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1.
目的观察甲硝唑纱条联合挂线术对促进肛周脓肿创面愈合的效果。方法纳入本院80例肛周脓肿患者作为研究对象,随机分为两组,每组各40例。观察组采用甲硝唑纱条联合挂线术,对照组采用高锰酸钾坐浴、凡士林纱条联合挂线术。比较两组手术疗效及创面愈合质量。结果观察组痊愈33例,对照组痊愈30例,两组痊愈率和总体手术疗效差异均无统计学意义(均P0.05),观察组术后3 d和1 w时VAS评分低于对照组(均P0.05),观察组术后3 d和1 w时创面渗出评分高于对照组(均P0.05)。两组肉芽组织生长评分差异均无统计学意义(均P0.05)。观察组创面腐肉脱落时间和创面愈合时间短于对照组(均P0.05),观察组术后3 w时创面愈合率高于对照组(P0.05)。结论甲硝唑纱条联合挂线术用于肛周脓肿能缩短创面愈合时间,促进患者早期康复。  相似文献   

2.
目的观察重组人表皮生长因子对肛周脓肿患者术后创面愈合的影响。方法随机将112例肛周脓肿手术患者分为治疗组(n=56)和对照组(n=56)。治疗组:创面用生理盐水消毒,以浸有重组人表皮生长因子凝胶纱条填塞。对照组:常规消毒,用甲硝唑纱条或雷佛奴尔纱条填塞。手术后3、7、10 d观察创面水肿情况及愈合时间。结果治疗组和对照组手术后3、7、10 d创面水肿评分分别为[(1.20±0.70)、(1.00±0.67)、(1.05±0.69)]和[(1.70±0.66)、(1.90±0.74)、(1.70±0.73)],两组比较差异有统计学意义(P0.05),两组创面愈合时间比较,差异有统计学意义(P0.05)。结论重组人表皮生长因子能明显促进创面愈合。  相似文献   

3.
目的:观察扶正生肌油纱条对肛瘘术后患者创面愈合的影响。方法:选择 2019年 1月—2021年 1月于南京中医药大学徐州附属医院治疗的 160例行肛瘘手术的低位单纯肛瘘患者 160例,按随机数字表法分为两组,每组 80例,对照组术后给予凡士林纱条治疗,研究组术后给予扶正生肌油纱条治疗,治疗后检测两组患者表皮生长因子( EGF)、血管内皮生长因子( VEGF)、炎症指标、免疫球蛋白指指标,给予视觉模拟评分( VAS)评价,记录两组患者创面愈合时间,比较两组患者临床疗效。结果:研究组 IgG水平高于对照组 [(10.12±3.14)g/L vs (7.52±2.19)g/L],研究组 IgA水平低于对照组 [(1.01±0.30)g/L vs (1.45±0.41)g/L,(P<0.05)],研究组 EGF、VEGF水平 [(7.61±2.18)μg/L、(139.02± 36.32)ng/L vs(5.93±1.26)μg/L、(121.84±33.25)ng/L]高于对照组,差异有统计学意义( P<0.05),研究组 IL-1β水平低于对照组 [(23.66±6.94)ng/L VS (31.31±10.13)ng/L,P<0.05],研究组 IL-10水平高于对照组 [(65.19± 16.06)pg/mL vs(56.61±15.52)pg/mL,P<0.05],研究组患者 VAS评分低于对照组 [(2.73±0.81)分 vs(4.18±1.13)分, P<0.05],研究组患者创面愈合时间低于对照组 [(22.78±6.32)d vs(29.45±8.33)d,P<0.05],研究组患者总有效率( 97%)高于对照组( 76%),差异有统计学意义( P<0.05)。结论:扶正生肌油纱条治疗肛瘘术后患者,可提升患者 EGF、VEGF水平,调控免疫球蛋白分泌,抑制患者炎症,缓解患者疼痛,促进创面愈合,提升临床疗效。  相似文献   

4.
目的 观察扶正生肌汤对低位肛瘘患者的临床效果。方法:选取2020年6月—2021年1月我院收治的116例低位肛瘘患者,采用随机数字表法分为对照组和研究组,每组各58例。两组患者均行肛瘘切开肌层缝合内口引流术,对照组术后给予常规治疗,研究组术后在常规治疗的基础上另给予扶正生肌汤治疗。对比两组患者的创面愈合率、新生肉芽情况、临床疗效、炎性因子、生长因子、肛门功能、肛管直肠压力及安全性。结果:研究组术后1周、2周创面愈合率、新生肉芽评分均高于对照组(P<0.05)。研究组总有效率高于对照组(P<0.05)。研究组术后2周降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平均低于对照组(P<0.05)。研究组术后2周血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)水平均高于对照组(P<0.05)。两组患者术后2周肛门功能评分、肛管最大收缩压对比,差异无统计学意义(P>0.05);研究组术后2周肛管静息压高于对照组(P<0.05)。两组患者治疗期间均无明显不良反应。结论:扶正生肌汤治疗低位肛瘘患者可促进术后创面愈合,提高临床疗效,调节炎性因子、生长因子水平,保护肛门功能,且安全可靠。  相似文献   

5.
目的:观察复方生肌玉红膏油纱条换药促进肛瘘术后创面愈合的疗效。方法:选取2021年11月至2022年11月,本院80例肛瘘术后患者,随机分成治疗组和对照组,每组各40例。治疗组术后创面外敷生肌玉红膏油纱条,对照组创面外敷凡士林油纱条。观察2组临床疗效,创面愈合时间,肉芽组织及上皮组织出现时间,创面疼痛评分及肉芽组织生长评分。结果:治疗组总有效率高于对照组(P<0.05),术后肉芽组织出现时间早于对照组(P<0.05),创面愈合速度明显快于对照组(P<0.05),创面疼痛、水肿及肉芽组织生长评分明显低于对照组(P<0.05)。结论:肛瘘术后采用复方生肌玉红膏纱条换药,临床效果优于传统凡士林纱条换药。可加速创面愈合,减轻术后水肿及疼痛。  相似文献   

6.
探讨负压封闭引流治疗高位肛周脓肿的疗效。94例高位肛周脓肿患者按数字随机表法分为两组,每组47例。治疗组给予负压封闭引流治疗,对照组给予低位切开引流治疗,比较两组手术时间、住院时间、创面愈合时间、住院费用;比较两组术后第2日疼痛视觉模拟评分(VAS)和Wexner肛门失禁评分;比较两组术前及术后7 d血清肿瘤坏死因子-α(TNF-α)和表皮生长因子(EGF)水平;术后4周比较两组治愈率。治疗组术后住院时间、创面愈合时间及住院费用均少于对照组(P<0.01);术后第2日治疗组VAS评分、Wexner评分均低于对照组(P<0.01);术后7 d治疗组血清TNF-α水平低于对照组(P<0.01),EGF水平高于对照组(P<0.01),术后4周治疗组治愈率高于对照组(P<0.05),差异均有统计学意义。负压封闭引流术治疗高位肛周脓肿可有效保护肛门功能,缓解术后疼痛,减少创面愈合时间和住院时间,提高治愈率。  相似文献   

7.
目的:探究生肌膏对糖尿病足患者的疗效及对创面愈合相关指标和预后的影响。方法:选取我科收治的120例糖尿病足患者,根据治疗方式的不同,分为研究组及对照组两组(各60例),其中对照组采用常规治疗,研究组在常规治疗基础上联合生肌膏治疗,比较两组患者的临床疗效、中医证候积分、相关血清指标及生活质量评分等差异。结果:治疗后,研究组患者的创面相关愈合指标均较对照组明显改善(P<0.05);治疗后研究组患者患足的中医证候积分均较对照组明显改善(P<0.05);治疗后研究组患者的血小板衍生生长因子(PDGF)、血管内皮生长因子(VEGF)均较对照组明显改善(P<0.05);1个月后,研究组患者的生活质量评分显著高于对照组患者(P<0.05)。结论:生肌膏对糖尿病足患者的疗效较佳,不仅可促进创面愈合,还可提高患者的生活质量,值得临床推广应用。  相似文献   

8.
目的:探讨自体脂肪源性干细胞(Adipose-derived stem cells,ADSCs)联合外膜敷贴对老年患者慢性创面生长因子的影响。方法:选取笔者医院2014年2月-2019年2月收治的老年慢性创面患者84例,根据随机数字表法分成对照组、观察组,各42例。对照组采用外膜敷贴(无菌生物护创膜)治疗,观察组采用自体ADSCs联合外膜敷贴治疗。在患者治疗2个月后复查时评估创面愈合效果。分别在治疗前、治疗2个月时取创面组织检测两组碱性成纤维细胞生长因子(bFGF)、表皮生长因子(EGF)、血管内皮细胞生长因子(VEGF)、血小板衍化生长因子(PDGF)水平,观察创面生长因子的变化。分析两组微血管计数(MVD)的变化,并记录两组创面愈合时间与并发症发生率。结果:观察组愈合率为92.86%显著高于对照组76.19%,差异有统计学意义(P0.05)。两组治疗后bFGF、EGF、VEGF、PDGF阳性表达率均高于治疗前,且观察组较对照组显著增高(P0.05)。观察组MVD计数为(38.53±2.45)个,较对照组的[(30.41±3.04)个]更高(P0.05)。观察组愈合时间为(47.53±5.47)d少于对照组的(55.39±3.86)d,差异有统计学意义(P0.05)。两组创面感染、破溃、皮肤坏死发生率比较差异无统计学意义(P0.05)。结论:与单用外膜敷贴相比,老年慢性创面患者经自体ADSCs联合外膜敷贴治疗,能上调bFGF、EGF、VEGF、PDGF阳性表达率,提高MVD计数,缩短愈合时间,促进创面修复,疗效更好。  相似文献   

9.
目的:探讨松花粉外用联合裸花紫珠口服对肛周脓肿术后患者的创面愈合以及炎症因子的影响。方法:选取2022年3月至2023年4月我院肛肠外科收治的肛周脓肿患者80例,根据治疗方法不同将其分为对照组37例和观察组43例。对照组患者术后常规治疗,观察组在对照组的基础上给予松花粉外用联合裸花紫珠口服治疗,比较2组患者创面愈合时间、创面水肿消失时间,创口肉芽组织中的血管内皮生长因子(VEGF)mRNA表达水平、碱性成纤维生长因子(bFGF)mRNA表达水平、疼痛评分、血清白细胞介素-6(IL-6)水平以及血清肿瘤坏死因子-α(TNF-α)水平。结果:观察组患者创面愈合时间以及创面水肿消失时间均短于对照组(P<0.05)。在术后第10天,观察组患者的VEGF、bFGF的mRNA表达水平均高于对照组(P<0.05);2组患者在术后第10天的疼痛评分以及血清IL-6、TNF-α水平均低于术后第1天,且观察组低于对照组(P<0.05)。结论:松花粉外用联合裸花紫珠口服可促进肛周脓肿患者术后创面愈合以及降低血清炎症因子水平。  相似文献   

10.
目的:观察促愈外用方熏洗对热毒炽盛型肛周脓肿术后创面愈合的临床疗效。方法:采用随机数字表法将90例肛周脓肿患者随机分为对照组和治疗组各45例。两组患者均行脓肿切开引流术(低位肛周脓肿行单纯脓肿切开引流术,高位肛周脓肿行脓肿切开置管引流术)。对照组术后予以高锰酸钾溶液熏洗坐浴,治疗组予以促愈外用方熏洗坐浴。分别检测两组患者术前及术后第3天的白细胞(WBC)、C反应蛋白(CRP)、中性粒细胞与淋巴细胞比率(NLR);比较患者术后第1、7、14天肛门疼痛、创面渗出、肉芽组织评分;在术后第21天评价两组疗效,记录创面愈合时间及不良事件;随访1年,比较两组成瘘率。结果:治疗组的炎症指标(术后第3天)、肛门疼痛(术后第7、14天)、创面渗出(术后第14天)、肉芽组织情况(术后第7、14天)、临床疗效和创面愈合时间均优于对照组(P <0.05)。治疗组成瘘率有低于对照组的趋势,但差异无统计学意义(P> 0.05)。结论:促愈外用方熏洗坐浴可有效降低肛周脓肿的炎症指标,减轻术后肛门疼痛,减轻创面渗出,改善肉芽组织,缩短愈合时间,减少术后肛瘘形成,安全有效,值得临床推广。  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

13.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

14.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

15.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

16.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

17.
Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg?1 i. v. and 32 μg · kg?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg?1. The mean ED50s, calculated from dose-response curves, were 5.4 mg · kg?1, 3.9 μg · kg?1 and 0.4 mg · kg?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg?1 i. v. or midazolam 0.05 mg · kg?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg?1 and 8 μg · kg?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.  相似文献   

18.
Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg?1 · min?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min?1 · m?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO2I) and oxygen consumption index (VO2I) were also significantly increased in the dopexamine group (DO2I: from 416±91 to 717±110 ml/m2 · m2; VO2I: from 98±25 to 157±22 ml/m2 · m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.  相似文献   

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Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.  相似文献   

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