Objective To find a better method of emergency repair of skin and soft tissue defects in the lower leg, ankle and foot. Methods The distally based superficial sural artery flap was designed on the posterior aspect of the leg. From February 2000 to December 2003, 18 patients with skin and soft tissue detects of the lower leg, ankle and foot were treated with island fasciocutaneous flap supplied by superficial sural artery by emergency. The size of the flap ranged form 4 cm× 5 cm to 11 cm×12 cm. Results The flaps survived totally in 16 cases and necrosed partially in 2 cases. After 1-2 year postoperative follow-up, the results were satisfactory except that in 2 flaps. Conclusion The island fasciocutaneous flap supplied by superficial sural artery may provide a useful method for emergency repair of soft tissue defect of the lower limbs.
An elderly female patient, with systemic multiple organ dysfunction, suffered from severe aortic valve stenosis, was to undergo transcatheter aortic valve replacement (TAVR). She was intolerance of the computed tomography examination before surgery. Bedside echocardiography was employed to evaluate the patient’s aortic valve stenosis, valve anatomy and type, the condition of aortic root, the distance from coronary to aortic root, and lower-extremity vascular access. Finally, the emergent TAVR was successfully performed under general anesthesia, and the aortic valve trans-prosthetic gradient met a remarkable decrease after surgery.
目的:总结汶川地震损伤院内急救护理的特点,探讨灾害事件中急诊护士蕴藏的救援能力及今后灾害护理学应关注及建设规范的任务及课题。方法:通过对2118例地震损伤伤员的护理救护活动进行分析、总结经验。结果:根据院内救治地震损伤例数数量排前几位的依次分为开放性伤口851例、闭合性伤口809例、多发伤322例、伤口感染86例、气性坏疽32例、肢体离断伤18例、死亡2例。结论:灾害损伤与急救护理密不可分。灾害应急护理是一个需要探索、重视、实践长期建设规划的任务及课题.
Objective To evaluate the effects of emergency coronary artery bypass grafting (ECABG) in the treatment of emergent patients, and to summarize our experience. Methods We retrospectively analyzed the clinical data of 160 patients who underwent coronary artery bypass grafting (CABG) in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013. The patients were divided into an ECABG group (operation underwent on the day diagnosed, n=27, 22 males and 5 females, at age of 70.2±10.2 years) and a conventional group (CABG operation underwent on 5 days after diagnosed, n=133, 104 males and 29 females, at age of 66.3±8.9 years). Results Statistical differences were found between the ECABG group and the conventional group in EuroSCORE (5.8±3.2 versus 3.4±2.1, P=0.001), acute myocardial infarction (33.3% vs. 11.3%, P=0.007), rate of application of IABP (29.6% versus 12.0%, P=0.034), pericardium and mediastinal tube drainage (533.4±132.8 ml versus 414.8±124.3 ml, P=0.018). There was no statistical difference in continuous renal replacement therapy (P=0.677), postoperative sternal wound complication (P=1.000), the length of hospital stay (P=0.589), or 30-day-mortality (P=0.198) between the two groups. We followed up 24 patients(88.89%) for 3-36 months in the ECABG group. One patient occurred angina symptoms at the end of 1 year follow-up. The symptoms disappeared after treatment. The other patients had no symptoms of angina pectoris and myocardial ischemia. Conclusion ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients. Sufficient preoperative assessment, good myocardial protection, full revascularization, and comprehensive treatment plays an important role in the success of ECABG.
摘要:目的:探讨基层医院开展急诊经皮冠状动脉支架植入术(PCI)治疗急性心肌梗死(AMI)的可行性、安全性。方法:回顾分析2002年11月~2009年4月我院41例AMI患者的急诊PCI资料。结果:41例AMI患者,急诊开通梗死相关动脉(IRA)39例(即时成功率95.1%),开通IRA者中术后死亡2例(死亡率4.9%),总成功率90.2％。结论:在有条件的基层医院开展急诊PCI安全有效。Abstract: Objective: To explore the feasibility and safety of primary percutaneous coronary intervention in patients with acute myocardial infarction in elementary hospital. Methods: The clinical data of 41 AMI patients who underwent emergent PCI from November 2002 to April 2009 were retrospectively analyzed. Results: Among the 41 AMI patients referred to PCI, infarctrelated arteries were recanalized in 39 cases. The immediate success rate was 95.1%. 2 cases of them died. The total success rate was 90.2%.Conclusion: Emergent PCI is safe and effective in the hospitals which could carry out PCI.
ObjectiveThe aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.MethodsThe studies published from January 1, 2000 to July 31, 2018 were searched from Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, and VIP database. RevMan 5.3 software was used for data analysis.ResultsA total of 21 studies were included in this meta-analysis. Compared to emergency surgery, selective surgery after colonic stenting had significant lower mortality rate [OR=0.44, 95% CI was (0.26, 0.73), P<0.05], permanent stoma rate [OR=0.46, 95% CI was (0.23, 0.94), P<0.05], complication rate [OR=0.47, 95% CI was (0.35, 0.63), P<0.05], and wound infection rate [OR=0.40, 95% CI was (0.25, 0.65), P<0.05）], but had significant higher primary anastomosis rate [OR=3.30, 95% CI was (2.47, 4.41), P<0.05] and laparoscopic surgery rate [OR=12.55, 95% CI was (3.64, 43.25), P<0.05]. But there was no significant differences between the two groups as to anastomotic leak rate [OR=0.86, 95% CI was (0.48, 1.55), P>0.05].ConclusionsSelective surgery after colonic stenting can be identified in a reduced incidence of mortality rate, complication rate, permanent stoma rate, and wound infection rate, and also can increase primary anastomosis rate and laparoscopic surgery rate. Thus, for acute obstructive colorectal cancer, selective surgery after colonic stenting is better than emergency surgery.
Objective To analyze the case data of children with maxillofacial skin lacerations and provide a reference for the diagnosis and treatment of maxillofacial skin lacerations in children. Methods The medical records of children with maxillofacial skin lacerations who underwent emergency cosmetic suturing at the Lingang Branch of Yibin Second People’s Hospital between March 2023 and March 2024 were retrospectively collected. The clinical characteristics, diagnosis, treatment, and follow-up of the children were analyzed and summarized. Results A total of 210 children with maxillofacial skin lacerations were included, of which 142 were boys, accounting for 67.62%. The age of the children was most common at 3 years old, accounting for 18.57% (39 cases). A total of 5 children had two lacerations, 3 cases of which were in the same location and 2 cases were not in the same location. The most common site of skin laceration in children was the forehead, accounting for 46.23% (98 cases). The most common cause of maxillofacial skin lacerations was spontaneous falls, accounting for 51.43% (108 cases). The maxillofacial skin lacerations of the children were mainly minor injuries (168 cases, accounting for 80.00%). All children underwent modified vertical mattress suture, and the postoperative satisfaction of the children families was relatively high. Finally, 37 children were successfully followed up, and the follow-up results showed that the wound healing of the maxillofacial skin lacerations were good, the skin scars were not obvious, and the appearance of the skins were basically normal. Conclusion For children with maxillofacial skin lacerations, using the modified vertical mattress suture for emergency cosmetic suturing is beneficial for their injury recovery and facial aesthetics.