Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future mana...Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.Data sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.Results: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.Conclusion: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.展开更多
Objective: To confirm that acupuncture applied to patients would improve the clinical curative effect and accelerate the patienfs recovery by introducing the application of acupuncture in pre-operation, during operati...Objective: To confirm that acupuncture applied to patients would improve the clinical curative effect and accelerate the patienfs recovery by introducing the application of acupuncture in pre-operation, during operation, and post-operation. Data sources: Literature cited in this review was retrieved from PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) and was primarily published in English or Chinese from 2010 to 2018, with keywords of "acupuncture,""electroacupuncture," uperioperative period,"usedation,""analgesia," and "recovery." Relevant citations in the retrieved articles were also screened to include more data. Study selection: All retrieved literature was scrutinized, most typical articles related on perioperative acupuncture application in clinical study were reviewed. Results: Acupuncture could relieve anxiety and stress during the preoperative stage. It reduces the usage of narcotics and stress response, and maintains the respiratory stability and homeostasis during surgery. It also exerts a protective effect on vital organs, and during the postoperative stages, enhances the recovery while effectively alleviating the postoperative pain. This phenomenon prevents common postoperative discomforts such as nausea and vomiting. In addition, it might improve the patients, long-term prognosis. Conclusions: The novel concept uperioperative acupuncture medicine55 is to focus on the optimal treatment in the perioperative period of surgical patients. The review reveals the important role of acupuncture in enhancing rapid recovery of patients during the perioperative period.展开更多
AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from No...AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.展开更多
目的探讨股骨粗隆间骨折患者围手术期隐性失血的特点和影响因素。方法回顾性研究2008年1月至2010年12月我科行手术治疗的股骨粗隆间骨折患者68例,其中男35例,女33例;年龄34～92岁,平均年龄(76.4±3.4)岁。动力髋螺钉内固定(dynamic ...目的探讨股骨粗隆间骨折患者围手术期隐性失血的特点和影响因素。方法回顾性研究2008年1月至2010年12月我科行手术治疗的股骨粗隆间骨折患者68例,其中男35例,女33例;年龄34～92岁,平均年龄(76.4±3.4)岁。动力髋螺钉内固定(dynamic hip screw,DHS)32例,根据Evans-Jensen分型,Ⅰb型20例,Ⅱa型12;防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)内固定患者36例,其中Ⅱb型16例,Ⅲ型20例。肥胖组38例(BMI大于30),非肥胖组(BMI小于等于30)30例。高龄组(年龄大于等于80岁)32例,非高龄组(年龄小于80岁)36例。所有病例均为初次单侧新鲜股骨粗隆间骨折患者,术后24h补液总量不超过2000mL即可维持正常血压。通过Gross方程,根据身高、体重和手术前后的红细胞压积(Hct)计算患者的失血总量,减去显性失血量即为隐性失血量。结果所有患者平均失血总量为871mL,其中平均显性失血量149mL,平均隐性失血量722mL,显性失血和隐性失血占失血总量的比例分别为17.1%和82.9%,隐性失血量远多于显性失血量。DHS组与PFNA组间、男女组间和肥胖组与非肥胖组间的术后失血无显著性差异,高龄组术后失血总量和隐性失血量大于非高龄组。结论隐性失血是股骨粗隆间骨折手术围手术期失血的主要原因,应予以关注并及时补充血容量,手术方式、性别和肥胖不是隐性失血的危险因素,高龄是隐性失血的危险因素,应特别重视高龄患者的隐性失血,注意及时补充血容量,帮助患者安全度过围手术期。展开更多
AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation pro...AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.展开更多
文摘Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.Data sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.Results: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.Conclusion: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy.
文摘Objective: To confirm that acupuncture applied to patients would improve the clinical curative effect and accelerate the patienfs recovery by introducing the application of acupuncture in pre-operation, during operation, and post-operation. Data sources: Literature cited in this review was retrieved from PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) and was primarily published in English or Chinese from 2010 to 2018, with keywords of "acupuncture,""electroacupuncture," uperioperative period,"usedation,""analgesia," and "recovery." Relevant citations in the retrieved articles were also screened to include more data. Study selection: All retrieved literature was scrutinized, most typical articles related on perioperative acupuncture application in clinical study were reviewed. Results: Acupuncture could relieve anxiety and stress during the preoperative stage. It reduces the usage of narcotics and stress response, and maintains the respiratory stability and homeostasis during surgery. It also exerts a protective effect on vital organs, and during the postoperative stages, enhances the recovery while effectively alleviating the postoperative pain. This phenomenon prevents common postoperative discomforts such as nausea and vomiting. In addition, it might improve the patients, long-term prognosis. Conclusions: The novel concept uperioperative acupuncture medicine55 is to focus on the optimal treatment in the perioperative period of surgical patients. The review reveals the important role of acupuncture in enhancing rapid recovery of patients during the perioperative period.
基金Supported by National Natural Scientific Foundation of China,No.31100643
文摘AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.
文摘目的探讨股骨粗隆间骨折患者围手术期隐性失血的特点和影响因素。方法回顾性研究2008年1月至2010年12月我科行手术治疗的股骨粗隆间骨折患者68例,其中男35例,女33例;年龄34～92岁,平均年龄(76.4±3.4)岁。动力髋螺钉内固定(dynamic hip screw,DHS)32例,根据Evans-Jensen分型,Ⅰb型20例,Ⅱa型12;防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)内固定患者36例,其中Ⅱb型16例,Ⅲ型20例。肥胖组38例(BMI大于30),非肥胖组(BMI小于等于30)30例。高龄组(年龄大于等于80岁)32例,非高龄组(年龄小于80岁)36例。所有病例均为初次单侧新鲜股骨粗隆间骨折患者,术后24h补液总量不超过2000mL即可维持正常血压。通过Gross方程,根据身高、体重和手术前后的红细胞压积(Hct)计算患者的失血总量,减去显性失血量即为隐性失血量。结果所有患者平均失血总量为871mL,其中平均显性失血量149mL,平均隐性失血量722mL,显性失血和隐性失血占失血总量的比例分别为17.1%和82.9%,隐性失血量远多于显性失血量。DHS组与PFNA组间、男女组间和肥胖组与非肥胖组间的术后失血无显著性差异,高龄组术后失血总量和隐性失血量大于非高龄组。结论隐性失血是股骨粗隆间骨折手术围手术期失血的主要原因,应予以关注并及时补充血容量,手术方式、性别和肥胖不是隐性失血的危险因素,高龄是隐性失血的危险因素,应特别重视高龄患者的隐性失血,注意及时补充血容量,帮助患者安全度过围手术期。
基金Supported by Social Development Fund of Jiangsu Province,No. BS2007054
文摘AIM:To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS:One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge,while 104 consecutive patients underwent conventional care after resection of colorectal cancer.Their gastrointestinal functions,postoperative complications and hospital stay time were recorded.RESULTS:The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care(2.1 d vs 3.2 d,P < 0.01).The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(13.2% vs 26.9%,P < 0.05).Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care(6.6% vs 15.4%,P < 0.05).The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care(5 d vs 7 d,P < 0.01).No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care(3.8% vs 8.7%).CONCLUSION:The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.
