ObjectiveTo investigate the influencing factor of intraoperative hypothermia during laparotomy.MethodsA total of 81 patients underwent laparotomy in our hospital from October 1, 2018 to January 1, 2019 were enrolled. The difference of preoperative baseline data and surgical data between the hypothermia and non-hypothermia groups was compared, and the influencing factor of intraoperative hypothermia during laparotomy was explored.ResultsOf the 81 patients, 32 patients occurred hypothermia during operation. There were no significant differences in gender, age, BMI, HGB, WBC count, PLT count, TB, AST, ALT, ALB, PT, operation time, postoperative hospital stay, and Clavien-Dindo grade between the hypothermia group and the non-hypothermia group (P>0.05), but there were significant differences in intraoperative infusion volume, intraoperative blood loss, and surgical mode (P<0.05). The intraoperative infusion volume and intraoperative blood loss in the hypothermia group were higher than those in the non-hypothermia operation group, and the proportion of hepatectomy was higher than that in the non-hypothermia group. The multivariate analysis show that the intraoperative blood loss, intraoperative infusion volume, and kind of operation were the risk factors for the hypothermia during laparotomy (P<0.05).ConclusionsIntraoperative hypothermia is related to intraoperative bleeding volume, intraoperative fluid infusion volume, and the kind of operation. Therefore, for patients with less bleeding, the intraoperative hypothermia can be reduced by limiting the volume of intraoperative fluid infusion. For those patients with more intraoperative bleeding, warming fluid infusion may reduce the incidence of intraoperative hypothermia.
ObjectiveTo review the application of omega-3 polyunsaturated fatty acids (Ω-3PUFAs) in patients with gastric cancer.MethodThe related literatures about the application of Ω-3PUFAs in patients with gastric cancer were reviewed by searching domestic and international databases.ResultsΩ-3PUFAs didn’t only improve the perioperative immune function and inflammatory response in patients with gastric cancer, but also prevent the occurrence of gastric cancer, inhibit the proliferation and promote the apoptosis of gastric cancer cells, increase the sensitivity of chemotherapy, and reduce the occurrence of chemotherapy-related adverse events.ConclusionsΩ-3PUFAsis an immunological nutrition, which can provide energy and also has functions of anti-inflammatory, anti-cancer, immunity regulation. It has been widely used in patients with gastric cancer, but the relevant mechanism needs further to be investigated.
Objective To explore the effect of different nutrition on the immune function of patients with colorectal cancer. Methods A total of 640 colorectal cancer patients were randomized into the enteral nutrition and peripheral nutrition groups. The peripheral venous blood was sampled before operation and on the postoperative days 1 and 7 to determine the serum levels of IgG, IgA, IgM, the percentage of T lymph cell subgroups CD3, CD4, CD4/CD8 and CRP, PGE, α- antitrypsin etc. The patient’s general condition, side-effects, and complications were observed intimately after surgery. Results Compared with the control group, the IgG, IgA, IgM, CD3, CD4,CD4/CD8 levels of the trial group on postoperative day 7 were higher. But the levels of CRP, PGE, α- antitrypsin were decreased. Hospitalization time and anal exsufflation time were shorter as well. There was no significant difference in either the general conditions or complications between the two groups. Conclusion Application of enteral nutrition after colorectal cancer surgery is safe, ,effective, and can improve the patient’s immune function and prognosis.
ObejectiveTo summarize the research progress of risk factors contributing to postoperative pulmonary infection in gastric cancer, so as to provide reference for medical decision-makers and clinical practitioners to effectively control the incidence of postoperative pulmonary infection in gastric cancer, ensure medical safety and improve the quality of life of patients. MethodThe researches at home and abroad on the factors contributing to pulmonary infection after gastric cancer surgery in recent years were reviewed and analyzed. ResultsThere was currently no uniform diagnostic standard for pulmonary infection. The incidence of postoperative pulmonary infection for gastric cancer varied in the different countries and regions. The pathogenic bacteria that caused postoperative pulmonary infection of gastric cancer was mainly gram-negative bacteria, especially Pseudomonas aeruginosa, Escherichia coli, Acinetobacter boulardii, and Klebsiella pneumoniae. The patient’s age, history of smoking, preoperative pulmonary function, preoperative laboratory indicators, preoperative comorbidities, preoperative nutritional status, preoperative weakness, anesthesia, tumor location, surgical modality, duration of surgery, blood transfusion, indwelling gastrointestinal decompression tube, wound pain, and so on were possible factors associated with postoperative pulmonary infection of gastric cancer. ConclusionsThe incidence of postoperative pulmonary infection for gastric cancer is not promising. Based on the recognition of related factors, it is proposed that it is necessary to develop a risk prediction model for postoperative pulmonary infection of gastric cancer to identify high-risk patients. In addition to the conventional intervention strategy, taking the pathogenesis as the breakthrough, finding the key factors that lead to the occurrence of postoperative pulmonary infection of gastric cancer is the fundamental way to reduce its occurrence.
ObjectiveTo assess the effect of chewing gum on the recovery of postoperative gastrointestinal function in patients with colorectal cancer. MethodsA comprehensive search for relevant randomised controlled trials (RCTs) was conducted in domestic and international databases such as PubMed, The Cochrane Library, Web of Science, Chinese Science and Technology Journal Full-text Database, Chinese Periodicals Full-text Database, Wanfang data, and other databases, with a timeframe up to September 2023. The literature was screened according to the inclusion and exclusion criteria. Simultaneously, the literature quality evaluation and data extraction were performed. The continuous variables were described using mean difference (95% confidence interval) and the binary variables were described using odds ratio (95% confidence interval). Test level was α=0.05. ResultsA total of 28 RCTs covering 2 523 postoperative colorectal cancer patients were included. The meta-analysis results showed that the postoperative chewing gum could shorten the time of the first flatus [–11.99 (–14.45, –9.53)], the first defecation [–18.79 (–23.58, –14.00)], the first bowel sounds [–6.35 (–6.64, –6.06)] or the first starvation [–5.20 (–10.11, –0.28)], and the hospital stay [–1.35 (–1.99, –0.70)], as well as could increase the serum gastrin level [23.70 (14.88, 32.53)]. Furthermore, it also could decrease the incidence of postoperative complications, such as nausea [0.66 (0.48, 0.91)], abdominal distension [0.48 (0.35, 0.67)], and intestinal obstruction [0.34 (0.20, 0.59)]. However, there was a non-significant effect on vomiting [0.81 (0.60, 1.09)] or time of the first oral intake [–0.67 (–1.99, 0.65)]. ConclusionsFrom the results of this meta-analysis, postoperative gum chewing aids to promote the recovery of gastrointestinal function and reduce the risk of postoperative complications in colorectal cancer patients. Although further studies are needed to verify the long-term effects and the feasibility of clinical application, the results of this study provide an important empirical support for the utilize of chewing gum in the management of postoperative gastrointestinal function.
The development of the fifth generation mobile networks (5G) technology has brought great breakthroughs and challenges to clinical medicine and medical education. In the context of “5G + medicine”, the development of telemedicine, emergency rescue, intelligent analysis and diagnosis has opened up new horizons for clinical medicine. Facing the constant impact of high technology, the focus of medical education should be on the cultivation of students’ integrated medical view, critical thinking, communication abilities and skills, and creativity. The “5G + education” model will be presented by means of virtual reality, artificial intelligence, cloud computing and other technologies, providing a new direction for the development of medical education. This article summarizes the key points and prospects of medical education under 5G technology in order to provide a reference for the field of medical education to adapt to the changes in the 5G era.
Objective To compare the differences in evaluating readiness for hospital discharge between nurses and colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) pathway. Methods A cross-sectional survey was conducted in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Patient-reported Readiness for Hospital Discharge Scale (RHDS) and nurse-reported RHDS were delivered to 130 CRC patients and 40 nurses respectively. All patients were followed ERAS pathway during perioperative periods. The differences were compared in evaluating readiness for hospital discharge between nurses and CRC patients. Results This study investigated 130 CRC patients and 40 responsible nurses. The scores of RHDS from nurses and patients were 162.86±27.95 and 149.86±33.65 respectively. When evaluating whether patients were ready to go home after discharge, the consistency between nurses’ results and patients’ results was weak（κ=0.365, P<0.001）. Items in patients’ RHDS scoring ranking from high to low were expected support, coping ability, knowledge, and personal status. Items in nurses’ RHDS scoring ranking from high to low were expected support, knowledge, coping ability, and personal status. Besides the " social support” dimension, the scores of other 3 dimensions from nurses were significantly higher than those from patients (P<0.05). Conclusion There is a gap between the assessment of RHDS from nurses and patients, nurses overestimated patients’ discharge readiness level.
目的：总结护理干预在预防胰肾联合移植术后感染中的作用。方法：分析我科2007年3月实施的1例胰肾联合移植病例围手术期护理资料。结果：患者术后恢复顺利，未发生呼吸道、泌尿道、腹腔、切口、深静脉插管等处感染。结论:积极、有效的护理干预能预防和降低术后感染的发生。
Objective To analyze the research status of immunonutrition in China based on Chinese databases, and to provide a reference for clinical practice and future research. Methods Literatures about the application of immunonutrition in nutrition support were searched in China National Knowledge Infrastructure, SinoMed, Chongqing VIP and Wanfang databases using bibliometrics methods. The retrieval time was up to August 2022, and the document characteristics such as the number of publications, the institutions and the citation frequency and other features were analyzed. Results A total of 725 literatures were included, with the highest number of literatures issued in 2015 and 2020, both 62. The areas with the most published literatures were Jiangsu (10.6%) and Guangdong (8.4%). The institutions with the most published literatures were General Hospital of Eastern Theater Command (4.8%) and West China Hospital of Sichuan University (3.9%). There were 78 dissertations and 647 journal articles in total. The most published journal was Parenteral & Enteral Nutrition (6.5%). The top three citations were all reviews. The degree of cooperation was 2.7, and the co-authorship rate was 70.1%. A total of 121 articles reported the supporting funds and projects. The research types included 499 original studies (68.8%) and 226 secondary studies (31.2%). The analysis of the subjects showed that immunonutrition was mostly applied to gastrointestinal diseases, especially gastrointestinal cancer patients, accounting for 42.5%. Nutritional support was divided into enteral nutrition and parenteral nutrition. Enteral nutrition was adopted in most literatures, accounting for 88.4%. Conclusions The research content of immunonutrition in Chinese database in China is relatively simple. Most of them focus on the comparison between immunonutrition and general nutrition support. The selection of immune nutrients and the application of immunonutrition in critically ill patients such as sepsis need further research.
目的 了解局部麻醉下腹股沟疝无张力修补术后患者排便变化的相关影响因素。 方法 采用自行设计的问卷调查表，对2010年5月－6月行无张力修补术的腹股沟疝患者术后排便情况及变化进行调查，并就相关影响因素采用logistic回归方法进行统计分析。 结果 腹股沟疝无张力修补术后患者进食量减少、活动量减少、饮食成分变化、担心排便引起复发是术后排便变化的影响因素。 结论 加强该病症术后健康宣传，指导患者正常进食、多活动，消除患者对腹股沟疝复发的焦虑，可促进其早期排便。Objective To research on the risk factors for change of defecation after inguinal hernia mesh-repairs under local anesthesia. Methods Self-made questionnaires were used to investigate the defecation change among patients having undergone inguinal hernia mesh-repairs from May to June 2010, and the correlated factors for change of defecation were analyzed by logistic regression analysis. Results Reduction of activity and food, changes of food ingredients, and worries about recurrence were risk factors for change of defecation. Conclusion In order to facilitate the recovery of the patients, nurses should promote patients’ knowledge on the surgery, guide them to eat as usual and do more exercises, and eliminate their anxiety on recurrence of the disease.