目的 調查胃腸道疾病患者圍手術期的疼痛狀況，為建立無痛病房，優化醫療和護理服務提供依據。 方法 對2011年12月5日－2012年1月14日胃腸外科所有的新住院患者共227例，采用《四川大學華西醫院住院病人疼痛現狀調查問卷》進行調查，并同期調查胃腸外科27名主管醫師對疼痛藥物了解狀況。 結果 有明確行為能力的216例患者完成調查問卷，其中有195例（90.28%）接受手術治療，全身麻醉患者193例（占手術患者98.97%），診斷為胃腸道腫瘤163例（占手術人數的83.59%），手術等級為三級146例（占手術人數的74.87%）。有168例（86.15%）患者術后鎮痛，在術后鎮痛過程中使用鎮痛泵156例（92.86%），其中75例（48.08%）認為鎮痛泵鎮痛“基本有效”，30例（19.23%）認為“無效”。39例術后未使用鎮痛泵，其中20例（51.28%）認為“未使用術后鎮痛泵”最主要原因為“不了解鎮痛泵”。受調查的主管醫師了解的疼痛藥物僅占羅列藥物52種的（20 ± 5.36）種。 結論 疼痛現象在胃腸道疾病圍手術期患者中屬普遍現象，由于不斷增強鎮痛意識和鎮痛需求與相關知識缺乏的矛盾存在，及較少的醫療護理干預，導致鎮痛效果不佳，影響了疼痛管理長效機制的建立和無痛病房的建設。
ObjectiveTo systematically evaluate the efficacy and safety of computer-aided detection (CADe) and conventional colonoscopy in identifying colorectal adenomas and polyps. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) comparing the effectiveness and safety of CADe assisted colonoscopy and conventional colonoscopy in detecting colorectal tumors from 2014 to April 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was performed by RevMan 5.3 software. ResultsA total of 9 RCTs were included, with a total of 6 393 patients. Compared with conventional colonoscopy, the CADe system significantly improved the adenoma detection rate (ADR) (RR=1.22, 95%CI 1.10 to 1.35, P<0.01) and polyp detection rate (PDR) (RR=1.19, 95%CI 1.04 to 1.36, P=0.01). It also reduced the missed diagnosis rate (AMR) of adenomas (RR=0.48, 95%CI 0.34 to 0.67, P<0.01) and the missed diagnosis rate (PMR) of polyps (RR=0.39, 95%CI 0.25 to 0.59, P<0.01). The PDR of proximal polyps significantly increased, while the PDR of ≤5 mm polyps slightly increased, but the PDR of >10mm and pedunculated polyps significantly decreased. The AMR of the cecum, transverse colon, descending colon, and sigmoid colon was significantly reduced. There was no statistically significant difference in the withdrawal time between the two groups. Conclusion The CADe system can increase the detection rate of adenomas and polyps, and reduce the missed diagnosis rate. The detection rate of polyps is related to their location, size, and shape, while the missed diagnosis rate of adenomas is related to their location.
Skeletal muscle and metabolic function are important factors affecting the health status of the elderly. Branched-chain amino acids (BCAA) can improve muscle recovery, reduce muscle soreness after exercise, and BCAA can also enhance metabolic health, helping to regulate blood sugar levels and improve insulin sensitivity in the elderly. In addition, BCAA can improve cognitive function, reducing the risk of age-related cognitive decline. This article reviews the relationship between BCAA and aging, skeletal muscle, and metabolic diseases, explaining how BCAA can support and promote muscle mass and function in the elderly, as well as have a positive impact on metabolic health and cognitive function.
【摘要】 目的 調查胃癌患者的營養風險及營養支持應用現狀。 方法 2009年9月-2010年1月，對某三甲醫院普外科收治的120例胃癌住院患者營養情況進行營養風險篩查2002（nutritional risk screening 2002，NRS 2002）評估，并就營養支持應用方式進行分析。 結果 所有患者中營養不足和營養風險的發生率分別為11.7%和27.5%；在33例有營養風險患者中，有26例（78.8％）接受了營養支持；在無營養風險的87例患者中，有30例（34.5％）接受了營養支持。 結論 對有營養風險的患者進行必要的營養支持，對于減少患者住院期間感染性并發癥或其他不良臨床結局的發生有積極作用。NRS 2002的方法簡便，適用于胃癌患者的營養風險篩查，但醫護人員需要進一步加強對腸外、腸內營養指南的認識。【Abstract】 Objective To investigate the clinical situation of nutritional risk screening for hospitalized patients with gastric cancer. Methods From September 2009 to January 2010, we applied nutrition risk screening 2002 (NRS 2002) to investigate the nutritional status of 120 hospitalized gastric cancer patients in the surgery department of a tertiary hospital, and analyzed the way of nutritional support for these patients. Results Among all the patients, the incidences of undernutrtion and nutritional risk were respectively 11.7% and 27.5%. Twenty-six out of the 33 nutritional risk patients received nutrition support, and 30 out of the 87 patients without nutritional risk received nutrition support. Conclusions Nutritional support for patients with nutritional risk is important in decreasing the occurrence of in-hospital infectious complications and other bad clinical outcomes. NRS 2002 is a simple and easy tool for predicting the nutrition risk in hospitalized gastric cancer patients, but the guideline of enteral nutrition and parenteral nutrition must be reinforced among doctors and nurses.
Objective To investigate the relevance among sarcopenia, peripheral inflammatory, and nutritional factors, as well as the impact of sarcopenia on the prognosis of gastric cancer. Methods A total of 174 patients with gastric cancer in Department of Gastrointestinal Surgery in West China Hospital of Sichuan University from July 2016 to December 2020 were retrospectively included. The skeletal muscle index (SMI) of the third lumbar vertebra level was calculated using CT images, and male patients with SMI<52.4 cm2/m2 and female patients with SMI<38.5 cm2/m2 were considered sarcopenia. The key clinicopathological features of patients were collected for prognostic analysis. ResultsAmong the 174 patients with gastric cancer, 73 patients (41.95%) were diagnosed with sarcopenia. Compared with those of non-sarcopenia, the patients who were diagnosed with sarcopenia showed a significantly elder age and lower body mass index (BMI). In addition, males demonstrated a significantly higher rate of sarcopenia. Further, patients with sarcopenia showed a significant increasing in the incidence of postoperative pulmonary infections and length of hospitalization than patients without sarcopenia. The two groups showed significant differences in type 2 diabetes, peripheral C-reaction protein (CRP), interleukin-6 (IL-6), albumin, prealbumin, and hemoglobin. Overall, the multivariate analysis and Kaplan-Meier survival curves indicated that sarcopenic patients had a significantly lower survival rate than the non-sarcopenia patients. Conclusion Sarcopenia is closely related to higher levels of inflammation, malnutrition, and poor prognosis in patients with gastric cancer. Therefore, we should diagnose sarcopenia patients as early as possible, and give nutritional support to the patients.
目的 分析持續腹膜透析患者發生腹膜炎的情況及相關因素，降低腹膜透析患者腹膜炎發生率、退出率，提高患者的生存率、生活質量。 方法 回顧分析2011年1月－6月收治的41例在家中行持續非臥床性腹膜透析且發生腹膜炎患者的臨床資料，觀察腹膜炎的發生率及轉歸，腹膜炎癥狀出現后初始的處理，對腹膜炎的誘因進行分析。 結果 41例腹膜透析患者共發生腹膜炎43例次，痊愈35例（85.4%），轉血液透析3例（7.3%），死亡3例（7.3%）。在癥狀出現初期，3例（7.3%）患者繼續在家觀察，10例（24.4%）患者立即到當地就醫，15例（36.6%）患者采用電話咨詢，13例（31.7%）患者到腹膜透析中心就診；18例（43.9%）患者直接將腹膜透析引流液帶到醫院進行藥敏試驗。就感染誘因而言，16例（39.0%）患者未嚴格進行空氣消毒，13例（31.7%）患者未嚴格進行環境清潔，10例（24.4%）患者操作過程存在污染行為。 結論 加強對居家行腹膜透析患者的初次培訓、操作指導及監測，可避免腹膜炎的發生，提高患者生活質量。