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Effect of axillary perineural dexmedetomidine on hemodynamic changes and postoperative pain in patients undergoing upper limb surgery under general anesthesia: A randomized double-blind study 腋窝神经周右美托咪定对全身麻醉下上肢手术患者血流动力学改变和术后疼痛的影响:一项随机双盲研究
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_11_22
M. Razavizadeh, M. Rajabi, Abbas Arshia, H. Akbari, M. Mahdian
Background and Objectives: Perineural dexmedetomidine as an adjuvant of local anesthetics has been used in regional anesthesia to prolong the duration of analgesia. This study aimed to assess the effects of perineural injection of dexmedetomidine alone on the duration of postoperative analgesia, narcotic consumption, and hemodynamic changes in the patients undergoing upper limb surgery under general anesthesia. Methods: Sixty patients undergoing upper limb surgery were randomly allocated into two equal groups. The intervention group received 100 μg dexmedetomidine/20 ml normal saline (NS) as perineural axillary brachial plexus injection, whereas the control group received 20 ml NS injection. Patients were compared for hemodynamic changes, postoperative pain through Visual Analog Scale, consumed narcotics and side effects. Results: The postoperative analgesia in the dexmedetomidine group was significantly longer than the control one. The amount of opioid administered in the control group was significantly more than that amount used in the intervention group. Mean arterial pressure (MAP) and heart rate (HR), in parallel, in the intervention group at 15, 30, 45, and 60 min after induction of anesthesia were significantly decreased in the intervention group than the control group. No dramatic drop in MAP and HR was observed. No significant complication also was reported. Conclusions: Perineural axillary brachial plexus injection of 100 μg dexmedetomidine/20 ml NS prolonged postoperative analgesia and reduced narcotic consumption in patients undergoing upper limb surgery under general anesthesia without noticeable side effects.
背景与目的:神经周围右美托咪定作为局部麻醉剂的辅助药物,已被用于区域麻醉,以延长镇痛时间。本研究旨在评估在全身麻醉下接受上肢手术的患者中,经神经单次注射右美托咪定对术后镇痛持续时间、麻醉剂消耗和血液动力学变化的影响。方法:将60例上肢手术患者随机分为两组。干预组接受100μg右美托咪定/20ml生理盐水(NS)作为腋窝臂丛神经束神经注射,对照组接受20ml NS注射。通过视觉模拟量表比较患者的血液动力学变化、术后疼痛、服用麻醉剂和副作用。结果:右美托咪定组术后镇痛时间明显长于对照组。对照组的阿片类药物给药量明显高于干预组的给药量。在麻醉诱导后15、30、45和60分钟,干预组的平均动脉压(MAP)和心率(HR)同时显著低于对照组。MAP和HR没有明显下降。无明显并发症报告。结论:100μg右美托咪定/20 ml NS神经丛注射延长了全麻下上肢手术患者的术后镇痛,减少了麻醉消耗,没有明显的副作用。
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引用次数: 0
Outcomes of nonoperative management of splenic injury: A retrospective cohort from a level 1 trauma center in Thailand 脾损伤非手术治疗的结果:来自泰国一级创伤中心的回顾性队列研究
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_105_20
Naruthep Nuchaikaew, Osaree Akaraborworn, Teeravut Tubtawee, B. Sangthong, Komet Thongkhao
Background and Objectives: Nonoperative management (NOM) of splenic injury is the standard treatment for all splenic injury patients who are hemodynamically stable. However, it may be a challenge in developing countries with limited intensive care resources. This study aimed to review the outcomes and identify the factors of unsuccessful NOM of splenic injury in a Level 1 trauma center in Thailand. Materials and Methods: This was a retrospective review that collected data from the trauma registry. The enrolled patients had a splenic injury and underwent NOM from 2009 to 2016. Failure of NOM was defined as the need for an operation on the spleen after NOM. The outcomes of NOM were described, and the predictors for failure of NOM were identified. Results: Seventy-two splenic injury patients were included in the study. The majority of patients were involved in a motorcycle crash (56%). The average injury severity score was 20. Fifty-nine patients (89%) were successfully treated as NOM. Six patients underwent embolization (8%), and none of the patients required operative management. Univariate analysis showed that hemoperitoneum in ≥4 regions (odds ratio [OR] 3.96, 95% confidence interval [CI] 0.79–25.53; (P = 0.05) and received packed red cells >2 units within 24 h (OR 20, 95% CI 2.15–242; P = 0.003) were significantly associated with failure of NOM. Conclusions: NOM of splenic injury can be performed successfully in a trauma center in a developing country. Splenic angioembolization might be helpful to increase the success rate. The amount of hemoperitoneum was a significant predictor of failed NOM.
背景与目的:脾损伤的非手术治疗是所有血流动力学稳定的脾损伤患者的标准治疗方法。然而,在重症监护资源有限的发展中国家,这可能是一项挑战。本研究旨在回顾泰国一家一级创伤中心脾损伤手术失败的结果和因素。材料和方法:这是一项回顾性研究,收集了创伤登记处的数据。纳入的患者在2009年至2016年期间患有脾损伤并接受了NOM。NOM失败定义为在NOM后需要对脾脏进行手术。描述了NOM的结果,并确定了NOM失败的预测因素。结果:本组脾损伤患者72例。大多数患者(56%)涉及摩托车事故。损伤严重程度平均评分为20分。59例(89%)患者成功治疗为NOM, 6例(8%)患者接受栓塞治疗,无一例患者需要手术治疗。单因素分析显示,≥4个区域存在腹膜出血(优势比[OR] 3.96, 95%可信区间[CI] 0.79-25.53;(P = 0.05),并在24 h内接受充血红细胞(OR 20, 95% CI 2.15-242;P = 0.003)与手术失败有显著相关性。结论:在发展中国家的创伤中心可以成功地进行脾损伤的手术。脾血管栓塞可能有助于提高手术成功率。腹腔积血量是NOM失败的重要预测因子。
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引用次数: 0
Knowledge and attitude of elementary school health-care providers with regard to emergency management of traumatic dental injuries in Kashan city 卡山市小学保健人员对牙外伤应急管理的认识和态度
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_18_21
Sina Hosseinpoor, A. Kashani, H. Akbari, Mohammadreza Molaee
Background and Objectives: Dental trauma is a common problem seen in children. Since schools are one of the main places where traumatic dental injuries (TDIs) occur, school health care providers have an important role to reduce the possible consequences. The study aimed at examining the awareness and attitudes of elementary school health-care providers about the emergency management of TDIs in children. Methods: This cross-sectional study was conducted on all health-care providers of elementary schools in Kashan, Iran. Data were collected using a four-part questionnaire. The collected data were analyzed using descriptive statistics (percentage, frequency, mean, and standard deviation) by the SPSS 26 software. Results: Regarding emergency management of traumatic dental injures, the scores of health care providers' knowledge and health care providers' attitude were 65% and 86.5%, respectively. There was no statistically significant association between the level of knowledge and a length of service, gender, and the educational level. Conclusions: The elementary school health-care providers did not have a high level of awareness about how to deal with TDIs.
背景和目的:牙齿创伤是儿童常见的问题。由于学校是发生创伤性牙科损伤的主要场所之一,学校卫生保健提供者在减少可能的后果方面发挥着重要作用。该研究旨在调查小学保健提供者对儿童TDI紧急管理的认识和态度。方法:这项横断面研究对伊朗卡山所有小学的医疗保健提供者进行。使用由四部分组成的问卷收集数据。使用SPSS 26软件对收集的数据进行描述性统计(百分比、频率、平均值和标准差)分析。结果:在外伤性牙外伤的应急管理方面,医护人员的知识和态度得分分别为65%和86.5%。知识水平与服务年限、性别和教育水平之间没有统计学上的显著关联。结论:小学保健提供者对如何处理TDIs的认识不高。
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引用次数: 0
An epidemiological analysis of injuries among cyclists and clinical characteristics of them: A single-center experience from Northwest of Iran 骑自行车者受伤的流行病学分析及其临床特征:来自伊朗西北部的单中心经验
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_69_21
Saber Gaffarifam, E. Sarbazi, Z. Ghorbani, H. Azizi, H. Soleimanpour, B. Khami, Amin Daemi, H. Sadeghi-Bazargani
Background and Objectives: The most common cause of death and serious disability in cyclist's crashes is traumatic brain injury. The The present study aimed to provide accurate statistics and information on traffic accidents based on epidemiologic characteristics and outcomes of cyclists' injuries in East Azerbaijan province-Iran, based on International Classification of Diseases ICD-10 and International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) guidelines. Materials and Methods: This cross-sectional study was conducted in Tabriz, Iran, on 317 cyclists who sustained an injury through road traffic accidents. Multivariable Cox regression, reported as hazard ratios (95% confidence interval), quantified the association between explanatory variables such as age, gender, and anatomical regions with mortality. Results: The present study included 317 trauma patients with an average age of 34.72 (SD= 24.14) years old; 89.6% of the patients were male. Collision with truck or van, pick-up, and automobiles collisions (42.9%) were the most common counterpart vehicle used [V13]. The most common anatomical regions affected by the cyclists were head injuries (72.2%) (S00–S09). The highest proportion of injuries incurred by cyclists was superficial (46%) [S00-T00]. Closure of skin and subcutaneous tissue of other sites were the most clinical modification provided for the patients (54.1%) (86.59). The obtained regression coefficient showed that age increased the odds ratio of mortality by 0.02. Conclusions: Men were the most injured group. Head injuries were the most common injuries. Skin and subcutaneous tissue sutures commonly require surgery. Also, the chance of mortality increases with age. All cyclists need to wear a helmet to reduce head-impairing injuries.
背景和目的:自行车碰撞事故中最常见的死亡和严重残疾原因是创伤性脑损伤。本研究旨在根据伊朗东阿塞拜疆省骑自行车者受伤的流行病学特征和结果,根据国际疾病分类ICD-10和国际疾病分类第九次修订,临床改良(ICD-9-CM)指南,提供有关交通事故的准确统计数据和信息。材料和方法:这项横断面研究在伊朗大不里士进行,共有317名骑自行车的人因道路交通事故受伤。以风险比(95%置信区间)报告的多变量Cox回归量化了年龄、性别和解剖区域等解释变量与死亡率之间的相关性。结果:本研究包括317名创伤患者,平均年龄34.72岁(SD=24.14);男性占89.6%。与卡车或面包车的碰撞、皮卡车和汽车的碰撞(42.9%)是最常见的对应车辆[V13]。受骑车人影响最常见的解剖区域是头部损伤(72.2%)(S00–S09)。骑车人受伤的比例最高的是表面损伤(46%)[S00-T00]。闭合皮肤和其他部位的皮下组织是为患者提供的最多的临床改良(54.1%)(86.59)。获得的回归系数显示,年龄使死亡率的比值比增加了0.02。结论:男性是受伤最严重的群体。头部损伤是最常见的损伤。皮肤和皮下组织缝合通常需要手术。此外,死亡率随着年龄的增长而增加。所有骑自行车的人都需要戴头盔,以减少头部损伤。
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引用次数: 0
Nonoperative management of blunt abdominal trauma cases at a tertiary care center in India – An effective strategy 印度三级护理中心钝性腹部创伤病例的非手术治疗——一种有效的策略
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_54_21
Tanvi Luthra, K. Bedi, S. Sahu, Sayani Banerjee
Background and Objectives: An emerging paradigm is observed toward the application of nonoperative management for blunt abdominal trauma (BAT) over invasive surgery. It is postulated that the nonoperative approach is more effective financially, is safe and has a higher success rate. To evaluate the success of the shift from an aggressive operative approach to nonoperative management in solid organ injuries due to BAT at a tertiary care center in North India. Materials and Methods: An observational study was undertaken to evaluate the management of 95 cases of BAT presenting to the emergency department at a tertiary care center in North India, over 12 months. Operative and nonoperative managements were recorded, and the outcome was assessed at 72 h. Categorical variables were analyzed using the Chi-square test; P < 0.05 was taken to indicate a significant difference. Results: Out of the 95 patients, 46% were between 20 and 40 years and 84% were males. The most common mechanism of trauma was road traffic accidents (67%), followed by falls. Specific organ injuries were found in 59% of cases; of these, 38% were injuries to the liver and 34% to the spleen. Overall, 21% of all the cases underwent operative management, whereas 79% were managed nonoperatively. Nonoperative management showed satisfactory outcomes in 89% of cases overall. Furthermore, 88.90% of solid organ injuries with computed tomography American Association for the Surgery of Trauma (CT-AAST) Grades of III or above were successfully managed with nonoperative management. Conclusions: Nonoperative management shows successful results while allowing us to avoid surgical stress, complications, and financial burdens along with an acceptable morbidity rate and low mortality rate. A high CT-AAST grade of injuries does not warrant surgery, and operative management should be used judiciously.
背景和目的:观察到一种新的范式,即非手术治疗钝性腹部创伤(BAT)优于侵入性手术。据推测,非手术方法在经济上更有效,更安全,成功率更高。评估北印度一家三级护理中心因BAT导致的实体器官损伤从积极手术方法转变为非手术治疗的成功率。材料和方法:进行了一项观察性研究,以评估在北印度一家三级护理中心急诊科就诊的95例BAT患者在12个月内的管理情况。记录手术和非手术治疗,并在72小时评估结果。使用卡方检验分析分类变量;P<0.05表示有显著性差异。结果:在95名患者中,46%的患者年龄在20至40岁之间,84%的患者为男性。最常见的创伤机制是道路交通事故(67%),其次是跌倒。在59%的病例中发现了特定的器官损伤;其中肝损伤占38%,脾损伤占34%。总的来说,所有病例中有21%接受了手术治疗,而79%接受了非手术治疗。89%的病例的非手术治疗结果令人满意。此外,88.90%的美国创伤外科计算机断层扫描协会(CT-AAST)III级或以上的实体器官损伤通过非手术治疗成功。结论:非手术治疗取得了成功,同时避免了手术压力、并发症和经济负担,并具有可接受的发病率和低死亡率。高CT-AAST级别的损伤不需要手术,应明智地使用手术管理。
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引用次数: 0
COVID-19 pandemic and lessons learned for traffic accidents prevention 新冠肺炎大流行和预防交通事故的经验教训
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_2_22
M. Mahdian, M. Atharizadeh
{"title":"COVID-19 pandemic and lessons learned for traffic accidents prevention","authors":"M. Mahdian, M. Atharizadeh","doi":"10.4103/atr.atr_2_22","DOIUrl":"https://doi.org/10.4103/atr.atr_2_22","url":null,"abstract":"","PeriodicalId":45486,"journal":{"name":"Archives of Trauma Research","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45894795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Proficiency of topical platelet-rich plasma with vacuum-assisted closure over platelet-rich plasma alone in diabetic foot ulcers – A clinical, prospective, comparative study 局部富含血小板血浆加真空辅助封闭治疗糖尿病足溃疡的疗效优于单独使用富含血小板血浆的疗效——一项临床、前瞻性、比较研究
IF 0.4 Pub Date : 2022-01-01 DOI: 10.5455/njppp.2022.12.00135202219012022
K. Arora, R. Kapila, P. Chaudhary, Anjali Singhal, A. Patra, S. Kapila
Background and Objectives: Type 2 diabetes mellitus is usually associated with peripheral neuropathy, peripheral vascular disease with consequential limb ischemia, and eventually diabetic foot ulcers (DFUs). The healing process is slow due to microangiopathy and wound is easily infected with microbials leading to superficial infection, progressing to deep infection, and eventually landing in amputation most of the times. Platelet-rich plasma (PRP) is very cost effective, readily available blood derivative and has the capability to stimulate cell proliferation and differentiation. It improves tissue healing and regeneration and exhibit potent activities against a number of pathogens. Vacuum-assisted closure (VAC), on the other hand, is a new novel way to treat DFUs by having negative pressure wound healing. The present study focused on the advantage of (PRP + VAC) dressing over (topical PRP application with its peripheral injection) alone for aiding and enhancing the process of wound healing in DFU. Materials and Methods: This was a prospective comparative study of 100 cases to compare the outcomes of wound healing by topical PRP application with its peripheral injection. Results: Mean time taken for the appearance of granulation tissue, 100% granulation tissue, average reduction in wound surface area, showed significant (P ≥ 0.005) differences between the (PRP + VAC) and the (topical PRP application with its peripheral injection) dressing groups. Conclusions: (PRP + VAC) dressings are more effective than conventional (topical PRP application with its peripheral injection) dressings in wound healing of DFUs.
背景和目的:2型糖尿病通常伴有周围神经病变、周围血管疾病伴肢体缺血,最终伴有糖尿病足溃疡(DFUs)。由于微血管病变,愈合过程缓慢,伤口容易被微生物感染,导致浅表感染,发展为深部感染,最终以截肢为主。富血小板血浆(PRP)是一种成本效益高、容易获得的血液衍生物,具有刺激细胞增殖和分化的能力。它可以促进组织愈合和再生,并对许多病原体表现出强有力的活性。另一方面,真空辅助闭合(VAC)是一种通过负压伤口愈合治疗dfu的新方法。本研究的重点是(PRP + VAC)敷料在帮助和促进DFU伤口愈合过程中的优势,而不是单独(局部应用PRP并周围注射)。材料与方法:本研究是一项前瞻性比较研究,通过100例病例,比较局部应用PRP与外周注射PRP的伤口愈合效果。结果:(PRP + VAC)与(PRP外周注射)敷料组肉芽组织出现的平均时间、100%肉芽组织出现的平均时间、创面面积减少的平均时间差异有统计学意义(P≥0.005)。结论:(PRP + VAC)敷料比常规(PRP外用外周注射)敷料对dfu创面愈合更有效。
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引用次数: 3
A simple mini-fixator for complex thumb fractures 用于复杂拇指骨折的简易迷你固定器
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_33_21
L. Alexander
The role of external fixators in hand injuries is well entrenched, especially in complex, comminuted phalangeal, and metacarpal fractures where internal fixation is not always possible. We describe a simple, low cost, lightweight, and “easy to construct and easy to use” mini-fixator which can be used for complex, comminuted, open, or closed thumb fractures for definitive fixation with consistent and predictable outcomes. These self-made mini-fixators can also be used for other phalangeal and metacarpal fractures. This represents a viable, alternative option to commercially available mini-fixators which are costly, not readily available, and complicated to use.
外固定器在手部损伤中的作用是根深蒂固的,尤其是在复杂的粉碎性指骨和掌骨骨折中,内固定并不总是可行的。我们描述了一种简单、低成本、重量轻、“易于建造和使用”的迷你固定器,可用于复杂、粉碎性、开放性或闭合性拇指骨折,以获得一致和可预测的结果。这些自制的微型固定器也可用于其他指骨和掌骨骨折。这代表了一种可行的、替代商业上可获得的微型固定器的选择,这些固定器成本高昂、不易获得且使用复杂。
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引用次数: 0
Minimally invasive stabilization of an isolated dorsal distal radioulnar joint dislocation using a suture button suspension system 应用缝合扣悬吊系统微创固定孤立性尺桡骨远端背侧关节脱位
IF 0.4 Pub Date : 2022-01-01 DOI: 10.4103/atr.atr_76_21
S. Kokly, M. Aarabi, A. Castagna, Behnam Ariaeefar
Isolated dislocation of distal radioulnar joint (DRUJ) is rare. The first choice of treatment is closed reduction and casting. If it is unsuccessful, operative intervention is the next step. In this report, we present a patient suffering from an unstable DRUJ dorsal dislocation after attempting closed reduction under general anesthesia. The instability was confirmed clinically and radiologically. The surgical treatment included a minimally invasive stabilization technique in which a suture button suspension system was applied to the extra-articular part of a DRUJ. At a 6-month follow-up, a pain-free full range of motion of forearm and stable DRUJ were achieved. Level of evidence: 4.
孤立性尺桡关节脱位是罕见的。首选的处理方式是闭式还原和铸造。如果不成功,手术干预是下一步。在本报告中,我们介绍了一名患者在全麻下尝试闭合复位后,出现不稳定的DRUJ背侧脱位。临床和放射学证实了这种不稳定性。手术治疗包括微创稳定技术,其中缝合按钮悬挂系统应用于DRUJ的关节外部分。在6个月的随访中,前臂获得了无痛的全范围运动和稳定的DRUJ。证据级别:4。
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引用次数: 0
Epidemiology, incidence, and trend of injuries in Iran: A national study 伊朗的流行病学、发病率和伤害趋势:一项全国性研究
IF 0.4 Pub Date : 2021-12-22 DOI: 10.21203/rs.3.rs-1159880/v1
H. Akbari, M. Mahdian, M. Motalebi, F. Asgarian
Introduction: Injuries are one of the well-known leading causes of disability and mortality in all societies. This study aims to determine the incidence and trend of injuries and their epidemiologic characteristics in Iran. Methods: In a cross-sectional study, injury fatality data from 2008 to 2016 were obtained from the registry of the Ministry of Health and Medical Education (Iran) and analyzed to determine the epidemiological pattern of injuries. Data were analyzed using descriptive analysis. Excel and the statistical package of SPSS version 22 were used for data analysis. P ≤ 0.05 was considered statistically significant. Results: The highest incidence of injuries was related to traffic injuries with 546.4/100,000 population, followed by trauma and falls from heights with 497.7 and 195.2/100,000 population, respectively. The highest incidence of traffic injuries in Iran had occurred in 2011 with 628.1/100,000 population. Conclusion: Regarding the high incidence of injuries, especially traffic crashes, traumas, and falls, the priorities for close monitoring of these injuries during the high-risk periods to decrease and control the rate of the injuries strongly felt.
引言:在所有社会中,受伤是众所周知的导致残疾和死亡的主要原因之一。本研究旨在确定伊朗受伤的发生率、趋势及其流行病学特征。方法:在一项横断面研究中,从伊朗卫生和医学教育部登记处获得2008年至2016年的伤害致死数据,并进行分析,以确定伤害的流行病学模式。使用描述性分析对数据进行分析。数据分析采用Excel和SPSS 22统计软件包。P≤0.05被认为具有统计学意义。结果:受伤发生率最高的是交通伤害,为546.4/10万人,其次是创伤和高处坠落,分别为497.7人和195.2/10万人。2011年,伊朗的交通伤害发生率最高,为628.1/10万人口。结论:关于受伤的高发率,特别是交通事故、创伤和跌倒,强烈认为在高风险时期密切监测这些受伤情况以降低和控制受伤率是当务之急。
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引用次数: 1
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Archives of Trauma Research
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