湿润烧伤膏在CO2点阵激光治疗浅表性瘢痕术后创面护理中的效果

目的 分析湿润烧伤膏在CO2点阵激光治疗浅表性瘢痕术后创面护理中的效果。方法 选择2020 年3月-2021年11月本院收治的60例接受CO2点阵激光治疗的浅表性瘢痕患者,按照随机数字表法分为对照 组和观察组,各30例。对照组予以莫匹罗星软膏对创面进行护理,观察组予以湿润烧伤膏对创面进行护 理,比较两组疼痛情况、创面愈合天数、瘢痕程度及色素沉着发生率。结果 观察组NRS评分高于对照组 （P＜0.05）;观察组创面愈合天数短于对照组（P＜0.05）;观察组护理厚度、色泽、柔软度、血管分布 评分低于对照组（P＜0.05）;观察组色素沉着发生率为3.33%,低于对照组的20.00%（P＜0.05）。结论 CO2点阵激光治疗浅表性瘢痕术后创面护理中应用湿润烧伤膏有助于减轻患者疼痛,缩短创面愈合天数, 瘢痕治疗效果明显,且可降低色素沉着发生几率。     

重组人表皮生长因子凝胶联合美宝湿润烧伤膏治疗热力Ⅱ度烧伤创面临床分析

目的探讨重组人表皮生长因子凝胶联合美宝湿润烧伤膏治疗Ⅱ度热力烧伤创面的方法和效果。方法随机将巩义市人民医院2014-07—2017-07间收治的128例Ⅱ度热力烧伤患者分为2组,各64例。2组均全身给予营养支持及辅助治疗。治疗组采用人表皮生长因子凝胶联合美宝湿润烧伤膏处理创面,对照组采用磺胺嘧啶锌软膏处理创面。观察2组的用药不良反应、创面愈合时间及愈合后创面的外观。结果对照组治疗期间发生药疹1例(1.56%),经对症处理后缓解;治疗组未发生不良反应。2组差异无统计学意义(P0.05)。治疗组烧伤创面愈合时间及愈合后创面外观均优于对照组,差异有统计学意义(P0.05)。结论重组人表皮生长因子凝胶联合美宝湿润烧伤膏治疗Ⅱ度热力烧伤创面,不良反应少,可促进创面良好愈合,应用效果满意。     

美宝湿润烧伤膏治疗乳腺脓肿的疗效观察

目的:观察美宝湿润烧伤膏对乳腺脓肿切排术后创面愈合是否有促进作用.方法:选择乳腺脓肿切排术后病人47例,随机分为实验组(25例)和对照组(22例),实验组采用美宝湿润烧伤膏(MEBO)换药,对照组采用常规方法换药,观察伤口愈合情况.结果:实验组和对照组愈合天数分别为24.3±9.2d和37.6±14.5d(P＜0.05),换药次数分别为10.5±4.0和17.5±5.0(P＜0.05).结论:美宝湿润烧伤膏对乳腺脓肿切排术后创面愈合有明显促进作用.     

早期治疗与康复一体化护理模式对深Ⅱ度烧伤创面愈合效果的影响分析

目的:探讨早期治疗与康复一体化护理模式对深Ⅱ度烧伤创面愈合效果的影响。方法:选择笔者医院2017年1月-2018年12月收治的106例深Ⅱ度烧伤患者作为研究对象,根据入院先后顺序,采用随机数字表法分为观察组和对照组,各53例。对照组沿用常规康复护理模式,观察组实施早期治疗与康复一体化护理模式。随访3个月,记录伤后14d视觉模拟评分法(Visual analogue scoring,VAS)评分、创面上皮覆盖比例和创面完全愈合时间,观察创面愈合后瘢痕增生情况,并采用温哥华瘢痕量表(Vancouver scar scale,VSS)评估瘢痕增生程度,采用简明烧伤健康量表(Burn specific health scale,BSHS-A)评估生存质量。结果:观察组伤后14d VAS评分低于对照组,创面上皮覆盖比例高于对照组,创面完全愈合时间短于对照组,差异均有统计学意义(P0.05)。两组患者均获得随访,观察组出院时及出院3个月VSS评分均明显低于对照组,差异均有统计学意义(P0.05)。在治疗前BSHS-A评分上两组差异无统计学意义(P0.05)。出院时及出院3个月,观察组BSHS-A评分均明显高于对照组,差异均有统计学意义(P0.05)。结论:实施早期治疗与康复一体化护理模式能加快深Ⅱ度烧伤创面愈合,在减轻疼痛程度、延续愈合后瘢痕增生上较常规康复护理模式具有显著优势,值得临床推广应用。     

植皮联合负压封闭引流技术修复深度烧伤创面的应用观察及并发症分析

目的:探讨植皮联合负压封闭引流(Vacuum sealing drainage,VSD)技术修复深度烧伤创面的应用效果。方法:选取2015年10月-2017年10月收治的70例深度烧伤患者进行研究,随机分为观察组及对照组,每组35例。观察组采用创面植皮联合VSD技术进行治疗,对照组进行创面植皮后使用普通敷料加压包扎封闭创面,对两组患者的平均换药次数、平均住院时间、术后两周创面愈合率、创面愈合时间、并发症发生率进行统计分析,评价两种方式效果差别。结果:观察组患者平均换药次数、平均住院时间、术后两周创面愈合率及创面愈合时间均优于对照组,差异均具有统计学意义(P0.05);观察组患者术后并发症发生率为5.7%低于对照组的22.9%,差异有统计学意义(P0.05)。结论:深度烧伤创面采用植皮联合VSD技术修复,术后相关指标改善明显,并发症风险明显降低,操作简便安全且效果更佳,值得临床推广应用。     

综合护理在深度烧伤患者实施湿润烧伤膏创面修复中的应用

目的 探讨在使用湿润烧伤膏进行创面修复的深度烧伤患者中采用综合护理的效果。方法 选取 2020年12月-2023年12月本院收治的80例深度烧伤患者为研究对象,采用随机数字表法分为对照组 （n =40）和研究组（n =40）。两组均接受湿润烧伤膏创面修复治疗,对照组给予常规护理,研究组给予 综合护理,比较两组疼痛程度、负性情绪、瘢痕情况、生活质量及并发症发生情况。结果 研究组干预 后VAS评分低于对照组（P ＜0.05）;研究组干预后SAS、SDS评分低于对照组（P ＜0.05）;研究组干预后 瘢痕厚度、色泽、血管分布、柔软度评分低于对照组（P ＜0.05）;研究组干预后躯体功能、心理功能、 社会关系、一般健康状况评分高于对照组（P ＜0.05）;研究组并发症发生率为5.00%,低于对照组的 25.00%（P＜0.05）。结论 在使用湿润烧伤膏进行创面修复的深度烧伤患者中采用综合护理的效果较好,能 够缓解患者疼痛,改善其负性情绪及瘢痕情况,进而提高其生活质量,减少并发症发生,值得临床应用。     

湿润烧伤膏在CO2点阵激光治疗浅表性瘢痕术后创面护理中的效果观察

目的：观察美宝湿润烧伤膏在CO2点阵激光治疗浅表性瘢痕术后创面护理中的应用效果。方法：将40例浅表性瘢痕患者随机分成实验组和对照组,用CO2点阵激光治疗。激光治疗后实验组使用美宝湿润烧伤膏护理创面,对照组使用莫匹罗星软膏护理创面,比较两组患者的疼痛指数、创面愈合时间、温哥华瘢痕量表评分和色素沉着发生率。结果：实验组患者的疼痛指数、创面愈合时间、温哥华瘢痕量表评分和色素沉着发生率四项指标均优于对照组,P〈0．05,差异均有统计学意义。结论：CO2点阵激光治疗浅表性瘢痕后使用美宝湿润烧伤膏护理创面可减轻创面疼痛,促进创面愈合,加强瘢痕治疗效果,减少色素沉着的发生。     

改良负压封闭引流术在难愈性烧伤创面治疗中的应用

目的探讨改良负压封闭引流术(vacuum sealing drainage, VSD)对难愈性烧伤创面的治疗效果。方法选取自2013年2月至2016年10月收治的难愈性创面患者76例,按随机数字表法分为实验组(38例)和对照组(38例)。对照组患者采用常规VSD治疗;实验组患者采用改良VSD治疗,即在常规VSD治疗基础上增加银离子敷料覆盖创面。观察两组患者的治疗效果、创面愈合时间、敷料维持时间和住院时间以及创面细菌感染率并进行比较分析;采用视觉模拟评分法(visual analogue acale, VAS)对两组患者治疗前后的疼痛程度进行评价。结果实验组和对照组患者总有效率分别为92.11%(35/38)和73.68%(28/38),两组差异具有统计学意义(P0.05);与对照组比较,实验组创面愈合时间与住院时间均明显缩短,辅料维持时间明显延长(P0.05);两组患者治疗前的VAS评分比较,其差异无统计学意义(P0.05);实验组治疗后的VAS评分明显低于对照组(P0.05);实验组与对照组患者创面的细菌感染率分别为5.26%(2/38)和21.05%(8/38),两组差异具有统计学意义(P0.05)。结论在常规VSD基础上增用银离子敷料可显著提高难愈性烧伤创面的疗效,有效缩短创面愈合时间,减少更换敷料的次数,从而降低创面细菌的感染率,具有临床推广价值。     

康复护理联合VSD技术对大面积伤口和皮肤组织缺损患者创面愈合的影响

目的 分析对大面积伤口、皮肤组织缺损患者应用康复护理及持续性负压引流（VSD）技术的干 预效果及对患者创面愈合的影响。方法 选取2021年6月-2023年5月本院收治的70例大面积伤口、皮肤组织 缺损患者为研究对象,随机分为对照组和观察组,各35例。对照组给予常规护理联合VSD技术,观察组给 予康复护理联合VSD技术,比较两组创面恢复效果、创面分泌物细菌感染情况、预后指标及满意度。结果 观察组创面恢复各项评分均高于对照组（P ＜0.05）;观察组干预后细菌计数低于对照组,HA、VEGF水 平高于对照组（P ＜0.05）;观察组创面愈合时间、住院时间均短于对照组（P ＜0.05）;观察组满意度为 97.14%,高于对照组的80.00%（P ＜0.05）。结论 康复护理联合VSD技术在大面积伤口和皮肤组织缺损患 者中的应用效果确切,可发挥对大面积伤口和皮肤组织缺损的保护作用,减少炎症反应,促使创面尽早愈 合,有利于提高患者满意度,值得临床应用。     

湿润烧伤膏联合重组人表皮生长因子凝胶在Ⅱ度烧伤中的临床应用

目的探讨湿润烧伤膏(MEBO)联合重组人表皮生长因子凝胶治疗烧伤的效果。方法对152例不同面积的Ⅱ度烧伤创面应用湿润烧伤膏联合重组人表皮生长因子凝胶并配合全身治疗,回顾性分析患者的临床资料。结果本组88例浅Ⅱ度烧伤患者创面愈合时间(6.52±1.28)d,64例深Ⅱ度烧伤创面愈合时间(13.38±3.06)d。102例(71.05%)无瘢痕形成,24例(15.79%)轻度色素沉着,10例(6.58%)色素缺失,18例(11.84%)遗留轻中度瘢痕增生。结论湿润烧伤膏联合重组人表皮生长因子凝胶有效缩短烧伤创面愈合时间,减少烧伤瘢痕形成程度。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。