Peripheral arterial surgery

  • 文章类型: Journal Article
    背景:闭合切口负压治疗可降低外周动脉手术后患者手术部位感染的风险。
    目的:探讨外周动脉手术后腹股沟切口应用负压治疗的患者经验,并研究他们对血管科收到的自我护理信息表的看法和态度。
    方法:一项以伽达默尔哲学解释学为基础的定性研究是在治疗结束后第7天通过电话进行半结构化访谈,共有10名参与者。所有人都在出院时收到了自我护理信息表,并在家中接受了封闭切口负压治疗3-6天。参与者以股骨血栓内膜切除术的形式在腹股沟进行了开放的外周动脉手术。Kvale和Brinkmann的研究指导了数据收集,分析,和解释。
    结果:患者在外周动脉手术后发现自己在应对陌生情况,因此需要隐藏作为切口治疗一部分的泵和管道,以保护自身形象。他们的治疗成为了永恒的伴侣,一些患者将设备视为他们身体的延伸,而另一些患者则感觉到其对日常生活活动的影响。患者认为治疗提供了安慰,尽管有限制,导致可管理性的感觉和越来越多的控制感。他们认为书面信息内容丰富,但仍有改进的空间。
    结论:患者在外周动脉手术后出院后对腹股沟切口进行闭合切口负压治疗的经验表明,他们认为这是安全且可控的。病人需要支持,然而,在学习如何隐藏治疗和扩大自己的参与和提高自我保健。研究发现,患者的参与和个性化的信息对于促进从医院到家庭自我护理的健康过渡至关重要,并且必须进一步改善书面信息。
    Closed-incision negative pressure therapy may lower the risk of surgical site infections in patients after peripheral arterial surgery.
    To explore patient experience of negative pressure therapy applied to groin incisions after discharge following peripheral arterial surgery, and to study their perception and attitudes toward the self-care information sheet they received at the vascular department.
    A qualitative study underpinned by Gadamer\'s philosophical hermeneutics was conducted semi-structured interviews by telephone around day seven after therapy ended with ten participants. All had received self-care information sheet at the discharge and been home with closed-incision negative pressure therapy for 3-6 days. The participants had open peripheral arterial surgery in the groin in form of femoral thromboendarterectomy. Kvale and Brinkmann\'s research guided the data collection, analysis, and interpretation.
    Patients found themselves coping with an unfamiliar situation after peripheral arterial surgery and the need arose to conceal the pump and tubing that were part of their incision treatment to protect their self-image. Their treatment became a constant companion, with some patients viewing the equipment as an extension of their bodies and others feeling its impact on activities of daily living. Patients perceived the treatment as providing reassurance, albeit with constraints, leading to feelings of manageability and an increasing sense of control. They viewed the written information as informative but with room for improvement.
    Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery showed that they perceived it as safe and manageable. Patients need support, however, in learning how to hide the treatment and to expand their own involvement and improve self-care. The study found that patient involvement and individually tailored information is essential to facilitating a healthy transition from hospital to self-care at home and that written information must be improved further.
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  • 文章类型: Journal Article
    OBJECTIVE: Patient treatment within the Swedish medical service system can claim negligence injuries to the malpractice insurance review board and request financial compensation. The aim of this paper was to analyse the consequences of a negligence claim after arterial surgery between two periods with increasing use of endovascular treatment.
    METHODS: This was a retrospective cohort study of the arterial surgery negligence claims from two three year periods 2005-2007 (Period A) and 2012-2014 (Period B) from the County Council\'s Mutual Insurance Company. The analysis was restricted to aortic, carotid, and lower limb arterial diseases. The magnitude of surgery for vascular diseases was obtained from the Swedish vascular register (Swedvasc).
    RESULTS: The number of patients undergoing arterial procedures increased from 16 628 to 20 709 (p = .01). There was an increase of 54% in the number of negligence claims between the periods. In Period A, the number of compensated claims was 22 out of 83 (29%) and in Period B 60 out of 151 (41%) (p = .06). Patients treated for aortic disorders and peripheral arterial surgery received compensation with increasing frequency whereas carotid diseases decreased. Claimants treated for aortic disorders were compensated in four out of 23 (17%) and 21 out of 54 (39%) in the two periods (p = .07), and after lower limb arterial surgery in six out of 34 (18%) and in 24 out of 71 (34%) (p = .09). After carotid surgery the corresponding figures were 12 out of 26 (46%) and 14 out of 25 (46%) (p = .48). The increasing use of endovascular procedures (but not in carotid artery surgery) did not seem to influence the pattern of negligence claims.
    CONCLUSIONS: Between the two three year periods there has been an increase in negligence claims but not in compensated ones. The increased use of endovascular procedures has not influenced the pattern of compensated negligence claims.
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  • 文章类型: Journal Article
    目的:评估低血红蛋白(Hb)浓度对外周动脉手术患者主要不良心脏事件(MACE)和死亡率的影响。
    方法:这是一项在三级血管中心接受外周动脉重建手术的患者的回顾性队列研究。单变量分析(P≤1)中与MACE发生和死亡相关的术前因素包括在多变量模型中,以确认与结果变量的独立关联。
    结果:在2004年1月至2011年12月期间,共纳入360名连续患者(238名男性),平均(标准差)年龄为69(10.7)岁,Hb为13.0(2.12)g/dL,由一名专科医生治疗。其中,193例(53.6%)贫血。总之,26例(7%)发生术后MACE,18例(5%)死亡。在多变量分析中,年龄>80岁(比值比[OR]=3;95%置信区间[CI][1.2-7.5];P=0.025),肾损害(OR=3.2;95%CI[.99-10.2];P=.053),冠状动脉疾病(OR=3.6;95%CI[1.5-8.7];P=0.005),和低Hb(每下降1g/dL低于平均值=1.4[1.13-1.7];P=0.002)是MACE的独立危险因素。计划外手术(OR=4.5;95%CI[1.2-16.9];P=0.025)和低Hb(每1g/dL下降至平均值以下的OR=1.5;95%CI[1.14-1.86];P=0.002)是死亡的独立危险因素。
    结论:在外周动脉手术中,术前低Hb与MACE和死亡有关。需要进一步调查以阐明这种关系是否是因果关系。同时,在这种情况下,应考虑将术前贫血作为不良结局的重要危险因素.
    OBJECTIVE: To assess the influence of low hemoglobin (Hb) concentration on major adverse cardiac events (MACE) and mortality in patients undergoing peripheral arterial surgery.
    METHODS: This was a retrospective cohort study of patients undergoing peripheral arterial reconstructive surgery at a tertiary vascular center. Preoperative factors linked with the occurrence of MACE and death on univariate analysis (P ≤ .1) were included in a multivariate model to confirm the independent association with the outcome variables.
    RESULTS: A total of 360 consecutive patients (238 men) with a mean (standard deviation) age of 69 (10.7) years and Hb of 13.0 (2.12) g/dL treated under the care of a single specialist between January 2004 and December 2011 were included in the analysis. Of these, 193 (53.6%) were anemic. In all, 26 (7%) had a postoperative MACE and 18 (5%) died. On multivariate analysis, age > 80 years (odds ratio [OR] = 3; 95% confidence interval [CI] [1.2-7.5]; P = .025), renal impairment (OR = 3.2; 95% CI [.99-10.2]; P = .053), coronary disease (OR = 3.6; 95% CI [1.5-8.7]; P = .005), and low Hb (OR for each 1 g/dL drop below the mean = 1.4 [1.13-1.7]; P = .002) were independent risk factors for MACE. Unplanned surgery (OR = 4.5; 95% CI [1.2-16.9]; P = .025) and low Hb (OR for each 1 g/dL drop below the mean = 1.5; 95% CI [1.14-1.86]; P = .002) were independent risk factors for death.
    CONCLUSIONS: In peripheral arterial surgery, preoperative low Hb is associated with MACE and death. Further investigation is necessary to elucidate whether this relationship is causal. Meanwhile, consideration should be given to treating preoperative anemia as a significant risk factor for adverse outcome in this setting.
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