。P组麻醉诱导后行双侧胸肋间筋膜平面阻滞,C组不行神经阻滞,术后均使用舒芬太尼静脉自控镇痛。采用15项恢复质量评分量表(QoR-15)评价术前24 h、术后24、72 h恢复情况,记录诱导前、切皮时、锯胸骨时、关胸时、出手术室时的HR和MAP,拔管后4、8、12 h静息和活动(咳嗽)时VAS疼痛评分。记录术中和术后48 h内舒芬太尼用量、拔管时间、重症监护病房(ICU)停留时间、术后首次肛门排气时间、术后住院时间,术后恶心呕吐、低血压、呼吸抑制等不良反应的发生情况和住院期间死亡情况。结果与C组比较,P组术后24、72 h QoR-15评分明显升高(P<0.05),拔管后4、8、12 h静息和活动时VAS疼痛评分明显降低(P<0.05),术中和术后48 h内舒芬太尼用量明显减少(P<0.05),拔管时间、术后首次肛门排气时间、ICU停留时间明显缩短(P<0.05),术后恶心呕吐发生率明显降低(P<0.05)。两组不同时点HR和MAP、术后住院时间、住院期间死亡率差异无统计学意义。P组未发生神经阻滞相关并发症。结论PIFB可以降低正中切口心脏瓣膜置换手术患者术后疼痛,提高术后恢复质量,促进术后康复。