There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11). A prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty. 335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0

Surgical Site Infection (SSI) is one of the common postoperative complications after gastric cancer surgery. Previous studies have explored the risk factors (such as age, diabetes, anaemia and ASA score) for SSI in patients with gastric cancer. However, there are large differences in the research results, and the correlation coefficients of different research results are quite different. We aim to investigate the risk factors of surgical site infection in patients with gastric cancer. We queried four English databases (PubMed, Embase, Web of Science and the Cochrane Library) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biological Medicine Database, Wanfang Database and Chinese Scientific Journal Database (VIP Database)) to identify published literature related to risk factors for surgical site infection in patients with gastric cancer. Rev Man 5.4 and Stata 15.0 were used in this meta-analysis. A total of 15 articles (n = 6206) were included in this analysis. The following risk factors were found to be significantly associated with surgical site infection in gastric cancer: male (OR = 1.28, 95% CI [1.06, 1.55]), age >60 (OR = 2.75, 95% CI [1.65, 4.57]), smoking (OR = 1.99, 95% CI [1.46, 2.73]), diabetes (OR = 2.03, 95% CI [1.59, 2.61]), anaemia (OR = 4.72, 95% CI [1.66, 13.40]), preoperative obstruction (OR = 3.07, 95% CI [1.80, 5.23]), TNM ≥ III (OR = 2.05, 95% CI [1.56, 2.70]), hypoproteinemia (OR = 3.05, 95% CI [2.08, 4.49]), operation time ≥3 h (OR = 8.33, 95% CI [3.81, 18.20]), laparotomy (OR = 2.18, 95% CI [1.61, 2.94]) and blood transfusion (OR = 1.44, 95% CI [1.01, 2.06]). This meta-analysis showed that male, age >60, smoking, diabetes, anaemia, preoperative obstruction, TNM ≥ III, hypoproteinemia, operation time ≥3 h, open surgery and blood transfusion were the risk factors for SSI in patients with gastric cancer.

目的:观察吴茱萸热敷联合穴位贴敷治疗肝癌患者术后恶心呕吐的效果.方法:选取2021年1月—2022年8月广东省中医院行全麻下腹腔镜下肝切除手术的106例肝恶性肿瘤患者.根据术后治疗恶心呕吐的方法不同分为对照组与观察组各53例.对照组实施术后常规治疗,观察组在对照组治疗基础上实施吴茱萸热敷联合穴位贴敷治疗.比较两组患者在术后0～6 h、术后6～12 h、术后12～24 h 3个时间段内恶心呕吐的发生率,术后恶心呕吐发生程度、术后首次排气时间以及术后首次排便时间.结果:术后0～6 h,两组患者恶心呕吐的发生率

目的:运用德尔菲法构建中西医互补防治肝癌科普宣教指标体系,为肝癌科普宣教栏目的制定提供参考.方法:通过文献研究法初步构建中西医互补防治肝癌科普宣教指标,采用德尔菲法对16名相关领域的医疗、护理专家进行两轮咨询.结果:最终形成中西医互补防治肝癌科普宣教指标体系,包括5项一级指标、23项二级指标、49项三级指标.两轮专家咨询的有效应答率分别为100.00％、93.75％,专家权威系数分别为0.934和0.927,整体指标的专家意见协调系数分别为0.191和0.215(P<0.001).结论:中西医互补防治肝癌科普宣教指标体系可为肝癌健康科普栏目提供理论框架,引导肝癌病人积极配合治疗和改善疾病预后,引导公众正确认识、防治肝癌,建立健康生活习惯.

目的 构建基于核心能力的中医专科护士资质认证方案,为我国中医专科护士的资质认证做出探索和提供参考.方法 在前期构建中医专科护士核心能力评价指标体系的基础上,结合文献研究,采用 Delphi法构建基于核心能力的中医专科护士资质认证方案.结果 2轮专家函询结束后,形成包含 3项认证准入指标、12项高级护理实践项目和 12项核心能力认证考核方式的中医专科护士资质认证方案.2轮专家函询问卷有效回收率为 100%,专家权威系数(Cr)分别为 0.947、0.950,肯德尔协调系数分别为 0.257、0.308(P<0.001).结论 本研究构建的中医专科护士资质认证方案具有科学性和临床适用性,可为中医专科护士的培训与认证工作提供参考与指引,有助于提高中医专科护士培养质量,充分发挥中医专科护士优势.

目的 构建中医专科护士核心能力评价指标体系,为中医专科护士的培养与管理提供参考依据.方法 通过文献研究法、理论分析法初步构建中医专科护士核心能力评价指标,采用Delphi法对17名专家进行2轮咨询.结果 整合专家反馈意见后,最终形成包括7项一级指标,22项二级指标,67项三级指标的中医专科护士核心能力评价指标体系;3轮专家咨询的有效应答率均为100％,专家权威系数分别为0.947、0.950、0.962,肯德尔协调系数分别为0.237、0.192、0.173(P<0.05).结论 中医专科护士核心能力评价指标体系科学合理、内容全面,可为我国中医护理人才核心能力的培养、资质认证、岗位任用与管理提供参考依据.

目的:观察大黄附子细辛汤中药灌肠治疗腹腔镜肝癌患者术后胃肠功能障碍的临床疗效.方法:选取2018年7月—2020年7月在广东省中医院肝胆外科行腹腔镜肝癌切除且术后出现胃肠功能障碍的患者102例,按随机数字表法分为治疗组和对照组,每组51例.两组患者均实施快速康复外科护理方案,对照组予以开塞露灌肠,治疗组予以大黄附子细辛汤灌肠,疗程为3 d,比较两组患者胃肠功能恢复情况,以及治疗前后腹胀评分.结果:治疗组肠鸣音恢复、首次肛门排气及首次排便时间均短于对照组,差异有统计学意义(P<0.05);治疗前,两组腹胀评分差异无统计学意义(P>0.05),治疗后,治疗组24 h、48 h腹胀评分均明显低于对照组,差异有统计学意义(P<0.05).治疗过程中,两组患者均未出现明显的不良反应.结论:大黄附子细辛汤灌肠治疗腹腔镜肝癌术后胃肠功能障碍的疗效显著,能快速促进腹腔镜肝癌术后患者胃肠功能恢复,且无不良反应,安全有效.

目的 探讨胆道手术后带T管出院患者院外护理需求及移动健康教育的作用效果.方法 选取2019年8月1-31日我院行胆道手术后带T管出院的116例患者作为研究对象.出院前调查患者对T管护理知识的掌握程度与院外护理需求.出院后实施移动健康教育,借助微信渠道实施健康宣教、在线咨询与指导等院外护理.回院复查时再次调查患者院外护理知识掌握程度.随访患者在此期间并发症发生情况及对移动健康教育的满意度情况.结果 移动健康教育干预前患者对护理知识的掌握程度评分为(31.35±5.06)分,干预后患者对护理知识的掌握程度评分为(50.81±6.42)分,评分较干预前显著升高(P＜0.05).116例患者中出现5例管道移位或脱落、3例腹部不适、1例皮肤刺激,未出现胆道感染;总的并发症发生率为7.76％,总满意度为98.28％.结论 胆道手术后带T管出院患者对院外护理需求较高,院外T管护理知识掌握水平低,需要加强出院后的健康教育.采用移动健康教育能改善其院外护理知识的掌握程度,减少并发症的发生,提升患者的满意度.

目的 评价吴茱萸择时选穴热熨对肝癌患者腹腔镜术后腹胀程度及胃肠功能恢复的影响.方法 采用便利的抽样的方法,于2017年1月—2019年1月选择在本院肝胆胰外科住院治疗行腹腔镜肝切除术肝癌患者156例,按入院先后顺序编号,采用简单随机数字表法,分为观察组和对照组,每组各78例.术后观察组基于子午流注理论,选择大肠经、胃经(脾经)最旺盛的交汇点06:45～07:20这段时间内进行吴茱萸加粗盐热熨;对照组采用吴茱萸加粗盐热敷,整个过程30min,1次/d,连续3d.于干预前、术后24h、术后48h观察两组患者腹胀程度及两组患者肠鸣音恢复时间及首次肛门排气、排便时间的差异.结果 广义估计方程分析显示,患者腹胀程度改善的时间效应、组间效应有统计学意义(P<0.001).术后24h、术后48h观察组患者腹胀程度均较对照组低,差异有统计学意义(P<0.05).观察组患者肠鸣音恢复时间及首次肛门排气、排便时间均较对照组短,差异有统计学意义(P<0.001).观察组在治疗期间无出现不良反应.结论 吴茱萸择时选穴热熨可有效改善肝癌患者腹腔镜术后腹胀程度和加速患者胃肠功能的恢复,并且是安全的.

Objective: To examine the surgical approach, practical cognition as well as clinical effect of the orthotopic resection for laparoscopic pancreatoduodenectomy(OLPD). Methods: From March 2019 to December 2019, 32 cases were treated with laparoscopic pancreatoduodenectomy (LPD) in a novel approach without mobilization of pancreatoduodenum in Pancreas Center of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine.There were 16 male patients and 16 female patients.The mean age was (64.8±9.5) years old.Body mass index was 14.9 to 31.0 kg/m(2).All patients were diagnosed as ampullary or pancreatic head tumors and were not unresectable cases.In the surgical strategy, Kocher's dissociation, turning and pulling of the pancreaticoduodenal region, was not performed first.Anatomy in situ, separation of vessels which enter and exit from pancreas, separation of lymphatics and isolation of tumors were carried out in priority through the combined middle and left posterior approaches.Finally, the pancreatic head and duodenum region was mobilized and the entire resection of pancreas in situ was carried out.Digestive tract reconstruction was performed through Child method. Results: Postoperative pathology showed that 27 cases were pancreatic or ampullary malignant tumors and five cases were benign tumors among 32 patients.The operative time was (357.3±64.3) minutes.The diameter of pancreatic ducts was (3.0±1.0) mm. The pancreas of 20 cases (62.5%) were soft. Five patients suffered from pancreatic fistula (Grade B) and one patient suffered from intra-abdominal hemorrhage postoperatively.No other complications like pancreatic fistula (Grade C) or biliary fistula delayed gastric emptying or mortality were encountered.The postoperative hospital day was (13.7±3.6) days. Conclusions: Combining the multi-angle of the laparoscopic approaches and excising the pancreaticoduodenal specimen in situ, OLPD is a kind of surgical method which can realize the concept of no touch tumor surgery.Patients who undergo the OLPD can receive better treatments and results.

Objective To observe the application effect of three kinds of venous indwelling needles in surgical inpatients.Methods A total of 360 patients who were admitted to the Department of Surgery of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from November 2016 to July 2017 were selected for study. They were divided into three groups by numerical table method. 118 patients who were treated with integrated positive-pressure connected indwelling needle constituted the first group. 121 patients who were provided with ordinary closed indwelling needle connected with heparin cap comprised the second group. 121 patients who were given ordinary closed indwelling needle connected with syringe-free infusion joint with the partitive membranes constituted the third group. The incidence of complications such as pipe blockage of the indwelling needle, phlebitis, exosmosis, needle-stick injuries as well as the maximum dripping rate after indwelling for 72 hours were compared among the three groups. Results There was no statistically significant difference in the incidence of pipe blockage, phlebitis, exosmosis and needle-stick injuries among the three groups (P>0.05). Furthermore, the incidence of pipe blockage in the first group was 0, the incidence of needle-stick injuries in all the three groups was 0. There was statistically significant difference in the maximum dripping rate of the patients among three groups after 72-h indwelling (P<0.05), and the groups with dripping rates in descending order were the third group, the first group, and the second group successively. Conclusion Different types of indwelling needles have their own advantages, and therefore, it is necessary for the nurses to take correct operation and maintenance methods.

目的 探讨穴位按摩联合热敏灸对肝癌术后气滞型呃逆患者呃逆缓解有效率及缓解时间的影响.方法 抽取2014年1月—2018年1月本院肝胆胰外科病房因肝癌行腹腔镜或开腹手术术后2 h麻醉清醒后出现呃逆,经常规处理1 h无效的患者作为研究对象.采用简单随机数字表法分为对照组(n=23)及观察组(n=25),对照组在穴位按摩基础上予盐酸甲氧氯普胺注射液10 mg肌内注射,观察组予穴位按摩联合热敏灸,1次/d,3 d为1个疗程,干预1个疗程.观察2组患者干预3 d末呃逆缓解有效率、呃逆缓解起效时间及起效后4h内呃逆复发率.结果 干预3d末,观察组肝癌术后气滞型呃逆患者呃逆缓解有效率为92％,对照组为70％,差异有统计学意义(x2=6.873,P<0.05);对照组干预后呃逆症状缓解起效时间为90(60,120)min;起效后4 h内呃逆复发率为69％,观察组干预后呃逆症状缓解起效时间为30(22,35)min,起效后4 h内呃逆复发率为17％,2组间比较,差异均有统计学意义(P<0.05).结论 穴位按摩联合热敏灸可有效缓解肝癌术后患者气滞型呃逆,缩短症状缓解的起效时间及起效后4h内呃逆复发率.

Objective To study the application effect of enhanced recovery after surgery (ERAS) for laparoscopic pancreatoduodenectomy (LPD) patients.Methods From July 2013 and March 2017,in Guangdong Provincial Hospital of Traditional Chinese Medicine,the clinical data of 85 patients who underwent LPD were analyzed retrospectively.The 43 patients treated with ERAS measures were as ERAS group,and the 42 treated with conventional program were as control group.The intraoperative and postoperative situation were compared.Results There was no statistically significant dif ference in operation time and operative blood loss,rates of special complication,the operative mortality and relaparotomy in two groups (P ＞ 0.05).Comapred with control group,the time of postoperative first flatus was earlier,postoperative length of stay and total length of stay were less,rate of overall complication was less in ERAS group,the differences were statistically significant (P ＜ 0.05 or P ＜ 0.01).Conclusion The ERAS pathway is effective and safe for LPD patients.

Objective To study the influence of external adjuvant application of Fructus Evodiae plus Natrii Sulfas on the degree of systemic inflammatory response and target organ damage in patients with severe acute pancreatitis.Methods Eighty cases of patients with severe acute pancreatitis admitted to Guangdong Hospital of Traditional Chinese Medicine from February 2013 to January 2017 were collected,and the enrolled patients were divided into two groups by single blind randomized controlled method,with 40 cases in each group.The control group received conventional therapy,on basis of which,the observation group was added with external adjuvant application of Fructus Evodiae plus Natrii Sulfas.At admission,one week after treatment,the contents of serum inflammatory indexes were measured by enzyme linked immunosorbent assay (ELISA),the contents of serum liver function indexes were detected by semi automatic biochemical analyzer,the contents of intestinal mucosal barrier indexes were measured by spectrophotometer method.Results At admission,there were no significant differences in the degree of systemic inflammatory response,liver function and intestinal mucosal barrier function between the two groups (P ＞ 0.05).One week after treatment,the contents of serum interleukin-6 (IL-6),interleukin-8 (IL-6),monocyte chemoattractant protein-1 (MCP-1),alanine aminotransferase (ALT),total bilirubin (TBiL),alkaline phosphatase (AKP),lactic acid,D-amine oxidase (DAO),endotoxin of the two groups were significantly lower than those at admission,and the contents of serum IL-6,IL-8,MCP-1,ALT,TBiL,AKP,D-lactic acid,DAO,endotox of observation group were significantly lower than those of control group (P ＜ 0.05).Conclusion External adjuvant application of Fructus Evodiae plus Natrii Sulfas can alleviate the degree of systemic inflammatory response in patients with severe acute pancreatitis,and protect target organ function.

目的:观察四黄水蜜外敷治疗急性胆囊炎的疗效及总结其护理要点.方法:将61例诊断为急性胆囊炎的患者随机分为观察组34例和对照组27例,对照组采用西医常规治疗和护理,观察组在对照组基础上加四黄水蜜外敷治疗和中医护理.在治疗前和治疗24h、72h后进行体温、白细胞计数、疼痛强度的评定以及出院满意度.结果:治疗24h后,两组体温比较,差异有统计学意义(P＜0.05),但治疗72h以后,两组体温比较,差异无统计学意义(P＞0.05).而治疗24h和72h后,两组白细胞计数、VAS疼痛评分比较,差异有统计学意义(P＜0.05).满意率观察组为96.8％,对照组为92.0％.结论:四黄水蜜外敷结合中医护理干预能够有效缓解急性胆囊炎的疼痛,减轻患者的临床表现,对急性胆囊炎患者有积极的治疗作用.

目的：探讨优质护理理念在肝胆外科临床护理带教中的应用效果。方法通过带教计划、带教实施、带教考核评价三阶段方法，将优质护理理念融入临床带教工作中，总结优质护理中护理带教的注意事项。结果实习护生的动手能力及主动性大大提高，对患者病情的观察更加及时细致，提高了护生的沟通、判断能力，也提高了带教老师的业务水平和人文素质，同时也提高了患者对实习护生的满意度。结论在肝胆外科临床护理带教中，按优质护理服务理念要求可提高临床护理带教质量。

目的:观察腧穴热敏化艾灸护理Ⅱ、Ⅲ期压疮病人的效果.方法:将80例Ⅱ期、Ⅲ期压疮病人随机分为2组,2组均采用外科换药,去除坏死组织后生肌油纱布覆盖或填塞换药.观察组再加用腧穴热敏化艾灸护理.比较2组病人压疮护理效果和治愈时间.结果:治疗后,观察组Ⅱ、Ⅲ期压疮治愈时间均短于对照组,差异均有统计学意义(P＜0.01).2组治疗后第7、14、21天压疮愈合评价量表(PUSH)评分分别比较,差异均有统计学意义(P＜0.05),观察组优于对照组.结论:腧穴热敏化艾灸可促进压疮伤口的愈合.

Objective To explore the PDCA cycle management model for improving the role of patients’anxiety in pa-tients with T tube drainage. Methods 60 cases with T tube drainage were randomly divided into experimental group (from September 2013 to March 2014, using conventional care method + applying PCDA cycle management) and con-trol group (from March to August 2013, using conventional care method). The anxiety score was adopted by Zung self-rating anxiety scale in the third day after surgery and the day before removing tube. The satisfaction was evaluated by the indwelling T tube patients’satisfaction questionnaire designed by medical staff. The anxiety situation and satisfac-tion in two groups were compared. Results The scores were (46.25±9.49) scores and (51.08±10.66) scores in experi-mental group and control group in the third day after surgery, there was no statistically significant difference (P =0.069). The scores were (41.58±7.95) scores and (47.83±6.92) scores in experimental group and control group in the day before removing tube, there was statistically significant difference (P= 0.002). In experimental group, the anxiety score in the day before removing tube was significantly lower than in third day after surgery, there was statistically significant difference (P=0.043). In control group, the anxiety score in the day before removing tube was a little bit lower than in third day after surgery, there was no statistically significant difference (P=0.167). The satisfaction were 96.67%and 80.00%in experimental group and control group in the day before removing tube, there was statistically significant difference (P=0.049). Conclusion PDCA cycle management model can reduce patients’anxiety and improve patients’satisfaction.

目的：观察新癀片外敷用于预防化疗性静脉炎的疗效。方法：选择80例乳腺癌根治术后行周围静脉滴化疗的患者（化疗方案相同），随机分为对照组和观察组，每组40例。对照组采用常规预防静脉炎发生的方法，观察组除采用常规预防方法外，并实施新癀片外敷，观察两组化疗患者化疗期间发生静脉炎的例数。结果：观察组化疗后发生静脉炎5例，无静脉滴炎发生的35例，静脉炎的发生率为14.3%；对照组发生静脉炎19例，无静脉炎发生的21例，静脉炎的发生率为47.5%，两组比较差异有统计学意义（ P﹤0.05）。结论：对于应用周围静脉滴化疗的患者采用新癀片外敷能明显减少静脉炎的发生，值得临床推荐。

乳腺癌作为一种身心疾病已逐渐得到广泛认同,心理因素在治疗和康复中有着极大的影响[1],因此,选择较好的心理干预模式,激发乳腺癌患者自身的正向能量,参与到治疗及康复活动中来,使临床护理健康教育有效地顺利进行.我们将聚焦解决模式用于乳腺癌患者的健康教育中,具体如下. 1 临床资料