AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After s...AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After systematic review of the literature,33 articles were selected to compare the efficiency of the three procedures.Criteria such as cost,infections,capacity of reconstruction of the abdominal wall,diseases associated with the technique,among others were analyzed.RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost,what is not observed in the VAC procedure.The VAC technique is the most efficient,not only because it reduces the tension on the boarders of the lesion,but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division.Bogota bag presents the higher rates of skin laceration and evisceration,greater need for a stent for draining fluids and wash-ups,higher rates of intestinal adhesion to the abdominal wall.The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing.The VAC dressing can generate irritation and dermatitis when the drape is applied,in addition to pain,infection and bleeding,as well as toxic shock syndrome,anaerobic sepsis and thrombosis.CONCLUSION The VAC technique,showed to be superior allowing a better control of liquid on the third space,avoiding complications such as fistula with small mortality,low infection rate,and easier capability on primary closure of the abdominal cavity.展开更多
Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complicatio...Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.展开更多
目的:观察连续髂筋膜间隙阻滞镇痛在老年髋部骨折手术患者中的应用效果。方法:选取2021年1月至2022年12月叶县人民医院收治的102例老年髋部骨折手术患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各51例。对照组采用静脉...目的:观察连续髂筋膜间隙阻滞镇痛在老年髋部骨折手术患者中的应用效果。方法:选取2021年1月至2022年12月叶县人民医院收治的102例老年髋部骨折手术患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各51例。对照组采用静脉自控镇痛,观察组采用连续髂筋膜间隙阻滞镇痛。比较两组术后不同时间(术后12、24、48 h)疼痛[视觉模拟评分法(VAS)]评分,手术前后疼痛介质[前列腺素E_(2)(PGE_(2))、神经生长因子(NGF)]水平、应激指标[内皮素-1(ET-1)、肾上腺素(E)、去甲肾上腺素(NE)]水平,以及不良反应发生率。结果:观察组术后12、24、48 h VAS评分均低于对照组,差异有统计学意义(P<0.05);术后24 h,观察组PGE_(2)、NGF、ET-1、E、NE水平均低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为5.88%(3/51),低于对照组的19.61%(10/51),差异有统计学意义(P<0.05)。结论:连续髂筋膜间隙阻滞镇痛应用于老年髋部骨折手术患者可降低疼痛评分、疼痛介质水平、应激指标水平和不良反应发生率,效果优于静脉自控镇痛。展开更多
文摘AIM To compare the 3 main techniques of temporary closure of the abdominal cavity,vacuum assisted closure(vacuum-assisted closure therapy- VAC),Bogota bag and Barker technique,in damage control surgery.METHODS After systematic review of the literature,33 articles were selected to compare the efficiency of the three procedures.Criteria such as cost,infections,capacity of reconstruction of the abdominal wall,diseases associated with the technique,among others were analyzed.RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost,what is not observed in the VAC procedure.The VAC technique is the most efficient,not only because it reduces the tension on the boarders of the lesion,but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division.Bogota bag presents the higher rates of skin laceration and evisceration,greater need for a stent for draining fluids and wash-ups,higher rates of intestinal adhesion to the abdominal wall.The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing.The VAC dressing can generate irritation and dermatitis when the drape is applied,in addition to pain,infection and bleeding,as well as toxic shock syndrome,anaerobic sepsis and thrombosis.CONCLUSION The VAC technique,showed to be superior allowing a better control of liquid on the third space,avoiding complications such as fistula with small mortality,low infection rate,and easier capability on primary closure of the abdominal cavity.
文摘Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.
文摘目的:观察连续髂筋膜间隙阻滞镇痛在老年髋部骨折手术患者中的应用效果。方法:选取2021年1月至2022年12月叶县人民医院收治的102例老年髋部骨折手术患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各51例。对照组采用静脉自控镇痛,观察组采用连续髂筋膜间隙阻滞镇痛。比较两组术后不同时间(术后12、24、48 h)疼痛[视觉模拟评分法(VAS)]评分,手术前后疼痛介质[前列腺素E_(2)(PGE_(2))、神经生长因子(NGF)]水平、应激指标[内皮素-1(ET-1)、肾上腺素(E)、去甲肾上腺素(NE)]水平,以及不良反应发生率。结果:观察组术后12、24、48 h VAS评分均低于对照组,差异有统计学意义(P<0.05);术后24 h,观察组PGE_(2)、NGF、ET-1、E、NE水平均低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为5.88%(3/51),低于对照组的19.61%(10/51),差异有统计学意义(P<0.05)。结论:连续髂筋膜间隙阻滞镇痛应用于老年髋部骨折手术患者可降低疼痛评分、疼痛介质水平、应激指标水平和不良反应发生率,效果优于静脉自控镇痛。
