ObjectiveTo discuss the clinical effects of intercostals nerve freezing technique for analgesia on post-operative chest. MethodsWe included 80 patients with thoracotomy in Zhongshan Hospital in Xiamen University between June 2013 and June 2014. The patients were divided into a trial group (30 males and 10 females at average age of 59.90± 10.62 years) and a control groups (28 males and 12 females at average age of 59.85± 10.52 years) by random digital table. The patients in the trial group were treated with frozen the intercostals nerve roots located in the incision and next intercostals before closing the chest by cryotherapy therapy apparatus (K520 type, Beijing Kulan Company). The patients in the control group were treated with self-control intravenous analgesia pump post-operation. We compared the postoperative incision pain and cough, sputum reflection score, and pulmonary complications between the two groups. ResultsThe pain degree in the trial group was significantly weaker than that in the control group on the first day, the second day and the seventh day after operation (t=-6.45, -4.95, -3.14, P < 0.05). Cough, sputum reflection score were significantly higher than those in the control group (P < 0.01). Pulmonary complications were significantly lower (t=3.023, P < 0.05). There were 4 patients with pneumonia and no pulmonary atelectasis in the trial group. While there were 8 patients with pneumonia in the control group and 1 patient with pulmonary atelectasis. ConclusionIntercostals nerve freezing technique can drastically reduce postoperative pain in the patients with open thoracic operation, effectively promote patient cough and expectoration, and reduce pulmonary complications rate.
ObjectiveTo investigate the socioeconomic benefits of enhanced recovery after surgery (ERAS) in perioperative period of selective laparoscopic cholecystectomy (LC) by prospective, randomized, controlled clinical study.MethodsA total of 90 patients were recruited in the Hetian Regional People’s Hospital from November 1, 2019 to December 25, 2019. PASS 11 software was used to calculate the sample size. They were grouped into an ERAS group and a tradition group by 1∶1 by random digital table. The patients in the ERAS and the tradition groups were treated with ERAS conception and traditional method respectively during the perioperative period. The postoperative hospitalization time, the first feeding time, the first getting out of bed time, and the first anal exhaust time after operation; the total hospitalization costs, intraoperative infusion, and postoperative total infusion; the intraoperative anesthesia intubation method, trocar layout, and operation time; the pain points of 6 h,12 h and 24 h after operation; the nausea and vomiting after operation; complications and re-hospitalization rate within 30 d after operation were compared between two groups.ResultsA total of 86 patients finally were included in the study, including 44 cases in the ERAS group and 42 cases in the tradition group. The basic data such as the gender, age, body mass index, etiology, blood routine, liver and kidney functions, etc. between the two groups were not statistically significant (P>0.05). Between the two groups, there were no significant differences in the intraoperative anesthesia intubation method, trocar layout, and operation time (P>0.05). Compared with the tradition group, the hospitalization time, the first feeding time, the first getting out of bed time, and the first anal exhaust time after operation were shorter (P<0.05); the total hospitalization costs, intraoperative infusion, and postoperative total infusion were less (P<0.05); the pain points of 6 h,12 h and 24 h after operation were lower (P<0.05); and the times of nausea and vomiting after operation were less (P<0.05) in the ERAS group. There were no complications such as the intraperitoneal bleeding, biliary leakage, and infection after operation, and no re-hospitalized patients within 30 d in both groups.ConclusionApplication of ERAS conception in selective LC perioperative period in Hetian Regional People’s Hospital of Xinjiang Uygur Autonomous Region cannot only shorten postoperative hospitalization time, reduce costs of hospitalization, help to overcome poverty, but also reduce occurrence of complications such as pain, nausea and vomiting, etc.
ObjectiveTo probe into the clinical value of supine cervical vertebra traction with neck flexion in treating cervical spondylotic radiculopathy. MethodsFrom August 2011 to December 2013, 71 patients were divided randomly into a treatment group of 36 cases and a control group of 35 cases. They were treated respectively with supine cervical vertebra traction with neck flexion, and cervical vertebra traction on a sitting position. Both groups had acupuncture, moxibustion, massage and medium frequency electrotherapy. The period of observation was 15 days. We evaluated the results by surveying physiological curvature of the cervical spine on lateral radiograph, and visual analogue scale (VAS), neck disability index (NDI), criteria of diagnosis and therapeutic effect of syndromes in traditional Chinese medicine syndrome and clinical assessment scale for cervical spondylosis (CASCS) were also used. ResultsPhysiological curvature of cervical spine was much improved in both groups after treatment (P<0.05). The distance of cervical vertebra arc between vertebral anterior edge sequences in treatment group before treating was (4.07±3.63) mm and it was (9.03±4.31) mm after treatment. For the control group, those two numbers were respectively (4.13±3.02) and (8.87±3.97) mm. There was no significant difference in the distance of cervical vertebra arc and its increase between vertebral anterior edge between the two groups after treatment. There was significant difference in the efficiency rate between the two groups (P<0.05) (treatment group 100.00%, control group 97.14%). When cured rate and cured-markedly effective rate were added, the treatment group (80.56%) was much better than the control group (51.43%) (P<0.01). As to VAS score, NDI and CASCS scores, both groups got much better after treatment (P<0.01). For VAS, the treatment group decreased from 8.43±0.75 before treatment to 1.40±0.61 after treatment, while the control group from 8.35±0.78 before treatment to 2.55±0.59 after treatment. For NDI, the treatment group decreased from 54.13±7.44 before treatment to 10.78±4.55 after treatment, while the control group from 55.85±8.72 to 12.66±5.48. For CASCS, the treatment group rose from 34.88±5.39 before treatment to 74.65±6.73 after treatment, while the control group from 34.77±4.89 to 69.03±6.21. After treatment, VAS score of the treatment group was much lower than the control group (P<0.01). There was no difference between the two groups on NDI (P>0.05). CASCS score of the treatment group was significantly higher than the control group after the treatment (P<0.01). There was no significant difference in the increase of CASCS score between the two groups after treatment (P>0.05). ConclusionVertebra traction combined with acupuncture, moxibustion, massage and medium frequency electrotherapy is therapeutic for cervical spondylotic radiculopathy and traction at a supine and flexing position is better.
ObjectiveTo investigate the effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament (ACL) reconstruction. MethodsA total of 160 patients with ACL injuries who met the selection criteria and were admitted between November 2020 and August 2021 were selected and divided into 4 groups according to the random number table method (n=40). Group A began to take imrecoxib 3 days before operation (100 mg/time, 2 times/day); group B began to take imrecoxib 1 day before operation (100 mg/time, 2 times/day); group C took 200 mg of imrecoxib 2 hours before operation (5 mL of water); and group D did not take any analgesic drugs before operation. There was no significant difference in gender, age, body mass index, constituent ratio of meniscal injuries with preoperative MRI grade 3, constituent ratio of cartilage injury Outerbridge grade 3, and visual analogue scale (VAS) score at the time of injury and at rest among 4 groups (P>0.05). The operation time, hospitalization stay, constituent ratio of perioperative American Society of Anesthesiologists (ASA) grade 1, postoperative opioid dosage, and complications were recorded. The VAS scores were used to evaluate the degree of knee joint pain, including resting VAS scores before operation and at 6, 24, 48 hours, and 1, 3, 6, and 12 months after operation, and walking, knee flexion, and night VAS scores at 1, 3, 6, and 12 months after operation. The knee injury and osteoarthritis score (KOOS) was used to evaluate postoperative quality of life and knee-related symptoms of patients, mainly including pain, symptoms, daily activities, sports and entertainment functions, knee-related quality of life (QOL); and the Lysholm score was used to evaluate knee joint function. ResultsAll patients were followed up 1 year. There was no significant difference in operation time, hospitalization time, or constituent ratio of perioperative ASA grade 1 among 4 groups (P>0.05); the dosage of opioids in groups A-C was significantly less than that in group D (P<0.05). Except for 1 case of postoperative fever in group B, no complications such as joint infection, deep vein thrombosis of the lower extremities, or knee joint instability occurred in each group. The resting VAS scores of groups A-C at 6 and 24 hours after operation were lower than those of group D, and the score of group A at 6 hours after operation was lower than those of group C, and the differences were significant (P<0.05). At 1 month after operation, the knee flexion VAS scores of groups A-C were lower than those of group D, the walking VAS scores of groups A and B were lower than those of groups C and D, the differences were significant (P<0.05). At 1 month after operation, the KOOS pain scores in groups A-C were higher than those in group D, there was significant difference between groups A, B and group D (P<0.05); the KOOS QOL scores in groups A-C were higher than that in group D, all showing significant differences (P<0.05), but there was no significant difference between groups A-C (P>0.05). There was no significant difference in VAS scores and KOOS scores between the groups at other time points (P>0.05). And there was no significant difference in Lysholm scores between the groups at 1, 3, 6, and 12 months after operation (P>0.05). ConclusionCompared with the traditional analgesic scheme, applying the concept of preemptive analgesia with imrecoxib to manage the perioperative pain of ACL reconstruction can effectively reduce the early postoperative pain, reduce the dosage of opioids, and promote the early recovery of limb function.
Objective To compare the efficacy of incision healing by abdominal wall closure measure without suturing subcutaneous fat layer and the traditional abdominal wall closure measure. Methods Four hundreds patients underwent operation of abdominal median incision and abdominal paramedian incision from Sep. 2010 to Sep. 2012 in our department were randomly assigned to observation group （n=199） and control group （n=201）. The patients in obser- vation group underwent abdominal wall closure measure without suturing subcutaneous fat layer， and those of control group were subjected to abdominal wall closure by traditional layer suture technique. Comparison of efficacy of incision healing in the 2 groups was performed. Results The incidences of fat liquefication 〔1 （0.5%） vs.18 （9.0%）〕， incision swelling 〔3 （1.5%） vs.16 （8.0%）〕， incision induration 〔1 （0.5%） vs.15 （7.5%）〕， and dehiscence of wound 〔0 （0） vs.9 （4.5%）〕 in observation group were significantly lower than those of control group （P＜0.01）， but there was no significant difference in incidence of subcutaneous hematoma 〔2 （1.0%） vs.0 （0）， P＞0.05〕. The rate of primary healing in obser-vation group was significantly higher than those of control group 〔199 （100%） vs.186 （92.5%）， P＜0.01〕. Duration of abdominal closure 〔（13.0±1.6） min vs.（18.0±2.2） min〕 and postoperative hospital stay 〔（7.7±1.3） days vs.（9.6±1.9） days〕 were all shorter than those of control group （P＜0.01）. Conclusion The abdominal wall closure measure without suturing subcutaneous fat layer is obviously more effective to the traditional layer suture technique， which is a suture way worthy to spread.
Objective To compare the clinical effect between neo-adjuvant chemotherapy combined with operation and simple operation under multi-disciplinary team in rectal cancer. Methods A survey of 72 patients with rectal cancer from Nov. 2007 to Mar. 2008 were studied. Patients were divided into two groups using a simple random method: 33 cases in combined therapy group were treated with single period neo-adjuvant chemotherapy as well as operation and 39 cases in control group received operation only. To compare the differences of perioperative period indexes between two groups. Results During the differences of indexes of age, gender, differentiation degree, clinicopathologic stage as well as the distance to dentate line of tumor, there was no statistical significance between combined therapy group and control group (Pgt;0.05). And at the same time, the operative type, operative time and bleeding quantity in operation had no statistically significant difference between two groups (Pgt;0.05). As for the postoperative rehabilitation indexes, the time of vent to normal in combined therapy group was earlier than that in control group, but the intake time was later than that in control group （Plt;0.05）. Falling range from preoperative CEA to postoperative CEA was larger in combined therapy group than that in control group （Plt;0.05）; and the falling range from preoperative WBC to postoperative WBC had no significant difference between two groups （Pgt;0.05）. Conclusion The clinical effect of combined therapy is obviously superior to simple operation, suggesting that neo-adjuvant chemotherapy combined with operation is feasible and safe.
摘要:目的: 随机对照研究、评估生物反馈训练治疗慢性功能性便秘的疗效。 方法 : 60例慢性功能性便秘患者,随机分为治疗组30例和对照组30例。治疗组接受1个疗程(5周)生物反馈训练治疗(10次为一个疗程、一次30～45分钟、每周2次)。对照组患者接受聚乙二醇4000 10g BID 口服,疗程5周。治疗前后作便秘症状评分、结肠通过试验检测、直肠肛门压力检测。 结果 : 生物反馈训练和聚乙二醇4000均可使多数慢性功能性便秘患者的大便次数、大便性状及伴随症状恢复正常或缓解,总有效率分别为667%和80%(P ＞005)。生物反馈训练和聚乙二醇4000口服治疗后,结肠通过试验72小时标志物排出率分别为75%及73%,均较治疗前明显增加。生物反馈训练治疗后力排时肛门压明显下降。 结论 : 生物反馈训练对出口梗阻型、慢传输型便秘均有效,是一种有效的、新兴的治疗慢性功能性便秘的方法,可作为功能性便秘的一线治疗方法。Abstract: Objective: To assess the clinic effect of biofeedback therapy for functional constipation. Methods : Sixty cases of chronic functional constipation were randomly divided into treatment group (30 cases) and control group (30 cases). Cases in the treatment group were exposed to biofeedback for a fiveweeklong treatment course—individual treatment lasted for 3045 minutes and twice per week. Patients in the control group received PEG 4000 10g BID for five weeks. Data from constipation symptom score, colonic transit test, and anorectal manometry were done and compared before and after two kinds of treatments. Results : Biofeedback training and PEG 4000 could restore the stoolfrequency, stool characteristics and accompanying symptoms to normal or mitigation of the majority of patients with chronic functional constipation, with the total effective rates being 667% and 80% (P gt;005), respectively. After biofeedback training and PGE 4000 treatment, the discharge rate of 72hour markers of colonic transit test significantly increased to 75% and 73%, respectively. Additionally, anorectal pressure decreased dramatically after biofeedback training. Conclusion : Biofeedback training would play a positive role in outlet obstruction and slow transit constipation. Thus, it could be an effective firstline treatment of chronic functional constipation.
ObjectiveTo evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass.MethodsIn this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation.ResultsThere was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01).ConclusionApplication of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.
ObjectivesTo systematically review the efficacy of intra-articular injection of sodium hyaluronate for kashin-beck disease. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CBM, VIP, WanFang Data, and CNKI were electronically searched from inception to January 2016 to collect randomized controlled trials (RCTs) about sodium hyaluronate in the treatment of kashin-beck disease. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 6 RCTs involving 1 276 patients were included. The result of metaanalysis suggested that the sodium hyaluronate group was significantly superior to the control group in clinical effect (OR=5.89, 95% CI 4.10 to 8.47, P < 0.000 01) and the Lequesne index (SMD=-1.66, 95% CI-2.14 to-1.13, P < 0.000 01). ConclusionIntra-articular injection of sodium hyaluronate is helpful in the improvement of kashin-beck disease in clinical effect and the Lequesne index. Due to the limited quality and quantity of the included studies, more high quality studies are need to verify the above conclusion.