检索结果-南通市图书馆

Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant

World Journal of Gastroenterology 2010年第22期16卷 2793-2800页

作者： jorge avalos-gonzález Eliseo Portilla-deBuen Caridad Aurea Leal-Cortés Abel Orozco-Mosqueda María del Carmen Estrada-Aguilar Gabriela Abigail Velázquez-Ramírez Gabriela Ambriz-gonzález Clotilde Fuentes-Orozco Aldo Emmerson Guzmán-Gurrola Alejandro gonzález-Ojeda Research Unit in Clinical Epidemiology High Specialized Medical Unit Surgical Research Division National Western Medical Center Department of Surgery Regional General Hospital #1 of the Mexican Institute for Social Security Avenida Héroes de Nocupetaro y Nicolás de Regules Colonia Centro Department of Pediatric Surgery Children's Hospital National Western Medical Center

AIM: To assess whether the use of fibrin sealantshortens the closure time of postoperative enterocutaneous fistulas (ECFs). METHODS: The prospective case-control study included 70 patients with postoperative ECFs with an output of 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support. RESULTS: There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 ± 14.2 d and 32.5 ± 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 ± 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 ± 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition. CONCLUSION: Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.

关键词： Enterocutaneous fistulas Fibrin sealant Spontaneous closure

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Timing, method and discontinuation of hydrocortisone administration for septic shock patients

引用

World Journal of Critical Care Medicine 2017年第1期6卷 65-73页

作者： Miguel A Ibarra-Estrada Quetzalcóatl Chávez-Pe?a Claudia I Reynoso-Estrella jorge Rios-Zerme?o Pável E Aguilera-gonzález Miguel A García-Soto Guadalupe Aguirre-avalos Critical Care Unit Instituto Jalisciense de Cancerología Critical Care Unit Hospital General Regional #180 Instituto Mexicano del Seguro Social Transplant Care Unit Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Centro Universitario de Ciencias de la Salud Universidad de Guadalajara Critical Care Unit Hospital Civil Fray Antonio Alcalde

AIM To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better *** This prospective cohort study included 59 patients with septic shock who received stress-dose *** was performed at 2 critical care units in academic hospitals from June 1st, 2015, to July 31 st, 2016. Demographic data, comorbidities, medical management details, adverse effects related to corticosteroids, and outcomes were collected after the critical care physician indicated initiation of hydrocortisone. Univariate comparison between continuous and bolus administration of hydrocortisone was performed, including multivariate analysis, as well as Kaplan-Meier analysis to compare the proportion of shock reversal at 7 d after presentation. Receiver operating characteristic(ROC) curves determined the best cut-off criteria for initiation of hydrocortisone associated with the highest probability of shock reversal. We addressed the effects of the taper strategy for discontinuation of hydrocortisone, noting risk of shock relapse and adverse *** All-cause 30-d mortality was 42%. Hydrocortisone was administered as a continuous infusion in 54.2% of patients; time to reversal of shock was 49 h longer in patients who were given a bolus administration [59 h(range, 47.5-90.5) vs 108 h(range, 63.2-189); P = 0.001]. The maximal dose of norepinephrine after initiation of hydrocortisone was lower in patients on continuous infusion [0.19 μg/kg per minute(range, 0.11-0.28 μg)] compared with patients who were given bolus [0.34 μg/kg per minute(range, 0.16-0.49); P = 0.004]. Kaplan-Meier analysis revealed a higher proportion of shock reversal at 7 d in patients with continuous infusion compared to those given bolus(83% vs 63%; P = 0.004). There was a good correlation between time to initiation of hydrocortisone and time to reversal of shock(r = 0.80; P < 0.0001)

关键词： Corticosteroids Hydrocortisone Timing Administration Discontinuation Septic shock

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：