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1.
Seven burn patients treated with silver nitrate dressings were studied during the first 10 days after injury. Minute ventilation, oxygen consumption, and ventilatory equivalent were measured. Minute ventilation was increased two- to threefold, as was oxygen consumption. Ventilatory equivalent was only slightly increased. THree patients were initially treated with silver nitrate, and then, when clinically stable, were switched to Sulfamylon. They showed a 50% rise in ventilation, tidal volume, ventilatory equivalent, and a slight increase in respiratory rate and VD/VT. In addition, their PO2 increased and base excess fell. Five normal subjects were then given Diamox, and their minute ventilation, O2 consumption, and ventilatory equivalent were measured at rest, with a standard exercise, and with an added dead space. Diamox produced only a 25% increase in minute ventilation and ventilatory equivalent. The results suggest that, although some of the increased ventilation of Sulfamylon is due to carbonic anhydrase inhibition, another factor, such as pain casued by the topical agent, also plays a role.  相似文献   

2.
A controlled trial showed that 1 per cent silver sulphadiazine (SSu) cream applied daily (or at intervals of 2 or 3 days) to burns had greater prophylactic value against Pseudomonas aeruginosa than a cream containing 0.4 per cent silver phosphate with 0.2 per cent chlorhexidine gluconate (SPCI). In another controlled trial, SSu cream had greater prophylactic value against Staphylococcus aureus, P. aeruginosa, proteus species and miscellaneous coliform bacilli than a 10 per cent povidone iodine (PVP-I) cream. It was inferred, from the results of an earlier trial, that silver nitrate chlorhexidine (SNCI) cream would be more effective than SPCI cream as a prophylactic agent against P. aeruginosa, apparently because of the greater solubility of silver nitrate; for this reason, SNCI cream was judged to be an appropriate substitute for SSu cream when sulphonamide-resistant Gram-negative bacilli were predominant in the ward.A trial of 10 per cent povidone iodine and 0–5 per cent silver nitrate solutions applied 6 hourly to exposed bums of the face, compared with no topical application, showed that both solutions reduced bacterial colonization of the burns, but there was no significant reduction in colonization by individual pathogens.  相似文献   

3.
Although there are excellent clinical results from using cerium nitrate plus silver sulphadiazine in the treatment of deep dermal burns in our burn centre, its mechanism of action remains unexplained. We set up a prospective study to establish a hypothesis which could explain the formation of the typical leathery crust. Burns treated with cerium nitrate plus silver sulphadiazine and silver sulphadiazine alone were compared histologically and metallurgically. Application of cerium nitrate plus silver sulphadiazine on deep dermal burns caused superficial connective tissue calcification with few deep dermal changes. Cerium penetration was low and silver was never detected intradermally. The precipitation of cerium and pyrophosphate destroys the calcification inhibitory function of the latter, creates multiple calcification nuclei and leads to superficial dermal calcification. No calcium was detectable in biopsies from silver sulphadiazine-treated wounds. No major toxicological side-effects were seen during this study. The clinical results were favourable, as have been reported previously.  相似文献   

4.
In 1965, Moyer revived interest in silver nitrate solution. He concluded on the basis on in vitro and in vivo studies that a 0.5% solution represented the lowest concentration at which antibacterial action (against Staphylococcus aureus, haemolytic streptococci and generally against Pseudomonas aeruginosa and E. coli) was obtained. Mafenide acetate was introduced a short time after the reintroduction of silver nitrate, followed a few years later by silver sulphadiazine. Thus, in a short period of time three medicaments appeared on the market which represented a radical change in the topical treatment of burns. The action of silver sulphadiazine has been intensively studied. Since silver sulphadiazine does not offer sufficient protection to prevent or retard the growth of gram-negative bacteria in patients with burns covering more than 50% of body surface, Monafo introduced the combined preparation silver sulphadiazine and cerium nitrate. Although various attempts have been made to develop more effective silver compounds, so far silver sulphadiazine still remains the most widely used substance of this type.  相似文献   

5.
Recent adoption of 0.5% silver nitrate dressings as a topical treatment of the burn wound at the Massachusetts General Hospital and other centres has led to an impressive reduction of infection. Infection is the major cause of the mortality in burns today. The use of topical silver nitrate is described, together with a report of the problems associated with such therapy. It is concluded that topical silver nitrate therapy represents a major advance in the care of the burn wound.  相似文献   

6.
Twenty patients are reported who suffered acute thermal bums of the perineum and buttocks and were treated at the Shriners Burns Institute, Cincinnati Unit. Seventeen of the 20 patients had burns which resulted from ignition of clothing. The most common source of ignition was refuse fires. Ages ranged from 11 months to 12 years; 17 of the patients were males and 3 were females.Topical agents used to treat the perineal burns consisted of mafenide (Sulfamylon), gentamicin and silver sulphadiazine. All perineal burns were treated by the open technique. The whirlpool was used two times a day for cleansing and débriding the superficial eschar. Initial wound care, in addition to hydrotherapy, consisted of cleaning the perineum twice a day with a mixture of saline, peroxide and ‘Dreft’, after which the topical agent was applied. Once the eschar was removed, the wounds were prepared for grafting by the use of porcine xenografts or cadaver allografts. Meshed skin grafts were used for final coverage.Pseudomonas aeruginosa was the most common organism recovered; Escherichia coli was a close second. Follow-up on these patients revealed that late complications of the buttocks and perineum were minimal. A colostomy was performed in 1 of the 20 patients. This experience indicated that colostomy is not necessary for the handling of perineal burns and that involvement of the perineum in acute burns can be handled by relatively simple means.  相似文献   

7.
This study was performed in order to investigate serum and tissue silver levels in burns which were used 10 percent silver nitrate as a topical agent. We formed four groups of animals and pulverized 10 percent silver nitrate solution to the first group (GI) that included ten rabbits of which backs were burned by boiling water and silver sulphadiazine cream to second group (GII) with nine rabbits. We carried out 10 percent silver nitrate solution to the first control group (GIII) and silver sulphadiazine cream to the second control group (GIV) each of which had seven animals with unburned skin. We obtained blood samples from every animal before and after application of topical agent on the 1st, 3rd, 7th, 15th, 21st and 28th. We determined serum and tissue silver levels by atomic absorption spectrophotometer in kidney and liver of the animals which were sacrificed on the 28th day. In first and second groups we found that serum silver values reached on 3rd day to the maximum level and then the values decreased gradually. We also determined that diminution of the serum silver levels were prominent following on 15th day. It was shown that there was no silver in the serum on 28th day except four animals. The silver deposition in the liver was much more than in the kidney. Between these two groups there was significant difference neither in the serum on the same days nor the tissue silver levels. According to these data it was concluded that serum and tissue silver levels with 10 percent silver nitrate used in burns produced no difference from that of 1 percent silver sulphadiazine cream.  相似文献   

8.
An increase in the proportion of gentamicin-resistant Pseudomonas aeruginosa in a burns unit is explained by the fact that silver nitrate preparations used for the topical treatment of patients damaged the waterproof mattress covers. This allowed the organisms from patients to percolate through to the mattress itself which became a reservoir of Pseudomonas aeruginosa. Details of the investigation into this problem and laboratory experiments to demonstrate how this can occur are described. Recommendations are given for the importance of using the right agents for cleaning such mattresses.  相似文献   

9.
硝酸银软膏对Ⅱ度烧伤创面治疗作用的多中心临床研究   总被引:6,自引:0,他引:6  
目的观察硝酸银(AgNO3)软膏对浅Ⅱ、深Ⅱ度烧伤创面的治疗效果,并评价其药物不良反应。方法选择80例浅Ⅱ度和40例深Ⅱ度烧伤患者,进行多中心、随机、阳性药物平行对照和同体试验研究(共4个中心,每个中心30例)。将患者创面按用药不同分为AgNO3组和磺胺嘧啶银(SD-Ag)组,观察各组创面完全愈合时间、指定时相点下创面愈合率、创面细菌培养情况、药物疗效和安全性、药物对创面的刺激性等。结果浅Ⅱ度创面:AgNO3组完全愈合时间为(9.5±2.7)d, SD-Ag组为(10.8±3.4)d,用药后7 d创面愈合率分别为(77.9±20.5)%及(67.3±22.6)%;深Ⅱ度创面:AgNO3组完全愈合时间为(21.5±4.8)d,SD-Ag组为(23.3±6,4)d,用药后20 d创面愈合率分别为(86.6±15.9)%及(78.5±17.7)%。同等深度烧伤创面上述各项数据两组间比较,差异均有统计学意义(P<0.01)。同等深度烧伤创面AgNO3组与SD-Ag组比较,具有同样明显的杀菌作用,但前者对创面的刺激性更小。结论AgNO3软膏是一种可用于浅Ⅱ、深Ⅱ度烧伤创面的有效、安全的外用药。  相似文献   

10.
Long-term functional results of selective treatment of hand burns   总被引:1,自引:0,他引:1  
Four hundred seventy-eight patients with hand burns (786 hands) were treated at the burn service of the Massachusetts General Hospital. Long-term evaluation showed that early incision and immediate autografting of deep second degree, mixed second and third degree, and third degree full-thickness hand burns resulted in 93 percent, 95 percent, and 93 percent, respectively, excellent to good functional results. There was no significant differences in results in patients with superficial second degree burns treated nonsurgically with silver nitrate dressings and early physical therapy compared with results in patients with deep second degree, mixed second and third degree, and third degree hand burns treated with early excision and grafting. No patient with fourth degree burns had excellent to good results. Permanent damage was related to extent of original injury to the extensor tendons and joint capsules. On the basis of this broad experience, it is believed that all burned hands judged unlikely to heal within 3 weeks will benefit from early excision and grafting by experienced surgical personnel.  相似文献   

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