Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery

BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.

Intracameral lidocaine as supplement to classic topical anesthesia for relieving ocular pain in cataract surgery

AIM: To evaluate safety, efficacy, and patient adherence of intracameral lidocaine as supplement of classic topical anesthetic drops in cataract surgery.METHODS: A prospective and controlled trial including a large cohort of 1650 individuals suffering with bilateral cataract not complicated, in program by phacoemulsification surgery, were randomly assigned to 2 different groups for the type of anesthesia received, 0.4% oxybuprocaine hydrochloride(INN) drops, and INN drops associated to intracameral 1% lidocaine hydrochloride monohydrate. At the end of surgery, tables were assigned to each patient indicating the degree of pain(0-3) felt during the operation.RESULTS: Thirty-two percent of patients in group 1 declared to have not felt any pain against the 77% of patients in group 2. Fifty-nine percent of patients in group 1 complained about only a slight discomfort against 20% of group 2 patients. Only a small percentage of patients in group 1(5%) admitted severe pain, while no patient in group 2 admitted severe pain. Four patients of group 2 reported an episode of transient amaurosis, lasting several hours after surgery.CONCLUSION: Intracameral administration of lidocaine is a simple and secure method able to increase the analgesia during the cataract surgery, eliminating the discomfort and increasing also the cooperation of the patients during the steps of manipulation.

Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury

BACKGROUND: Rapid and effective pain relief in acute traumatic limb injuries(ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous(IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.METHODS: In this double-blind randomized clinical trial, 320 patients with ATLI, who presented to the emergency department(ED) from February 2016 to April 2016, were randomly divided into two groups. One group(160 patients) received 0.1 mg/kg IV morphine. The other group(160 patients) received 1 mcg/kg IV fentanyl. Patients' demographic data, pain score at specif ic intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.RESULTS: Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up(P value=0.00). However, at 10, 30, and 60-minute follow-ups no signifi cant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12(7.7%) patients in the fentanyl group and in 48(31.6%) patients in the morphine group(P value=0.00). No signifi cant difference was observed regarding side effects, vital signs and patients' satisfaction between the two groups.CONCLUSION: Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

Pain Management in Pediatric Nursing

Children often experience pain in different stage of life. After birth, newborns are exposed to many painful attempts and their anxiety levels increase with it. These painful attempts lead to metabolic or physiological problems in newborns. Excessive protein expenditure when exposed to pain for a long time, electrolyte inhalation, weakening of the immune system. Even repetitive painful procedures increase mortality and morbidity. Children experience pain due to acute onset diseases such as otitis media or pharyngitis and also in different medical interventions such vaccination, blood transfusion, vascular access, dressing change, lumber punching, or sickle cell anemia. Appropriate assessment scales should be used to treat pain effectively and adequately. Pharmacological treatment as well as non-pharmacological treatment methods has been found to be effective in the treatment of pain. Non-pharmacological methods allow your body to release natural endorphins and help to lift the pain to a minimum level or completely. In this study, current approaches and studies about pain in children will be presented. Non-pharmacological methods will be examined in more detail. Every child has right to live a painless life. It is one of the main purposes of nursing care to relieve children’s pain and improve their life quality.

MECHANISM OF ANALGESIC EFFECTS OF PROPOFOL ON INCISIONAL PAIN:A RAT MODEL STUDY

Objective To clarify the role of propofol in controlling incisional pain and its potential effects on the spinal opioid receptor expression. Methods A postoperative model of nociception was established in male Sprague-Dawley rats weighing 200 -250 g. A total of 96 rats were randomly divided into 8 groups. All drugs were administered intravenously either 5 rain pre-operation or 5 rain post-operation. The analgesic effects of systemic propofol were demonstrated by the measurement of a cumulative pain score （ CPS ）. After that, the lumbar enlargement of the spinal cord was removed to evaluate the mRNA level of the μ-opioid receptor （ MOR ） and δ-opioid receptor （ DOR） by RT-PCR. Results CPS and DOR mRNA expressions significantly increased after the operation. Both propofol post-treatment and propofol pre-treatment groups showed significant suppression of the increased CPS and the expression of DOR mRNA evoked by pain stimulation. Interestingly, propofol pre-treatment had a more pronounced effect in decreasing CPS and the expression of DOR mRNA. Furthermore, these observations were dose-dependent. MOR mRNA expression significantly increased after operation in all animals and propofol treatment had no impact on it. Conclusion Based on these findings, we suggest that propofol can serve as a valuable adjunct in acute postoperative pain management. Systemic propofol induces an analgesic effect on acute incisional pain in a dose-dependant manner, and this effect is mediated in the spinal cord and may be associated with the spinal DOR.

运动疗法激活臀肌改善青年男性膝前痛患者的下肢肌力

背景:目前发现膝前痛与下肢生物力学有关,但仍缺少臀肌训练对膝关节及下肢日常活动影响的研究。目的:探究臀肌激活运动疗法对青年男性膝前痛患者髋、膝关节肌群肌肉力量和疼痛的影响。方法:纳入25例男性青年膝前痛患者,随机分为2组,臀肌激活组12例和空白对照组13例。臀肌激活组进行40 min/次、3次/周、为期6周的臀肌激活运动;空白对照组不进行任何干预。入组和干预6周后评估患侧髋关节、膝关节在60(°)/s和180(°)/s下等速屈伸运动测试的相对峰力矩、总功、屈伸肌群比值、肌肉耐力值,爬楼运动测试中停止爬楼的楼层,以及目测类比评分。结果与结论:①等速屈伸运动测试:髋关节,干预后臀肌激活组在60(°)/s和180(°)/s的相对峰力矩较干预前显著提高29.74%和25.95%(P=0.022,P=0.024);空白对照组在180(°)/s时的肌耐力较干预前降低12.12%(P=0.000)。膝关节,干预后臀肌激活组在60(°)/s和180(°)/s的相对峰力矩较干预前显著提高18.69%和7.27%(P=0.006,P=0.033);空白对照组各指标干预前后无著性变化(P>0.05)。②爬楼运动测试:臀肌激活组爬楼运动停止时的楼层数较空白对照组高(6.41±6.1)层(P=0.024),干预后较干预前增高(P=0.016);空白对照组干预前后无显著改变(P>0.05)。③疼痛评估:干预后臀肌激活组目测类比评分显著低于空白对照组(P=0.036),干预后较干预前降低(P=0.000);空白对照组干预前后无显著性变化(P>0.05)。结果表明:6周臀肌激活运动疗法可改善下肢肌群的爆发力和耐力,减轻膝前痛程度,对于膝前痛患者有必要进行臀肌训练,以促进康复。

Intranasal ketamine for the treatment of patients with acute pain in the emergency department

BACKGROUND:Pain in the emergency department(ED)is common but undertreated.The objective of this study was to examine the efficacy and safety of intranasal(IN)ketamine used as an analgesic for patients with acute injury with moderate to severe pain.METHODS:This study was a cross sectional,observational study of patients more than 8 years old experiencing moderate to severe pain[visual analog score(VAS)>50 mm].The initial dose of IN ketamine was 0.7 mg/kg with an additional dose of 0.3 mg/kg if VAS was more than 50 mm after 15minutes.Pain scores and vital signs were recorded at 0,15,30 and 60 minutes.Side-effects,sedation level and patient's satisfaction were also recorded.The primary outcome was the number of patients achieving≥20 mm reductions in VAS at 15 minutes.Other secondary outcome measures were median reduction in VAS at 15,30 and 60 minutes,changes of vital signs,adverse events,satisfaction of patients,and need for additional ketamine.RESULTS:Thirty-four patients with a median age of 29.5 years(IQR 17.5–38)were enrolled,and they had an initial median VAS of 80 mm(IQR 67–90).The VAS decreased more than 20 mm at15 minutes in 27(80%)patients.The reduction of VAS from baseline to 40 mm(IQR 20–40),20 mm(IQR 14–20)and 20 mm(IQR 10–20)respectively at 15,30 and 60 minutes(P<0.001).No critical changes of vital signs were noted and adverse effects were mild and transient.CONCLUSION:This study showed that IN ketamine is an analgesic choice for patients with acute injury in moderate to severe pain in an overcrowded and resource limited ED.

肌内效贴对前交叉韧带重建后康复疗效的Meta分析

目的:一些研究显示肌内效贴在提升前交叉韧带重建后患者肌肉力量、改善关节稳定性、减轻疼痛及水肿方面具有积极效应,然而现有研究关于肌内效贴的临床疗效存在相互矛盾的结果。文章采用Meta分析方法,系统评价肌内效贴对前交叉韧带重建术后康复疗效的影响。方法:应用计算机检索PubMed、Web of Science、Embase、The Cochrane Library、EBSCO、中国知网、万方、维普数据库,搜集有关肌内效贴对前交叉韧带重建后患者影响的随机对照试验,检索时限均从各数据库建库至2022-12-06,结局指标包括股四头肌力量、腘绳肌力量、膝关节肿胀、膝关节活动度、Lysholm膝关节功能评分、目测类比评分6个连续型变量。运用EndNote X9.1筛选文献,采用Cochrane风险偏倚评估工具和Jadad量表评估纳入文献质量,采用RevMan 5.3软件进行Meta分析。结果:①共纳入6项随机对照试验,包括252例前交叉韧带重建后患者,其中对照组126例,肌内效贴组126例;②Meta分析结果显示,与对照组相比,肌内效贴组患者腘绳肌力量显著增加[SMD=0.68,95%CI(0.12,1.23),P=0.02]、目测类比评分显著降低[MD=-0.56,95%CI(-1.04,-0.08),P=0.02],两组患者间股四头肌力量、膝关节肿胀、膝关节活动度及Lysholm膝关节功能评分比较差异均无显著性意义(P>0.05)。结论:当前证据显示,肌内效贴可能有助于提升前交叉韧带重建后患者腘绳肌力量、减轻患者疼痛,然而并不能显著改善患者股四头肌力量、膝关节肿胀、膝关节活动度和功能评分。

A study on the effectiveness of intravenous tramadol in the management of severe traumatic pain in emergency department

Introduction:Patients with pain contribute to 60%-70% of emergency department(ED)attendance and the tramadol is among analgesic of choice in ED.However,the use of intravenous tramadol is limited to moderate pain intensity because of its weak opiod agonist properties.We conducted a study to examine the effectiveness of intravenous tramadol among patients who suffer from severe traumatic pain.Methodology:In this prospective study,eligible patients received a loading dose of intravenous tramadol(2mg/kg).If visual analogue score(VAS)more than 30 mm after the loading dose,intermittent bolus intravenous tramadol 20mg will be administered every 10 minutes.At 30 minutes of study,rescue medication(i.e.morphine or pethidine)will be provided to those patients with VAS more than 30 mm.VAS score,vital signs and side effects were recorded for every 10 minutesResults:Forty-seven patients who suffered from fracture and soft tissue injury were analysed.The median VAS score on presentation and at 30 minutes was 90 mm 20 mm respectively.The median total dose of IV tramadol received by the patients at 30 minutes was 150 mg(IQR=34.0).There was a significant change in medium pain score at 10,20 and 30 minutes treatment(P<0.001).Vital signs were within normal range throughout the study period.About 66.1% of them had side effects of tramadol.The common side effects were sleepiness(75.0%)and dizziness(56.3%).Conclusion:The intravenous tramadol is a safe and effective analgesia in severe traumatic patients if an initial and intermittent dose is given adequately.

加速康复外科在低温等离子下扁桃体切除患者中的护理效果

目的探究加速康复外科在低温等离子下扁桃体切除患者中的护理效果。方法选取2021年1—12月于丰城市人民医院行低温等离子下扁桃体切除术的40例患者作为研究对象,以入院日期单双号为标准分为对照组与观察组,每组20例。对照组采用常规护理,观察组采用加速康复外科护理,比较两组术期相关指标、疼痛程度、临床症状消失时间、手术相关并发症。结果观察组术后正常进食时间、白膜形成时间、白膜脱落时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术后1、3、5、7d,观察组视觉模拟评分法(visual analogue scale,VAS)评分均低于对照组,差异有统计学意义(P<0.05)。观察组术后睡眠呼吸粗重、鼻翼煽动、流鼻涕、鼻塞症状消失时间均短于对照组,差异有统计学意义(P<0.05)。观察组手术相关并发症发生率为5.00%,低于对照组的30.00%,差异有统计学意义(P<0.05)。结论加速康复外科理念对低温等离子下扁桃体切除护理效果显著,能减轻患者术后疼痛,提高术后舒适度,缩短住院时间,值得临床推广应用。

颈项功治疗颈型颈椎病60例的疗效观察

目的:通过对颈型颈椎病患者进行锻炼干预,比较颈项功和常规米字操治疗颈型颈椎病的临床疗效及对颈痛、压痛阈(Pressure Pain Threshold,PPT)的影响。方法:选择2020年11―12月浙江中医药大学纳入的60例颈型颈椎病患者,应用随机数字表法将60例颈型颈椎病患者分为功法组和常规米字操组,每组各30例。功法组患者采用功法“仙鹤点水”锻炼,常规米字操组患者采用常规米字操锻炼,两组患者每天早晚各锻炼1次,以锻炼4周为一个疗程。锻炼前对两组患者进行压痛点筛查,结果得到两组患者压痛点多在肩井穴和C3夹脊穴,并以此作为PPT值的采集点。观察各组患者在锻炼前后的视觉模拟评分法(Visual Analogue Scale,VAS)评分、Northwick Park颈痛量表(Northwick Park Neck-pain Questionnaire,NPQ)评分及肩井穴和C3夹脊穴的PPT值,并综合评定各组的临床疗效。结果:锻炼4周后两组患者的VAS评分和NPQ评分均较锻炼前降低(P<0.05),两组患者肩井穴的PPT值均较锻炼前升高(P <0.05),功法组C3夹脊穴的PPT值较锻炼前升高(P <0.05),常规米字操组C3夹脊穴的PPT值与锻炼前差异无统计学意义(P> 0.05)。功法组的总有效率为86.67%(26/30),优于常规米字操组的63.33%(19/30)(P <0.05)。结论:功法和常规米字操均能改善颈型颈椎病患者的颈部疼痛和压痛,但功法的疗效更加显著。

身痛逐瘀汤降低急性骨骼肌损伤疼痛的疗效及对血清炎性因子的影响分析

目的 探讨身痛逐瘀汤对急性骨骼肌损伤的疗效及作用机理。方法 选取2023年1月~2023年7月在解放军总医院就诊的82名急性骨骼肌损伤患者,随机数表法分为中药组和西药组,各41例。中药组给予身痛逐瘀汤治疗,西药组给与双氯芬酸钠双释放肠溶胶囊治疗。观察两组患者受损骨骼肌疼痛评分及血清炎症因子变化。结果 治疗7 d后,中药组患者的疼痛评分低于西药组[(0.61±0.80)分vs.(1.46±1.43)分],差异有统计学意义(t=-3.327,P<0.05);中药组患者的TNF-α、IL-6、CRP、IL-8低于西药组[(4.82±2.24)pg/ml vs.(9.10±3.47)pg/ml、(2.09±1.52)pg/ml vs.(3.24±2.11)pg/ml、(0.34±0.20)mg/dl vs.(0.49±0.26)mg/dl、(26.13±13.23)pg/ml vs.(36.72±16.68)pg/ml],差异均有统计学意义(t=-6.650、-2.846、-3.125、-3.184,P<0.05)。结论 身痛逐瘀汤治疗急性骨骼肌损伤可以明显减轻疼痛程度,抑制炎性因子的释放是其部分作用机制,值得在临床应用。

膝关节骨性关节炎致内侧疼痛患者的腓骨截骨治疗效果及对生活质量、关节功能、疼痛评分的影响

目的探讨膝关节骨性关节炎致内侧疼痛患者的腓骨截骨治疗效果及对生活质量、关节功能、疼痛评分的影响。方法选择2022年3月—2023年6月本院收治的54例膝关节骨性关节炎致内侧疼痛患者,随机分为对照组(n=27)和观察组(n=27),对照组采用关节镜下膝关节清理术治疗,观察组采用腓骨截骨术联合关节镜下膝关节清理术治疗。对比两组生活质量、关节功能、疼痛评分。结果观察组生活质量评分方面显著高于对照组,组间差异有统计学意义(P<0.05);观察组VAS评分显著低于对照组,组间差异有统计学意义(P<0.05);观察组HSS评分显著高于对照组,组间差异有统计学意义(P<0.05)。结论膝关节骨性关节炎致内侧疼痛患者在常规关节镜下膝关节清理术治疗的基础上给予腓骨截骨治疗,有利于减轻疼痛感,改善关节功能状况,提升生活质量,临床应用价值较高。

超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用

目的 探讨超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用效果。方法 选择2022年1月至2023年6月在寿光市人民医院实施全身麻醉气管插管下腹腔镜全子宫切除术的80例患者,按照随机数字表法分为两组,各40例。对照组采取气管插管全身麻醉,观察组在对照组基础上于全身麻醉诱导前实施超声引导腰方肌阻滞术。比较两组术后12h疼痛评分及血清P物质水平、并发症发生情况、镇痛泵按压次数、单次追加镇痛药物次数。结果 观察组术后12h疼痛评分、血清P物质水平低于对照组(P<0.05);观察组麻醉复苏阶段并发症总发生率低于对照组(P<0.05);观察组镇痛泵按压次数及单次追加镇痛药物次数少于对照组(P <0.05)。结论 超声引导腰方肌阻滞技术在腹腔镜全子宫切除术中的应用效果较好,能够减轻术后疼痛,降低并发症发生率,减少镇痛泵按压次数及单次追加镇痛药物次数。

酒石酸布托啡诺复合罗哌卡因用于剖宫产术后镇痛的效果

目的探讨酒石酸布托啡诺复合罗哌卡因用于剖宫产术后镇痛的效果。方法选取2021年4月至2022年6月滨州市中心医院收治的80例剖宫产产妇为研究对象,采用奇偶数法分为对照组和观察组,每组40例。对照组采用罗哌卡因术后镇痛,观察组采用酒石酸布托啡诺复合罗哌卡因术后镇痛,比较两组镇痛效果。结果观察组术后2、8、12、24 h疼痛评分低于对照组(P<0.05);观察组术后24 h内自控镇痛次数少于对照组,术毕至首次自控镇痛时间长于对照组(P<0.05);两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论酒石酸布托啡诺复合罗哌卡因用于剖宫产术后镇痛的效果显著,值得推广。

中医穴位按摩联合自由体位对初产妇阴道分娩产程时间及产后出血量的影响

目的:探讨中医穴位按摩联合自由体位对初产妇阴道分娩产程时间及产后出血量的影响。方法:选取2021年6月-2023年6月于本院分娩的初产妇120例,随机分组,其中采用常规分娩模式产妇为常规组,采用中医穴位按摩联合自由体位分娩产妇为联合组,比较两组产程时间及产后出血量。结果:联合组阴道分娩率(91.7%)高于常规组(75.0%),第1产程(356.4±69.0 min)、第2产程(34.5±10.8 min)、第3产程(6.1±1.1 min)时间均短于常规组(442.2±82.6 min、46.1±14.5 min、9.6±1.5 min),分娩时疼痛等级≤2级占比(90.0%)高于常规组(68.3%),分娩控制感评分(178.41±19.68分)高于常规组(121.88±16.54分),产后出血量(208.4±30.0 ml)及分娩时并发症(11.7%)发生率低于常规组(292.5±37.3ml、31.7%)(均P<0.05)。结论:应用中医穴位按摩联合自由体位能够减少初产妇剖宫产率,缩短产程,减轻分娩疼痛,减少产后出血量,降低分娩并发症发生。

经皮穿刺腹膜透析置管术在肥胖终末期肾病患者中的临床应用观察

目的:探究经皮穿刺腹膜透析置管术在肥胖终末期肾病患者中的应用效果。方法:采用随机数字表法将我院2021年1月—2022年12月收治的60例肥胖终末期肾病患者分为两组,各30例。经皮组采用经皮穿刺腹膜透析置管术,手术组于直视下采用传统开放手术切开置管。对比两组手术情况、近期及远期并发症。结果:经皮组置管时间及住院时间均短于手术组,手术切口长度短于手术组,有统计学差异(P<0.05)。两组近期并发症发生率比较,无统计学差异(P>0.05)。两组远期并发症发生率、导管生存率对比,无统计学差异(P>0.05)。结论:经皮穿刺腹膜透析置管术在肥胖终末期肾病患者应用中借助超声定位,可有效缩短手术时间,减少手术对患者造成的创伤,无明显并发症,安全可靠,对确保患者顺利透析提供有效置管方法,值得推广应用。

Prince-Henry联合长海痛尺在肋骨骨折疼痛评分中的初步应用

目的探讨Prince-Henry联合长海痛尺评分法:动静评分法(motional and restrictive rating scale,MAR)在评估肋骨骨折疼痛中的应用。方法回顾性分析上海市浦东新区人民医院胸外科2018年5月—2022年9月收治的肋骨骨折患者,其中手术组234例,非手术组558例,分别应用长海痛尺及本研究自行设计的动静评分法,收集两组患者伤后1-7 d的疼痛评分。结果非手术组:在评分方面,两种评分方法1-7 d总体均呈下降趋势,但长海痛尺评分第3天出现反弹。手术组:长海痛尺评分第4天开始下降,MAR评分第3天开始出现下降。两组比较:长海痛尺评分第1-3天手术组高于非手术组(P<0.05),第4-7天,手术组低于非手术组(P<0.05);MAR评分第1、2、7天,手术组评分高于非手术组(P<0.05);第3、4、5、6天,手术组低于非手术组(P<0.05)。疼痛评分改善方面,长海痛尺评分,第3-7天,手术组改善程度高于非手术组(P<0.05);MAR评分,第3-6天,手术组改善程度高于非手术组(P<0.05)。结论长海痛尺疼痛评分和MAR疼痛评分具有较好的一致性,MAR评分能更早识别活动性疼痛。

婴儿经右腋下小切口治疗先天性心脏病的疗效分析

目的探讨经右腋下小切口建立体外循环在婴儿心内直视手术中应用的效果。方法回顾性分析2018年6月—2022年2月在新疆医科大学第一附属医院小儿心胸外科接受心脏手术的185例先天性心脏病(CHD)患儿(3~12个月),其中房间隔缺损98例,室间隔缺损87例。将两组患儿按照手术方法不同分为胸骨正中切口组(A组)与右侧腋下小切口组(B组)。比较A、B组房间隔缺损与室间隔缺损患儿手术时间、体外循环时间、主动脉阻断时间、术后住院时间、ICU滞留时间、呼吸机插管时间、术后24 h胸腔引流量、FLACC评分、患儿家属切口满意度及并发症发生情况。结果房间隔缺损患儿A、B组手术时间、体外循环时间、主动脉阻断时间比较,差异均无统计学意义(P>0.05)。房间隔缺损患儿B组住院时间、ICU滞留时间、呼吸机插管时间短于A组(P<0.05),术后24 h胸腔引流量少于A组(P<0.05)。房间隔缺损患儿不同时间点的FLACC评分有差异(P<0.05);两组的FLACC评分有差异(P<0.05),B组低于A组;两组FLACC评分的变化趋势有差异(P<0.05)。房间隔缺损患儿家属满意度评分B组高于A组(P<0.05)。房间隔缺损患儿术后均未出现相关并发症。室间隔缺损患儿A、B两组手术时间、体外循环时间、主动脉阻断时间比较,差异均无统计学意义(P>0.05)。室间隔缺损患儿B组住院时间、ICU滞留时间、呼吸机插管时间均短于A组(P<0.05),术后24 h胸腔引流量少于A组(P<0.05)。室间隔缺损患儿不同时间点的FLACC评分有差异(P<0.05);两组的FLACC评分有差异(P<0.05),B组低于A组;两组FLACC评分的变化趋势无差异(P>0.05)。室间隔缺损患儿家属B组切口满意度评分高于A组(P<0.05)。室间隔缺损患儿A组有2例出现胸廓畸形,1例切口感染;B组出现1例术后肺不张。结论在婴儿群体中经右腋下小切口治疗CHD,切口隐蔽、美观,对患儿的身体及心理创伤小,住院时间缩短,术后呼吸机插管时间缩短、胸腔引流量减少,能有效减轻疼痛,更容易被患儿及其家属接受,临床疗效优于正中开胸。