Clinical efficacy of endovascular revascularization combined with vacuum-assisted closure for the treatment of diabetic foot

BACKGROUND The diabetic foot is a common cause of disability and death,and comorbid foot infections usually lead to prolonged hospitalization,high healthcare costs,and a significant increase in amputation rates.And most diabetic foot trauma is complicated by lower extremity arteriopathy,which becomes an independent risk factor for major amputation in diabetic foot patients.AIM To establish the efficacy and safety of endovascular revascularization(ER)combined with vacuum-assisted closure(VAC)for the treatment of diabetic foot.METHODS Clinical data were collected from 40 patients with diabetic foot admitted to the Second Affiliated Hospital of Soochow University from April 2018 to April 2022.Diabetic foot lesions were graded according to Wagner’s classification,and blood flow to the lower extremity was evaluated using the ankle-brachial index test and computerized tomography angiography of the lower extremity arteries.Continuous subcutaneous insulin infusion pumps were used to achieve glycemic control.Lower limb revascularization was facilitated by percutaneous transluminal balloon angioplasty(BA)or stenting.Wounds were cleaned by nibbling debridement.Wound granulation tissue growth was induced by VAC,and wound repair was performed by skin grafting or skin flap transplantation.RESULTS Of the 35 cases treated with lower limb revascularization,34 were successful with a revascularization success rate of 97%.Of these,6 cases underwent stenting after BA of the superficial femoral artery,and 1 received popliteal artery stent implantation.In the 25 cases treated with infrapopliteal artery revascularization,39 arteries were reconstructed,7 of which were treated by drug-coated BA and the remaining 32 with plain old BA.VAC was performed in 32 wounds.Twenty-four cases of skin grafting and 2 cases of skin flap transplantation were performed.Two patients underwent major amputations,whereas 17 had minor amputations,accounting for a success limb salvage rate of 95%.CONCLUSION ER in combination with VAC is a safe and effective treatment for diabetic foot that can significantly improve limb salvage rates.The use of VAC after ER simplifies and facilitates wound repair.

Successful treatment of cervical esophageal leakage by endoscopic-vacuum assisted closure therapy

AIM: To evaluate the efficacy and safety of endoscopic-vacuum assisted closure (E-VAC) therapy in the treatment of cervical esophageal leakage. METHODS: Between May and November 2012, three male patients who developed post-operative cervical esophageal leakage were treated with E-VAC therapy. One patient had undergone surgical excision of a pharyngo-cervical liposarcoma with partial esophageal resection, and the other two patients had received surgical treatment for symptomatic Zenker's diverticulum. Following endoscopic verification of the leakage, a trimmed polyurethane sponge was fixed to the distal end of a nasogastric silicone tube and endoscopically positioned into the wound cavity, and with decreasing cavity size the sponge was positioned intraluminally to cover the leak. Continuous suction was applied, and the vacuum drainage system was changed twice a week.RESULTS: The initial E-VAC placement was technically successful for all three patients, and complete closure of the esophageal leak was achieved without any procedure-related complications. In all three patients, the insufficiencies were located either above or slightly below the upper esophageal sphincter. The median duration of the E-VAC drainage was 29 d (range: 19-49 d), with a median of seven sponge exchanges (range: 5-12 sponge exchanges). In addition, the E-VAC therapy reduced inflammatory markers to within normal range for all three patients. Two of the patients were immediately fitted with a percutaneous enteral gastric feeding tube with jejunal extension, and the third patient received parenteral feeding. All three patients showed normal swallow function and no evidence of stricture after completion of the E-VAC therapy. CONCLUSION: E-VAC therapy for cervical esophageal leakage was well tolerated by patients. This safe and effective procedure may significantly reduce morbidity and mortality following cervical esophageal leakage.

Percutaneous Patent Foramen Ovale Closure versus Medical Therapy in Cryptogenic Stroke: An Update Meta-Analysis of Randomized Controlled Trials

Objectives: Concerns regarding the real efficacy of transcatheter patent foramen ovale (PFO) closure versus medical therapy in patients with cryptogenic stroke remained unresolved. We performed a meta-analysis using the randomized controlled trials on the efficacy and safety of transcatheter PFO closure in patients with cryptogenic stroke. Methods: Web of Science, EMBASE, PubMed, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs). The primary outcome was recurrent stroke and transient-ischemic attack (TIA). Original data, hazard ratio (HR) with 95% confidence interval (95% CI) were abstracted to calculate a pooled effect size. Results: Our meta-analysis showed benefit with device closure when compared with medical therapy with an HR of 0.54 (95% CI: 0.39 - 0.74, P = 0.108) in the intention-to-treat cohort, 0.44 (95% CI: 0.24 - 0.82, P = 0.103) in the per-protocol populations, and 0.43 (95% CI: 0.31 - 0.60, P = 0.019) in the as-treated populations. There was a significantly higher incidence of new-onset atrial fibrillation in PFO closure patients (OR = 4.53, 95% CI: 2.58 - 7.97, P = 0.094). PFO Patients with an atrial septal aneurysm benefit from device closure (OR = 0.39, 95% CI: 0.22 - 0.69, P = 0.053). Patients with a substantial PFO shunt benefit the greatest with device closure with a pooled OR of 0.27 (95% CI: 0.14 - 0.56, P = 0.525). Conclusions: The meta-analysis concluded that PFO closure was associated with significantly lower risk of recurrent stroke in PFO patients with cryptogenic stroke than with medical therapy alone. The benefit of PFO closure was greater in patients with a substantial shunt and atrial septal aneurysm. PFO closure was associated with higher rates of new-onset atrial fibrillation.

The study of the safety and efficacy of different antithrombotic therapy after left atrial appendage closure

Background It’s essential to prevent from thrombosis on device without increasing the risk of bleeding complications after successfully implanted left atrial appendage device.At present,no guidelines recommend about postoperative antithrombotic therapy of left atrial appendage closure(LAAC).The purpose of this study is to investigate the safety and efficacy of different antithrombotic therapies after LAAC.

Endoscopic vacuum assisted closure of esophagogastric anastomosis dehiscence:A case report

BACKGROUND Esophagogastric leakage is one of the most severe postoperative complications.Partial disruption of the anastomosis,can be successfully treated with an endoscopic vacuum assisted closure(E-VAC).The advantage of that method of treatment is the ability to adjust a vacuum dressing individually to the size of the dehiscence and thus to reduce the risk of a secondary fistula or abscess.The authors present two patients with postoperative gastroesophageal leakage treated successfully with E-VAC.CASE SUMMARY Two male patients developed a potentially life threatening esophagogastric leakage.Patient A underwent resection of the distal half of the esophagus and upper part of the stomach due to Siewert type II adenocarcinoma of the gastroesophageal junction.Proximal resection of the stomach was performed in the patient B after massive bleeding from Mallory-Weiss tears.Both patients were treated successfully with an individually adapted E-VAC with concomitant correction of fluid and electrolyte disturbances,and treatment of sepsis with appropriate antibiotics.CONCLUSION Endoscopic vacuum closure is an effective alternative to endoscopic stenting or relaparotomy.Through individual approach it allows a more accurate assessment of healing.

Treating Tropical Pyomyositis (Myositis Tropicans) Using Primary Closure and Vacuum Drainage

Introduction: Tropical pyomyositis refers to bacterial infection that affects skeletal muscles causing single or multiple abscesses filled with pus. Aim: The study seeks to find out the effectiveness in the use of primary closure and vacuum drainage in the treatment of pyomyositis. Materials and Methods: The study was conducted between March 1, 2007 and February 28, 2014 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana on patients with pyomyositis. Results: Seventy-seven patients comprising 58 (75.32%) males and 19 (24.68%) females were included in the study with their ages ranging from 15 to 68 years. There was improvement in patient’s healing outcome. Conclusion: Primary wound closure and vacuum drainage provides patients with much satisfaction and better outcome as well and it is also effective.

Effectiveness of negative pressure wound therapy in complex surgical treatment of necrotizing fasciitis of the upper limb

BACKGROUND Necrotizing fasciitis(NF)of the upper extremities is a severe surgical pathology,and the incidence of this disease has been steadily increasing in recent decades.Surgical treatment is accompanied by the formation of extensive wounds,which can be treated with significant difficulties.In recent years,negative pressure wound therapy(NPWT)has proven to be highly effective.It is also promising for the treatment of NF.AIM To explore the effectiveness of NPWT in the treatment of NF of the upper extremities.METHODS The results of the treatment of 36 patients with NF of the upper extremities in two groups(NPWT group and control group;2022−2023)were retrospectively analyzed.In the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical treatment.The number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound process.The duration of fixation of one bandage was up to 2−3 d.In the control group,conventional methods of local wound treatment were used.The following indicators were analyzed:The treatment delay,the prevalence of inflammation,the microbial landscape,the number of debridements,the duration of wound preparation for surgical closure,and the nature of skin plastic surgery.RESULTS Most patients experienced a significant treatment delay[4 d,interquartile range(IQR):2–7 d],which led to the spread of the pathological process to the forearm and shoulder.The most common pathogens were Staphylococcus aureus(14;38.9%)and Streptococcus pyogenes(22;61.1%).The average number of debridements per patient was 5(IQR:3–7),with no difference between groups.The average time to prepare wounds for surgical closure was 11±4 d in the NPWT group and 29±10 d(P=0.00001)in the control group.In the NPWT group,the wounds were more often closed with local tissues(15;83.3%),and in the control group,split-thickness skin grafts were more often used(4;50%).CONCLUSION The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II.Multiple debridement procedures have become a feature of this disease treatment.The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure.Early closure of wounds allows for more frequent use of local tissue repair,which ensures better results.NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF.

Role of negative pressure wound therapy in total hip and knee arthroplasty

Negative-pressure wound therapy(NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trialsincluding single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections.

Evidence based review of negative pressure wound therapy

Vacuum-assisted closure, sometimes referred to as microdeformational wound therapy or most commonly negative pressure wound therapy(NPWT), has significantly improved wound care over the past two decades. NPWT is known to affect wound healing through four primary mechanisms(macrodeformation, microdeformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms(including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) which are described in this review. In addition, the technique has many established uses, for example in wound healing of diabetic and pressure ulcers, as well as burn and blast wounds. This therapy also has many uses whose efficacy has yet to be confirmed, for example the use in digestive surgery. Modifications of the traditional NPWT have also been established and are described in detail. This therapy has various considerations and contraindications which are summarized in this review. Finally, future perspectives, such as the optimal cycling of the treatment and the most appropriate interface material, are touched upon in the final segment. Overall, despite the fact that questions remain to be answered about NPWT, this technology is a major breakthrough in wound healing with significant potential use both in the hospital but also in the community.

Negative Pressure Wound Therapy—An Effective, Minimally Invasive Therapeutic Modality in Burn Wound Management

Despite the advancement in burn therapy in the last decades the treatment of burn wounds still remains a challenging task. Infection is still a common complication;while sepsis remains the leading cause of death in severe burns. The research guided integration of new and effective techniques in burn wound management is mandatory. Negative pressure wound therapy (NPWT) is an effective and widely used technique in the management of problematic wounds. Previously existing indications include soft tissue traumas and chronic wounds such as diabetic, arterial, venous and pressure ulcers. The characteristics and challenges of these wounds have a lot in common with burns. Since the early 2000’s there are experiences with the use of NPWT for the healing of second degree burn wounds. Our clinical experience shows that it is a minimally invasive and effective way of improving burn wound management. In this article we give a review of the literature showing the mechanisms, unmapped future opportunities, financial issues, and possible adverse effects of NPWT in burn therapy.

Tumor Recurrence after Negative Pressure Wound Therapy: An Alert Call

In this report, we present a 22-year-old patient with soft tissue sarcoma of the lower extremity that developed wound dehiscence after surgery. Biopsy demonstrated negative margins for cancer. He was treated with negative pressure wound therapy for 6 weeks and started to present increased wound exudates, local pain and proliferating tissue that was positive for tumor recurrence. Consequently he underwent lower extremity amputation with hip disarticulation by the orthopedic team. Although we cannot determine with certainty a full causative relationship, it seems prudent to advise cautious use of negative pressure wound therapy in oncologic related wound beds.

How to preserve the native or reconstructed esophagus after perforations or postoperative leaks: A multidisciplinary 15-year experience

BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition.The optimal management strategy is still unclear.AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks.METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023.Clinical outcomes were analyzed,and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus,when feasible.RESULTS Among the whole series of 60 patients,an urgent surgery was required in 8 cases due to a septic state.Fifty-six patients were managed by endoscopic or hybrid treatments,obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus.The mean time to resolution was 54.95±52.64 days,with a median of 35.5 days.No severe complications were recorded.Ten patients out of 56(17.9%)developed pneumonia that was treated by specific antibiotic therapy,and in 6 cases(10.7%)an atrial fibrillation was recorded.Seven patients(12.5%)developed a stricture within 12 months,requiring one or two endoscopic pneumatic dilations to solve the problem.Mortality was 1.7%.CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.

ExoSeal血管封堵器在急性缺血性脑卒中桥接治疗中的安全性和有效性

目的 探讨ExoSeal血管封堵器在接受桥接治疗的急性缺血性脑卒中(AIS)患者中的安全性和有效性。方法 回顾性分析2018年6月至2020年12月在潍坊市人民医院接受全量重组组织型纤溶酶原激活剂(rt-PA)溶栓后桥接血管腔内机械取栓治疗的142例AIS患者临床资料。所有患者在血管腔内机械取栓手术时均使用8 F股动脉鞘,术毕股动脉穿刺点由指压法封堵68例,7 F ExoSeal封堵器封堵74例。比较指压法组和封堵器组股动脉穿刺点封堵成功率及穿刺点相关并发症发生率。结果 封堵器组与指压法组相比,手术成功率显著增高(94.6%比83.8%,P=0.037)。指压法组、封堵器组患者术后至出院前分别有11例(16.2%)、4例(5.4%)发生穿刺点相关并发症(P=0.030),6例(8.8%)、2例(2.7%)发生深静脉血栓(P=0.109),均未发生动静脉瘘、假性动脉瘤、同侧下肢急性缺血、穿刺点相关大出血及需要血管外科手术或介入治疗的并发症。结论 ExoSeal封堵器可安全地应用于溶栓后桥接血管腔内机械取栓治疗的AIS患者,股动脉穿刺点封堵成功率较高,且降低穿刺点血肿发生率。

单纯输送鞘法经胸超声引导封堵卵圆孔未闭的临床疗效

目的探讨单纯输送鞘法行经胸超声引导下经皮卵圆孔封堵手术的临床治疗效果。方法回顾性分析2020年1月至2022年12月于我院行介入封堵手术或单纯输送鞘法经胸超声引导经皮卵圆孔封堵手术的卵圆孔未闭患者临床资料,分别设为介入封堵组(40例)和单纯输送鞘组(39例)。比较2组患者的手术时间、手术并发症发生率及手术成功率;术后超声评价封堵效果;术后随访6个月,评估患者临床症状缓解情况。结果单纯输送鞘组手术成功率(100%)高于介入封堵组(90.0%),差异有统计学意义(P<0.05)。单纯输送鞘组手术时间长于介入封堵组,差异有统计学意义(P<0.05)。介入封堵组1例患者术中出现少量心包积液;单纯输送鞘组2例患者术中出现血压降低、心率减慢,对症处理后症状消失。2组并发症发生率比较,差异无统计学意义(P>0.05)。术后6个月随访,封堵伞位置良好,无残余漏;介入封堵组28例患者头痛、头晕症状消失,8例患者症状明显缓解;单纯输送鞘组30例患者头痛、头晕症状消失,9例患者症状明显缓解。结论单纯输送鞘法经胸超声引导经皮卵圆孔封堵手术安全可行,疗效满意,手术成功率高,无辐射危害,值得临床推广。

噻吗洛尔滴眼液在急性房角关闭危象序贯治疗中的疗效

目的观察噻吗洛尔滴眼液在急性房角关闭危象序贯治疗中的疗效。方法前瞻性随机双盲病例对照研究。连续纳入2021年4月至2023年10月河北大学附属医院诊断为急性房角关闭危象(acute angle-closure crisis,AACC)的患者,收集其病例资料并以随机数字表法分为应用噻吗洛尔组(A组)与安慰剂组(B组)。所有患者序贯应用药物治疗、前房穿刺、激光周边虹膜成形术,以治疗后2 h、4 h、6 h为治疗节点,记录并统计在各个节点2组患者的眼压下降值、AACC得到控制的眼数及所需时间。结果在序贯治疗后2 h、4 h、6 h的3个节点,A组的眼压下降值分别为(13.87±13.85)mmHg(1 mmHg=0.133 kPa)、(28.42±12.87)mmHg、(35.69±8.51)mmHg,AACC得到控制的眼数分别为23眼(29.87%)、51眼(66.23%)、71眼(92.20%);B组的眼压下降值分别为(15.88±14.95)mmHg、(28.17±13.63)mmHg、(33.90±13.59)mmHg,AACC得到控制的眼数分别为30眼(36.59%)、58眼(70.73%)、75眼(91.46%);治疗有效的患者中,AACC控制的时间A组为(3.29±1.31)h,B组为(3.38±1.34)h。2组患者在序贯治疗各个节点的眼压下降值、AACC缓解的眼数及病情缓解所需时间差异均无统计学意义(P>0.05)。结论在AACC的序贯治疗过程中,噻吗洛尔滴眼液对于提高治疗成功率无明显帮助。

肌痛型颞下颌关节紊乱病封闭治疗的疗效观察

目的:观察封闭治疗对不同部位、不同亚类肌痛型颞下颌关节紊乱病(temporomandibular disorder,TMD)的临床疗效。方法:回顾性研究肌痛型TMD患者53例,给予利多卡因、维生素B12联合复方倍他米松局部肌肉封闭治疗,对比分析治疗前、治疗后第1、3个月的临床疗效评价,最大开口度,下颌运动距离,肌肉压痛指数(palpation index,PI),视觉模拟评分法(visual analogue scale,VAS)评分。结果:经过1个疗程的治疗,患者最大开口度、下颌运动距离较治疗前增加(P<0.01),PI及VAS评分较治疗前降低(P<0.01),临床疗效较好。结论:对于不同部位、不同亚类的肌痛型TMD,封闭治疗能有效缓解疼痛、减轻功能障碍程度,该诊疗方法具有一定的临床价值。

负压辅助愈合治疗系统对糖尿病足溃疡患者创面愈合及疼痛程度的影响

目的 探讨负压辅助愈合治疗系统对糖尿病足溃疡患者创面愈合及疼痛程度的影响。方法 选取2022年2月—2024年2月南通市第三人民医院收治的80例糖尿病足溃疡患者为研究对象,按照治疗方法的不同分为对照组和观察组,每组40例。对照组接受常规创面处理,观察组在对照组基础上使用负压辅助愈合治疗系统。比较两组创面愈合效果、血液炎症指标、视觉模拟法(Visual Analogue Scale, VAS)评分。结果 治疗后,观察组创面深度和溃疡面积均小于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组白细胞计数、中性粒细胞比率、C反应蛋白、降钙素原水平均低于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组VAS评分低于对照组,差异有统计学意义(P<0.05)。结论 负压辅助愈合治疗系统能促进糖尿病足溃疡患者的创面愈合,改善血液炎症指标,并有效降低疼痛程度,为糖尿病足溃疡的综合治疗提供了重要的临床依据。

环激光闭合治疗大隐静脉曲张术后并发症的临床分析及预防要点

目的探讨分析环激光闭合治疗大隐静脉曲张术后并发症以及预防要点。方法选取本院2020年5月—2023年5月收治的行大隐静脉曲张手术患者50例。将所有研究对象按照手术类型分为观察组(n=25)和对照组(n=25),其中观察组患者采用环激光(单环,波长1470nm)闭合治疗,对照组患者采用传统手术治疗,对比分析两组研究对象手术指标、术后恢复、术后并发症以及VCSS、CIVIQ评分等情况。结果观察组术中出血量和对照组患者相比较少,手术时间、切口总长度短于对照组,两组数据对比意义显著(P<0.05)。观察组患者VAS评分和对照组患者评分相比较低,患肢酸胀感消失时间、出院时间、患肢沉重麻木感消失时间和对照组指标相比较短,两组数据对比差异有统计学意义(P<0.05)。观察组术后出现皮下瘀斑、血栓性浅静脉炎、隐神经受损、切口感染等并发症和对照组相比较低,两组数据对比差异有统计学意义(P<0.05)。两组研究对象术前的VCSS、CIVIQ评分对比差异无统计学意义(P>0.05)。术后6月后,两组研究对象VCSS、CIVIQ评分均优于术前(P>0.05)。观察组患者术后6个月VCSS、CIVIQ评分优于对照组,差异有统计学意义(P<0.05)。结论环激光闭合治疗大隐静脉曲张操作规范,创伤小,整体安全性高,可有效降低术后并发症发生。

NVAF患者左心耳封堵术后双联抗血小板治疗与单药抗血小板治疗临床疗效的荟萃分析

目的荟萃分析左心耳封堵术(LAAC)后双联抗血小板治疗(dual-antiplatelet therapy,DAPT)与单药抗血小板治疗(single-antiplatelet therapy,SAPT)高出血风险或不耐受口服抗凝药物的非瓣膜性心房颤动(NVAF)患者的有效性与安全性。方法采取主题词与自由词相结合进行文献检索,主题词检索时采用扩展检索组配全部副主题词,由2名研究者独立筛选文献,提交资料并交叉核对,如遇分歧则讨论解决,或交由第三名研究者协助判断。计算机检索PubMed、EMBASE、The Cochrane Library数据库、临床试验注册中心,纳入2012年1月1日~2023年4月1日对比LAAC术后DAPT与SAPT抗栓治疗的临床研究。研究观察终点包括缺血性脑卒中(ischemia stroke,IS),大出血以及器械相关血栓(device-related thrombus,DRT)。本研究共纳入18项非随机对照试验共3637例患者,其中DAPT组2479例,DES组1158例。结果DAPT组IS发生率有低于SAPT组的趋势(2.5%vs.3.3%,OR:0.75,95%CI:0.40~1.42,P=0.380,I^(2)=0%),但差异无统计学意义。DAPT组大出血发生率有高于SAPT组的趋势(5.4%vs.4.3%,OR:0.91,95%CI:0.46~1.79,P=0.790,I^(2)=52%),但差异无统计学意义;去除异质性来源Vignali-2023研究后,高质量文献亚组,DAPT组大出血发生率显著高于SAPT组(6.5%vs.2.3%,OR:2.64,95%CI:1.23~5.68,P=0.010,I^(2)=0%),差异有统计学意义(P<0.05)。DAPT组与SAPT组DRT发生率相近(2.5%vs.2.7%,OR:0.68,95%CI:0.42~1.12,P=0.130,I^(2)=0%),但差异无统计学意义。结论对于高出血风险或无法耐受口服抗凝药物治疗的NVAF患者,LAAC术后DAPT与SAPT预防IS与DRT事件同样有效,SAPT大出血发生率低于DAPT,但差异无统计学意义。

负压闭合技术在处理慢性伤口中的应用及效果分析

目的：负压闭合技术是治疗伤口的新技术,国内相关临床应用及研究刚起步。文中探讨负压闭合技术用于处理慢性伤口的操作流程、适宜疗程及效果。方法：12例伤口面积〉100 cm2或有潜行、腔道引流不畅或久治难愈（病程≥1个月）的慢性或伴发感染的伤口,采用＂便携式压力可控式负压伤口治疗仪＂和十步法操作流程行负压伤口治疗,规定疗程30-50 d。观察治疗前后伤口愈合计分、治愈率、愈合方式和愈合时间。结果：12例负压治疗时间（27.7±22.6）d,9例愈合,1例好转,2例经湿性治疗后转外科手术治疗愈合,治愈率91.7%,愈合时间（59.36±22.88）d。相关分析结果显示,年龄越大所需愈合时间越长,其他因素与愈合时间和治愈率之间无显著相关。结论：负压闭合技术适用于任何年龄患者的慢性伤口,适宜疗程30-50 d,有助于提高难愈伤口的治愈率。