Objective To explore the application of fast track surgery (FTS) mode through multidisciplinary cooperation for the perioperative period of liver cancer. Methods A total of 188 patients with liver cancer treated between April and December 2014 were randomly divided into two groups: FTS group (n=94) and control group (n=94). The FTS group was treated with multidisciplinary cooperative FTS mode, while the control group was treated with traditional perioperative treatment. The self-care ability of daily life, pain, ambulation time and frequency, anal exhaust time, defecation time, hospital stay, hospitalization expenses and readmission rate were compared between the two groups. Results Compared with the control group, patients in the FTS group had a better ability of self-care one to three days after surgery, more reduced pain 8, 24 and 48 hours after surgery, more frequent ambulation and longer ambulation time three days after surgery, shorter time of defecation and exhaust, shorter hospital stay and lower hospitalization expenses. All the above differences were statistically significant (P<0.05). The readmission rate, self-care ability four to seven days after surgery, pain scores 72 and 96 hours after surgery were not significantly different (P>0.05). Conclusion Multidisciplinary cooperative FTS mode for liver cancer perioperative rehabilitation can improve patients’ self-care ability, promote a speedy recovery, reduce hospitalization costs, save medical resources and improve disciplinary teamwork ability.
ObjectiveTo explore the continuous care demands in liver transplant recipients and the influencing factors. MethodFrom October to December 2013, 235 liver transplant recipients were investigated with self-designed questionnaire to learn their continuous care demands. Factors affecting demands for continuous care were analyzed with single factor Chi square analysis and binary logistic regression analysis. ResultsA total of 130 recipients (55.3%) needed continuous care. Single factor chi-square analysis showed that three factors including complications, re-hospitalization and time to get to the nearest medical organization were significant for continuous care demands (P<0.05). Binary logistic regression analysis showed that the longer the time spent by liver transplant recipients to reach the nearest medical organization was, the more they hoped for continuous care[OR=3.040, 95%CI (1.585, 5.829), P=0.001]; the patients with readmisson within one year after surgery hoped less continuous care[OR=0.515, 95%CI (0.292, 0.907), P=0.022]. ConclusionsAt present, acceptance degree for continuous care in the liver transplant recipients is quite high. In the continuous care research and practice, we should develop new models and tools to shorten the time and distance between nurses and patients so as to meet the individualized care demands of the patients and improve their quality of life.
【摘要】 目的 总结血管腔内覆膜支架植入术治疗腹主动脉瘤患者围手术期并发症的预防、观察和临床护理要点。 方法 对2008年1-8月行血管腔内覆膜支架植入术治疗的27例腹主动脉瘤患者的临床资料进行回顾性分析。 结果 27例手术均获成功，术后未发生严重并发症，治疗及护理效果良好。 结论 有效的护理措施是保证治疗成功的重要因素。【Abstract】 Objective To summarize and analyze the prevention, observation and clinical care of perioperative complications in patients with abdominal aortic aneurysm (AAA). Methods We retrospectively analyzed the clinical data of 27 patients with AAA who underwent endovascular covered stent grafting surgery in our hospital from January to August 2008. Results With appropriate treatment and good care, all grafting surgeries were successful without any severe postoperative complications. Conclusion Effective care measures are an important factor to ensure successful treatment.
Objective To analyze the risk factors associated with fungal infections in adult recipients after living donor liver transplantation (LDLT). Methods Data of 189 recipients from January 2006 to December 2012 who received LDLT at our center were retrospectively analyzed. Cox regression analysis was used to analyze the risk factors for postoperative fungal infections. Results Postoperative fungal infection was found in 12 recipients. The most common infectious site was lung, whereas the most common fungal pathogen was Candida albicans. Multivariate analysis suggested preoperative low albumin level [HR=0.792, 95%CI (0.694, 0.903), P=0.001], massive intraoperative red blood cell transfusion [HR=4.322, 95%CI (1.308, 14.277), P=0.016] and longer postoperative intensive care unit (ICU) stay [HR=3.399, 95%CI (1.004, 11.506), P=0.049] were the independent risk factors for postoperative fungal infections. Conclusions Lung is the most common fungal infection site after LDLT. Preoperative low albumin level, massive intraoperative red blood cell transfusion and longer postoperative ICU contribute to fungal infections after LDLT.
Objective To investigate the status quo of implementation ofIntravenous Practice Standard in a tertiary A hospital in Sichuan. Methods At 09:00-11:30 am, on March 16th, 2016, a questionnaire designed by intravenous team (IV Team) was used to conduct the investigation in all the inpatiets according to inclusion and exclusion criteria. The SPSS 17.0 software was used to perform all statistical analysis. Results The intravenous infusion rate in the hospital was 76.87%, while the rate in Emergency Department peaked up to 96.11%. Indwelling needle was the most common used device for intravenous therapy in clinical practice, which was used in 77.91% of the inpatients, and steel needle, peripherally inserted central catheter (PICC), central venous catheter, and implantable venous access port were also widely used. Peripheral intravenous catheter was used in 2 990 inpatients, and 78.12% of the puncture sites met the standard; PICC was used in 397 inpatients, and 90.17% of the puncture sites met the standard. The incidence of intravenous infusion related-complications was 15.08%, the incidence of drug exosmosis / exudation was 10.06%, and the incidence of catheter-related blood stream infection (CRBSI) was 2.89%. Conclusions On the whole, the intravenous infusion rate in this hospital accords with the national average level, but the rate in some departments should be controlled. The selection of device for intravenous therapy is reasonable, but the selection of intravenous site should be more standardized. The incidence of intravenous infusion related-complications is low, but the prevention and control of drug exosmosis / exudation and CRBSI should be reinforced. Health care organizations should pay more attention to enforce the Intravenous Practice Standard into practice to promote clinical medical service.
ObjectiveTo analyze the relevant literatures on the use of midline catheters in China, and to provide references for further studies of midline catheters.MethodsAll literatures related to midline catheters from the date of database establishment to February 2019 were searched in the China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), Wan-Fang Database, and China Biomedical Literature Database (CBM). Bibliometric analysis methods were used to analyze the search results.ResultsTotally 47 articles related to midline catheters were recruited and the number of publications increased in recent years. About 44.68% papers were focused on introducing experiences of the operation process, nursing points, prevention and treatment of complications, and about 38.30% papers were observational studies about indwelling time of midline catheters and complications rate.ConclusionsMore and more attention has been paid to the midline catheters, but further studies with large samples and high quality are still needed, in order to provide more evidence for the application and popularization of midline catheters in China, and choose a safe, comfortable, convenient, low-cost and high-benefit intravenous infusion device for patients.
Objective To systematically evaluate effects of enhanced recovery after surgery (ERAS) programme on clinical outcomes of liver resection during perioperative period. Methods The randomized controlled trials (RCTs) of comparing ERAS programme with traditional care programme in patients underwent liver resection were searched by Wanfang, VIP, CNKI, PubMed, Embase, and Cochrane Library databases from inception to January 2016. The quality of the included RCT was assessed independently according to the Cochrane handbook–version 5.1.0 by two reviewers. Meta-analysis was conducted for the eligible RCTs by using RevMan 5.3.0. Results Seven RCTs containing 844 patients were included in this meta-analysis. There were 35 cases of benign tumor, 809 cases of malignant tumor. The ERAS programmes were performed in 415 patients, while the traditional care programmes were performed in 429 patients. Compared with the traditional care programme, the overall complications rate and the Dindo-Clavien grade Ⅰ complications rate were significantly lower〔OR=0.59, 95%CI (0.41, 0.87),P=0.007;OR=0.45, 95%CI (0.27, 0.76),P=0.002〕, the hospital stay and the first anal exhaust time were significantly shorter〔WMD=–2.66, 95%CI (–3.64, –1.69),P<0.000 01;WMD=–20.25, 95%CI (–32.08, –8.42),P=0.000 8〕 in the ERAS programme, but there was no statistically significant difference of the Dindo-Clavien grade Ⅱ–Ⅳ complications rate between these two groups〔OR=0.93, 95%CI (0.53, 1.63),P=0.80〕. Conclusions ERAS is a safe and effective programme in liver resection during perioperative period. Future studies should define active elements to optimize postoperative outcomes for liver resection.