Cases Of Postoperative Patients Research Articles

Impact of self-care intervention on self-care ability and quality of life in postoperative patients with hyperplastic diabetic retinopathy vitrectomy

Objective To study the impact of self-care intervention on self-care ability and quality of life in postoperative patients with hyperplastic diabetic retinopathy vitrectomy. Methods A total of 62 cases of postoperative patients with diabetic retinopathy vitrectomy were randomly divided into the control group and the observation group with 31 cases (31 eyes) in each group according to the sequence of operation. Both groups were given routine holistic nursing method, the observation group received self-care intervention based on routine nursing. The items such as vision recovery, self-care ability and quality of life score were compared between two groups after intervention. Results Three months after self-care intervention, the condition of vision recovery in the observation group was better than that in the control group (19 cases vs. 12 cases with improved vision),χ2=3.458, P <0.05. The total score of self-care ability in the observation group was higher than that in the control group [(127.49±15.0) points vs.(122.63±14.97) points],t=5.603,P< 0.05. The scores of role-physical, vitality, role-emotional and total score of quality of life in the observation group were higher than those in the control group[(66.23±21.06) points vs.(42.48±37.13) points, (85.24±20.19) points vs.(72.95±15.66) points, (72.93±32.48) points vs. (53.27±38.82) points, (67.85±14.59) points vs. (53.78±13.76) points],t=4.825, 3.546, 4.630, 4.369,P <0.05, the differences were statistically significant. Conclusions Self-care intervention can improve self-care ability and quality of life and promote the recovery in postoperative patients with diabetic retinopathy vitrectomy. Key words: Diabetic retinopathy; Vitrectomy; Self-care

Perioperative nursing of huge malignant lobulated breast tumor

Objective To summarize the perioperative nursing of huge malignant lobulated breast tumor, so as to promote the recovery of patients. Methods A total of 11 patients with huge malignant lobulated breast tumor patients were selected, assessed the preoperative status,finished breast tumor site nursing, strengthen psychological nutritional assessment, the adjustment of the respiratory system for the operation, prevent falls. In addition to do a good job in general nursing and postoperative pain management, but should also focus on the observation of the chest wall flap, drainage tube care, to prevent bleeding and infection, etc. Results By implementing the nursing plan, 1 case of breathing difficulties preoperative patients with respiratory function improved, 1 case of refuse treatment of patients accepted surgical treatment after psychological intervention, 2 cases of postoperative patients with skin flap necrosis, local treatment, after compression bandage, 1 case of good recovery, 1 case of poor treatment effect for the wound recovered well after back surgery graft; 1 case of patients with subcutaneous effusion, to adjust the drainage tube, suction fluid, after compression bandage, partial treatment, recovering well. Patients were good recovery, discharged smoothly. Conclusions By constantly sum up experience, through positive assessment of patients after preoperative mental and physical health and attaches importance to patients' skin flap, bleeding, pain, completes the drainage tube nursing and prevention of infection, can effectively promote the recovery of patients. Key words: Breast neoplasms; Perioperative nursing

Research on effect of regular family visit on rehabilitation promotion of hysterectomy patients

Objective To observe regular family visit on rehabilitation promotion of hysterectomy patients. Methods Random convenience sampling method was used to select 240 cases of postoperative patients and the patients were divided into supervision group and control group with 120 cases each group. Patients of two groups were treated with the same clinical nursing methods, in supervision group were added family visit on the basis of regular nursing. Evaluations were done with physiological status questionnaire and recovery situation questionnaire in hospital patients before and after hospital discharge 3 and 6 months, the results were compared. Results After hysterectomy, some patients showed ovarian hypothyroidism and discharge function disorder symptoms. And discharged after 3 months and 6 months, patients'wound pain incidence, recovery time of supervision groups were significantly lower than those of the control group(P<0.05). Conclusions Regular family visit patients after discharge solve with various health problems and improve the self nursing knowledge and ability, promote the rehabilitation and the satisfaction of patients obviously are improved. Key words: Hysterectomy; Family supervision; Health education; Rehabilitation

Analysis of postoperative life quality and influence factors of patients with hematopoietic stem cell transplantation

Objective To investigate the life quality of postoperative patients with hematopoietic stem cell transplantation (HSCT) and analyze its influencing factors, thus putting forward suggestions for follow-up visits and intervention of postoperative patients with HSCT. Methods A total of 64 cases of postoperative patients with HSCT in Beijing University Shenzhen Hospital and 36 cases of postoperative patients with HSCT in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University were chosen as research objects from October 2003 to October 2013. The General Information Questionnaire and the World Health Organization Quality of Life-Brief (WHOQOL-BREF) were adopted to investigate the patients' quality of life. The General Information Questionnaire included gender, age, marital status, education level, disease types, the severity of graft versus host disease (GVHD), the types of transplantation, transplantation time and so on. The WHOQOL-BREF included four dimensions: physiological, psychological, environmental and social relations dimension. It consisted of 26 items and each item was one to five scores, the full mark was 130 scores. The survey results about postoperative life quality of patients with HSCT were analyzed by univariate analysis and multivariate analysis. The study protocol was approved by the Ethical Reviews Board of Investigation in Human Being of Beijing University Shenzhen Hospital and Sun Yat-Sen Memorial Hospital. Informed consent was obtained from all participants. Results ①The life quality scores of 100 patients were from 61 to 124 scores and the average scores was (96.6±12.1) scores which was in the medium level. The score of economic status item was lowest, only 15% patients thought that their economic conditions could meet the needs of treatment cost. ②Univariate analysis results showed that the quality of life after transplantation was closely related to these influencing factors: the transplant type, severity of GVHD, time after transplantation, working conditions and financial situation (P<0.05). The multiple linear regression analysis results of the 4 dimensions in WHOQOL-BREF showed that the descending order of influencing degree on the patients' quality of life after HSCT was physiological field, psychological field, environmental field and social relations field. Physiological field dimension was the most relevant dimension with patients' quality of life among four dimensions (R2=0.815, P=0.000). Conclusions The life quality of HSCT postoperative survivors is not high which should be improved. It prompts medical workers to strengthen the follow-up visits and take some corresponding intervention measures to maximally reduce their body pain, meet their spiritual needs, in order to improve the life quality of patients after HSCT operation. Key words: Hematopoietic stem cell transplantation; Quality of life; Influential factor

Effect of hydrogel bandage applicator together with wound care bandage in the prevention of indwelling intravenous catheter phlebitis

Objective To investigate the prevention of indwelling intravenous catheter phlebitis through nursing care. Methods 300 cases of postoperative patients admitted to the gynecology department, from January 2010 to October 2010, were randomly assigned into 3 groups. The punctured regions were treated by cold magnesium sulfate gauze together with wound care bandage （ experimental group 1 ）, hydrogel bandage applicator together with wound care bandage （experimental group 2 ）, and wound care bandage （control group）, respectively. The intravenous catheter retention time and incidence of phlebitis were observed. Results The 3-day retention rate of indwelling intravenous catheter of the three groups was 86%, 97%, 71%, respectively. There were significant differences between experimental group 1, experimental group 2 and the control group （ Hc = 6.80,26.15 ; P 〈 0. 05 or P 〈 0. 01 ）. There was also significant difference between experimental group land experimental group 2 （ Hc = 7. 80, P 〈 0. 05 ）. The incidence of phlebitis was 23%, 6%, 44%, respectively. There were significant differences between experimental group 1, experimental group 2 and the control group （ Hc = 9.94,38.64; P 〈 0. 05 or P 〈 0. 01 ）. There was also significant difference between experimental group land experimental group 2 （ Hc = 11. 81, P 〈 0. 01 ）. The effective rate of phlebitis prevention was 90%, 97%, 78%, respectively. Conclusions The use of magnesium sulfate or hydrogel bandage can effectively extend the indwelling intravenous catheter retention time and prevent catheter phlebitis, and the latter may be superior in preventing phlebitis. Key words: Phlebitis; Dressing; Hydrogel bandage; Prevention; Indwelling intravenous catheter

Beneficial effects of preventive cholecystectomy in patients with hepatic cancer

There is no conclusive answer to the question whether excising gall bladder is helpful to the patient with hepatic cancer. The survival rate of patients with hepatic cancer for more than two years has been increased, and the incidence of complications of cholecystitis and gall stone are relatively higher among these patients, which may seriously complicate treatment of advanced hepatic cancer and decrease quality of life. The researchers conducted a prospective clinical investigation from 2002 to 2006 to assess the clinical significance of preventive cholecystectomy in patients with hepatic cancer. One hundred and eighteen cases of postoperative patients with hepatic cancer, who survived for more than two years, were followed up. Based on whether cholecystectomy was performed, the patients were divided into two groups including 48 cases with cholecystectomy and 70 cases with cholecyst reserved. The two-year morbidity of gall stone and morbidity of pain in the right upper abdomen of cholecyst reservation group were 54.29% and 68.57%, respectively, obviously higher than 0.00% and 20.83% of cholecystectomy group. Mainly for those treated with transcatheter arterial chemo-embolization, the morbidity of gall stone was 86.67% (P < 0.01). Therefore, preventive cholecystectomy is strongly recommended during hepatectomy to decrease the incidence of chronic cholecystitis and gall stone, especially for those whose chemotherapy and embolization will be carried out through hepatic artery and portal vein.

Dissociation of ACTH, beta-endorphin and cortisol in graded sepsis.

The function of the hypothalamic-pituitary-adrenal axis as related to the degree of severity of a septic process was assessed by measuring plasma levels of beta-endorphin, ACTH and cortisol. Sixty-one cases of postoperative patients treated at the intensive care unit were classified into four groups according to the severity of infection: Group 1 (control) included patients who did not show any sign of infection, group 2 patients with sepsis, group 3 patients with septic syndrome and group 4 patients with septic shock. Compared to G1 patients' ACTH values (4.16+/-2.6pg/ml), a statistically significant increase in ACTH values in various stages of septicemia (p < 0.005) with a noticeable difference also between G3 (7.11 +/-3.7pg/ml) and G4 (11.5+/-6.6pg/ml) (p<0.05) was found. Differences were also observed in beta-endorphin (with a level of significance between the several groups of p = 0.0001). Also, beta-endorphin values in G4 (40.6+/-30.3 pg/ml) differed significantly from each of G1 (17.5 +/-6.6 pg/ml), G2 (21.1+/-11.3 pg/ml) and G3 (23.5+/-12 pg/ ml) (p<0.05). A progressive hypercortisolemia was obvious, with values of G4 (37.2+/-15.6 microg/dl) differing significantly from those of G1 (18+/-4.6microg/dl) and G2 (24-/+8.4microg/dl) (p<0.05) and of G3 (28.5+/-12.3 microg/dl) from that of G1 (p < 0.05). Interestingly, a dissociation of ACTH, beta-endorphin and cortisol was observed, in that the increased values of beta-endorphin and cortisol, detected in the G3 were not associated with a parallel increase in ACTH. These findings might be interpreted in the sense of an impairment of the stress stimulation of the hypothalamic pituitary adrenal axis. Provided that such a situation can be lethal, our results further confirm the idea that a low-dose, steroid replacement might be beneficial to critical illness.

大量輸血患者におけるＡＴＬＡ抗体陽性率

In order to determine the transmission of ATL-virus (ATLV) by blood transfusion in ATL-nonendemic area, we surveyed the antibodies to ATLA in sera from patients receiving massive blood transfusion.Results were as follows;1) Anti-ATLA antibodies were positive in 4 of 61 (6.6%) cases of post-operative patients with heart disease using extracorporeal circulation. Ninteen of 40 (47.5%) cases of patients with acute leukemia were defined seroconverstion after blood transfusion.2) The rate of anti-ATLA antibodies positivity of the healthy inhabitants in Hokkaido were 0.74%, on the other hand it was very high in the family members of ATL patients (30.3%), and in the family members of healthy carrier (16.7%).3) After short time culture with PHA using peripheral lymphocytes from six cases of seroconverted patients with acute leukemia, ATLA were detectable in 4 cases.Eight cases of seroconverted patients with acute leukemia were followed for 7 months to 8 years, the titer against anti-ATLA antibodies continued without change in titer.4) We postulated that for preventing the transmission of ATLV by blood transfusion, screening test for anti-ATLA antibodies of blood donar is necessary even in the ATL-nonendemic area.