Search

腹部按摩護理改善COPD合并便秘患者的癥狀評分觀察

摘要:目的:觀察腹部按摩護理對慢性阻塞性肺疾病(COPD)合并便秘患者的癥狀評分影響。方法:61例COPD合并便秘患者住院期間接受了腹部按摩護理干預(由下腹回盲部開始,沿結腸走向,從右至左環行按摩,力度適中,3次/d,5～10 min/次),干預前后進行“便秘癥狀及療效評估問卷”評分。結果:入選對象干預后便秘癥狀總分(10.06±2.93)明顯低于干預前(12.77±3.40),Plt;0.05),同時他們便秘癥狀的各分項評分指標也明顯優于治療前(P均lt;0.05～0.01)。結論:腹部按摩護理可明顯改善COPD合并便秘患者的癥狀評分。

Advances in Surgical Treatment for Colon Slow Transit Constipation

單吻合器行經肛門直腸膨出修補和直腸黏膜切除術治療排便障礙綜合征的臨床療效觀察

目的對由于直腸前突引起的排便障礙綜合征患者使用單吻合器行經肛門直腸膨出修補和直腸黏膜切除，并行術前、術后臨床癥狀和功能評估，評價該方法的手術效果。 方法2010年8月-2013年12月對39例患有直腸前突經過至少4個月的保守治療未見明顯好轉的女性患者采取單吻合器行經肛門直腸膨出修補和直腸黏膜切除術（TRREMS）治療，并觀察手術效果、并發癥及復發率。 結果平均手術時間為（40.00±3.78）min，術中平均出血量（15.00±5.01）mL，全部患者術后住院觀察24 h，均未見明顯早期并發癥，經隨訪12～24個月，3例出現手術相關并發癥（7.69%），1例吻合口狹窄（2.56%），經擴肛治療后，癥狀緩解，能自行排氣排便，2例出現肛門周圍疼痛不適（5.13%），疼痛評分3級，予以肛周局部外用藥物治療后疼痛緩解。術后排糞造影顯示共4例（10.26%）存在直腸前突殘留（均為Ⅰ級）。全部患者術后未出現出血、直腸陰道瘺、性交痛等并發癥。 結論TRREMS手術治療直腸前突引起的排便障礙綜合征無論在解剖學上還是在功能評價上都是安全有效的，且術后并發癥少，術后疼痛輕。

原發性便秘的外科治療

Clinical study of anorectal sensation and dynamics changes in irritable bowel syndrome with constipation

ObjectiveTo investigate changes in anal dynamics and anorectal sensory function in patients with irritable bowel syndrome with constipation (IBS-C) and detect its status of basin’s myoelectric pressure. MethodsThirty-six patients with IBS-C (IBS-C group) and 28 healthy volunteers (control group) were collected. The rectal-anal canal pressure and the change of the basin’s myoelectric status were detected by the ZJ-D3 gastrointestinal motility tester and bio-stimulus feedback instrument, respectively. The anal canal resting pressure, rectal resting pressure, anorectal pressure difference, length of anal canal high pressure area, rectal sensation threshold, rectal compliance, and basin’s myoelectric voltage were compared between these two groups. ResultsThere were no significant differences in the rectal resting pressure and anal canal resting pressure between the IBS-C group and the control group (t=–2.312, P=0.851; t=–5.464, P=0.283), but the difference value of anorectal pressure of the IBS-C group was significantly higher than that of the control group (t=4.371, P=0.017), and the length of the anal canal hypertension area in the IBS-C group was significantly longer than that of the control group (t=6.180, P=0.042). The maximal and minimum basin’s myoelectric voltage and frequency of the basin’s myoelectric voltage in the IBS-C group were significantly higher than those in the control group (t=3.386, P=0.031; t=5.763, P=0.042; t=8.410, P<0.001). ConclusionAnorectal dynamics and rectal sensory dysfunction are one of important causes of IBS-C, it might be existed abnormal changes in basin’s myoelectric voltage.

玉樹地震傷員便秘護理

地震傷員；便秘；護理

舒適護理在腰椎間盤突出臥床患者便秘中的應用

目的評價舒適護理應用于腰椎間盤突出患者臥床期間便秘中的效果，探討其臨床適用性。 方法將2013年5月-2014年5月就診的67例腰椎間盤突出患者隨機分為研究組（34例）和對照組（33例）。對照組患者實施常規護理，研究組患者在常規護理的基礎上增加了有針對性的膳食指導、心理疏導、腹部按摩、溫水洗肛及訓練反射性排便等舒適護理干預。觀察并記錄兩組患者治療后一般情況及干預療效。 結果接受護理干預的34例患者的術后首次排便時間、平均排便相隔時間和平均每次排便時間均低于對照組，差異有統計學意義（P＜0.05），研究組患者的護理干預療效高于對照組，差異有統計學意義（χ2=4.831， P=0.028）。 結論舒適護理對腰椎間盤突出患者臥床期間便秘中有很好的干預效果。

Dolichocolon with Colorectal Cancer: Report of 17 Cases and Review of The Literatures

目的總結結腸冗長癥合并結直腸癌的臨床病理特征，并文獻復習結腸冗長癥與結直腸癌的關系。 方法回顧性分析蘭州大學第一醫院普外一科2011年1月至2012年12月期間收治的17例結腸冗長癥合并結直腸癌患者的臨床資料。 結果184例結直腸癌患者中合并結腸冗長癥17例（9.24%），合并家族性息肉病惡變2例（1.09%），合并遺傳性非息肉病性結直腸癌1例（0.54%），合并炎癥性腸病1例（0.54%）。合并結腸冗長癥的比例較高（P＜0.05）。其中術前經結腸氣鋇灌腸檢查診斷為結腸冗長癥5例，術中診斷為結腸冗長癥12例。所有患者均行手術治療，切除結腸13～80 cm，平均33.8 cm。術后發生肺部感染、切口液化1例，腹水1例，腸瘺1例，骶前感染1例。術后17例患者均獲隨訪，隨訪時間6～12個月，中位數為10個月。隨訪期間，1例患者于術后1年出現卵巢轉移。 結論結腸冗長癥合并頑固性便秘可能是結直腸癌發病的高危因素。

Stapled Transanal Rectal Resection Versus Transvaginal Procedure for Treatment of Rectocele

Objective Both stapled transanal rectal resection (STARR) and vaginal bridge repair are new operative techniques for treatment of rectocele transanal and transvaginal, respectively. In this study we observe the clinical outcomes for STARR as compared with vaginal bridge repair procedure. Methods The clinical data of 31 patients with obstructive defecation syndrome from January 2007 to May 2009 were retrospectively analyzed. The patients were divided into 2 groups according to different operative approach: STARR group (n=18) and bridge repair suture group (n=13). The clinical outcomes observed were operative time, blood loss, length of stay, cost of hospitalization, complication and the improvement of obstructed defecation syndrome. Results There was no difference in the age and severity in the patients of two groups. Evaluation of the clinical outcomes showed 16 (88.9%) patients in the STARR group and 6 (46.2%) in the bridge repair suture group reported improvement in symptoms (P=0.017). STARR had a shorter operative time (24.6 min vs. 33.2 min， Plt;0.01), less estimated blood loss (3.9 ml vs. 16.2 ml， Plt;0.01), more costly (10 743 yuan vs. 3 543 yuan, Plt;0.01) and a higher anal incontinenc rate but reversible. The length of stay was similar (average 6 d). Conclusion The stapled transanal rectal resection procedure is more superior to the vaginal bridge repair suture for improvement of obstructed defecation syndrome from rectocele, however, it has a higher cost and some patient with reversible slight anal incontinence after surgery.

Investigation on Constipation during the First 30 Days after Hip Fracture

ObjectiveTo research on the condition of constipation during the first 30 days after hip fracture. MethodsOne hundred and four patients with hip fracture treated between May 2014 and March 2015 participated in this study. We judged whether there was constipation by recording the defecation pattern and stool consistency in three time periods: from admission to the time just before surgery, from the end of surgery to the time of discharge, and from discharge to 30 days after injury. The defecation pattern was assessed using Bristol Stool Scale and a scale of four-stage defecation was used to assess the stool consistency. ResultsThere were 51.9% (54) of the patients who developed constipation during the first time period, 69.0% (69) during the second time period, and 63.4% (59) in the third time period. The proportion increased by 17% during the second period over the first (P=0.003), while there was no significant difference between the latter two time periods (P=0.581). Normal defecation pattern was re-established 9.7 days after surgery, though 23.7% (22) of the patients did not re-establish normal defecation pattern within the first 30 days after injury. ConclusionThe incidence of constipation during the first 30 days after hip fracture is high. The results imply that further studies are needed to prevent constipation.