Objective To investigate the effect of short-term administration of growth hormone (GH) on serum insulin-like growth factor-1 (IGF-1) level and nutritional status in patients after gastrointestinal operation, and evaluate whether postoperative application of GH rise the risk of tumor recurrence. Methods Forty-eight patients undergoing major gastrointestinal operation were randomly divided into two groups: GH group （n=24） and control group （n=24）. The two groups received isocaloric isonitrogenous nutrition with daily injection of either GH 0.15 U/kg or placebo for a period of day 3-9 postoperatively. Serum albumin, fibronectin, and IGF-1 were measured before operation as a baseline, and day 3 and 10 after operation using standard laboratory techniques. Nitrogen balance was measured daily from day 3 to day 9 after operation. Postoperative complications and adverse reaction were observed. All cancer patients received regular abdominal B-type ultrasonography and chest X-ray examination during 2 years of follow-up. Results Compared with control group, GH treatment did not influence serum IGF-1 and serum albumin level （Pgt;0.05）, but improved significantly the rise from day 3 to day 10 of serum fibronectin level 〔(22.8±5.8) mg/L vs.（9.6±3.6） mg/L， P＜0.05〕 and the cumulative nitrogen balance 〔（11.37±16.82） g vs.（－9.11±17.52） g， P＜0.01〕 postoperatively. There was no severe adverse effects and complications during GH treatment. The tumor-recurrence rates were not statistically different between two groups during follow-up. Conclusions Short-term administration of low-dose GH combined with early nutrition support can improve total nitrogen retention and protein metabolism, but not influence serum IGF-1 level after major abdominal surgery. Short-term administration of low-dose GH may not cause the tumor-recurrence.
目的 分析胃肠外科手术切口感染的影响因素，为医院感染的防治提供理论依据。 方法 回顾性分析2010年12月－2012年12月764例行胃肠外科手术患者的临床资料，并用单因素χ2检验统计分析患者医院感染的危险因素。 结果 共有65例患者发生手术切口感染，其感染率为8.5%，且分离培养出合格菌株48株，阳性率73.8%，其中G−菌32株，占66.7%，G+菌16株，占33.3%。G−菌主要以大肠杆菌、变形杆菌、克雷伯杆菌和肠杆菌为主，分别占29.2%、18.8%、12.5%和6.2%；G+菌以肠球菌和表皮葡萄球菌为主，分别占22.9%和10.4%。单因素χ2检验显示年龄＞60岁、手术时间＞120 min、术中有输血、且有肿瘤病变的患者具有较高的切口感染发生率（P＜0.05）。 结论 胃肠外科手术切口感染的主要致病菌是G−杆菌，患者的年龄、手术时间、术中输血情况和疾病良恶性质是术后切口感染的高危因素，积极采取相应的预防措施有望减低其感染的发生率。
目的:探讨益生菌联合营养支持对胃肠外科术后患者肠功能和肠道菌群的影响。方法:36例胃肠道中等以上手术的患者,随机分为研究组和对照组,每组18例。两组术后均接受等氮等能量的营养支持,研究组患者于术后第3天开始每天加用益生菌制剂(6.6 × 10.7 colony forming units),共7天。监测治疗期间患者的胃肠道症状、生命体征、腹泻情况和菌群比例等。结果:两组患者术后腹痛、腹胀、肠鸣音异常等胃肠道症状均无显著差异 (Pgt;0.05),两组患者在术后第8和9天的腹泻比例和腹泻评分差异有显著性意义(Plt;0.05)。治疗结束后,研究组患者肠道双歧杆菌和乳酸杆菌计数均较对照组高,两组间差异有显著性意义(Plt;0.05)。 结论:在胃肠外科术后患者中应用益生菌可改善胃肠道症状、减轻腹泻程度和纠正肠道菌群失调。
Objective To investigate the infection rate and observe the healing courses of the incision after gastrointestinal surgery which was managed by positioning extraperitoneal U-type latex drainage strip. Methods Two hundred patients after abdominal operation were divided into drainage group (n=97) and control group (n=103). Drainage group were treated with positioning extraperitoneal U-type latex drainage strip, while control group were treated with no latex drainage strip. The infection rate of incision, the mean time in hospital and mean time of incision healing were observed. Results The infection rate of drainage group was significantly lower than that of control group 〔7.22% (7/97) vs. 18.45% (19/103), P=0.024〕. The mean time in hospital and the mean time of incision healing in drainage group were significantly shorter than those in control group 〔(8.86±1.48) d vs. (14.12±2.63) d， P=0.000； (8.24±1.02) d vs. (12.32±3.47) d， P=0.000〕. Conclusion The infection rate and the healing course of incision of gastrointestinal surgery could be improved by positioning extraperitoneal U-type latex drainage strip.
ObjectiveTo evaluate the infiuence of doctor-nurse double check table applied before operation on the completion of preoperative preparation in gastrointestinal surgery department of class-three grade-one hospitals. MethodsA total of 647 selective operation patients from April to September 2013 in the Department of Gastrointestinal Surgery were divided into observation group (n=315) and control group (n=332) based on admission time. After training for medical staff, the check tables were filled, and relatively high frequency issues were followed up for quality tracking. The completion of preoperative preparation was compared between the two groups after operation. ResultsCompared with the control group, the completion of preoperative preparation and satisfaction of patients of the observation group were significantly higher and the operation delay was significantly lower (P<0.05). ConclusionPreoperative application of doctor-nurse double check table can significantly improve the completion rate of preoperative preparation, the operation delay phenomenon and satisfaction of patients, promote the communication between doctors and nurses, reduce the risk of operation, and ensure the safety of surgical patients.
ObjectiveTo explore the effect of "HIS" nursing service mode in promoting the quality of clinical nursing service for key specialties in the department of gastrointestinal surgery. MethodsIn the Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, "HIS" nursing service mode was carried out on January 1, 2012.Questionnaires surveying hospitalized patients' satisfaction before (n=360, between January and December 2011) and after (n=360, between January and December 2012) the implementation of "HIS" nursing service mode were retrospectively compared and analyzed. ResultsThe patients' general satisfaction score was improved significantly from 83.27±5.71 to 97.92±6.23 after the implementation of "HIS" nursing service mode (t=-8.001, P < 0.05).For all the 14 items in the satisfaction questionnaire, the differences before and after the implementation had statistical significance (P < 0.05). ConclusionThe "HIS" nursing service mode can effectively improve patients' satisfaction of clinical nursing service for key specialties in the department of gastrointestinal surgery, and it is worthy of further promotion.
Objective To explore the status of nutrition risk and its relative factors in patients of department of gastrointestinal surgery, and to observe the effectiveness of nutrition support on post-operative recovery of patients with gastric cancer. Methods A total of 1 048 cases of in-patients in Department of Gastrointestinal Surgery of Jinan Central Hospital Affiliated Shandong University from January 2015 to January 2016 were collected prospectively, and then screened the nutrition risk of these patients by nutritional risk screening 2002 (NRS-2002) and evaluated the actual malnutrition situation when they left hospital. Then collected 52 gastric cancer patients whose NRS-2002 score ≥3, and divided them to control group and experimental group randomly. The patients of experimental group received extra standard medical nutrition support while the patients of control group did not. Compared the nutritional indexes as well as some postoperative recovery indexes, such as the postoperative exhaust time, postoperative defecation time, infusion stop time, length of hospital stay, and incidence of complications. Results ① Nutritional risk. Among the 1 048 cases, 230 cases (21.9%) had nutritional risk while 118 cases (11.3%) developed to malnutrition. Age and degree of cancer were all related with nutritional risk (P<0.05) while gender was irrelevant (P>0.05). Patients with age ≥60 years, advanced gastric cancer, and colorectal cancer in Ⅲ+Ⅳ staging, had higher rates of nutritional risk than patients with age <60 years, early gastric cancer, and colorectal cancer inⅠ+Ⅱstaging. Results of actual malnutrition was in good accordance with the screening result of NRS-2002 (κ=0.57). ② Influence of nutritional support on gastric cancer patients. Compared with control group, there was an improvement in albumin, pre-albumin, and weight of experimental group and the distinction had statistical significance (P<0.05). The distinction of postoperative exhaust time and incidence of complication between the two groups were not statistically significant (P>0.05), but postoperative defecation time, infusion stop time, and the length of hospital stay of the experimental group were shorter than those of the control group with statistical significance (P<0.05). Conclusions The problem of malnutrition exists generally in the in-patients of department of gastrointestinal surgery. Applying the instrument of nutritional risk assessment to assess the risk as early as possible and giving appropriate nutrition support therapy positively, will make favorable influence to the prognosis of gastric cancer patients.
Objectives To investigate the association of anesthesia recovery time and bispectral index (BIS) monitoring after gastrointestinal surgeries under general anesthesia. Methods A total of 404 cases of selective gastrointestinal surgeries under general anesthesia with BIS monitoring in West China Hospital of Sichuan University from January 2016 to June 2016 were retrieved from anesthesia medical record system as BIS monitoring exposure cohort (group BIS). In addition, 404 cases of selective gastrointestinal surgeries without BIS monitoring were matched as none BIS monitoring exposure cohort (group non-BIS). The primary outcome was the anesthesia recovery time, including the time from the end of surgery to endotracheal extubation (t1) and exiting the operation room (t2). A sub-group analysis was conducted based on patients’ age, length of operation time (t0) and type of surgery(open surgeries vs laparoscopic surgeries). Results The gender, age, body weight and ASA categories between two groups had no significant differences (P>0.05). The length of operation time also had no significant differences between two groups (P>0.05). The extubation time (10.1±4.4vs. 16.4±6.8) and OR exiting time (21.7±12.3 vs. 27.4±14.6) in group BIS were shorter than those in group non-BIS (P<0.05). This difference was markedly significant among elderly patients (age>60) or patients undergoing long operations (operation time>5hours). Among each group, the recovery time had no significant difference between open surgeries and laparoscopic surgeries. Conclusions There is an association between BIS monitoring and shorter anesthesia recovery time in gastrointestinal surgery, including the time of endotracheal extubation and exiting the operation room. BIS monitoring enhances anesthesia recovery among elderly patients and patients undergoing long-lasting operations in particular. There is no significant difference in anesthesia recovery time between open surgeries and laparoscopic surgeries.