ABSTRACT
Objective To evaluate the efficacy of ultrasound-guided continuous brachial plexus block for analgesia after fixation of upper extremity fractures in the pediatric patients.Methods Sixty American Society of Anesthesiologists physical status Ⅰ pediatric patients of both sexes,aged 3-10 yr,weighing 13-46 kg,with body height of 97-152 cm,scheduled for open reduction and internal fixation of distal humeral fractures,were selected and divided into 2 groups (n =30 each) using a random number table:intravenous analgesia group (group Ⅴ) and continuous brachial plexus block group (group B).Surgery was completed under brachial plexus block combined with general anesthesia in the two groups.At the end of surgery,patient-controlled intravenous analgesia was used in group Ⅴ,and continuous brachial plexus block was performed with 0.1％ ropivacaine 250 ml (background infusion 0.1 ml · kg-1 · h-1,bolus dose 0.2 ml/kg,lockout interval 30 min) in group B.Tramadol was given as rescue analgesic when necessary.Ramsay sedation scores were assessed and recorded at 2,4,8,12,24,36 and 48 h after surgery,and the development of over-sedation was recorded.The require,nent for rescue analgesics and development of respiratory depression,dizziness,nausea and vomiting,pruritus and urinary retention during analgesia were recorded.The development of adverse reactions such as vascular and nerve injury,local hematoma and pneumothorax was recorded in group B.Family's satisfaction with analgesia was assessed and scored.Results Compared with group Ⅴ,Ramsay sedation scores at 2-12 h after surgery,the incidence of oversedation,nausea and dizziness and requirement for tramadol were significantly decreased (P＜0.05),and no significant change was found in the degree of family's satisfaction with analgesia in group B (P＞ 0.05).The adverse reactions such as vascular and nerve injury,local hematoma or pneumothorax were not found in group B.Conclusion Ultrasound-guided continuous brachial plexus block can be safely and effectively used for analgesia after fixation of upper extremity fractures in the pediatric patients.
ABSTRACT
BACKGROUND:Autologous island flap transplantation is the main therapy for burn scars. Floating and necrosis of transplanted flaps mainly impact the therapeutic effects. Dexamethasone has immunoregulatory function during trauma and stress process. OBJECTIVE:To investigate the effect of dexamethasone on immune balance of Th1/Th2 and prognosis in patients with burn scars undergoing autologous island flap transplantation. METHODS:Sixty-eight patients with burn scars undergoing transplantation of pedicled island flap were selected and randomly divided into control group and experimental group. Patients in the two groups were treated with negative pressure drainage under skin flap, infection prevention, improvement of microcirculation. After that, dexamethasone sodium phosphate (0.2 mg/kg) was immediately given in the experimental group, and the dose gradualy decreased after 3 days until drug withdrawal at 7 days. Levels of Th1, Th2, Th1/Th2 and interferon-γ, interleukin-4 were compared between the two groups before and 1 week after transplantation. In addition, incidence rates of skin flap necrosis, hemodynamic disorder, and effusion were compared between the two groups. RESULTS AND CONCLUSION:The levels of Th1, Th2, Th1/Th2, interferon-γ and interleukin-4 had no obvious differences between the two groups before flap transplantation. At 1 week after transplantation, the levels of Th1 and Th1/Th2 were higher, while the levels of Th2, interferon-γ and interleukin-4 were lower in the experimental group than the control group. Moreover, the incidence of complications was also lower in the experimental group than the control group. In conclude, dexamethasone can decrease the incidence of complications after island flap transplantation, which is maybe the result of adjusting immune balance of Th1/Th2.
ABSTRACT
Objective To discuss the effect of expanded deltopectoral skin flaps in repairing scar contracture deformity of facio-cervical .Methods Twenty-four patients with scar contracture deformity of faciocervical were included into the study .We expanded the deltopectoral skin flap with dilator .8-10 weeks later ,the deltopectoral skin flap were transferred after resection of faciocervical scar .3-4 weeks later ,the pedicles were cut off ,and then the remaining wound were repaired .Results They had not exudation .Ex-pander exposure ,local hematoma and local infection respectively were 1 ,3 ,4 cases ,all did not affect operation effect by symptomatic treatment ,and obtain good postoperative effect .Deltopectoral flap was for 27 cases ,blood supply obstruction low temperature and skin flap necrosis respectively were 4 ,2 ,1 cases ,all get good healing after corresponding .Followed up for 0 .5 year ,all flaps were survived well ,no ectropion or mental cervical adhesion ,its color and texture were similar with surrounding normal skin appearance , so they were got high satisfaction .Conclusion Application of expanded deltopectoral skin flaps to repair scar contracture deformity of faciocervical can achieve good effect and may be an ideal method to repair ,which is worthy of clinical application .