目的 探讨运用李可老中医学术思想,从“中气”论治术后肠梗阻的疗效。方法 采用前瞻性临床观察队列研究方法,选择82例术后肠梗阻患者,按照随机化原则平均分为两组:观察组为西医治疗基础上,联合从“中气”论治应用方剂,对照组为单纯西医治疗。结果 观察组的有效率为95.12%,首次排气时间为(12.46±2.75)h,首次排便时间为(31.52±5.38)h,腹痛腹胀完全消失时间为(15.71±3.57)h,平均住院时间为(18.69±3.82)d;对照组的有效率为73.17%,首次排气时间为(36.57±2.75)h,首次排便时间为(62.39±5.73)h,腹痛腹胀完全消失时间为(42.58±8.27)h,平均住院时间为(25.95±5.84)d;有效率对比,观察组高于对照组(P＜0.05),观察组症状改善时间较对照组明显缩短(P＜0.05)。结论 对于术后肠梗阻的治疗,西医联合从“中气”论治疗效优于单纯西医治疗。

Objective To explore the therapeutic effect on postoperative ileus with Li Ke's academic thought of traditional Chinese medicine: by mediating the Qi in the middle energizer(Stomach and Spleen). Methods Using prospective clinical observation cohort study, 82 patients with postoperative ileus were randomly divided into two groups on average: the observation group was treated with Western medicine and Chinese medicine decoction in which prescribed by the principle of mediating the Qi in the middle energizer(stomach and spleen). while the control group was treated with Western medicine only. Results The effective rate of the observation group was 95.12%, the average time of first farting of the patients was(12.46±2.75) h, the average time of first defecation was (31.52±5.38)h, the average time of complete disappearance of abdominal pain and abdominal distension was (15.71±3.57) h, and the average hospital stays was (18.69±3.82) d. In the control group, the effective rate was 73.17%, the average time of first farting of the patients was (36.57±2.75)h, the average time of first defecation was (62.39±5.73)h, the average time of complete disappearance of abdominal pain and abdominal distension was (42.58±8.27)h, and the average hospital stays was (25.95±5.84)d. Compared with the control group, the effective rate was higher in the observation group (P <0.05), and the symptom improvement time in the observation group was shorter than that in the control group (P <0.05). Conclusion For the treatment of postoperative ileus, western medicine combined with Chinese medicine decoction in which prescribed by the principle of mediating the Qi in the middle energizer(stomach and spleen) is better than Western medicine only.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.

目的 探讨中药吴茱萸治疗术后早期炎性肠梗阻的临床疗效,并探讨其应用价值。方法 将50例术后早期炎性肠梗阻患者随机分为治疗组(吴茱萸封包+常规西药治疗)和对照组(常规西药治疗),观察比较腹胀、腹痛、便秘、呕吐等临床表现、腹平片结果;对比分析2组患者腹胀缓解时间、肠鸣音恢复时间、排气排便时间、胃液引流量。结果 ①治疗组治愈率80.8%,高于对照组41.7%,有差异(P＜0.01);②治疗组腹胀缓解、肠鸣音恢复、肛门排气排便时间及24 h胃液引流量均较对照组缩短,差异有统计学意义(P＜0.05)。结论 吴茱萸封包穴位外敷能显著提高术后早期炎性肠梗阻临床疗效。

Objective To explore the clinical curative effect of Wuzhuyu in treatment of early inflammatory bowel obstruction and its application value. Methods 50 cases of early inflammatory bowel obstruction were randomly divided into the treatment group (Wuzhuyu packet+conventional western medicine treatment) and the control group (routine western medicine treatment), to observe the results of abdominal distention, abdominal pain, constipation, vomiting. The time of abdominal distension of the two groups, the recovery time of the bowel sound, the time of exhaust defecation and the drainage of gastric juice were compared and analyzed. Results ① The cure rate of treatment group 80.8% was higher than the control group of 41.7%, and the difference was statistical significant (P<0.01);② the time of abdominal distention of the treatment group, the recovery of the intestinal singing tone, the time of exhaust defecation and the drainage of the gastric juice were shortened than that of the control group, and the difference was statistical significant (P< 0.05). Conclusion The clinical effect of the treatment of early postoperative inflammatory bowel obstruction may be significantly improved by Wuzhuyu closure.

目的 研究对比胃癌患者术前胃镜活检病理与外科术后病理的异同并进行观察。方法 选取我院消化科于2016年7月—2017年12月收治的64例胃癌患者作为此次研究对象,术前均展开胃镜活检,术后展开外科病理检查,判断两种诊断方法的异同。结果 胃癌确诊率对比,术前胃镜活检后确诊胃癌患者占比85.9%(55/64),疑似胃癌患者占比10.9%(7/64),排除胃癌患者占比3.1%(2/64),术前胃镜活检确诊率85.9%,低于术后病理诊断95.3%,组间比较差异无统计学意义(P>0.05);胃镜活检病理结果对比,术前胃镜检查黏液腺癌占比35.9%,乳头状腺癌占比51.6%,均高于术后病理检查的25.0%、28.1%,组间比较差异具有统计学意义(P＜0.05);胃镜活检分化程度结果对比,胃镜病理与术后病理检查结果对比有明显差异,具有统计学意义(P＜0.05)。结论 对胃癌进行诊断时,尽管术前胃镜活检病理检查与外科术后病理检查结果存在差异,但术前胃镜活检对胃癌确诊率较为理想,可作为术前诊断参考,外科术后病理检查对全面评估胃癌病情具有较高应用价值,值得在临床中应用。

目的 探讨快速康复外科(enhanced recovery after surgery, ERAS)理念在膀胱癌根治加回肠膀胱术后护理的有效性和安全性。方法 分析我院2012年1月—2016年12月行膀胱癌根治加回肠膀胱术的患者共98例,其中ERAS组47例,传统组51例。比较两组术后伤口感染率、出血率、吻合口瘘率、肺部感染率及术后住院日等指标。结果 两组患者的伤口感染率、出血率、吻合口瘘率无差异,ERAS组的肺部感染率4.26%低于传统组21.57%,差异有统计学意义(P＜0.05)。ERAS组的术后住院日短于对照组[(8.53±1.82)vs (13.21±2.16)],差异有统计学意义(P＜0.05)。ERAS组的30天内再入院率6.38%低于传统组19.61%,差异有统计学意义(P＜0.05)。两组的非计划再次手术率无统计学差异。结论 快速康复外科理念应用在膀胱癌根治加回肠膀胱术后护理是有效和安全的,ERAS能减少术后并发症及缩短术后住院日。

目的 探讨腔镜手术治疗老年肺癌的疗效及对肺功能的影响。方法 我们纳入90例老年肺癌患者作为研究对象,随机抽签分为2组,各45例。观察组45例行胸腔镜肺癌切除术,对照组45例行传统开胸肺癌切除术。比较两组患者手术时间、术中出血量、胸腔引流时间、淋巴结清扫数量、术后住院时间、疼痛评分、肺功能及术后并发症情况。结果 两组手术时间、淋巴结清扫数量无差异(P>0.05);观察组术后胸腔引流时间、术中出血量、疼痛评分、住院时间少于对照组(P＜0.05)。观察组术后并发症总发生率低于对照组(P＜0.05)。观察组术后一秒用力呼气容积、用力肺活量、肺活量、一秒用力呼气容积与用力肺活量比值恢复情况优于对照组(P＜0.05)。结论 腔镜微创手术用于老年肺癌患者能够显著降低围术期并发症,缩短患者术后恢复时间,且有助于改善肺功能。

Objective To investigate the efficacy and safety of endoscopic surgery in the treatment of elderly patients with lung cancer. Methods 90 elderly patients with lung cancer in our hospital were divided into two groups,45 cases in each group. The observation group was treated with thoracoscopic lung resection in 45 cases, the control group of 45 cases received conventional open lung cancer resection. The operation time, intraoperative blood loss, thoracic drainage time, lymph node dissection, postoperative hospital stay, pain score, pulmonary function assessment and postoperative complications were compared. Results There were no significant differences in the operation time and lymph node dissection between the two groups (P>0.05). The thoracic drainage time,intraoperative blood loss pain score and hospitalization time in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). The forced expiratory volume, forced vital capacity, vital capacity, one-second forced expiratory volume and forced vital capacity of the observation group were better than those in the control group after operation(P<0.05). Conclusion Endoscopic minimally invasive surgery may significantly reduce perioperative complications in elderly patients with lung cancer, shorten the postoperative recovery time and improve lung function.

目的 比较不同浓度罗哌卡因横纹肌阻滞应用于剖宫产术后镇痛的临床效果。方法 选取2015年3月—2016年3月于我院剖宫产的孕妇300例,随机分为A组、B组、C组,每组100例,A组产妇给予质量浓度为1.5 g/L的罗哌卡因1.5 mg/kg,B组产妇给予质量浓度为2 g/L的罗哌卡因1.5 mg/kg,C组产妇给予质量浓度为2.5 g/L的罗哌卡因1.5 mg/kg,同时给予所有产妇镇痛泵辅助镇痛。记录观察所有产妇术后6 h、12 h、24 h、36 h、48 h的疼痛视觉模拟评分(VAS)、镇痛泵按压次数、产妇对镇痛效果的满意程度以及腹横肌平面阻滞(TAP)不良反应发生情况。结果 B、C组产妇的VAS评分均低于A组产妇(P＜0.05),24 h后C组产妇的VAS评分低于B组产妇(P＜0.05);与B、C组产妇相比,A组产妇的镇痛泵按压次数更多,镇痛效果满意度较低(P＜0.05),同时B组产妇的镇痛泵按压次数多于C组产妇(P＜0.05);3组产妇均未出现术后不良反应。结论 使用质量浓度为2.5 g/L的罗哌卡因横纹肌阻滞进行剖宫产术后镇痛,效果显著、安全性较高,临床中可推广使用。

Objective To compare the clinical effects of different concentrations of ropivacaine for postoperative analgesia after cesarean section. Methods 300 cases of pregnant women undergoing cesarean section in our hospital from March 2015 to March 2016 were selected and were randomly divided into group A, group B and group C with 100 cases in each group. The patients in group A were given 0.15% ropivacaine 1.5 mg/kg, 0.20% ropivacaine 1.5 mg/kg in group B and 0.25% ropivacaine 1.5 mg/kg in group C, and at the same time all the pregnant women were given analgesic pump assisting analgesia. The pain visual analogue scales (VAS) of the pregnant women were recorded at 6 hours, 12 hours, 24 hours and 36 hours after cesarean section and the number of times of analgesia pressing pump were also recorded. The satisfaction degree of analgesic effect and the TAP occurrence of adverse reactions of the patients were also recorded. Results The VAS scores of group B and group C were lower than that of group A(P<0.05). 24 hours after cesarean section, the VAS score of group C was lower than that of group B (P<0.05). Compared with group B and C, the number of times of analgesia pressing pump in group A were more but the analgesic effect of satisfaction was lower (P<0.05), and at the same time the number of times of analgesia pressing pump in group B were more than those in group C (P<0.05). No adverse reactions were found in the three groups. Conclusion The treatment of using of 0.25% of ropivacaine for muscle block for postoperative analgesia after cesarean section is effective and safe, which may be widely used in clinical practice.

目的 通过分析6例阴茎折断患者术后主要护理的要点,以提高阴茎折断患者术后的护理水平。方法 回顾性分析阴茎折断患者术后护理。对6例术后患者进行心理辅导,病情观察,正确体位的摆放,出院指导等护理干预。结果 6例患者在明确诊断后均急诊行阴茎血肿清除加白膜修补术,其中1例另外行尿道修补术。住院时间10~15天,平均9天,住院期间伤口愈合良好,无出现术后并发症。术后随访2~12个月,平均8个月。5例患者阴茎外观正常,性生活满意,无阴茎弯曲、痛性勃起、尿道狭窄等并发症。1例阴茎外观有轻度弯曲,但不影响性生活。结论 目前阴茎折断治疗的方法主要是手术治疗,护理人员帮助患者消除手术顾虑保持良好心态积极面对手术是手术成功的关键, 重视术后局部的护理以及病情观察,预防并发症的发生;指导患者积极进行功能锻炼和配合治疗,促进患者恢复。

Objective To summarize the experience of nursing intervention in diagnosis and treatment of penile fracture, and to improve the level of nursing of penile fracture. Methods The clinical data of 6 cases with penile fracture were retrospectively analyzed, the nursing intervention mode and significance in diagnosis and treatment were evaluated. 6 patients have emergency surgery after the diagnosis, and one patient urethra accepted surgical repair. Results The hospitalized period varied from 10 to15 days(average 9 days), and the patients were followed up for 2~12 months(average 8 months). 5 patients showed a very good outcome without complications, such as the penile deviation, pain, ED and urethral stricture, and 1 patient with penile deviation did not impede sexual activity. Conclusion Prompt surgical intervention of penile fracture showed a satisfied long-term outcome and get better therapeutic effects. Nursing intervention is important to improve the success rate of surgical, and targeted nursing after surgical can reduce complications.

目的 探讨黄芪枳术汤结合肠内营养的对颅脑术后患者ALB/PA/TP的影响。方法 将60例颅脑术后患者随机分为观察组(n=30)和对照组(n=30)。观察组给予中药黄芪枳术汤和整蛋白肠内营养液,对照组仅给予整蛋白肠内营养液。通过观察两组病人营养支持前后各项营养指标的变化和胃肠道的并发症,对两种治疗方式的疗效进行比较。结果 观察组病人营养支持后第7,14 天各项营养指标总蛋白(TP),白蛋白(ALB),前白蛋白(PA),血红蛋白(HGb)水平均高于对照组,差异有意义(P均＜0.05),观察组的胃肠道症状的发生率较对照组少。结论 黄芪枳术汤能加强肠内营养疗效,促进胃肠功能恢复及减少术后并发症,黄芪枳术汤结合肠内营养能增加颅脑术后患者的摄入量,提高血清蛋白水平,改善机体的营养状况,促进患者的早日康复。

      目的   回顾分析高原地区儿童阑尾炎术后早期炎性肠梗阻的临床特征，总结治疗经验。方法   回顾分析青海省妇女儿童医院2019—2023年收治的49例儿童阑尾炎术后早期炎性肠梗阻病例资料。结果   纳入研究的49例患儿，阑尾炎发病时间3～8 d，平均（5.38±1.25）d，术后出现肠梗阻时间3~11 d，平均时间（4.81±1.70）d，其中48例经过保守治疗后梗阻解除，恢复排气、排便，肠功能恢复时间4~13 d，平均（5.93±2.49）d，1例经积极保守治疗后病情进展，最终经手术治愈。49例患儿均顺利治愈出院，住院时间10～26 d，平均（15.69±3.79）d。术后随访1～2年，患儿饮食、排便均无异常。结论   高原地区儿童阑尾炎术后早期粘连性肠梗阻预防是关键，采取保守治疗同样可获得较高的治愈率，若保守治疗无效或病情进展应及时积极采取手术治疗。

       Objective  To review the clinical characteristics of early postoperative inflammatory small bowel obstruction（EPISBO） in children with appendicitis in plateau area and summarize the treatment experience．Methods  The data of 49 cases of appendicitis EPISBO in children admitted to Qinghai Women and Children’s Hospital from 2019 to 2023 were  retrospectively analyzed．Results  The onset time of appendicitis was 3-8 days，with an average of（5.38±1.25）days，and the time of intestinal obstruction was 3-11 days after surgery，with an average of（4.81±1.70）days．After conservative treatment，48 cases were relieved of obstruction，resumed exhaust and defecation，and intestinal function recovered in 4-13 day，average（5.93±2.49）d，1 case had progression after conservative treatment，and was cured by surgery．All the 49 children were successfully cured and discharged．The length of hospital stay was 10-26 days，with an average of（15.69±3.79）days．Postoperative follow-up of 1 to 2 years showed normal eating and bowel movements．Conclusions  The prevention of EPISBO in children with appendicitis in plateau area is the key．Conservative treatment can also achieve a higher cure rate．If conservative treatment is ineffective or the disease progresses，timely surgical treatment should be provided．