纤维蛋白胶联合绷带型角膜接触镜在翼状胬肉切除术中的应用

目的：探讨应用纤维蛋白胶联合绷带型角膜接触镜减轻翼状胬肉切除联合自体角膜缘干细胞移植术后疼痛的效果。 方法：对52例72眼行翼状胬肉切除联合自体角膜缘干细胞移植手术治疗的初发性翼状胬肉患者,随机分为试验组（纤维蛋白胶联合绷带型角膜接触镜组）28例38眼和对照组（缝线组）24例34眼。试验组及对照组给予常规20 g/L利多卡因浸润麻醉后进行翼状胬肉切除联合自体角膜缘干细胞移植术。试验组采用黏合剂将植片与植床进行粘贴,对照组采用10-0缝线缝合植片与植床。术毕,试验组角膜表面放置角膜接触镜,对照组不配戴角膜接触镜。主要术后观察患者的术后1,2,3,5,7 d疼痛评分。术后随访6mo,观察植床与植片的匹配程度及感染、复发、植片愈合不良、结膜下囊肿等并发症情况。 结果：试验组患者疼痛程度评分均较对照组显著降低（均为P=0.000）。观察期内,两组植床与植片均成功固定于巩膜表面,并全部成活,同时两组患者均未发生感染、复发、植片愈合不良、结膜下囊肿等并发症。 结论：联合运用纤维蛋白胶黏合剂粘及角膜接触镜,可明显减轻翼状胬肉术后的疼痛反应。     

护理干预对截石位手术患者血压变化的影响

目的探讨医用弹力绷带及下肢被动运动护理干预对截石位手术患者血压变化的影响。方法选取我院采取截石位手术的患者300例,随机分为3组各100例。其中A组仅行常规护理,作为对照组;B组在常规护理的基础上给予医用弹力绷带护理干预;c组在B组措施的基础上给予下肢被动运动护理干预。对3组患者血压的波动情况进行比较。结果未经过医用弹力绷带与下肢被动运动护理的患者,双下肢放平后血压明显降低;平均动脉压在放平双下肢即刻以及5min后明显降低;上述改变与B、C组经过护理干预的患者相比差异有统计学意义。结论医用弹力绷带与下肢被动运动2种护理干预的方式均对截石位手术患者起到了稳定血压的作用,值得临床推广。     

可吸收绷带治疗严重肝脏爆冲伤的对照研究：小型猪实验

Background  The aim of this research was to evaluate the feasibility and efficacy of absorbable bandage wrapping in the treatment of cases of severe liver trauma.

Methods  Electric firecrackers were detonated in 16 miniature swine to produce a severe blast liver injury. After fluid resuscitation, the animals were randomly divided into two groups (n=8 each) and were either treated with absorbable bandage wrapping of the injured lobe of liver (Group B) or hepatic lobectomy (Group H). Time to hemostasis, blood loss during the treatment period, and other parameters were compared, including postoperative serum total bilirubin (TB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST).

Results  Blood loss during the treatment period was significantly lower in Group B than that in Group H ((81.3±26.0) ml vs. (130.8±29.5) ml, P=0.0031). Serum AST and ALT were transiently increased post-surgically. These transient increases were significantly higher in Group B. No difference in time to hemostasis was noted ((8.70±2.27) minutes vs. (10.28±1.93) minutes, P=0.1559) in Groups B and H, respectively. Two pigs were humanely euthanized 28 days post-surgically and the wrapped liver lobes appeared atrophies. Microscopically, there was evidence of emerging and mature fibrous tissue.

Conclusion  Absorbable bandage wrapping is both feasible and effective in the treatment of severe blast liver injury.

     

Robert Jones bandage versus cast in the treatment of distal radius fracture in children: A randomized controlled trial

PurposeThe present study aimed to treat fractures of the distal end of the radius in children with Robert Jones (RJ) bandage. The objective was to compare this treatment modality with the cast regarding the frequency of the complication occurrence, child comfortability, and family satisfaction.MethodsThe study was a randomized controlled non-inferiority clinical trial including children with recent (less than 5 days) fractures at the distal end of the radius OTA/AO 23-A2, which is usually treated conservatively. Those with open fractures, pathological fracture, severely displaced fracture that needs reduction or multiple injuries were excluded. The participants were divided randomly into 2 groups according to the treatment modalities. Group 1 was treated by plaster of Paris cast (the control group), and Group 2 by modified RJ bandage (the trial group). The difference between the 2 groups was found by the Chi-squared test. The difference was considered statistically significant when the p value was less than 0.05.ResultsThere were 150 children (aged 2 – 12 years, any gender) included in the study, 75 in each group. The complications occured in 5 (3.3%) cases only, pressure sores of 3 cases in Group 1 and fracture displacement of 2 cases in Group 2. There was no statistically significant difference in the rate of complication occurrence between both modalities of treatment (p = 0.649). Children treated by RJ bandages were more comfortable than those treated by the cast (97.3% vs. 73.3%, p < 0.001) with a statistically significant difference between them. Contrary to that, the families were more satisfied with the cast than RJ bandage (88.0% vs. 81.3%), but without a statistically significant difference (p = 0.257).ConclusionRJ bandage is a non-inferior alternative to the cast for the treatment of fractures at the distal end of the radius that can be treated conservatively in children.     

经尿道前列腺电切术后患者导尿管牵引的护理

目的探讨经尿道前列腺电切术后导尿管用不同材料牵引的护理效果。方法按照患者入院日期将192例前列腺电切术后的患者分为两组,单日应用胶布粘贴牵引患者102例为胶布粘贴牵引组。双日应用脱脂绷带打结牵引患者90例为脱脂绷带打结牵引组。比较两组牵引并发症发生情况。结果脱脂绷带打结牵引组患者无1例出现皮肤损伤和皮肤过敏、发痒、红肿、水疱等症状。胶布粘贴牵引组有25例患者出现氧化锌过敏,皮肤发红发痒,并有多个小水疱,需敷药治疗。经精确概率法卡方检验,有显著性差异,P<0.001。结论脱脂绷带打结法牵引导尿管方法效果优于胶布粘贴法。对于皮肤容易过敏和糖尿病患者,脱脂绷带打结法牵引导尿管方法是一种有效的护理措施。     

翼状胬肉切除联合角膜干细胞移植术后配戴绷带镜的效果评价

目的：评价翼状胬肉切除联合角膜干细胞移植术后配戴绷带镜的临床效果。

方法：本研究为前瞻性分析,选择2015-08/2018-02入我院行翼状胬肉切除联合角膜干细胞移植术患者110例110眼,随机数字表法将其分为对照组和观察组各55例55眼,对照组术后常规观察,观察组术后配戴绷带镜; 采用视觉模拟评分(VAS)比较术后1、3d,1wk的疼痛情况,采用荧光素钠染色法(FL)评估角膜上皮愈合情况及并发症发生率。

结果：观察组术后1、3d,1wk VAS评分和角膜上皮愈合评分均明显低于对照组,差异均有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。

结论：翼状胬肉切除联合角膜干细胞移植术后配戴绷带镜有较好的应用安全性和有效性,可减轻胬肉手术后疼痛,促进上皮愈合。     

Les lymphœdèmes : du diagnostic au traitement

Lymphedema results from impaired lymphatic transport with increased limb volume. Lymphedema are divided in primary and secondary forms. Upper-limb lymphedema secondary to breast cancer treatment is the most frequent in France. Primary lymphedema is sporadic, rarely familial or associated with complex malformative or genetic disorders. Diagnosis of lymphedema is mainly clinical and lymphoscintigraphy is useful in primary form to assess precisely the lymphatic function of the two limbs. Erysipelas (cellulitis) is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lipedema is the main differential diagnosis, defined as an abnormal accumulation of fat from hip to ankle. Lymphedema management is based on complete decongestive physiotherapy (multilayer low-stretch bandage, manual lymph drainage, skin care, exercises). The first phase of treatment leads to a reduction of lymphedema volume and the second phase stabilizes the volume. Multilayer low-stretch bandage and elastic compression is the cornerstone of the complete decongestive physiotherapy. Patient-education programs, including self-management, aim to improve patient autonomy.     

海藻酸钠敷料止血性能的实验研究

目的:研究一种功能型敷料:海藻酸敷料(本项目已申请国家专利,并初审合格,申请号:201010213206.4)的止血性能。方法:取新西兰兔5只,在背部两侧对称性剪6个直径1cm的圆形创口,分别用与创面大小相当的海藻酸敷料和云南白药创口贴止血,观察与创面的粘附情况,记录出血时间;止血停止后,将海藻酸敷料和云南白药创口贴放入预先配制好的氰化高铁血红蛋白检测试剂中仔细清洗,用分光光度计在540nm波长处光度比色,测出的Hb光度吸收值表示出血量。结果:海藻酸敷料与创面粘附较好,海藻酸敷料组、云南白药创口贴组的出血时间分别为(84.63±19.1)s、(169.33±22.6)s,Hb光度吸收值分别为(1.069±0.4)、(1.735±0.733),经统计学分析,两组数据都有显著性差异(P0.01),海藻酸敷料组明显优于云南白药创口贴组。结论:海藻酸敷料具有较好的止血性能。     

新生儿脐带暴露法对脐部感染和脐带残端脱落的影响

目的 比较应用WHO倡导的脐带暴露法与传统的脐带包扎法对预防新生儿脐部感染和脐带残端脱落时间长短的影响.方法 选择2012年10月至11月住院分娩的356例新生儿,随机分为脐带暴露法组与脐带包扎法组,两组脐带结扎方法相同,脐带暴露法组断脐后在产房开始即暴露脐带,日常护理用清水清洁脐部,不用任何消毒液;脐带包扎法组断脐后使用脐带卷包扎,日常护理仍然使用75％酒精消毒脐部并每日包扎.比较分析两组新生儿脐带残端脱落时间、脱落率、脐部分泌物及脐炎发生率情况.结果 脐带暴露法组脐带残端脱落时间多集中在6～7天,而脐带包扎法组多在7天以上,两组脱落率分别有显著差异（P＜0.01）;脐带暴露法组脐部分泌物和轻度脐炎发生率明显低于脐带包扎法组（P＜0.01和P＜0.05）.结论 采用脐带暴露法可明显缩短脐带残端脱落时间,并能降低脐部感染率,是一种安全有效的新生儿脐部护理方法.     

绷带型角膜接触镜在治疗神经麻痹性角膜炎的疗效观察

目的探讨绷带式角膜接触镜在治疗神经麻痹性角膜炎的临床应用效果。方法回顾自2011年1月至2015年1月在治疗的神经麻痹性角膜炎患者29例(29眼),其中佩戴绷带式角膜接触镜联合药物治疗14例(14眼),单纯药物组15例(15眼)使用相同的药物治疗,分别评估治疗后7和14 d角膜炎愈合情况及并发症情况。结果佩戴绷带式角膜接触镜组第7天好转率64%,14天治愈率为64%,均显著高于药物组(P≤0.05)。在观察期间没有出现并发症。结论佩戴绷带式角膜接触镜可以促进角膜上皮的愈合,有效提高神经麻痹性角膜炎患者治愈率,提高患者生活质量,观察期间无并发症。