CICARE需求评估联合支持性照护对手部烧伤病人瘢痕整形术后应对方式及心理弹性的影响

目的:探讨CICARE需求评估联合支持性照护对手部烧伤病人瘢痕整形术后应对方式及心理弹性的影响。方法:将2016年3月—2019年3月收治的94例手部烧伤瘢痕整形术病人随机分为对照组、观察组各47例,对照组采用常规护理,观察组在常规护理基础上给予CICARE需求评估联合支持性照护。干预1周后采用简易应对方式量表、中文版心理弹性水平量表(CD-RISC)评价病人应对方式、心理弹性。结果:观察组病人积极应对评分高于对照组,消极应对评分低于对照组(P<0.05);观察组病人CD-RISC量表中坚韧控制、力量、乐观维度评分高于对照组(P<0.05)。结论:CICARE需求评估联合支持性照护在手部烧伤瘢痕整形术病人中的应用,能转变其术后应对方式,提升心理弹性水平。     

腹腔镜下连续褥式内翻缝合治疗外生型剖宫产切口部妊娠的临床研究

目的 探讨经腹腔镜下连续褥式内翻缝合治疗外生型剖宫产切口部妊娠（CSP-Ⅱ）的安全性和有效性。方法 选择2019年1月1日－2020年6月30日在该院就诊的CSP-Ⅱ患者41例,分为A组（实验组,n = 20）和B组（对照组,n = 21）。A组行腹腔镜下连续褥式内翻缝合,B组行腹腔镜下子宫切开取胚术。比较两组患者手术时间、术中出血量、术后第1天血清β-人绒毛膜促性腺激素（β-HCG）值、住院时间、β-HCG转阴时间、术后第1天血红蛋白（HB）值、恢复月经时间、术后第1天较手术前1天血清β-HCG的下降百分率。结果 A组术后第1天β-HCG值较B组高,但两组比较,差异无统计学意义（P > 0.05）;B组住院时间较A组时间长,但两组比较,差异无统计学意义（P > 0.05）;A组β-HCG转阴时间和恢复月经时间较B组长,术后第1天HB值较B组高,两组比较,差异均有统计学意义（P < 0.05）;A组术中出血量少于B组,手术时间短于B组,两组比较,差异有统计学意义（P < 0.05）;两组术后第1天血清β-HCG水平均较术前1天下降50.00%以上。B组瘢痕肌层切除后,行病理检查发现：肌层内存在少许绒毛组织,纤维平滑肌组织间见大量增生的滋养细胞。结论 腹腔镜下连续褥式内翻缝合治疗CSP-Ⅱ具有手术简单、术中出血少、手术时间短、创伤小等优势,可切除憩室、增加子宫下段厚度和缩短避孕时间的优点,但术后血清β-HCG下降缓慢、恢复月经时间长。     

Clinical outcomes in patients on preinjury ibuprofen with traumatic brain injury

Background

The aim of our study was to evaluate the clinical outcomes in patients on preinjury Ibuprofen with traumatic brain injury.

Methods

We performed a 2-year analysis of all patients on prehospital Ibuprofen with traumatic brain injury and intracranial hemorrhage. Patients on preinjury Ibuprofen were matched using propensity score matching to patients not on Ibuprofen in a 1:2 ratio for age, Glasgow Coma Scale, head-abbreviated injury scale, injury severity score, International Normalized Ratio, and neurologic examination. Outcome measures were progression on repeat head computed tomography (RHCT) and neurosurgical intervention.

Results

A total of 195 matched (Ibuprofen 65, no-Ibuprofen 130) patients were included. There was no difference in the progression on RHCT (Ibuprofen 18% vs no-Ibuprofen 24%; P = .50). The neurosurgical intervention rate was 18.9% (n = 37). There was no difference for need for neurosurgical intervention (26% vs 16%; P = .10) between the 2 groups.

Conclusions

In a matched cohort of trauma patients, preinjury Ibuprofen use was not associated with progression of initial intracranial hemorrhage and the need for neurosurgical intervention. Preinjury use of Ibuprofen as an independent variable should not warrant the need for a routine RHCT scan.     

The impact of intracranial pressure monitoring on mortality after severe traumatic brain injury

Background

The effect of intracranial pressure (ICP) monitoring on mortality after severe traumatic brain injury (sTBI) remains unclear. We hypothesized that ICP monitoring would not be associated with improved survival in patients with sTBI.

Methods

A retrospective analysis was performed on sTBI patients, defined as admission Glasgow Coma Scale score of 8 or less with intracranial hemorrhage. Patients who underwent ICP monitoring were compared with patients who did not. The primary outcome measure was inhospital mortality.

Results

Of 123 sTBI patients meeting inclusion criteria, 40 (32.5%) underwent ICP monitoring. On bivariate and multivariate regression analyses, ICP monitoring was associated with decreased mortality (odds ratio = .32, 95% confidence interval = .10 to .99, P = .049). This finding persisted on propensity-adjusted analysis.

Conclusions

ICP monitoring is associated with improved survival in adult patients with sTBI. In addition, significant variability exists in the use of ICP monitoring among patients with sTBI.     

电视胸腔镜与传统开胸手术治疗外伤性血气胸的效果比较

目的 比较电视胸腔镜(VATS)和传统开胸手术治疗外伤性血气胸的临床效果.方法 血气胸患者41例随机分为实验组和对照组,对照组26例,采用传统开胸手术方法;实验组15例,采用VATS治疗,对两组患者一般临床资料、术中出血量、手术时间、术后胸管放置时间、术后引流量等进行比较.结果 41例患者均无手术死亡、二次开胸止血,术后均未呼吸机辅助呼吸.实验组术中出血量[(176.5 ±78.5) ml]明显少于对照组[(401.3±90.7)ml],手术时间[实验组(64.7-±21.3) min,对照组(129.4±30.3) min]、术后胸管放置时间[实验组(2.3±0.9)d,对照组(4.5±1.0)d]、住院时间[实验组(9.1±2.1)d,对照组(12.7±2.2)d]及术后并发症发生率等方面均少于对照组,两组比较差异有统计学意义(P＜0.05).结论 VATS治疗外伤性血气胸与传统开胸手术比较,诊断快速准确,安全可靠,并发症少.     

Scar Ectopic Pregnancy

Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. This is a life-threatening form of abnormal implantation of embryo within the myometrium and fibrous tissues in a previous scar on the uterus, especially following caesarean section. With the increasing rate of caesarean section, there is a substantial increase in this condition with better understanding of this disease. The early and accurate diagnosis with timely management can prevent pregnancy complications such as haemorrhage, uterine rupture and can preserve fertility.     

Comparison of fondaparinux sodium and low molecular weight heparin in the treatment of hypercoagulability secondary to traumatic infection

Purpose: To compare the effects and side-effects of fondaparinux sodium and low molecular weight heparin in patients with hypercoagulability accompanied with traumatic infection. Methods: Thirty-six patients with post-traumatic infections in our hospital intensive care center were diagnosed with hypercoagulability from February 2012 to February 2013. These patients were randomly divided into 2 groups. In group F (18 patients), the patients were treated with fondaparinux sodium, 2.5 mg, 1/d for 11 d. In group L (18 patients), the patients were treated with low molecular weight heparin, 4100 U, 1/12 h for 11 d. The incidence of deep vein thrombosis, bleeding events and multiple organ dysfunction syndrome (MODS) and mortality of two groups after anticoagulation therapy were analyzed. Fibrinogen, D-dimer level and activity of antithrombin III were measured by the coagulation analyzer. Results: The incidence of deep vein thrombosis, MODS incidence and mortality were not significantly different between the two groups. The rate of bleeding evens in group F was lower than group L (p < 0.05). Antithrombin III got an upward trend after anticoagulant therapy, in which it was higher in group F than in group L on the 5th d and 11th d (p<0.05). Fibrinogen levels were gradually increased, and there was no significant difference between two groups (p>0.05). D-dimer was significantly decreased after anticoagulant therapy for 5 d (p<0.01), and there were significant differences between two groups on the 5th d and 7th d (p < 0.05). It showed no significant difference on the 11th d (p>0.05). Conclusion: Fondaparinux sodium and low molecular weight heparin can effectively improve coagulopathy in patients with traumatic infection. Compared with low molecular weight heparin, fondaparinux sodium may reduce the risk of bleeding events in patients with hypercoagulability accompanied by traumatic infection.