【摘要】 目的 探讨整体护理在压疮治疗中的应用和效果。 方法 2006年1月-2009年11月对98例压疮患者采用整体护理程序，从评估、提出护理诊断、实施护理措施以及评价作用效果四个方面对患者进行护理。 结果 50例压疮完全愈合，38例压疮经过护理后达到显效标准，10例压疮经过护理后好转。 结论 整体护理应用于压疮患者可取得满意的效果。【Abstract】 Objective To assess the application and effects of holistic nursing in the treatment of pressure sore. Methods Ninety-eight patients with pressure sores were treated from January 2006 to November 2009 in this department, accompanying with the holistic nursing which includes assessment, proposed nursing diagnosis, implementation and evaluation of the effect. Results Fifty patients were completely healed, 38 patients showed obvious effect and 10 patients relieved slightly. Conclusion The holistic nursing has satisfactory effects on the patients with pressure sores.
Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV1%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV1/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To analyze the changes of perioperative symptoms of lung cancer patients by using patient-reported outcomes at different time points. MethodsA total of 109 patients who underwent thoracoscopic lung cancer resection in the department of thoracic surgery of our hospital from March to April 2021 were selected, including 55 (50.46%) males and 54 (49.54%) females. The mean age was 55.19±12.12 years. The postoperative symptom scale for lung cancer patients was used to investigate the changes of symptoms before surgery, 1 day after surgery, the day of discharge, and 30 days after surgery. Results The mean hospital stay was 6.89±2.25 days. None of the patients reported any clinical symptoms related to lung cancer before surgery. The most prominent symptoms 1 day after surgery were pain (3.33±0.96 points), nausea (2.81±1.18 points), dizziness (2.00±0.85 points), fatigue (1.89±0.79 points) and shortness of breath (1.79±1.37 points). The patients with dizziness, nausea, fatigue and other symptoms gradually decreased, and the symptoms were relieved significantly (P<0.05). However, the symptoms of conscious pain, cough and shortness of breath lasted for a long time. At 30 days after surgery, 70.64%, 64.22% and 33.03% of patients felt pain, cough and shortness of breath, respectively, and the degree of cough was aggravated (P<0.001). Conclusion Pain, cough, dizziness, shortness of breath and fatigue are the core postoperative symptoms of lung cancer patients. Most postoperative adverse symptoms can be effectively controlled in a short period of time, but pain, cough and shortness of breath still present persistent characteristics, which deserve further study.
Objective To evaluate the effect of perioperative fluid management on postoperative pulmonary complications (PPCs) of esophagectomy, and to find out the optimal scheme for perioperative fluid administration. Methods This retrospective cohort study enrolled 75 patients with esophageal squamous cell cancer who have received esophagectomy in West China Hospital from June to December 2014. We used the Kroenke's postoperative pulmonary complications classification system to define the PPCs. Patients with PPCs of grade Ⅱ-Ⅳ were considered as PPCs group (n=13, 12 males, 1 female, age of 64.62±8.64 years), and others were considered as non-complication group (n=62, 50 males, 12 females, age of 60.55±8.73 years). Intraoperative and postoperative fluid inputs and outputs as well as clinical characteristics between groups were compared. Results Between two groups, there was a great difference in postoperative albumin infusion, intraoperative fluid administration [net input, total input, net input/kg, total input/kg, net input/(kg·h) and total input/(kg·h)] and fluid input on the first postoerative 1–3 days (total input and total input/kg). The cutoff value for total input/(kg·h) in operation and total input on the first 1–3 postoerative days was 12.07 ml/(kg·h) and 178.57 ml/kg, respectively. Conclusion The speed of fluid infusion in operation and total input on postoperative 1-3 days are most important influence factors of PPCs. The speed in operation should not exceed 12.07 ml/(kg·h) and the total input on postoperative 1-3 days should not exceed 178.57 ml/kg. Within this range, an appropriate increase in fluid volume can make patients feel better.
Pusher syndrome (PS) is a postural control disorder that occurs after stroke, which is mainly manifested as a balance dysfunction that is difficult to correct, leading to a significant decline in activity safety of stroke patients and hindering the process of rehabilitation treatment. Proper interventions are needed as soon as possible. Based on the research results of PS both domestic and foreign, this paper firstly summarizes the foundations of the mechanism of PS occurrence, and elaborates the existing disputes. Secondly, this paper systematically introduces the current mainstream assessment and treatment methods of PS, summarizes the problems in relevant clinical practice, and on this basis, gives some suggestions on the possible research directions in the future. The purpose is to provide reference for clinical application and future research directions.
ObjectiveTo analyze the causes and potential risk factors of re-catheterization after failure of no urinary catheter in patients undergoing lung cancer surgery.MethodsThe clinical data of 1 618 patients without urinary catheter indwelling during the perioperative period of thoracic surgery in our hospital from 2013 to 2019 were retrospectively analyzed, including 791 males and 827 females, with a median age of 58 years, ranging from 27 to 85 years. And the risk factors for re-insertion after failure of urinary catheter were investgated.ResultsThe rate of catheter re-insertion was 1.5% (24/1 618). Compared with patients without re-insertion, patients with re-insertion had longer operation time [120.0 (95.0, 130.0) min vs. 120.0 (115.0, 180.0) min, P=0.015] and more intraoperative fluid infusion [800.0 (600.0, 1 100.0) mL vs. 1 150.0 (725.0, 1 350.0) mL, P=0.008]. Further multivariate analysis found that the operation time (OR=1.014, P=0.004, 95%CI 1.005-1.024) and intraoperative fluid infusion (OR=1.001, P=0.022, 95%CI 1.001–1.002) were independent risk factors for re-insertion.ConclusionThe rate of catheter re-insertion in lung cancer patients is relatively low, and conventional no placement of catheter is safe and feasible after lung cancer surgery. Increasing operation time or intraoperative infusion volume may increase the risk of catheter re-insertion after lung cancer surgery.
Objective To investigate the awareness and clinical needs of wearable artificial kidney among maintenance hemodialysis (MHD) patients, and to analyze the related influencing factors. Methods MHD patients were recruited from 2 tertiary hospitals in Sichuan province between April and June 2021. The convenient sampling method was used to select patients. The factors influencing the awareness and demand of MHD patients for wearable artificial kidney were analyzed. Results A total of 119 MHD patients were included. The awareness of wearable artificial kidney among the patients was mainly “never heard” (61 cases) and “heard” (58 cases). Most MHD patients (60 cases) were willing to use and participate in clinical trials in the future. The results of logistic regression indicated that the cost on household economy and treatment effect on life quality were the influencing factors for MHD patients’ awareness of wearable artificial kidney (P＜0.05). The average duration of single dialysis and the impact of treatment on working or studying were the influencing factors for MHD patients’ needs of wearable artificial kidney (P＜0.05). Conclusions The awareness of wearable artificial kidney is low among MHD patients. However, most MHD patients showed great interest in the wearable artificial kidney after preliminary understanding, suggesting that the future clinical application of wearable artificial kidney has great demand.
ObjectiveTo investigate the current status of work readiness and its influencing factors among postoperative lung cancer patients returning to work. MethodsA retrospective study was conducted on young and middle-aged postoperative lung cancer patients who were treated at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to September 2023 and returned to their jobs. Data were collected through a general information questionnaire, readiness for return-to-work scale (RRTW), general self-efficacy scale (GSES), and simplified coping style questionnaire (SCSQ). Univariate and multivariate logistic regression analyses were used to explore the factors affecting the work adaptation of returning patients. ResultsA total of 219 patients were included, with 59 males and 160 females aged 18-60 years. Among the postoperative lung cancer patients returning to work, 73.1% were in the active maintenance stage of return-to-work readiness with a RRTW score of (17.59±1.48) points, and 26.9% were in the uncertain maintenance stage with a RRTW score of (16.22±1.50) points. Bivariate logistic regression analysis showed that patients aged≤30 years (OR=52.381), employees of enterprises and institutions (OR=7.682), agricultural, pastoral, fishery, forestry laborers (OR=15.665), and those with higher self-efficacy (OR=1.157) had higher return-to-work readiness, while patients with≥2 children (OR=0.055), positive coping (OR=0.022), and out-of-pocket expenses (OR=0.044) had lower return-to-work readiness. ConclusionThe return-to-work readiness of young and middle-aged postoperative lung cancer patients needs to be improved, and occupation, job nature, main coping styles, and general self-efficacy are associated with return-to-work readiness.
The severe situation of the spread of novel coronavirus pneumonia (COVID-19) poses a huge challenge to the admission and management of patients undergoing selective thoracic surgery. In order to ensure that patients can receive surgical treatment in time, and we can effectively prevent the outbreak and spread of the disease in the surgical department, the department should comb the relevant content from multiple aspects in accordance with the specific situation. It is necessary to adopt a new admission process of patients undergoing selective surgery and COVID-19 investigation process for patients and their families during the epidemics. We should improve the companion and suspected patient management system during the epidemic. Patients who are planning to undergo surgery need to be strictly checked for COVID-19 infection before surgery. The treatment and management strategies of patients undergoing thoracic surgery in our department are summarized in this paper.
ObjectiveTo investigate the current status of outpatient pain management in patients with pulmonary disease after surgery by WeChat and to provide a basis for postoperative pain management.MethodsA total of 449 patients who underwent thoracic surgery in our hospital from December 2017 to May 2018 were enrolled, including 156 males and 293 females with an average age of 22-83 (55.54±11.17) years. Brief Pain Inventory was adopted for pain assessment in 24-48 hours after discharge and 24 hours after removal of from the wound.ResultsTotally 98.22% of the patients reported that they suffered from pain in 24-48 h after discharge, most pain position was still at drainage port (45.21%), the overall pain score was 2.75 (2.00, 3.25) points, and 82.85% of patients adopted physical methods to relieve pain. After removal of stitches at the drainage port, 79.29% of the patients suffered from pain, the pain site was mainly at the drainage port (47.88%), and the overall pain score was 1.75 (1.25, 2.25) points, and 73.94% of patients adopted physical methods to relieve pain. The score of the overall influence degree of pain on patients was 2.29 (1.86, 2.86) points and 1.86 (1.29, 2.43) points, while pain had the greatest influence on sleep and mood. The scores were 4.00 (3.00, 5.00) points, 3.00 (2.00, 4.00) points and 2.00 (1.00, 4.00) points, 3.00 (2.00, 4.00) points, respectively.ConclusionUnder the concept of enhanced recovery after surgery, the overall pain level of patients with pulmonary disease after discharge is mild pain, but the application rate of drug analgesia in patients is low. The overall effect of pain on postoperative patients with lung cancer is low, but it has a great impact on sleep and mood. Medical staff should strengthen the pain education for patients in order to improve their pain self-management ability.