全程护理干预对产后抑郁的影响

目的 探讨系统健康教育对胃大部切除术患者术后恢复及与进食有关的并发症的影响。方法 将行胃大部切除术的98例胃、十二指肠溃疡病患者按入院顺序分为对照组（48例）和观察组（50例）。对照组进行常规护理与健康教育，观察组对患者及家属实施系统健康教育。观察记录患者术后肛门首次排气时间、倾倒综合征发生率及住院时间。结果 两组术后肛门首次排气时间、倾倒综合征发生率及住院时间比较，差异有显著性意义（P〈0．05，P〈0．01）。结论 对患者实施系统健康教育可有效促进胃大部切除患者术后肠功能的恢复，减少与进食有关并发症的发生，缩短住院时间。     

胃术后倾倒综合征

倾倒综合征 (ｄｕｍｐｉｎｇｓｙｎｄｒｏｍｅ)是胃大部切除术和各式迷走神经切断术附加引流性手术后常见的并发症。 1913年Ｈｅｒｔｚ首先将胃术后患者进食后的一系列症状与胃排空过速联系在一起 ;而倾倒综合征的概念是由Ａｎｄｒｅｗ和Ｍｉｘ于 192 0年提出的 ,他们应用放射性核素显影的方法对某些具有一系列循环及胃肠道系统症状的胃术后患者进行观察 ,发现其体内胃排空过快。目前人们对手术的要求不仅仅是要根治疾病 ,而且要求尽可能的不影响生活质量 ,因此临床医生应加强对胃术后倾倒综合征的认识 ,以便对其进行更好的防治。症状与诊断…     

胃大部切除手术患者的健康教育

胃大部分切除是普外科一种常见的手术，由于该手术对病人的打击较大，患者往往伴有巨大的心理压力。因此，加强胃大部分切除手术病人的健康教育非常重要。我科自从2001年开展整体护理以来，针对胃大部分切除病人的特点，进行了有计划的健康教育，效果理想，简述如下。     

护士及胃大部切除术后患者对术后饮食的认知

目的 了解护士及胃大部切除术后患者对术后饮食的认知情况.方法 采用自设护士及胃大部切除术后患者对术后饮食知识问卷,对北京市某三级甲等医院的58名普通外科护士和45例胃大部切除术后患者进行调查.结果 护士对胃大部切除术后饮食知识得分64.7±11.2,患者得分65.5±14.2,两者比较,差异无统计学意义(P>0.05);护士和患者得分较低的前5项均包含拔胃管当天每次饮水量、拔胃管当天饮水间隔时间、清流食的种类、容易形成胃结石的食物、不宜进食的食物;护士和患者有关胃大部切除术后饮食知识的来源不同.结论 护士与患者对胃大部切除术后饮食知识了解不足,应加强对护士有关临床营养知识的继续教育,落实对患者术后饮食知识的健康教育.     

胃大部切除术后残胃胃瘫综合征临床分析

目的探讨胃大部切除术后残胃胃瘫综合征的发生原因、诊断及治疗。方法回顾性分析2007-01～2010-01施行胃大部分切除术后发生残胃胃瘫综合征8例患者的临床资料。结果本组病例均于术后10～48d(平均25.3d)通过保守治疗恢复胃动力,其中2周内恢复1例,3周内2例,4周内3例,4周者2例,无再次手术者,6月后随访无复发。结论胃大部切除术后残胃胃瘫综合征在术前流出道梗阻、胃肠毕Ⅱ式吻合的病人中发病率较高,患者经过6周的非手术治疗后,多数可以缓解恢复,从而避免了二次手术的痛苦。     

胃促生长素对胃大部切除大鼠术后早期恢复的影响

目的探讨应用外源性胃促生长素(ghrelin)对胃大部切除术后大鼠早期恢复的影响。方法将12只胃大部切除(毕Ⅰ式)大鼠随机均分为2组,分别于腹腔内注射生理盐水或胃促生长素,称量术前和术后1~7 d的大鼠体重和每日摄食量;术后第7天处死大鼠,实时荧光定量PCR法测定大鼠胃底组织中胃促生长素mRNA表达相对量,并检测吻合口爆破压和吻合口组织中羟脯氨酸含量。结果 2组大鼠之间术前及术后1~7 d体重的差异均无统计学意义(P>0.05)。生理盐水组大鼠体重术后逐渐降低,并均明显低于术前(P<0.01),且在术后第5天达到最低(P<0.01),后逐渐增加,但仍均低于术前(P<0.01);胃促生长素组大鼠体重术后逐渐降低,除术后1 d与术前比较的差异无统计学意义(P=0.693)外,均明显低于术前(P<0.01),在术后第4天达到最低(P<0.01),后逐渐增加,但仍均低于术前(P<0.05或P<0.01)。胃促生长素组大鼠的累积摄食量为(52.50±6.77)g,明显高于生理盐水组大鼠的(45.67±7.47)g,P<0.05。术后第7天胃促生长素组大鼠胃底组织中胃促生长素mRNA表达相对量为0.08±0.04,明显低于生理盐水组大鼠的0.22±0.07(P<0.01)。胃促生长素组大鼠吻合口爆破压为(172.33±10.44)mm Hg(1 mm Hg=0.133 kPa),明显高于生理盐水组的(155.83±6.62)mm Hg,P<0.05。胃促生长素组大鼠吻合口组织中羟脯氨酸含量为(0.50±0.29)μg/mg wet tissue,明显高于生理盐水组大鼠的(0.43±0.05)μg/mg wet tissue,P<0.01。结论 胃促生长素能有效促进胃大部切除术后大鼠的早期恢复,而外源性胃促生长素的摄入可抑制机体术后早期的负反馈性代偿作用。     

胃大部切除术后胃瘫综合征患者的心理干预

目的 探讨心理干预对胃大部切除术后胃瘫综合征(PGS)患者焦虑及胃肠功能的影响.方法 将60例PGS患者随机分为对照组和观察组各30例.对照组给予常规治疗和护理;观察组在此基础上评估患者需求,讲解与分析PGS发生原因等知识,给予松弛疗法、腹部按摩及家庭干预等心理干预措施.连续干预15 d后评价效果.结果 干预后观察组焦虑评分显著低于对照组(P<0.01),胃肠功能各项指标显著优于对照组(均P<0.01).结论 心理干预可有效缓解PGS患者的焦虑状况,促进胃肠功能恢复.     

预防术后肠胃反流的胃大部切除手术

胃大部切除术后患者易出现肠胃返流情况,尤其以传统Billroth-Ⅱ（B-Ⅱ）式发生较多,主要表现为剑突下烧灼样疼痛、反酸以及呕吐等,严重影响患者的日常生活[1-3]。     

胃大部切除术后胃瘫综合征患者的心理干预

目的探讨心理干预对胃大部切除术后胃瘫综合征（PGS）患者焦虑及胃肠功能的影响。方法将60例PGS患者随机分为对照组和观察组各30例。对照组给予常规治疗和护理;观察组在此基础上评估患者需求,讲解与分析PGS发生原因等知识,给予松弛疗法、腹部按摩及家庭干预等心理干预措施。连续干预15d后评价效果。结果干预后观察组焦虑评分显著低于对照组（P〈0．01）,胃肠功能各项指标显著优于对照组（均P〈0．01）。结论心理干预可有效缓解PGS患者的焦虑状况,促进胃肠功能恢复。     

预防术后肠胃反流的胃大部切除手术

目的探讨预防胃大部切除术后碱性反流性胃炎的术式。方法回顾性分析42例行胃大部切除术患者的临床资料。分为传统Billroth-Ⅱ(B-Ⅱ)式组和改良B-Ⅱ式组各21例,对2组患者术后碱性反流性胃炎发生情况进行比较。结果传统B-Ⅱ式组胃肠引流液量平均为(330±35)mL,而改良B-Ⅱ式组胃肠引流液量平均为(105±20)mL,2组间比较差异有统计学意义(P0.05)。结论与传统B-Ⅱ式相比,改良B-Ⅱ式碱性反流性胃炎发生率明显降低。     

留置镇痛泵对胃癌术后患者恢复的影响

对39例股骨头缺血性坏死患儿采用患侧髂动脉药物灌注,术前、术后配合患肢持续皮牵引治疗。结果患儿行皮牵引均未出现水泡、破渍等反应。经过1～3年门诊随访,髋关节疼痛消失,X线平片显示患侧股骨头不同程度的修复。提出术前心理护理、皮牵引的护理．术后患肢血液循环及穿刺局部观察是其重点。     

Complications After Sleeve Gastrectomy for Morbid Obesity

Background  Laparoscopic sleeve gastrectomy (LSG) is an increasingly used bariatric surgical procedure. Methods  We report our complications after LSG and compared to 17 other published LSG series. The individual types of complications for the published series were evaluated, with sample size calculations being performed to determine the number of patients required for a study that would detect halving the odds of the most common complications. Results  Of 53 patients who underwent LSG, 42 were women. Mean age was 51 years with a mean initial body mass index of 53.5 kg/m² and mean of eight comorbidities. Mean excess weight loss was 52.2% at 12 months and 59.2% at 18 months. No patients died. Five patients (9.4%) developed complications which included two staple line leaks that required reoperations, one preceded by a salmonella infection associated with vomiting, the other by postoperative pneumonia associated with coughing. Of the three staple line hemorrhages, one required hospitalization. The median complication rate for the 17 articles was 4.5%. With the number of patients for each series taken into account, the current series had a complication rate of 1.24 (95% CI 0.45–2.87) times that of the 17 published series. Published LSG complications were diverse, with the most common being reoperation, occurring after 3.6% of procedures. A study designed to detect halving the odds of reoperation would require more than 3,000 procedures. Conclusion  LSG is a safe procedure with low morbidity. Because leaks and reoperation in this series were preceded by large increments in intraabdominal pressure, attention to staple line reinforcements that increase burst pressure may be warranted. Paper presented at the North Texas ACS meeting in Dallas on February 21, 2008. Received award as best paper in GI surgery.     

Severity of Complications After Gastrectomy in Elderly Patients With Gastric Cancer

Background

The risk of surgery for gastric cancer has not been fully evaluated, and this study aimed to assess the severity of postoperative complications after D2 or modified D2 gastrectomy in elderly patients.

Methods

Eligible patients were retrospectively selected from the Kanagawa Cancer Center database between 1990 and 2009 based on the following criteria: age ≥80?years and D2 or modified D2 gastrectomy as a primary treatment for gastric cancer. The severity of complications was evaluated using the Clavien–Dindo classification.

Results

A total of 83 patients with a median age of 82?years (range 80–88?years) were entered in this study. Sixty (72?%) had at least one co-morbid condition. American Society of Anesthesiologists scores were 2 in 66 patients and 3 in 17 patients. The extent of gastrectomy was distal in 65 (78?%) and total in 18 (22?%) patients. The procedure used for lymphadenectomy was modified D2 in 38 (46?%) and D2 in 45 (54?%) patients. Altogether, 18 complications were observed in 15 patients. The overall morbidity rate was 18?% [95?% confidence interval (CI) 9.7–26.2?%], and the mortality rate was 3.6?% (95?% CI 0–7.6?%). Complications were classified as grade 2 (n?=?9), grade 3a (n?=?1), grade 3b (n?=?4), grade 4 (n?=?1), and grade 5 (n?=?3). Severe complications (≥ grade 3) occurred in 8.4?% (95?% CI 2.4–14.4?%).

Conclusions

The morbidity rate was acceptable, but that of severe complications was high, suggesting that surgery for gastric cancer in elderly patients is risky and should be limited.     

Gastric Emptying After Pylorus-Preserving Gastrectomy in Comparison with Conventional Subtotal Gastrectomy for Early Gastric Carcinoma

(Received for publication on Oct. 14, 1996; accepted on May 12, 1997)     

健康教育对腹腔镜胆囊切除术后患者胃肠道功能恢复的影响

目的探讨健康教育对腹腔镜胆囊切除术(LC)患者术后胃肠道功能恢复的影响。方法将行LC的60 例患者,随机分为观察组与对照组各30例。对照组给予常规指导,观察组给予系统化一对一健康指导。结果观察组饮食护理知识掌握率显著高于对照组,术后肛门排气时间、进食时间显著短于对照组(均P<0.05)。结论做好围手术期的健康教育有利于患者术后胃肠道功能的恢复。     

胃大部切除与胃肠重建

胃大部切除术又称胃次全切除术 ,切除包括胃体大部、胃窦部、幽门及部分十二指肠球部 (图 1) ,范围为胃远端的 2 /3～3/4(75 %左右 ) ,即最高二支胃短动脉为止。该手术主要用于治疗胃及十二指肠溃疡病及其并发症、胃癌等疾病。现主要介绍胃大部切除后 ,残胃与肠道吻合的经典术式。1　ＢｉｌｌｒｏｔｈⅠ式与ＢｉｌｌｒｏｔｈⅡ式及其改良术式1 1　手术发展史Ｂｉｌｌｒｏｔｈ (ＴｈｅｏｄｏｒＢｉｌｌｒｏｔｈ) (182 9 1894)生于奥地利贝尔根 ,先后任苏黎士大学 (186 0 186 7)和维也纳大学 (186 7 1894)外科教授 ,是现代腹部外科学的奠基人…     

健康教育对精神分裂症患者康复的影响

目的探讨健康教育对精神分裂症患者的疗效及满意度的影响。方法将164例精神分裂症患者随机分成观察组与对照组各82例。观察组实施有目的、有计划的健康教育、阳性强化疗法和心理支持。对照组采用常规健康教育。结果两组BPRS评分及疾病知晓情况、健康教育满意度评分比较，差异有显著性意义（P〈0．05，P〈0．01）。结论健康教育对精神分裂症患者的康复有促进作用。