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腹腔镜下胃转流术治疗病理性肥胖患者围手术期护理

目的　讨论病理性肥胖患者行腹腔镜下胃转流术中围手术期的护理方法及作用。 方法　对2010年6月－2012年1月30例病理性肥胖患者行腹腔镜下胃转流术的护理方法及预后进行回顾性分析。 结果　29例患者术后恢复良好，1例吻合口瘘，经积极治疗及专业护理后痊愈出院。合并糖尿病者术后1个月行葡萄糖耐量试验均提示糖尿病病情好转，6个月时血糖控制理想；合并高血压病者血压控制稳定。所有患者术后体重均有明显下降。 结论　良好的围手术期护理，可提高手术成功率，减少术后感染，缩短住院日，提高患者术后生活质量。

大肠癌患者术前营养评分

目的　对住院大肠癌患者术前进行营养风险评估，为手术的顺利施行及预后提供参考依据及风险控制。 方法　2008年4月－2009年3月期间，采用欧洲营养风险筛查（NRS-2002）对252例确诊为大肠癌的术前患者进行营养风险评分。 结果　营养风险评分0～1分111例，2分68例，3分及以上73例，且不同肿瘤部位、不同年龄段患者的评分结果差异有统计学意义（P＜0.05）。 结论　不同的年龄、肿瘤位置对大肠癌患者术前营养状况的影响具有差异，应针对具体情况予以不同水平的营养支持。

Investigation and Analysis on the Clinical Situation of Nutritional Risk Screening in Patients with Gastric Cancer

【摘要】　目的　调查胃癌患者的营养风险及营养支持应用现状。　方法　2009年9月-2010年1月，对某三甲医院普外科收治的120例胃癌住院患者营养情况进行营养风险筛查2002（nutritional risk screening 2002，NRS 2002）评估，并就营养支持应用方式进行分析。　结果　所有患者中营养不足和营养风险的发生率分别为11.7%和27.5%；在33例有营养风险患者中，有26例（78.8％）接受了营养支持；在无营养风险的87例患者中，有30例（34.5％）接受了营养支持。　结论　对有营养风险的患者进行必要的营养支持，对于减少患者住院期间感染性并发症或其他不良临床结局的发生有积极作用。NRS 2002的方法简便，适用于胃癌患者的营养风险筛查，但医护人员需要进一步加强对肠外、肠内营养指南的认识。【Abstract】　Objective　To investigate the clinical situation of nutritional risk screening for hospitalized patients with gastric cancer.　Methods　From September 2009 to January 2010, we applied nutrition risk screening 2002 (NRS 2002) to investigate the nutritional status of 120 hospitalized gastric cancer patients in the surgery department of a tertiary hospital, and analyzed the way of nutritional support for these patients.　Results　Among all the patients, the incidences of undernutrtion and nutritional risk were respectively 11.7% and 27.5%. Twenty-six out of the 33 nutritional risk patients received nutrition support, and 30 out of the 87 patients without nutritional risk received nutrition support.　Conclusions　Nutritional support for patients with nutritional risk is important in decreasing the occurrence of in-hospital infectious complications and other bad clinical outcomes. NRS 2002 is a simple and easy tool for predicting the nutrition risk in hospitalized gastric cancer patients, but the guideline of enteral nutrition and parenteral nutrition must be reinforced among doctors and nurses.

Peutz-Jeghers综合征肠套叠术后肠梗阻并发肠瘘妊娠患者护理一例

以团队为基础的教学与以问题为基础的教学整合教学法在静脉治疗专科护理临床教学中的应用

目的 探讨以团队为基础的教学（TBL）与以问题为基础的教学（PBL）相结合的整合教学方法在静脉治疗专科护理临床教学中的应用效果。 方法 整群抽样选择2013年3月－2014年4月静脉治疗专科护理教学基地的54名静脉治疗专科护士学员，回顾性分析实施TBL、PBL整合教学法的病房见习组（观察组，28人）和实施单纯TBL教学法病房见习组（对照组，26人）学员的教学效果反馈，以及出科时较入科时的专业知识、专科护理技能提升情况。 结果 28名观察组学员中，对教学满意的有27人（92.9%），较满意1人（7.1%）；26名对照组学员中，对教学满意的有18人（76.9%），较满意8人（23.1%）。两组学员对教学的满意率比较，差异有统计学意义（P＜0.05）。在教学效果方面，观察组学员的静脉治疗、经外周静脉置入中心静脉导管穿刺、维护、并发症处理等操作技能、静脉治疗专科理论知识成绩增长值均较对照组多（P＜0.05）。 结论 在静脉治疗专科护理临床教学中应用TBL、PBL整合教学方法，可以有效调动专科护士的学习积极性，巩固已掌握的静脉治疗专科理论知识，提升静脉治疗专科护理技能，加强临床实践效果，值得推广。

Correlation study on the changes of retinal artery angle in idiopathic epiretinal membrane and its correlation with visual acuity and optical coherence tomography classification

Objective To observe the change of retinal artery angle in eyes with idiopathic epiretinal membrane (ERM) and to analyze the relationship between retinal artery angle, ERM classification based on optical coherence tomography (OCT), and visual acuity. MethodsA retrospective cross-sectional clinical study. A total of 187 eyes in 187 patients diagnosed with monocular idiopathic ERM (IERM group) in Department of Ophthalmology of Zhejiang Provincial People's Hospital and the Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou from November 2018 to January 2023 were included in the study. The contralateral healthy eyes were included as the control group. All patients underwent best corrected visual acuity (BCVA), fundus photography, spectral-domain OCT, OCT angiography (OCTA) and axial length (AL) measurement. BCVA examination was performed using the standard logarithmic visual acuity chart, which was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The foveal avascular zone (FAZ) area was measured by OCTA. The central macular thickness (CMT) was measured by spectral domain OCTaccording to the grading criteria of ectopic inner foveal layer (EIFL) was divided into stages 1 to 4 with 42, 45, 62, and 38 eyes, and the IERM group was subdivided into stage 1, stage 2, stage 3, and stage 4 groups accordingly. Image J was used to measure the retinal artery angle and the 1/2 retinal artery angle on fundus images. Multiple linear regression analysis was used to analyze the correlation between BCVA and artery angle, 1/2 artery Angle, CMT, FAZ area and AL. ResultsCompared with the control group, eyes in IERM group had worse BCVA (t=9.727), thicker CMT (t=12.452), smaller FAZ area (t=－14.329), smaller artery angle (t=－9.165) and smaller 1/2 artery angle (t=－9.549). The differences were statistically significant (P＜0.001). With the increase of IERM stage, the artery angle and 1/2 artery angle decreased significantly (F=21.763, 12.515; P＜0.001). There was no significant difference in artery angle and 1/2 artery angle between stage 1 group and stage 2 group, and 1/2 arterial angle between stage 2 group and stage 3 group (P＞0.05). There were significant differences in artery angle and 1/2 artery angle between the other groups (P＜0.05). There were significant differences in CMT and logMAR BCVA among different classification subgroups in IERM groups (P＜0.05). There was no significant difference in FAZ area between grade 3 group and grade 4 group (P＞0.05). There were significant differences in FAZ area between the other groups (P＜0.05). Correlation analysis showed that decreased artery angle (P=0.013) and increased CMT (P＜0.001) were associated with decreased BCVA. ConclusionsCompared with healthy eyes, the artery angle decreases significantly with the increase of ERM stage. Decreased retinal artery angle is associated with decreased visual acuity in IERM eyes.