早期放置无创、压力可调的筋膜再贴合装置可改善开腹手术筋膜间隙的缩小:一项回顾性队列研究。

IF 2.1 Q3 CRITICAL CARE MEDICINE
Trauma Surgery & Acute Care Open Pub Date : 2024-10-12 eCollection Date: 2024-01-01 DOI:10.1136/tsaco-2024-001529
Asad Naveed, Niels D Martin, Mohammed Bawazeer, Atif Jastaniah, Joao B Rezende-Neto
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引用次数: 0

摘要

背景:由于目前的筋膜牵引方法涉及侵入性手术,因此通常在开腹手术(OA)的后期才使用。本研究旨在评估早期与晚期放置非侵入性压力调节装置对 OA 患者进行筋膜再贴合和间隙缩小的效果:研究对象包括 2020 年 1 月 1 日至 2023 年 12 月 31 日期间在一家学术医院接受创伤和急诊普外科损伤控制手术后腹部筋膜故意留置开口,并使用该装置进行管理的所有患者。装置放置时间与开腹手术结束时间的关系被定义为早期(≤24 小时)与晚期(>24 小时)。使用描述性分析和线性回归分析评估了与时间相关的筋膜间隙中切口宽度缩小情况和筋膜闭合情况:结果:早期(≤24 小时)AbClo 置入组与晚期(>24 小时)AbClo 置入组相比,开腹手术中点筋膜间隙缩小的百分比明显更高,中位数分别为 76% 和 43%,p 结论:与延迟放置(>24 小时)相比,在首次开腹手术后早期(≤24 小时)无创应用该装置可更大程度地减少筋膜间隙,提高初次筋膜闭合率。早期无创干预可预防OA患者腹壁肌筋膜回缩:证据级别:IV。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early placement of a non-invasive, pressure-regulated, fascial reapproximation device improves reduction of the fascial gap in open abdomens: a retrospective cohort study.

Background: Since current fascial traction methods involve invasive procedures, they are generally employed late in the management of the open abdomen (OA). This study aimed to evaluate early versus late placement of a non-invasive, pressure-regulated device for fascial reapproximation and gap reduction in OA patients.

Methods: The study included all patients who had the abdominal fascia intentionally left open after damage control operation for trauma and emergency general surgery and were managed with the device in an academic hospital between January 1, 2020, and December 31, 2023. Time of device placement in relation to the end of index laparotomy was defined as early (≤24 hours) versus late (>24 hours). Time-related mid-incisional width reduction of the fascial gap and fascial closure were assessed using descriptive and linear regression analysis.

Results: There was a significantly higher percent reduction in the fascial gap at the midpoint of the laparotomies in the early (≤24 hours) AbClo placement group compared with the late (>24 hours) AbClo placement group, respectively, median 76% versus 43%, p<0.001. Linear regression adjusting for body mass index and the number of takebacks indicated that fascial approximation was 22% higher for early placement (β=0.22; CI 0.12, 0.33, p<0.001). Primary myofascial closure rate with early (≤24 hours) application of the device was 98% versus 85% with late application.

Conclusion: Early non-invasive application of the device (≤24 hours) after the initial laparotomy resulted in greater reduction of the fascial gap and higher primary fascial closure rate compared with late placement (>24 hours). Early non-invasive intervention could prevent abdominal wall myofascial retraction in OA patients.

Level of evidence: IV.

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来源期刊
CiteScore
3.70
自引率
5.00%
发文量
71
审稿时长
12 weeks
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