苏肤凝胶在烧烫伤换药中的疗效观察及应用

目的:观察苏肤凝胶在烧烫伤换药中的效果。方法:患者均为Ⅱ度烧烫伤及深Ⅱ度烧烫伤所导致的创面共96例,随机分为治疗组48例,对照组48例。治疗组使用为生理盐水消毒伤口后再在伤口上涂抹苏肤凝胶(医用壳聚糖创面修复膜凝胶)进行伤口换药,对照组使用为生理盐水消毒伤口后再在伤口上涂抹磺胺嘧啶银进行伤口换药,观察并同时记录两组患者在伤口换药后的伤口愈合时间、换药伤口疼痛的情况。结果:治疗组的愈合时间明显短于对照组(P<0.01),治疗组伤口换药疼痛程度明显低于对照组(P<0.01)。结论:苏肤应用于Ⅱ度烧烫伤及深Ⅱ度烧烫伤创面的换药中,有较好的促进创面修复作用,止痛效果好,清除余热快,可为创面提供生理湿润环境,减少瘢痕形成等功效,能有效缩短烧伤创面的愈合时间。     

紫花地丁烫伤酊治疗大鼠烫伤模型试验

目的评价紫花地丁烫伤酊治疗大鼠浅Ⅱ度烫伤和深Ⅱ度烫伤作用及机制。方法预试验确定浅Ⅱ度烫伤和深Ⅱ度烫伤标准;SD大鼠分组后连续给药21 d,与给药后第7、14和21天观察创面结痂时间、测定创面结痂面积、计算创面愈合率和脱痂愈合时间,免疫组化法检查创面组织修复中Ⅰ和Ⅲ型胶原表达。结果紫花地丁烫伤酊可减少浅Ⅱ度及深Ⅱ度烫伤创面结痂面积、提高烫伤创面愈合率;减少浅Ⅱ度和深Ⅱ度烫伤创面脱痂时间;升高深Ⅱ度烫伤创面组织中Ⅲ型胶原蛋白表达;降低深Ⅱ度烫伤创面组织中Ⅰ型胶原蛋白表达。结论紫花地丁烫伤酊具有治疗浅Ⅱ度和深Ⅱ度烫伤作用,其作用机制与升高创面组织中Ⅲ型胶原表达,降低Ⅰ型胶原蛋白表达有关。     

亲水性凝胶治疗浅Ⅱ度烧伤创面的临床观察

目的通过对比观察亲水性凝胶(商品名:富林蜜伤口愈合凝胶)治疗浅Ⅱ度烧伤创面的效果,提供一种较好的创面修复方法以供选择。方法采用同体对照方法,治疗组创面应用亲水性凝胶,对照组创面应用聚维酮碘,均采取加压包扎疗法;分别观察两组创面愈合时间、创面分泌物情况、细菌培养结果、病人接受程度等。结果治疗组比对照组创面愈合时间平均提早2.33天(P<0.05),创面分泌物提前减少及消失,病人接受程度高;两组细菌培养均为阴性。结论亲水性凝胶治疗浅Ⅱ度烧伤创面,可缩短创面愈合时间,病人疼痛程度明显减轻。     

辐照猪皮在急诊烧伤创面上的运用

目的：探讨辐照猪皮在烧伤创面上运用的方法和经验。方法：对在深浅Ⅱ度及Ⅲ度创面上使用辐照猪皮进行感染及粘附度比较，对辐照猪皮治疗组和SD－Ag冷霜治疗组的愈合时间、色素沉着情况进行比较。结果：浅Ⅱ度创面使用辐照猪皮感染率明显低于深Ⅱ度创面（P＜0．01），前者粘附度优于后者，Ⅲ度创面感染率高，无一例粘附良好。 辐照猪皮治疗组的创面愈合时间比SD－Ag冷霜组缩短（P＜0．05），前者治疗的病例，愈合后色素沉着情况较少。结论：辐照猪皮是浅Ⅱ度创面理想的生物敷料，深Ⅱ度创面上应谨慎使用，Ⅲ度创面不宜使用辐照猪皮。     

羧甲基纤维素钠敷料在急性伤口中的应用

“湿性愈合理论”认为,将创面置于一个封闭、湿润的环境中,有利于创面的加速愈合。封闭敷料（occlusive dressings）是在“湿性愈合理论”指导下研发的新型伤口敷料。其中应用最多的水胶体敷料其基本成分是羧甲基纤维素钠（sodium carboxymethyl cellulose,CMC）,具有吸收创面渗液形成凝胶的特性,可以起到保持创面适宜的温湿度、支撑创面的作用。本文对羧甲基纤维素钠在急性伤口中的应用进行简述。     

贝复济促进烧伤植皮创面修复的临床观察

贝复济即外用重组牛碱性成纤维细胞生长因子（bFGF），可促进参与创面愈合的各种细胞分化、增殖，促进创面的主动修复，对慢性创面（如糖尿病溃疡、放射性溃疡、褥疮等），新鲜创面（包括外伤、手术切口等）和烧烫伤（浅Ⅱ度烧伤、深Ⅱ度烧伤、肉芽）创面均具有良好的效果。     

壳聚糖生物护伤喷膜功能敷料在犬咬伤严重暴露创面伤口床准备的对比观察

目的壳聚糖生物护伤喷膜功能敷料在犬咬伤严重暴露创面伤口床准备的临床疗效。方法本研究来自某医院急诊2016年1月至2017年10月接诊的100例犬咬伤患者,分层抽样,分别为治疗组和对照组,对照组患者采用常规处置方法,研究组患者在常规处置方法的基础上,采用壳聚糖生物护伤喷膜功能敷料对患者进行治疗,观察患者3、7、14 d的愈合情况,比较两组患者的创面愈合率。结果患者在前3 d,生理盐水纱条敷料与壳聚糖生物护伤喷膜功能敷料在患者伤口愈合情况相似,不存在统计学意义(t=-1.47,P=0.07)。在患者伤口处理第7天和第14天体内对患者创面愈合情况进行比较,研究组患者创面愈合情况明显优于对照组。结论壳聚糖生物护伤喷膜功能敷料在犬咬伤严重暴露创面伤口床准备中的临床疗效较好,具有临床推广意义。     

羧甲基壳聚糖复合水凝胶的制备及其性能研究

目的 制备羧甲基壳聚糖复合水凝胶并对其粘附和抑菌等性能进行研究,为创伤敷料的开发奠定基础。方法 以羧甲基壳聚糖(CMCS)、氧化淀粉(OST)和单宁酸(TA)为原料,通过席夫碱反应制备系列水凝胶，在对其形貌、流变学、溶胀度和粘附性等性能表征基础上，进一步并对其生物相容性和抑菌活性进行评价。结果 CMCS与OST/TA溶液体积比为2:1时，制备的水凝胶COT-2凝胶化时间最短(8.3±0.9 s)，粘附强度最高(13.1 kPa)，孔径大小适中(200 μm)，有可自愈合能力，且对HaCaT细胞没有明显毒性，对金黄色葡萄球菌和大肠杆菌具有良好的抑制作用。结论 水凝胶COT-2具有较强的粘附性、机械性能和可自愈合能力，并且表现出良好的生物相容性和抑菌活性，有开发成为是伤口敷料的潜力。     

新型静电纺丝伤口敷料的止血性能及促愈合作用研究

目的 评价新型静电纺丝伤口敷料的止血性能及促创伤愈合作用,为该敷料的进一步开发应用奠定基础。方法 将胶原蛋白和壳聚糖的混合溶液通过静电纺丝技术纺在海藻酸盐无纺布基布上,制备成新型静电纺丝伤口敷料（胶原蛋白-壳聚糖静电纺丝膜复合海藻酸盐敷料,Collagen-Chitosan Electrostatic spinning membrane Alginate Dressing,CCEAD）。通过体外凝血实验、兔耳动脉创伤止血实验和兔背部创伤止血实验评价CCEAD的止血性能。建立大鼠背部全皮层创伤模型,分别在术后3、5、7、12 d拍照计算伤口愈合率,测定CCEAD的促愈合作用;取伤口创面皮肤组织,HE染色观察组织病理学变化;免疫组化染色观察在伤口愈合过程中CD31、FGF-2和TGF-β的表达情况。结果 CCEAD组的体外凝血指数BCI为36.91±6.62,显著小于阳性对照明胶海绵组（69.82±1.83）和阴性对照医用纱布组（79.93±6.30）（P＜0.01）。兔耳动脉创伤止血实验中,CCEAD组的止血时间（107.67±17.62) s短于医用纱布组（163.67±15.50） s（P＜0.05）。兔背部创伤止血实验中,CCEAD组Hb光度吸收值（0.120±0.052）明显低于医用纱布组（0.294±0.021）（P＜0.01）。在促创伤愈合实验中,术后第7天,CCEAD组愈合率为65.70%±4.94%,高于阳性对照壳聚糖敷料组（48.78%±8.33%,P＜0.05）,明显高于医用纱布组（37.76%±6.35%,P＜0.01）。HE染色显示,CCEAD在伤口愈合早期能够促进成纤维细胞生长和新生血管形成,促进肉芽组织的生成。免疫组化结果显示,CCEAD能促进CD31、FGF-2和TGF-β在伤口愈合早期的表达,有利于伤口的愈合。结论 新型静电纺丝伤口敷料（胶原蛋白-壳聚糖静电纺丝膜复合海藻酸盐敷料）止血性能优良,具有明显的促创伤愈合作用,有望开发成新型伤口敷料。     

纳米银敷料与重组人表皮生长因子联合治疗Ⅱ度烧伤的疗效分析

目的 观察纳米银外用敷料联合重组人表皮生长因子对烧伤创面的治疗效果.方法 选择浅Ⅱ度及深Ⅱ度创面共96例,分别随机分为A组34例（纳米银敷料联合重组人表皮生长因子换药）,B组32例（单纯纳米银敷料换药）,C组30例（用碘伏凡士林纱布换药）,于伤后7、10、15、20、25 d分别对3组进行创面分泌物细菌培养及鉴定,全程观察记录创面愈合率及愈合时间,观察药物不良反应.结果 浅Ⅱ度和深Ⅱ度创面细菌检出率,A组与B组比较差异均无统计学意义（P＞0.05）,C组明显高于A、B组,差异均有统计学意义（P＜0.05）.伤后7d开始,无论浅Ⅱ度创面,还是深Ⅱ度创面,A、B组创面愈合率均较C组明显增大,差异均有统计学意义（P＜0.05）.3组间创面平均愈合时间比较,A组最短,B组次之,C组最长,并且3组间的两两比较差异均有统计学意义（P＜0.01）.3组均无过敏反应,A组有1例浅Ⅱ度创面患者换药后出现局部烧灼感,10 min后症状自行缓解.结论 纳米银敷料抗菌作用强,重组人表皮生长因子能促进组织修复,两者联合可以加速烧伤创面愈合.     

鱼油伤口护理软膏的制备及其对皮肤切线伤的促愈合作用

鱼油中的多不饱和脂肪酸具有促进皮肤损伤修复的功能。以富含多不饱和脂肪酸的鱼油为原料，复配黄凡士林、液体石蜡，制备油性伤口护理软膏敷料。测试了该软膏敷料的细胞相容性、阻水性、阻菌性及其对Sprague Dawley（SD）大鼠切线伤的促愈合作用。结果表明，软膏浸提液培养的L929细胞相对存活率为（99.5 ± 2.2）%，具有优异的细胞相容性；软膏具有优异的阻水性和阻菌性；在切线伤护理中，所制备膏状敷料能够促进创面胶原的沉积与重排，减轻瘢痕的生成。鱼油伤口护理软膏在浅表性皮肤创面护理方面有着良好的应用前景。     

In situ injectable nano-composite hydrogel composed of curcumin, N,O-carboxymethyl chitosan and oxidized alginate for wound healing application

In this paper, an in situ injectable nano-composite hydrogel composed of curcumin, N,O-carboxymethyl chitosan and oxidized alginate as a novel wound dressing was successfully developed for the dermal wound repair application. Nano-curcumin with improved stability and similar antioxidant efficiency compared with that of unmodified curcumin was developed by using methoxy poly(ethylene glycol)-b-poly(?-caprolactone) copolymer (MPEG-PCL) as carrier followed by incorporating into the N,O-carboxymethyl chitosan/oxidized alginate hydrogel (CCS-OA hydrogel). In vitro release study revealed that the encapsulated nano-curcumin was slowly released from CCS-OA hydrogel with the diffusion-controllable manner at initial phase followed by the corrosion manner of hydrogel at terminal phase. In vivo wound healing study was performed by injecting hydrogels on rat dorsal wounds. Histological study revealed that application of nano-curcumin/CCS-OA hydrogel could significantly enhance the re-epithelialization of epidermis and collagen deposition in the wound tissue. DNA, protein and hydroxyproline content in wound tissue from each group were measured on 7th day of post wounding and the results also indicated that combined using nano-curcumin and CCS-OA hydrogel could significantly accelerate the process of wound healing. Therefore, all these results suggested that the developed nano-curcumin/CCS-OA hydrogel as a promising wound dressing might have potential application in the wound healing.     

Accelerated wound healing and anti-inflammatory effects of physically cross linked polyvinyl alcohol–chitosan hydrogel containing honey bee venom in diabetic rats

Diabetes is one of the leading causes of impaired wound healing. The objective of this study was to develop a bee venom-loaded wound dressing with an enhanced healing and anti-inflammatory effects to be examined in diabetic rats. Different preparations of polyvinyl alcohol (PVA), chitosan (Chit) hydrogel matrix-based wound dressing containing bee venom (BV) were developed using freeze–thawing method. The mechanical properties such as gel fraction, swelling ratio, tensile strength, percentage of elongation and surface pH were determined. The pharmacological activities including wound healing and anti-inflammatory effects in addition to primary skin irritation and microbial penetration tests were evaluated. Moreover, hydroxyproline, glutathione and IL-6 levels were measured in the wound tissues of diabetic rats. The bee venom-loaded wound dressing composed of 10 % PVA, 0.6 % Chit and 4 % BV was more swellable, flexible and elastic than other formulations. Pharmacologically, the bee venom-loaded wound dressing that has the same pervious composition showed accelerated healing of wounds made in diabetic rats compared to the control. Moreover, this bee venom-loaded wound dressing exhibited anti-inflammatory effect that is comparable to that of diclofenac gel, the standard anti-inflammatory drug. Simultaneously, wound tissues covered with this preparation displayed higher hydroxyproline and glutathione levels and lower IL-6 levels compared to control. Thus, the bee venom-loaded hydrogel composed of 10 % PVA, 0.6 % Chit and 4 % BV is a promising wound dressing with excellent forming and enhanced wound healing as well as anti-inflammatory activities.     

银锌霜治疗烧伤279例体会

目的：观察银锌霜在烧伤创面的应用效果。方法：创面应用银锌霜外涂或涂布包扎治疗。结果：应用银锌霜后,浅Ⅱ度创面愈合时间为1周左右,深Ⅱ度创面愈合时间为2-3周,浅Ⅲ度创面3-4周愈合。结论：银锌霜是一种较理想的烧伤创面外用药。     

Thermosensitive Hydrogel as a Tgf-β1 Gene Delivery Vehicle Enhances Diabetic Wound Healing

PURPOSE: To accelerate diabetic wound healing with TGF-beta1 gene delivery system using a thermosensitive hydrogel made of a triblock copolymer, PEG-PLGA-PEG. METHODS: Two 7 x 7 mm full thickness excisional wounds were created in parallel at the back of each genetically diabetic mouse. The hydrogel containing plasmid TGF-beta1 was administered to the wound and formed an adhesive film in situ. Controls were either untreated or treated with the hydrogel without DNA. We used a commercial wound dressing, Humatrix, either with or without DNA, to compare the therapeutic effect with the thermosensitive hydrogel. RESULTS: We found that thermosensitive hydrogel alone is slightly beneficial for reepithealization at early stage of healing (day 1-5), but significantly accelerated repithelializaion, increased cell proliferation, and organized collagen were observed in the wound bed treated with thermosensitive hydrogel containing plasmid TGF-beta1. The accelerated reepithelialization was accompanied with enhanced collagen synthesis and more organized extracellular matrix deposition. Humatrix alone or with plasmid TGF-beta1, had little effect. CONCLUSIONS: Thermosensitive hydrogel made of PEG-PLGA-PEG triblock copolymer provides excellent wound dressing activity and delivers plasmid TGF-beta1 to promote wound healing in a diabetic mouse model.     

医用壳聚糖创面修复膜对阑尾炎手术伤口恢复的效果

目的探讨医用壳聚糖创面修复膜对阑尾炎手术伤口恢复的临床效果。方法行开腹手术治疗的60例阑尾炎患者,随机分为观察组和对照组,各30例。两组术后均给予常规伤口处理,观察组在此基础上加用医用壳聚糖创面修复膜。比较两组疗效。结果观察组伤口愈合效果显著好于对照组,愈合时间显著短于对照组,差异均具有统计学意义（P〈0.01）。结论医用壳聚糖创面修复膜能够促进阑尾炎手术伤口更好更快的恢复,使用方法简单,适用范围广泛,值得临床考虑。     

Natural and synthetic polymers for wounds and burns dressing

In the last years, health care professionals faced with an increasing number of patients suffering from wounds and burns difficult to treat and heal. During the wound healing process, the dressing protects the injury and contributes to the recovery of dermal and epidermal tissues. Because their biocompatibility, biodegradability and similarity to macromolecules recognized by the human body, some natural polymers such as polysaccharides (alginates, chitin, chitosan, heparin, chondroitin), proteoglycans and proteins (collagen, gelatin, fibrin, keratin, silk fibroin, eggshell membrane) are extensively used in wounds and burns management. Obtained by electrospinning technique, some synthetic polymers like biomimetic extracellular matrix micro/nanoscale fibers based on polyglycolic acid, polylactic acid, polyacrylic acid, poly-?-caprolactone, polyvinylpyrrolidone, polyvinyl alcohol, polyethylene glycol, exhibit in vivo and in vitro wound healing properties and enhance re-epithelialization. They provide an optimal microenvironment for cell proliferation, migration and differentiation, due to their biocompatibility, biodegradability, peculiar structure and good mechanical properties. Thus, synthetic polymers are used also in regenerative medicine for cartilage, bone, vascular, nerve and ligament repair and restoration. Biocompatible with fibroblasts and keratinocytes, tissue engineered skin is indicated for regeneration and remodeling of human epidermis and wound healing improving the treatment of severe skin defects or partial-thickness burn injuries.     

壳聚糖对大鼠Ⅲ度烧伤创面表皮生长因子的影响研究

目的:研究壳聚糖对大鼠Ⅲ度烧伤创面表皮生长因子(EGF)和EGFmRNA表达的影响及意义。方法:105只Wistar大鼠除5只作为正常对照组外,其余建立烧伤模型后分为壳聚糖低、中、高浓度(1%、2%、4%)组及贝复济组(阳性对照组)和自然愈合组(模型组),每日2次连续21d于受伤处喷以相应药物,采用免疫组织化学法、核酸分子杂交法及图象分析法检测烧伤后3、7、14、21d时大鼠Ⅲ度烧伤创面EGF和EGFmRNA的表达。结果:与模型组比较,壳聚糖各浓度组均可增强EGF和EGFmRNA的表达,并呈浓度依赖性,尤以4%壳聚糖组作用更强(P<0.01或P<0.05)。结论:壳聚糖对大鼠Ⅲ度烧伤创面有促愈合作用,其促愈合机制与增强创面EGF和EGFmRNA表达有关。     

异种(猪)脱细胞真皮基质在小儿Ⅱ度烧伤创面中的应用

目的探讨应用异种(猪)脱细胞真皮基质一次包扎治疗小儿Ⅱ度烧伤的临床效果。方法回顾分析本科收治的患儿90例。烧伤面积7%～38%TBSA,烧伤深度为浅Ⅱ度和深Ⅱ。所有烧伤病例随机分两组,基质组采用异种(猪)脱细胞真皮基质一次包扎治疗,对照组采用传统的包扎疗法。比较两组的创面愈合时间和创面感染率。结果基质组的创面愈合时间和感染率明显低于对照组。结论采用异种(猪)脱细胞真皮基质一次包扎治疗小儿Ⅱ度烧伤,既能有效防止创面加深,缩短创面愈合时间,又能减轻患儿痛苦,降低感染率。     

负压封闭引流技术用于治疗烧伤的护理

目的：探讨负压封闭引流技术治疗烧伤的应用效果及护理方法。方法60例深Ⅱ、Ⅲ度烧伤的患者中40例患者采用负压封闭引流（观察组）,20例患者采用常规换药（对照组）,比较两组的创面愈合情况、植皮成功率、舒适度以及护理满意度。结果观察组的创面愈合率、植皮成活率高于对照组,愈合时间、住院时间少于对照组,细菌培养阳性率、并发症少于对照组,疼痛评分低于对照组,均有统计学意义（ P＜0．05）。观察组在生理、心理、社会环境、文化方面的舒适度评分均高于对照组,护理满意度高于对照组,均有统计学意义（P＜0．05）。结论负压封闭引流技术能够显著促进烧伤患者的创面愈合,减轻感染,提高植皮成功率。