{"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\/lv\/longmed-skin-closure-device-randomized-study\/","title":{"rendered":"Zip Stitch Longmed br\u016b\u010du aizv\u0113r\u0161anas ier\u012bces nejau\u0161in\u0101ts p\u0113t\u012bjums"},"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

Zip Stitch Longmed br\u016b\u010du aizv\u0113r\u0161anas ier\u012bces nejau\u0161in\u0101ts p\u0113t\u012bjums<\/h2>\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

Randomiz\u0113ts p\u0113t\u012bjums par jaunu neinvaz\u012bvu \u0101das aizdares ier\u012bci ar r\u0101v\u0113jsl\u0113dz\u0113ju, kas paredz\u0113ta lieto\u0161anai p\u0113c iedzimt\u0101m sirds oper\u0101cij\u0101m<\/h2>\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

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

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

Sirds un asinsvadu \u0137irur\u0123ijas noda\u013ca, Gunma B\u0113rnu medic\u012bnas centrs, Shibukawa; un Sirds un asinsvadu \u0137irur\u0123ijas noda\u013ca,<\/p>

Kitasato universit\u0101tes slimn\u012bca, Sagamihara, Jap\u0101na<\/p>\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\"Longmed\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

Fons:<\/p>

M\u0113s zi\u0146ojam par jaunu Zip Stitch Longmed neinvaz\u012bvu br\u016b\u010du aizv\u0113r\u0161anas ier\u012bce<\/a> (ZheJiang Longmed Medical Technology Co., Ltd.). Tiek uzskat\u012bts, ka \u0161ai ier\u012bcei ir labi kosm\u0113tiskie rezult\u0101ti p\u0113c oper\u0101cij\u0101m un tiek samazin\u0101ts oper\u0101cijas laiks. \u0160aj\u0101 p\u0113t\u012bjum\u0101 \u0101das aizv\u0113r\u0161ana, izmantojot ier\u012bci Closure, tika sal\u012bdzin\u0101ta ar zem\u0101das \u0161uv\u0113m, un tika nov\u0113rt\u0113ta \u0161\u012bs jaun\u0101s ier\u012bces lietder\u012bba un dro\u0161\u012bba.<\/p>

Metodes:<\/p>

\u0160is bija prospekt\u012bvs, randomiz\u0113ts p\u0113t\u012bjums, kur\u0101 piedal\u012bj\u0101s 214 pacienti, kuriem no 2014.\u00a0gada j\u016bnija l\u012bdz 2015.\u00a0gada decembrim tika veiktas sirds oper\u0101cijas, izmantojot medi\u0101nas sternotomiju. 136 pacientiem \u0161\u012b bija pirm\u0101 oper\u0101ciju grupa, no kuras 71 pacientam tika veikta br\u016b\u010du aizv\u0113r\u0161anas ier\u012bce (sl\u0113g\u0161anas grupa) un 65\u00a0pacientiem. pacientiem tika veiktas subkutikul\u0101ras \u0161uves (\u0161uvju grupa). 78 pacientiem \u0161\u012b bija atk\u0101rtotas oper\u0101cijas grupa, no kur\u0101m 42 pacienti bija Closure grup\u0101 un 36 pacienti bija \u0161uvju grup\u0101. Kosm\u0113tikas rezult\u0101ti, izmantojot Vank\u016bveras r\u0113tu skalu, tika nov\u0113rt\u0113ti atsevi\u0161\u0137i pirm\u0101s oper\u0101cijas grup\u0101 un atk\u0101rtotas oper\u0101cijas grup\u0101.<\/p>\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

Rezult\u0101ti:<\/p>

Bija b\u016btiskas at\u0161\u0137ir\u012bbas kop\u0113j\u0101 Vank\u016bveras r\u0113tu skalas v\u0113rt\u0113jum\u0101 starp pirm\u0101s oper\u0101cijas grupu (p < 0,001) un atk\u0101rtotas oper\u0101cijas grupu (p [ 0,007). \u0100das aizv\u0113r\u0161anas laiks bija iev\u0113rojami \u012bs\u0101ks Closure grup\u0101 nek\u0101 \u0161uvju grup\u0101 (113,0 \u00b1 9,1 sekunde pret 375,9 \u00b1 60,2 sekundes, p < 0,001). Netika konstat\u0113tas b\u016btiskas at\u0161\u0137ir\u012bbas attiec\u012bb\u0101 uz \u0137irur\u0123isk\u0101s vietas infekcijas bie\u017eumu starp grup\u0101m. \u0160ai ier\u012bcei rakstur\u012bg\u0101s komplik\u0101cijas ietv\u0113ra \u0101das kr\u0101sas izmai\u0146as(0,9%), epidermol\u012bze (0,9%) un ier\u012bces p\u012blings (1,8%); tom\u0113r nopietnas komplik\u0101cijas neatt\u012bst\u012bj\u0101s.<\/span><\/p>\n

<\/p>\n

Secin\u0101jumi:<\/p>

Iedzimt\u0101s sirds oper\u0101cij\u0101s, izmantojot vid\u0113jo sternotomiju, br\u016bces aizv\u0113r\u0161anas ier\u012bce bija lieliska izv\u0113le kosm\u0113tisk\u0101 izskata uzlabo\u0161anai un br\u016b\u010du sl\u0113g\u0161anas laika samazin\u0101\u0161anai. Turkl\u0101t izr\u0101d\u012bj\u0101s, ka t\u0101 ir ier\u012bce, ko var dro\u0161i lietot.<\/span><\/p>\n

(Ann Thorac Surg 2016;102:1368\u201374) 2016.\u00a0gads, torak\u0101lo \u0137irurgu biedr\u012bba<\/p>\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

\u0136irur\u0123iskas vietas infekcijas un hipertrofiskas r\u0113tas ir galven\u0101s p\u0113coper\u0101cijas br\u016b\u010du komplik\u0101cijas, un t\u0101s da\u017ek\u0101rt var rasties p\u0113c sirds un asinsvadu oper\u0101cij\u0101m [1\u20133]. Ir zi\u0146ots par vair\u0101ku \u0101das aizv\u0113r\u0161anas ier\u012b\u010du, piem\u0113ram, ci\u0101nakril\u0101ta l\u012bmes un \u0137irur\u0123isko skavas, izmanto\u0161anu [4\u20136], un ir pier\u0101d\u012bts, ka \u0161\u012bm ier\u012bc\u0113m ir labs potenci\u0101ls, lai samazin\u0101tu \u0101das aizv\u0113r\u0161anas laiku, uzlabotu kosm\u0113tisko izskatu un samazin\u0101tu infekciju bie\u017eumu. . Br\u016b\u010du aizv\u0113r\u0161anas ier\u012bce (ZheJiang Longmed Medical Technology Co., Ltd.) ir jauna, neinvaz\u012bva p\u0113d\u0113j\u0101 sl\u0101\u0146a \u0101das aizv\u0113r\u0161anas ier\u012bce, kas samazina potenci\u0101lu.\u00a0br\u016b\u010du komplik\u0101cij\u0101m [7, 8].<\/span><\/p>

Zip stitch Longmed br\u016b\u010du aizv\u0113r\u0161anas ier\u012bces izstr\u0101des koncepcija bija sa\u012bsin\u0101t \u0101das aizv\u0113r\u0161anas laiku un nov\u0113rst hipertrofisku r\u0113tu p\u0113c oper\u0101cijas. Lai gan ir zi\u0146ots par aizv\u0113r\u0161anas ier\u012bces lieto\u0161anu cit\u0101s jom\u0101s, iz\u0146emot sirds un asinsvadu \u0137irur\u0123iju, nav zi\u0146u par to, ka br\u016bces aizv\u0113r\u0161anas ier\u012bce b\u016btu izmantota iedzimtu pacientu \u0137irur\u0123isko br\u016b\u010du aizv\u0113r\u0161anai, kuriem tika veikta vid\u0113j\u0101 sternotomija. \u0160aj\u0101 p\u0113t\u012bjum\u0101 m\u0113s nov\u0113rt\u0113j\u0101m, vai br\u016b\u010du aizv\u0113r\u0161anas ier\u012bce ir noder\u012bga un dro\u0161a aizv\u0113r\u0161anas ier\u012bce\u00a0\u0137irur\u0123iskie griezumi<\/a> iedzimtiem pacientiem p\u0113c sirds un asinsvadu oper\u0101cij\u0101m ar medi\u0101nas sternotomijas pal\u012bdz\u012bbu.<\/span><\/p>

\u00a0<\/p>

Pie\u0146emts public\u0113\u0161anai 2016. gada 23. mart\u0101.<\/p>

Adrese korespondence Dr Tanaka, B\u0113rnu sirds \u0137irur\u0123ijas noda\u013ca, Gunma B\u0113rnu medic\u012bnas centrs, 779 Shimohakoda, Hokkitsumati, Shibukawa, Gunma 377-8577, Jap\u0101na; e-pasts: tfjgp484@yahoo.co.jp.<\/span><\/p>

2016, torak\u0101lo \u0137irurgu biedr\u012bba 0003-4975\/$36.00 Izdev\u0113js Elsevier<\/span><\/p>

\u00a0<\/p>\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

Pacienti un metodes<\/p>

P\u0113t\u012bjuma protokolu \u0161im br\u016b\u010du sl\u0113g\u0161anas ier\u012bces p\u0113t\u012bjumam apstiprin\u0101ja m\u016bsu iest\u0101des P\u0113t\u012bjumu p\u0101rskata padome saska\u0146\u0101 ar Helsinku deklar\u0101ciju.<\/p>\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

Pacienti un p\u0113t\u012bjuma dizains<\/p>

Br\u016b\u010du sl\u0113g\u0161anas ier\u012bces p\u0113t\u012bjum\u0101 tika iek\u013cauti 238 pacienti, kuriem no 2014. gada j\u016bnija l\u012bdz 2015. gada oktobrim p\u0113c k\u0101rtas tika veiktas sirds oper\u0101cijas, izmantojot medi\u0101nas sternotomiju Gunma B\u0113rnu medic\u012bnas centra Sirds un asinsvadu \u0137irur\u0123ijas noda\u013c\u0101 \u0160ibukav\u0101, Jap\u0101n\u0101. Re\u0123istr\u0113tie pacienti p\u0113c nejau\u0161\u012bbas principa tika iedal\u012bti br\u016b\u010du aizv\u0113r\u0161anas ier\u012b\u010du grup\u0101 (sl\u0113g\u0161anas grupa) vai subkutikul\u0101ro \u0161uvju grup\u0101 (\u0161uvju grupa), izmantojot apr\u0113\u0137ina vienk\u0101r\u0161u randomiz\u0101ciju, un tika p\u0113t\u012bti.\u00a0perspekt\u012bvi (1. att\u0113ls). Visi pacienti sniedza rakstisku inform\u0113tu piekri\u0161anu piedal\u012bties.<\/span><\/p>

Pacienti, kuriem bija aizkav\u0113ta kr\u016b\u0161u kaula sl\u0113g\u0161ana, un tie, kuriem bija hromosomu anom\u0101lijas, kas nav 21. trisomija, tika izsl\u0113gti no p\u0113t\u012bjuma, lai vienk\u0101r\u0161otu nov\u0113rt\u0113\u0161anu \u0161aj\u0101 p\u0113t\u012bjum\u0101. P\u0113t\u012bjum\u0101 tika izsl\u0113gti 20 pacienti, kuriem bija aizkav\u0113ta kr\u016b\u0161u kaula sl\u0113g\u0161ana, 1 pacients, kuram bija hromosomu anom\u0101lija, kas nav 21. trisomija, un 3 pacienti, kuri nomira 3 m\u0113ne\u0161u laik\u0101 p\u0113c oper\u0101cijas, atst\u0101jot 214 pacientus \u0161aj\u0101 p\u0113t\u012bjum\u0101. Atk\u0101rtotas oper\u0101cijas pacienti un tie, kuriem ir 21. trisomija. tika iek\u013cauti.<\/p>

Tika apkopoti demogr\u0101fiskie dati un kl\u012bnisk\u0101s \u012bpa\u0161\u012bbas, kas ietv\u0113ra dzimumu, vecumu, \u0137erme\u0146a svaru, to, vai pacientam bija Dauna sindroms, vai tas bija z\u012bdainis vai jaundzimu\u0161ais, \u0137irur\u0123isk\u0101s br\u016bces garums, kop\u0113jais oper\u0101cijas laiks un asi\u0146o\u0161anas apjoms. \u0160aj\u0101 p\u0113t\u012bjum\u0101 analiz\u0113tie rezult\u0101ti ietv\u0113ra kosm\u0113tisko izskatu, \u0101das aizv\u0113r\u0161anas laiku un komplik\u0101ciju bie\u017eumu.<\/p>

214 pacienti tika sadal\u012bti pirm\u0101s oper\u0101cijas (FO) grup\u0101 vai atk\u0101rtotas oper\u0101cijas (RO) grup\u0101, un katrai grupai tika analiz\u0113ts kosm\u0113tiskais izskats. Tom\u0113r visi pacienti tika apkopoti, lai sal\u012bdzin\u0101tu \u0101das aizv\u0113r\u0161anas laikus un komplik\u0101ciju bie\u017eumu starp Closure grupu un \u0161uvju grupu. Iepriek\u0161 m\u0113s analiz\u0113j\u0101m iesp\u0113jam\u0101s komplik\u0101cijas, kas rakstur\u012bgas br\u016b\u010du aizv\u0113r\u0161anas ier\u012bcei, kas ietv\u0113ra \u0101das kr\u0101sas izmai\u0146as, epidermol\u012bzi, aler\u0123isku reakciju pret ier\u012bci un<\/p>

ier\u012bces boj\u0101jumi un lob\u012b\u0161an\u0101s. \u0160\u012bs komplik\u0101cijas tika analiz\u0113tas, pamatojoties uz uz\u0146\u0113muma sniegto inform\u0101ciju un person\u012bgo pieredzi, k\u0101 ar\u012b tika iek\u013cauti ier\u012bces boj\u0101jumi, lai nov\u0113rt\u0113tu ier\u012bces dro\u0161\u012bbu.<\/p>\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\"Zhejiang\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

Ier\u012bce un tehnika<\/p>\n

\u0160aj\u0101 p\u0113t\u012bjum\u0101 iek\u013cautajiem 214 pacientiem tika veiktas automa\u0161\u012bnas diovaskul\u0101ras oper\u0101cijas, izmantojot vid\u0113jo sternotomiju, ar vai bez kardiopulmon\u0101l\u0101s apvedce\u013ca. Gan sl\u0113g\u0161anas, gan \u0161uvju grup\u0101s zem\u0101das audi tika \u0161\u016bti, izmantojot 4-0 Vicryl (Ethicon, Cincinnati, OH) absorb\u0113jamas daudzpavedienu \u0161uves. Sl\u0113g\u0161anas grup\u0101 \u0137irur\u0123isk\u0101s br\u016bces \u0101r\u0113j\u0101 virsma tika aizv\u0113rta ar br\u016bces aizv\u0113r\u0161anas ier\u012bci (2. att\u0113ls). \u0160uvju grup\u0101 nep\u0101rtrauktas zem\u0101das \u0161uves parasti tika ievietotas, izmantojot 5-0 Prolene \u0161uves (Ethicon) ar \u0137irur\u0123isko klipsi \u0161uves gal\u0101.<\/span><\/p>\n

Br\u016b\u010du aizsardz\u012bba tika pan\u0101kta, izmantojot steriliz\u0113tu marli, kas tika aizst\u0101ta ar jaunu marli, bez dezinfekcijas l\u012bdzek\u013ca, ja t\u0101 bija notraip\u012bta ar sviedriem vai izsv\u012bdumiem. Visiem pacientiem ier\u012bces no\u0146em\u0161ana vai \u0161uvju no\u0146em\u0161ana notika 7 dienas p\u0113c oper\u0101cijas. Br\u016bces aizv\u0113r\u0161anas ier\u012bces no\u0146em\u0161ana tika pan\u0101kta, izmantojot adh\u0113zijas no\u0146em\u0161anas l\u012bdzekli (Nichiban, Bunkyo, Tokija, Jap\u0101na), lai aizsarg\u0101tu \u0101du. P\u0113c ier\u012bces vai \u0161uvju no\u0146em\u0161anas pacientiem tika at\u013cauts doties vann\u0101.<\/p>\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\"Longmed\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

P\u0113cp\u0101rbaude un datu v\u0101k\u0161ana<\/p>

Elektroniskie medic\u012bniskie ieraksti un Jap\u0101nas iedzimto sirds un asinsvadu \u0137irur\u0123ijas datub\u0101ze tika izmantoti k\u0101 instrumenti kl\u012bnisko datu ierakst\u012b\u0161anai. Visi demogr\u0101fiskie dati un kl\u012bnisko raksturojumu dati tika re\u0123istr\u0113ti pirms oper\u0101cijas un\u00a0intraoperat\u012bvi. \u0100das aizv\u0113r\u0161anas laiki tika re\u0123istr\u0113ti intraoperat\u012bvi ar hronometru. Br\u016b\u010du \u0101rst\u0113\u0161ana\u00a0<\/span>protokols tika piem\u0113rots visiem pacientiem. Nov\u0113ro\u0161anas un komplik\u0101ciju datus 1, 2, 4, 8 un 12 ned\u0113\u013cas p\u0113c oper\u0101cijas sav\u0101ca 3 sirds un asinsvadu \u0137irurgi. Kosm\u0113tiskais izskats tika re\u0123istr\u0113ts 3 m\u0113ne\u0161us p\u0113c oper\u0101cijas. P\u0113c izrakst\u012b\u0161anas pacienti tika uzraudz\u012bti k\u0101 ambulatori m\u016bsu iest\u0101d\u0113.<\/span><\/p>\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

Br\u016b\u010du nov\u0113rt\u0113jums<\/p>

Kosm\u0113tisko rezult\u0101tu nov\u0113rt\u0113\u0161anu veica 2 plastikas \u0137irurgi 3 m\u0113ne\u0161us p\u0113c oper\u0101cijas, kuri bija akli pret izmantoto \u0101das aizdares veidu. Kosm\u0113tiskais izskats tika nov\u0113rt\u0113ts, izmantojot Vank\u016bveras r\u0113tu skalu (VSS), pla\u0161i atz\u012btu apdegumu r\u0113tu nov\u0113rt\u0113\u0161anas skalu, ko Salivans pirmo reizi aprakst\u012bja 1990. gad\u0101. VSS ir visbie\u017e\u0101k izmantot\u0101 \u0137irur\u0123isko r\u0113tu nov\u0113rt\u0113\u0161anas skala [9\u201311], un tai ir \u010detras skalas. kategorijas, kuru pamat\u0101 ir vaskularit\u0101te, pigment\u0101cija, lokan\u012bba un augstums [12]. Kop\u0113jais punktu skaits sv\u0101rst\u0101s no 0 l\u012bdz 13, kur rezult\u0101ts 0 atspogu\u013co norm\u0101lu \u0101du (1. tabula).<\/p>\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\"1.\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

Statistikas metodes<\/p>

Programmat\u016bra StatView 5.0 (SAS Institute Inc, Cary, NC) un Excel 2013 (Microsoft Corp, Redmond, WA) tika izmantota\u00a0datu anal\u012bze. Rezult\u0101ti tiek par\u0101d\u012bti k\u0101 vid\u0113jais SD vai medi\u0101nas un starpkvarti\u013cu diapazons ar 95% ticam\u012bbu kvantitat\u012bvo main\u012bgo interv\u0101los, un kategoriskie main\u012bgie ir apkopoti p\u0113c absol\u016btaj\u0101m frekvenc\u0113m un procentu\u0101l\u0101 vecuma. Nep\u0101rtraukti main\u012bgie tika sal\u012bdzin\u0101ti, izmantojot studentu testu un Mann-Whitney U testu. Kategoriskie main\u012bgie tika sal\u012bdzin\u0101ti, izmantojot P\u012brsona X\u00b2 testu vai Fi\u0161era prec\u012bzu testu, ja paredzam\u0101s frekvences bija maz\u0101kas par 5. P v\u0113rt\u012bbas 0,05 vai maz\u0101k tika uzskat\u012btas par statistiski noz\u012bm\u012bg\u0101m.<\/span><\/p>

\u00a0<\/p>

Rezult\u0101ti<\/span><\/p>

FO grup\u0101 bija 136 pacienti (sl\u0113g\u0161anas grup\u0101: 71 pacients; \u0161uvju grup\u0101: 65 pacienti) un RO grup\u0101 bija 78 pacienti (nosl\u0113g\u0161anas grup\u0101: 42 pacienti; \u0161uvju grup\u0101: 36 pacienti). M\u016bsu ambulator\u0101 noda\u013ca visus pacientus uzraudz\u012bja vair\u0101k nek\u0101 3 m\u0113ne\u0161us p\u0113c sirds oper\u0101cijas. Demogr\u0101fisko datu un kl\u012bnisko \u012bpa\u0161\u012bbu anal\u012bze par\u0101d\u012bja, ka nav\u00a0b\u016btiskas at\u0161\u0137ir\u012bbas starp grupu un \u0161uvju grupu (2. tabula). Ar\u012b b\u016btiskas at\u0161\u0137ir\u012bbas nebija\u00a0<\/span>kop\u0113jos vid\u0113jos VSS r\u0101d\u012bt\u0101jos RO grup\u0101 pirmsoper\u0101cijas period\u0101 (Sl\u0113g\u0161ana: VSS 3,2 1,2; \u0161uve: VSS 3,3 1,3; p \u00bc 0,57). Vid\u0113jais vecums un \u0137erme\u0146a svars bija augst\u0101ki RO grup\u0101, sal\u012bdzinot ar FO grupu, un vid\u0113jais kop\u0113jais darb\u012bbas laiks bija gar\u0101ks RO grup\u0101, lai gan \u0161ie rezult\u0101ti nebija noz\u012bm\u012bgi.<\/span><\/p>

\u00a0<\/p>\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

Kosm\u0113tiskais izskats<\/p>

Kosm\u0113tisko izskatu VSS nov\u0113rt\u0113ja 3 m\u0113ne\u0161us p\u0113c oper\u0101cijas (3. att.). FO grup\u0101 Closure grupas VSS bija iev\u0113rojami zem\u0101ks par \u0161uvju grupu visiem VSS main\u012bgajiem (3. tabula). RO grup\u0101 vaskularit\u0101te, pigment\u0101cija un kop\u0113jais VSS r\u0101d\u012bt\u0101js bija iev\u0113rojami zem\u0101ks Closure grup\u0101 nek\u0101 \u0161uvju grup\u0101. Turkl\u0101t kop\u0113jais VSS r\u0101d\u012bt\u0101js pacientiem ar 21. trisomiju bija iev\u0113rojami zem\u0101ks Closure grup\u0101, sal\u012bdzinot ar \u0161uvju grupu (4. tabula). Turkl\u0101t kop\u0113jais VSS r\u0101d\u012bt\u0101js z\u012bdai\u0146iem bija iev\u0113rojami zem\u0101ks Closure grup\u0101 nek\u0101 \u0161uvju grup\u0101 (tabula). 5). L\u012bdz\u012bgi jaundzimu\u0161ajiem kop\u0113jais VSS rezult\u0101ts Closure grup\u0101 bija iev\u0113rojami zem\u0101ks nek\u0101 \u0161uvju grup\u0101 (3,0 2,0 pret 5,2 2,3, p < 0,017). Starp diviem \u0137irurgiem nebija b\u016btisku at\u0161\u0137ir\u012bbu VSS v\u0113rt\u0113jumos par br\u016b\u010du aizv\u0113r\u0161anu (p \u00bc 0,96) un \u0161uv\u0113m (p \u00bc 0,79).<\/p>

\u00a0<\/p>

Br\u016b\u010du sl\u0113g\u0161anas ier\u012bce \u0100das aizv\u0113r\u0161anas laiks<\/p>

Kop\u0113j\u0101 oper\u0101cijas laika at\u0161\u0137ir\u012bba starp Closure grupu un \u0161uvju grupu (340,3\u00a0127,1\u00a0min\u016btes pret 328,2\u00a0120,7\u00a0min\u016bt\u0113m) nebija noz\u012bm\u012bga (p \u00bc 0,70). Tom\u0113r \u0101das aizv\u0113r\u0161anas laiks Closure grup\u0101 bija iev\u0113rojami \u012bs\u0101ks nek\u0101 \u0161uvju grup\u0101. \u0161uvju grupa (113,0 9,1 sekundes pret 375,9 60,2 sekundes, p <0,001; 4. att.). Vid\u0113jais \u0101das aizv\u0113r\u0161anas laiks bija 113 sekundes (diapazons no 98 l\u012bdz 135 sekund\u0113m) aizv\u0113r\u0161anas grup\u0101 un 389 sekundes (diapazons no 256 l\u012bdz 470 sekund\u0113m) \u0161uvju grup\u0101.<\/p>\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\"2.\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

Komplik\u0101cijas un fiziski atkl\u0101jumi<\/p>

Komplik\u0101ciju bie\u017eums tika sal\u012bdzin\u0101ts starp sl\u0113g\u0161anas grupu (n \u00bc 113) un \u0161uvju grupu (n \u00bc 101). \u0136irur\u0123isk\u0101s br\u016bces infekcija rad\u0101s 1 pacientam Closure grup\u0101 un 2 pacientiem \u0161uvju grup\u0101. \u0136irur\u0123isk\u0101s infekcijas bie\u017eums Closure grup\u0101 un \u0161uvju grup\u0101 b\u016btiski neat\u0161\u0137\u012br\u0101s (0,9% pret 2,0%, p \u00bc 0,50). Tr\u012bs pacientiem bija \u0137irur\u0123iskas vietas infekcijas, kas nebija smagas, un t\u0101s uzlaboj\u0101s, lietojot antibiotikas un mazg\u0101jot ar s\u0101ls \u0161\u0137\u012bdumu. \u0136irur\u0123isk\u0101s br\u016bces atdal\u012b\u0161an\u0101s notika 2 pacientiem Closure grup\u0101 un 3 pacientiem \u0161uvju grup\u0101. Nebija b\u016btisku at\u0161\u0137ir\u012bbu \u0137irur\u0123isk\u0101s br\u016bces atdal\u012b\u0161an\u0101s starp ab\u0101m grup\u0101m (1,8% pret 3,0%, p \u00bc 0,56). Visi pacienti, kuriem rad\u0101s br\u016bces atsl\u0101\u0146o\u0161an\u0101s, bija jaundzimu\u0161ie vai ar trisomiju 21. Komplik\u0101cijas, kas rakstur\u012bgas Closure ier\u012bcei, bija \u0101das kr\u0101sas mai\u0146a (0,9%), epidermol\u012bze (0,9%) un ier\u012bces eksfoli\u0101cija (1,8%). Kr\u0101sas izmai\u0146as rad\u0101s l\u012bmlentes izvirduma d\u0113\u013c, kas tika uzlabota, uzkl\u0101jot stero\u012bdu ziedi. Ar ziedi tika \u0101rst\u0113ta ar\u012b epidermol\u012bze. Pacientiem, kuriem ier\u012bces nolob\u012bj\u0101s, tika piestiprin\u0101tas jaunas ier\u012bces.<\/p>

Tom\u0113r nopietnas komplik\u0101cijas, piem\u0113ram, aler\u0123ija pret ier\u012bc\u0113m vai boj\u0101jumi, neatt\u012bst\u012bj\u0101s. M\u0113s nevar\u0113j\u0101m nov\u0113rt\u0113t niezi vai s\u0101pes, jo m\u016bsu pediatriskie pacienti, tostarp z\u012bdai\u0146i, nevar\u0113ja s\u016bdz\u0113ties par \u0161iem simptomiem.<\/p>

Tom\u0113r br\u016bces aizv\u0113r\u0161anas ier\u012bces vai \u0161uvju no\u0146em\u0161anas laik\u0101 iev\u0113rojami maz\u0101k pacientu raud\u0101ja vai s\u016bdz\u0113j\u0101s Sl\u0113g\u0161anas grup\u0101, sal\u012bdzinot ar \u0161uvju grupu (7,1% pret 52,5%, p < 0,001).<\/p>\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\"Longmed\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\"3.\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\"4.\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\"5.\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\"Br\u016bces\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

koment\u0113t
\u0160is p\u0113t\u012bjums ir pirmais randomiz\u0113tais kontrol\u0113tais p\u0113t\u012bjums par br\u016b\u010du aizv\u0113r\u0161anas ier\u012bci b\u0113rniem, kuriem tika veiktas sirds oper\u0101cijas. Lai gan ir iesniegti da\u017ei neseni zi\u0146ojumi par gad\u012bjumiem, kas saist\u012bti ar br\u016bces aizv\u0113r\u0161anas ier\u012bci, neviens nezi\u0146oja par sirds oper\u0101cij\u0101m, izmantojot vid\u0113jo sternotomiju [7, 8]. Ar\u012b ieguvumi vai komplik\u0101ciju risks b\u0113rniem joproj\u0101m nav zin\u0101ms. M\u016bsu p\u0113t\u012bjum\u0101 m\u0113s nov\u0113rt\u0113j\u0101m b\u0113rnus, kuriem bija veiktas sirds oper\u0101cijas, izmantojot vid\u0113jo sternotomiju. M\u016bsu rezult\u0101ti uzr\u0101d\u012bja iev\u0113rojami lab\u0101ku rezult\u0101tu grup\u0101 Closure, sal\u012bdzinot ar \u0161uvju grupu. \u0145emot v\u0113r\u0101, ka \u0137irur\u0123isko br\u016b\u010du kosm\u0113tisko izskatu ietekm\u0113 vair\u0101ki faktori, piem\u0113ram, elektrokauterijas izmanto\u0161ana, infekcija, pieeja un \u0161uvju materi\u0101ls [13\u201315] , m\u0113s izmantoj\u0101m konsekventu \u0137irur\u0123isku griezumu pieeju un \u0161uvju materi\u0101lu, un visiem pacientiem tika izmantota elektrokauterija, lai veiktu vid\u0113jo sternotomiju. M\u016bsu rezult\u0101ti par\u0101d\u012bja, ka br\u016b\u010du aizv\u0113r\u0161anas ier\u012bcei ir kosm\u0113tiskas priek\u0161roc\u012bbas neatkar\u012bgi no t\u0101, vai t\u0101 bija pirm\u0101 oper\u0101cija vai atk\u0101rtota oper\u0101cija. B\u0113rnu sirds \u0137irur\u0123ij\u0101 daudziem pacientiem ir 21. trisomija [16]. Turkl\u0101t b\u0113rniem, kuriem ir sirds defekti, sirds oper\u0101cijas bie\u017ei tiek veiktas z\u012bdai\u0146a vecum\u0101 [17, 18].<\/p>\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

Pamatojoties uz \u0161\u012b izm\u0113\u0123in\u0101juma rezult\u0101tiem, m\u0113s uzskat\u0101m, ka \u0161o br\u016b\u010du aizv\u0113r\u0161anas ier\u012bci var veiksm\u012bgi izmantot pla\u0161am pacientu lokam.
Attiec\u012bb\u0101 uz aizv\u0113r\u0161anas laiku \u0137irur\u0123isk\u0101m br\u016bc\u0113m, kas sl\u0113gtas, izmantojot br\u016bces aizv\u0113r\u0161anas ier\u012bci, bija ac\u012bmredzami izcils sniegums sal\u012bdzin\u0101jum\u0101 ar br\u016b\u010du aizv\u0113r\u0161anu, izmantojot \u0161uves. T\u0101pat 2-oktilci\u0101nakril\u0101ta l\u012bmes izmanto\u0161ana var ar\u012b samazin\u0101t \u0137irur\u0123isk\u0101s br\u016bces sl\u0113g\u0161anas laiku [4, 19]. Tom\u0113r nav zi\u0146u, ka oktilci\u0101nakril\u0101ts b\u016btu izmantots vid\u0113jai sternotomijai, kas apgr\u016btina t\u0101 dro\u0161\u012bbas un aizv\u0113r\u0161anas laika sal\u012bdzin\u0101\u0161anu ar br\u016bces aizv\u0113r\u0161anas ier\u012bci. \u0160aj\u0101 p\u0113t\u012bjum\u0101,
\u0100das sl\u0113g\u0161anas laika dispersija laik\u0101 Closure grup\u0101 bija \u0101rk\u0101rt\u012bgi maza, kas noz\u012bm\u0113, ka \u0161\u012bs ier\u012bces lieto\u0161anu neietekm\u0113ja ne br\u016bces garums, ne da\u017e\u0101di \u0137irurgi. T\u0101p\u0113c, jo gar\u0101ka ir br\u016bce, jo liel\u0101ku relat\u012bvo labumu var sagaid\u012bt.
Lai gan at\u0161\u0137ir\u012bba \u0137irur\u0123isko br\u016b\u010du infekcijas bie\u017eum\u0101 starp Closure grupu un \u0161uvju grupu nebija noz\u012bm\u012bga, Closure grup\u0101 br\u016b\u010du infekciju bija maz\u0101k. Ir zi\u0146ots, ka \u0137irur\u0123iskas vietas infekciju bie\u017eums p\u0113c sirds oper\u0101cij\u0101m b\u0113rniem ir robe\u017e\u0101s no 2,3% l\u012bdz 8% [20\u201323]. \u0160aj\u0101 p\u0113t\u012bjum\u0101 p\u0113coper\u0101cijas br\u016b\u010du infekcijas bie\u017eums Closure grup\u0101 bija 0,9%, kas ir \u0101rk\u0101rt\u012bgi zems infekcijas l\u012bmenis, \u0146emot v\u0113r\u0101 to, ka Closure grup\u0101 epiderm\u0101 nebija palieku. Silikona gela lieto\u0161ana, lai nov\u0113rstu \u0137irur\u0123iskas br\u016bces infekcijas vai ir par\u0101d\u012btas hipertrofiskas r\u0113tas [24\u201326]. Tom\u0113r br\u016bces aizv\u0113r\u0161anas ier\u012bcei ir papildu ieguvums, jo tas sa\u012bsina br\u016bces aizv\u0113r\u0161anas laiku.
papildus \u0137irur\u0123isko br\u016b\u010du infekciju un \u0137irur\u0123isko r\u0113tu nov\u0113r\u0161anai.<\/p>\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

L\u012bdz\u012bgi k\u0101 br\u016b\u010du infekcijas bie\u017eums, \u0137irur\u0123isk\u0101s br\u016bces atdal\u012b\u0161anas bie\u017euma r\u0101d\u012bt\u0101js Z grup\u0101 bija vien\u0101ds vai liel\u0101ks par \u0161uvju grupu. Tom\u0113r br\u016bces aizv\u0113r\u0161anas ier\u012bcei ir liel\u0101ka elast\u012bba br\u016bces atdal\u012b\u0161anai, un t\u0101 ir neinvaz\u012bv\u0101ka. \u0160uvi vai ier\u012bci no\u0146\u0113m\u0101m 7 dienas p\u0113c oper\u0101cijas saska\u0146\u0101 ar p\u0113t\u012bjuma pl\u0101nu. Tom\u0113r m\u0113s uzskat\u0101m, ka ier\u012bces no\u0146em\u0161ana j\u0101veic atkar\u012bb\u0101 no br\u016bces st\u0101vok\u013ca jaundzimu\u0161ajiem un pacientiem ar 21. trisomiju, jo br\u016bces atdal\u012b\u0161an\u0101s tika nov\u0113rota tikai \u0161iem pacientiem. Ier\u012bcei rakstur\u012bg\u0101s komplik\u0101cijas ir \u0101das kr\u0101sas mai\u0146a, epidermol\u012bze un ier\u012bces atsl\u0101\u0146o\u0161an\u0101s, lai gan neviena no t\u0101m nenotika \u013coti bie\u017ei vai nebija nopietna. L\u012bdz ar to secin\u0101j\u0101m, ka br\u016bces aizv\u0113r\u0161anas ier\u012bci var dro\u0161i lietot.
Br\u016bces aizv\u0113r\u0161anas ier\u012bces izcila iez\u012bme ir sp\u0113ja piel\u0101got t\u0101s garumu un spriegojumu. Ier\u012bces garumu var viegli regul\u0113t, nogrie\u017eot ier\u012bci atbilsto\u0161\u0101 viet\u0101. Ier\u012bces spriegojumu var regul\u0113t bez ierobe\u017eojumiem, pateicoties adapt\u012bvajai strap-rock sist\u0113mai. Piem\u0113ram, ier\u012bces spriegojumu var noregul\u0113t vair\u0101kas reizes atkar\u012bb\u0101 no t\u016bskas vai br\u016b\u010du dz\u012b\u0161anas pak\u0101pes p\u0113c oper\u0101cijas. Turkl\u0101t br\u016b\u010du dz\u012b\u0161anas pak\u0101pi var apstiprin\u0101t, atvienojot r\u0101v\u0113jsl\u0113dz\u0113jus. T\u0101d\u0113j\u0101di ier\u012bce var piel\u0101goties atv\u0113r\u0161anai, atkal \u0161\u016bpojot r\u0101v\u0113jsl\u0113dz\u0113ju, neizmantojot \u0161uves.<\/p>\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

No \u0161\u012b p\u0113t\u012bjuma rezult\u0101tiem m\u0113s uzskat\u0101m, ka liel\u0101k\u0101s priek\u0161roc\u012bbas, izmantojot br\u016b\u010du aizv\u0113r\u0161anas ier\u012bci, ir labs kosm\u0113tiskais izskats un samazin\u0101ts aizv\u0113r\u0161anas laiks. Ar\u012b ier\u012bces dro\u0161\u012bba bija tikpat laba k\u0101 zem\u0101das \u0161uves. Tom\u0113r br\u016bces aizv\u0113r\u0161anas ier\u012bces at\u0161\u0137ir\u012bg\u0101 iez\u012bme bija t\u0101, ka t\u0101 bija maz\u0101k s\u0101p\u012bga, kad to no\u0146em, padarot to \u012bpa\u0161i izdev\u012bgu b\u0113rniem. Faktiski iev\u0113rojami maz\u0101kam pacientu skaitam Sl\u0113g\u0161anas grup\u0101 bija s\u0101pes vai raud\u0101\u0161ana ier\u012bces vai \u0161uvju no\u0146em\u0161anas laik\u0101, sal\u012bdzinot ar \u0161uvju grupu. Turpretim br\u016bces aizv\u0113r\u0161anas ier\u012bces izmaksu veiktsp\u0113ja nav tik laba k\u0101 \u0161uvju. Br\u016bces aizv\u0113r\u0161anas ier\u012bces izmaksas ir $85, kas ir aptuveni tr\u012bs reizes augst\u0101kas nek\u0101 zem\u0101das \u0161uves. Tom\u0113r m\u0113s uzskat\u0101m, ka \u0161o ier\u012bci ir v\u0113rts izmantot, \u0146emot v\u0113r\u0101 t\u0101s kosm\u0113tisko un aizv\u0113r\u0161anas laika efektivit\u0101ti.<\/p>

\u0160im p\u0113t\u012bjumam ir vair\u0101ki ierobe\u017eojumi. Pirmk\u0101rt, \u0161is p\u0113t\u012bjums tika veikts vien\u0101 iest\u0101d\u0113; t\u0101p\u0113c m\u016bsu rezult\u0101tu visp\u0101rin\u0101\u0161ana ir ierobe\u017eota. Tom\u0113r \u0161ie dati ir svar\u012bgi, jo \u0161is ir pirmais perspekt\u012bvais randomiz\u0113ts p\u0113t\u012bjums, kur\u0101 zi\u0146ots par br\u016b\u010du aizv\u0113r\u0161anas ier\u012bces lieto\u0161anu b\u0113rniem, kuriem tika veikta vid\u0113j\u0101 sternotomija.<\/p>

Otrk\u0101rt, pacientu ar Dauna sindromu skaits ir sal\u012bdzino\u0161i neliels, k\u0101 rezult\u0101t\u0101 nav pietiekama statistisk\u0101 jauda, lai nov\u0113rt\u0113tu ier\u012bces efektivit\u0101ti Dauna sindroma popul\u0101cij\u0101.<\/p>

Tre\u0161k\u0101rt, p\u0113t\u012bjum\u0101 tika izsl\u0113gti pacienti ar hromosomu anom\u0101lij\u0101m, iz\u0146emot 21. trisomiju, un pacienti, kuriem bija aizkav\u0113ta kr\u016b\u0161u kaula sl\u0113g\u0161ana. T\u0101d\u0113j\u0101di m\u0113s nevar\u0113j\u0101m p\u0101rbaud\u012bt rezult\u0101tus \u0161aj\u0101s popul\u0101cij\u0101s. Attiec\u012bb\u0101 uz ier\u012bci un tehniku nep\u0101rtraukta subkutikul\u0101ra \u0161\u016b\u0161ana, izmantojot neabsorb\u0113jamas polipropil\u0113na \u0161uves ar \u0161uvju no\u0146em\u0161anu, var b\u016bt reta metode. Visbeidzot, \u0161is p\u0113t\u012bjums bija randomiz\u0113ts p\u0113t\u012bjums ar pediatriskiem pacientiem, un m\u0113s nep\u0101rbaud\u012bj\u0101m efektivit\u0101ti pieaugu\u0161iem pacientiem. T\u0101d\u0113\u013c ir nepiecie\u0161ams prospekt\u012bvs, randomiz\u0113ts kl\u012bnisks p\u0113t\u012bjums ar pieaugu\u0161iem pacientiem, lai apstiprin\u0101tu ier\u012bces lieto\u0161anu pieaugu\u0161o popul\u0101cij\u0101.<\/p>\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

Nosl\u0113gum\u0101 j\u0101saka, ka \u0161is ir pirmais randomiz\u0113tais p\u0113t\u012bjums, lai nov\u0113rt\u0113tu r\u0101v\u0113jsl\u0113dz\u0113ja Longmed br\u016b\u010du aizv\u0113r\u0161anas ier\u012bces rezult\u0101tus pediatriskiem pacientiem, kuriem tika veiktas sirds oper\u0101cijas, izmantojot vid\u0113jo sternotomiju. M\u016bsu p\u0113t\u012bjums par\u0101d\u012bja, ka ier\u012bcei ir lieliska veiktsp\u0113ja, uzlabojot kosm\u0113tisko izskatu un samazinot \u0101das aizv\u0113r\u0161anas laiku. T\u0101 ir neinvaz\u012bva ier\u012bce, ko var lietot vienk\u0101r\u0161i un dro\u0161i, un t\u0101 var b\u016bt piem\u0113rota b\u0113rniem, jo t\u0101 ir maz\u0101k s\u0101p\u012bga.<\/p>\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

Atsauces<\/p>

  1. Jina H, Simcock J. Vid\u0113j\u0101s sternotomijas r\u0113tas nov\u0113rt\u0113jums. NZ Med J 2011;124:57\u201362.<\/li>
  2. Cotogni P, Barbero C, Rinaldi M. Dzi\u013cas kr\u016b\u0161u kaula br\u016bces infekcija p\u0113c sirds oper\u0101cijas: pier\u0101d\u012bjumi un str\u012bdi. World J Care Med 2015; 4:265\u201373.<\/li>
  3. Lemaignen A, Birgand G, Ghodhbane W u.c. Kr\u016b\u0161kurvja br\u016bces infekcija p\u0113c sirds oper\u0101cijas: sastopam\u012bba un riska faktori atbilsto\u0161i kl\u012bniskajam att\u0113lam. Clin Microbiol Infect 2015;21:674.e11\u201318.<\/li>
  4. Krishnamoorthy B, Najam O, Kharn UA, Waterworth P, Fildes JE, Yonan N. Randomiz\u0113ts perspekt\u012bvs p\u0113t\u012bjums, sal\u012bdzinot parasto subkutikulu \u0101das aizv\u0113r\u0161anu ar Dermabond \u0101das l\u012bmi p\u0113c saphenous v\u0113nu nov\u0101k\u0161anas. Ann Thorac Surg 2009;88:1445\u201350.<\/li><\/ol>
    1. Chambers A, Scarci M. Vai \u0101das aizv\u0113r\u0161ana ar ci\u0101nakril\u0101ta l\u012bmi ir efekt\u012bva kr\u016b\u0161kurvja br\u016b\u010du infekciju profilaksei.Interact CardioVasc Thorac Surg 2010;10:793\u20136.<\/li>
    2. Lavazzo C, Gkegkes ID, Vouloumanou EK, Mamais I, Peppas G, Falagas ME. \u0160uves pret skav\u0101m \u0137irur\u0123isku br\u016b\u010du \u0101rst\u0113\u0161anai: randomiz\u0113tu kontrol\u0113tu p\u0113t\u012bjumu metaanal\u012bze. Am Surg2011;77:1206\u201321.<\/li>
    3. Gorsulowsky DC, Talmor G. Jauna neinvaz\u012bva br\u016b\u010du aizv\u0113r\u0161anas ier\u012bce k\u0101 p\u0113d\u0113jais sl\u0101nis \u0101das aizv\u0113r\u0161an\u0101. Dermatol Surg 2015;41:987\u20139.<\/li>
    4. Marija ED. Jauna \u0101das aizv\u0113r\u0161anas sist\u0113ma atvieglo br\u016b\u010du dz\u012b\u0161anu p\u0113c kardiovaskul\u0101r\u0101s implant\u0113jam\u0101s elektronisk\u0101s ier\u012bces oper\u0101cijas. Pasaules J Clin lietas 2015; 3:675\u20137.<\/li>
    5. Bae SH, Bae YC. Da\u017e\u0101du r\u0113tu nov\u0113rt\u0113\u0161anas skalu lieto\u0161anas bie\u017euma anal\u012bze, pamatojoties uz bailes st\u0101vokli un \u0101rst\u0113\u0161anas metodi. Arch Plast Surg 2014;41:111\u20135.<\/li>
    6. Truong PT, Abnousi F, Yong CM u.c. Standartiz\u0113ts kr\u016bts v\u0113\u017ea \u0137irur\u0123isko r\u0113tu nov\u0113rt\u0113jums, integr\u0113jot Vank\u016bveras r\u0113tu skalu, \u012bsas formas McGill s\u0101pju aptauju un pacientu perspekt\u012bvas. Plast Reconstr Surg 2005;116:1291\u20139.<\/li><\/ol>
      1. Lee SH, Zheng Z, Roh MR. Agr\u012bna p\u0113coper\u0101cijas \u0137irur\u0123isko r\u0113tu \u0101rst\u0113\u0161ana, izmantojot s frakcion\u0113tu dioks\u012bda l\u0101zeru: dal\u012bta r\u0113ta, nov\u0113rt\u0113t\u0101ja akls p\u0113t\u012bjums. Dermatol Surg 2013;39:1190\u20136.<\/li>
      2. Femonti R, Bond J, Erdmann D, Levinson H. P\u0101rskats par r\u0113tu un r\u0113tu m\u0113r\u012b\u0161anas ier\u012bc\u0113m. Eplasty 2010;10:e43.<\/li>
      3. Dzied\u0101t\u0101js AJ, Quinn JV, Thode HC Jr, Hollander JE. Slikt\u0101 izn\u0101kuma determinanti p\u0113c pl\u012bsuma un \u0137irur\u0123iska griezuma labo\u0161anas. Plast Reconstr Surg 2002;110:429\u201337.<\/li>
      4. Niessen FB, Spauwen PH, Kon M. \u0160uvju materi\u0101la loma hipertrofisku r\u0113tu veido\u0161an\u0101: monokrils vs vikrilrapide. Ann Plast Surg 1997;39:254\u201360.<\/li>
      5. Crossland DS, Jackson SP, Lyall R u.c. Pacientu attieksme pret sternotomijas un torakotomijas r\u0113t\u0101m. Thorac Cardiovasc Surg 2005;53:93\u20135.<\/li>
      6. Freeman SB, Taft LE, Dooley KJ u.c. Iedz\u012bvot\u0101ju p\u0113t\u012bjums par iedzimtiem sirds defektiem Dauna sindrom\u0101. Am J Med Genet 1998;80:213\u20137.<\/li>
      7. Moller J. Sirds anom\u0101liju izplat\u012bba un sastopam\u012bba. In: Moller JH (red). Perspekt\u012bvas b\u0113rnu kardiolo\u0123ij\u0101: iedzimtu sirds slim\u012bbu \u0137irur\u0123ija: Pediatric Cardiac Care Consortium, 1984-1995. Armonk, NY: Futura; 1998: 619\u201326.<\/li>
      8. Dikinsons DF, Arnolds R., Vilkinsons JL. Iedzimta sirds slim\u012bba 160\u00a0480 dz\u012bvi dzimu\u0161iem b\u0113rniem Liverp\u016bl\u0113 no 1960. l\u012bdz 1969. gadam. Ietekme uz \u0137irur\u0123isko \u0101rst\u0113\u0161anu. Br Heart J 1981;46:55\u201362.<\/li><\/ol>
        1. Quinn J, Wells G, Satcliffe T u.c. Randomiz\u0113ts p\u0113t\u012bjums, kur\u0101 sal\u012bdzina oktilci\u0101nakril\u0101ta audu l\u012bmi un \u0161uves pl\u0113stu br\u016b\u010du \u0101rst\u0113\u0161an\u0101. JAMA 1997;277:1527\u201330.<\/li>
        2. Barker GM, O'Brien SM, Welke KF u.c. Liela infekcija p\u0113c b\u0113rnu sirds oper\u0101cijas: riska nov\u0113rt\u0113\u0161anas modelis. Ann Thorac Surg 2010;89:843\u201350.<\/li><\/ol>
          1. Pollock EM, Ford-Jones EL, Rebeyka I u.c. Agr\u012bnas nozokomi\u0101l\u0101s infekcijas b\u0113rniem sirds un asinsvadu \u0137irur\u0123ijas pacientiem. Crit Care Med 1990;18:378\u201384.<\/li>
          2. Levy I, Ovadia B, Erez E. Nozokomi\u0101l\u0101s infekcijas p\u0113c sirds oper\u0101cijas z\u012bdai\u0146iem un b\u0113rniem: sastopam\u012bba un riska faktori. J Hosp Infect 2003;53:111\u20136.<\/li>
          3. Allpress AL, Rosenthal GL, Goodrich KM, Lupinetti FM, Zerr DM. Oper\u0101cijas vietas infekciju riska faktori p\u0113c b\u0113rnu sirds un asinsvadu oper\u0101cijas. Pediatr Infect Dis J 2004; 23:231\u20134.<\/li><\/ol>
            1. Chan KY, Lau CL, Adeeb SM, Somasundaram S, NasirZahari M. Randomiz\u0113ts, placebo kontrol\u0113ts, dubultmask\u0113ts, perspekt\u012bvs silikona g\u0113la kl\u012bniskais p\u0113t\u012bjums, lai nov\u0113rstu hipertrofisku r\u0113tu att\u012bst\u012bbu vid\u0113j\u0101 sternotomijas br\u016bc\u0113. Plast Reconstr Surg 2005;116:1013\u201320.<\/li>
            2. Sakuraba M, Takahashi N, Akahoshi T, Miyasaka Y, Suzuki K. Silikona g\u0113la lok\u0161\u0146u pieredze pacientiem ar kelo\u012bdu r\u0113t\u0101m p\u0113c vid\u0113j\u0101s sternotomijas. Gen Thorac Cardiovasc Surg 2010;58:467\u201370.<\/li>
            3. Pai VB, Cummings I. Vai ir k\u0101das labas kelo\u012bdu r\u0113tu \u0101rst\u0113\u0161anas metodes p\u0113c sternotomijas? Interact Cardiovasc Thorac Surg 2011;13:415\u20138.<\/li><\/ol>\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":"

              Randomiz\u0113ts p\u0113t\u012bjums ar r\u0101v\u0113jsl\u0113dz\u0113ju garu br\u016b\u010du aizv\u0113r\u0161anas ier\u012bci. Randomiz\u0113ts p\u0113t\u012bjums par jaunu neinvaz\u012bvu \u0101das aizv\u0113r\u0161anas ier\u012bci ar r\u0101v\u0113jsl\u0113dz\u0113ju, kas paredz\u0113ta lieto\u0161anai p\u0113c iedzimt\u0101m sirds oper\u0101cij\u0101m Yuki Tanaka, MD, Takashi Miyamoto, MD, PhD, Yuji Naito, MD, PhD, Shuichi, YMD Sasahara, MD, un Kagami Miyaji, MD, sirds un asinsvadu \u0137irur\u0123ijas noda\u013cas doktora gr\u0101ds, Gunma B\u0113rnu medic\u012bnas centrs,\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\/lv\/wp-json\/wp\/v2\/posts\/741","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/comments?post=741"}],"version-history":[{"count":0,"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/posts\/741\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/media\/689"}],"wp:attachment":[{"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/media?parent=741"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/categories?post=741"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/longmed-medical.com\/lv\/wp-json\/wp\/v2\/tags?post=741"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}