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.
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.
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 evaluate anal function in patients with rectal carcinoma after low anastomosis operation. Methods Five hundred and forty-one patients with low rectal carcinoma were followed up for 1-3 years to assess anal function after low or ultra-low Dixon anastomosis. The evaluation was based on Xu Zhong-fa Assessment Criteria of Anal Function, anastomotic position and time-to-operation. Defecation function training and rehabilitation instructions were administered after the operation. Results The evaluation of defecation function showed that in the low Dixon operation group, 75.8%(211/278) scored “excellent”, 11.8%(33/278) scored “good”, 10.1%(28/278) scored “fair” and 2.2%(6/278) scored “poor”. In the ultra-low Dixon operation group, 70.7%(186/263) scored “excellent”, 13.3%(35/263) scored “good”, 10.6% (28/263) scored “fair”, and 5.3%(14/263) scored “poor”. No statistical difference was found between the low and ultra-low Dixon groups in this evaluation (Z= –1.429,P=0.136). However, there was statistical difference in the “awareness of defecation”(Z= –4.610,P=0.000) and “sense of defecation” (Z= –5.252, P=0.000) domains between the two groups. The defecation functions were similar between the low and the ultra-low Dixon operation groups after 6-month post-operation training(Z= –0.550, P=0.582). Conclusions There is no difference in defecation function between low and ultra-low Dixon anastomotic operation patients with rectal carcinoma by nursing.
ObjectiveTo systematically review the efficacy of enteral nutrition combined with parenteral nutrition (EN+PN) and enteral nutrition alone (EN) in gastric cancer patients undergoing gastrectomy. MethodsPubMed, EMbase, CNKI and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of EN+PN and EN in gastric cancer patients undergoing gastrectomy from inception to September 25th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 23 RCTs were included. The results of meta-analysis showed that compared to EN group, EN+PN group had a shorter hospital stay (MD=?1.75, 95%CI ?2.45 to ?1.05, P<0.000 1) and a lower risk of postoperative complications (RR=0.55, 95%CI 0.46 to 0.66, P<0.000 1). However, there was no statistical difference in the first exhaust time between the two groups. ConclusionThe current evidence shows that EN+PN may contribute to reducing the incidence of postoperative complications and shortening the length of hospital stay in gastric cancer patients. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
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 explore the correlation between readiness for hospital discharge and short-term quality of life among colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) mode.MethodsSurveys of 127 CRC patients following ERAS mode were conducted in the West China Hospital of Sichuan University. The Readiness for Hospital Discharge Scale and EORTC QLQ-C30 Scale were issued at the discharge and 1 month after the operation, respectively.ResultsThe total score of RHDS was 149.43±33.25. The score of global quality of life was 66.80±18.84. Correlation analysis showed that the total score of RHDS was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with the scores of fatigue, nausea and vomiting, pain, loss of appetite (r=–0.304, P=0.001; r=–0.189, P=0.033; r=–0.257, P=0.004; r=–0.254, P=0.004). The score of personal status dimension were positively correlated with the score of global quality of life and emotional function (r=0.213, P=0.016; r=0.197, P=0.027), and negatively correlated with scores of fatigue, pain and insomnia (r=–0.311, P=0.000; r=–0.264, P=0.003; r=–0.257, P=0.004). The score of knowledge dimension was negatively correlated with nausea and vomiting, pain and loss of appetite (r=–0.212, P=0.017; r=–0.182, P=0.040; r=–0.239, P=0.007). The score of coping ability dimension was positively correlated with the score of global quality of life and physical function (r=0.204, P=0.021; r=0.204, P=0.021), while negatively correlated with scores of fatigue, pain, insomnia and loss of appetite (r=–0.349, P=0.000; r=–0.240, P=0.007; r=–0.202, P=0.022; r=–0.201, P=0.024). The score of expected support was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with scores of fatigue and loss of appetite (r=–0.249, P=0.005; r=–0.227, P=0.010).ConclusionsThe short term quality of life among CRC patients following ERAS keeps at upper middle level, and positively correlated with the readiness for hospital discharge. It is suggested that discharge preparation service is of great significance to improve the quality of life of patients.
ObjectiveTo analyze the relationship between preoperative pulmonary function indexes and postoperative pneumonia (POP) in patients undergoing upper gastrointestinal surgery.MethodsThe clinical data of 303 patients who underwent lung function examination and upper gastrointestinal surgery in West China Hospital, Sichuan University from September 2020 to January 2021 were prospectively collected and analyzed. There were 217 males and 86 females, with an average age of 61.61±10.42 years. Pulmonary function was evaluated from four aspects including ventilatory function, pulmonary volume, diffusion function and airway resistance. Relevant pulmonary function indicators were displayed as the percentage of actual measured value to predicted value (%pred). The outcome index was pneumonia within 30 days after the surgery. Logistic regression was used to analyze the relationship between preoperative pulmonary function indicators and POP.ResultsA total of 196 patients with gastric cancer and 107 patients with esophageal cancer were included, and the incidence of POP in patients undergoing upper gastrointestinal surgery was 26.7% (81/303). Patients with preoperative low peak expiratory flow (PEF%pred) had a 3.094 times higher risk of developing POP than those with normal PEF%pred [OR=3.094, 95%CI (1.362, 7.032), P=0.007]. The incidence of POP had no correlation with the other preoperative indicators.ConclusionPreoperative PEF%pred may be an important indicator for predicting the occurrence of POP in patients undergoing upper gastrointestinal surgery.
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 summarize the research status and progress of intestinal microecology and trauma, in order to provide ideas for high-quality and effective treatment of trauma. Method The literatures on intestinal microecology and trauma at home and abroad in recent years were analyzed and reviewed. Results Intestinal microecology changed after trauma, but the mechanism of trauma on intestinal microecology was not clear. Intestinal microecological agents (such as probiotics), fecal bacteria transplantation, and traditional Chinese medicine treatment could maintain post-traumatic intestinal microecology. Conclusions The relationship between trauma and intestinal microbiota may provide valuable diagnostic, preventive, and therapeutic insights for improving the outcome after trauma, but the impact, mechanism, and intervention measures of trauma on intestinal microecology still need to be further studied.