Objective To evaluate the effects of a preoperative pain education program on patients’ knowledge of postoperative pain management, measures taken for such pain management and the actual postoperative pain. Methods A total of 84 patients undergoing abdominal surgery were non-randomly divided into two groups, 42 in each group. Patients in group A received routine preoperative care and 30 minutes of education about pain management, while patients in group B received routine preoperative care only. All patients completed the Postoperative Pain Management Questionnaire on the second postoperative day. Results Patients in group A achieved higher scores for their knowledge about postoperative pain management than those in group B (Plt;0.05). More patients in group A took non-medical pain relief methods after surgery (Plt;0.05); and patients in group A were able to use the PCA pump more correctly than those in group B (Plt;0.05). No significant differences were observed between the two groups in the frequency of asking for analgesics or their pain score when they requested analgesics (Pgt;0.05). The average score for postoperative pain was lower for group A compared to group B (Plt;0.05). Conclusions A program of preoperative pain education can improve patients’ knowledge of postoperative pain management and encourage them to participate actively in such pain management, so as to further relieve the postoperative pain.
Objective To evaluate whether to defer abdomen surgery in patients having poorly controlled or untreated hypertension before operation. MethodsThe perioperative clinical data of 531 patients with hypertension in our hospital from January 1997 to December 1998 was retrospectively analyzed. ResultsThe modility of perioperative hypertensive events was not significantly different, between controlled and uncontrolled patients with grade one and grade two（Pgt;0.05）. In grade three and systolic hypertension, certain complications in patients with poorly controlled hypertension were higher than in those with wellcontrolled hypertension（P＜0.05）. Conclusion The patients with grade one and grade two hypertension are not at increased operative risk. In patients with grade three and systolic hypertension, perioperative complications are increased and elective surgery should be postponed until their blood pressure is brought under 24/14.7 kPa （180/110 mm Hg） over 1 to 2 weeks.
Objective To evaluate the therapeutic effects of different airway management strategies early used for patients after abdominal surgery in general anesthesia. Methods According to gender, age,and operation location,200 patients after abdominal surgery in general anesthesia were randomly assigned to four groups, ie. a conventional treatment group ( Group A) , an incentive spirometry ( IS) therapy group ( Group B) , an aerosol inhalation group ( Group C) , a combination of inhalation and IS therapy group ( Group D) . Inhalation drugs included Budesonide, Terbutaline, and Ambroxol. The index of pulmonary function test ( FVC, FEV1 , PEF) and arterial blood gases analysis ( ABG) were measured, and the effect of secretions clearance and the improvement of respiratory symptoms were evaluated at 0.5 h,24 h, 48 h after extubation.Intratracheal intubation of the patients after leaving ICUwas followed up. Results FVC, FEV1 , PEF, ABG,sputumvolume, the effect of secretions clearance, clinical efficacy, and intratracheal intubation rate in group B, C and D were improved more significantly than those in group A. And the therapeutic effect was best in group D ( P lt;0. 05) . The secretions clearance was improved more better in group C and D, especially in those high-risk patients with advanced age, smoking history, and pulmonary cormobidities ( P lt; 0. 05) .Conclusions The combined use of IS training and inhalation therapy can improve airway secretions clearance and pulmonary function particularly for those patients after abdominal surgery in general anesthesia, especially for those high-risk patients.
Objective To compare the effect of intravenous and epidural analgesia on postoperative complications after abdominal and thoracic surgery. Methods A literature search was conducted by using computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1985 to Jan 2009. Further searches for articles were conducted by checking all references describing postoperative complications with intravenous and epidural anesthesia after abdominal and thoracic surgery. All included randomized controlled trials (RCTs) were assessed and data were extracted by the standard of Cochrane systematic review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results Thirteen RCTs involving 3 055 patients met the inclusion criteria. The results of meta-analyses showed that, a) pulmonary complications and lung function: patient-controlled epidural analgesia can significantly decrease the incidence of pneumonia (RR=0.66, 95%CI 0.53 to 0.83) and improve the FEV1 (WMD=0.17, 95%CI 0.05 to 0.29) and FVC (WMD=0.21, 95%CI 0.1 to 0.32) of lung function after abdominal and thoracic surgery, but no differences in decreasing postoperative respiratory failure (RR=0.77, 95%CI 0.58 to 1.02) and prolonged ventilation (RR=0.75, 95%CI 0.51 to 1.13) compared with intravenous analgesia; b) cardiovascular event: epidural analgesia could significantly decrease the incidence of myocardial infarction (RR=0.58, 95%CI 0.35 to 0.95) and arrhythmia (RR=0.64, 95%CI 0.47 to 0.88) than the control group, but could not better reduce the risk of heart failure (RR=0.79, 95%CI 0.47 to 1.34) and hypotension (RR=1.21, 95%CI 0.63 to 2.29); and c) Other complications: epidural and intravenous analgesia had no difference in decreasing the risk of postoperative renal insufficient (RR=0.78, 95%CI 0.53 to 1.14), gastrointestinal hemorrhage (RR=0.78, 95%CI 0.49 to 1.23), infection (RR=0.89, 95%CI 0.70 to 1.12) and nausea (RR=1.03, 95%CI 0.38 to 2.81). Conclusions Epidural analgesia can obviously decrease the risk of pneumonia, myocardial infarction and severe arrhythmia, and can improve the lung function after abdominal or thoracic surgery.
【摘要】 目的 探讨腹部手术史对急性阑尾炎腹腔镜阑尾切除术（LA）的影响。 方法 2005年1月-2010年9月，将既往有腹部手术史并行LA的111例患者纳入观察组，同期随机抽取无腹部手术史行LA的220例患者纳入对照组。入选患者排除多次手术史、免疫功能低下、肝肾功能不全及血液病。比较两组中转开腹率、手术时间、术中出血量、术后并发症及住院时间的差异。 结果 两组均未出现术中并发症及死亡，两组患者的中转开腹率、手术时间、术中出血量、术后并发症及住院时间比较，差异均无统计学意义（Pgt;0.05）。 结论 即往腹部手术史对急性阑尾炎LA没有明显影响。【Abstract】 Objective To investigate the effect of previous abdominal surgery on appendectomy under laparoscope for acute appendicitis. Methods From January 2005 to September 2010, 111 patients with a history of abdominal surgery who had undergone laparoscopic appendectomy due to acute appendicitis were in the observe group and 220 patients selected randomly from the patients without a history of previous abdominal surgery who had undergone laparoscopic appendectomy were in the control group. The patients with a history of multiple operations, immunodeficiency, liver and kidney dysfunction, and hematopathy were excluded. The data were collected retrospectively and the differences of conversion rate, operative time, intraoperative blood loss, postoperative complications, and hospital staying were compared between the two groups. Results There were no death or intraoperative complications in both of the two groups. The differences in the conversion rate, operative time, intraoperative blood loss, postoperative complication rates, and hospital staying between the two groups were not significant (Pgt;0.05). Conclusion Previous abdominal surgery has no significant effect on laparoscopic appendectomy for acute appendicitis.
【摘要】 目的 研究全身麻醉腹部手术患者术前焦虑对术后疼痛、镇痛药用量及对术后镇痛满意度的影响。 方法 选取2009年8月-2010年4月68例ASAⅠ～Ⅱ级，拟行气管插管全身麻醉的腹部手术患者，术前采用状态-特质焦虑量表和抑郁评分量表进行焦虑程度的测评，术后观察VAS疼痛评分、总的镇痛药用量以及患者对镇痛的满意度，分析术前焦虑与术后VAS评分、镇痛药用量及镇痛满意度的相关性。 结果 68例受试者术前STAI为50±13，BDI为16±13，术后VAS评分为4.0±2.1，术后24 h镇痛药芬太尼的用量为（0.80±0.21） mg；术后镇痛药用量、患者镇痛满意度评分与术前STAI明显相关（r=0.68和r=-0.88，Plt;0.01）。术后VAS评分与术前STAI及BDI也有一定的相关（r=0.35和r=0.3）。 结论 术前焦虑程度可以影响腹部手术患者对镇痛治疗的满意度， 显著增加镇痛药用量。【Abstract】 Objective To investigate the effect of preoperative anxiety on postoperative pain, amount of analgesics and satisfaction of postoperative pain relief for patients undergoing abdominal surgery with general anesthesia. Methods A total of 68 patients undergoing abdominal surgery with general anesthesia from August 2009 to April 2010 were selected (ASA I-II). Preoperational anxiety levels were evaluated using State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) and postoperative VAS pain score, the total amount of analgesics used and satisfaction of pain relief were observed. The relationship between preoperative anxiety and post-operative VAS score, and total amount of analgesics used and satisfaction of pain relief were analyzed. Results The mean STAI and BDI of 68 samples were 50±13 and 16±13, respectively; the mean postoperative VAS was 4.0±2.1, and the mean amount of analgesics fentanyl used in 24 hours after the operation was (0.80±0.21) mg; the amount of post-operative analgesics used and the satisfaction of pain relief of the patients were found to be highly related to pre-operative STAI (r=0.68, -0.88; Plt;0.01). Post-operative VAS score was also related to preoperational STAI and BDI (r=0.35, 0.3). Conclusion Preoperative anxiety is closely related to the postoperative analgesics and satisfaction of pain relief for patients who had abdominal operation. Severe preoperative anxiety can significantly increase the amount of postoperative analgesics used and dissatisfaction of pain relief.
ObjectiveTo study the application value of mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations in treatment for incomplete adhesive intestinal obstruction after laparotomy. MethodsOne hundred and twentyeight patients diagnosed incomplete adhesive intestinal obstruction admitted to this hospital from March 2005 to May 2008 were randomly divided into trial group and control group. For the control group, the tradition therapy including fasting, gastrointestinal decompression, fluid replacement therapy, and enema with soap and water were used for treatment. For the trial group, the mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations were injected into stomach by the nasogastric tube on the basis of traditional treatment used for the control group. Some indicators including the successful rate of nonoperative treatment, the time that obstructive symptoms resolved and returned to normal exhaust and defecation and normal diet, and recurrence rate were compared between two groups. ResultsThe successful rate of nonoperative treatmentin in the trial group were significantly higher than that in the control group 〔92.1% (70/76) versus 69.2% (36/52), Plt;0.01〕. The average time that recovered to normal exhaust and defecation in the trial group and the control group was 32.5 d and 47.8 d, respectively. The average time that recovered to normal diet in the trial group and the control group was 3.2 d and 5.3 d, respectively. The time that recovered to normal exhaust and defecation, and diet in the trial group were significantly shorter than those in the control group (Plt;0.01). The recurrence rate had no significant difference between two groups (Pgt;0.05). ConclusionThe mixed formulations consisting of paraffin oil, dimethyl silicone oil, and senna preparations improve recovery of intestinal function and reduce surgical intervention rate.
ObjectiveTo analyze the risk factors of postoperative cognitive dysfunction (POCD) in elderly patients after abdominal surgery. MethodsThe clinical data of 2 286 patients over 60 years old after abdominal surgery were retrospectively analyzed, which were divided into non-POCD group with 2 248 patients and POCD group with 38 patients. The influencing factors of POCD in elderly patients after abdominal surgery, including the age, gender, anesthetic way, the premedication, cormobided with lung or heart disease, diabetes, jaundice, anemia or hypoproteinemia, the duration of surgery, and postoperative analgesia protocols, were analyzed between two groups. ResultsThe age, anesthetic way, cormobided with lung or heart disease, diabetes, jaundice, with or without continuous postoperative effective analgesia, and surgery duration over four hours were relevant with POCD (Plt;0.05), while gender, the premedication, and preexisted anemia or hypoproteinemia were not relevant with that (Pgt;0.05). ConclusionAge over 70 years, general anaesthesia, cormobided with lung or heart disease, diabetes, jaundice, surgery duration over four hours, and incomplete postoperative analgesia are the risk factors of POCD after abdominal surgery.