Objective:To investigate the effects of preoperative administration of parecoxib sodium on stress reaction and postoperative nausea and vomiting score in patients undergoing laparoscopic cholecystectomy.Methods:A total of 112 patients undergoing laparoscopic cholecystectomy in Lishui City People's Hospital from January 2020 to January 2021 were included in this study. They were randomly divided into observation group and control group, with 56 patients per group. The observation group was intravenously administered 40 mg parecoxib sodium 30 minutes before surgery, and the control group was identically administered equal amount of 0.9% sodium chloride injection. At 1, 6, 12 and 24 hours after surgery, Visual Analogue Scale (VAS) score, cortisol and adrenocorticotropic hormone levels and postoperative nausea and vomiting score were compared between the two groups.Results:At 1, 6 and 12 hours after surgery, VAS score in the observation group was (3.23 ± 0.85) points, (2.44 ± 0.76) points, (2.37 ± 0.69) points, respectively, which were significantly lower than (4.06 ± 1.12) points, (3.24 ± 0.95) points, (3.10 ± 1.07) points in the control group ( t = 4.41, 4.92, 4.29, all P < 0.001). At 1, 6, 12 and 24 hours after surgery, cortisol level in the observation group was (287.79 ± 35.46) ng/L, (303.55 ± 34.77) ng/L, (368.58 ± 31.22) ng/L, (397.16 ± 32.60) ng/L, respectively, which were significantly lower than (337.64 ± 39.52) ng/L, (364.18 ± 36.90) ng/L, (405.56 ± 37.29) ng/L, (455.51 ± 37.81) ng/L in the control group ( t = 7.02, 8.94, 5.69, 8.74, all P < 0.05). At 1, 6, 12 and 24 hours after surgery, adrenocorticotropic hormone level in the observation group was (59.25 ± 7.63) ng/L, (65.27 ± 8.23) ng/L, (72.29 ± 7.49) ng/L, (83.63 ± 8.57) ng/L, which were significantly lower than (64.48 ± 8.06) ng/L, (71.44 ± 8.59) ng/L, (79.79 ± 8.15) ng/L, (90.08 ± 8.26) ng/L in the control group ( t = 3.52, 3.88, 5.07, 4.05, all P < 0.05). Within 24 hours after surgery, the incidence of postoperative nausea and vomiting in the observation group was significantly lower than that in the control group [12.50% (7/56) vs. 28.57% (16/56), χ2 = 4.43, P < 0.05). Within 2 hours, 2-6 hours, and > 6-24 hours, postoperative nausea and vomiting score in the observation group was (1.31 ± 0.26) points, (1.43 ± 0.32) points, and (1.46 ± 0.41) points, respectively, which was significantly lower than (1.67 ± 0.41) points, (1.83 ± 0.39) points, (1.88 ± 0.44) points in the control group ( t = 2.12, 2.37, 2.14, all P < 0.05). Conclusion:Preoperative administration of parecoxib sodium exhibits a good postoperative analgesic effect in patients undergoing laparoscopic cholecystectomy. It can effectively reduce postoperative stress reactions, decrease the incidence of postoperative nausea and vomiting, and lower the severity of postoperative nausea and vomiting, and thereby can be widely used in clinical practice.

目的 探讨原发性中小肝癌行肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗的观察与护理.方法 对我院102例不愿手术或不能外科手术以及术后复发的中小肝癌患者,行肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗,序贯治疗前做好心理护理和一般护理,治疗后重视疼痛管理,加强发热、出血、胃肠道反应、肝功能异常等并发症的观察与护理,并同时做好出院指导.采用随机数字表法将102例分成实验组53例和对照组49例,对照组术前不使用芬太尼,术后疼痛评分≥4分再遵医嘱给予止痛药;实验组术前6h常规予芬太尼透皮贴4.2 mg贴前胸壁,术后常规医嘱给予氨酚羟考酮长期口服.结果 两组术后平均疼痛VAS评分比较,实验组低于对照组(P＜0.05);实验组患者满意度高于对照组(P＜0.05);102例患者治疗后病灶控制良好,无严重并发症发生.结论 对肝动脉化疗栓塞联合射频消融序贯治疗后患者应实施相应的护理措施,可提高疗效,以降低患者不舒适感,减少并发症发生,达到快速康复.

目的 探讨循证护理对减少腹腔镜手术后置管发生下肢静脉血栓及并发症的影响.方法 选取我院2014年8月～2016年8月的100例腹腔镜手术后置管患者进行研究,将患者随机分为对照组和试验组各50例,其中对照组患者采用常规护理方式进行干预,试验组患者在对照组的基础上采用循证护理对患者进行护理干预,观察两组患者腹胀、感染、皮下气肿、下肢静脉血栓等发生情况;采用生活质量核心量表(QOL-30)对患者生活质量进行评估.结果 两组患者护理干预后,试验组腹胀、感染、皮下气肿、下肢静脉血栓等发生率明显低于对照组,差异有统计学意义(P＜0.05);护理后试验组的生活质量评分明显高于对照组,差异有统计学意义(P＜0.05);护理后试验组满意度(98.0％)明显高于对照组(78.0％),差异有统计学意义(P＜0.05).结论 对腹腔镜手术后置管患者进行循证护理干预能够明显的减少患者下肢静脉血栓及并发症发生,有效的改善患者生活质量,值得推广应用.

腹腔镜保脾、胰体尾切除术治疗胰体尾部肿物,因创伤小、恢复快、并发症少、治愈率高等优点,被越来越多的应用于临床.2012 年 8 月至 2013 年 12 月,我科应用腹腔镜保脾胰体尾切除术治疗胰体尾肿物 7例,经密切观察及护理,患者恢复顺利,现将其护理经验总结如下: 1 临床资料 7例中男5例,女2例;年龄60~69岁.

性梗阻性黄疸，在重新开通闭塞胆道的同时，联合125Ⅰ粒子条腔内照射治疗控制肿瘤生长，从而延缓阻塞性黄疸复发，在提高患者生活质量上有明显疗效。作为护理人员，了解胆道支架联合125Ⅰ粒子条治疗的方法和观察要点，制定切实有效的护理措施尤为重要。现将我院收治的36例恶性梗阻性黄疸病例经胆道支架联合125Ⅰ粒子条治疗的护理体会报告如下。

<正>1991年Reich H[1]首次报道腹腔镜肝脏肿瘤切除术,随着腹腔镜肝脏手术经验的不断积累、操作技巧的不断提高以及新的腹腔镜专用器械、设备的出现,腹腔镜肝切除术(laparoscopic hepatectomy,LH)在肝脏疾病治疗中得到快速发展,并显示良好的疗效。我院2009年2月～2012年1月成功地为14例患者实施了腹腔镜肝左外叶切除术,积累了一些临床护理经验,现将围术期护理体会报告如下。

目的探讨瑞素乳剂在胃癌术后肠内营养的应用及护理要点。方法选择胃癌根治性手术病人65例,分为肠内营养(EN)33例,肠外营养(PN)32例。EN组通过液囊空肠管术后24h开始肠内营养,PN组给予静脉营养。检测手术前后营养状况及观察临床表现。结果术后EN组血清前蛋白、血红蛋白及体重较PN组上升快,差异有统计学意义(P<0.05);肛门排气时间EN组比PN组早(P<0.01);术后住院时间EN组较PN组短(P<0.01);营养治疗费用EN组较PN组少(P<0.01)。结论胃癌术后给予肠内营养支持,可促进胃肠功能恢复、改善营养代谢、缩短术后住院日、减轻营养治疗费用。