A Mixed-Methods Study of the Effect of Abdominal Binders on Opioid Use and Postoperative Pain After Cesarean Birth

ObjectiveTo compare levels of postoperative oxycodone use and incisional pain between two randomized groups—an intervention and a control.DesignMixed-methods design; quantitative data achieved via a randomized controlled trial, with qualitative data collected on binder use. The primary variable was oxycodone (in milligrams) required during the first 48 hours after birth, and the secondary variable was incisional pain levels measured on Postoperative Days 1 and 2.SettingAcute-care community hospital in Wheat Ridge, Colorado, and an acute care urban hospital in Denver, Colorado.ParticipantsA total of 220 individuals in the postpartum period after having cesarean birth.Interventions/MeasurementsParticipants were randomized to the intervention group (binder) or the control group (no binder). Data were collected on opioid usage for the first 48 hours. Participants in both groups were asked to rate their incisional pain on Postoperative Day 1 (24 hours after birth) and Postoperative Day 2 (48 hours after birth). Participants in the binder group were also asked to provide feedback on their experience wearing the binder.ResultsA total of 196 participants completed the study. The overall amount of oxycodone taken by individuals in the binder group was lower than that in the control group, but the difference was not statistically significant (p = .10). Pain scores in the binder group were significantly lower on Day 2 compared with the control group (p = .002). The majority of individuals in the binder group provided positive feedback about their experience wearing the binder.ConclusionIndividuals routinely receive medications to assist with pain management postoperatively. Because of growing concerns related to the nation’s opioid addiction crisis, there is interest in using multimodal treatments to achieve adequate pain control for individuals postoperatively. Abdominal binders are a low-cost intervention to assist with pain management and, given the results of this study, seem like a reasonable option to consider.     

右美托咪啶与芬太尼联合对ICU 腹部外科术后机械通气患者镇静镇痛的效果比较

目的:探讨右美托咪啶与芬太尼联合在ICU腹部外科术后机械通气患者中的应用效果及对镇静、镇痛作用的影响。方法:选择2018年5月—2019年6月ICU腹部外科术后机械通气患者62例,随机分为对照组(n=31例)和观察组(n=31例)。两组均采用芬太尼持续静脉泵入,对照组采用咪达唑仑镇静镇痛,观察组采用右美托咪啶镇静镇痛,比较两组镇痛镇静效果、镇静剂使用剂量、苏醒及达到镇静所需时间、血流动力学水平及安全性。结果:两组T2、T3时间点VAS评分分别为(2.40±0.31 vs 2.43±0.32和2.01±0.12 vs 2.05±0.15)、Ramsay量表评分分别(3.21±0.35 vs 3.20±0.33和3.01±0.25vs 3.00±0.24)均低于T1时间点(VAS评分2.94±0.69 vs 2.96±0.71;Ramsay量表评分3.57±0.61 vs 3.58±0.62)(P0.05);观察组右美托咪啶联合芬太尼镇痛镇静达到镇静所需时间(34.29±3.56) min长于对照组(23.63±3.21)(t=5.535,P=0.043);观察组镇静剂使用剂量(220.59±15.25)μg、苏醒时间(3.29±0.69)min均少(短)于对照组镇静剂使用剂量(386.44±18.92)μg、苏醒时间(7.56±1.21)min(t=6.294、6.092,P=0.023、0.025);两组T1、T2时间点心率[观察组T1(88.47±9.76)次/min、T2(86.41±9.43)次/min;对照组T1(89.53±10.41)次/min、T2(87.46±9.58)次/min]均高于T0时间点[观察组(78.78±4.35)次/min、对照组(79.12±4.41)次/min](P0.05);观察组T1、T2时间点MVP(79.58±5.71、87.53±6.76)mmHg高于对照组(74.12±4.69、75.26±5.61)mmHg(t=9.613、7.223,P=0.011、0.016);观察组的不良反应发生率为6.45%,与对照组的12.90%差异无统计学意义(χ~2=1.214, P=0.643)。结论:将右美托咪啶联合芬太尼用于ICU腹部外科术后机械通气患者中能获得良好的镇痛、镇静效果,缩短苏醒及达到镇静所需时间,血流动力学相对稳定,药物安全性较高,值得推广应用。     

参芪润肠通便汤治疗小儿便秘的临床疗效

目的观察参芪润肠通便汤治疗小儿便秘的临床疗效。方法选定麻城市人民医院中医儿科门诊治疗的小儿便秘患儿80例,研究时段自2017年2月—2019年1月,按照治疗方式进行分组,分对照组(40例,常规药物治疗)、试验组(40例,参芪润肠通便汤治疗),回顾分析患儿临床资料,比较临床疗效、症状积分。结果试验组临床总有效率(95.00%)显著较对照组(77.50%)高,P<0.05;试验组治疗前1 d大便全程干燥、腹部胀满、胃纳减退评分与对照组相比存在差异,但P<0.05,治疗2周后两组上述评分均降低,且试验组较对照组低,P<0.05。结论针对小儿便秘患儿,参芪润肠通便汤可改善患者症状,促进其病情恢复,患儿整体状态得以改善,值得借鉴。     

Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution

Objective: To evaluate the long-term clinical effect of high-intensity focussed ultrasound (HIFU) as a non-invasive modality for ablation of abdominal wall endometriosis (AWE) foci.

Methods: All women who were diagnosed with cutaneous endometriosis and underwent HIFU ablation and 4-year follow-up were included. Patient symptoms, imaging performed, HIFU ablation, recurrence, lesion location, size and number were collected and analyzed.

Results: A total of 51 women with 57 painful abdominal wall masses with a median volume of 4.00?cm³ and a mean age of 30.5±2.12 years were treated with HIFU. The main symptoms were a palpable painful abdominal mass (93%), protrusion of the skin (28.1%, 16) or lack of protrusion of the skin (71.9%, 41). Ultrasound was initially performed in 100% (51) of women, whereas 6% (3) required MRI examinations to distinguish the features and range of the masses. Ablation was performed with a median 300?s of sonication time, 40?min treatment time, 150?W of power and 41800?J of total energy to treat lesions that were a median volume of 3.83?cm³. No severe complications occurred, except in one patient with a first-degree skin burn, during the 48-month follow-up period. The pooled recurrence of cutaneous endometriosis occurred in 3.9% (2) of women.

Conclusion: The diagnosis of AWE should be confirmed with imaging of the lesion number, location, size and features before HIFU ablation. HIFU should be the first choice for the treatment of AWE as it is a non-invasive method, with high efficiency and safety and rapid postoperative recovery.     

脂肪抽吸联合腹壁成形术改善腹部形态临床应用

目的探讨脂肪抽吸与腹壁成形术联合进行腹壁体形重塑的临床疗效,总结手术成功与减少并发症的经验。方法对18例腹部脂肪堆积伴腹壁皮肤松弛的患者采用肿胀麻醉,负压吸引器行腹壁脂肪抽吸;做耻骨联合上W形切口,折叠缝合腹直肌前鞘,切除多余皮瓣后分层缝合腹壁。结果所有切口均Ⅰ期愈合,随访4~24个月,腹部平坦,切口瘢痕不明显,腹围平均缩小15 cm,外形满意。结论根据患者腹部皮肤、皮下脂肪、腹壁肌肉等多方面的情况,有针对性的采用脂肪抽吸与腹壁整形相结合的腹壁体形重塑术,能够获得满意的效果,手术方法安全可靠。     

Hernias de la incisión de asistencia tras resección colorrectal laparoscópica. Influencia de la localización de la incisión y del uso de una malla profiláctica

Objectives

To determine the incidence of incisional hernia (IH) in the extraction incision (EI) in colorectal resection for cancer. To analyze whether the location of the incision has any relationship with the incidence of hernias and whether mesh could be useful for prevention in high-risk patients.

不同手术方法治疗复杂胫骨平台骨折临床疗效观察

目的探讨不同手术方法治疗复杂胫骨平台骨折临床疗效。方法选择2016年1月—2018年12月84例复杂胫骨平台骨折患者,随机分组。单侧锁定钢板内固定组选择单侧锁定钢板内固定手术,双侧切口双侧解剖钢板内固定组选择双侧切口双侧解剖钢板内固定。分析手术操作时间、手术失血、平均住院天数以及复杂胫骨平台骨折愈合时间;治疗前后患者视觉模拟评分和Rasmussen膝关节功能评分;膝关节僵硬发生率。结果双侧切口双侧解剖钢板内固定组视觉模拟评分和Rasmussen膝关节功能评分、手术操作时间、手术失血、平均住院天数以及复杂胫骨平台骨折愈合时间、膝关节僵硬发生率和单侧锁定钢板内固定组比较有优势,P<0.05。结论复杂胫骨平台骨折患者实施双侧切口双侧解剖钢板内固定可获得较好效果。     

两例 SMILE 术中特殊情况更改 SBK 手术的疗效观察

目的：通过对同一患者双眼不同手术方式的自身对比，了解飞秒扫描后改SBK手术的疗效差异，为不同患者屈光手术方式的选择提供临床指导依据。方法回顾分析2例右眼行飞秒激光小切口透镜取出术（ SMILE），左眼SMILE术中负压环脱失和激光扫描不良透镜分离困难而改行机械刀制瓣准分子激光手术（ SBK）的患者，比较术后视力、等效球镜（ SE）、对比敏感度（ CSF）、波前像差（ HAOS）以及泪膜破裂时间（ BUT）、泪液分泌功能试验（ Schimer I）和SPEED、OSDI干眼症状问卷调查分析差异。结果（1）术后个月，均能达到最佳矫正视力（BSCVA），等效球镜均在±0．75 D以内，双眼比较无显著性差异。（2）CSF的比较，左右眼无显著性差异，略低于正常水平。（3）术后3个月，BUT和Schimer检查中，双眼无显著性差异。（4）HAOS比较中，总像差RMS和高阶像差这两项， SMILE眼低于SBK眼；球差（S）的比较，SMILE眼高于SBK眼。（5）SPEED和OSDI问卷评分双眼无显著差异。结论 SMILE失败眼改SBK后视觉质量与SMILE眼无显著差异，其视觉质量、疗效不受影响。