ObjectiveTo investigate the efficacy and safety of internal rib fixation for patients with multiple rib fractures.
MethodsA total of 141 patients with multiple rib fractures who were admitted to Department of Thoracic Surgery of the Sixth Affiliated Hospital of Xinjiang Medical University between January 2010 and January 2013 and whose chest trauma score (AIS-ISS) was 9-20 (16±2) were recruited in this study. Using the random number generator of SPSS, all the patients were randomly divided into an internal fixation group [69 patients including 41 males and 28 females with their age of 25-61 (37±4) years] who underwent internal rib fixation, and a control group [72 patients including 43 males and 29 females with their age of 24-63 (35±5) years] who received conservative therapy. Plasma C-reactive protein (CRP) patients' satisfaction degree with thoracic appearance,incidence of lung infection,pain-relieving efficacy,postoperative chest drainage duration and length of hospital stay were compared between the 2 groups.
ResultsPlasma CRP levels of the internal fixation group were not statistically different from those of the control group in 1-3 days after injury (P>0.05) but were significantly lower than those of the control group in 4-12 days after injury (P<0.05). Patients' satisfaction degree with thoracic appearance (97.1% vs. 48.6%,P<0.05) and pain-relieving efficiency (91.3% vs. 68.1%,P<0.05) of the internal fixation group were significantly higher than those of the control group. Incidence of lung infection of the internal fixation group was significantly lower than that of the control group(11.6% vs. 37.5%,P<0.01). Postoperative chest drainage duration [(3±2) d vs. (7±4) d,P<0.05] and length of hospital stay [(9±4) d vs. (15±7) d,P<0.05] of the internal fixation group were significantly shorter than those of the control group.
ConclusionsFor patients with multiple rib fractures and stable vital signs,internal fixation surgery is helpful to shorten length of hospital stay, relieve chest pain and improve thoracic appearance. It can also reduce lung inflammation and increase surgical safety so as to improve treatment outcomes of multiple rib fractures.
ObjectiveTo systematically review the effectiveness and safety of aspirin-clopidogrel combined anti-platelet therapy after coronary artery bypass grafting (CABG).
MethodsDatabases including The Cochrane Library (Issue 2, 2013), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from their inception to September 2013 for randomized controlled trials (RCTs) about aspirin-clopidogrel combined anti-platelet therapy after CABG. Two reviewers selected literature independently according to the inclusion and exclusion criteria. After data extraction and methological quality assessment of the included studies, meta-analysis was performed using RevMan 5.2 software.
ResultsA total of six RCTs involving 901 patients were included, of which 449 cases were in the aspirin-clopidogrel group (A+C) and 452 cases were in the aspirin with or without placebo group (A+P). The results of meta-analysis showed that: compared with A+P, A+C significantly reduced occlusion rates of the saphenous vein graft (RR=0.59, 95% CI 0.43 to 0.80, P=0.000 6). But no significant difference was found between the two groups in occlusion rates of the left internal mammary artery graft (RR=0.88, 95% CI 0.35 to 2.18, P=0.78), radial artery graft (RR=0.43, 95% CI 0.13 to 1.46, P=0.18), pleural fluid drainage volume (MD=-1.68, 95%CI-48.69 to 45.32, P=0.94), incidence of major bleeding events (RR=1.20, 95% CI 0.39 to 1.65, P=0.75), major cardiovascular events (OR=0.81, 95% CI 0.38 to 1.72, P=0.58), and mortality within 30 days (RR=0.64, 95% CI 0.17 to 2.44, P=0.52).
ConclusionIn reducing occlusion rates of the saphenous vein graft, the A+C group is more effective than the A+P group. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
With the promoting of “the Belt and Road Initiative”, medical assistance to Xinjiang is one ofthe important tasks of public hospitals in China. West China Hospital of Sichuan University actively explores the“Huaxi-Karamay” model of multi-disciplinary group assistance and scientific and technological assistance to Xinjiang, and leverages the technical leadership and leading role of medical experts to improve the medical and health service capabilities of Karamay, especially in chronic diseases management. This article takes the People’s Hospital ofKaramay City in Xinjiang province as an example to discuss the exploration and practice of the new chronic diseasemanagement model of the endocrinology and metabolism center with medical assistance from West China Hospital ofSichuan University, aiming to provide a certain reference for the in-depth development of medical aid to Xinjiang in thefuture.
