To explore the effect of accelerated rehabilitation strategy on gastrointestinal function recovery, pain and stress response factors in patiens with gasroesophageal reflux disease (GERD) treated by laparoscopic sugery.

Totally 62 cases of patients with GERD were selected for laparoscopic surgery from Septemper 2017 to June 2018 in the Xinjiang Uygur Automous Region People's Hospital. According to the stochastic numerical table method, all patients were divided into 2 groups, the accelerated rehabilitation group and the control group, with 31 cases in each group. The accelerated rehabilitation group was treated with enhanced recovery strategy in the perioperative period; the control group was treated with traditional anesthesia. The recovery time of gastrointestinal function (including bowel recovery time, anus exhaust time), postoperative pain visual simulation score (VAS), postoperative stress index [incuding C-reaction protein (CRP), cortisol level and white blood cell (WBC) count], postoperative activity time, hospital stay time, patients satisfaction, postoperative complication etc were recorded, and compared with t test.

The time of anus exhaust, the bowel recovery time, postoperative activity time were shorter than those in control group, and the differences were statistically significant (t=14.95, 16.39, 14.94, all P<0.001). However, there was no statistically significant difference in hospital stay time and patients satisfaction scores. The scores postoperative pain VAS score was lower in the accelerated rehabilitation group than in control group, the difference was statistically significant (t=5.942, P< 0.001). In the control group, postoperative CRP level, WBC count were both higher than those before surgery, but the differences were not statistically significant. Cortisol level was also higher than that before surgery, but the difference was statistically significant (t=13.15, P=0.048). There were no statistically significant difference in CRP, cortisol level and WBC count before and after surgery between the two groups. CRP, cortisol level in the postoperative accelerated rehabilitation group were lower than those in the control group, and the difference were statistically significant (t=0.60, P=0.001; t=4.640, P<0.001). No serious complication occurred in the two groups.

In laparoscopic GERD operation at perioperative period, the application of accelerated rehabilitation strategy for anesthesia management can significantly promote the recovery of gastrointestinal function, alleviate postoperative pain, decrease the postoperative inflammatory response, and has higher security.

Gastroesophageal reflux disease(GERD)is one of the most common diseases in the digestion internal medicine department which belongs to the obstructive in digestive power.It refers to a symptom or complication leads by the condition in which the stomach contents leak backwards from the stomach into esophagus and oral cavity(include the throat)or the lung.The main mechanisms of relux are not all the same in patients with different esophageal dynamic disorders.High resolution manometry is an intuitive, accurate assessment of esophageal dynamic conditions, which can provide us evidences for the selection of treatment strategy and help clinicians to manage GERD patients individualy and differently.

To explore the effect of standardized nursing procedures on the quality of life and efficacy of patients with gastroesophageal reflux disease(GERD)in outpatient department.

The patients diagnosed with GERD from June 2016 to September 2016 in People′s Hospital Xinjiang Uygur Autonomous Region were randomly divided observation group(n=41)and control group(n=40). Observation group was treated with standardized nursing procedure, control group was treated with routine nursing procedure, compared two groups of patients with gastroesophageal reflux questionary(GERD-Q), compliance and satisfaction.

After 6 months follow-up, the observation group of GERD-Q score was(6.2±1.9), the control group of GERD-Q score was(7.9±2.2), there was statistical difference between two groups(P=0.028). Compliance of the patients was improved(P=0.000), the satisfaction of the observation group was significantly higher than the control group(P=0.012).

The standardized nursing can make patients get individualized and comprehensive nursing services, which can effectively improve the GERD treatment effect and the quality of life of patients and improve the psychological state of patients and compliance as well as the satisfaction of nursing staff.It is obviously worth for clinical application.

To evaluate the application of Gerd Q in the diagnosis of gastroesophageal reflux disease(GERD)in patients with gastroesophageal reflux disease.

Patients were selected from June 2015 to June 2016 in People′s Hospital of Xinjiang Uygur Autonomous Region who was suspected as GERD and ask them to fill the Gerd Q. All patients received Gerd Q questionnaire survey, gastroscope, 24h pH monitoring of esophageal and/or proton pump inhibitor(PPI)treatment.gastroscope, 24h pH monitoring of esophageal and/or PPI treatment were regarded as golden diagnosis standards.The results were compared with Gerd Q scores, in order to calculate the diagnostic sensitivity, specificity and accuracy of Gerd Q.

Gerd Q scores were mainly concentrated in 7~14 points, and non GERD group mainly concentrated below 7 points, after the Gerd Q diagnostic threshold increases, the sensitivity decreases and the specificity increases, when the area under the ROC curve is 0.802 the best diagnostic sensitivity and specificity were 77.5% and 87.3% respectively when score 8 was set as the critical value for the Gerd Q, The Youden index reached a maximum of 0.648.The positive coincidence rate of diagnosis in patients with GERD was 77.72%, and the negative coincidence rate was 87.8%.

The Gerd Q is a good screening test for the diagnosis of GERD, the preliminary diagnosis rate is high, which can be used as a noninvasive, simple, easy, economical and effective method for the clinical diagnosis of GERD.

To discuss the effect and postoperative complications of gastroesophageal reflux disease with hiatus hernia after fundoplication treatment of laparoscopic Nissen and Toupet.

Review the 57patients with laparoscopic esophageal hiatal hernia complicated with gastroesophageal reflux disease which be treated with Nissen and Toupet fundoplication from July 2014 to July 2016 in Shengjing Hospital affiliated to China Medical University, 24 patients underwent Nissen surgery(group Nissen), 33 patients underwent Toupet operation(group Toupet). Observed and compare the anti reflux effect and postoperative complications of the two groups.

57 cases were successfully completed laparoscopically, without laparotomy, the average operation time was (75.8±6.4)minutes(the total operation time was 68 minutes~115 minutes); the average amount of bleeding was (22±5)ml(the amount of bleeding was 15 to 30 ml); patch repair was used in the two methods; after 24 hours into the liquid, the mean postoperative hospitalization was (10.5±3)d.57cases were followed up for a period of 6 months to 2.5 years(mean, 18 months). None of the patients had regurgitation, heartburn and other typical symptoms of gastroesophageal reflux disease after the surgery.In group Nissen, dysphagia occurred in 2 patients(8.2%); In group Toupet, dysphagia occurred in 8 patients(24.2%). The incidence of postoperative complications in group Toupet was significantly higher than that in group Nissen.All patients with gastroesophageal reflux disease underwent gastroscopy before operation.They had different degrees of esophageal inflammation.All patients reexamined gastroscopy, esophageal manometry an esophageal 24 hours PH monitor.Review results showed: the pressure of the lower esophageal sphincter was significantly increased in the two groups after operation; the length of the lower esophageal sphincter was also significantly prolonged.

laparoscopic Nissen surgery in the postoperative incidence of choke is better than the Toupet operation.But there was no significant difference between them.