Effects of platelet‐rich plasma on the healing of sternal wounds: A meta‐analysis

Sternal wound infection (SWI) is a devastating complication after cardiac surgery. Platelet‐rich plasma (PRP) may have a positive impact on sternal wound healing. A systematic review with meta‐analyses was performed to evaluate the clinical effectiveness of topical application of autologous PRP for preventing SWI and promoting sternal wound healing compared to placebo or standard treatment without PRP. Relevant studies published in English or Chinese were retrieved from the Cochrane Central Register of Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of Science, Springer Link, and the WHO International Clinical Trials Registry Platform (ICTRP) using the search terms “platelet‐rich plasma” and “sternal wound” or “thoracic incision.” References identified through the electronic search were screened, the data were extracted, and the methodological quality of the included studies was assessed. The meta‐analysis was performed for the following outcomes: incidence of SWI, incidence of deep sternal wound infection (DSWI), postoperative blood loss (PBL), and other risk factors. In the systematic review, totally 10 comparable studies were identified, involving 7879 patients. The meta‐analysis for the subgroup of retrospective cohort studies (RSCs) showed that the incidence of SWI and DSWI in patients treated with PRP was significantly lower than that in patients without PRP treatment. However, for the subgroup of randomized controlled trials (RCTs), there was no significant difference in the incidence of SWI or DSWI after intervention between the PRP and control groups. There was no significant difference in PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in‐situ recurrences were reported. According to the results, PRP could be considered as a candidate treatment to prevent SWI and DSWI. However, the quality of the evidence is too weak, and high‐quality RCTs are needed to assess its efficacy on preventing SWI and DSWI.     

Growth factor therapy in patients with partial‐thickness burns: a systematic review and meta‐analysis

Growth factor (GF) therapy has shown promise in treating a variety of refractory wounds. However, evidence supporting its routine use in burn injury remains uncertain. We performed this systematic review and meta‐analysis assessing randomised controlled trials (RCTs) to investigate efficacy and safety of GFs in the management of partial‐thickness burns. Electronic searches were conducted in PubMed and the Cochrane databases. Endpoint results analysed included wound healing and scar formation. Thirteen studies comprising a total of 1924 participants with 2130 wounds (1131 GF receiving patients versus 999 controls) were identified and included, evaluating the effect of fibroblast growth factor (FGF), epidermal growth factor (EGF) and granulocyte macrophage‐colony stimulating factor (GM‐CSF) on partial‐thickness burns. Topical application of these agents significantly reduced healing time by 5·02 (95% confidence interval, 2·62 to 7·42), 3·12 (95% CI, 1·11 to 5·13) and 5·1 (95% CI, 4·02 to 6·18) days, respectively, compared with standard wound care alone. In addition, scar improvement following therapy with FGF and EGF was evident in terms of pigmentation, pliability, height and vascularity. No significant increase in adverse events was observed in patients receiving GFs. These results suggested that GF therapy could be an effective and safe add‐on to standard wound care for partial‐thickness burns. High‐quality, adequately powered trials are needed to further confirm the conclusion.     

The effects of honey compared to silver sulfadiazine for the treatment of burns: A systematic review of randomized controlled trials

Evidence from animal studies and trials suggests that honey may accelerate wound healing. The objective of this review was to assess the effects of honey compared with silver dressings on the healing of burn wounds. Relevant databases for randomized controlled trials (RCTs) of honey compared with silver sulfadiazine (SSD) were searched. The quality of the selected trials was assessed using the Cochrane Risk of Bias Assessment Tool. The primary endpoints considered were wound healing time and the number of infected wounds rendered sterile. Nine RCTs met the inclusion criteria. Based on moderate quality evidence there was a statistically significant difference between the two groups, favoring honey in healing time (MD ?5.76 days, 95% CI ?8.14 to ?3.39) and the proportions of infected wounds rendered sterile (RR 2.59; 95% CI 1.58–2.88). The available evidence suggests that honey dressings promote better wound healing than silver sulfadiazine for burns.     

Negative‐pressure wound therapy for III/IV pressure injuries: A meta‐analysis

This meta‐analysis was conducted to identify the potential benefits and the efficacy of negative‐pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32‐1.70). There were significant differences in wound healing time (WMD = ?16.47 days, 95% [CI (?22.36, ? 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = ?2.39, 95% CI [?3.47, ?1.30], P ≤ .001); (SMD = ?2.55, 95% CI [?4.07, ?1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = ?3.61, 95% [CI (?4.57, ? 2.66) times, P ≤ .001]). Our meta‐analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high‐quality multicenter RCTs.     

胰岛素泵在肝移植术后糖代谢异常的应用研究

目的探讨肝移植围手术期糖代谢异常的不同处理方法。方法肝移植手术后糖代谢异常患者27例,随机分为连续皮下胰岛素输注组（Continuous subcutaneous insulin infusion,CSII）与多次皮下注射胰岛素组（Multiple daily subcutaneous injection,MDSI）。对两组患者住院期间的血糖控制情况、血糖达标时间、院内感染率、伤口愈合时间、胰岛素用量、低血糖的发生率以及术后半年的糖代谢状态进行比较。结果两组患者血糖均可以达到目标值,CSII组较MDSI组每天胰岛素用量少,血糖达标时间短,切口愈合时间短,院内感染率低。两组患者术后半年的糖代谢状态无显著差异。结论对肝移植术后糖代谢异常的控制,胰岛素泵较传统的多次皮下注射胰岛素更有优势。     

局部应用胰岛素对烫伤大鼠创面愈合的影响

目的观察局部应用小剂量胰岛素对烫伤大鼠创面愈合的影响,探讨其可能的作用机制.方法制作深Ⅱ度烫伤大鼠模型.部分大鼠创面下浸润注射0.1、1.0 U胰岛素,分别设为B、C组;以创面下浸润注射等渗盐水(A组)和腹部皮下注射0.1 U胰岛素(D组)的烫伤大鼠作为对照.记录各组创面愈合时间,伤后3 d起隔日计算A、B、C组的创面愈合百分率.观察各组创面愈合后的组织形态学改变,采用流式细胞仪对各组创面表皮细胞进行细胞周期分析,并测定血糖浓度的变化. 结果A、B、C、D组创面愈合时间分别为(24.57±5.19)、(18.36±4.12)、(21.46±2.97)、(24.50±1.05)d,B组较其他3组明显缩短(P<0.01).伤后5、9、11、13、15、17、19 d B组创面愈合率均明显高于A组,且伤后17 d时明显高于C组(P<0.05～0.01).组织形态学观察可见A组表皮层薄,钉脚数量少,真皮层内多见纤维细胞;B、C组表皮层增厚,钉脚数量多,真皮层内多见成纤维细胞.B组伤后4 d S期细胞比例明显高于A组(P<0.01);B组伤后4、5 d G2-M期细胞比例均明显高于A、C组(P<0.05～0.01).烫伤后24 h A组血糖波动在3.42～4.62 mmol/L;B组血糖变化规律与A组相似;C、D组注射后1 h血糖明显降低(P<0.01),注射后4 h逐渐恢复正常.结论局部应用小剂量胰岛素能明显地促进烫伤大鼠创面愈合,胰岛素可加速修复细胞的增殖分裂可能是其作用机制之一.     

Topical negative pressure for treating chronic wounds: a systematic review.

Some wounds take a long time to heal, fail to heal or recur, causing significant pain and discomfort to the patient and cost to the National Health Service. This review assesses the effectiveness of topical negative pressure (TNP) in treating chronic wounds. The Cochrane Wounds Group Specialised Trials Register was searched for randomised controlled trials (RCTs) that evaluated the effectiveness of TNP on chronic-wound healing. Eligibility for inclusion, data extraction and details of trial quality were conducted by two reviewers independently. A narrative synthesis of results was undertaken as only two small trials, with different outcome measures, fulfilled the selection criteria. Trial 1 considered any type of chronic wound, trial 2 considered diabetic foot ulcers. Both trials compared TNP with saline-gauze dressings. Trial 1 reported a statistically significant difference in the percentage change in wound volume after 6 weeks, in favour of TNP. Trial 2 reported a difference in the number of days to healing and a difference in the percentage change in wound surface area after 2 weeks, in favour of TNP. These two small trials provide weak evidence to suggest that TNP may be superior to saline-gauze dressings in terms of wound healing. However, due to the small sample sizes and the methodological limitations of the studies, these findings must be interpreted with extreme caution. The effects of TNP on cost, quality of life, pain and comfort were not reported. It was not possible to determine the optimum TNP regimen. Further high-quality RCTs that address these issues are required.     

Efficacy and safety of extracorporeal shock wave therapy for acute and chronic soft tissue wounds: A systematic review and meta‐analysis

This study aimed to evaluate and compare the effects of extracorporeal shock wave therapy (ESWT) and conventional wound therapy (CWT) for acute and chronic soft tissue wounds. All English‐language articles on ESWT for acute and chronic soft tissue wounds indexed in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, Physiotherapy Evidence Database, and HealthSTAR published prior to June 2017 were included, as well as corresponding articles cited in reference lists of related review articles. The methodological quality of the selected studies was assessed with the Cochrane Collaboration''s “risk of bias” tool. Study design, subject demographics, wound aetiology, treatment protocols, assessment indexes, and follow‐up duration were extracted. The fixed or random‐effects model was used to calculate the pooled effect sizes according to studies’ heterogeneity. Ten randomised controlled trials (RCTs) involving 473 patients were included in this systematic review and meta‐analysis. The meta‐analysis showed that ESWT statistically significantly increased the healing rate of acute and chronic soft tissue wounds 2.73‐fold (odds ratio, OR = 3.73, 95% confidence interval, CI: 2.30‐6.04, P < .001) and improved wound‐healing area percentage by 30.45% (Standardized Mean Difference (SMD) = 30.45; 95% CI: 23.79‐37.12; P < .001). ESWT reduced wound‐healing time by 3 days (SMD = −2.86, 95% CI:‐3.78 to −1.95, P < .001) for acute soft tissue wounds and 19 days (SMD = −19.11, 95% CI: −23.74 to −14.47, P < .001) for chronic soft tissue wounds and the risk of wound infection by 53% (OR = 0.47, 95% CI: 0.24‐0.92, P = .03) when compared with CWT alone. Serious adverse effects were not reported. ESWT showed better therapeutic effects on acute and chronic soft tissue wounds compared with CWT alone. However, higher‐quality and well‐controlled RCTs are needed to further assess the role of ESWT for acute and chronic soft tissue wounds.     

皮下置管负压引流技术在预防腹部切口脂肪液化中的应用研究

目的探讨皮下引流管持续负压引流对肥胖病人腹壁切口脂肪液化的预防作用。方法选取2004年6月至2009年8月行腹部手术的肥胖病人300例,随机分为对照组及治疗组各150例。对照组按传统切口缝合方法,治疗组在腹直肌前鞘与皮下脂肪间置引流管1根,术后持续负压引流。观察脂肪液化发生率及伤口愈合情况。结果治疗组切口脂肪液化率显著低于对照组,而切口甲级愈合率明显高于对照组,两组间差异均具有统计学意义(P0.01)。结论皮下置管负压引流技术对肥胖病人腹壁切口脂肪液化有较好的预防作用。     

Effects and safety of atmospheric low‐temperature plasma on bacterial reduction in chronic wounds and wound size reduction: A systematic review and meta‐analysis

The use of atmospheric low‐temperature plasma (AP) on chronic wounds and its effect on microbial bioburden in open wounds has not been explored with a systematic review and meta‐analysis. PRISMA guidelines were followed and PubMed, Embase, CENTRAL, and CINAHL databases searched for randomised controlled trials (RCTs), which compared AP with no AP for the management of open, chronic wounds. The primary outcomes of reduction of bioburden or wound size were included. Meta‐analyses were performed; odds ratio (OR) and 95% confidence intervals (CIs) were extracted and pooled in a random effects model. Four RCTs investigated the effect of AP on chronic wound healing. Chronic wounds treated with AP did not show a significant improvement in healing (AP vs control: OR = 1.46; 95% CI = 0.89‐2.38; P = 0.13). Five further RCTs investigated the reduction of bioburden in wounds, but AP demonstrated no significant reduction of bioburden (AP vs control: OR = 0.85; 95% CI = 0.45‐1.62; P = 0.63). All nine RCTs recorded the presence of any severe adverse events (SAEs) in the 268 patients studied, with only one unrelated SAE identified in each group (AP vs control: OR = 1.00; 95% CI = 0.05‐19.96; P = 1.00). Use of AP in wound care is safe, but the retrieved evidence and meta‐analysis show that there is no clinical benefit of AP in chronic open wounds using currently available AP device settings.     

肝移植术后脂肪液化伤口采用水胶体拉合免缝法联合负压治疗效果观察

目的 探讨水胶体拉合免缝法联合负压治疗肝移植术后脂肪液化伤口的效果.方法 47例肝移植术后脂肪液化患者按照入院时间分组,2017年2月至2018年7月的患者分为对照组(26例),2018年8月至2019年12月的患者分为观察组(21例).两组均行伤口评估及常规伤口床准备,对照组采用常规方法行伤口换药,观察组采用水胶体拉合免缝法联合负压治疗.结果 两组伤口总愈合时间、总愈合速度、总换药时间、换药总次数、换药费用、单位时间伤口缩小面积、单位时间伤口深度改变、单位时间伤口愈合速度等指标比较,差异有统计学意义(均P＜0.01).结论 水胶体拉合免缝法联合负压治疗能促进肝移植术后脂肪液化伤口愈合,且不增加经济负担,同时减轻护理工作量.     

Enzymatic debridement with collagenase in wounds and ulcers: a systematic review and meta‐analysis

Enzymatic debridement with collagenase is a technique that is commonly used in clinical practice. This systematic review examines the effect of collagenase on all kinds of wounds, compared to an alternative therapy, on wound healing, wound bed characteristics, cost‐effectiveness and the occurrence of adverse events. We conducted a systematic literature search on available literature in Cochrane databases, MEDLINE, EMBASE and CINAHL. Two investigators independently assessed the titles and abstracts of all randomised controlled trials obtained involving collagenase of all kinds of wounds based on inclusion criteria. Of the 1411 citations retrieved, 22 studies reported outcomes with the use of collagenase either for wound healing or wound debridement. Results support the use of collagenase for enzymatic debridement in pressure ulcers, diabetic foot ulcers and in conjunction with topical antibiotics for burns. However, studies presented a high risk of bias. Risk ratio of developing an adverse event related to collagenase versus the alternative treatment was statistically significant (for 10 studies, RR: 1·79, 95% CI 1·24–2·59, I²=0%, P = 0·002). There is very limited data on the effect of collagenase as an enzymatic debridement technique on wounds. More independant research and adequate reporting of adverse events are warranted.     

Preoperative carbohydrate loading for elective surgery: a systematic review and meta-analysis

Background and objective

It is unclear whether the preoperative administration of oral carbohydrates (CHO) is safe and effective, and therefore we herein evaluated the efficacy and adverse events associated with CHO for elective surgery.

Methods

Comprehensive searches were conducted to identify randomized controlled trials (RCTs), which evaluated preoperative CHO for elective surgery. Two reviewers independently selected the trials, extracted data, and assessed the methodological qualities and evidence levels. The data were analyzed by the RevMan 5.0 software program.

Result

CHO increased the insulin and glucose levels on the first day after surgery higher than those in overnight fasting group (fifteen RCTs) and i.v. glucose infusion group (three RCTs). The pooled results of thirteen RCTs showed greater declines in the insulin level at the induction of anesthesia and a smaller increase in the glucose level at the end of surgery, and fewer decreases in the postoperative insulin sensitivity index in the CHO group were observed as compared to the placebo group. No aspiration was observed in any of the included studies.

Conclusion

CHO appears to be safe, and may attenuate postoperative insulin resistance as compared to placebo. However, the quality of most of the published trials has been poor, and the evidence levels for most outcomes were low, so rigorous and larger RCTs are needed in the future.     

Metabolic effects of testosterone replacement therapy on hypogonadal men with type 2 diabetes mellitus： a systematic review and meta-analysis of randomized controlled trials

This systematic review was aimed at assessing the metabolic effects of testosterone replacement therapy （TRT） on hypogonadal men with type 2 diabetes mellitus （T2DM）. A literature search was performed using the Cochrane Library, EMBASE and PubMed. Only randomized controlled trials （RCTs） were included in the meta-analysis. Two reviewers retrieved articles and evaluated the study quality using an appropriate scoring method. Outcomes including glucose metabolism, lipid parameters, body fat and blood pressure were pooled using a random effects model and tested for heterogeneity. We used the Cochrane Collaboration＇s Review Manager 5.2 software for statistical analysis. Five RCTs including 351 participants with a mean follow-up time of 6.5months were identified that strictly met our eligibility criteria. A meta-analysis of the extractable data showed that testosterone reduced fasting plasma glucose levels （mean difference （MD）. -1.10; 95% confidence interval （CI） （-1.88, -0.31））, fasting serum insulin levels （MD： -2.73; 95% CI （-3.62, -1.84））, HbAlc % （MD.. -0.87; 95% CI （-1.32, -0.42）） and triglyceride levels （MD： -0.35; 95% CI （-0.62, -0.07））. The testosterone and control groups demonstrated no significant difference for other outcomes. In conclusion, we found that TRT can improve glycemic control and decrease triglyceride levels of hypogonadal men with T2DM. Considering the limited number of participants and the confounding factors in our systematic review; additional large, well-designed RCTs are needed to address the metabolic effects of TRT and its long-term influence on hypogonadal men with T2DM.     

The mechanisms and evidence of efficacy of electrical stimulation for healing of pressure ulcer: A systematic review

The objective of this article is to provide a systematic review of the efficacy of electrical stimulation in healing pressure ulcer and to review its mechanism of action. The Cochrane Library, PubMed, CINAHL, Medline, EMBASE, and NHS EED were searched for relevant interventional studies including randomized controlled trials (RCTs) and observational studies. A best‐evidence synthesis was performed to summarize the results of the included studies. A total of seven RCTs and two observational studies met the inclusion criteria. Moderate level of evidence of efficacy with low risk of bias was shown in all seven RCTs. Although some studies have used continuous direct current, most other investigators opted to use high‐voltage pulsed current to minimize the risk of skin burn and to achieve greater current penetration. Overall, the incidence of adverse effects was very low. Two studies that assessed the economic impacts of electrical stimulation revealed substantial health care cost savings. The mechanisms through which electrical stimulation exerts a positive effect on pressure ulcer healing are reasonably well established. Clinical trials have revealed a moderate level of evidence to support its use as an ancillary treatment modality for healing pressure ulcer. Recommendations regarding the optimal electrical stimulation parameters and dosage of use are provided. Further studies to investigate potential barriers that may impede widespread use in different clinical settings are needed.     

A systematic review of randomized controlled trials of wound dressings for chronic venous ulcer

OBJECTIVE: To determine whether more "modern" complex wound dressings further improve the healing of venous ulcers over that with simple wound dressings, we conducted a systematic review of randomized controlled trials (RCTs) of wound dressing trials that were published from October 1, 1997, through September 1, 2005. METHODS: We searched MEDLINE, CINAHL, and the Cochrane Controlled Trials Registry Database to identify RCTs. Criteria for ultimate selection included treatment with compression and an objective outcome describing the proportion of wounds healed. Twenty RCTs were identified that satisfied these criteria and were classified into three wound dressing classes: semiocclusive/occlusive group (n = 8), growth factor group (n = 7), and human skin equivalent group (n = 5). RESULTS: Assessment of study design quality for the 20 RCTs showed a low percentage (<49%) of RCTs that incorporated at least 3 of 7 indicators of trial quality, but it seemed better in the 5 RCTs that showed significance for ulcer healing; 4 of the studies used at least 6 of the 7 characteristics of adequate study design. Five (25%) of the 20 RCTs had a statistically significantly improved proportion of ulcers healed in the experimental dressing group over control values: zinc oxide paste bandage (79% vs 56%) and Tegasorb (59% vs 15%) in the semiocclusive/occlusive group and perilesional injection of granulocyte-macrophage colony-stimulating factor (57% vs 19%) and porcine collagen derived from small-intestine submucosa (Oasis; 55% vs 34%) in the growth factor group. In the sole significant RCT from the human skin equivalent group, Apligraf (63%) was superior to Tegapore (48%). Four of these five studies also showed an improved time to complete healing by Kaplan-Meier estimate. CONCLUSIONS: Certain wound dressings can improve both the proportion of ulcers healed and the time to healing over that achieved with adequate compression and a simple wound dressing. The selection of a specific dressing, however, will depend on the dressing characteristics for ease of application, patient comfort, wound drainage absorption, and expense.     

Local insulin-zinc injection accelerates skin donor site wound healing

BACKGROUND: Systemically administered insulin has been shown to accelerate wound healing. To minimize the hypoglycemic and hypokalemic effects of insulin, we investigated a new route of insulin administration by local injection into skin wounds. MATERIALS AND METHODS: Partial thickness skin donor site wounds were created on the backs of adult rabbits with a dermatome set at 0.015 inch. The wounds were covered by Aquaphor gauze (Smith and Nephew, Largo, FL), and OpSite membrane (Smith and Nephew, Hull, United Kingdom) and protected by rabbit jackets. Long-acting insulin-zinc suspension was selected for local injection. In study 1, insulin was injected into the wound at different doses, and the concentrations of blood glucose and wound insulin were measured to determine the proper dose and injection frequency. In study 2, wound healing days were compared between two groups (n = 7 each) receiving local injection of either insulin-zinc or zinc alone as control. Based on the results from study 1, a dose of 0.25 units of long-acting insulin-zinc suspension was injected into the wound every other day in the insulin group. RESULTS: After injection, 0.25 units of insulin decreased blood glucose concentration (minimum 60 mg/dL) during the first 3 h, which then returned to the preinjection level (80 mg/dL). One injection maintained wound insulin concentration above 50 muU/mL for more than 24 h. With local injection of 0.25 units insulin-zinc every other day, the wound healing time was 11.2 +/- 2.3 d, which was faster (P = 0.02) than 15.1 +/- 4.1 d in the control group. CONCLUSION: Local injection of long-acting insulin-zinc suspension accelerated skin wound healing without major systemic side effects, demonstrating its potential usefulness in burn treatment.     

皮下间断内翻缝合法在四肢手术切口的临床应用

目的:探讨皮下间断内翻缝合法在四肢手术切口中的临床应用。方法:将250例四肢手术患者随机分成两组,分别采用皮下间断内翻缝合法和传统单纯对合缝合法缝合皮下组织,对切口愈合情况、瘢痕面积等进行观察和分析。结果:两组切口愈合时间比较无统计学差异(P0.05),脂肪液化、线头冒出、皮下硬结比较有显著统计学差异(P0.01),瘢痕面积之差(50例)比较有统计学意义(P0.05)。结论:骨科手术使用间断内翻缝合法较传统的单纯对合缝合法更能提高切口愈合质量,提高患者对切口的远期满意度,值得临床推广使用。     

NMDA受体拮抗剂预防瑞芬太尼诱发术后痛觉过敏的效果:Meta分析

目的 采用Meta分析评价N-甲基-D-天冬氨酸(NMDA)受体拮抗剂预防瑞芬太尼诱发术后痛觉过敏的效果.方法 检索PubMed、EMBase、Springer及Cochrane图书馆,收集NMDA受体拮抗剂预防瑞芬太尼诱发术后痛觉过敏的临床随机对照研究.采用Cochrane协作网系统评价文献质量,并提取有关资料,主要包括术后镇痛药需要量、疼痛评分、手术结束至第1次需要镇痛治疗的时间以及术后不良反应的发生情况.采用RevMan 5.0软件进行Meta分析.结果 共纳入14项研究,包括623例患者,其中氯胺酮组223例,硫酸镁组87例,对照组313例.NMDA受体拮抗剂可降低术后4h时疼痛评分(P＜0.05),对术后镇痛药需要量、第1次需要镇痛治疗的时间及不良反应的发生率无影响(P＞0.05).结论 NMDA受体拮抗剂(氯胺酮和硫酸镁)不能预防瑞芬太尼诱发的术后痛觉过敏.     

局部高渗环境对慢性创伤性窦道的治疗效果分析

〓【摘要】〓目的〓局部高渗引流及普通引流方法的比较,分析高渗环境下引流对慢性窦道的治疗效果。 方法〓慢性创伤性窦道病例62例进行随机分成2组,其中31例伤口窦道内使用28%高渗氯化钠纤维/聚酯无纺布敷料进行引流,31例使用0.9%氯化钠纱条进行引流观察治疗效果及不良反应。 结果〓28%高渗氯化钠纤维/聚酯无纺布敷料治疗组(高渗引流组)平均痊愈时间18.6天,0.9%氯化钠纱条组(等渗引流组)平均痊愈时间22.5天,两组慢性创面窦道痊愈时间差异有显著统计学意义(P<0.05);高渗引流组患者创面细菌培养阳性例数也明显低于等渗引流组。 结论〓局部高渗压环境引流可显著抑制慢性创伤性窦道细菌微生物被膜的形成,对慢性窦道的愈合有显著的效果。