目的:总结喉返神经修复重建术围手术期的护理配合。方法：我科2007年10～11月手术治疗双侧喉返神经麻痹患者3例，手术前加强患者的心理护理、密切观察病情变化，及时处理声带麻痹引起的喉梗阻、误吸、呛咳等症状。术后重视体位护理、呼吸道的管理、保证药物及时准确使用，协助患者进行正确的吞咽进食训练、声带协调运动训练等康复护理。结果：3例患者术后均获完整随访，3月后均顺利拔除气管套管，无吸气性呼吸困难，无发音困难，嗓音质量较术前明显改善。结论：良好的围手术期护理有助于手术的成功。
目的：比较常规鼻胃管置入法与鼻咽部局部喷雾麻醉后置胃管法对喉癌患者的影响。方法：将需要安置胃管的100例患者随机分成两组，每组50例。实验组行鼻咽部喷雾麻醉，对照组按常规操作，比较两组患者流泪、恶心、呕吐、咳嗽反应，一次成功率及插管所需要时间、插入中暂停次数。结果：实验组一次成功率高，患者反应轻，插管所需时间有显著差异。结论：常规置胃管常因病员难受而中途暂停置管，实验组置胃管前先作鼻咽部局部喷雾麻醉，可明显减轻患者的痛苦，提高插胃管的一次成功率，插管过程中因病员难受暂停次数也明显减少，使临床护理工作时间缩短，对临床护理工作有积极意义。
【Abstract】 Objective To summarize the recent progress in related research on transforming growth factor β1 （TGF-β1）/Smad3 signal transduction pathway and post-traumatic scar formation. Methods Recent related literature at home and abroad on TGF-β1/Smad3 signal transduction pathway and post-traumatic scar formation was reviewed and summarized. Results TGF-β1 is an important influence factor of fibrotic diseases, and it plays biological effects by TGF-β1/Smad3 signal transduction pathway. The pathway is regulated by many factors and has crosstalk with other signal pathways at cellular and molecular levels. The pathway is involved in the early post-traumatic inflammatory response, wound healing, and late pathological scar formation. Intervening the transduction pathway at the molecular level can influence the process of fibrosis and extracellular matrix deposition. Conclusion TGF-β1/Smad3 signal transduction pathway is an important way to affect post-traumatic scar formation and extracellular matrix deposition. The further study on the pathway will provide a theoretical basis for promotion of wound healing, as well as prevention and treatment of pathological scar formation.
Objective To evaluate the preliminary effect of using the sternal head of the sternocleidomastoid myocutaneous flap to reconstuct a defect in the maxillofacial region. Mathods From May 2004 to September 2006, 5 male patients aged 2334 underwent the reconstruction for the defect in the maxillofacial region by using the sternal head of the sternocleidomastoid myocutaneous flap. Their defects were caused by an infection of the face, an injection of medicine in the mother’s uterus or a scar or depressed abnormality left by an electric injury. The defects ranged in size from 5 cm×3 cm to 9 cm×6 cm. Results All the 5 sternocleidomastoid myocutaneous flaps survived, with a little necrosis of the epidermis because of the venous return disturbance, but 2-3 weeks after operation the necrosis healed spontaneously with just a little scar formation around the flap. One patient had weakness in the left shoulder after operation, which almost recovered 6 months after operation. The postoperative follow-up for 1-6 months revealed that 1 patient had a little fat and clumsy appearance in the flap pedicle, 1 patient had an obvious scar at the operation site, but the 2 patients still felt satisfaction. The other 3patients were satisfied with their good appearance at the operation sites. Conclusion The sternal head of the sternocleidomastoid myocutaneous flap can be designed with more flexibility compared with the entire sternocleidomastoid myocutaneous flap. It can provide an enough tissue mass for restoring the defect. The sternal head of the sternocleidomastoid myocutaneous flap is an ideal tissue flap for restoring defects in the maxillofacial region.
Objective To evaluate the safety and efficacy of botulinum toxin type A injection around internal anal sphincter and sector resection combined with epluchage and drainage by a small incision in treatment for stage Ⅱ and Ⅲ anal fissure，explore its surgical procedures and key points，and introduce a new surgical treatment for anal fissure. Methods The patients according to the inclusive criteria were divided into trial group and control group in randomized，parallel，controlled clinical trial method．The botulinum toxin type A injection around internal anal sphincter and sector resection combined with epluchage and drainage by a small incision was performed in the trial group, the anal fissure resection and part internal anal sphinctor latero-resection was perfermed in the control group. The safety index （including anal stenosis，incontinence，acute urinary retention，postoperative pain，and rectal anal tube pressure） and validity indicators （including cure rate，operation time，wound healing，wound healing grade，and scar size） were compared before and after operation between two groups．Results No anal stenosis and acute urinary retention occurred in the two groups. The anal incontinence score was not significantly different between two groups （P＞0.05）．The postoperative pain score in the trial group was significantly lower than that in the control group （24 h，the first defecation，and on week one after operation，all P＜0.01）．The difference of rectal anal canal pressure was not statistically significant between two groups （P＞0.05）．The cure rate was higher （P＜0.05），operation time and wound healing time were shorter （P＜0.01），wound healing was better （P＜0.05），scar area was smaller （P＜0.01） in the trial group as compared with the control group．Conclusions Comparing with the control group，high cure rate，short wound healing time，small size of scar，short operation time and minimal invasion are seen in the trial group．The shape and function of the anus are better reserved than that of the control group，this technique has a good clinical efficacy and safety．
Objective To investigate the current status of fear of disease progression and sleep quality among laryngeal cancer patients, and analyze the correlation between them. Methods Laryngeal cancer patients who were hospitalized in West China Hospital of Sichuan University between March 2021 and February 2022 were selected for this cross-sectional survey. Sociodemographic and disease-related data questionnaires, Chinese version of Fear of Progression Questionaire Short Form, and Pittsburgh Sleep Quality Index (PSQI) Scale were used to investigate the laryngeal cancer patients who met the inclusion criteria, and the correlation between fear of disease progression and PSQI score in laryngeal cancer patients was analyzed by Spearman correlation analysis. Multiple linear stepwise regression analysis was used to analyze the effects of sociodemographic and disease-related characteristics on the total score of fear of disease progression in laryngeal cancer patients, and the effects of sociodemographic, disease-related characteristics and total score of fear of disease progression on the total score of PSQI of laryngeal cancer patients. Scores were expressed as median (lower quartile, upper quartile). Results A total of 312 copies of questionnaires were distributed and 309 valid copies were recovered, with an effective recovery rate of 99.0%. The total score of fear of disease progression in the laryngeal cancer patients was 22.00 (16.00, 30.00), including 12.00 (8.00, 17.00) in physiological health dimension, and 10.00 (7.00, 14.00) in social and family dimension. The total score of PSQI was 5.00 (3.00, 8.50). The correlations of the physiological health dimension score, the social and family dimension score, and the total score of fear of disease progression with the total score of PSQI in laryngeal cancer patients were positive with statistical significance (rs=0.294, P<0.001; rs=0.234, P<0.001; rs=0.287, P<0.001). Multiple linear stepwise regression analyses showed that the total score of fear of disease progression in laryngeal cancer patients was affected by the stage of disease, occupation, primary caregiver and treatment plan (P<0.05), and the total score of PSQI of laryngeal cancer patients was affected by level of education, treatment plan and the total score of fear of disease progression (P<0.05). Conclusions The fear of disease progression in laryngeal cancer patients has a significant negative correlation with the sleep quality. Meanwhile, alleviating the level of fear of disease progression may improve sleep quality.
Objective To summarize the optimal evidence for improving the management of chronic wounds exudate, so as to provide evidence-based references for medical professionals, therapists, patients, and their caregivers. Methods PubMed, Wanfang, CNKI, Medlive, UpToDate, etc., were searched by computer for literature about chronic trauma exudate management. The retrieval time limit was from 1998 to 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and finally extracted evidence from the literature that met the quality evaluation criteria. Results A total of 11 articles were included, including 2 expert consensuses, 7 systematic reviews, 1 randomized controlled trial, and 1 guideline, covering 7 aspects of the assessment of the nature of chronic wounds exudate, selection of exudate assessment tools, management of antimicrobial concerns, selection and application of wound dressings, negative pressure wound drainage therapy, wound drainage bags, and affected limb elevation or compression therapy for patients with venous leg ulcers. A total of 13 best evidences were extracted. Conclusions When applying evidence, medical professionals should fully evaluate and combine the individual circumstances of the patient, make full use of existing resources, new treatment concepts and technologies, and carry out comprehensive integrated management. This can optimize the management of chronic wounds exudate and improve the quality of life of patients.
【摘要】 目的 建立兔耳中期瘢痕动物模型，寻找兔耳瘢痕形成的最佳位点。 方法 选用日本大耳白兔20只，在兔耳腹侧选定6个位点，作直径1 cm直达软骨表面的皮肤全层及软组织缺损240个。创面暴露，于伤后7 d去除软骨上面的肉芽及血浆痂壳一次。术后连续3个月观察创面自然愈合及瘢痕增生情况;用HE及苦味酸-天狼星红染色观察瘢痕形成及胶原分布情况;用计算机图像分析系统测定胶原含量。 结果 兔耳腹侧可制作类似人的增生性瘢痕模型，瘢痕的发生率42.5%~56.7%，瘢痕增生的高峰在造创后30~50 d。不同位点瘢痕增生程度不同，胶原含量也不同。 结论 兔耳腹侧可建立中期瘢痕动物模型，兔耳腹侧的中分和耳尖外侧部分是制作兔耳增生性瘢痕的理想位点。【Abstract】 Objective To establish an animal model of intermediate stage hypertrophic scar on the rabbit ears and to find out the best sites of scar formation. Methods A total of 240 full-thickness skin and tissue defect directing access to the cartilage surface was created on the ventral side in 20 Japan white rabbits and each ear contain 6 defect sites.The wound was treated by exposure method.On the 7th day after operation, the granulation tissue and plasma shell were removed on the cartilage.Wound healing and scar proliferation under natural condition were observed continuously for 3 months.The scar formation and collagen distribution were observed by HE and Sirius red staining, and the collagen content was analyzed by using computer image analysis system. Results The ventral wound of rabbit’s ears produced hypertrophic scar similar to human hypertrophic scar, the incidence of scar was between 42.5% to 56.7%.The peak of scar proliferation was in 30 days to 50 days after operation.The degree of scar proliferation and collagen content varied at different sites. Conclusion The ventral wound of rabbit’s ears can produce intermediate stage hypertrophic scar model, the middle sites and the lateral ear tip are ideal site for madding animal model of hypertrophic scar on the rabbit ears.
Obstructive sleep apnea hypopnea syndrome (OSAHS) can affect the growth and development of minors. Although the gold standard for OSAHS diagnosis is an overnight polysomnography, its clinical application is limited due to the high requirements for equipment and environmental conditions. Body shape indicators can reflect the accumulation of fat in specific parts of the body. In recent years, body shape indicators (body mass index, neck circumference, waist circumference, waist to hip ratio, waist to height ratio, neck circumference to height ratio) have been increasingly used in the evaluation of minor OSAHS. This article will review the application of the above body shape indicators in the evaluation of minor OSAHS, aiming to provide a basis for better use of these indicators in the diagnosis and treatment of minor OSAHS.
Cancer is a disease that incidence rate, disability rate and mortality rate are high all over the world. It brings great physical and mental pain to patients. Cancer patients are in a life-threatening state of disease for a long time, which will produce fear of progression (FoP). FoP is a psychological state in which fear of disease may recur or progress. As early as the 1980s, foreign countries began the psychological research on the FoP of cancer patients. They found that this fear really exists in cancer patients and is affected by many factors. This paper reviews the concept of FoP and the related factors affecting FoP in cancer patients. The purpose is to provide reference for clinical early evaluation and reducing the FoP of cancer patients and formulating corresponding nursing measures.