Objective:To explore the application effect of comfort-based light sedation strategy nursing model in early rehabilitation exercises for critically ill patients after gastrointestinal surgery, aiming to provide a reference for the recovery of patients after gastrointestinal surgery.Methods:A randomized controlled trial was conducted using purposive sampling to select 110 critically ill patients who underwent gastrointestinal surgery from July 2022 to December 2023 in the Department of Critical Care Medicine of Shantou Central Hospital. Patients were randomly assigned into the control group and the observation group, with 55 cases in each group. The control group received routine sedation care, while the observation group adopted a comfort-based light sedation strategy nursing model. The NRS (Digital Rating Scale for Pain), RASS (Rationalizing Self-Assessment Scale), SAS (Self-Rating Anxiety Scale), analgesic and sedative drug usage, postoperative bowel sounds, flatus, and defecation onset time, ICU length of stay, delirium incidence, postoperative 24-hour MRC muscle strength score, and discharge Modified Barthel Index (MBI) scores were compared between the two groups at 8 hours, 24 hours, 48 hours, 72 hours, and 96 hours postoperatively.Results:During the study, 5 cases dropped out from both the observation and control groups, leaving 50 cases each complete. The control group consisted of 32 males and 18 females, with an average age of (66.94 ± 14.39) years; the observation group consisted of 34 males and 16 females, with an average age of (68.01 ± 14.76) years. At 8, 24, 48, 72, 96 hours postoperatively, the NRS scores for the observation group were (3.11 ± 0.58), (3.14 ± 0.53), (3.09 ± 0.56), (2.97 ± 0.50), and (2.48 ± 0.45), respectively, were all lower than those of the control group (3.55 ± 0.61), (3.46 ± 0.59), (3.42 ± 0.62), (3.38 ± 0.54), (2.87 ± 0.53), with statistically significant differences ( t values were 2.80 - 3.97, all P<0.05). The RASS scores at postoperative 8, 24, 48, 72, 96 hours were (- 1.42 ± 0.43), (- 1.41 ± 0.42), (- 1.39 ± 0.44), (- 1.36 ± 0.41), (- 1.32 ± 0.40) respectively, compared to the control group (- 1.85 ± 0.47), (- 1.78 ± 0.44), (- 1.81 ± 0.50), (- 1.80 ± 0.48), (- 1.68 ± 0.45), with statistically significant differences ( t values were 4.23 - 4.93, all P<0.05). The SAS scores at postoperative 48, 72, 96 hours were (49.68 ± 4.55), (48.69 ± 4.41), (46.71 ± 4.33) respectively, compared to the control group (53.75 ± 4.76), (53.13 ± 4.69), (52.84 ± 4.51), with statistically significant differences ( t = 4.37, 4.89, 6.93, all P<0.05); the propofol dosage in the observation group (3 228.52 ± 587.78) mg and the dexmedetomidine dosage (1 205.58 ± 311.46) μg were all lower than those of the control group (4 056.77 ± 638.04) mg and (1 650.77 ± 432.69) μg, with statistically significant differences ( t = 6.75, 5.92, both P<0.05). The start time of bowel sounds in the observation group was (18.63 ± 5.96) hours, the start time of flatus was (1.42 ± 0.57) days, and the start time of defecation was (2.02 ± 1.25) days. The ICU hospitalization duration of the observation group (5.54 ± 1.51) days was shorter than that of the control group (7.36 ± 1.89) days, with differences being statistically significant ( t values were 2.71 - 5.32, all P<0.05). The postoperative delirium incidence rate of the observation group was 8.00% (4/50) lower than that of the control group 24.00% (12/50), with differences being statistically significant ( χ2 = 4.76, P<0.05). The postoperative 24-hour MRC muscle strength score (5.34 ± 0.58) and the discharge MBI score (77.56 ± 11.34) in the observation group were both significantly higher than those of the control group (4.79 ± 0.65) and (68.25 ± 10.47), respectively ( t = 4.46, 4.27, both P<0.05). Conclusions:The comfort-oriented light sedation strategy nursing model can improve the postoperative sedation and analgesia effects for ICU gastrointestinal surgery patients, promote gastrointestinal function recovery, shorten ICU hospital stay, reduce delirium incidence, and accelerate patient postoperative recovery.

Objective:To examine the long-term efficacy and complications of fecal microbiota transplantation (FMT) for the treatment of diseases related to intestinal dysbiosis.Methods:This was a retrospective descriptive study. Relevant data were collected from the records of 15 000 patients who had undergone FMT and been followed up for more than 3 months during the period from May 2017 to September 2024. The patient cohort comprised 3746 male and 11 254 female patients aged (45.3±12.2) years. The inclusion criterion was meeting the indications for FMT. Application of this criterion yielded 8258 patients with constipation, 684 with Clostridium difficile infection, 1730 with chronic diarrhea, 510 with inflammatory bowel disease, 432 with radiation enteritis, 1940 with irritable bowel syndrome, 365 with autism, 870 with postoperative gastrointestinal dysfunction, and 211 with neurodegenerative diseases. The three routes of delivering FMT comprised infusion of an enterobacterial solution through a nasoenteric tube into the jejunum for 6 consecutive days (upper gastrointestinal FMT group, 11 125 patients), oral intake of enterobacterial capsules for 6 consecutive days (oral capsule FMT, 3597 patients), and a single injection of a bacterial solution into the colon via colonoscopy (lower gastrointestinal FMT group, 278 patients). Other treatments were discontinued during the treatment and follow-up period and administration of other medications was not recommended unless absolutely necessary. The primary outcomes were the efficacy of FMT after 3, 12 and 36 months of treatment, and improvement in chronic constipation, C. difficile infection, chronic diarrhea, inflammatory bowel disease, radiation enteritis, irritable bowel syndrome, post-surgery gastrointestinal dysfunction, and autism. Other outcomes included the occurrence of short-term (within 2 weeks after treatment) and long-term (within 36 months after treatment) adverse reactions.Results:At 3, 12 and 36 months after treatment, the overall rates of effectiveness of treatment were 71.8% (10 763/15 000), 64.4% (7600/11 808) and 58.8% (3659/6218), respectively. Specifically, the rates of clinical improvement were 70.3% (5805/8258), 62.6% (3970/6345), and 56.5% (1894/3352), respectively, for constipation; 85.8% (587/684), 72.3% (408/564), and 67.3% (218/324), respectively, for C.difficile infection; 81.0% (1401/1730), 78.1% (1198/1534), and 72.3% (633/876), respectively, for chronic diarrhea; 64.3% (328/510), 52.3% (249/476), and 46.6 % (97/208), respectively, for inflammatory bowel disease; 77.3% (334/432), 65.4% (212/324), and 53.6% (82/153), respectively, for radiculitis; 70.6% (1370/1940), 64.5% (939/1456), and 60.4% (475/786), respectively, for irritable bowel syndrome; 75.3% (275/365), 70.0% (201/287), and 63.6% (112/176), respectively, for autism; 65.3% (568/870), 54.3% (355/654), and 46.5% (114/245), respectively, for post-surgical gastrointestinal dysfunction; and 45.0% (95/211), 40.5% (68/168), and 34.7% (34/98), respectively, for neurodegenerative diseases. At 3, 12, and 36 months post-treatment, clinical improvement rates were 77.1% (8580/11 125), 67.1% (6437/9595), and 62.1% (3196/5145), respectively, in the upper gastrointestinal route group; and 57.3% (2062/3597), 53.6% (1115/2081), and 45.0% (453/1006), respectively, in the oral capsule group; and 43.5% (121/278) , 36.4% (48/132) and 14.9% (10/67), respectively, in the lower gastrointestinal route group. No serious adverse reactions occurred during treatment or follow-up. The most common adverse reactions in the upper gastrointestinal route group, oral capsule group, and lower gastrointestinal route group were respiratory discomfort (20.4%, 2269/11 125), nausea and vomiting on swallowing the capsule (7.6%, 273/3597), and diarrhea (47.5%, 132/278), respectively; these symptoms resolved at the end of treatment. At 36 months of follow-up, 19 patients reported exacerbation of symptoms of pre-existing diseases and there had been 16 deaths that were not directly related to FMT. Additionally, no systemic diseases had developed after FMT.Conclusion:FMT for the treatment of intestinal dysfunction associated with disorders of the intestinal flora and related extraintestinal diseases is effective and not associated with serious adverse events.

Objective:To examine the long-term efficacy and complications of fecal microbiota transplantation (FMT) for the treatment of diseases related to intestinal dysbiosis.Methods:This was a retrospective descriptive study. Relevant data were collected from the records of 15 000 patients who had undergone FMT and been followed up for more than 3 months during the period from May 2017 to September 2024. The patient cohort comprised 3746 male and 11 254 female patients aged (45.3±12.2) years. The inclusion criterion was meeting the indications for FMT. Application of this criterion yielded 8258 patients with constipation, 684 with Clostridium difficile infection, 1730 with chronic diarrhea, 510 with inflammatory bowel disease, 432 with radiation enteritis, 1940 with irritable bowel syndrome, 365 with autism, 870 with postoperative gastrointestinal dysfunction, and 211 with neurodegenerative diseases. The three routes of delivering FMT comprised infusion of an enterobacterial solution through a nasoenteric tube into the jejunum for 6 consecutive days (upper gastrointestinal FMT group, 11 125 patients), oral intake of enterobacterial capsules for 6 consecutive days (oral capsule FMT, 3597 patients), and a single injection of a bacterial solution into the colon via colonoscopy (lower gastrointestinal FMT group, 278 patients). Other treatments were discontinued during the treatment and follow-up period and administration of other medications was not recommended unless absolutely necessary. The primary outcomes were the efficacy of FMT after 3, 12 and 36 months of treatment, and improvement in chronic constipation, C. difficile infection, chronic diarrhea, inflammatory bowel disease, radiation enteritis, irritable bowel syndrome, post-surgery gastrointestinal dysfunction, and autism. Other outcomes included the occurrence of short-term (within 2 weeks after treatment) and long-term (within 36 months after treatment) adverse reactions.Results:At 3, 12 and 36 months after treatment, the overall rates of effectiveness of treatment were 71.8% (10 763/15 000), 64.4% (7600/11 808) and 58.8% (3659/6218), respectively. Specifically, the rates of clinical improvement were 70.3% (5805/8258), 62.6% (3970/6345), and 56.5% (1894/3352), respectively, for constipation; 85.8% (587/684), 72.3% (408/564), and 67.3% (218/324), respectively, for C.difficile infection; 81.0% (1401/1730), 78.1% (1198/1534), and 72.3% (633/876), respectively, for chronic diarrhea; 64.3% (328/510), 52.3% (249/476), and 46.6 % (97/208), respectively, for inflammatory bowel disease; 77.3% (334/432), 65.4% (212/324), and 53.6% (82/153), respectively, for radiculitis; 70.6% (1370/1940), 64.5% (939/1456), and 60.4% (475/786), respectively, for irritable bowel syndrome; 75.3% (275/365), 70.0% (201/287), and 63.6% (112/176), respectively, for autism; 65.3% (568/870), 54.3% (355/654), and 46.5% (114/245), respectively, for post-surgical gastrointestinal dysfunction; and 45.0% (95/211), 40.5% (68/168), and 34.7% (34/98), respectively, for neurodegenerative diseases. At 3, 12, and 36 months post-treatment, clinical improvement rates were 77.1% (8580/11 125), 67.1% (6437/9595), and 62.1% (3196/5145), respectively, in the upper gastrointestinal route group; and 57.3% (2062/3597), 53.6% (1115/2081), and 45.0% (453/1006), respectively, in the oral capsule group; and 43.5% (121/278) , 36.4% (48/132) and 14.9% (10/67), respectively, in the lower gastrointestinal route group. No serious adverse reactions occurred during treatment or follow-up. The most common adverse reactions in the upper gastrointestinal route group, oral capsule group, and lower gastrointestinal route group were respiratory discomfort (20.4%, 2269/11 125), nausea and vomiting on swallowing the capsule (7.6%, 273/3597), and diarrhea (47.5%, 132/278), respectively; these symptoms resolved at the end of treatment. At 36 months of follow-up, 19 patients reported exacerbation of symptoms of pre-existing diseases and there had been 16 deaths that were not directly related to FMT. Additionally, no systemic diseases had developed after FMT.Conclusion:FMT for the treatment of intestinal dysfunction associated with disorders of the intestinal flora and related extraintestinal diseases is effective and not associated with serious adverse events.

Objective:To explore the application effect of comfort-based light sedation strategy nursing model in early rehabilitation exercises for critically ill patients after gastrointestinal surgery, aiming to provide a reference for the recovery of patients after gastrointestinal surgery.Methods:A randomized controlled trial was conducted using purposive sampling to select 110 critically ill patients who underwent gastrointestinal surgery from July 2022 to December 2023 in the Department of Critical Care Medicine of Shantou Central Hospital. Patients were randomly assigned into the control group and the observation group, with 55 cases in each group. The control group received routine sedation care, while the observation group adopted a comfort-based light sedation strategy nursing model. The NRS (Digital Rating Scale for Pain), RASS (Rationalizing Self-Assessment Scale), SAS (Self-Rating Anxiety Scale), analgesic and sedative drug usage, postoperative bowel sounds, flatus, and defecation onset time, ICU length of stay, delirium incidence, postoperative 24-hour MRC muscle strength score, and discharge Modified Barthel Index (MBI) scores were compared between the two groups at 8 hours, 24 hours, 48 hours, 72 hours, and 96 hours postoperatively.Results:During the study, 5 cases dropped out from both the observation and control groups, leaving 50 cases each complete. The control group consisted of 32 males and 18 females, with an average age of (66.94 ± 14.39) years; the observation group consisted of 34 males and 16 females, with an average age of (68.01 ± 14.76) years. At 8, 24, 48, 72, 96 hours postoperatively, the NRS scores for the observation group were (3.11 ± 0.58), (3.14 ± 0.53), (3.09 ± 0.56), (2.97 ± 0.50), and (2.48 ± 0.45), respectively, were all lower than those of the control group (3.55 ± 0.61), (3.46 ± 0.59), (3.42 ± 0.62), (3.38 ± 0.54), (2.87 ± 0.53), with statistically significant differences ( t values were 2.80 - 3.97, all P<0.05). The RASS scores at postoperative 8, 24, 48, 72, 96 hours were (- 1.42 ± 0.43), (- 1.41 ± 0.42), (- 1.39 ± 0.44), (- 1.36 ± 0.41), (- 1.32 ± 0.40) respectively, compared to the control group (- 1.85 ± 0.47), (- 1.78 ± 0.44), (- 1.81 ± 0.50), (- 1.80 ± 0.48), (- 1.68 ± 0.45), with statistically significant differences ( t values were 4.23 - 4.93, all P<0.05). The SAS scores at postoperative 48, 72, 96 hours were (49.68 ± 4.55), (48.69 ± 4.41), (46.71 ± 4.33) respectively, compared to the control group (53.75 ± 4.76), (53.13 ± 4.69), (52.84 ± 4.51), with statistically significant differences ( t = 4.37, 4.89, 6.93, all P<0.05); the propofol dosage in the observation group (3 228.52 ± 587.78) mg and the dexmedetomidine dosage (1 205.58 ± 311.46) μg were all lower than those of the control group (4 056.77 ± 638.04) mg and (1 650.77 ± 432.69) μg, with statistically significant differences ( t = 6.75, 5.92, both P<0.05). The start time of bowel sounds in the observation group was (18.63 ± 5.96) hours, the start time of flatus was (1.42 ± 0.57) days, and the start time of defecation was (2.02 ± 1.25) days. The ICU hospitalization duration of the observation group (5.54 ± 1.51) days was shorter than that of the control group (7.36 ± 1.89) days, with differences being statistically significant ( t values were 2.71 - 5.32, all P<0.05). The postoperative delirium incidence rate of the observation group was 8.00% (4/50) lower than that of the control group 24.00% (12/50), with differences being statistically significant ( χ2 = 4.76, P<0.05). The postoperative 24-hour MRC muscle strength score (5.34 ± 0.58) and the discharge MBI score (77.56 ± 11.34) in the observation group were both significantly higher than those of the control group (4.79 ± 0.65) and (68.25 ± 10.47), respectively ( t = 4.46, 4.27, both P<0.05). Conclusions:The comfort-oriented light sedation strategy nursing model can improve the postoperative sedation and analgesia effects for ICU gastrointestinal surgery patients, promote gastrointestinal function recovery, shorten ICU hospital stay, reduce delirium incidence, and accelerate patient postoperative recovery.