{"id":741,"date":"2023-07-05T15:45:50","date_gmt":"2023-07-05T07:45:50","guid":{"rendered":"http:\/\/longmed-medical.com\/?p=741"},"modified":"2023-12-21T14:17:16","modified_gmt":"2023-12-21T06:17:16","slug":"zip-stitch-longmed-wound-closure-device","status":"publish","type":"post","link":"https:\/\/longmed-medical.com\/cs\/zip-stitch-longmed-wound-closure-device\/","title":{"rendered":"Randomizovan\u00e1 studie se zap\u00edn\u00e1n\u00edm na zip Longmed"},"content":{"rendered":"
\n\t\t\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t

Randomizovan\u00e1 studie se zap\u00edn\u00e1n\u00edm na zip Longmed<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t

Randomizovan\u00e1 studie nov\u00e9ho neinvazivn\u00edho za\u0159\u00edzen\u00ed na uzav\u00edr\u00e1n\u00ed k\u016f\u017ee zipov\u00fdm stehem pro pou\u017eit\u00ed po vrozen\u00fdch srde\u010dn\u00edch operac\u00edch<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Yuki Tanaka, MD, Takashi Miyamoto, MD, PhD, Yuji Naito, MD, PhD, <\/b><\/strong><\/p>

Shuichi Yoshitake, MD, Akihiro Sasahara, MD, a Kagami Miyaji, MD, PhD <\/b><\/strong><\/p>

Odd\u011blen\u00ed kardiovaskul\u00e1rn\u00ed chirurgie, Gunma Children's Medical Center, Shibukawa; a Klinika kardiovaskul\u00e1rn\u00ed chirurgie,<\/p>

Univerzitn\u00ed nemocnice Kitasato, Sagamihara, Japonsko<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Longmed\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Pozad\u00ed:<\/p>

Hl\u00e1s\u00edme nov\u00fd neinvazivn\u00ed Zip Stitch Longmed za\u0159\u00edzen\u00ed na uzav\u00edr\u00e1n\u00ed r\u00e1ny<\/a> (ZheJiang Longmed Medical Technology Co., Ltd.,). Toto za\u0159\u00edzen\u00ed je pova\u017eov\u00e1no za za\u0159\u00edzen\u00ed s dobr\u00fdmi kosmetick\u00fdmi v\u00fdsledky po operac\u00edch a zkracuje dobu operace. V t\u00e9to studii bylo uzav\u0159en\u00ed k\u016f\u017ee pomoc\u00ed za\u0159\u00edzen\u00ed Closure srovn\u00e1v\u00e1no se subkutikul\u00e1rn\u00edmi stehy a byla hodnocena u\u017eite\u010dnost a bezpe\u010dnost tohoto nov\u00e9ho za\u0159\u00edzen\u00ed.<\/p>

Metody:<\/p>

Jednalo se o prospektivn\u00ed, randomizovanou studii 214 pacient\u016f, kte\u0159\u00ed podstoupili srde\u010dn\u00ed operace prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie od \u010dervna 2014 do prosince 2015. U 136 pacient\u016f se jednalo o prvn\u00ed opera\u010dn\u00ed skupinu, z toho 71 pacient\u016f podstoupilo za\u0159\u00edzen\u00ed na uz\u00e1v\u011br r\u00e1ny (Closure group) a 65 pacienti podstoupili subkutikul\u00e1rn\u00ed stehy (skupina steh\u016f). U 78 pacient\u016f se jednalo o reopera\u010dn\u00ed skupinu, z toho 42 pacient\u016f ve skupin\u011b Closure a 36 pacient\u016f ve skupin\u011b sutury. Kosmetick\u00e9 v\u00fdsledky pomoc\u00ed Vancouver Scar Scale byly hodnoceny samostatn\u011b v prvn\u00ed opera\u010dn\u00ed skupin\u011b a reopera\u010dn\u00ed skupin\u011b.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

V\u00fdsledek:<\/p>

Mezi skupinou prvn\u00ed operace (p < 0,001) a skupinou reoperace (p [ 0,007) byly signifikantn\u00ed rozd\u00edly v celkov\u00e9m sk\u00f3re Vancouver Scar Scale. Doba uzav\u0159en\u00ed k\u016f\u017ee byla signifikantn\u011b krat\u0161\u00ed ve skupin\u011b s uzav\u0159en\u00edm ne\u017e ve skupin\u011b se suturou (113,0 \u00b1 9,1 sekund vs. 375,9 \u00b1 60,2 sekund, p < 0,001). Mezi skupinami nebyly nalezeny \u017e\u00e1dn\u00e9 signifikantn\u00ed rozd\u00edly, pokud jde o m\u00edru infekce m\u00edsta chirurgick\u00e9ho z\u00e1kroku. Mezi komplikace typick\u00e9 pro toto za\u0159\u00edzen\u00ed pat\u0159ilo zbarven\u00ed k\u016f\u017ee(0,9%), epidermol\u00fdza (0,9%) a exfoliace za\u0159\u00edzen\u00ed (1,8%); nedo\u0161lo v\u0161ak k \u017e\u00e1dn\u00fdm z\u00e1va\u017en\u00fdm komplikac\u00edm.<\/span><\/p>\n

<\/p>\n

Z\u00e1v\u011bry:<\/p>

P\u0159i vrozen\u00fdch srde\u010dn\u00edch operac\u00edch prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie bylo za\u0159\u00edzen\u00ed pro uz\u00e1v\u011br r\u00e1ny an vynikaj\u00edc\u00ed volba pro zlep\u0161en\u00ed kosmetick\u00e9ho vzhledu a zkr\u00e1cen\u00ed doby uzav\u0159en\u00ed r\u00e1ny. Nav\u00edc se uk\u00e1zalo, \u017ee jde o za\u0159\u00edzen\u00ed, kter\u00e9 lze bezpe\u010dn\u011b pou\u017e\u00edvat.<\/span><\/p>\n

(Ann Thorac Surg 2016; 102: 1368\u201374) 2016 od The Society of Thoracic Surgeons<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Infekce v m\u00edst\u011b chirurgick\u00e9ho z\u00e1kroku a hypertrofick\u00e9 jizvy jsou hlavn\u00edmi komplikacemi poopera\u010dn\u00ed r\u00e1ny, kter\u00e9 se n\u011bkdy mohou objevit po kardiovaskul\u00e1rn\u00edch operac\u00edch [1\u20133]. Bylo pops\u00e1no pou\u017eit\u00ed n\u011bkolika za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed k\u016f\u017ee, jako je kyanoakryl\u00e1tov\u00e9 lepidlo a chirurgick\u00e9 svorky [4\u20136] a bylo prok\u00e1z\u00e1no, \u017ee tato za\u0159\u00edzen\u00ed maj\u00ed dobr\u00fd potenci\u00e1l zkr\u00e1tit dobu uzav\u0159en\u00ed k\u016f\u017ee, zlep\u0161it kosmetick\u00fd vzhled a sn\u00ed\u017eit m\u00edru infekce. . Za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed r\u00e1ny (ZheJiang Longmed Medical Technology Co., Ltd.) je nov\u00e9, neinvazivn\u00ed za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed k\u016f\u017ee s kone\u010dnou vrstvou, kter\u00e9 sni\u017euje potenci\u00e1l\u00a0pro komplikace r\u00e1ny [7, 8].<\/span><\/p>

Koncepce v\u00fdvoje za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed r\u00e1ny zipem Longmed spo\u010d\u00edvala ve zkr\u00e1cen\u00ed doby uzav\u0159en\u00ed k\u016f\u017ee a prevenci hypertrofick\u00e9 jizvy po operaci. A\u010dkoli pou\u017eit\u00ed uzav\u00edrac\u00edho za\u0159\u00edzen\u00ed bylo hl\u00e1\u0161eno v jin\u00fdch oblastech ne\u017e kardiovaskul\u00e1rn\u00ed chirurgie, neexistuj\u00ed \u017e\u00e1dn\u00e9 zpr\u00e1vy o pou\u017eit\u00ed uzav\u00edrac\u00edho za\u0159\u00edzen\u00ed k uzav\u0159en\u00ed chirurgick\u00fdch ran u vrozen\u00fdch pacient\u016f, u kter\u00fdch byla provedena st\u0159edn\u00ed sternotomie. V t\u00e9to studii jsme hodnotili, zda je za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed r\u00e1ny u\u017eite\u010dn\u00fdm a bezpe\u010dn\u00fdm za\u0159\u00edzen\u00edm k uzav\u0159en\u00ed\u00a0chirurgick\u00e9 \u0159ezy<\/a> u vrozen\u00fdch pacient\u016f po kardiovaskul\u00e1rn\u00edch operac\u00edch prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie.<\/span><\/p>

\u00a0<\/p>

Ke zve\u0159ejn\u011bn\u00ed p\u0159ijato 23. b\u0159ezna 2016.<\/p>

Korespondenci adresujte Dr. Tanakovi, Odd\u011blen\u00ed d\u011btsk\u00e9 srde\u010dn\u00ed chirurgie, Gunma Children's Medical Center, 779 Shimohakoda, Hokkitsumati, Shibukawa, Gunma 377-8577, Japonsko; e-mail: tfjgp484@yahoo.co.jp.<\/span><\/p>

2016 od Spole\u010dnosti hrudn\u00edch chirurg\u016f 0003-4975\/$36.00 Vydalo nakladatelstv\u00ed Elsevier<\/span><\/p>

\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Pacienti a metody<\/p>

V\u00fdzkumn\u00fd protokol pro tuto studii o za\u0159\u00edzen\u00ed na uzav\u00edr\u00e1n\u00ed r\u00e1ny byl schv\u00e1len Radou pro hodnocen\u00ed studi\u00ed v na\u0161\u00ed instituci v souladu s Helsinskou deklarac\u00ed.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Pacienti a design studie<\/p>

Studie za\u0159\u00edzen\u00ed pro uz\u00e1v\u011br r\u00e1ny zahrnovala 238 pacient\u016f, kte\u0159\u00ed n\u00e1sledn\u011b podstoupili srde\u010dn\u00ed operace prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie od \u010dervna 2014 do \u0159\u00edjna 2015 na odd\u011blen\u00ed kardiovaskul\u00e1rn\u00ed chirurgie Gunma Children's Medical Center v Shibukawa, Japonsko. Za\u0159azen\u00ed pacienti byli n\u00e1hodn\u011b rozd\u011bleni do skupiny pom\u016fcek pro uz\u00e1v\u011br r\u00e1ny (skupina s uz\u00e1v\u011brem) nebo do skupiny subkutikul\u00e1rn\u00edch steh\u016f (skupina sutur) pomoc\u00ed vypo\u010d\u00edtan\u00e9 jednoduch\u00e9 randomizace a byli studov\u00e1ni\u00a0prospektivn\u011b (obr. 1). V\u0161ichni pacienti poskytli p\u00edsemn\u00fd informovan\u00fd souhlas s \u00fa\u010dast\u00ed.<\/span><\/p>

Pacienti, kte\u0159\u00ed podstoupili opo\u017ed\u011bn\u00fd uz\u00e1v\u011br hrudn\u00ed kosti, a ti, kte\u0159\u00ed m\u011bli chromozom\u00e1ln\u00ed abnormalitu jinou ne\u017e trizomii 21, byli ze studie vylou\u010deni, aby se hodnocen\u00ed v t\u00e9to studii zjednodu\u0161ilo. Ze studie bylo vylou\u010deno 20 pacient\u016f, kte\u0159\u00ed m\u011bli opo\u017ed\u011bn\u00fd uz\u00e1v\u011br hrudn\u00ed kosti, 1 pacient, kter\u00fd m\u011bl chromozom\u00e1ln\u00ed abnormalitu jinou ne\u017e trizomii 21, a 3 pacienty, kte\u0159\u00ed zem\u0159eli do 3 m\u011bs\u00edc\u016f po operaci, tak\u017ee v t\u00e9to studii z\u016fstalo 214 pacient\u016f. Pacienti s reoperac\u00ed a pacienti s trizomi\u00ed 21 byly zahrnuty.<\/p>

Byly shrom\u00e1\u017ed\u011bny demografick\u00e9 \u00fadaje a klinick\u00e9 charakteristiky, kter\u00e9 zahrnovaly pohlav\u00ed, v\u011bk, t\u011blesnou hmotnost, zda pacient m\u011bl Down\u016fv syndrom nebo byl kojenec \u010di novorozenec, d\u00e9lku opera\u010dn\u00ed r\u00e1ny, celkovou dobu operace a mno\u017estv\u00ed krv\u00e1cen\u00ed. V\u00fdsledky analyzovan\u00e9 v t\u00e9to studii zahrnovaly kosmetick\u00fd vzhled, dobu uzav\u0159en\u00ed k\u016f\u017ee a m\u00edru komplikac\u00ed.<\/p>

214 pacient\u016f bylo rozd\u011bleno do skupiny prvn\u00ed operace (FO) nebo skupiny reoperace (RO) a ka\u017ed\u00e1 skupina byla analyzov\u00e1na na kosmetick\u00fd vzhled. V\u0161ichni pacienti v\u0161ak byli shrom\u00e1\u017ed\u011bni, aby se porovnaly doby uzav\u0159en\u00ed k\u016f\u017ee a \u010detnost komplikac\u00ed mezi skupinou s uzav\u0159en\u00edm a skupinou se suturou. P\u0159edem jsme analyzovali potenci\u00e1ln\u00ed komplikace typick\u00e9 pro za\u0159\u00edzen\u00ed na uz\u00e1v\u011br r\u00e1ny, kter\u00e9 zahrnovaly zm\u011bnu barvy k\u016f\u017ee, epidermol\u00fdzu, alergickou reakci na za\u0159\u00edzen\u00ed a<\/p>

po\u0161kozen\u00ed a exfoliace za\u0159\u00edzen\u00ed. Tyto komplikace byly analyzov\u00e1ny na z\u00e1klad\u011b informac\u00ed poskytnut\u00fdch spole\u010dnost\u00ed a osobn\u00edch zku\u0161enost\u00ed a bylo zahrnuto i po\u0161kozen\u00ed za\u0159\u00edzen\u00ed pro hodnocen\u00ed bezpe\u010dnosti za\u0159\u00edzen\u00ed.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Za\u0159\u00edzen\u00ed\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Za\u0159\u00edzen\u00ed a technika<\/p>\n

214 pacient\u016f zahrnut\u00fdch do t\u00e9to studie podstoupilo kardiovaskul\u00e1rn\u00ed operace prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie, s kardiopulmon\u00e1ln\u00edm bypassem nebo bez n\u011bj. Ve skupin\u011b uz\u00e1v\u011bru i sutury podko\u017en\u00ed tk\u00e1n\u011b byly se\u0161ity pomoc\u00ed 4-0 Vicryl (Ethicon, Cincinnati, OH) absorbovateln\u00fdch multifilamentn\u00edch steh\u016f. Ve skupin\u011b Closure byl vn\u011bj\u0161\u00ed povrch chirurgick\u00e9 r\u00e1ny uzav\u0159en za\u0159\u00edzen\u00edm pro uz\u00e1v\u011br r\u00e1ny (obr. 2). Ve skupin\u011b steh\u016f byly kontinu\u00e1ln\u00ed subkutikul\u00e1rn\u00ed stehy konven\u010dn\u011b um\u00edst\u011bny pomoc\u00ed steh\u016f 5-0 Prolene (Ethicon) s chirurgickou svorkou na konci stehu.<\/span><\/p>\n

Ochrana r\u00e1ny byla dosa\u017eena pomoc\u00ed sterilizovan\u00e9 g\u00e1zy, kter\u00e1 byla nahrazena novou g\u00e1zou, bez dezinfekce, v p\u0159\u00edpad\u011b pot\u0159\u00edsn\u011bn\u00ed nebo v\u00fdpotku. U v\u0161ech pacient\u016f do\u0161lo 7 dn\u00ed po operaci k odstran\u011bn\u00ed za\u0159\u00edzen\u00ed nebo odstran\u011bn\u00ed steh\u016f. Odstran\u011bn\u00ed za\u0159\u00edzen\u00ed pro uzav\u0159en\u00ed r\u00e1ny bylo dosa\u017eeno pou\u017eit\u00edm odstra\u0148ova\u010de adhez\u00ed (Nichiban, Bunkyo, Tokio, Japonsko) k ochran\u011b k\u016f\u017ee. Po odstran\u011bn\u00ed za\u0159\u00edzen\u00ed nebo steh\u016f se pacienti nechali vykoupat.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Za\u0159\u00edzen\u00ed\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

N\u00e1sledn\u00e1 opat\u0159en\u00ed a sb\u011br dat<\/p>

Elektronick\u00e9 l\u00e9ka\u0159sk\u00e9 z\u00e1znamy a japonsk\u00e1 datab\u00e1ze vrozen\u00e9 kardiovaskul\u00e1rn\u00ed chirurgie byly pou\u017eity jako n\u00e1stroje pro z\u00e1znam klinick\u00fdch dat. V\u0161echny demografick\u00e9 \u00fadaje a \u00fadaje o klinick\u00fdch charakteristik\u00e1ch byly zaznamen\u00e1ny p\u0159ed operac\u00ed a\u00a0intraopera\u010dn\u011b. \u010casy uzav\u0159en\u00ed k\u016f\u017ee byly zaznamen\u00e1v\u00e1ny b\u011bhem operace pomoc\u00ed stopek. L\u00e9\u010dba ran\u00a0<\/span>protokol byl aplikov\u00e1n na v\u0161echny pacienty. \u00dadaje o sledov\u00e1n\u00ed a komplikac\u00edch byly shrom\u00e1\u017ed\u011bny 3 kardiovaskul\u00e1rn\u00edmi chirurgy 1, 2, 4, 8 a 12 t\u00fddn\u016f po operaci. Kosmetick\u00fd vzhled byl zaznamen\u00e1n 3 m\u011bs\u00edce po operaci. Po propu\u0161t\u011bn\u00ed byli pacienti ambulantn\u011b sledov\u00e1ni v na\u0161em \u00fastavu.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Hodnocen\u00ed ran<\/p>

Hodnocen\u00ed kosmetick\u00fdch v\u00fdsledk\u016f provedli 2 plasti\u010dt\u00ed chirurgov\u00e9 3 m\u011bs\u00edce po operaci, kte\u0159\u00ed byli zaslepeni v\u016f\u010di typu pou\u017eit\u00e9ho ko\u017en\u00edho uz\u00e1v\u011bru. Kosmetick\u00fd vzhled byl hodnocen pomoc\u00ed Vancouver Scar Scale (VSS), \u0161iroce uzn\u00e1van\u00e9 \u0161k\u00e1ly pro hodnocen\u00ed jizev po pop\u00e1lenin\u00e1ch, kterou poprv\u00e9 popsal Sullivan v roce 1990. VSS je nej\u010dast\u011bji pou\u017e\u00edvanou \u0161k\u00e1lou hodnocen\u00ed chirurgick\u00fdch jizev [9\u201311] a m\u00e1 \u010dty\u0159i kategorie zalo\u017een\u00e9 na vaskularit\u011b, pigmentaci, poddajnosti a v\u00fd\u0161ce [12]. Celkov\u00e9 sk\u00f3re se pohybuje mezi 0 a 13, p\u0159i\u010dem\u017e sk\u00f3re 0 odr\u00e1\u017e\u00ed norm\u00e1ln\u00ed ple\u0165 (tabulka 1).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Tabulka\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Statistick\u00e9 metody<\/p>

Software StatView 5.0 (SAS Institute Inc, Cary, NC) a Excel 2013 (Microsoft Corp, Redmond, WA) byly pou\u017eity pro\u00a0anal\u00fdza dat. V\u00fdsledky jsou prezentov\u00e1ny jako pr\u016fm\u011br SD nebo medi\u00e1n a interkvartiln\u00ed rozmez\u00ed se spolehlivost\u00ed 95% v intervalech pro kvantitativn\u00ed prom\u011bnn\u00e9 a kategorick\u00e9 prom\u011bnn\u00e9 jsou shrnuty podle absolutn\u00edch \u010detnost\u00ed a procentn\u00edho v\u011bku. Spojit\u00e9 prom\u011bnn\u00e9 byly porovn\u00e1ny pomoc\u00ed studentsk\u00e9ho testu a Mann-Whitneyho U testu. Kategorick\u00e9 prom\u011bnn\u00e9 byly porovn\u00e1ny pomoc\u00ed Pearsonova X\u00b2 testu nebo s Fisherov\u00fdm exaktn\u00edm testem, kdy\u017e byly o\u010dek\u00e1van\u00e9 frekvence ni\u017e\u0161\u00ed ne\u017e 5. Hodnoty P 0,05 nebo ni\u017e\u0161\u00ed byly pova\u017eov\u00e1ny za statisticky v\u00fdznamn\u00e9.<\/span><\/p>

\u00a0<\/p>

V\u00fdsledek<\/span><\/p>

Skupina FO m\u011bla 136 pacient\u016f (uzav\u0159en\u00e1 skupina: 71 pacient\u016f; skupina sutur: 65 pacient\u016f) a skupina RO m\u011bla 78 pacient\u016f (skupina uzav\u0159en\u00e1: 42 pacient\u016f; skupina sutur: 36 pacient\u016f). Na\u0161e ambulance sledovala v\u0161echny pacienty v\u00edce ne\u017e 3 m\u011bs\u00edce po operaci srdce. Anal\u00fdza demografick\u00fdch \u00fadaj\u016f a klinick\u00fdch charakteristik uk\u00e1zala, \u017ee \u017e\u00e1dn\u00e9 nebyly\u00a0v\u00fdznamn\u00e9 rozd\u00edly mezi skupinou a skupinou steh\u016f (tabulka 2). Nebyl zde tak\u00e9 \u017e\u00e1dn\u00fd v\u00fdznamn\u00fd rozd\u00edl\u00a0<\/span>v celkov\u00e9m pr\u016fm\u011brn\u00e9m sk\u00f3re VSS ve skupin\u011b RO p\u0159ed operac\u00ed (uzav\u0159en\u00ed: VSS 3,2 1,2; sutura: VSS 3,3 1,3; p \u00bc 0,57). Pr\u016fm\u011brn\u00fd v\u011bk a t\u011blesn\u00e1 hmotnost byly vy\u0161\u0161\u00ed ve skupin\u011b RO ve srovn\u00e1n\u00ed se skupinou FO a pr\u016fm\u011brn\u00e1 celkov\u00e1 doba operace byla del\u0161\u00ed ve skupin\u011b RO, i kdy\u017e tyto v\u00fdsledky nebyly v\u00fdznamn\u00e9.<\/span><\/p>

\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Kosmetick\u00fd vzhled<\/p>

Kosmetick\u00fd vzhled byl hodnocen pomoc\u00ed VSS 3 m\u011bs\u00edce po operaci (obr. 3). Ve skupin\u011b FO byla VSS ve skupin\u011b Closure signifikantn\u011b ni\u017e\u0161\u00ed ne\u017e u skupiny se suturou pro v\u0161echny prom\u011bnn\u00e9 VSS (tabulka 3). Ve skupin\u011b RO byla vaskularita, pigmentace a celkov\u00e9 sk\u00f3re VSS signifikantn\u011b ni\u017e\u0161\u00ed ve skupin\u011b s uz\u00e1v\u011brem ne\u017e ve skupin\u011b se suturou. Krom\u011b toho bylo celkov\u00e9 sk\u00f3re VSS u pacient\u016f s trizomi\u00ed 21 v\u00fdznamn\u011b ni\u017e\u0161\u00ed ve skupin\u011b s uz\u00e1v\u011brem ve srovn\u00e1n\u00ed se skupinou s stehem (Tabulka 4). Krom\u011b toho bylo celkov\u00e9 sk\u00f3re VSS u kojenc\u016f v\u00fdznamn\u011b ni\u017e\u0161\u00ed ve skupin\u011b s uz\u00e1v\u011brem ne\u017e ve skupin\u011b s stehem (Tabulka 5). Podobn\u011b u novorozenc\u016f bylo celkov\u00e9 sk\u00f3re VSS ve skupin\u011b s uz\u00e1v\u011brem v\u00fdznamn\u011b ni\u017e\u0161\u00ed ne\u017e ve skupin\u011b se suturou (3,0 \u00b1 2,0 vs 5,2 \u00b1 2,3, p < 0,017). Mezi t\u011bmito 2 chirurgy nebyly \u017e\u00e1dn\u00e9 v\u00fdznamn\u00e9 rozd\u00edly ve sk\u00f3re VSS pro uzav\u0159en\u00ed r\u00e1ny (p \u00bc 0,96) a suturu (p \u00bc 0,79).<\/p>

\u00a0<\/p>

Za\u0159\u00edzen\u00ed na uzav\u0159en\u00ed r\u00e1ny Doba uzav\u0159en\u00ed k\u016f\u017ee<\/p>

Rozd\u00edl v celkov\u00e9 dob\u011b operace mezi skupinou uzav\u0159enou a skupinou suturou (340,3 127,1 minut vs 328,2 120,7 minut) nebyl v\u00fdznamn\u00fd (p \u00bc 0,70). Doba uzav\u0159en\u00ed k\u016f\u017ee ve skupin\u011b s uzav\u0159en\u00edm byla v\u0161ak v\u00fdznamn\u011b krat\u0161\u00ed ne\u017e ve skupin\u011b skupina steh\u016f (113,0 9,1 sekund vs 375,9 60,2 sekund, p < 0,001; obr. 4). St\u0159edn\u00ed doba uzav\u0159en\u00ed k\u016f\u017ee byla 113 sekund (rozsah 98 a\u017e 135 sekund) ve skupin\u011b uzav\u0159en\u00ed a 389 sekund (rozsah 256 a\u017e 470 sekund) ve skupin\u011b sutury.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Tabulka\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Komplikace a fyzik\u00e1ln\u00ed n\u00e1lezy<\/p>

\u010cetnost komplikac\u00ed byla srovn\u00e1v\u00e1na mezi uzav\u0159enou skupinou (n \u00bc 113) a skupinou se suturou (n \u00bc 101). Infekce opera\u010dn\u00ed r\u00e1ny se vyskytla u 1 pacienta ve skupin\u011b s uz\u00e1v\u011brem a u 2 pacient\u016f ve skupin\u011b se suturou. M\u00edra chirurgick\u00e9 infekce se v\u00fdznamn\u011b neli\u0161ila mezi skupinou uzav\u0159enou a skupinou suturou (0,91 TP2T vs 2,01 TP2T, p \u00bc 0,50). T\u0159i pacienti m\u011bli infekce v m\u00edst\u011b chirurgick\u00e9ho z\u00e1kroku, kter\u00e9 nebyly z\u00e1va\u017en\u00e9 a zlep\u0161ili se antibiotiky a myt\u00edm soln\u00fdm roztokem. Dehiscence chirurgick\u00e9 r\u00e1ny se vyskytla u 2 pacient\u016f ve skupin\u011b uzav\u0159en\u00ed a u 3 pacient\u016f ve skupin\u011b suturou. Mezi t\u011bmito dv\u011bma skupinami nebyl \u017e\u00e1dn\u00fd v\u00fdznamn\u00fd rozd\u00edl v dehiscenci chirurgick\u00e9 r\u00e1ny (1,8% vs 3,0%, p \u00bc 0,56). V\u0161ichni pacienti, u kter\u00fdch do\u0161lo k dehiscenci r\u00e1ny, byli novorozenci nebo s trizomi\u00ed 21. Mezi komplikace, kter\u00e9 jsou charakteristick\u00e9 pro za\u0159\u00edzen\u00ed Closure, pat\u0159ilo zbarven\u00ed k\u016f\u017ee (0,9%), epidermol\u00fdza (0,9%) a exfoliace za\u0159\u00edzen\u00ed (1,8%). Ke zm\u011bn\u011b barvy do\u0161lo v d\u016fsledku erupce lepic\u00ed p\u00e1sky, co\u017e bylo zlep\u0161eno aplikac\u00ed steroidn\u00ed masti. Pomoc\u00ed masti byla tak\u00e9 l\u00e9\u010dena epidermol\u00fdza. Nov\u00e1 za\u0159\u00edzen\u00ed byla p\u0159ipevn\u011bna u pacient\u016f, jejich\u017e za\u0159\u00edzen\u00ed se odlepila.<\/p>

Nedo\u0161lo v\u0161ak k \u017e\u00e1dn\u00fdm z\u00e1va\u017en\u00fdm komplikac\u00edm, jako je alergie nebo po\u0161kozen\u00ed p\u0159\u00edstroj\u016f. Sv\u011bd\u011bn\u00ed nebo bolest jsme nemohli posoudit, proto\u017ee na\u0161i d\u011bt\u0161t\u00ed pacienti, mezi n\u011b\u017e pat\u0159ili i kojenci, si na tyto p\u0159\u00edznaky nemohli st\u011b\u017eovat.<\/p>

B\u011bhem odstra\u0148ov\u00e1n\u00ed za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed r\u00e1ny nebo steh\u016f v\u0161ak v\u00fdznamn\u011b m\u00e9n\u011b pacient\u016f plakalo nebo si st\u011b\u017eovalo ve skupin\u011b s uzav\u0159en\u00fdm stehem ve srovn\u00e1n\u00ed se skupinou se suturou (7,1% vs 52,5%, p < 0,001).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Za\u0159\u00edzen\u00ed\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Tabulka\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Tabulka\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Tabulka\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Doba\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Koment\u00e1\u0159
Tato studie je prvn\u00ed randomizovanou kontrolovanou studi\u00ed za\u0159\u00edzen\u00ed pro uz\u00e1v\u011br r\u00e1ny u d\u011btsk\u00fdch pacient\u016f, kte\u0159\u00ed podstoupili srde\u010dn\u00ed operaci. A\u010dkoli byly prezentov\u00e1ny n\u011bkter\u00e9 ned\u00e1vn\u00e9 kazuistiky spojen\u00e9 se za\u0159\u00edzen\u00edm pro uzav\u00edr\u00e1n\u00ed r\u00e1ny, \u017e\u00e1dn\u00e1 nepopsala srde\u010dn\u00ed operace prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie [7, 8]. Rovn\u011b\u017e p\u0159\u00ednosy nebo rizika komplikac\u00ed u pediatrick\u00fdch pacient\u016f z\u016fst\u00e1vaj\u00ed nezn\u00e1m\u00e9. V na\u0161\u00ed studii jsme hodnotili d\u011btsk\u00e9 pacienty, kte\u0159\u00ed podstoupili srde\u010dn\u00ed operaci prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie. Na\u0161e v\u00fdsledky prok\u00e1zaly signifikantn\u011b lep\u0161\u00ed v\u00fdsledek ve skupin\u011b s uz\u00e1v\u011brem ve srovn\u00e1n\u00ed se skupinou se suturou. Vzhledem k tomu, \u017ee kosmetick\u00fd vzhled opera\u010dn\u00edch ran ovliv\u0148uje \u0159ada faktor\u016f, jako je pou\u017eit\u00ed elektrokauterizace, infekce, p\u0159\u00edstup a \u0161ic\u00ed materi\u00e1l [13\u201315] , pou\u017eili jsme d\u016fsledn\u00fd chirurgick\u00fd incizn\u00ed p\u0159\u00edstup a \u0161ic\u00ed materi\u00e1l a u v\u0161ech pacient\u016f byla k proveden\u00ed st\u0159edn\u00ed sternotomie pou\u017eita elektrokauterizace. Na\u0161e v\u00fdsledky uk\u00e1zaly, \u017ee za\u0159\u00edzen\u00ed na uzav\u00edr\u00e1n\u00ed r\u00e1ny m\u00e1 kosmetick\u00e9 v\u00fdhody, bez ohledu na to, zda se jednalo o prvn\u00ed operaci nebo reoperaci. V d\u011btsk\u00e9 kardiochirurgii m\u00e1 mnoho pacient\u016f trizomii 21 [16]. D\u00e1le u d\u011btsk\u00fdch pacient\u016f, kte\u0159\u00ed maj\u00ed srde\u010dn\u00ed vady, se kardiooperace \u010dasto prov\u00e1d\u011bj\u00ed ji\u017e v kojeneck\u00e9m v\u011bku [17, 18].<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Na z\u00e1klad\u011b v\u00fdsledk\u016f t\u00e9to studie se domn\u00edv\u00e1me, \u017ee toto za\u0159\u00edzen\u00ed pro uz\u00e1v\u011br r\u00e1ny m\u016f\u017ee b\u00fdt \u00fasp\u011b\u0161n\u011b pou\u017eito u \u0161irok\u00e9ho spektra pacient\u016f.
Pokud jde o dobu uzav\u0159en\u00ed, chirurgick\u00e9 r\u00e1ny uzav\u0159en\u00e9 pomoc\u00ed za\u0159\u00edzen\u00ed pro uzav\u0159en\u00ed r\u00e1ny m\u011bly zjevn\u011b vynikaj\u00edc\u00ed v\u00fdkon ve srovn\u00e1n\u00ed s uzav\u0159en\u00edm r\u00e1ny pomoc\u00ed steh\u016f. Podobn\u011b m\u016f\u017ee pou\u017eit\u00ed 2-oktylkyanoakryl\u00e1tov\u00e9ho lepidla tak\u00e9 zkr\u00e1tit dobu uzav\u0159en\u00ed chirurgick\u00e9 r\u00e1ny [4, 19]. Neexistuj\u00ed v\u0161ak \u017e\u00e1dn\u00e9 zpr\u00e1vy, ve kter\u00fdch by byl oktylkyanoakryl\u00e1t pou\u017eit pro st\u0159edn\u00ed sternotomii, co\u017e zt\u011b\u017euje srovn\u00e1n\u00ed jeho bezpe\u010dnosti a doby uzav\u0159en\u00ed se za\u0159\u00edzen\u00edm pro uzav\u0159en\u00ed r\u00e1ny. V t\u00e9to studii,
do\u010dasn\u00fd rozptyl doby uzav\u0159en\u00ed k\u016f\u017ee ve skupin\u011b Closure byl mimo\u0159\u00e1dn\u011b mal\u00fd, co\u017e znamen\u00e1, \u017ee pou\u017eit\u00ed tohoto za\u0159\u00edzen\u00ed nebylo ovlivn\u011bno d\u00e9lkou r\u00e1ny nebo r\u016fzn\u00fdmi chirurgy. \u010c\u00edm je tedy r\u00e1na del\u0161\u00ed, t\u00edm v\u011bt\u0161\u00ed relativn\u00ed p\u0159\u00ednos lze o\u010dek\u00e1vat.
I kdy\u017e rozd\u00edl v m\u00ed\u0159e infekce opera\u010dn\u00ed r\u00e1ny mezi skupinou se zav\u00edr\u00e1n\u00edm a skupinou se suturou nebyl v\u00fdznamn\u00fd, ve skupin\u011b s uzav\u0159enou r\u00e1nou se vyskytlo m\u00e9n\u011b infekc\u00ed r\u00e1ny. Incidence infekce v m\u00edst\u011b chirurgick\u00e9ho z\u00e1kroku po d\u011btsk\u00fdch srde\u010dn\u00edch operac\u00edch se uv\u00e1d\u00ed v rozmez\u00ed od 2,3% do 8% [20\u201323]. V t\u00e9to studii byl v\u00fdskyt infekce poopera\u010dn\u00ed r\u00e1ny ve skupin\u011b s uz\u00e1v\u011brem 0,91 TP2T, co\u017e je extr\u00e9mn\u011b n\u00edzk\u00e1 m\u00edra infekce vzhledem k tomu, \u017ee ve skupin\u011b s uz\u00e1v\u011brem nebyl \u017e\u00e1dn\u00fd zbytek v epidermis. Pou\u017eit\u00ed silikonov\u00e9ho gelu k prevenci infekc\u00ed chirurgick\u00fdch ran nebo byly prezentov\u00e1ny hypertrofick\u00e9 jizvy [24\u201326]. Pom\u016fcka pro uzav\u0159en\u00ed r\u00e1ny m\u00e1 v\u0161ak dal\u0161\u00ed v\u00fdhodu ve zkr\u00e1cen\u00ed doby uzav\u0159en\u00ed r\u00e1ny
krom\u011b prevence infekc\u00ed opera\u010dn\u00edch ran a chirurgick\u00fdch jizev.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Podobn\u011b jako u \u010detnosti infekce r\u00e1ny, \u010detnost v\u00fdskytu dehiscence chirurgick\u00e9 r\u00e1ny ve skupin\u011b Z byla stejn\u00e1 nebo vy\u0161\u0161\u00ed ne\u017e u skupiny steh\u016f. Za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed r\u00e1ny m\u00e1 v\u0161ak v\u011bt\u0161\u00ed flexibilitu pro dehiscenci r\u00e1ny a je v\u00edce neinvazivn\u00ed. Suturu nebo za\u0159\u00edzen\u00ed jsme odstranili 7 dn\u00ed po operaci v souladu s designem studie. Domn\u00edv\u00e1me se v\u0161ak, \u017ee odstran\u011bn\u00ed za\u0159\u00edzen\u00ed by m\u011blo b\u00fdt provedeno v z\u00e1vislosti na stavu r\u00e1ny u novorozenc\u016f a pacient\u016f s trizomi\u00ed 21, proto\u017ee pouze u t\u011bchto pacient\u016f byla pozorov\u00e1na dehiscence r\u00e1ny. Komplikace typick\u00e9 pro za\u0159\u00edzen\u00ed zahrnuj\u00ed zm\u011bnu barvy k\u016f\u017ee, epidermol\u00fdzu a exfoliaci za\u0159\u00edzen\u00ed, i kdy\u017e \u017e\u00e1dn\u00e9 se nevyskytovaly ve vysok\u00e9 m\u00ed\u0159e nebo nebyly z\u00e1va\u017en\u00e9. V d\u016fsledku toho jsme dosp\u011bli k z\u00e1v\u011bru, \u017ee za\u0159\u00edzen\u00ed pro uzav\u0159en\u00ed r\u00e1ny lze bezpe\u010dn\u011b pou\u017e\u00edvat.
Vynikaj\u00edc\u00ed vlastnost\u00ed uz\u00e1v\u011bru r\u00e1ny je mo\u017enost nastaven\u00ed jej\u00ed d\u00e9lky a nap\u011bt\u00ed. D\u00e9lku za\u0159\u00edzen\u00ed lze snadno upravit od\u0159\u00edznut\u00edm za\u0159\u00edzen\u00ed na p\u0159\u00edslu\u0161n\u00e9m m\u00edst\u011b. Napnut\u00ed za\u0159\u00edzen\u00ed lze neomezen\u011b nastavovat d\u00edky adaptivn\u00edmu syst\u00e9mu strap-rock. Nap\u011bt\u00ed pom\u016fcky lze nap\u0159\u00edklad v\u00edcen\u00e1sobn\u011b upravit podle rozsahu otoku nebo hojen\u00ed r\u00e1ny po operaci. Stupe\u0148 hojen\u00ed r\u00e1ny lze nav\u00edc potvrdit rozepnut\u00edm zip\u016f. Za\u0159\u00edzen\u00ed se tedy m\u016f\u017ee p\u0159izp\u016fsobit dehiscenci op\u011btovn\u00fdm k\u00fdv\u00e1n\u00edm zipu bez pot\u0159eby steh\u016f.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Z v\u00fdsledk\u016f t\u00e9to studie se domn\u00edv\u00e1me, \u017ee nejv\u011bt\u0161\u00edmi v\u00fdhodami pou\u017eit\u00ed za\u0159\u00edzen\u00ed na uzav\u00edr\u00e1n\u00ed r\u00e1ny je dobr\u00fd kosmetick\u00fd vzhled a zkr\u00e1cen\u00e1 doba uzav\u0159en\u00ed. Tak\u00e9 bezpe\u010dnost za\u0159\u00edzen\u00ed byla stejn\u011b dobr\u00e1 jako subkutikul\u00e1rn\u00ed stehy. Charakteristick\u00fdm rysem za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed r\u00e1ny v\u0161ak bylo, \u017ee bylo m\u00e9n\u011b bolestiv\u00e9, kdy\u017e se vyj\u00edmalo, tak\u017ee bylo zvl\u00e1\u0161t\u011b v\u00fdhodn\u00e9 pro d\u011btsk\u00e9 pacienty. Ve skute\u010dnosti v\u00fdrazn\u011b m\u00e9n\u011b pacient\u016f ve skupin\u011b s uz\u00e1v\u011brem m\u011blo bolest nebo plakalo b\u011bhem odstra\u0148ov\u00e1n\u00ed za\u0159\u00edzen\u00ed nebo steh\u016f ve srovn\u00e1n\u00ed se skupinou suturou. Naopak, n\u00e1kladov\u00e1 v\u00fdkonnost za\u0159\u00edzen\u00ed pro uzav\u0159en\u00ed r\u00e1ny nen\u00ed tak dobr\u00e1 jako u sutur. N\u00e1klady na pom\u016fcku pro uzav\u0159en\u00ed r\u00e1ny jsou $85, co\u017e je p\u0159ibli\u017en\u011b t\u0159ikr\u00e1t v\u00edce ne\u017e u subkutikul\u00e1rn\u00ed sutury. Domn\u00edv\u00e1me se v\u0161ak, \u017ee se toto za\u0159\u00edzen\u00ed vyplat\u00ed pou\u017e\u00edvat na z\u00e1klad\u011b jeho kosmetick\u00e9 \u00fa\u010dinnosti a \u00fa\u010dinnosti doby uzav\u0159en\u00ed.<\/p>

Tato studie m\u00e1 n\u011bkolik omezen\u00ed. Za prv\u00e9, tato studie byla provedena v jedin\u00e9 instituci; proto je zobecn\u011bn\u00ed na\u0161ich v\u00fdsledk\u016f omezen\u00e9. Tyto \u00fadaje jsou v\u0161ak d\u016fle\u017eit\u00e9, proto\u017ee se jedn\u00e1 o prvn\u00ed prospektivn\u00ed randomizovanou studii, kter\u00e1 uv\u00e1d\u00ed pou\u017eit\u00ed za\u0159\u00edzen\u00ed pro uz\u00e1v\u011br r\u00e1ny u d\u011btsk\u00fdch pacient\u016f, kte\u0159\u00ed podstoupili st\u0159edn\u00ed sternotomii.<\/p>

Za druh\u00e9, po\u010det pacient\u016f s Downov\u00fdm syndromem je relativn\u011b mal\u00fd, co\u017e m\u00e1 za n\u00e1sledek nedostate\u010dnou statistickou s\u00edlu pro hodnocen\u00ed \u00fa\u010dinnosti za\u0159\u00edzen\u00ed v populaci Downova syndromu.<\/p>

Za t\u0159et\u00ed, studie vylou\u010dila pacienty s chromozom\u00e1ln\u00ed abnormalitou, s v\u00fdjimkou trizomie 21, a pacienty, kte\u0159\u00ed m\u011bli opo\u017ed\u011bn\u00fd uz\u00e1v\u011br hrudn\u00ed kosti. Proto jsme nemohli zkoumat v\u00fdsledky v t\u011bchto populac\u00edch. Pokud jde o p\u0159\u00edstroj a techniku, kontinu\u00e1ln\u00ed subkutikul\u00e1rn\u00ed \u0161it\u00ed nevst\u0159ebateln\u00fdmi polypropylenov\u00fdmi stehy s odstran\u011bn\u00edm steh\u016f m\u016f\u017ee b\u00fdt vz\u00e1cnou metodou. Tato studie byla nakonec randomizovanou studi\u00ed u d\u011btsk\u00fdch pacient\u016f a \u00fa\u010dinnost u dosp\u011bl\u00fdch pacient\u016f jsme nezkoumali. Proto je pro ov\u011b\u0159en\u00ed pou\u017eit\u00ed za\u0159\u00edzen\u00ed u dosp\u011bl\u00e9 populace vy\u017eadov\u00e1na prospektivn\u00ed randomizovan\u00e1 klinick\u00e1 studie u dosp\u011bl\u00fdch pacient\u016f.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Z\u00e1v\u011brem lze \u0159\u00edci, \u017ee se jedn\u00e1 o prvn\u00ed randomizovanou studii k vyhodnocen\u00ed v\u00fdsledk\u016f zipov\u00e9ho stehu Longmed pro uz\u00e1v\u011br r\u00e1ny u d\u011btsk\u00fdch pacient\u016f, kte\u0159\u00ed podstoupili srde\u010dn\u00ed operace prost\u0159ednictv\u00edm st\u0159edn\u00ed sternotomie. Na\u0161e studie uk\u00e1zala, \u017ee za\u0159\u00edzen\u00ed m\u00e1 vynikaj\u00edc\u00ed v\u00fdkon p\u0159i zlep\u0161ov\u00e1n\u00ed kosmetick\u00e9ho vzhledu a zkr\u00e1cen\u00ed doby uzav\u0159en\u00ed poko\u017eky. Jde o neinvazivn\u00ed za\u0159\u00edzen\u00ed, kter\u00e9 lze jednodu\u0161e a bezpe\u010dn\u011b pou\u017e\u00edvat a m\u016f\u017ee b\u00fdt vhodn\u00e9 pro d\u011btsk\u00e9 pacienty, proto\u017ee je m\u00e9n\u011b bolestiv\u00e9.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

\n\t\t\t\t\t\t
\n\t\t\t\t\t
\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Reference<\/p>

  1. Jina H, Simcock J. Hodnocen\u00ed st\u0159edn\u00ed jizvy po sternotomii. NZ Med J 2011;124:57\u201362.<\/li>
  2. Cotogni P, Barbero C, Rinaldi M. Infekce hlubok\u00e9 stern\u00e1ln\u00ed r\u00e1ny po kardiochirurgick\u00e9 operaci: d\u016fkazy a kontroverze. World J Care Med 2015;4:265\u201373.<\/li>
  3. Lemaignen A, Birgand G, Ghodhbane W, a kol. Infekce stern\u00e1ln\u00ed r\u00e1ny po kardiochirurgick\u00e9m v\u00fdkonu: incidence a rizikov\u00e9 faktory podle klinick\u00e9ho obrazu. Clin Microbiol Infect 2015;21:674.e11\u201318.<\/li>
  4. Krishnamoorthy B, Najam O, Kharn UA, Waterworth P, Fildes JE, Yonan N. Randomizovan\u00e1 prospektivn\u00ed studie srovn\u00e1vaj\u00edc\u00ed konven\u010dn\u00ed subkutikul\u00e1rn\u00ed uz\u00e1v\u011br k\u016f\u017ee ko\u017en\u00edm lepidlem Dermabond po odb\u011bru saf\u00e9ny. Ann Thorac Surg 2009;88:1445\u201350.<\/li><\/ol>
    1. Chambers A, Scarci M. Je ko\u017en\u00ed uz\u00e1v\u011br kyanoakryl\u00e1tov\u00fdm lepidlem \u00fa\u010dinn\u00fd pro prevenci infekc\u00ed stern\u00e1ln\u00ed r\u00e1ny. Interact CardioVasc Thorac Surg 2010;10:793\u20136.<\/li>
    2. Lavazzo C, ID Gkegkes, Vouloumanou EK, Mamais I, Peppas G, Falagas ME. Stehy versus svorky pro l\u00e9\u010dbu chirurgick\u00fdch ran: metaanal\u00fdza randomizovan\u00fdch kontrolovan\u00fdch studi\u00ed. Am Surg2011;77:1206\u201321.<\/li>
    3. Gorsulowsky DC, Talmor G. Nov\u00e9 neinvazivn\u00ed za\u0159\u00edzen\u00ed pro uzav\u00edr\u00e1n\u00ed ran jako kone\u010dn\u00e1 vrstva p\u0159i uzav\u00edr\u00e1n\u00ed k\u016f\u017ee. Dermatol Surg 2015;41:987\u20139.<\/li>
    4. Maria ED. Nov\u00fd syst\u00e9m uzav\u00edr\u00e1n\u00ed k\u016f\u017ee usnad\u0148uje hojen\u00ed ran po operaci kardiovaskul\u00e1rn\u00edho implantovateln\u00e9ho elektronick\u00e9ho za\u0159\u00edzen\u00ed. Sv\u011btov\u00e9 p\u0159\u00edpady J Clin 2015;3:675\u20137.<\/li>
    5. Bae SH, Bae YC. Anal\u00fdza \u010detnosti pou\u017e\u00edv\u00e1n\u00ed r\u016fzn\u00fdch \u0161k\u00e1l hodnocen\u00ed jizev na z\u00e1klad\u011b stavu vyd\u011b\u0161en\u00ed a zp\u016fsobu l\u00e9\u010dby. Arch Plast Surg 2014;41:111\u20135.<\/li>
    6. Truong PT, Abnousi F, Yong CM a kol. Standardizovan\u00e9 hodnocen\u00ed chirurgick\u00fdch jizev po rakovin\u011b prsu integruj\u00edc\u00ed Vancouver Scar Scale, Short-Form McGill Pain Questionnaire a perspektivy pacient\u016f. Plast Reconstr Surg 2005;116:1291\u20139.<\/li><\/ol>
      1. Lee SH, Zheng Z, Roh MR. \u010casn\u00e1 poopera\u010dn\u00ed l\u00e9\u010dba chirurgick\u00fdch jizev pomoc\u00ed frak\u010dn\u00edho oxidov\u00e9ho laseru: studie s roz\u0161t\u011bpenou jizvou, zaslepen\u00e1 hodnotitelem. Dermatol Surg 2013;39:1190\u20136.<\/li>
      2. Femonti R, Bond J, Erdmann D, Levinson H. P\u0159ehled za\u0159\u00edzen\u00ed pro m\u011b\u0159en\u00ed jizev a jizev. Eplasty 2010;10:e43.<\/li>
      3. Zp\u011bv\u00e1k AJ, Quinn JV, Thode HC Jr, Hollander JE. Definice \u0161patn\u00e9ho v\u00fdsledku po tr\u017en\u00e9 r\u00e1n\u011b a oprav\u011b chirurgick\u00e9ho \u0159ezu. Plast Reconstr Surg 2002;110:429\u201337.<\/li>
      4. Niessen FB, Spauwen PH, Kon M. Role \u0161ic\u00edho materi\u00e1lu p\u0159i tvorb\u011b hypertrofick\u00e9 jizvy: monocryl vs. vicryl-rapide. Ann Plast Surg 1997;39:254\u201360.<\/li>
      5. Crossland DS, Jackson SP, Lyall R, a kol. Postoj pacient\u016f k jizv\u00e1m po sternotomii a torakotomii. Thorac Cardiovasc Surg 2005;53:93\u20135.<\/li>
      6. Freeman SB, Taft LE, Dooley KJ a kol. Popula\u010dn\u00ed studie vrozen\u00fdch srde\u010dn\u00edch vad u Downova syndromu. Am J Med Genet 1998;80:213\u20137.<\/li>
      7. Moller J. Prevalence a incidence srde\u010dn\u00edch malformac\u00ed. In: Moller JH (ed). Perspektivy v d\u011btsk\u00e9 kardiologii: chirurgie vrozen\u00fdch srde\u010dn\u00edch vad: Pediatric Cardiac Care Consortium, 1984-1995. Armonk, NY: Futura; 1998: 619\u201326.<\/li>
      8. Dickinson DF, Arnold R, Wilkinson JL. Vrozen\u00e1 srde\u010dn\u00ed choroba u 160 480 \u017eiv\u011b narozen\u00fdch d\u011bt\u00ed v Liverpoolu v letech 1960 a\u017e 1969. D\u016fsledky pro chirurgickou l\u00e9\u010dbu. Br Heart J 1981;46:55\u201362.<\/li><\/ol>
        1. Quinn J, Wells G, Sutcliffe T, a kol. Randomizovan\u00e1 studie porovn\u00e1vaj\u00edc\u00ed oktylkyanoakryl\u00e1tov\u00e9 tk\u00e1\u0148ov\u00e9 lepidlo a stehy p\u0159i l\u00e9\u010db\u011b tr\u017en\u00fdch ran. JAMA 1997;277:1527\u201330.<\/li>
        2. Barker GM, O'Brien SM, Welke KF a kol. Z\u00e1va\u017en\u00e1 infekce po d\u011btsk\u00e9 kardiochirurgick\u00e9 operaci: model odhadu rizika. Ann Thorac Surg 2010;89:843\u201350.<\/li><\/ol>
          1. Pollock EM, Ford-Jones EL, Rebeyka I a kol. \u010casn\u00e9 nozokomi\u00e1ln\u00ed infekce u d\u011btsk\u00fdch kardiovaskul\u00e1rn\u00edch pacient\u016f. Crit Care Med 1990;18:378\u201384.<\/li>
          2. Levy I, Ovadia B, Erez E. Nozokomi\u00e1ln\u00ed infekce po kardiochirurgick\u00fdch operac\u00edch u kojenc\u016f a d\u011bt\u00ed: incidence a rizikov\u00e9 faktory. J Hosp Infect 2003;53:111\u20136.<\/li>
          3. Allpress AL, Rosenthal GL, Goodrich KM, Lupinetti FM, Zerr DM. Rizikov\u00e9 faktory pro infekce v m\u00edst\u011b chirurgick\u00e9ho z\u00e1kroku po d\u011btsk\u00e9 kardiovaskul\u00e1rn\u00ed chirurgii. Pediatr Infect Dis J 2004;23:231\u20134.<\/li><\/ol>
            1. Chan KY, Lau CL, Adeeb SM, Somasundaram S, NasirZahari M. Randomizovan\u00e1, placebem kontrolovan\u00e1, dvojit\u011b zaslepen\u00e1, prospektivn\u00ed klinick\u00e1 studie silikonov\u00e9ho gelu v prevenci rozvoje hypertrofick\u00e9 jizvy u st\u0159edn\u00ed sternotomick\u00e9 r\u00e1ny. Plast Reconstr Surg 2005;116:1013\u201320.<\/li>
            2. Sakuraba M, Takahashi N, Akahoshi T, Miyasaka Y, Suzuki K. Zku\u0161enosti se silikonov\u00fdmi gelov\u00fdmi pl\u00e1ty pro pacienty s keloidn\u00edmi jizvami po st\u0159edn\u00ed sternotomii. Gen Thorac Cardiovasc Surg 2010;58:467\u201370.<\/li>
            3. Pai VB, Cummings I. Existuj\u00ed n\u011bjak\u00e9 dobr\u00e9 zp\u016fsoby l\u00e9\u010dby keloidn\u00edch jizev po sternotomii? Interact Cardiovasc Thorac Surg 2011;13:415\u20138.<\/li><\/ol>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

              Randomizovan\u00e9 za\u0159\u00edzen\u00ed na uzav\u00edr\u00e1n\u00ed ran zipem Longmed Randomizovan\u00e1 studie nov\u00e9ho neinvazivn\u00edho za\u0159\u00edzen\u00ed na uzav\u00edr\u00e1n\u00ed r\u00e1ny zipem pro pou\u017eit\u00ed po vrozen\u00fdch srde\u010dn\u00edch operac\u00edch Yuki Tanaka, MD, Takashi Miyamoto, MD, PhD, Yuji Naito, MD, PhD, Shuichi Yoshitake, MD, Akihiro Sasahara, MD, a Kagami Miyaji, MD, PhD Odd\u011blen\u00ed kardiovaskul\u00e1rn\u00ed chirurgie, Gunma Children's Medical Center,\u2026<\/p>","protected":false},"author":1,"featured_media":689,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"footnotes":""},"categories":[2],"tags":[41,10,19,28],"class_list":["post-741","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-longmed-skin-closure-device","tag-wound-closure-device","tag-wound-closure-strips-longmed-zip-stitch-emergency-laceration-closures","tag-zip-stitch"],"_links":{"self":[{"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/posts\/741","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/comments?post=741"}],"version-history":[{"count":0,"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/posts\/741\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/media\/689"}],"wp:attachment":[{"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/media?parent=741"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/categories?post=741"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/longmed-medical.com\/cs\/wp-json\/wp\/v2\/tags?post=741"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}