ObjectiveTo investigate the protein intake of patients in the general surgery intensive care unit (ICU) and to analyze the factors, both hindering and facilitating, that affecting protein intake from the perspective of healthcare professionals. MethodsA mixed-methods approach was used in this study, including a quantitative study and a qualitative study. The quantitative study was use to assess the protein intake in the ICU patients. The qualitative study was used to analyze the perspectives of healthcare professionals via semi-structured interviews. In the quantitative study, 32 variables were analyzed, and the sample size was estimated to be 10 times the number of study variables. The qualitative study employed the maximum difference sampling strategy, with the sample size determined by data saturation. The multiple linear regression was used to identify the risk factors affecting protein intake achievement, with a significance level of α=0.05. ResultsThe quantitative study included 459 patients, with a protein intake of (0.739±0.552) g/(kg·d). Of the patients, 90 (19.6%) had a protein intake of 1.2–2.0 g/(kg·d), 11 (2.3%) had 2.0 g/(kg·d) or more, and 358 (78.0%) had less 1.2 g/(kg·d). The multiple linear regression analysis identified several risk factors influencing protein intake attainment, including male, higher body mass index, elevated blood glucose levels upon ICU admission, early initiation of enteral nutrition (≤48 h), nasoenteric tube placement, and the only use of enteral nutrition feedings. In the qualitative study, three key themes relevant protein intake attainment were identified from the interviews: inadequate infrastructure, healthcare workers’ factors, and patient-related factors. ConclusionsThe findings of this study suggest a substantial gap between the protein intake of general surgical ICU patients and the guideline-recommended intake. The study highlights patient groups at risk for inadequate protein intake based on identified risk factors. Future efforts should focus on improving the efficiency of protein supplementation, enhancing the nutritional status of patients, standardizing protein supplementation protocols, and increasing education for both healthcare workers and patients.
Objective To investigate the risk factors for insulin resistance (IR) after selective operation in the department of general surgery. Methods Two hundred and sixty-three patients including 122 males and 141 females after selective operation between March 2009 and October 2009 in The First Affiliated Hospital of Xi’an Jiaotong University were studied. Sex, age, histories of smoking and drinking, hypertensive disease, history of operation, height, weight, waist circumference, anesthesia method, operation duration, operation method, and volumes of transfusion and liquid injection during operation were recorded. The fasting blood glucose (BG) and fasting plasma insulin (INS) were tested for selectively operative patients on day 1 before and after surgery. Insulin resistance index (HOMA-IR) and the index of insulin secretion (HOMA-β) were calculated with homeostasis model assessment (HOMA). Logarithms of HOMA-IR (lnHOMA-IR) was taken because that HOMA-IR was not normal distribution. Results The levels of fasting BG, fasting plasma INS, and lnHOMA-IR on day 1 after operation were higher than those on day 1 before operation (Plt;0.001). IR was correlated with patients’ sex (P=0.002), the history of smoking (P=0.033), waist circumference (P=0.000), operation method (P=0.007), and the volume of liquid injection during operation (P=0.001). A significant elevation of the change of lnHOMA-IR level was found between abdominal and nonabdominal surgery (Plt;0.001). Conclusions IR occurs in selectively operative patients in the department of general surgery. It is helpful for depressing IR to control the intensity of surgery.
【Abstract】Objective To study the advances in clinical application of shape memory alloy (SMA) in general surgery. Methods The literature in the recent years on the advances of SMA was reviewed. Results At present clinical application of SMA have been developed. Different stents could dilate the benign and malignant stricture of blood vessels, biliary ducts, cola, recta and gastric outlet obstruction. The SMA catheter system was effective for peroral cholangiopancreatoscopy. Novel nitinol basket instrument might be useful for percutaneous cholecystolithotomy. Compression anastomoses was safe and sound in gastrointestinal surgery using a device made of SMA. Nitinol stent could be used in transjugular intrahepatic portosystemic stent shunt (TIPSS) with satisfactory results. Nitinol occlusion devices was superior to stainless steel coils. The Simon nitinol filter represented a new generation of venous interruption devices designed to prevent recurrent pulmonary embolism. Conclusion Clinical application of SMA will be increased by the development of endoscope, laparoscope and interventional technique.
ObjectiveTo summarize the application status and related progress of robot-assisted technology in general surgery.MethodThe related researches about robot-assisted technology in general surgery in recent year were searched and reviewed.ResultsRobot-assisted techniques had similar safety and effectiveness to endoscopic surgery in general surgery. In addition, in rectal cancer, thyroid and pancreatic surgery, due to the narrow operation space, the advantages of robot-assisted surgery was more obvious.ConclusionsThe application of robot-assisted techniques in general surgery is safe and effective. With the decrease of the cost of robotic surgery, which has wide application value in general surgery.
Objective To investigate the characteristics of the pathogens causing bloodstream infection after general surgery in infant and young children patients, and to provide the references for disease treatment and nosocomial infection control. Methods The clinical and laboratory examination data after general surgery in infant and young children patients, who were admitted to our hospital from January 2012 to March 2017, were retrospectively collected. The pathogens and drug resistance were analyzed by SPSS 18.0 software. Results In this study, 109 cases were included, and 117 strains of the pathogens were isolated, including 53 isolates (45.3%) of gram negative bacteria, 41 isolates (35.0%) of gram positive bacteria, and 23 isolates (19.7%) of fungi. Escherichia coli (16/117, 13.7%), Enterococcus faecium (13/117, 11.1%), Candida parapsilosis (12/117, 10.3%), Klebsiella pneumoniae (9/117, 7.7%) and Enterococcus faecalis (8/117, 6.8%) were the top 5 species. Strains producing extended-spectrum beta-lactamase accounted for 87.5% of E. coli (14/16) and 44.4% (4/9) of K. pneumoniae isolates. Both E. faecium and E. faecalis were susceptible to vancomycin. C. parapsilosis showed the susceptibility to the antifungal agents. Conclusion Gram negative bacteria are predominant pathogens causing bloodstream infection after general surgery in infant and young children patients, and infection caused by resistant isolates should be prevented and controlled.
目的 探討胃大部切除術中應用直線型切割縫合器的臨床經驗及優點。方法 總結直線型切割縫合器的使用方法，并比較分析傳統胃大部切除術和采用直線型切割縫合器行胃大部切除術的手術時間和術后并發癥。結果 使用直線型切割縫合器使手術時間縮短60～120 min (P=0.000)，術后出血并發癥明顯減少(P=0.024)。結論 應用直線型切割縫合器行胃大部切除術可以縮短手術時間和減少術后出血的發生。
目的 探討普通外科手術患者發生院內感染與手術室護理管理的相關性，為有效控制院內感染提供理論依據。 方法 收集普通外科2008年4月－2009年6月接受手術治療的150例患者為對照組，2009年7月－2011年9月接受手術治療的150例患者作為干預組，分析可能影響院內感染的手術室護理因素。 結果 出院后隨訪6個月，對照組感染率為20.67%，高于干預組的8.00%（P＜0.05）；普通外科手術醫院感染與手術時間、術前抗生素應用、有無參觀人員等手術室因素密切相關。 結論 在手術室護理工作中，要采取一系列手術室護理干預措施，以提高護理管理質量，降低普通外科手術的院內感染發生。