目的 调查胃肠道疾病患者围手术期的疼痛状况，为建立无痛病房，优化医疗和护理服务提供依据。 方法 对2011年12月5日－2012年1月14日胃肠外科所有的新住院患者共227例，采用《四川大学华西医院住院病人疼痛现状调查问卷》进行调查，并同期调查胃肠外科27名主管医师对疼痛药物了解状况。 结果 有明确行为能力的216例患者完成调查问卷，其中有195例（90.28%）接受手术治疗，全身麻醉患者193例（占手术患者98.97%），诊断为胃肠道肿瘤163例（占手术人数的83.59%），手术等级为三级146例（占手术人数的74.87%）。有168例（86.15%）患者术后镇痛，在术后镇痛过程中使用镇痛泵156例（92.86%），其中75例（48.08%）认为镇痛泵镇痛“基本有效”，30例（19.23%）认为“无效”。39例术后未使用镇痛泵，其中20例（51.28%）认为“未使用术后镇痛泵”最主要原因为“不了解镇痛泵”。受调查的主管医师了解的疼痛药物仅占罗列药物52种的（20 ± 5.36）种。 结论 疼痛现象在胃肠道疾病围手术期患者中属普遍现象，由于不断增强镇痛意识和镇痛需求与相关知识缺乏的矛盾存在，及较少的医疗护理干预，导致镇痛效果不佳，影响了疼痛管理长效机制的建立和无痛病房的建设。
Skeletal muscle and metabolic function are important factors affecting the health status of the elderly. Branched-chain amino acids (BCAA) can improve muscle recovery, reduce muscle soreness after exercise, and BCAA can also enhance metabolic health, helping to regulate blood sugar levels and improve insulin sensitivity in the elderly. In addition, BCAA can improve cognitive function, reducing the risk of age-related cognitive decline. This article reviews the relationship between BCAA and aging, skeletal muscle, and metabolic diseases, explaining how BCAA can support and promote muscle mass and function in the elderly, as well as have a positive impact on metabolic health and cognitive function.
ObjectiveTo systematically evaluate the effectiveness and safety of computer-aided detection (CADe) and conventional colonoscopy in identifying colorectal adenomas and polyps. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) comparing the effectiveness and safety of CADe assisted colonoscopy and conventional colonoscopy in detecting colorectal tumors from 2014 to April 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was performed by RevMan 5.3 software. ResultsA total of 9 studies were included, with a total of 6 393 patients. Compared with conventional colonoscopy, the CADe system significantly improved the adenoma detection rate (ADR) (RR=1.22, 95% CI 1.10 to 1.35, P<0.01) and polyp detection rate (PDR) (RR=1.19, 95% CI 1.04 to 1.36, P=0.01). It also reduced the missed diagnosis rate (AMR) of adenomas (RR=0.48, 95% CI 0.34 to 0.67, P<0.01) and the missed diagnosis rate (PMR) of polyps (RR=0.39, 95% CI 0.25 to 0.59, P<0.01). The PDR of proximal polyps significantly increased, while the PDR of ≤ 5mm polyps slightly increased, but the PDR of >10mm and pedunculated polyps significantly decreased; The AMR of the cecum, transverse colon, descending colon, and sigmoid colon was significantly reduced. There was no statistically significant difference in the withdrawal time between the two groups. Conclusion The computer-aided detection system can increase the detection rate of adenomas and polyps, and reduce the missed diagnosis rate. The detection rate of polyps is related to their location, size, and shape, while the missed diagnosis rate of adenomas is related to their location.
【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.
目的 分析持续腹膜透析患者发生腹膜炎的情况及相关因素，降低腹膜透析患者腹膜炎发生率、退出率，提高患者的生存率、生活质量。 方法 回顾分析2011年1月－6月收治的41例在家中行持续非卧床性腹膜透析且发生腹膜炎患者的临床资料，观察腹膜炎的发生率及转归，腹膜炎症状出现后初始的处理，对腹膜炎的诱因进行分析。 结果 41例腹膜透析患者共发生腹膜炎43例次，痊愈35例（85.4%），转血液透析3例（7.3%），死亡3例（7.3%）。在症状出现初期，3例（7.3%）患者继续在家观察，10例（24.4%）患者立即到当地就医，15例（36.6%）患者采用电话咨询，13例（31.7%）患者到腹膜透析中心就诊；18例（43.9%）患者直接将腹膜透析引流液带到医院进行药敏试验。就感染诱因而言，16例（39.0%）患者未严格进行空气消毒，13例（31.7%）患者未严格进行环境清洁，10例（24.4%）患者操作过程存在污染行为。 结论 加强对居家行腹膜透析患者的初次培训、操作指导及监测，可避免腹膜炎的发生，提高患者生活质量。
Objective To investigate the relevance among sarcopenia, peripheral inflammatory, and nutritional factors, as well as the impact of sarcopenia on the prognosis of gastric cancer. Methods A total of 174 patients with gastric cancer in Department of Gastrointestinal Surgery in West China Hospital of Sichuan University from July 2016 to December 2020 were retrospectively included. The skeletal muscle index (SMI) of the third lumbar vertebra level was calculated using CT images, and male patients with SMI<52.4 cm2/m2 and female patients with SMI<38.5 cm2/m2 were considered sarcopenia. The key clinicopathological features of patients were collected for prognostic analysis. ResultsAmong the 174 patients with gastric cancer, 73 patients (41.95%) were diagnosed with sarcopenia. Compared with those of non-sarcopenia, the patients who were diagnosed with sarcopenia showed a significantly elder age and lower body mass index (BMI). In addition, males demonstrated a significantly higher rate of sarcopenia. Further, patients with sarcopenia showed a significant increasing in the incidence of postoperative pulmonary infections and length of hospitalization than patients without sarcopenia. The two groups showed significant differences in type 2 diabetes, peripheral C-reaction protein (CRP), interleukin-6 (IL-6), albumin, prealbumin, and hemoglobin. Overall, the multivariate analysis and Kaplan-Meier survival curves indicated that sarcopenic patients had a significantly lower survival rate than the non-sarcopenia patients. Conclusion Sarcopenia is closely related to higher levels of inflammation, malnutrition, and poor prognosis in patients with gastric cancer. Therefore, we should diagnose sarcopenia patients as early as possible, and give nutritional support to the patients.