ObjectiveTo investigate the efficacy and safety of multiple-dose intravenous tranexamic acid (TXA) for reducing blood loss in complex tibial plateau fractures with open reduction internal fixation by a prospective randomized controlled trial. MethodsA study was conducted on patients with Schatzker type Ⅳ-Ⅵ tibial plateau fractures admitted between August 2020 and December 2022. Among them, 88 patients met the selection criteria and were included in the study. They were randomly allocated into 3 groups, the control group (28 cases), single-dose TXA group (31 cases), and multiple-dose TXA group (29 cases), using a random number table method. There was no significant difference (P>0.05) in terms of age, gender, body mass index, the Schatzker type and side of fracture, laboratory examinations [hemoglobin (Hb), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib), international normalized ratio (INR), D-dimer, and interleukin 6 (IL-6)], and preoperative blood volume. The control group received intravenous infusion of 100 mL saline at 15 minutes before operation and 3, 6, and 24 hours after the first administration. The single-dose TXA group received intravenous infusion of 1 g TXA (dissolved in 100 mL saline) at 15 minutes before operation, followed by an equal amount of saline at each time point after the first administration. The multiple-dose TXA group received intravenous infusion of 1 g TXA (dissolved in 100 mL saline) at each time point. The relevant indicators were recorded and compared between groups to evaluate the effectiveness and safety of TXA, including hospital stays, operation time, occurrence of infection; the occurrence of lower extremity deep vein thrombosis, intermuscular vein thrombosis, and pulmonary embolism at 1 week after operation; the lowest postoperative Hb value and Hb reduction rate, the difference (change value) between pre- and post-operative APTT, PT, Fib, and INR; D-dimer and IL-6 at 24 and 72 hours after operation; total blood loss, intraoperative blood loss, hidden blood loss, drainage flow during 48 hours after operation, and postoperative blood transfusion. Results ① TXA efficacy evaluation: the lowest Hb value in the control group was significantly lower than that in the other two groups (P<0.05), and there was no significant difference between the single- and multiple-dose TXA groups (P>0.05). The Hb reduction rate, total blood loss, intraoperative blood loss, drainage flow during 48 hours after operation, and hidden blood loss showed a gradual decrease trend in the control group, single-dose TXA group, and multiple-dose TXA group. And differences were significant (P<0.05) in the Hb reduction rate and drainage flow during 48 hours after operation between groups, and the total blood loss and hidden blood loss between control group and other two groups. ② TXA safety evaluation: no lower extremity deep vein thrombosis or pulmonary embolism occurred in the three groups after operation, but 3, 4, and 2 cases of intermuscular vein thrombosis occurred in the control group, single-dose TXA group, and multiple-dose TXA group, respectively, and the differences in the incidences between groups were not significant (P>0.05). There was no significant difference in the operation time between groups (P>0.05). But the length of hospital stay was significantly longer in the control group than in the other groups (P<0.05); there was no significant difference between the single- and multiple-dose TXA groups (P>0.05). ③ Effect of TXA on blood coagulation and inflammatory response: the incisions of the 3 groups healed by first intention, and no infections occurred. The differences in the changes of APTT, PT, Fib, and INR between groups were not significant (P>0.05). The D-dimer and IL-6 in the three groups showed a trend of first increasing and then decreasing over time, and there was a significant difference between different time points in the three groups (P<0.05). At 24 and 72 hours after operation, there was no significant difference in D-dimer between groups (P>0.05), while there was a significant difference in IL-6 between groups (P<0.05). Conclusion Multiple intravenous applications of TXA can reduce perioperative blood loss and shorten hospital stays in patients undergoing open reduction and internal fixation of complex tibial plateau fractures, provide additional fibrinolysis control and ameliorate postoperative inflammatory response.
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 compare the knee flexion degree after high-flexion versus standard total knee arthroplasty (TKA). MethodRelevant randomized controlled trials on comparison of knee flexion degree after high-flexion versus standard TKA were identified from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure from the establishment of these databases until October 2015. A systematic review was performed to compare knee flexion degree, knee function score and complications between the two types of prostheses. Analyses were conducted using RevMan version 5.2.0 software. ResultsTwenty-one studies were included in this Meta-analysis. The results showed that the knee flexion degree was higher in high-flexion group than that in the standard group[WMD=2.71°, 95%CI (0.96, 4.46)°, P=0.002]; while the difference was not significant leaving out six low-quality literatures[WMD=0.72°, 95%CI (-0.15, 1.60)°, P=0.10]. There was no significant difference in knee function score between the two groups[WMD=-0.54, 95%CI (-1.34, 0.25), P=0.18]. There was no significant difference in complications between the two groups[OR=0.99, 95%CI (0.53, 1.84), P=0.98]. ConclusionsThe important finding from the current study is that there is no evidence to support that the use of high-flexion prostheses is superior to the standard prostheses during total knee arthroplasty.
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.
Objective To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. MethodsAccording to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them (n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m2 (mean, 23.09 kg/m2). There was no significant difference in the age and body mass index between groups (P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. Results In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant (P<0.05). There was no significant difference between the groups in the VSS scores and scar widths (P>0.05). ConclusionModerate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.
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.
Objective To explore the safety, effectiveness, and mid-term efficacy of total thoracoscopic mitral valvuloplasty (MVP) with chordal replacement (CR) and quadrangular resection (QR) for the treatment of mitral regurgitation (MR), and to provide reference for guiding the development and selection of clinical diagnosis and treatment methods for MR patients. Methods A prospective randomized controlled study was performed to collect patients with MR who underwent MVP at the Department of Cardiovascular Surgery, Leshan People's Hospital from January 2021 to March 2022. They were randomly divided into a CR group and a QR group by using a random number table, and were followed up for 12 months after the operation. The medical history, perioperative data and adverse cardiac endpoint events during the follow-up period were collected. The differences in surgical efficacy between the two groups were evaluated and compared, and the Kaplan-Meier method was used to compare the differences in survival rates between the two groups of patients. Results A total of 100 patients were enrolled. There were 46 patients in the CR group, including 27 males and 19 females with an average age of 49.50±9.23 years; there were 46 patients in the QR group, including 24 males and 22 females with an average age of 49.91±11.48 years. The aortic occlusion time in the CR group was longer than that in the QR group (P<0.05). Other surgical indicators, including total surgical time, extracorporeal circulation time, ventilator-assisted time, ICU hospitalization time, size of the valve ring, concomitant surgery during the same period, and the incidence of perioperative complications were not statistically different between the two groups (P>0.05). The left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, and left ventricular ejection fraction (LVEF) of the two groups before discharge after the surgery were significantly improved compared to those before surgery (P<0.05). There was a statistical difference in LVEF between the two groups before discharge after the surgery (P<0.05). There was no statistical difference in clinical efficacy between the two groups (P>0.05). Kaplan-Meier analysis showed that the overall incidence of exemption from mild and above mitral regurgitation 12 months after the surgery in the CR group and QR group was 84.8% and 89.1%, respectively. According to the log-rank test, there was no statistical difference in the overall survival curve between the two groups (χ2=0.356, P=0.551). Conclusion CR and QR are both safe and effective methods for the treatment of simple posterior MR.
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 evaluate the efficacy and safety of traditinal Chinese Medicine (TCM) syndrome classification and intervention for the prophylaxis of menstrual migraine. MethodsPatients consistent with the inclusion criteria from January 2013 to June 2014 were included in the trial. Patients were randomized by their visiting order into two groups:the experimental group was treated with Chinese traditional medicine compound decoctions (two doses for three days), and the control group was treated with vitamin B2 (400 mg once daily). The patients were treated for thirty days consecutively. Efficacy was assessed using the records of the frequency, duration, and severity of migraine attacks. Laboratory tests, vital signs, and adverse events were monitored. ResultsBoth treatments led to a significant reduction in the frequency, duration, and severity of migraine attacks (P<0.05). TCM therapy was significantly better than vitamin B2 for reducing the frequency and the duration of migraine (P<0.05). No serious adverse drug reaction was found in both groups. ConclusionTCM syndrome classification and intervention is effective and relatively safe in the prophylaxis of menstrual migraine attacks.