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Painkillers in the outpatient surgery setting Instructions for use of instructions 止痛药在门诊手术设置的使用说明
Pub Date : 2018-12-04 DOI: 10.21518/1995-1477-2018-3-4-6-11
D. S. Zubkov
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引用次数: 0
Treatment of lower extremity telangiectasias by thermocoagulation method using TS-3000 apparatus TS-3000型热凝治疗下肢毛细血管扩张
Pub Date : 2018-06-20 DOI: 10.21518/1995-14772018-1-2-72-79
Е. П. Бурлева, М. В. Эктова, С. М. Беленцов, С. А. Чукин, С. Е. Макаров, Б. А. Веселов
Objective: this paper aims at studying the efficacy of the thermocoagulation (TCG) method using TC-3000 apparatus for the treatment of lower extremity telangiectasias. Materials and methods. The TCG method has been used in 145 patients (223 cases) with telangiectasias (TA) and reticular veins (RV) of the lower extremities for 2 years. 17 patients (11.7%) had classes C1, 2 chronic venous diseases (CHV), and they underwent correction of pathological refluxes in the subcutaneous and perforating veins prior to TCG. Out of 128 patients with class C1 CHV, 25 people (19.5%) underwent microsclerotherapy (MST) in the past, just before the TCG procedure or in combination with it, MST was performed in 46 (35.9%). MST was performed for RV situated outside or within TA areas, and also was performed for TA from 0.6 to 1.0 mm in diameter. The TCG procedures were performed using TC-3000 (Belgium) apparatus, which operation is based on the impact of high-frequency electromagnetic field (4 MHz) on the dilated vessels in the skin. Needles made of nickel with a working diameter of 0.150 mm were used. Thermocoagulation was applied for the treatment of TA with a diameter of 0.3 mm to 0.6 mm. The results were evaluated within the following time-limits: 3 months (64 patients/97 limbs), 6 months (72/110), 12 months (70/107). Results of the treatment. The patients reported the results of the treatment as «no change and worse» in 73.4% of cases, pigmentation was detected in 73.2%, and residual TA in 81.4% of cases 3 months following the treatment. According to subjective assessment, the results were reported as «excellent» + «better» in 47.2%, pigmentation phenomena and residual TA were observed in 50.0% and in 50.9% of cases 6 months following the treatment. According to subjective assessment, the results were reported as «excellent» + «better» in 75.7%, pigmentation in 14.9%, residual TA in 13.1%, relapses TA in 14.0% 12 month following the treatment. Conclusion. 13.1% of patients with TA showed tolerance towards TCG. A positive effect included the absence of registered necrosis of the skin 3 months following the treatment, as well as atrophic and hypertrophic scars 12 months following the treatment.
目的:探讨TC-3000器械热凝(TCG)法治疗下肢毛细血管扩张的疗效。材料和方法。采用TCG法治疗下肢毛细血管扩张症(TA)和网状静脉症(RV) 145例(223例)2年。17例(11.7%)患有C1、2级慢性静脉疾病(CHV),在TCG前接受了皮下和穿静脉病理性反流的纠正。在128例C1级CHV患者中,25例(19.5%)患者在TCG手术前或与TCG联合接受了微硬化治疗(MST),其中46例(35.9%)患者接受了MST治疗。MST用于位于TA区域外或内的RV,也用于直径0.6至1.0 mm的TA。TCG手术采用TC-3000(比利时)设备,其操作是基于高频电磁场(4mhz)对皮肤扩张血管的冲击。使用镍制成的针,工作直径为0.150 mm。热凝法处理直径为0.3 mm ~ 0.6 mm的TA。随访时间分别为3个月(64例/97条肢体)、6个月(72/110)、12个月(70/107)。治疗结果。73.4%的患者报告治疗结果为“无变化且更糟”,73.2%的患者检测到色素沉着,81.4%的患者在治疗3个月后发现残留TA。根据主观评价,47.2%的患者报告为“优秀”+“较好”,50.0%和50.9%的患者在治疗6个月后观察到色素沉着现象和残余TA。根据主观评价,75.7%的患者评价为“优秀”+“较好”,14.9%的患者评价为色素沉着,13.1%的患者评价为残留TA, 14.0%的患者评价为治疗后12个月TA复发。结论:13.1%的TA患者对TCG有耐受。积极的影响包括治疗后3个月没有皮肤坏死,治疗后12个月没有萎缩和增生性疤痕。
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引用次数: 2
Профилактика венозных тромбоэмболических осложнений в хирургии 预防手术中的静脉栓塞并发症
Pub Date : 2018-06-20 DOI: 10.21518/1995-14772018-1-2-20-25
М. Р. Кузнецов, Иван Петрович Марченко, Е. Е. Федоров
В статье разбираются эпидемиологические данные о частоте венозных тромбоэмболических осложнений (ВТЭО) в хирургии. Представлены группы риска в зависимости от клинических характеристик пациента, видов хирургических операций, основные меры первичной профилактики данного осложнения. Обсуждаются методы стимуляции венозного кровотока в нижних конечностях, различные возможные антикоагулянты, которые могут использоваться для этих целей. Показывается большая антитромботическая эффективность и безопасность низкомолекулярных гепаринов (НМГ) по сравнению с нефракционированным гепарином (НФГ), преимущество низкомолекулярных гепаринов с максимально низкой массой. Обсуждается длительность первичной профилактики, в т. ч. у онкологических больных. Приводятся данные о возможности применения НМГ с наименьшей массой - бемипарина у пациентов со спинальной анальгезией и его положительное влияние на общую выживаемость при онкологических заболеваниях.
这篇文章描述了外科手术中静脉栓塞并发症频率的流行病学数据。风险群体根据病人的临床特征、外科手术类型、对并发症的基本预防措施而异。讨论了下肢血管刺激的方法,可能用于这些目的的各种抗凝血剂。低分子肝素(hmg)的抗血栓效率和安全性相对于无武器肝素(nfg),显示低分子肝素的最大质量。目前正在讨论癌症患者的初级预防性持续时间。有证据表明,脊髓痛患者的hmg含量最低,对癌症患者的整体存活率有积极影响。
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引用次数: 2
Therapeutic potential of sulfathiazole silver for topical treatment of wound infection 磺胺噻唑银局部治疗伤口感染的治疗潜力
Pub Date : 2018-06-20 DOI: 10.21518/1995-14772018-1-2-42-51
A. V. Rodin, V. Privolnev, A. Barsukov
This article discusses the advantages and disadvantages of using silver compound-based preparations for topical treatment of wound infections. Comparative clinical studies showed the advantages of topical silver preparations that were used to treat the wound process. It also describes the advantages of sulfathiazole silver as a topical agent for the topical treatment of wound infections.
本文讨论了使用银化合物基制剂局部治疗伤口感染的优点和缺点。比较临床研究表明,局部银制剂用于治疗创面过程的优势。它还描述了磺胺噻唑银作为局部治疗伤口感染的局部剂的优点。
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引用次数: 2
Anesthesia in outpatient phlebology practice 麻醉在门诊静脉实践中的应用
Pub Date : 2018-06-20 DOI: 10.21518/1995-14772018-1-2-52-56
O. Bukina, A. A. Sinitsin
Tumescent and/or conductive anaesthesia is the most frequently performed procedure to anesthetize the thermal types of surgical interventions, mini-phlebectomy and stripping of subcutaneous veins in outpatient settings. These interventions have become a common outpatient procedure almost everywhere, which made the issue of local anaesthesia more sensitive over the past 5 years in Russia. The aim is to compare the efficacy, safety and comfort when injecting various anaesthetic solutions to relieve pain during endovenous laser obliteration/radio frequency catheter ablation, stripping of the subcutaneous veins and mini-phlebectomy. Searching method. We searched for original articles in PubMed, in the archives of «Phlebology» and «Angiology and Vascular Surgery» journals issued for the period between 2001 and November 2018 and the search for official instructions in the state register of medicinal products. Selection criteria. We included all comparative studies: randomized and non-randomized, in which pain was assessed both during injection of a tumescent solution before EVLO and/or mini-phlebectomy and during surgery, as well as systematic reviews and monographs. Data analysis. In total, we identified 9 studies: 7 randomized and 2 non-randomized, one systematic review and two monographs. The advantage of a buffered solution over unbuffered one in terms of reducing pain during injection is revealed in three randomized, one simple comparative study and on the basis of systematic review data. A great efficacy of combining tumescent anaesthesia with a femoral nerve blockade, which was equivalent to spinal anaesthesia, was found in 4 randomized trials, two of which were double-blind, and one non-randomized. In addition, a smaller degree of motor block was reported after blocking the femoral nerve in comparison with spinal anaesthesia. In one randomized trial in which pain was assessed using cold and warm solutions, no significant differences in pain were observed either during or after surgery. In order to prepare a tumescent solution, lidocaine, prilocaine and mepivacaine were used at concentrations ranging from 0.028% to 0.2%; the advantages of higher concentrations over the lower ones have not been revealed. No adverse reactions and complications of anaesthesia have been reported in the studies, except for one where methaemoglobinemia of mild degree was detected in a small number of patients when using 0.2% prilocaine. The conclusion. Local anaesthesia, namely, conductive and tumescent anaesthesia, is an effective and safe anaesthesia method in outpatient surgery. Even very low concentrations of anaesthetic solutions are effective for tumescent anaesthesia. The use of buffered solutions increases significantly patient comfort during the injection. The combination of tumescent anaesthesia and femoral nerve block increases the effectiveness of anaesthesia. The femoral nerve block has significant advantages in comparison with spinal anaesthesia in terms
肿胀和/或传导麻醉是门诊环境中最常用的麻醉方法,用于麻醉热手术干预、小静脉切除术和剥离皮下静脉。这些干预措施已经成为一种常见的门诊程序几乎无处不在,这使得局部麻醉的问题在过去的5年里在俄罗斯更加敏感。目的是比较各种麻醉溶液在静脉内激光闭塞/射频导管消融、皮下静脉剥离和小静脉切除术中缓解疼痛的有效性、安全性和舒适性。搜索方法。我们在PubMed上检索了2001年至2018年11月期间出版的“静脉学”和“血管学和血管外科”期刊档案中的原始文章,并在国家药品注册中检索了官方说明。选择标准。我们纳入了所有的比较研究:随机和非随机,在EVLO和/或小静脉切除术前注射肿胀溶液和手术期间评估疼痛,以及系统评价和专著。数据分析。我们总共纳入了9项研究:7项随机研究和2项非随机研究,1项系统综述和2篇专著。缓冲溶液相对于非缓冲溶液在减少注射时疼痛方面的优势是在三个随机的,一个简单的比较研究和系统评价数据的基础上揭示的。在4项随机试验中发现,肿胀麻醉与股神经阻滞联合使用的效果与脊髓麻醉相当,其中2项为双盲试验,1项为非随机试验。此外,与脊髓麻醉相比,阻断股神经后的运动阻滞程度较小。在一项随机试验中,使用冷溶液和热溶液评估疼痛,在手术期间和手术后都没有观察到明显的疼痛差异。用浓度为0.028% ~ 0.2%的利多卡因、丙罗卡因和甲哌卡因配制肿胀溶液;高浓度相对于低浓度的优势尚未被揭示。除少数患者在使用0.2%丙洛卡因时发现轻度甲基血红蛋白血症外,所有研究均未报告麻醉不良反应和并发症。结论。局部麻醉,即传导麻醉和肿胀麻醉,是门诊手术中一种有效、安全的麻醉方法。即使很低浓度的麻醉溶液对肿胀麻醉也是有效的。缓冲溶液的使用显著增加了注射过程中患者的舒适度。肿胀麻醉与股神经阻滞相结合可提高麻醉效果。与脊髓麻醉相比,股神经阻滞在安全性方面具有显著优势。
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引用次数: 0
Pharmacotherapy of chronic venous insufficiency of the lower extremities 下肢慢性静脉功能不全的药物治疗
Pub Date : 2018-06-20 DOI: 10.21518/1995-14772018-1-2-26-31
O. Dzhenina, V. N. Lobanov, B. S. Gordeev
Chronic venous insufficiency (CVI) is the most common pathology of the peripheral vascular system. One of the main principles of conservative treatment for both small and complicated forms is pharmacotherapy with the use of venoactive drugs. The effectiveness of therapy is largely associated with the choice of phlebotrophic drug. The article discusses approaches to systemic and topical drug therapy depending on the form and stage of CVI.
慢性静脉功能不全(CVI)是周围血管系统最常见的病理。小型和复杂形式的保守治疗的主要原则之一是使用静脉活性药物进行药物治疗。治疗的效果在很大程度上与药物的选择有关。本文讨论了根据CVI的形式和分期进行全身和局部药物治疗的方法。
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引用次数: 1
Conservative treatment of chronic obliterating diseases of lower limb arteries 慢性下肢动脉闭塞性疾病的保守治疗
Pub Date : 2018-06-20 DOI: 10.21518/1995-14772018-1-2-14-19
V. Bogachev, B. Boldin, S. V. Rodionov, P. Turkin
The incidence of peripheral arteries atherosclerosis varies in the general population between 3 to 10%, increasing to 15 to 20% in patients older than 70 years. Due to the high and constantly increasing prevalence, chronic obliterating diseases of lower limbs arteries (CODLLA) constitute an important medical and socioeconomic problem that cannot be solved only through wide introduction and application of various innovative surgical technologies. The fact is that even the most modern and knowledge-intensive surgical interventions do not exert a fundamental influence on the principles of the CODLLA pathogenesis. Moreover, there is no doubt that the success of arterial reconstruction and its prolongation are largely determined by adequate conservative treatment, the principles of which are discussed in this article.
外周动脉粥样硬化的发病率在一般人群中为3% ~ 10%,在70岁以上的患者中增加到15% ~ 20%。下肢动脉慢性闭塞性疾病(chronic oblidative diseases of lower limbs artery, codla)发病率高且持续上升,是一个重要的医学和社会经济问题,仅通过广泛引进和应用各种创新手术技术是无法解决的。事实是,即使是最现代和知识密集型的手术干预也不会对codla发病原理产生根本影响。此外,毫无疑问,动脉重建的成功及其延长在很大程度上取决于适当的保守治疗,本文讨论了保守治疗的原则。
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引用次数: 2
Choosing conservative therapy in acute hemorrhoids 选择保守治疗急性痔疮
Pub Date : 2018-06-20 DOI: 10.21518/1995-14772018-1-2-57-63
L. Blagodarny, M. V. Abritsova, S. N. Zhdankina
The article presents the results of conservative therapy in patients with acute hemorrhoids over a 7-day follow-up period. A prospective, randomized study was based on the evidence base for the efficacy of the micronized purified flavonoid fraction (MPFF) used for the treatment of patients with hemorrhoidal disease. The use of MPFF in patients with acute hemorrhoids showed a statistically significant reduction of pain intensity, analgesics consumption, and intensity of bleeding.
文章介绍了保守治疗在急性痔疮患者超过7天的随访期的结果。一项前瞻性,随机研究是基于证据基础的微粉纯化类黄酮提取物(MPFF)用于治疗痔疮患者的疗效。急性痔疮患者使用MPFF后,疼痛强度、镇痛药用量和出血强度均有统计学意义的降低。
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引用次数: 4
Stationary replacement technologies in the surgical treatment of simultaneous pathology in gynecological patients 固定式替代技术在妇科患者同步病理手术治疗中的应用
Pub Date : 2018-06-20 DOI: 10.17116/REPRO201723645-53
A. N. Shikhmetov, A. A. Pazichev, A. M. Zadikjan
The authors analyzed the results of simultaneous operations in 238 patients with regard to the combined surgical and gynecological pathology performed in the hospital-replacing environment of the ВСDС of PAO «Gazprom». Previously, all patients were assigned to the sequence of stages, the location of trocars, taking into account the additional stages of the operation, the position of the monitor, the location of the operating team, the position of the patient on the operating table during each stage. Performing simultaneous laparoscopic operations does not lead to an increase in the number of intra- and postoperative complications in comparison with isolated interventions and is not accompanied by great technical difficulties, but causes a somewhat longer duration (on average, 20.6 ± 1.5 min), which, in our opinion , is not critical for anesthesia. There were no significant differences in the course of the early postoperative period and the intensity of the functional systems of the body. Advantages of simultaneous operations are undeniable: two or three surgical diseases are cured simultaneously, progression or serious complication of the disease is prevented, operative treatment of which would be postponed for a later period, the risk of repeated surgery and anesthesia is eliminated, the time of total stay of the patient in the hospital and subsequent treatment is reduced, economic efficiency of treatment is increased.
作者分析了238例在医院替代PAO«Gazprom»ВСDС环境下进行的外科和妇科联合病理同时手术的结果。在此之前,考虑到手术的附加阶段、监护仪的位置、手术团队的位置、患者在每个阶段在手术台上的位置,所有患者都被分配到阶段的顺序、套管针的位置。与单独干预相比,同时进行腹腔镜手术不会导致术中和术后并发症的增加,也没有很大的技术困难,但会导致较长的持续时间(平均20.6±1.5分钟),我们认为这对麻醉来说不是关键。两组术后早期病程及机体功能系统强度无明显差异。同时手术的优点是不可否认的:同时治愈两种或三种外科疾病,防止疾病的进展或严重并发症,将手术治疗推迟一段时间,消除了重复手术和麻醉的风险,减少了患者在医院的总住院时间和后续治疗,提高了治疗的经济效益。
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引用次数: 1
期刊
Ambulatory surgery: hospital-replacing technologies
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