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find Keyword "围手术期管理" 13 results
  • 中老年继发孔型房间隔缺损的外科治疗

    目的 总结中老年(年龄≥40岁)继发孔型房间隔缺损的外科治疗经验。 方法 回顾性分析昆明市延安医院2000年1月至2007年9月手术治疗89例年龄大于40岁继发孔型房间隔缺损患者的临床资料,年龄40~68岁(平均年龄47.8岁),其中上腔型房间隔缺损23例、下腔型房间隔缺损31例,中央型房间隔缺损29例,混合型6例。全组均在全身麻醉低温体外循环下施行手术,均予涤纶补片修补房间隔缺损,合并三尖瓣关闭不全者同期行三尖瓣成形术。 结果 全组无死亡及严重并发症发生,术后平均住院时间13 d(9~37 d),术后1周复查右房室内径较术前明显缩小,随访3个月~8年,心功能及健康状况良好。 结论 中老年继发孔型房间隔缺损手术治疗效果良好;如无介入封堵术指征或伴中度以上三尖瓣关闭不全者均应手术治疗,补片修补及术中积极处理合并的三尖瓣关闭不全有利于术后恢复。

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • Completion Rate of Fast Track Items in Postoperative Management of Colorectal Cancer Surgery: What Are The Impacts?

    Objective To discuss the impacts of completion rate of fast track items on postoperative management of colorectal cancer surgery. Methods Between February 2010 and May 2010, 100 patients (Group “Year 2010”) were analyzed retrospectively, who were compared with 76 patients (Group “Year 2008”) from the same period of 2008. Postoperative recovery indexes, complications, and completion rate of fast track items were studied and compared. Results For major fast track items, the completion rates of restrict rehydration, early out-of-bed mobilization, early oral intaking, and management of gastric tube and drains were significantly higher in Group “Year 2010” than those in Group “Year 2008” (Plt;0.05). Meanwhile, the completion rate of urinary catheter management was significantly higher in Group “Year 2008” than that in Group “Year 2010” (Plt;0.05). In early rehabilitation, the first flatus of patients in Group “Year 2010” 〔(3.86±1.05) d〕 was significantly earlier than that in Group “Year 2008” 〔(4.28±1.22) d〕, Plt;0.05; for postoperative hospital stay, though, there was no statistically significant difference between two groups (Pgt;0.05). As to the complications, there was also no statistically significant difference between two groups (Pgt;0.05). Conclusions As the concepts of fast track surgery became increasingly favorable, completion rates of fast track items are increased. As a result, more and more fast track items turn into regular perioperative care. Although enhanced recovery has been achieved, better collaboration and localilzation are still needed to make the full advantage of fast track surgery.

    Release date:2016-09-08 10:50 Export PDF Favorites Scan
  • 麻醉医师主导的快速康复技术在日间手术中的应用

    麻醉医师主导的快速康复技术是指麻醉医师在已有临床证据的基础上,通过改进患者术前准备、优化术中管理、加快患者术后恢复等一系列围手术期管理措施,加速患者康复。将该技术应用于日间手术的围手术期管理,可以进一步加快患者术后恢复,缩短在院时间,减少整体医疗费用,进而促进医疗资源的合理利用,提高患者满意度。现就麻醉医师主导的快速康复技术在日间手术的应用作一综述,以便更多的临床医生了解快速康复技术并应用于日间手术的管理。

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  • Reasons for Delayed Discharge after Total Knee Arthroplasty under Fast-track Recovery Model

    Objective To illustrate the situation of delayed discharge of patients after total knee arthroplasty (TKA) under fast-track (FT) recovery model, and analyze the reasons. Methods We retrospectively analyzed the clinical data of 152 patients who accepted perioperative management under fast-track model from January to December 2014. The reasons for discharging over 72 hours after hospitalization were analyzed. Results Among the 152 patients, 119 were discharged over 72 hours after surgery, and the rate was 78.2%. The main reasons for delayed discharge were pain (32.8%), limited range of motion (31.9%) and unwillingness to be discharged (27.7%), respectively. Conclusion For patients who have undergone TKA, FT model can shorten hospital stay, save expenses, and accelerate postoperative rehabilitation, but there is still much room for improvement.

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  • Per-ventricular Device Closure of Doubly Committed Sub-arterial Ventricular Septal Defect ——Technical Consideration and Perioperative Management

    Doubly committed sub-arterial ventricular septal defect (VSD) is a unique type of VSD which is located beneath both the aortic and pulmonary valve. Open-heart repair is traumatic especially for pediatric patient while trans-catheter device closure is also not suitable for this type of VSD. Minimally invasive per-ventricular device closure has been introduced as an alternative method in the treatment of doubly committed VSD with encouraging results. In the review, we will illustrate the surgical technique as well as perioperative management strategy as for this technique in treating doubly committed VSD.

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  • Enhanced Recovery after Surgery Protocol Applying in Perioperative Treatment: Current Status and Issues

    The concept of enhanced recovery after surgery(ERAS) has been well accepted by medical providers, which can be realized by a multidisciplinary team approach and minimally invasive surgical technology performed during perioperative periods. As the outcomes of the ERAS protocols, well effects are anticipated, and consistent outcomes are actually obtained. At the same time, there are some aspects which are not consistent including ① the evolution and challenge of ERAS concept:connotation and extension, ② consensus and arguments on the evaluation standard of ERAS protocol, ③ the cause of poorly compliance in medical providers and patient, ④ the function of multimodal programme and multidisciplinary team approach in ERAS protocol, which one is better? ⑤ methods and barriers of implementing enhanced recovery in clinic application.

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  • 直肠癌合并疑似分泌多巴胺的嗜铬细胞瘤一例

    Release date:2021-06-18 03:02 Export PDF Favorites Scan
  • Effect of enhanced recovery after surgery on perioperative management of elderly patients with intertrochanteric fractures

    ObjectiveTo explore the clinical effect of applying the concept of enhanced recovery after surgery (ERAS) to the perioperative management of elderly patients with intertrochanteric fractures.MethodsThe clinical data of 64 elderly patients with intertrochanteric fractures admitted to West China Hospital of Sichuan University from January 2016 to December 2017 were retrospectively analyzed. Among them, 32 patients admitted from January to December in 2017 were in ERAS group, and 32 patients admitted from January to December 2016 were in control group. The control group used conventional orthopedic perioperative management measures, and the ERAS group combined the ERAS concept on the basis of conventional treatment measures for perioperative management. The incidence of perioperative complications, Visual Analogue Scale score, modified Barthel Index score, inpatient satisfaction and length of hospital stay were compared between the two groups.ResultsThere was no significant difference in age, gender, American Society of Anesthesiologists grade, combined disease, modified Barthel Index or Visual Analogue Scale score at admission, or time from injury to surgery between the two groups (P>0.05). The total incidence of perioperative complications (12.5% vs. 37.5%) and length of hospital stay [(8.09±2.33) vs. (10.41±3.63) d] in the ERAS group were lower than those in the control group (P<0.05). The Visual Analogue Scale scores of the two groups of patients before operation, on the first day and the third day after operation were lower than those at admission (P<0.05). The comparison between the two groups at each time point showed that the Visual Analogue Scale scores of patients in the ERAS group were lower than those in the control group before operation, on the first day and the third day after operation, and the differences were statistically significant (P<0.05). The modified Barthel Index scores of the two groups of patients on the third day, and 1 month, 3 months and 6 months after operation showed a rising trend with time. The modified Barthel Index scores of the ERAS group were better than those of the control group on the third day, and 1 month and 3 months after operation (P<0.05). There was no significant difference between the two groups 6 months after operation (P>0.05). The hospitalization satisfaction score of the ERAS group was 95.56±5.12, which was higher than that of the control group (92.84±5.62), and the difference was statistically significant (P<0.05).ConclusionsThe implementation of ERAS perioperative management for elderly patients with intertrochanteric fractures may reduce the incidence of perioperative complications, relieve patient pain, promote the short-term recovery of activities of daily living of patients, improve the inpatient satisfaction and shorten the length of hospital stay.

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  • Expert consensus on the operative safety management and visual function evaluation index setting of gene therapy for inherited retinal diseases

    Inherited retinal diseases (IRDs) are a group of severe retinal degenerative diseases leading to permanent visual impairment. IRDs are the major cause of irreversible blindness in children and working age groups. Gene therapy is a new clinical treatment method and currently the only clear and effective treatment for IRDs, while, there are still risks in clinical research and application. How to standardize perioperative management and reduce the potential risks of treatment is one of the keys to ensure the safety and effectiveness of treatment. However, there is no systematic and standardized guidance on the perioperative management for IRDs gene therapy. Therefore, in order to standardize the perioperative management, the Fundus Disease Group of Ophthalmology Society of Chinese Medical Association and Chinese Medical Doctor Association organized domestic experts to put forward standardized opinions on the perioperative management of IRDs gene therapy in China after repeated discussion and combined with domestic and foreign research experience, so as to provide clinicians with reference and application in clinical research and practice.

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  • Application of enhanced recovery after surgery scheme in perioperative period of unilateral biportal endoscopy technique surgery

    Objective To analyze the perioperative efficacy of enhanced recovery after surgery (ERAS) in the treatment of lumbar disc herniation using unilateral biportal endoscopy technique. Methods A total of 55 patients who received unilateral biportal endoscopy technique for the treatment of lumbar disc herniation in Tianjin Hospital between January and December 2020 were selected and randomly divided into the traditional group and the ERAS group according to random number table method. The routine inpatient care management was adopted in the traditional group, while the holistic integrated care plan was formulated in the ERAS group according to the multidisciplinary collaboration of the accelerated rehabilitation plan. The first postoperative exhaust time, the first time out of bed, length of hospital stay, hospital costs, Visual Analogue Scale (VAS) scores before operation, one day and three days after operation, Oswestry Disability Index (ODI) scores before operation and one month after operation, and the excellent and good rate of modified MacNab efficacy one month after operation were compared between the two groups. Results There were 28 cases in the traditional group and 27 cases in the ERAS group. The first postoperative exhaust time [(2.31±1.02) vs. (3.19±0.87) h], the first postoperative ambulation time [(1.06±0.40) vs. (2.00±0.53) d], length of hospital stay [(3.8±0.8) vs. (4.6±0.8) d], and hospital cost [(32.18±9.10) thousand yuan vs. (39.81±11.10) thousand yuan] in the ERAS group were all less than those in the traditional group, and the differences were statistically significant (P<0.05). The VAS scores of the ERAS group one day after operation (3.2±0.8 vs. 4.1±0.8) and three days after operation (1.4±0.5 vs. 1.7±0.5) were lower than those of the traditional group (P<0.05). The ODI scores of the ERAS group one month after operation was lower than that of the traditional group (13.3±4.0 vs. 16.6±4.8, P<0.05). In the modified MacNab efficacy evaluation one month after surgery, there was no significant difference in the excellent and good rate between the ERAS group and the traditional group (96.3% vs. 96.4%, P>0.05). Conclusions ERAS regimen can significantly accelerate the patients’ recovery, including shortening the first exhaust time, facilitating early ambulation, and reducing the hospital stay and hospitalization expenses. Meanwhile, ERAS regimen can effectively reduce the postoperative pain of the patients, and promote early functional recovery.

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