【摘要】 目的 探讨高原地区腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）患者的特点，以便更好地进行围手术期处理。 方法 对2009年2月-2010年5月收治的长期生活在西藏高原地区的患者（高原组）367例和非高原地区患者（非高原地区组）167例的一般资料、术前诊断、合并症情况进行回顾性分析，两组患者性别、年龄及病程比较，差异无统计学意义（Pgt;0.05），有可比性。两组患者诊断均以胆囊结石为主，其次为胆囊息肉，诊断构成比较，差异无统计学意义（Pgt;0.05）；两组患者合并症比较，高原组患者高血压、冠心病、血红蛋白增多症及窦性心动过缓的发生率高于非高原地区组（Plt;0.05）；肺部疾病、肝硬化、糖尿病及脑梗死的发生率两组患者比较差异无统计学意义（Pgt;0.05）。两组患者均采用常规LC进行治疗，对两组患者术后临床结果、并发症等进行统计学分析。 结果 高原组患者手术中转开腹率（7.1%）高于非高原地区组（2.4%）患者（Plt;0.05）；高原组患者较非高原地区组患者住院时间长、手术时间长、术中出血量多（Plt;0.05）；术后并发症比较差异无统计学意义（Pgt;0.05）。 结论 高原地区LC患者宜及时中转开腹，其围手术期处理得当将有助于减少术后并发症的发生。【Abstract】 Objective To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management. Methods We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (Pgt;0.05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (Pgt;0.05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (Plt;0.05). There was no significant difference in the incidence of lung disease, liver cirrhosis, diabetes mellitus and cerebral infarction between the two groups (Pgt;0.05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done. Results The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7.1%) was higher than that in patients in non-highland area (2.4%) (Plt;0.05). Hospitalization time, operation time and blood loss in Tibetan patients were significantly higher than those in patients in non-highland area (Plt;0.05), but there was no significant difference in postoperative complications between the two groups of patients (Pgt;0.05). Conclusions Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.
Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.
Objective To observe the changes and influencing factors on pulse oxygen saturation and hemoglobin in Tibetan residents of 4 200 meters above sea level. Methods The health examination data of the Tibetan village residents were collected in Rerong Country, Shannan Prefecture of Tibet autonomous region from January 4 to February 4, 2012. And the information of pulse oxygen saturation was recorded at the same time. The residents were categorized by sex, age and smoking history to observe the difference in each group. Results The clinical data of 234 healthy Tibetan residents were collected with average age of (37.9±13.9) years old, and 97 were male (41.5%). There were no difference in pulse oxygen saturation [(86.1±3.4)% and (86.0±4.7)%, P=0.784) between male and female residents, and heart rate of the male was less than that of the female [(77.9±9.8) bpm and (81.1±12.1) bpm, P=0.036], while the hemoglobin content was higher in male residents [(164.5±15.4) g/L and (139.1±19.2) g/L, P=0.000). With the increase of age, especially in the group older than 60 years, the pulse oxygen saturation significantly decreased (P=0.003), while hemoglobin content showed a gradual increase trend (P=0.000). And in the group which smoking history more than 20 pack-years, the pulse oxygen saturation was lesser than the other groups, and the hemoglobin content increased (P=0.000). Conclusions The pulse oxygen saturation level of Tibetan residents of 4 200 meters above sea level is negatively correlated with age and smoking history, and the level of hemoglobin is positively correlated with age and smoking history. In resting state, there is no significant difference in heart rate between the groups divided by ages.
ObjectiveTo discuss the treatment and nursing care for Daocheng tourists with acute altitude sickness, and analyze its related factors. MethodsFrom April to September 2012, 236 Daocheng tourists with acute altitude sickness were given drugs in time, and underwent oxygen inspiration. On the basis of observing the disease, nurses also provided care and health education to the patients. ResultsBy guiding patients' psychology, diet, oxygen uptake, medication and health related education, we cured 234 patients, and the rest 2 with high altitude cerebral edema were cured after being transferred to low-lying areas. ConclusionTourists from low-lying areas are vulnerable to altitude sickness when touring high lands. Preventive medicine before entering highland areas, more rest and less exercise are important factors to prevent the occurrence of altitude sickness. Health education from nursing care providers can effectively guarantee the safety of tourists entering plateau.
Objective To explore the clinical features, treatment measures, disease outcomes, and differences in patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau, and further analyze the risk factors. Methods A retrospective analysis was conducted on the clinical data of 297 patients with asthma admitted to Qinghai Provincial People’s Hospital and Tibet Autonomous Region People’s Hospital from 2015 to 2021. A standardized case report form (CRF) was designed and used to collect patients’ general information, International Classification of Diseases (ICD-10), clinical symptoms, treatment, laboratory examination, and pulmonary function test data. The clinical features of the patients were described, and the risk factors of the clinical features of asthma patients admitted to hospitals in Qinghai and Tibetan Plateau were analyzed by using a stepwise Logistic regression model. Results A total of 297 patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau were included in this study. The overall pulmonary function of asthma patients admitted to hospitals in Qinghai was worse than that in Tibetan Plateau (FEV1/FVC%: 73.22±13.59 vs. 80.70±18.36, P<0.001; TLC: 101.50 vs. 163.00, P=0.001). The incidence of related clinical symptoms in asthma patients admitted to hospitals in Qinghai were higher than those in Tibetan Plateau (dyspnea: 98.0% vs. 66.0%, P<0.001; cyanosis: 82.0% vs. 34.0%, P<0.001; pulmonary rales: 80.7% vs. 70.7%, P=0.046). There was no significant difference in treatment measures between patients in Qinghai and Tibetan Plateau (P>0.05). The main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence (OR=0.94, 95%CI: 0.91-0.98, P=0.004) and the co-existence of allergic diseases (OR=9.47, 95%CI: 2.68-3347.07, P=0.012).ConclusionsCompared with Tibet, the incidence of asthma symptoms and poorer lung function were higher among inpatients with asthma in Qinghai; there was no significant difference in treatment measures between the two regions, but there was a significant difference in prognosis; the main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence and the co-existence of allergic diseases.