超重及肥胖患者臀部肌内注射深度的探讨

目的探讨成人超重及肥胖患者臀部肌内注射的适宜深度。方法抽取超重及肥胖者200例（男、女各100例）,测量身高、体质量,计算体重指数（BMI）,根据BMI判断超重与肥胖;采用B超测定其臀部肌内注射部位皮下脂肪厚度。结果男性皮下脂肪厚度为（25．7±4．3）mm,女性为（25．8±3．9）mm;男、女性皮下脂肪厚度≥21．3mm（常规肌内注射的深度）者分别为92．0％、95．0％。男性、女性超重与肥胖者皮下脂肪厚度比较,差异无统计学意义（均P〉0．05）。结论常规肌内注射的深度对超重或肥胖者已不适用,注射时针头仅能到达皮下脂肪层而未达臀大肌,存在医疗隐患,需积极寻求解决方法。     

1例肌内注射致臀部巨大血肿的原因分析及护理

分析1例慢性乙型病毒性肝炎重症倾向患者肌内注射后引起臀部巨大血肿的原因。从疾病本身的原因,肝素使用史,肌内注射史,患者的体形和遵医行为进行分析。提示护士应具有敏锐的洞察力和预见性,为凝血功能差的患者注射时需选择准确的部位,行肌内注射或静脉穿刺完毕,延长按压时间;加强对药物及其不良反应的学习,加强监测患者凝血功能,才能减少血肿发生率。     

肥胖患者臀部皮下组织测量及注射针头选择

目的 探讨肥胖患者进行肌内注射时适宜的注射部位及合适的针头长度.方法 选择超重、肥胖、极度肥胖的235例行肌内注射患者,用超声技术检测臀大肌及臀中肌注射点的厚度,选择合适的注射针头.结果 臀大肌注射点的皮下组织厚度小于臀中肌(P＜0.01),男女臀大肌、臀中肌注射点皮下组织厚度差异有统计学意义(均P＜0.01).结论 对于肥胖患者,在使用同种标准针头注射时,选择臀大肌注射会更能保障肌内注射的效果;臀大肌注射点注射针头长度,男性32.3 mm、女性48.0 mm,臀中肌注射点注射针头长度,男性40.2 mm、女性49.7 cm为宜.     

1例肌内注射致臀部巨大血肿的原因分析及护理

分析1例慢性乙型病毒性肝炎重症倾向患者肌内注射后引起臀部巨大血肿的原因.从疾病本身的原因,肝素使用史,肌内注射史,患者的体形和遵医行为进行分析.提示护士应具有敏锐的洞察力和预见性,为凝血功能差的患者注射时需选择准确的部位,行肌内注射或静脉穿刺完毕,延长按压时间;加强时药物及其不良反应的学习,加强监测患者凝血功能,才能减少血肿发生率.     

1ml注射器在新生儿肌内注射中的应用

在给新生儿进行肌内注射过程中。由于新生儿皮下脂肪、肌肉较薄，注射时进针的深度难以掌握，容易进针过深，误入骨膜层而影响药物的吸收。鉴此，我科自2005年开始，在对新生儿进行肌内注射时，将2ml注射器改为1ml注射器或换用1ml注射器针头进行注射，效果满意。     

干扰素肌内注射溶剂的选择

目的 选择干扰素肌内注射的最佳溶剂，减少患者痛苦。方法 将80例患者随机分为A、B两组各40例。A组用灭菌注射用水稀释干扰素，B组用0．9％氯化钠注射液稀释干扰素。结果 A组疼痛发生率显著高于B组（P〈0．01），两组局部反应发生率比较，差异无显著性意义（P〉0．05）。结论 用0．9％氯化钠注射液稀释干扰素，可减轻对肌肉的刺激，使疼痛减轻。     

介绍一种肌内注射减轻疼痛的方法

肌内注射刺激性药物时所致的疼痛,常使病人难以忍受,甚至感到恐惧。经临床实践发现,注射中旋转针尖斜面的方向注药,有效减轻其疼痛程度,现介绍如下。     

注射器内少量空气对肌内注射疼痛的影响

为探讨注射器内少量空气对肌肉注射疼痛的影响。选择１００例门诊患者进行自身对照，采用改良注射液（注射时注射器内有０.2-0.3ml空气）和传统注射法（注射器内无空气）进行常规肌内注射，拔针３０s后评估局部空气能减轻局部疼痛，且减少药物浪费。     

肌内注射甲氧氯普胺致颈项强直1例

临床上，患者使用甲氧氯普胺后发生肌内震颤，口角歪的现象时有发生，但颈项强直，不能活动的报道尚少见，我科于2004年8月收治1例颈项强直的患者，现介绍如下。     

Prevention of Fat Embolism in Fat Injection for Gluteal Augmentation,Anatomic Study in Fresh Cadavers

Introduction: Liposuction is a popular surgical procedure. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have described a possible explanation as the puncture and tear of gluteal vessels during the procedure, especially when a deep injection is planned. Methods: A total of 10 dissections were performed in five fresh cadavers. Each buttocks was divided into four quadrants. We focused on the location where the gluteal vessels enter the muscle and the diameter of the vessels. Colorant at two different angles was injected (30° and 45°). We evaluated the relation of the colorant with the main vessels. Results: We found two perforators per quadrant. The thickness of the gluteal muscle was 2.84 ± 1.54 cm. The area under the muscle where the superior gluteal vessels traverse the muscle was located 6.4 ± 1.54 cm from the intergluteal crease and 5.8 ± 1.13 cm from the superior border of the muscle. The inferior gluteal vessels were located 8.3 ± 1.39 cm from the intergluteal crease and 10 ± 2.24 cm from the superior border of the muscle. When we compared the fat injected at a 30° angle, the colorant stayed in the muscle. Using a 45° angle, the colorant was in contact with the superior gluteal artery and the sciatic nerve. No puncture or tear was observed in the vessels or the nerve. Conclusions: The location where the vessels come in contact with the muscle, which can be considered for fat injection, were located in quadrants 1 and 3. A 30° angle allows for an injection into the muscle without passing into deeper structures, unlike a 45° injection angle.     

A Comparison of Fat Intake of Normal Weight, Moderately Obese and Severely Obese Subjects

Background: Excess dietary fat has been implicated in the etiology of obesity. Methods: This study examined the fat intake of three weight groups, normal (20.0 < BMI < 27.0), moderately obese (27.1 < BMI < 39.9) and severely obese (BMI > 40.0). Each group contained 50 subjects. Detailed 3-day food records were used to gather the nutritional data. Anthropometric and sociodemographic information was also collected. Results: Overall fat intake was 89±42 g/day or 37 ± 10% of total energy. Total fat (g/1000 kcalories) intake was found to be significantly higher in the obese groups (p < 0.05). Subjects in the moderately and severely obese groups consumed significantly more fat and cholesterol and less carbohydrate than did normal weight subjects. Compared to the normal weight subjects, obese subjects also had higher intakes of saturated, monounsaturated and polyunsaturated fat (as a percentage of dietary energy). There was no difference in energy or protein intake, and P/S ratio among the three groups. BMI was strongly positively correlated with total fat, saturated, monounsaturated, polyunsaturated fat, cholesterol, and protein intake (as g/day only), and negatively correlated with carbohydrate intake and the CHO/FAT ratio. Energy intake was not significantly associated with BMI. Conclusion: A high fat diet may promote obesity, independently of its calorie contribution.     

Emotional Eating in a Morbidly Obese Bariatric Surgery-Seeking Population

Background The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients describe other maladaptive eating patterns prior to surgery, such as eating in response to emotions.The goals of this study were to describe presurgical emotional eating patterns in morbidly obese individuals, determine whether these individuals were binge eaters, and assess the effect of this eating behavior on weight loss after surgery. Methods Prior to surgery, 144 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWPRevised (QEWP-R) and the Emotional Eating Scale to assess eating patterns prior to surgery. Their eating behavior, levels of depression, and weight were assessed after surgery. Results High emotional eaters tended to have higher levels of depression, binge eating, and eating in response to external cues than low emotional eaters prior to surgery.However, there appeared to be a distinct group of individuals who were high emotional eaters but who did not engage in binge eating. At a mean of 8 months after surgery, High Emotional Eaters and Low Emotional Eaters were indistinguishable on these subscales and there were no differences in weight lost. Conclusions RYGBP has an equally positive impact on eating behavior and weight loss for both High Emotional Eaters and Low Emotional Eaters. Further replication is needed with longer follow-up times and larger samples.     

Pretubercular Subcutaneous Thickness Is a Protective Factor for Superficial Wound Complications After Total Knee Arthroplasty in Nonmorbidly Obese Patients

BackgroundAnterior knee subcutaneous thickness has been associated with increased risk of early reoperation for surgical site infection after primary total knee arthroplasty (TKA) in morbidly obese patients. However, most patients undergoing TKA are not morbidly obese. The aims of this study were to (1) assess the association between anterior knee subcutaneous thickness and early superficial wound complications and (2) determine a threshold value for anterior knee subcutaneous thickness measures that can assist in preoperative risk stratification in nonmorbidly obese TKA patients.MethodsUsing retrospective analysis, we reviewed 494 primary TKAs performed in patients with a body mass index <40 kg/m² at our institution from January 1, 2010 to December 31, 2017. All patients developing a superficial surgical site infection within 90 days of index arthroplasty requiring treatment with antibiotics or reoperation were identified. Prepatellar thickness and pretubercular thickness were measured on preoperative lateral radiographs and associated with 90-day superficial wound complications.ResultsSixty-two of the 494 patients developed a superficial wound complication within 90 days of index arthroplasty. TKA patients in the superficial wound complication group had significantly less pretubercular thickness (P = .027). Risk of developing 90-day superficial wound complication was 1.85-fold lower when pretubercular thickness was ≥12 mm (P = .028). Prepatellar thickness (P = .895) was not significantly associated with superficial wound complications.ConclusionIncreased pretubercular thickness is a protective factor for developing superficial wound complications, with 12 mm being an ideal threshold value for preoperative risk stratification in nonmorbidly obese patients undergoing primary TKA surgery.     

The Effects of Fat Distribution on Resting Energy Expenditure in Premenopausal Morbidly Obese Females

Background: upper body, or abdominal, distribution of body fat is associated with a number of metabolic and hormonal aberrations that could influence resting energy expenditure REE. The purpose of our study was to examine the effects of fat distribution on REE of 96 morbidly obese premenopausal females. Methods: the study population consisted of three groups of study subjects, 32 with lower body fat distribution (LBD) and waist-to-hip circumference ratios WHR < 0.80, 20 with intermediate (INT) fat distribution and WHR between 0.80 and 0.85 and 34 females with upper body distribution of fat (UBD) and WHR > 0.85. Indices measured included: (1) REE; (2) maximal oxygen consumption during an exercise tolerance test (VO_2max); (3) basal respiratory quotient (RQ); (4) fasting blood glucose; and (5) serum cholesterol and triglycerides. Results: we found that morbidly obese women who store fat abdominally (WHR > 0.80) have significantly (p < 0.01) higher REE (kcal per h per BSA) than those with lower body obesity. Levels of triglyceride and glucose of the UBD group were also higher than those of the LBD subjects, i.e. 35% and 23%, respectively. VO_2max and RQ were similar between the study groups, suggesting that the elevated REE of the patients with abdominal adiposity were likely not the result of their greater muscle mass or differences in substrate utilization. Conclusion: fat distribution affects REE in morbidly obese premenopausal females, and further research is needed to identify the various entities regulating REE in the morbidly obese.     

High‐fat high‐sucrose diet leads to dynamic structural and inflammatory alterations in the rat vastus lateralis muscle

The influence of obesity on muscle integrity is not well understood. The purpose of this study was to quantify structural and molecular changes in the rat vastus lateralis (VL) muscle as a function of a 12‐week obesity induction period and a subsequent adaptation period (additional 16‐weeks). Male Sprague–Dawley rats consumed a high‐fat, high‐sucrose (DIO, n = 40) diet, or a chow control‐diet (n = 14). At 12‐weeks, DIO rats were grouped as prone (DIO‐P, top 33% of weight change) or resistant (DIO‐R, bottom 33%). Animals were euthanized at 12‐ or 28‐weeks on the diet. At sacrifice, body composition was determined and VL muscles were collected. Intramuscular fat, fibrosis, and CD68+ cells were quantified histologically and relevant molecular markers were evaluated using RT‐qPCR. At 12‐ and 28‐weeks post‐obesity induction, DIO‐P rats had more mass and body fat than DIO‐R and chow rats (p < 0.05). DIO‐P and DIO‐R rats had similar losses in muscle mass, which were greater than those in chow rats (p < 0.05). mRNA levels for MAFbx/atrogin‐1 were reduced in DIO‐P and DIO‐R rats at 12‐ and 28‐weeks compared to chow rats (p < 0.05), while expression of MuRF1 was similar to chow values. DIO‐P rats demonstrated increased mRNA levels for pro‐inflammatory mediators, inflammatory cells, and fibrosis compared to DIO‐R and chow animals, despite having similar levels of intramuscular fat. The down‐regulation of MAFbx/atrogin‐1 may suggest onset of degenerative changes in VL muscle integrity of obese rats. DIO‐R animals exhibited fewer inflammatory changes compared to DIO‐P animals, suggesting a protective effect of obesity resistance on local inflammation. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2069–2078, 2016.     

Laparoscopic Cholecystectomy in Obese and Nonobese Patients

Background: From November 1997 to November 1998, 145 cases of laparoscopic cholecystectomy (LC) have been attempted at the District General Hospital of Corfu. Methods: 23 (15.8%) were obese (Group I, BMI >30) and 122 (84.2%) were nonobese patients (Group II, BMI ≤30). One-fifth of these patients suffered from acute cholecystitis. Results: Operative time averaged 95 minutes in Group 1 and 78 minutes in Group II. There were no deaths. There were no significant differences between the obese and nonobese groups in conversion to open procedure (Group1: 0%, Group II: 2.4%), intraoperative and postoperative complications (Group I: 4.3%, Group II: 4.0%), operating time, and length of postoperative hospitalization. Conclusion: LC was a safe and effective treatment for obese patients with symptomatic cholelithiasis.     

Pressurized Air Injection Causing Subcutaneous Emphysema in a Pediatric Patient

This report describes the case of a young boy who sustained a bicycle-spoke puncture wound during which the tire air nozzle penetrated the cutaneous barrier about the ankle. Pressurized air was injected into the tissues resulting in subcutaneous emphysema. The subcutaneous gas was confirmed by roentgenogram, and a full recovery resulted after local wound care and antibiotic therapy. Care was taken to distinguish traumatic air injection from gas gangrene. ACFAS Level of Clinical Evidence: 4.