腹腔镜下大肠癌根治术中腹内压升高对患者治疗效果影响的考察

目的探讨腹腔镜下大肠癌根治术中腹内压升高对其预后的影响。 方法回顾性分析2014年1月至2017年6月收治的114例腹腔镜下大肠癌根治术患者的临床资料,按照术中不同气腹压分为A、B和C三组：A组,术中腹内压为10 mmHg,36例;B组术中腹内压为12 mmHg,41例;C组术中腹内压为15 mmHg,37例。数据采用SPSS 20.0统计软件进行分析,比较三组患者术后各项指标、外周血内D－乳酸、IL－6及TNF－α水平以( ±s)表示,组间对比采用t检验。各组患者术后6 h内鼻胃管拔出率及并发症发生情况组间对比采用χ²检验,以P<0.05表示差异具有统计学意义。 结果三组患者术后6 h内鼻胃管拔出率、首次排气时间、首次排便时间、首次肠鸣音时间、首次进食时间以及术后住院时间相比,差异均无统计学意义(P>0.05)。三组患者术后并发症发生率相比,差异均无统计学意义(P>0.05)。与术前相比,三组患者的D－乳酸和白细胞介素－6(IL－6)均明显升高,差异有统计学意义(P<0.05);TNF－α水平无显著变化(P>0.05)。术后C组的D－乳酸水平显著高于A、B组,差异有统计学意义(P<0.05)。 结论腹腔镜下大肠癌根治术中腹内压升高对患者的预后没有影响。     

High cost of stage IV pressure ulcers

Background

The aim of this study was to calculate and analyze the cost of treatment for stage IV pressure ulcers.

Methods

A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed up for a maximum of 29 months and analyzed. Costs directly related to the treatment of pressure ulcers and their associated complications were calculated.

Results

Nineteen patients with stage IV pressure ulcers (11 hospital-acquired and 8 community-acquired) were identified and their charts were reviewed. The average hospital treatment cost associated with stage IV pressure ulcers and related complications was $129,248 for hospital-acquired ulcers during 1 admission, and $124,327 for community-acquired ulcers over an average of 4 admissions.

Conclusions

The costs incurred from stage IV pressure ulcers are much greater than previously estimated. Halting the progression of early stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce health care expenditures by millions of dollars.     

Cost‐of‐illness of chronic leg ulcers in Germany

Chronic wounds are important because of their frequency, their chronicity and high costs of treatment. However, there are few primary data on the cost‐of‐illness in Germany. The aim was to determine the cost‐of‐illness of venous leg ulcers (VLU) in Germany. Prospective cost‐of‐illness study was performed in 23 specialised wound centres throughout Germany. Direct, medical, non medical and indirect costs to the patient, statutory health insurers and society were documented. Thereover, health‐related quality of life (QoL) was recorded as intangible costs using the Freiburg quality of life assessment for wounds (FLQA‐w, Augustin). A total of 218 patients (62.1% female) were recruited consecutively. Mean age was 69.8 ± 12.0 years. The mean total cost of the ulcer per year and patient was € 9569, [ € 8658.10 (92%) direct and € 911.20 (8%) indirect costs]. Of the direct costs, € 7630.70 was accounted for by the statutory health insurance and € 1027.40 by the patient. Major cost factors were inpatient costs, outpatient care and non drug treatments. QoL was strikingly reduced in most patients. In Germany, VLU are associated with high direct and indirect costs. As a consequence, there is a need for early and qualified disease management. Deeper‐going cost‐of‐illness‐studies and cost‐benefit analyses are necessary if management of chronic wounds is to be improved.     

女性压力性尿失禁患者在不同膀胱容量下漏尿点压的对照研究

目的:探讨女性压力性尿失禁患者在不同膀胱灌注量下漏尿点压的差异。方法:回顾性分析2016年1月至2018年12月本院收治的12例女性压力性尿失禁患者,在术前行尿动力检查时分别给予膀胱灌注200、250、300、350 mL时,测出腹压漏尿点压及咳嗽漏尿点压并分别进行比较。结果:不同膀胱容量下同时测得的腹压漏尿点压及咳嗽...     

Relationship between ultrasonographically low-echoic lesions under the skin,wheelchair sitting time,and interface pressure on ischial region in individuals with chronic spinal cord injury

Objective: To determine the relationship between physical findings, wheelchair sitting time, and interface pressure on ischial region in subjects with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Rehabilitation center in Japan.Participants: Manual wheelchair users with chronic SCI (n = 45).Interventions: Pressure ulcers (PU) were diagnosed by inspection, palpation, and ultrasonography. Self-reports were obtained on wheelchair sitting time and pressure mapping was recorded while the subject was seated on the wheelchair.Outcome measures: Subjects were divided into those with ultrasonographically low-echoic lesions (PU-positive group, n = 11) and no such lesions (PU-negative group, n = 34). Outcome measures included wheelchair sitting time and interface pressure at bilateral ischial regions.Results: Using ultrasonography, 13 low-echoic lesions were identified in 11 subjects of the PU-positive group. The pressure duration was longer and interface pressure was significantly higher in subjects of the PU-positive group compared with those of the PU-negative group (P < 0.05 and P < 0.001, respectively).Conclusions: This is the first study to evaluate the interrelationship between physical findings, sitting time, and ultrasonographically measured interface pressure on ischial region area in subjects with spinal cord injury. To prevent pressure ulcers, we recommend avoidance of prolonged wheelchair sitting and measures that can reduce the interface pressure. These variables should be carefully tailored to the needs of the individual subjects with SCI.     

臀上或臀下动脉穿支皮瓣修复臀部褥疮

目的 探讨保留臀大肌的臀上动脉或臀下动脉穿支皮瓣修复臀部褥疮.方法 术前常规用多普勒超卢探测仪探测穿支点并标记.设计将穿支点包括在内的不带臀大肌的臀上或臀下动脉穿支带蒂皮瓣修复臀部创面.结果 2006年8月至2009年5月临床应用15例,皮瓣大小为6cm×8 cm～7 cm×15 cm,术后皮瓣均完全成活,供区无血肿、血清肿等并发症发生.结论 臀上动脉或臀下动脉穿支皮瓣保留了臀大肌,血运可靠,能明显降低对供区的损伤,是修复臀部褥疮的一个良好选择.     

A home‐based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study

This study aimed to assess the feasibility of a home‐based exercise programme and examine the effects on the healing rates of venous leg ulcers. A 12‐week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow‐up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home‐based progressive resistance exercise programme. Further research is warranted with a larger multi‐site study.     

Improvisations in classic and modified techniques of flap surgery to improve the success rate for pressure ulcer healing in patients with spinal cord injury

The recurrence of pressure ulcers (PrUs) and dehiscence of reconstructive flap have always been a problem. The present study aimed to evaluate the results of reconstructive flap surgeries in patients with spinal cord injury (SCI) having PrUs, using classic and modified flaps with improvisations to decrease wound dehiscence, flap necrosis and tension in flap. This is a prospective clinical study. The setting was a tertiary care centre in northern India. Thirty‐five patients with SCI having 37 stage III and IV PrUs. PrUs were treated using classic and modified flaps with improvisations. The outcome was evaluated using criteria of wound dehiscence, flap necrosis and recurrence. The results of flap surgery were excellent in 32 (86·48%) patients, good in 4 (10·81%) patients and poor in 1 (2·7%) patient. Partial flap necrosis (2·7%), low incidence of PrU recurrence rate at flap site (5·4%) and overall PrU recurrence (11·4%) were the complications observed. Improvisation of classic and modified techniques of flap surgeries along with reinforcement of general care principles of paraplegia can be effective in minimising complications often associated with PrU reconstructive surgery thus improving the ultimate outcome.