研究封闭式负压吸引在皮肤或软组织缺损的四肢创伤中的治疗作用

目的:分析封闭式负压吸引在皮肤或软组织缺损的四肢创伤中的治疗效果.方法:在本次研究中选择2014年1月-2016年4月我院收治的由于皮肤或软组织缺损引起的四肢创伤的91例患者作为研究对象,将其分为对照组和治疗组,分别给予常规治疗和封闭式持续负压吸引方式进行治疗,对治疗作用进行分析.结果:治疗组的治疗优势明显高于对照组,治疗组的2期创面处理时间、住院时间和住院费用明显少于对照组,组间数据比较差异明显,具有统计学意义(p<0.05).结论:对皮肤或软组织缺损的四肢创伤患者应用封闭式负压吸引方式进行治疗,其优势明显,能减少患者的痛苦,值得推广和应用.     

封闭式负压引流治疗软组织缺损骨外露的观察及护理

目的探讨封闭式负压引流技术治疗皮肤软组织缺损骨外露的疗效。方法24例皮肤软组织缺损骨外露创面先行清创及封闭式负压吸引7～14d后应用组织瓣覆盖骨外露创面。结果24例创面经封闭式负压吸引7～14d感染得到控制,骨外露及周边有新鲜肉芽组织生长,细菌培养阴性,再次手术行游离植皮及组织瓣移植全部一次成活。结论封闭式负压引流吸引可以控制感染,免除换药刺激肉芽组织生长,为组织瓣移植提供了良好的条件,封闭式负压引流技术对皮肤软组织缺损骨外露具有很好的修复效果。     

封闭负压吸引治疗四肢创伤性软组织缺损

目的 探讨封闭负压吸引(VSD)治疗四肢创伤性软组织缺损创面的疗效.方法 对24例四肢创伤性软组织缺损创面先行清创及VSD治疗,负压维持在40 kPa.结果 24例患者创面肉芽组织生长新鲜,其中6例仍有明显骨外露者再次行VSD治疗1～2次,均于肉芽组织大致覆盖创面后行游离植皮、直接缝合或组织瓣移植修复创面,全部一次成功.随访3个月至2年,患肢功能恢复良好.结论 四肢创伤性软组织缺损使用VSD能够促进创面的愈合,减少创面污染,减轻医护人员工作量及患者的痛苦,为二期手术提供良好的条件.     

封闭负压吸引联合游离皮片移植技术后加用高压氧治疗手部严重软组织缺损的临床疗效及预后

目的探讨封闭负压吸引联合游离皮片移植技术后加用高压氧治疗手部严重软组织缺损的临床疗效及预后。方法收集2012年2月至2015年1月的手部严重软组织缺损患者96例,随机分为试验组和对照组,每组48例,试验组给予封闭负压吸引联合游离皮片移植技术后加用高压氧治疗,对照组给予封闭负压吸引联合游离皮片移植技术治疗,观察两组患者治疗效果和预后影响。结果试验组治疗后运动功能评分和感觉功能评分及不良预后结局发生率均低于对照组,而治疗有效率高于对照组,差异均有统计学意义(P<0.05)。结论封闭负压吸引联合游离皮片移植技术后加用高压氧治疗手部严重软组织缺损具有良好的治疗效果和较低的不良预后结局发生率。     

VSD封闭式负压引流在创伤性皮肤、软组织缺损中的应用及护理

目的：探讨创面VSD负压引流技术在创伤患者皮肤、软组织缺损中的应用及护理。方法：对2009年10月-2011年10月本院收治的48例创伤性皮肤、软组织缺损的患者,均行急诊彻底清创后应用VSD负压引流,治疗一周左右后行修剪直接缝合或二期植皮、皮瓣修复,并加强术前、术后护理。结果：34例患者持续引流一周后创面修剪直接缝合或植皮后创面愈合;8例患者经过二次植皮后创面愈合;6例患者因创伤重合并骨外露经皮瓣修复后创面愈合。未出现其他并发症。结论：持续封闭式负压引流技术能有效封闭创面,彻底清除创面的分泌物和坏死组织,改善局部微循环,刺激肉芽生长,加速创面愈合,缩短治疗时间,减轻患者痛苦。     

封闭式负压引流持续吸引与间断吸引临床效果的对照研究

目的评价封闭式负压引流(VSD)持续吸引与间断吸引两种方法在促进肉芽生长及游离植皮覆盖的临床效果。方法选自2010年10月至2011年3月,来我院采用VSD治疗的患者作为研究对象。将患者随机分为持续吸引组及间断吸引组。手术室内对患者受伤局部进行清创,清创后将VSD填充创面,VSD的引流管与负压吸引瓶相连。持续负压组VSD持续吸引7天;间断吸引组VSD敷料吸引2小时,停吸2小时,以此类推吸引7天。7天后手术室内拆除VSD(记为第一次拆除VSD),对两组的创面进行评估,包括创面清洁度、肉芽生长情况等,同时进行细菌培养。清创完成后,对创面采用自体韧厚皮移植并再次采用VSD覆盖并予吸引。两组吸引方式同前。10天后两组均拆除VSD(记为第二次拆除VSD),观察皮肤存活情况及周围有无感染。在整个VSD吸引过程中,记录吸引管引流情况包括是否畅通,VSD有无堵塞等。结果共有84例患者参与本次研究。其中VSD持续吸引组为47例,VSD间断吸引组为37例。第一次拆除VSD时,肉眼看两组创面之间的肉芽生长无明显差异,两组创面内也没有感染灶,两组肉芽的厚度基本相同。两组的细菌培养均为阴性。第二次拆除VSD时,持续吸引组未有皮肤坏死病例,间断吸引组有2例出现皮肤部分坏死;两组均未有感染出现。持续吸引组发生吸引管堵塞次数为62次,其中第一次53次,第二次9次。间断吸引组发生吸引管堵塞次数为85次,其中第一次72次,第二次13次。两组之间总的堵塞次数存在明显差异(P=0.014),但无论是第一次还是第二次拆除VSD时的堵塞数,两组均没有明显差异(P=0.054,P=0.210)。结论持续负压吸引与间断负压吸引在促进肉芽生长及植皮方面无明显差异,但间断吸引组的堵塞数高于持续吸引组,说明间断负压吸引更需要全方位的护理。     

负压封闭引流术在骨外科针对创伤软组织缺损的疗效探究

目的:在骨外科针对创伤软组织缺损应用负压封闭引流术进行治疗,探析其治疗效果.方法:选择我院2016年1月～12月之间收治的54例软组织缺损患者,随机分成对照组和观察组,对照组患者利用传统创面法进行治疗,观察组患者利用负压封闭引流术进行治疗,对比两组患者治疗效果.结果:观察组患者总有效率(96.3％)明显高于对照组(74.1％),观察组感染率、住院时间明显优于对照组,差异具有统计学意义,P＜ 0.05.结论:利用负压封闭引流术治疗创伤软组织缺损,对于减少患者住院时间与感染情况发生率、提升治疗有效率非常有利,与传统治疗方式相比效果更好,临床应用价值非常高.     

负压封闭引流术(VSD)对大面积软组织缺损的疗效分析

目的 对利用负压封闭引流术对患有大面积软组织缺损的患者进行治疗的临床效果进行研究分析.方法 抽取94例患有大面积软组织缺损的临床确诊患者病例,将其分为A、B两组,平均每组47例.分别采用临床常规方式和负压封闭引流术进行治疗.结果 B组患者治疗后的生存质量改善情况明显高于A组患者;该组患者在治疗后的McGill疼痛评分明显低于A组患者;两组患者在治疗过程中均没有出现治疗方法原因所导致的不良反应出现.结论 利用负压封闭引流术对患有大面积软组织缺损的患者进行治疗的临床效果非常明显.     

应用封闭式负压引流在大面积皮肤缺损合并感染疗效分析

目的 比较封闭式负压引流技术(VSD)与常规换药在大面积皮肤缺损合并感染中疗效,总结处理措施,预防并减少感染的发生.方法 将87例大面积皮肤缺损合并感染病例随机分为对照组37例和治疗组50例;两组均进行感染控制、清创并彻底冲洗伤口;治疗组采用封闭负压引流技术,对照组采用常规换药.结果 治疗组在清洁时间、创面愈合时间、创面愈合率分别为(7.2±1.85)d、(12.7±2.09)d、(96.5±2.34)％,对比两组患者创面愈合疗效,3个指标均优于对照组(P＜0.01);治疗组在换药次数、住院天数及治疗总费用分别为(3.4±1.7)次、(18.5±3.12)d、(7655.3±432.75)元,治疗组均优于对照组,差异有统计学意义(P＜0.01).结论 VSD技术更有利于保护创面、引流脓液、控制感染、促进创面愈合,在提高创面治疗效果同时减少护理工作量.     

内固定联合封闭负压吸引治疗胫腓骨骨折的疗效观察及护理

目的:探讨内固定联合封闭负压吸引治疗胫腓骨骨折的疗效及护理体会。方法:将44例胫腓骨骨折分成治疗组和对照组,治疗组采用内固定联合封闭负压吸引治疗技术;对照组采用传统的反复清创换药治疗方法,观察对比两组患者的治疗效果。结果:治疗组患者的创面修复和骨折愈合情况良好,住院时间、换药次数、而且创面修复时间以及创面感染率和对照组相比有明显地缩短,差异具有统计学意义(P<0.05)。结论:内固定联合负压吸引技术在治疗胫腓骨骨折并骨筋膜室综合征可缩短住院时间,降低感染率,缩短病程,减轻患者的心理和经济负担。     

分析正畸与修复联合治疗牙列缺损伴牙颌畸形患者的治疗效果

目的分析正畸与修复联合治疗牙列缺损伴牙颌畸形患者的治疗效果。方法选取2009年5月—2011年11月间入该院进行治疗的牙列缺损伴牙颌畸形患者100例为研究对象,随机分为对照组和研究组,实施正畸与修复治疗,观察牙功能恢复情况与患者满意度。结果研究组患者牙功能恢复情况和患者满意度均高于对照组,差异具有统计学意义（P〈0.05）,但是所需恢复时间较长。结论正畸与修复联合治疗牙列缺损伴牙颌畸形临床效果较好,对于患者牙功能的恢复具有积极意义。     

游离皮瓣修复手背软组织缺损及功能重建的临床疗效观察

目的：进一步研究和比较腹部带蒂皮瓣修复方法与游离皮瓣修复方法在手背软组织缺损及功能重建过程中的疗效差异,从而为临床实践提供切实可靠依据。方法：本文从本院2010年12月-2012年12月期间入院治疗手背软组织缺损的患者中选取了84例,进行了回顾性分析。结果：两组患者实施不同皮瓣修复方法治疗后,治疗组患者的住院时间显著短于对照组患者水平,组间比较差异有统计学意义（P〈0.05）;治疗组患者的手部关节总活动度显著大于对照组患者的水平,组间比较差异具有统计学意义（P〈0.05）。结论：在临床治疗手背软组织缺损及功能重建的过程中,与腹部带蒂皮瓣修复方法相比较,采用游离皮瓣修复方法的临床效果显著,是临床治疗手背软组织缺损的安全可靠选择。     

达托霉素治疗血液病合并皮肤软组织感染的临床观察

目的 评价达托霉素治疗血液病合并皮肤软组织感染的疗效和安全性。方法 回顾性分析2018年3月—2019年3月某院使用达托霉素治疗的血液病合并皮肤软组织感染患者的临床资料、实验室检查结果以及达托霉素治疗的效果和安全性，按患者是否存在粒细胞缺乏分为粒细胞缺乏组与非粒细胞缺乏组，比较两组治愈率的差异。结果 共18例血液病合并皮肤软组织感染的患者使用达托霉素治疗，14例患者达到临床治愈，治愈率为77.8%；粒细胞缺乏组与非粒细胞缺乏组患者治愈率比较（75.0% VS 80.0%），差异无统计学意义（P>0.05）。患者体温下降1℃中位时间12（4~24）h，退热中位时间1.65（0.2~4）d，未出现与达托霉素相关的不良反应。结论 达托霉素治疗血液病合并皮肤软组织感染安全有效，不良反应少。     

Epidemiology,treatment, and economics of patients presenting to the emergency department for skin and soft tissue infections

Objectives: Skin and soft tissue infections (SSTIs) are among the most common bacterial diseases and represent a significant disease burden. The purpose of this study was to describe the real-world management of patients with SSTIs presenting to the emergency department (ED).

Methods: This is a retrospective cohort study. Adult patients identified with a primary diagnosis of SSTI determined by ICD-9 codes were assessed from index presentation for up to 30 days. Records were reviewed 30 days prior to inclusion to ensure index hospitalization was captured. For recurrent visits, a similar strategy was implemented 30 days afterward.

Results: Of 446 encounters screened, 357 were included; 106 (29.7%) were admitted to the hospital and 251 (70.3%) were treated outpatient. Of patients with a Charlson Comorbidity Index (CCI) score two or greater, 60.9% were treated as inpatients, whereas admission rates were 30.1% and 14.1% for patients with a CCI score of one and zero, respectively. Inpatients had an average length of stay (LOS) of 7.3 ± 7.1 days. No difference was detected in overall re-presentation to the facility 22.6% and 28.3% (p > 0.05) or in SSTI related re-presentation 10.4% and 15.1% (p > 0.05) between inpatient and outpatients. The most common gram-positive organisms identified on wound/abscess culture were MSSA (37.1% inpatients) and MRSA (66.7% outpatients). Mean total cost of care was $13,313 for inpatients and $413 for outpatients.

Conclusion: This analysis identifies opportunities to improve processes of care for SSTIs with the aim of decreasing LOS, reducing readmissions, and ultimately decreasing burden on the healthcare system.     

VSD治疗复杂四肢创伤软组织缺损的临床应用

目的:本文通过介绍负压封闭引流技术的使用方法,作用机制与临床应用注意事项等,为复杂四肢创伤软组织缺损的治疗提供依据。方法:通过回顾某医院13例复杂四肢创伤软组织缺损病例的治疗,总结VSD技术的临床应用特点。结果:VSD技术应用于治疗复杂四肢创伤软组织缺损,取得满意的疗效。结论:VSD是一种安全有效,简便易行的治疗复杂四肢创伤软组织缺损的方法,值得临床推广应用。     

An evaluation of the dorset sheep as a predictive animal model for the response of glucose-6-phosphate dehydrogenase-deficient human erythrocytes to a proposed systemic toxic ozone intermediate, methyl oleate ozonide

Erythrocytes of both glucose-6-phosphate dehydrogenase (G-6-PD)-deficient humans and Dorset sheep, an animal model with an erythrocyte G-6-PD deficiency, responded in a dose-dependent manner to the oxidant stress of methyl oleate ozonide (MOO) as measured by decreases in G-6-PD activity, increases in methemoglobin (METHB) levels, and decreases in GSH. However, the human G-6-PD-deficient erythrocytes were considerably more sensitive to the formation of METHB than the sheep erythrocytes while the reverse was the case for the GSH parameter. The results suggest a qualitative difference in the response of sheep erythrocytes and human G-6-PD-deficient erythrocytes to MOO that seriously questions the value of the sheep erythrocyte as a quantitatively accurate predictive model.     

An evaluation of second generation tissue culture rabies vaccines for use in man: a four-vaccine comparative immunogenicity study using a pre-exposure vaccination schedule and an abbreviated 2-1-1 postexposure schedule

In a double-blind comparative trial the immunogenicity of three new tissue culture rabies vaccines was evaluated, using a commercial human diploid cell vaccine (HDCV) lot as the reference. Two different vaccination regimens, a pre-exposure schedule, and an abbreviated 2-1-1 postexposure schedule (two doses of the vaccine applied bilaterally on day 0, with subsequent single doses given on days 7 and 21) were employed. In both, two of the new vaccines, purified chick embryo cell vaccine and purified Vero rabies vaccine, induced an antibody response equivalent to that of HDCV, while the geometric mean titres for the fetal bovine kidney cell vaccine were somewhat lower. The 2-1-1 regimen, a candidate regimen for economical rabies postexposure treatment, evoked a rapid and high titre antibody response with all four vaccines, peaking on day 14.     

An evaluation of the success of dredging as remediation at a DDT-contaminated site in San Francisco Bay,California, USA

Lauritzen Canal, a portion of San Francisco Bay near Richmond, California, USA, was heavily contaminated with dichlorodiphenyltrichloroethane (DDT) and dieldrin as a result of releases from a pesticide-formulating firm. In 1996 and 1997, 82,000 m3 of contaminated sediment was removed from the canal by dredging. This study evaluated the success of the dredging based largely on body burdens of DDT and its metabolites (sigmaDDT) in resident biota, with some data on sediment- and water-contaminant levels and sediment toxicity testing. Sediment disturbance during dredging introduced a pulse of sigmaDDT into the Lauritzen Canal ecosystem, and body burdens of fish and invertebrates increased 2- to 76-fold, depending on the species. Approximately 1 1/2 years after remediation, 11 of 14 indicators showed contamination comparable with or worse than the contamination that existed prior to dredging. Monitoring of mussels up to four years postdredging suggests some modest improvement, although the sigmaDDT body burden of canal mussels remained far above the norm for San Francisco Bay. The elevated sigmaDDT body burdens in biota that persisted for years after remediation reflect recent exposure and are not merely a result of slow metabolic elimination of the sigmaDDT pulse associated with dredging. Sediment sigmaDDT concentrations were low immediately after dredging, but within months, the canal bottom became covered with a veneer of fine sediment as contaminated as that that had been removed. The source of this material has not been conclusively established, but we suspect it came from slumping and erosion from the flanks of the canal beneath docks and around pilings where dredging was not done. In retrospect, either capping in place or more thorough dredging may have been more successful in reducing pesticide exposure of the biota, although there were difficulties associated with both alternatives.