Objective:To explore an effective method for improving self-nursing ability of the patient through surveying the self-nursing effects for the patients with coronary heart disease(CHD).Methods:Using questionnaire and following up,70 selected cases with more than two relapsing for their self-nursing ability on their disease needs and control.Results:(1)34.29%of the cases had the effective self-nursing ability;(2)High educationalbackground patients had more effective self-nursing ability comparing with the less educationp's(P

Objective To summarize the clinical outcomes after the optimization of nutrition support in elderly patients after hepatic carcinoma surgery.Methods The clinical data of 52 elderly patients with hepatic carcinoma in Beijing Hospital were collected and analyzed from 2007 to 2009(research group).Nutritional Risk Screening(NRS)2002 was applied for the nutrition risk screening at admission.NRS 2002 score≥3 was regarded as at nutritional risk.Enteral nutrition(EN)or EN combined with parentoral nutrition(EN+PN)supports were provided during the peri-operative stage.The control group included 30 patients from 2005-2007 under the same conditions with rescareh group but only received PN supports pest-operatively.Nutritional parameters,complications,lengh of hospital stay,and healthcare expenditures were analyzed.Results Body weight and plasma albumin were no significantly different in two groups(P>0.05)by the 7th post-operative day.The incidence of infection-relatod complications and length of hospital stay were significantly lower in research group than in control group (P<0.05).Conclusions Nutrition risk screening should be performed for the elderly patients with hepatic carcinoma after admission.Optimization of peri-operative nutrition support can reduce complications and improve the clinical outcomes.

Objective To observe the feasibility of laryngeal mask ventilation general anesthesia com- bined epidural block in laparoseopie eholecystectomy. Methods One hundred and forty eases of selective laparoscopie eholecystectomy were performed to T8～T9 gap catheterization, with 1.5 percent lidoeaine epi- dural block, block levels in the following T4. After conventional anesthesia into 4# or 5# LMA, balloon gas was injected in 20 mL～30 mL, manual ventilation, respiratory resistance and the situation thorax ups and downs were observed. Results The patients epidural catheterization smoothly, in the anesthesia plane fol- lowing T4, insert the LMA blood pressure, heart rate without significant change. Pneumoperitoneum after the rebound in blood pressure[(20.6 5.0) mm Hg], heart rate did not change significantly, and then airway pressure increased[(5.7 1.6)cm H2O] , surgery performed smoothly, and quickly regained consciousness after the surgery, when all patients admitted gallbladder, they have resumed breathing independently. Con- dusion Laryngeal Mask Airway general anesthesia combined epidural block cause mechanical damage vocal cords and airway, make the stress response light and the sense of rapid recovery, which is a safe and feasible method of anesthesia.

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Objective To evaluate the effect of discharge planning service mode in patients with intracoronary stent implantation. Methods Total?ly 106 patients with intracoronary stent implantation were divided into intervention group and control group,the intervention group received discharge planning services. The control group received routine nursing and follow?up of Department of Cardiology. The intervention lasted 6 months. Compari?son of two groups of patients in hospitalization days,cost of hospitalization and cardiovascular events and the rate of readmission and Compliance be?havior and clinical indicators and quality of life. Results The incidence rate of cardiovascular events and readmission rate in discharge planning group is lower than the routine nursing group(P<0.05);Discharge planning group of smoking cessation rates,weekly rehabilitation exercise times and coronary heart disease in two level prevention drug use rate is superior to that of routine group(P<0.05). Discharge planning group,left ventric?ular ejection fraction,success rate of blood lipids and the quality of life is better than the routine group(P<0.05). Conclusion Discharge plan?ning intervention can reduce the incidence of cardiovascular events and readmission rate,improve ventricular function and the compliance behavior and the quality of life in patients with coronary stent implantation.

Objective To evaluate the helical CT diagnostic value of primary retroperitoneal neoplasm(PRN). Methods 32 cases of PRN confirmed by operation and pathology were retrospectively analyzed. Plain and enhanced CT scan were perfomed in 28 cases,and only 4 cases underwent plain CT scans. Results Of 32 cases,15 were benign tumor and 17 cases were malignant tumor.Among them ,16 cases were mesenchymal tissue-origin(11 cases were malignant neoplasm), 10 cases were nervous tissue-origin(3 cases were malignant neoplasm),3 cases were rudimental embryonal tissue-origin(all benign), and the source of unknown-origin were 3cases(all malignant neoplasm).To be correctly localized was 28 cases(87.5%) and correctly qualitative diagnosis of the tumor was 20 cases (62.5%) by CT before operation. Conclusion PRNs have many typies, helical CT provides informations in both position and characteristics before operation.

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Objective To explore the value of helical computed tomography (CT) in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thicked gallbladder cancer (GBC).Methods The CT signs of 18 XGCs and 20 wall-thicked GBCs were retrospectively analyzed.The maximum thickness of gallbladder wall, intramural hypoattenuated nodules, mucosal line of gallbladder inner wall,patterns of enhancement of thickened wall,whether combined with stones,the pericholecystic adjacent liver tissue involvement and biliary tract obstruction were observed.Measurement data were analyzed by independent sample t test and count date were analyzed by Fisher precisely the probability method.Results The mean maximum thickness of the gallbladder wall of XGC and wall-thicked GBC was (22.11±10.19) mm and (20.55±7.94) mm respectively,and there was no statistical significance (t=0.530,P=0.600).Eighteen cases of XGC and five cases of wall- thicked GBC patients were with intramural hypoattenuated nodules (Fisher precisely the probability method,P＜0.01 ),14 cases of XGC and six cases of GBC were with integrated mucosal line (Fisher precisely the probability method,P =0.004 ),three cases of XGC and 12 cases of GBC were with biliary tract obstruction (Fisher precisely the probability method,P=0.009).There was no statistical significance in the CT signs of the range of wall thickness,patterns of enhancement and enhanced degree of thickened wall,adjacent liver tissue involvement, lymphadenopathy, combined with gallbladder or bile duct stone between XGC and wall-thicked GBC patients (Fisher precisely the probability method,all P ＞ 0.05).Conclusions The thickened gallbladder wall with intramural hypoattenuated nodules and integrated gallbladder inner wall mucosal line were characteristic signs for diagnosing XGC.Helical CT scanning can provide evidence for differential diagnosis in XGC and wall- thicked GBC.

Objective To evaluate the hemostatic effect of hemocoagulase agkistrodon in elderly patients undergoing laparoscopic cholecystectomy and to analyze its influence on coagulation function and its safety.Methods A prospective,randomized,double blind and controlled research was conducted in 60 patients aged over 65 years.Patients were divided into 2 groups:the study group and the control group (n =30 each group).Patients in the study group were injected with 2 U hemocoagulase agkistrodon intravenously 20 minutes before operation and with 1 U hemocoagulase agkistrodon 4 hours after operation.Patients in the control group were injected with physiological saline instead of hemocoagulase agkistrodon.The intraoperative intraperitoneal hemorrhage and intraperitoneal drainage at 24 hours after operation were recorded.The changes in bemagglutination and safety were observed.Results 59 cases were finished in this study and 1 case was eliminated.The volume of intraoperative hemorrhage was less in the study group than in the control group [(53.6±68.1) g vs.(88.1±79.7) g,t =2.08,P=0.038].There was no significant difference in the volume of intraperitoneal drainage at 24 hours after operation between the study group and the control group [(71.7±113.3) g vs.(89.0±104.7) g,t =1.69,P=0.075].The hemoagglutinationindexes were similar between two groups and no thrombosis occurred.There was no significant difference in the time of hospital stay between the study group and the control group [(5.2±1.4) days vs.(5.3±1.7) days,t=0.52,P=0.61].No adverse event was reported.Conclusions Hemocoagulase agkistrodon has relatively good hemostatic effects and safety for the elderly patients undergoing laparoscopic cholecystectomy.

ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1％ (81/269) ; more specifically,37.5％ (21/56) among geriatric patients ( ≥80 years) and 17.6％ (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3％ (103/269) ; more specifically,57.1％ (32/56) among the geriatric patients and 29.3％ (72/245) among the other age groups (P ＜0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3％,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.