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中华烧伤杂志

中华烧伤杂志

北大核心

CSCD

CSTPCD

Chinese Journal of Burns
中华医学会主办。本刊是国内烧伤学术界惟一的全国性权威刊物，由国内外烧伤外科及相关学科著名专家组成编委会。烧伤的重要问题，通常也是内外科的基本问题。杂志力求充分展示本学科领域的新理论、新技术、新方法、新经验，注重实用性，讲究可读性。全方位展示本专业的研究进展、临床治疗和护理经验，将整形与康复理念贯穿于烧伤救治全过程，将独到的修复技术应用于各种类型的难治性创面。杂志目前已被《Medline》等10多个国际主要数据库收录，具有较大影响。
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  • 发文量：4620
  • 被引量：1821
  • H指数：3
  • 开始收录时间：2000,16(1)
  • CNKI综合因子：1.06
  • 维普期刊影响因子： 1.244
  • 万方期刊影响因子：1.18
  • 创刊时间：1985
  • 国内刊号/CN：50-1120/R
    国际刊号/ISSN：1009-2587
  • 发行周期：双月刊
    邮发代号：78-131
  • 主管单位：中国科学技术协会
    主办单位：中华医学会
中华烧伤杂志-联系信息
  • 主编：-
  • 电话：010-51322060
  • 邮箱：shaoshangzazhi@163.com
  • 地址：北京市西城区东河沿街69号
  • 邮编：100052
中华烧伤杂志-获奖情况
  • • 中华医学会优秀期刊三等奖;获第四届中国科协期刊优秀论文;获第二届中国科协期刊优秀学术论文奖;获第五届重庆市期刊好作品;获第四届中国科协期刊优秀论文;被评为“RCCSE中国权WEI学术期刊”;获第一届重庆出版政府奖优秀期刊奖;
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中华烧伤杂志 >2022年第2期

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  • 摘要：患者男,44岁,因大面积烧伤创面愈合后瘢痕增生伴残余创面4个月余,2011年2月3日入我院.查体见瘢痕面积达75％ TBSA;残余创面约5％ TBSA,呈散在点状分布.患者入院后卧翻身床并定时翻身,创面采用半暴露疗法,每3天全身用温水浸浴1次,瘢痕外涂复春散Ⅱ号(通化昌源灼伤瘢痕研究所,主要成分为冰片、白矾、没药、透皮剂等),四肢外加弹力绷带,通过上述措施防止瘢痕进一步发展,同时进行功能锻炼.入院后第2天查血常规、肝肾功能、电解质水平均正常.经治疗患者一般情况良好,生命体征平稳,残余创面逐渐缩小,创面较清洁、无明显分泌物.
  • 摘要：Scar,either hypertrophic scar or keloid,is one of the most common complications due to proliferative disorder of fibrosis in the process of wound healing after burn injuries,trauma,and surgical operations.To repair the cosmetic and functional impairments caused by scars poses a great challenge to all the burn surgery workers.With the advances in both basic research and clinical treatment,the understanding of scar formation and the therapeutic strategies of scar have been improved significantly.However,the remaining problems are still outstanding.In this discussion,the advances and problems in the scientific research in this field,including genetic predisposition,candidate gene,dysfunction of fibroblasts,interaction between fibroblasts and keratinocytes,as well as animal models for hypertrophic scar and keloid were summarized.In addition,the progreses in the clinical therapies are also discussed,including pressure treatment,silicone gel sheeting,corticosteroids,laser,and other emerging treatment strategies.The understanding and treatment of scar will improve in the future with further deepening basic research and clinical trials with stricter standard of assessment.%瘢痕是皮肤烧(创)伤、手术后最常见的并发症之一,修复其导致的外观损害和功能障碍是烧伤科医师面临的最棘手问题之一.皮肤损伤及外科手术后瘢痕的总体发病率为40％～70％,烧伤患者的发病率可高达91％[1].不同国家增生性瘢痕的发病率差异明显,发达国家每年新增瘢痕病例约400万,发展中国家该数字更高[2];仅在美国,瘢痕治疗的费用每年就高达40亿美元[3].目前,随着手术方法及综合治疗手段的不断改进,瘢痕治疗已进入一个新阶段,但如何从根本上减轻甚至阻止瘢痕产生,仍是医学界面临的巨大挑战,需在基础研究以及临床治疗中进行更深入的探索.
  • 摘要：患儿女,4岁,体质量20kg,出生时因缺氧发生脑性瘫痪,未治疗,于2010年9月27日被沸水烫伤,经当地医院简单处理,伤后1 d转入我院.查体:创面位于头面部、前躯、双上肢,大部分创面表皮剥脱,创基潮红,渗出较多,对疼痛刺激敏感.左侧颈前及左上肢大部分创面呈黑灰色焦痂,质韧,肿胀明显.左手手指温度较对侧明显偏低,指甲血液循环尚可.左上肢颤抖明显并处于屈曲位,伴有肌张力增高.诊断:(1)重度烫伤,总面积25％,其中浅Ⅱ度2％、深Ⅱ度8％、Ⅲ度15％ TBSA.(2)脑性瘫痪.积极行创面清创,头面部保痂治疗,双上肢包扎处理,经输液抗感染、补液及改善微循环等治疗,入院后2d患儿病情趋于稳定.后经多次创面处理,面部、右上肢、左前臂、左手剖面基本愈合,上皮新鲜红润;左上肢、前躯残余少量创面,面积约3％TBSA.因患儿家属拒绝手术植皮治疗,患儿于入院后28 d出院,于院外换药处理约1个月后剖面愈合.其后出现瘢痕增生,未行任何处理.2011年2月15日患儿因左上肢瘢痕挛缩再次入院.瘢痕分布于左上肢、颈部左侧下方,暗红,充血,高出周围正常皮肤,表面不平整,质硬,无明显压痛,左腋下局部破渍.左腋、左肘、左腕、左手各指挛缩明显.肩关节最大外展角度约40°,左肘关节屈曲于135°,左腕关节屈曲,左手拇指掌指关节脱位,呈反转畸形,其余掌指关节呈过度背伸.见图1a.于患儿再次入院后2d行左腋、左肘、左腕、左手背瘢痕橙解植皮术,术中彻底松解挛缩组织,将肩关节固定于外展(90°)位,肘关节固定于伸直位,手部固定于休息位,左手拇指掌指关节以克氏针固定.取左大腿中厚度,移植于瘢痕松解部位;供区采用凡士林纱布覆盖,多层无菌纱布包扎.见图1b.术后10 d行术部换药时见皮片成活良好,后经2次换药及拆线处理,患儿于术后17 d治愈出院,此后未来院复诊.
  • 摘要：随着烧伤医学事业的发展,保全生命、封闭创面已不能满足治疗的要求,伴发的肢体功能障碍、外貌毁损、躯体不适及心理适应等诸多问题更受关注,这对烧伤医务人员治疗的精细性提出了更高要求.临床康复医学是以人体功能障碍为研究对象,并对其进行预防、诊断、评估、治疗、训练的医学学科,已逐渐融入烧伤治疗过程中并将成为不可或缺的一部分,同临床治疗、护理一起为烧伤患者的康复提供全面服务.但目前康复工作在烧伤临床救治的开展过程中仍存在不少问题,值得深入思考.
  • 摘要：临床路径是一种针对患者管理的无序状况进行优化、简化和增效的管理方式.通过临床路径管理可以保证医疗质量,控制医疗成本,提高医院管理水平[1];同时,可以缩短住院时间、降低治疗费用,最终减轻患者负担[2].烧伤作为常见病,治疔方案较为明确,技术比较成熟且诊疗费用相对稳定[3],适合制定与实施临床路径管理标准.本研究拟分析烧伤患者年龄、严重程度、致伤部位、是否手术等因素对住院时间和费用的影响,为烧伤治疗临床路径的制定提供依据.
  • 摘要：例1 男,54岁,融铝炉爆炸致全身多处异物嵌入2 h入院.可见异物散布嵌入患者体内,以右侧头面部及右侧上肢为主.急诊行头颅正侧位X线片检查但影像效果欠佳(图1 a),于伤后第3天改行头面部螺旋CT扫描下的三维重建(以下简称3D,图1 b).因患者右小腿胫前被硬物砸伤深及骨腹,创面约3cm×2 cm,入院后先行负压吸引直至创面清洁.伤后第9天,在静脉吸入复合全身麻醉下根据3D成像提示,行面部异物取出术及右小腿胫前清创缝合术.分别在面部右侧下颌角、耳后、耳屏、眼眶及顳部取出数十颗金属矿物质异物,大小为3 mm×2 mm-6 mm×5 mm.体积分数3％过氧化氢溶液及生理盐水清洗面部创面,采用6-0可吸收线(薇乔,美国强生公司,下同)分层间断缝合较大创面,莫匹罗星软膏(百多邦,中美天津史克制药有限公司)外涂创面后无菌纱布覆盖.术后常规给予磺苄西林预防感染,第5天拆际皮肤层可吸收线,创面愈合良好.
  • 摘要：Objective To explore the expression of integrin-linked kinase(ILK) in scar in different growth stages,as well as its relationship with angiogenesis.Methods ( 1 ) Fifteen burn patients with scar formation time shorter than 6 months,ranging from 6 to 12 months,and longer than 12 months were hospitalized from December 2009 to December 2010.They were divided into A,B,and C groups according to the scar formation time,with 5 patients in each group.Scar specimens were harvested for obviation of ILK expression with immunohistochemistry method,and ILK mRNA expression with real time fluorescence quantitative RT-PCR.(2) Microvascular endothelial cells ( MEC ) were isolated from scar tissue in A group and cultured in vitro,and then they were purified by immunomagnetic beads and identified with coagulation factor Ⅷ marked by immunofluorescence (fibroblasts from human normal skin were used as control).The cultured cells in logarithmic growth phase were divided into control group ( cultured with M131 medium containing microvascular growth supplement ),transfection Ⅰ group (transfected with empty plasmid),and transfection 2 group ( transfected with ILK cDNA plasmid) according to the random number table.After 24 hour,the expressions of ILK mRNA,Flt-1 mRNA,and KDR mRNA were determined with real time fluorescence quantitative RT-PCR,Data were proceessed with one way analysis of variance.Results Immunohistochemical observation showed that ILK in A group mainly expressed in the basal layer cells of epidermis,cytoplasm of fibroblasts,and MEC in scar,while ILK in B group only distributed in the basal layer cells of epidermis,but ILK expression in C group was not obvious.The expression of ILK mRNA in A group (0.34 ±0.16) was significantly higher than those in B and C groups (0.17 ± 0.06,0.07 ± 0.13,F =37.007,P =0.000).MEC grew up showing cobble stone formation after purification.The expression of coagulation factor Ⅷ was positive in cytoplasm of purified MEC,while that was negative in fibroblast of human normal skin.The expressions of ILK mRNA (57.807 ± 5.556 ),KDR mRNA (0.836 ± 0.014),and Flt-1 mRNA (0.162 ± 0.005 ) in transfection 2 group were higher than those in control and transfection 1 groups (0.018 ±0.003,0.028 ±0.020,0.023 ±0.004 and 0.042 ±0.005,0.039 -±0.007,0.046 ±0.003;F ILK =87.110,FKDR =11.241,FFlt =18.199,withP values all below 0.01). Conclusions ILK mainly expressed in scar tissue with formation time shorter than 6 months,and it may affect vascularization of scar by regulating gene expressions of KDR and Flt-1 in MEC,which plays an important role in early scar formation.%目的 探讨不同生长期人类瘢痕中整合素连接激酶(ILK)表达及与血管生成的关系.方法 (1)将笔者单位2009年12月-2010年12月收治的15例烧伤瘢痕患者按瘢痕生长时间分为:小于6个月组、6～12个月组、大于12个月组,每组5例.采集各组瘢痕组织,用免疫组织化学法观察ILK的表达分布,实时荧光定量RT-PCR法检测ILK mRNA的表达水平.(2)取小于6个月组瘢痕组织,分离培养瘢痕微血管内皮细胞(MEC),免疫磁珠法纯化后用花青类荧光染料Cy3标记的凝血因子Ⅷ进行鉴定,以人皮肤Fb为对照.取对数生长期MEC,按随机数字表法分为3组:对照组,仅用含微血管生长添加剂的M131培养液培养；空质粒组,用空载质粒转染；ILK互补DNA转染组,用ILK互补DNA表达质粒转染.转染24h后,实时荧光定量RT-PCR法检测各组细胞中ILK、激酶功能区受体(KD R)、fms样酪氨酸激酶1(Flt1)的mRNA表达情况.对数据进行单因素方差分析. 结果 (1)小于6个月组瘢痕组织表皮基底细胞、MEC及Fb胞质中均有ILK阳性表达,6～12个月组瘢痕组织中仅表皮基底细胞可见ILK阳性表达,大于12个月组瘢痕组织中ILK阳性表达不明显.(2)小于6个月组瘢痕组织中ILK mRNA表达水平(0.34±0.16)明显高于6～12个月组(0.17±0.06)及大于12个月组(0.07±0.13),F=37.007,P - 0.000.(3)纯化后MEC呈铺路石样密集生长,胞质中凝血因子Ⅷ呈阳性表达；人皮肤Fb中未见凝血因子Ⅷ表达.(4)ILK互补DNA转染组瘢痕MEC中ILK、KDR及Flt-1的mRNA表达水平分别为57.807±5.556、0.836±0.014、0.162±0.005,均显著高于对照组的0.018±0.003、0.028±0.020、0.023±0.004和空质粒组的0.042±0.005、0.039±0.0070.046±0.003(F值分别为87.110、11.241、18.199,P值均小于0.01).结论 ILK主要表达于小于6个月的早期瘢痕组织中,并可以通过调节瘢痕MEC中的KDR及Flt-1 mRNA表达来影响早期瘢痕的血管生成,在早期瘢痕增生过程中具有重要作用.
  • 摘要：临床上对大面积烧伤患者常采用翻身床辅助治疗,为方便大小便的护理,翻身床设有排泄孔.目前临床使用的翻身床排泄孔尺寸单一,而臀部为脂肪堆积部位,加之大面积烧伤患者早期水肿大量补液以及处于回吸收期等原因,都会存在全身组织肿胀问题,致使臀部组织由于重力作用下坠,陷于排泄孔内,导致局部压力过大,易造成压疮、皮肤破损或不适感,尤其是肥胖患者及臀部有烧伤创面的患者易发生此类情况.针对上述问题,2009年6月笔者单位联合某医疗器械生产单位对传统翻身床的排泄孔进行改进,现将方法介绍如下.
  • 摘要：Objective To study the effect of substrate stiffness on proliferation,migration of fibroblast and integrin β1 expression in fibroblast.Methods Fibroblasts were inoculated on silicon substrate with stiffness of ( 16.2 ±0.5 ),( 19.8 ± 1.1 ),and ( 200.1 ± 2.6) kPa.After being cultured for 5 days or 6 days,cells were counted and cell proliferative activities ( recorded as absorbance value) were assessed with methyl thiazolyl blue (MTT).After being cultured for 3 days.cell cycle was detected and proliferation index (PI) was calculated,The cell scratch test was used for determination of cell migration rate on post scratch day (PSD) 0 ( the day of scratch ),1,2,and 3.After being cultured for 2 days,the expression of integrin β1 was determined by flow cytometry with fluorescence.Data were processed with one-way analysis of variance,Results (1)The proliferaive speed and proliferative activity of fibroblasts were all increased along with the increase in substrate stiffness.PI of fibroblasts inoculated on silicon substrate with stiffness of (16.2 ±0.5),(19.8 ± 1.1),and (200.1 ±2.6) kPa was respectively 24.8％,27.4％,32.4％.On PSD 2,migration rate of fibroblasts inoculated on silicon substrate with stiffness of ( 19.8 ± 1.1 ) and ( 200.1 ± 2.6 ) kPa was respectively ( 91.4 ± 5.1 ) ％,( 100.0 ± 1.3 ) ％,which were higher than that of fibroblasts inoculated on silicon substrate with stiffness of ( 16.2 ± 0.5 ) kpa [ ( 55.8 ± 6.8 ) ％,with F value respectively 3.5,4.0.P values all below 0.01 ].( 3 ) The expression rate of integrin β1 in fibroblasts inoculated on silicon substrate with stiffness of ( 16.2 ±0.5 ) kPa was the lowest (43.22％),and that in fibroblast inoculated on silicon substrata with stiffness of ( 200.1 ± 2.6 ) kPa was the highest ( 81.26％ ).Conclusions Substrate stiffnese may have a great effect on proliferation and migration of fibroblast during the process of wound healing and scar formation,which can be related to regulation of intergrin β1 expression.%目的 了解基底刚度对Fb增殖、迁移和整合素β1表达的影响. 方法 将Fb接种于刚度为(16.2±0.5)、(19.8±1.1)、(200.1±2.6)kPa的硅胶基底上.进行如下检测.(1)分别连续培养5 d或6d,进行细胞计数、噻唑蓝法检测细胞增殖活性(吸光度值表示).(2)培养3d,检测细胞周期,计算增殖指数(PI).(3)划痕实验后培养0(当日)、1、2、3 d,测定Fb迁移率.(4)培养2 d,流式荧光法检测细胞中整合素β1表达.对部分数据进行单因素方差分析. 结果 (1)细胞计数、噻唑蓝法检测均显示,Fb增殖速度及活性均随着硅胶基底刚度的增强而增加.细胞周期检测显示:在刚度为(16.2±0.5)、(19.8±1.1)(200.1±2.6)kPa的硅胶基底上,细胞的PI分别为24.8％、27.4％、32.4％.(2)培养2d,在刚度分别为(19.8±1)、(200.1±2.6) kPa的硅胶基底表面上,Fb迁移率分别为(91.4±5.1)％(100.0±1.3)％,均明显高于刚度为(16.2±0.5)kPa硅胶基底表面的Fb迁移率[(55.8±6.8)％,F值分别为3.5、4.0,P值均小于0.01].(3)刚度为(16.2±0.5)kPa硅胶基底表面的Fb中整合素β1表达率最低,仅43.2％；刚度为(200.1±2.6)kPa硅胶基底表面的Fb中整合素β1表达率最高(81.3％]. 结论 基底刚度对Fb在创面愈合和瘢痕形成过程中的增殖迁移有较大影响,这一效应与其调控Fb整合素β1表达作用相关.
  • 摘要：烧伤会导致人体局部或全身一系列病理损伤,也会引发抑郁、焦虑等心理疾患,不同程度地影响患者的生存质量.有针对性的烧伤康复应贯穿于烧伤治疗全过程以及患者回归社会的过程中.早期的康复治疗介入不但有助于降低病死率、致残率,对提高患者生存质量也有着重要意义.而烧伤患者在家庭和社区所接受的后继康复治疗也不容忽视.
  • 摘要：目的 探讨褪黑激素对人增生性瘢痕Fb增殖和凋亡的影响与机制. 方法 采用组织块法分离培养人增生性瘢痕Fb.按随机数字表法将细胞分为低、中、高浓度组和对照组.前3组细胞分别采用含1 × 10-5、1×10-3、1 mmol/L褪黑激素的培养液培养,对照组不加褪黑激素常规培养.处理后24 h进行如下检测:对各组细胞进行形态学观察；用四氮唑复合物( XTT)-硫酸酚嗪甲酯(PMS)比色法检测细胞增殖活性；对细胞行膜联蛋白V-异硫氰酸荧光素(FITC)和碘化丙啶(PI)双染色后,用流式细胞仪分析细胞周期和凋亡情况；荧光定量RT-PCR法检测细胞周期蛋白E(cyclin E)、p53和Fas mRNA表达量.对数据行方差分析和LSD检验. 结果 形态学观察显示,对照组Fb为长梭形,呈集落分布；3个浓度组Fb随着褪黑激素浓度升高,细胞逐渐分散,胞体变形缩小,胞膜皱缩,核质比例减小.对照组、低浓度组、中浓度组、高浓度组Fb增殖活性(吸光度值)依次下降,分别为1.79±0.10、1.49±0.15、1.24±0.20、0.92±0.09(F=67.61,P ＜0.05)；S期细胞百分比依次下降,分别为(16.9±1.3)％、(10.6±1.1)％、(6.1±1.2)％、(3.2±0.8)％(F=286.10,P ＜0.05);G2/M期细胞百分比依次下降,分别为(16.7±1.6)％、(13.5±1.1)％、(9.8±1.0)％(6.0±0.7)％(F=162.69,P＜0.05);早、晚期凋亡细胞百分比依次升高(F值分别为424.05、236.44,P值均小于0.05).对照组、低浓度组、中浓度组、高浓度组细胞cyclin E的mRNA表达量依次下降,分别为2.90±0.30、1.58±0.21、0.90±0.20、0.24±0.12(F=266.79,P＜0.05)；p53和Fas mRNA表达量依次升高(F值分别为10.11、12.03,P值均小于0.05). 结论 褪黑激素可通过影响细胞cyclin E、p53和Fas基因的表达,抑制增生性瘢痕Fb增殖并诱导该细胞凋亡.%Objective To study the effect of melatonin on proliferation and apoptosis of fibrohlasts in human hypertrophic scar and its mechanism.Methods Fibroblasts from human hypertrophic scar were isolated and cultured with DMEM medium containing 10％ FBS,and then they were divided into control (C,added with ethanol),low concentration (LC,added with 1 × 10 -5 mmol/L melatonin),middle concentration (MC,added with 1 × 10-3 mmol/L melatonin),and high concentration (HC,added with 1 mmol/L melatonin) groups according to the random number table.After being cultured for 24 hours,cell morphologic change was observed under microscope; XTT-PMS assay was used to examine cell proliferative activity; cell cycle and apoptosis were assessed with flow eytometry after double staining of FITC and PI,and the levels of cyclin E,p53,and Fas mRNA were determined with fluorescence quantitative RT-PCR.Data were processed with analysis of variance and LSD test.Results ( 1 ) Fibroblasts in C group were spindie-shaped with growth in colonies.Along with the increase in melatonin concentration,fibroblasts in LC,MC,and HC groups gradually dispesed,deformed and atrophied,with shrunk cellular membrane,and decrease in ratio of nucleus and cytoplasm.(2) Proliferative activity of fibroblasts in LC,MC,and HC groups decreased along with an increase in melatonin concentration ( 1.49 ± 0.15,1.24 ± 0.20,and 0.92 ± 0.09 ),which were lower that in C group ( 1.79 ± 0.10,F =67.61,P ＜0.05).Cell ratios of S and G2/M phases in LC,MC,and HC groups decreased along with an increase in melatonin concentration,which were all lower than those in C group [(10.6±1.1)％,(6.1 ±1.2)％,(3.2±0.8)％ vs.(16.9±1.3)％,F=286.10,P ＜0.05; (13.5±1.1)％,(9.8±1.0)％,(6.0±0.7)％ vs.(16.7±1.6)％.F =162.69,P ＜0.05].Apoptotic rates in early and late stages of LC,MC,and HC groups increased along with an increase in melatonin concentration,all higher than those in C group (with F value respectively 424.05,236.44,P values all below 0.05 ).The expressions of cyclin E mRNA in LC,MC,and HC groups decreased along with an increase in melatonin concentration,which were lower than that in C group (1.58 ± 0.21,0.90±0.20,and0.24±0.12 vs.2.90±0.30,F =266.79,P ＜0.05),while the expressions of p53 mRNA and Fas mRNA showed opposite tendency (with F value respectively 10.11,12.03,P values all below 0.05). Conclusions Melatonin can inhibit proliferation and induce apoptosis of fibroblasts in hypertrophic scar through regulating the gene expressions of cyclin E,p53,and Fas.
  • 摘要：Objective To explore the expression and significance of secretions of hypothalamus-pituitary-adrenal (HPA) axis in human hypeorophic scar.Methods Hypertrphic scar tissues obtained from 12 patients with deep-partial thickness burn or full-thickness burn and normal skin tissues from the same 7 patients with hypertrophic scar were harvested for determination of gene expression of corticotrophinreleasing hormone (CRH),CRH receptor 1 (CRH-R1),pro-opiomelanocortin (POMC),melanocortin receptor 2 ( MC-2R),and glucocorticoid receptor α ( GR-α ) by real-time fluorecence quantitative PCR.After addition of corresponding antibodies,distribution differences of CRH,CRH-R1,adrenocorticotropic hormone ( ATCH ),MC-2R,and CR-α were observed with immunohistochemical staining,Data were processed with t test.Results The mRNA expression of CRH,CRH-R1,POMC,and GR-α in hypertrophie scar was respectively 3.1 ± 0.8,0.05 ± 0.03,0.020 ± 0.007,and 0.0030 ± 0.0010,which were significantly lower than those in normal skin ( 20.6 ± 4.7,0.30 ± 0.12,0.060 ± 0.020,and 0.0200 ± 0.0070,with t values from 2.10 to 4.75,P values all below 0.05 ).There was no statistical difference in MC-2R mRNA expression between hypertrophic scar and normal skin ( t=1.48,P =0.15).Immunohiatochemical observation showed CRH,CRH-R1,ACTH,MC-2R,and GR-α in hypertphic scar were located in basal layer of epidermis,fibroblast of dermis,and tube wall of sweat gland.Expressions of these indexes could also be observed in sebaceous gland and hair follicle besides above-mentioned structures.Conclusions Decreasing expression of active material of HPA axis may be related to formation of hypertrophic scar.%目的 探讨增生性瘢痕组织中下丘脑-垂体-肾上腺皮质(HPA)轴成分的表达及意义.方法 应用实时荧光定量PCR法,检测人增生性瘢痕(12例)和正常皮肤(7例)组织中HPA轴的活性物质促肾上腺皮质素释放激素(CRH)、促肾上腺皮质素释放激素受体1(CRH-R1)、阿片-促黑素细胞皮质素原(POMC)、黑素皮质素受体2(MC-2R)以及糖皮质激素受体α(GR-α)的mRNA表达差异,免疫组织化学法观察CRH、CRH-R1、促肾上腺皮质激素(ACTH)、MC-2R以及GR-α的分布差异.对数据进行独立样本t检验. 结果 PCR结果显示,增生性瘢痕组织标本中CRH、CRH-R1、POMC及GR-α的mRNA表达分别为3.1±0.8、0.05±0.03、0.020±0.007、0.0000±0.0010,均低于正常皮肤组织的20.6±4.7、0.30±0.12、0.060±0.020、0.0200±0.0070,差异有统计学意义(t值为2.10-4.75,P值均小于0.05)；但2种组织中MC-2R mRNA表达水平接近(t=1.48,P=0.15).免疫组织化学法检测结果显示,CRH,CRH-R1、ACTH、MC-2R以及GR-α分布于瘢痕组织的表皮基底层、真皮层的Fb和汗腺管壁中.在正常皮肤组织中阳性细胞除分布于上述部位外,还可见于毛囊和皮脂腺. 结论 增生性瘢痕形成与组织中HPA轴的活性物质表达降低有关.
  • 摘要：1临床资料2006年5月-2011年2月,笔者单位烧伤整形科收治手部多处深度电烧伤患者24例,其中男20例,女4例,年龄3～61岁.患者伤后1 h～62 d入院,共29只患手,创面分布:手指67处、手掌7处、手背5处、虎口6处,创面面积1.2cm×1.0cm～15.0cm×12.0 cm,深度为Ⅲ～Ⅳ度,多处伴肌腱或骨骼外露及坏死.
  • 摘要：Objective To ohserve therapeutic effect of negative-pressure treatment combined with tissue transplantation on complicated and refractory wounds after debridement.Methods After debridement,20 patients with 20 complicated and refractory wounds hospitalized in our burn wards from May 2008 to June 2010 were randomly divided into treatment group (T,treated with negative-presaure from - 19 kPa to -8 kPa,n =10) and control group (C,covered with petrolatum gauze overlaid with saline gauze and dry gauze,n - 10) according to alternating method.On post treatment day (PTD) 4,7,and 14,granulation tissues of wound surface in size of 4 mm × 3 mm × 2 mm were harvested for histopathological observation ( including capillary growth,inflammatory cells,and collagen arrngement ) with HE staining,and the numbers of vascular endothelial cells ( VEC,with addition of rabbit anti-human coagulation factor Ⅷ related antigen polyclonal antibody ) and proliferation period cells (with addition of mouse anti-human Ki-67 monoclonal antibody) were counted by immunohistochemical staining.Data were proessed with t test.Another 59 patients harboring 62 complieated and refractory wounds admitted to our burn ward at the same period were treated with the same mode of debridement,negative-pressure therapy,followed by timely skin or skin flap grafting.Results (1) Granulation tissue in T group grew more rapidly than that in C group.More capillaries and less inflammatory cells were observed in T group on PTD 7 as compared with those in C group.Collagen in T group on PTD 14 was more regular in arrangement than that in C group.The number of VEC per 400 times visual field in T group on PTD 4,7,and 14 was respectively higher than that in C group ( 108.7 ± 11.2 vs.31.0±3.6,138.0±14.7 vs.34.6±4.5,68.7±6.9 vs.55.1 ±6.5,with t values from 4.62 to 30.28,P values all equal to 0.01 ).The number of proliferation period cell per 400 times visual field in T group on PTD4 and7 was respectively higher than that in C group (88.9 ±5.9 vs.16.6 ±3.3,128.1 ±13.0 vs.110.1 ± 8.9,with t value respectively 19.89,3.33,P values all below 0.05 ).The number of proliferation period cell per 400 times visual field in T group on PTD 14 was obviously lower than that in C group (26.7±5.1 vs.59.7 ±4.5,t =-12.43,P =0.01).(2) After being treated with above therapeutic mode,necrotic tissues were removed completely and granulation tissue grew rapidly in 62 complicated and refratory wounds with high survival rate of skin grafts or skin flaps with good repair effect. Conclusions Negative-pressure therapy can accelerate VEC formation and stimulate cell proliferation after debridenent.Debridement,negative-pressure therapy,and timely skins/skin flaps grafting can effectively increase healing rate of complicated and refractory wounds.%目的 观察清创术-负压治疗-组织移植模式对复杂、难愈性创面的临床疗效. 方法 选择2008年5月-2010年6月笔者单位收治的20例患者(共计20处复杂、难愈性创面),清创后按照交替法随机分为治疗组(负压治疗,- 19～-8 kPa)与对照组(凡士林纱布+生理盐水纱布+干纱布覆盖),每组10例.治疗4、7、14d切取4 mm×3 mm×2 mm创面肉芽组织进行HE染色,观察肉芽组织生长情况,包括毛细血管、炎性细胞数量及胺原纤维的排列；采用兔抗人凝血因子Ⅷ相关抗原多克隆抗体、鼠抗人Ki-67单克隆抗体进行免疫组织化学染色,计数血管内皮细胞和增殖期细胞.对数据进行t检验.在此基础上采用清创术-负压治疗(同前)-适时植皮(皮瓣)修复模式,治疗笔者单位同一时期收治的59例患者共计62处复杂、难愈性创面,观察疗效. 结果 (1)与对照组比较,治疗组治疗7d时毛细血管数量明显增多、炎性细胞少；治疗14 d,治疗组腔原排列较对照组规则.治疗组治疗4、7、14 d时血管内皮细胞计数分别为每400倍视野(108.7±11.2)、(138.0±14.7)、(68.7±6.9)个,明显高于对照组[(31.0±3.6)、(34.6±4.5)、(55.1±6.5)个,t值为4.62～30.28,P值均等于0.01].治疗组治疗4、7 d增殖期细胞计数分别为每400倍视野(88.9±5.9)、(128.1±13.0)个,明显高于对照组[(16.6±3.3)、(11.01±8.9)个,t值分别为19.89、3.33.P值均小于0.05],治疗组治疗14 d增殖期细胞计数为每400倍视野(26.7±5.1)个,明显低于对照组[(59.7±4.5)个,t=12 43,P =0.01].(2)经过上述模式治疗,62处复杂、难愈性创面坏死组织被彻底清除,肉芽组织生长快,皮片或皮瓣成活率高,创面修复教果好.结论 负压治疗能加速清创后组织血管内皮细胞生成,刺激细胞增殖.清创术-负压治疗-适时植皮(皮瓣)修复的模式能有效提高复杂、难愈性创面的愈合率.
  • 摘要：临床上复杂皮肤及软组织缺损并发感染,多见于深度烧伤、撕脱伤等严重外伤后或伴有较复杂全身性疾病患者.感染初期局部症状较重,严重者危及生命;感染控制后创面有时较大、受累组织种类多,修复困难.2009年10月-2010年10月,笔者对21例复杂皮肤软组织缺损伴创面严重感染的烧(创)伤患者进行综合治疗,效果较好,现报告如下.
  • 摘要：近年来,国内外研究者寻求用异体(种)真皮或其他生物材料研发可植入式真皮替代物,其中取自猪皮的ADM因其完整的胶原三维结构且来源广泛尤受重视,但因不能早期充分血管化,影响临床效果及推广[1-5].提高植入性材料本身的快速血管化能力,是目前组织工程材料急需解决的关键技术难题之一.本研究中,笔者采用独特激光模板悬空打孔技术(国家发明专利申请号:2010101273690)研制激光微孔猪ADM( LPADM)材料,研究其生物相容性和血管化能力.
  • 摘要：1临床资料2007年1月-2010年12月,笔者单位收治足部深度烧(创)伤患者15例,其中男12例、女3例,年龄19～43岁.致伤部位:拇趾背侧8例、跖趾关节5例、拇趾残端2例.致伤原因:热力烧伤3例、电烧伤5例、化学烧伤3例、车祸伤2例、摩擦伤2例.损伤范围3 cm×3～6cm4 cm,均合并肌腱、神经及骨组织损伤或外露.
  • 摘要：Objective To analyze the potential mechanism of preventive and therapeutic effects of 90Sr on hypertrophic scar,and to observe its clinical effect.Methods Fibroblasts isolated from human hypertrophic scar were cultured in vitro and radiated by 90Sr with the dose varying from 0 Gy ( control group)to 5 Gy ( LD group),10 Gy ( MD group),and 15 Gy ( HD group).The cell cycle and apoptosis rate were determined by flow cytometry at post radiation hour ( PRH ) 24,48,and 72,The concentration of type Ⅰ collagen in cell supernatant was detected by enzyme-linked immunosorbent assay ( ELISA ).Therapeutic effects of 90Sr radiation were evaluated among 348 patients with hypertrophic scars,40 patients with keloids,and 114 patients for scar prevention after surgical operation.The number of fibroblasts after HE staining was compared among normal skin tissue,hypertrophic scar,and hypertrophic scar treated with 90Sr radiation.Data were processed with one-way analysis of variance and q test,Results (1)Apoptotic rates in MD and HD groups at PRH 48 were higher than those at PRH 24,and the apoptotic rate was similar between MD group and HD group at PRH 72.Apoptotic rate in LD group at PRH 48 was significantly higher than that at PRH 24,but it decreased rapidly at PRH 72,which was significantly lower than those in MD and HD groups ( with F values all equal to 916.711,P values all below 0.01 ).( 2 ) At PRH 24,cell ratios of each phase in LD and HD groups were similar,and cell ratio of S phase in HD group [ (48.1 ± 1.0)％ ] was higher than those in the other three groups ( with F values all equal to 200.277,P values all below 0.01 ).At PRH 72,cell ratio of S phase in MD and HD) groups was respectively ( 85.7 ± 5.2 ) ％,( 73.0 ± 8.4 ) ％.implying that cells were blocked in S phase,and the values were all higher than those in control and LD groups ( with F values all equal to 111.105,P values all below 0.01 ).(3) At the same time point,the concentration of type Ⅰ collagen decreased along with the increase of radiation dose (with F values from 5044.449 to 8234.432,P values all below 0.01 ).With the same radiation dose,the concentration of type Ⅰ collagen increased along with prolongation of time (with F values from 333.395 to 2973.730,P values all below 0.01 ).(4) Clinical observation showed the (obvious) effective rate of radiation for pathological scars and that for scar prevention after surgical operation added up to 88.45％.The number of fibroblasts per 200 times visual field in patients after 90Sr radiation (86 ± 20) was less than that in patients without treatment [ ( 198 ± 65 ),F =208.405,P ＜ 0.05]. Conclusions The effect of 90 Sr radiation on fibroblasts and extracellular matrix can contribute to inhibition of scar formation,and the clinical effect is.significant.%目的 探讨90Sr防治瘢痕增生的作用机制并观察临床疗效. 方法 用90Sr敷贴器按照0、5、10,15 Gy剂量照射体外培养的人增生性瘢痕Fb.照射后24、48、72 h,流式细胞仪测定细胞周期及凋亡率变化,ELISA法检测细胞培养上清液中Ⅰ型腔原浓度.评价348例增生性瘢痕患者、40例瘢痕疙瘩患者及114例外科手术后瘢痕预防患者应用90Sr照射治疗的效果,并经HE染色对比正常皮肤组织、增生性瘢痕组织、经90SR照射治疗的增生性瘢痕组织中Fb数目.对数据进行单因素方差分析和q检验. 结果 (1)剂量为10、15 Gy的90Sr照射后24、48 h,细胞凋亡率呈逐渐上升趋势,至照射后72 h两者凋亡率相近.剂量为5 Gy的90Sr照射后48 h细胞凋亡率明显高于照射后24 h,但照射后72 h细胞凋亡率迅速下降,与剂量为10、15 Gy时比较差异均有统计学意义(F值均为916.711,P值均小于0.01).(2)照射后24h,90Sr照射剂量为5、10 Gy时,细胞各周期的百分比相近；90Sr照射剂量为15 Gy时,S期细胞明显增多[(48.1±1.0)％,F值均为200.277,P值均小于0.01].剂量为10 Gy及15 Gy的90Sr照射后72 h,细胞明显阻滞在S期,S期细胞百分比分别为(85.7±5.2)％、(73.0±8.4)％,与照射剂量为0 Gy和5 Gy时比较差异均有统计学意义(F值均为111.105,P值均小于0.01).(3)同一照射时相点下,照射剂量越大,Ⅰ型胶原浓度越低(F值为5044.449～8234.423,P值均小于0.01).同一照射剂量下,随着时间推移,Ⅰ型胶原浓度有不同程度的增加(F值为333.395～2973.730,P值均小于0.01).(4)临床病例观察显示,90Sr照射病理性瘢痕或术后瘢痕预防患者后,显效率及有效率累计88.45％.HE染色显示,90Sr照射治疗的人增生性瘢痕Fb数目[每200倍视野(86±20)个]少于未经照射治疗者[每200倍视野(198±65)个,F=208.405,P＜0.05]. 结论 90Sr抑制瘢痕的生长是其对瘢痕Fb和ECM共同作用的结果,且临床疗效显著.
  • 摘要：腋窝位于人体活动范围最大的肩关节下方,深度烧伤后容易出现蹼状瘢痕挛缩畸形.2009年3月-2011年2月,武警江西总队医院烧伤整形科应用筋膜瘢痕瓣五瓣法修复19例患者腋窝蹼状瘢痕挛缩畸形,效果满意.
  • 摘要：随着循证医学与转化医学的兴起和发展,临床研究的重要性日益凸显.近年来向《中华烧伤杂志》投递的临床研究稿件逐渐增多,一些研究的设计和试验尚可,但论文撰写中存在不少问题,反复修改多次才得以发表,影响论文的时效性,耗费作者和编者诸多精力.本文拟对部分论文文题、前言、材料与方法、结果以及讨论部分的问题进行梳理,提出一些建议仅供参考.
  • 摘要：细胞行为包括细胞的黏附、形貌、排列、活性、分化、迁移及合成ECM等[1].因为细胞行为受到遗传因素和环境因素的双重影响,所以在体外构建模拟细胞自然生长环境的结构,即纳米级结构,对于诱导细胞的正常行为十分重要[2].利用近年发展起来的静电纺丝技术制备的组织工程纳米纤维支架,经大量实验证实可模拟ECM结构并使其具有类似的功能.因此,深入了解根据不同参数构建的纳米纤维结构对细胞行为的影响,有助于设计出具有更好调控细胞行为能力的组织工程纳米纤维支架,并为解决目前组织工程皮肤的缺陷提供参考.笔者就目前纳米纤维结构对细胞行为的影响作一综述.
  • 摘要：目的 观察水通道蛋白4(AQP4)在严重烫伤早期合并脑水肿家兔脑组织中的表达规律以及与磁共振成像(MRI)信号变化的联系,探讨严重烫伤早期脑水肿水的跨膜转运特征. 方法 将35只健康新西兰大白兔按照随机数字表法分为正常对照组(5只)及烫伤组(30只),其中烫伤组家兔均造成50％TBSAⅢ度烫伤(经病理切片证实存在脑水肿).伤后1、2 3、4、5、6h,烫伤组家兔(每时相点5只)行MRI颅脑检查并动态检测表观弥散系数(ADC)值；烫伤组家兔取额叶、顳叶及顶叶皮质,基底节区及小脑组织,采用免疫组织化学法及RT-PCR分别检测AQP4蛋白和AQP4 mRNA的表达.正常对照组家兔同上进行检测.对数据进行单因素方差分析,对AQP4蛋白与ADC值进行一元线性相关分析和Pearson线性相关分析. 结果 与正常对照组比较,伤后6h内烫伤组家兔MRI图像(T1加权像、T2加权像、扩散加权成像)未见明显改变,伤后4～6 h烫伤组家兔脑组织各部位中ADC值均明显降低(F值为0.492～2 271,P值均小于0.05).烫伤组家兔伤后2～6 h脑组织各部位中AQP4蛋白表达趋势大体一致,均明显高于正常对照组(0.164±0.022 -0.247±0.018),其中伤后3 h或4 h达高峰(0.237±0.042-0.306±0.026),F值为2.420～11.439,P值均小于0.05.AQP4蛋白在脑组织各部位的表达均与相应ADC值变化呈显著负相关,其r值为-0.489 - -0.337P ＜0.05或P ＜0.01.烫伤组家兔伤后各时相点脑组织各部位中AQP4 mRNA表达均明显高于正常对照组(F值为39.992～238.584,P值均小于0.05),伤后2h达高峰,且在脑组织各部位表达趋势大体一致. 结论 家兔严重烫伤后早期脑水肿(伤后6h以内)以细胞毒性脑水肿为主,AQP4可能在其形成过程中发挥重要作用.ADC值对于反映AQP4变化,进而无创、便捷评估脑水肿发展状况可能具有重要参考价值.%Objective To observe expression pattern of aquaporin 4 (AQP4) in brain tissue of severely scalded rabbit during early stage of brain edema and its relationship with signal changes in magnetic resonance imaging (MRI),and to explore the feature of water transmembrane transportation in brain edema at early stage after severe scald.Methods Thirty-five healthy New Zealand white rabbits were divided into control group (C,n =5) and scald group (S,n =30) according to the random number table.Rabbits in S group were inflicted with 50％ TBSA full-thickness scald with brain edema ( confirmed by histopathologic examination),At post scald hour (PSH) 1,2,3,4,5,and 6,signel change in cerebyl MRI,as well as dynamie change in apparent diffusion coefficient (ADC) were examined in rabbits of S group.Specimens were harvested from frontal cortex,parietal cortex,temporal lobe cortex,basal ganglia,and cerebellum in rabbits of S group for determination of protein and gene expressions of AQP4 with immunohistochemieal method and RT-PCR.Above-mentioned indexes were also determined in C group.Data were processed with oneway analysis of variance and linear correlation analysis ( between protein expression of AQP4 and ADC value).Results There was no significant change in image signal of MRI at each time point in S group as compared with that in C group,including T1WI,T2WI,and DWI.Compared with those in C group,ADC in S group at PSH 4,5,and 6 were significantly decreased ( with F values from 0.492 to 2.271,P values all below 0.05 ).The expression of AQP4 protein in each part of brain tissue in S group was obviously increased at PSH 2,3,4,5,and 6 as compared with those in C group (from 0.164 ± 0.022 to 0.247 ± 0.018 ),and it peaked at PSH 3 or 4 ( from 0.237 ± 0.042 to 0.306 ± 0.026),with F values from 2.420 to 11.439,P values all below 0.05.The expressions of AQP4 protein were similar in brain tissue of all regions,and they were negatively correlated with corresponding ADC values ( with r values from - 0.489 to - 0.337,P ＜ 0.05 or P ＜ 0.01 ).Compared with that in C group,the expression of AQP4 mRNA in each part of brain tissue in S group was obviously increased at each time point,and it reached the peak at PSH 2 (with F values from 39.992 to 238.584,P values all below 0.05).The expressions of AQP4 mRNA were similar in all brain tissue regions. Conclusions Brain edema within 6 hours after severe scald was mainly characterized by cytotoxicity,in which AQP4 may play an important role.ADC value may have important reference value for non-invasive and convenient assessment of development of brain edema.
  • 摘要：Objective To study the effect of freeze-dried mouse epidermal growth factor(mEGF) on the expression of peroxisome proliferator-activated receptor β ( pPAR-β ) in mice during wound healing.Methods Full-thickness skin defect with area of 1.5 cm × 1.5 cm was reproduoed on both sides of the back of 70 BALB/c mice (2 wounds in each mouse).The wound on the left side in each mouse was trreted with 5 μg/mL mEGF solution (experiment group),and that on the right side in each mouse was treted with saline (control group).On post injury day (PID) 7,11,and 16,20 mice were used for determination of wound healing rate at each time point.On PID 1,3,7,11,14,and 18,specimens of wound edge were harvested for detemination of protein and gene expession of PPAR-β with immunohistochemical staining and in situ hybridization,with 10 specimens at each time point (denoted as integral absorbance value ).Data were processed with t test.Results ( 1 ) Wound healing rate.The wound healing rate in experiment group on PID 7,11,and 16 was respectively higher than that in control group ( with t value respectively 3.03,6.05,11.9.P values all below 0.01 ).( 2 ) Immunohistochemical observation.In both groups,the PPAR-β proteins highly expensed in fibroblasts of wound granulation tissues and nuclei of keratinocytes located in wound edge at early stage after injury,and they highly expressed in newly formed epidermis and their fibroblasts in the lower layer after wound epithelization.The expression of PPAR-β protein was gradually decreased after wound healing.The expression of PPAR-β protein at each time point in experiment group was respectively higher than that in control group ( with t values from 2.15 to 7.37,P ＜ 0.05 or P ＜ 0.01 ).The expression of PPAR-β protein peaked on PID 3 in experiment group [ (3.46 ± 1.33 ) × 103 ],which was (2.35 ± 1.09) × 103 in control group.(3) In situ hybridization.The expression levels of PPAR-β mRNA in both groups were up-regulated after injury,which were mainly observed in fibroblasts of wound and cytoplasm of KC in wound edge,but they were down-regulated after wound epithelization.The expression of PPAR-β mRNA at each time point in experiment group was respectively higher than that in control group ( with t values from 2.35 to 6.64,P ＜ 0.05 or P ＜ 0.01 ).The expression of PPAR-β mRNA in both groups peaked on PID3 [(7.3 ±2.6) ×106,(4.5±3.0) ×106,respectively]. Conclusions mEGF can upregulate the expression of PPAR-β in wound tissue of mice and promote wound healing.%目的 了解小鼠创面外用冻干鼠表皮生长因于(mEGF)后,过氧化物酶体增殖物激活受体β(PPAR-β)表达量的变化及对创面愈合的影响. 方法 于70只BALB/c小鼠背部脊柱两侧各制作1个1.5 cm×0.5 cm全层皮肤缺损创面,将左侧创面设为实验组、右侧创面作为对照组.实验组创面滴加mEGF溶液(5μg/mL)、对照组创面滴加生理盐水.(1)伤后7、11、16 d各取20只小鼠,评估创面愈合率.(2)伤后1、3、7、11、14、18 d切取创缘组织(每时相点创面数为10个),采用免疫组织化学染色法检测PPAR-β蛋白表达,原位杂交法检测PPAR-β mRNA表达量,结果均用积分吸光度(IA)值表示.对实验数据行t检验. 结果 (1)创面愈合率:伤后7、11、16 d,实验组创面愈合率均明显高于对照组(t值分别为3.03、6.05、11.90,P值均小于0.01).(2)免疫组织化学检测:伤后早期PPAR-β蛋白主要表达于2组剖面内芽组织Fb以及创缘KC胞核中,创面上皮化后主要表达于新生上皮及其下层Fb中,创面修复后表达逐渐减弱.实验组伤后各时相点PPAR-β蛋白表达量明显高于对照组(t值为2.15～7.37,P ＜0.05或P ＜0.01),其中伤后3d达高峰[IA值为(3.46±1.33)×103],此时对照组IA值为(2.35±1.09) ×103.(3)原位杂交:伤后2组创面PPAR-β mRNA表达均开始上调,主要阳性表达部位为创面Fb及创缘KC胞质,持续至创面上皮化基本完成时,表达量开始下降.实验组创面各时相点PPAR-β mRNA表达量均明显高于对照组(t值为2.35～6.64,P＜0.05或P ＜0.01),其中伤后3 d达峰值[IA值为(7.3±2.6)×106],此时对照组IA值为(4.5±3.0)×106. 结论 外用mEGF可上调小鼠创面组织中PPAR-β表达并促进创面愈合.
  • 摘要：患者男,47岁,2010年7月11日因液化气爆炸致全身多处烧伤,伤后3h左右于当地医院行抗休克、对症处理.伤后49 h经救护车运送,颠簸行驶1020 km,伤后65 h转入我院.诊断:(1)头、面、颈、四肢、躯干烧伤,总面积90％,其中浅Ⅱ度20％、深Ⅱ度60％、Ⅲ度10％ TBSA;(2)重度吸人性损伤.积极行补液、抗炎、对症处理,入院后第2天行四肢切削痂、微粒皮移植并气管切开术.切开第3、4软骨环,放置硅胶气囊套管(3d后更换为金属套管).术中纤维支气管镜检查显示:气管、左右支气管均通畅,黏膜充血、水肿;右支气管中下段可见少量出血、糜烂灶.术后3d患者体温高达39.9 ℃,出现呼吸困难、谵语、腹胀.胸部X线片提示:(1)肺水肿;(2)肺部感染.Hb 129 g/L,白蛋白22.2 g/L,血钠136 mmol/L,血钾4.40 mmol/L,送离子96 mmol/L.血气分析提示:呼吸性碱中毒合并代谢性酸中毒.经抗炎、脱水利尿、纠正低蛋白血症等治疗后,以上症状好转,但双肺呼吸音粗,双上肺可闻及少量湿性哕音.术后1周胸部X线片提示:(1)双上肺上中野渗出性病变;(2)双肺感染.术后2～3周患者反复出现呼吸困难,多次胸部X线片检查提示肺部感染仍存在,遂保留套管不予拔出.根据血、痰细菌培养结果选择敏感抗生素抗感染,积极行创面处理、加强营养等治疗,术后4周患者生命体征平稳,肺部感染症状明显好转.拟于入院29 d(术后27 d)行全身肉芽创面清创植皮,当日清晨2:30左右患者剧烈咳嗽,气管套管内涌出大量鲜红色液体,经抗休克、止血、吸出气道积血等处理,抢救无效死亡.立即行纤维支气管镜检查:气管套管尖端处无名动脉破裂出血.
  • 摘要：1临床资料2007年1月-2010年12月,笔者单位收治拇指掌指关节以远电烧伤患者12例,其中男10例、女2例,年龄为19～36岁.创面分布:指端8例、远节背侧4例,创面面积为2.0 cm×1.0 cm-4.0 cm×3.0 cm.所有创面均伴指骨外露,部分指骨炭化(Ⅳ度烧伤).
  • 摘要：Objective To investigate the effects of local injection of insulin on the level of systemic blood glucose and graulation tissue formation of wound in patients with diabetic foot ulcer.Mecthods Thirty-two patients with diabetic foot ulcer hospitalized in our wards from June 2009 to June 2010 were divided into insulin ( I,n =16) and control ( C,n =16) groups according to the random number table.For patients in Ⅰ group,after debridement,one half of calculated dose of insulin diluted with equal amount of normal saline was injected diffusely into the base of the ulcer,and another half dose of insulin was subcutaneously injected into abdominal wall for 7 days,two times a day.For patients in C group,after debridement,ptimary insulin was subcutaneously injected into abdominal wall,1 mL saline was subcutaneously injected into basal layer of ulcer for 7 days,two times a day.Before injection and 0.5,1.0,2.0,and 4.0 hours after injection ( PIH ),level of fasting blood glucose was determined.Before injection and on post injection day (PID) 3,5,and 7,the growth of granulation tissue was assessed,and wound specimens were harvested for observation of CD34 expression and calculation of microvessel density (MVD).Data were processed with t test.Results The levels of fasting blood glucose in both groups during observational time points ranged from 6.6 mmol/L to 12.8 mmol/L with a mean of ( 10.0 ± 2.2 ) mmol/L,and there was no statistical difference ( with t values from 0.000 to 2.209,p values all above 0.05 ).Growth of ganulation tissue in Ⅰ group was more exuberant from PID 5,especially on PID 7 [ ( 59.06 ± 1.58 ) ％ ],which was significantly richer than thai in C group [ (23.61 ± 1.57)％,t =17.420,P =0.000].New vessels were observed in Ⅰ group from PID 3 as indicated by CD34 expression.There was no obvious difference in the number of MVD between Ⅰ group and C group on PID 3 ( t =0.247,P ＞0.05).The number of MVD per 200 times visual field in Ⅰ group was respectively 8.34 ± 0.48,11.22 ± 0.97 on PID 5 and 7,which was respectively higher than that in C group (4.42 ± 0.14,5.44 ± 1.13,with t value respectively 16.568,27.664,P values all below 0.01 ). Conclusions Local injection of insulin has a significant effect on systemic blood glucose in patients with diabetic foot ulcer,and it can promote the growth of granulation tissue and wound healing.%目的 观察糖尿病足溃疡患者创面局部注射胰岛素对全身血糖和创面肉芽组织形成的影响. 方法 选择2009年6月-2010年6月在笔者单位住院治疗的糖尿病足患者32例,按随机数字表法分为胰岛素组和对照组,每组16例.所有患者预先清创.(1)胰岛素组:将胰岛素计算剂量的1/2用生理盐水稀释成1 mL后,浸润注射于溃疡创面基底部,另1/2计算量按常规行腹部皮下注射,均为2次/d.(2)对照组:将胰岛素计算剂量的全量常规注射于腹部皮下,溃疡创面基底部浸润注射1 mL生理盐水,均为2次/d.2组患者均连续注射7d.于患者每次注射前及注射后0.5、1.0、2.0、4.0 h,分别检测其空腹血糖值.于首次注射前及注射3、5、7 d,评估创面肉芽组织生长程度；取创面组织标本观察CD34表达情况,据此计算创面微血管密度(MVD).对实验数据行t检验.结果 2组患者观察期内空腹血糖值维持在6.6～12.8(10.0±2.2)mmol/L,各时相点组间比较,差异均无统计学意义(t值为0.000～2.209,P值均大于0.05).注射第5天起,胰岛素组患者局部创面肉芽组织明显增多；第7天达生长高峰[(59.06±1.58％],与对照组[(23.61±1.57)％]比较,差异有统计学意义(t=17.420,P=0.0.000).CD34表达情况显示,胰岛素组注射3 d起有新生血管形成,但此时MVD与对照组接近(t=0.0247,P＞0.05)；注射5、7d,胰岛素组创面组织MVD每200倍视野中分别为(8.34±0.48)、(11.22±0.97)个,明显多于对照组的(4.42±0.14)、(5.44±1.13)个,t值分别为16.568、27.664,P值均小于0.01. 结论 糖尿病足溃疡患者创面局部注射胰岛素对全身血糖有较明显影响,能加速肉芽组织生长,促进创面愈合.
  • 摘要：患者男,30岁,2008年9月7日全身多处火焰烧伤,2h后入院.诊断:(1)特重度烧伤,总面积85％,其中浅Ⅱ度5％、深Ⅱ度20％、Ⅲ度60％TBSA.(2)吸入性损伤.给予静脉补液抗体克、抗感染、气管切开、肢体环形焦痂切开减张、营养支持、四肢切痂植皮等治疗.患者面部包括鼻尖、鼻翼系深Ⅱ～Ⅲ度创面,伤后5周创面自愈,随后发生严重的瘢痕增生挛缩:双侧鼻翼纵向挛缩呈缺损状且右侧较重、口周环形挛缩、双侧上下睑外翻,鼻小柱与上唇粘连.行双侧上下睑瘢痕松解、植皮、睑粘连术,以及面部配戴弹性头套联合外用硅酮类抗瘢痕药物等治疗.伤后18个月,患者面部瘢痕软化,但右侧鼻冀缺损未恢复(图1 a).于患者全身麻醉下,在其残留鼻翼、鼻尖及鼻翼沟位置设计3个并列瘢痕皮瓣,其中A瓣呈不规则四边形,略宽于鼻孔宽度,较鼻翼缺损长2～3mm;B、C瓣位于A瓣两侧,近似三角形,最宽处3～4mm,长度较A瓣宽度长3-4 mm;A、B、C瓣蒂部均位于鼻孔缘(图1 b).局部肿胀麻醉,沿设计线切开,于软骨膜浅面掀起皮瓣,将A瓣向颏尖方向翻转作为再造鼻翼衬里(图1c);B、C瓣相向旋转,覆盖A瓣远端表面,B、C瓣Z形缝合后与A瓣远端缝合形成新的鼻翼缘,其蒂部鼻翼侧形成“猫耳”,予以保留(图1d).皮瓣供区移植中厚皮,打包固定,术后8～10d拆线.术毕用“o”形弹性塑料片裹油纱填塞鼻孔1～2个月.皮瓣、皮片均成活(图1 e).随访10个月,患者再造鼻翼稳定,效果较满意.

    中华烧伤杂志的期刊信息

    • 曾用名：中华整形烧伤外科杂志
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      Medicine:Critical Care and Intensive Care Medicine;Dermatology;Medicine (miscellaneous);

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