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Objective:To explore the influence of family participatory case management combined with the Internet remote health guidance model on the self-management behavior and self-efficacy of patients with type 2 diabetes who are first diagnosed in physical examination, in order to provide reference for early blood glucose management of diabetic.Methods:A total of 200 patients who were newly diagnosed as type 2 diabetes in Beijing Friendship Hospital Affiliated to Capital Medical University from October 2017 to June 2018 were selected and divided into observation group and control group according to the random number table method, with 100 cases in each group. Patients in the control group were treated with routine management methods, while patients in the observation group were treated with family participatory case management combined with internet nursing mode. The blood glucose index, self-management level, self-efficacy and cognition of basic knowledge were compared between the two groups after intervention.Results:After the intervention, the fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin in the observation group were (6.52±1.34) mmol/L, (8.24±1.25) mmol/L, (6.35±1.24)%, which were lower than those in the control group(6.94±1.45) mmol/L, (8.70±1.40) mmol/L, (6.75±1.18)%, the differences were statistically significant ( t values were -2.127, -2.451, -2.337, P<0.05); the scores of self-management of diet self-management, regular exercise, medication self-management, blood glucose monitoring, foot care, high and low blood glucose prevention and treatment in the observation group were (22.58±4.24), (15.38±2.45), (13.23±1.10), (18.66±1.15), (19.56±3.14), (17.35±1.87) points respectively, which were higher than those in the control group [(18.56±3.87), (11.64±2.82), (11.26±1.82), (15.38±2.49), (15.82±3.56), (15.34±2.14) points], the differences were statistically significant ( t values were 7.003-11.959, P<0.01); the scores of self-efficacy of emotion control, reasonable rest, pain and discomfort control, self-care, medication compliance management, health problems in the observation group were (9.12±0.45), (8.56±0.62), (8.86±0.72), (8.46±0.68), (9.26±0.39), (8.76±0.46) points respectively, which were higher than those in the control group [(8.14±0.82), (7.14±0.85), (7.58±0.93), (7.16±0.85), (8.14±0.42), (7.48±0.79) points], the differences were statistically significant( t values were 10.477-19.541, P<0.01). The cognitive level of basic knowledge in the observation group was (17.45±2.48) points, which was higher than (13.12±3.14) points in the control group, the differences was statistically significant ( t value was 10.822, P<0.01). Conclusions:Family participatory case management combined with the Internet-based nursing model can significantly improve the self-management ability, self-efficacy and disease awareness of type 2 diabetes patients, and have a positive effect on improving patients' blood glucose metabolism indicators.
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Objective:To explore the effect of Dachengqi Decoction and enteral nutrition on the recovery of gastrointestinal function in patients with gastric cancer.Methods:From September 2018 to September 2019, 100 patients with gastric cancer undergoing radical gastrectomy in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected as the research objects, and were divided into observation group and control group according to the random number table method, each group contained 50 cases. Among them, the control group was given routine diet before operation to provide pre adaptation of enteral nutrient solution; the observation group was added with Dachengqi Decoction on the basis of routine diet. The recovery of gastrointestinal function, plasma motilin (MTL), serum gastrin (GAS) and gastrointestinal complications were observed and compared between the two groups.Results:There were 3 cases of abdominal distention and diarrhea in the control group, 1 case of diarrhea and 1 case of nausea and vomiting in the control group. The total incidence of gastrointestinal complications was 16% (8/50). There was 1 case of abdominal distention and 1 case of diarrhea in the observation group, and the total incidence of gastrointestinal complications was 4%(2/50). The difference between the two groups was statistically significant ( χ2 value was 4.000, P<0.05). In the observation group, the time of first bowel sounds, exhaust time and defecation time were (26.12 ± 5.32) h, (25.49 ± 4.49) h, (32.63 ± 4.31) h, respectively, which were significantly shorter than those in the control group (32.24 ± 6.41) h, (46.74 ± 6.14) h, (49.51 ± 6.28) h, and the difference was statistically significant ( t value was 5.195, 19.754, 15.671, P<0.05). The plasma MTL and serum gas in the observation group were (346.54 ± 18.58) ng/L, (123.44 ± 6.19) ng/L. After operation, the results were (247.24 ± 11.40) ng/L, (85.46 ± 5.12) ng/L. The difference was statistically significant ( t value was 97.793, 250.990, P<0.05). The plasma MTL and serum gas of the control group before operation were (344.63±16.65) ng/L and (122.53 ± 6.35) ng/L respectively. After operation, the results were (205.84±10.21)ng/L, (64.79±5.24) ng/L. The difference was statistically significant ( t value was 152.390, 367.823, P<0.05). The levels of plasma MTL and serum gas in the observation group were significantly higher than those in the control group ( t value was 19.129, 19.95, P<0.05). Conclusions:The modified Dachengqi Decoction and the pre adaptation of enteral nutrition solution are helpful to reduce the occurrence of various gastrointestinal complications after gastric cancer operation and promote the rapid recovery of gastrointestinal function, which may be related to the promotion of the secretion of MTL and gas.
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Objective@#To explore the safety and effectiveness of transthoracic endoscopic thyroid surgery in thyroid surgery.@*Methods@#Retrospectively analyzed 230 patients with thyroid tumor aged from 19 to 71 years, including 67 males and 163 females, who were admitted to General minimally invasive surgery, First Affiliated Hospital of Henan University of Chinese Medicine from March 2018 to August 2019. All patients were divided into traditional operation group (n=95) and endoscopic group (n=135) according to the operation method. The general information of the two groups of patients before surgery, including the time of surgery and tumor removal, amount of bleeding during surgery, postoperative drainage and extubation time, were compared. And the hospital stay, hoarseness, postoperative bleeding, incision infection, numbness, twitching, satisfaction and other related indicators were calculated also. SPSS 22.0 software was used for statistical analysis. Normally distributed measurement data were expressed as Mean±SD, and conparisons between groups were calculated by t test or χ2 test. The non-normally distributed data were expressed as M(P25, P75) and were analyzed by the Mann-Whitney U test.@*Results@#Compared with the preoperative general data, the number of nodules in the traditional group was 3.00 (2.00, 3.00), and the number of nodules in the endoscope group was 2.00 (1.00, 3.00). The difference was statistically significant (Z=-4.461, P<0.01). The maximum diameter of the tumor in the traditional group is 1.00 (1.00, 2.00) cm, and the maximum diameter of the tumor in the endoscope group is 1.00 (1.00, 2.00) cm. The two are statistically significant (Z=-2.041, P=0.041). There were no significant differences in age, gender, course of disease, nodule type, cystic change, nodule location, aspect ratio, nodule echo, nodular morphology, and nodular calcification (all P>0.05). Comparison of intraoperative indicators, the operation time of the traditional group was shorter than that of the endoscope group [(67.51 ± 9.27) min vs (89.86 ± 10.32) min, t=11.462, P<0.01]; the tumor removal time of the traditional group was also shorter than that of the endoscope group [( 28.37 ± 8.94) min vs (33.35 ± 7.39) min, t=5.456, P<0.01]; the blood loss in the traditional group was significantly more than that in the endoscope group [(51.34 ± 3.26) ml vs (20.65 ± 5.89) ml, t=14.723, P<0.01]. The recurrent laryngeal nerve was explored intraoperatively in both groups with a detection rate of 100%, the anesthesia was good in both groups, and the drainage tubes were indwelling in both groups. The drainage volume of the traditional group was significantly higher than that of the endoscope group [(135.76 ± 60.55) ml vs (69.12 ± 37.13) ml, t=10.805, P<0.01]. The extubation time was longer in the traditional group than in the endoscope group [(5.54 ± 1.44) d vs (4.66 ± 1.55) d, t=2.384, P=0.023]. In terms of hospitalization time, the traditional group was significantly longer than the endoscope group [(10.48 ± 5.37) d vs (7.25 ± 3.68) d, t=11.549, P<0.01]. There were 11 cases of hoarseness in the traditional group and 4 cases of hoarseness in the endoscope group, and there has statistically significant (χ2=6.790, P=0.009). There were 5 cases of postoperative bleeding in the traditional group, 1 case of postoperative bleeding in the endoscope group, the difference between the two was statistically significant (χ2=4.365, P=0.037); 5 cases of incision infection in the traditional group, none in the endoscope group, and the difference was statistically significant (P=0.012); 4 cases of numbness convulsions in the traditional group, none in the endoscope group, and there was statistical significance (P=0.028); 87 cases of satisfaction in the traditional group, and 134 cases of satisfaction in the endoscope group, and the difference was statistically significant (χ2=6.825, P=0.009).@*Conclusions@#Transthoracic endoscopic thyroid surgery has fewer complications in thyroid surgery and quicker postoperative recovery. It is worthy of widespread promotion, but the specific implementation plan needs to be further optimized.
ABSTRACT
Objective To explore the safety and effectiveness of transthoracic endoscopic thyroid surgery in thyroid surgery.Methods Retrospectively analyzed 230 patients with thyroid tumor aged from 19 to 71 years,including 67 males and 163 females,who were admitted to General minimally invasive surgery,First Affiliated Hospital of Henan University of Chinese Medicine from March 2018 to August 2019.All patients were divided into traditional operation group (n =95) and endoscopic group (n =135) according to the operation method.The general information of the two groups of patients before surgery,including the time of surgery and tumor removal,amount of bleeding during surgery,postoperative drainage and extubation time,were compared.And the hospital stay,hoarseness,postoperative bleeding,incision infection,numbness,twitching,satisfaction and other related indicators were calculated also.SPSS 22.0 software was used for statistical analysis.Normally distributed measurement data were expressed as Mean ± SD,and conparisons between groups were calculated by t test or x2 test.The non-normally distributed data were expressed as M(P25,P75) and were analyzed by the Mann-Whitney U test.Results Compared with the preoperative general data,the number of nodules in the traditional group was 3.00 (2.00,3.00),and the number of nodules in the endoscope group was 2.00 (1.00,3.00).The difference was statistically significant (Z =-4.461,P ＜ 0.01).The maximum diameter of the tumor in the traditional group is 1.00 (1.00,2.00) cm,and the maximum diameter of the tumor in the endoscope group is 1.00 (1.00,2.00) cm.The two are statistically significant (Z =-2.041,P =0.041).There were no significant differences in age,gender,course of disease,nodule type,cystic change,nodule location,aspect ratio,nodule echo,nodular morphology,and nodular calcification (all P ＞ 0.05).Comparison of intraoperative indicators,the operation time of the traditional group was shorter than that of the endoscope group [(67.51 ± 9.27) min vs (89.86 ± 10.32) min,t =11.462,P ＜ 0.01];the tumor removal time of the traditional group was also shorter than that of the endoscope group [(28.37 ± 8.94) min vs (33.35 ± 7.39) min,t =5.456,P ＜0.01];the blood loss in the traditional group was significantly more than that in the endoscope group [(51.34 ± 3.26) ml vs (20.65 ± 5.89) ml,t =14.723,P ＜0.01].The recurrent laryngeal nerve was explored intraoperatively in both groups with a detection rate of 100％,the anesthesia was good in both groups,and the drainage tubes were indwelling in both groups.The drainage volume of the traditional group was significantly higher than that of the endoscope group [(135.76 ± 60.55) ml vs (69.12 ± 37.13) ml,t =10.805,P ＜0.01].The extubation time was longer in the traditional group than in the endoscope group [(5.54 ± 1.44) d vs (4.66 ± 1.55) d,t =2.384,P=0.023].In terms of hospitalization time,the traditional group was significantly longer than the endoscope group [(10.48 ± 5.37) d vs (7.25 ± 3.68) d,t =11.549,P ＜ 0.01].There were 11 cases of hoarseness in the traditional group and 4 cases of hoarseness in the endoscope group,and there has statistically significant (x2 =6.790,P =0.009).There were 5 cases of postoperative bleeding in the traditional group,1 case of postoperative bleeding in the endoscope group,the difference between the two was statistically significant (x2 =4.365,P =0.037);5 cases of incision infection in the traditional group,none in the endoscope group,and the difference was statistically significant (P =0.012);4 cases of numbness convulsions in the traditional group,none in the endoscope group,and there was statistical significance (P =0.028);87 cases of satisfaction in the traditional group,and 134 cases of satisfaction in the endoscope group,and the difference was statistically significant (x2 =6.825,P =0.009).Conclusions Transthoracic endoscopic thyroid surgery has fewer complications in thyroid surgery and quicker postoperative recovery.It is worthy of widespread promotion,but the specific implementation plan needs to be further optimized.