人纤维蛋白胶对供皮区创面的止血与修复作用

目的　探讨局部应用人纤维蛋白胶 (FS)对中厚供皮区创面的止血和修复作用。方法　选择 30例、90个创面为研究对象 ,分自然止血法组、凝血酶止血组以及FS组 ,均选择自体相应部位、相似深度创面进行对照。分别观察各组间创面的止血时间和术后创面完全愈合时间。结果　FS组的平均止血时间比自然止血组和凝血酶止血组分别缩短 36秒与 13秒 (P <0 .0 1) ;FS组创面完全愈合时间为 (12 .1± 2 .32 )天 ,自然止血组和凝血酶止血组创面完全愈合时间分别为 (19.8± 3.86 )天与 (19.2± 3.6 5 )天 ,前者与后两者相比 ,创面愈合时间明显提前 (P <0 .0 1)。结论　FS对中厚供皮区创面有明显的止血作用 ,并能促进创面提前愈合和预防创面感染。     

大鼠烫伤创面感染模型的研制

Objective To reproduce a reliable rat model of burn with infection for the study of prevention and treatment of infected wound. Methods ( 1 ) Electrical burn producing apparatus equipped with constant temperature (80 ℃ ) and pressure (0.5 kg) was used to reproduce burn injury (with area of 4.5 cm2 ) on both sides of the back in 50 SD rats for different duration (4, 6, 8, 10, 12 s) , with 10 rats for each burn duration. On post burn day (PBD) 1, gross condition of wounds was observed with naked eyes.Wounds on the left side were used to observe healing time. The wounds on the right side were used for histological observation to determine the depth of injury, and they were classified into superficial and deep partialthickness injury. (2) Another 36 SD rats were divided into A (inflicted with superficial partial-thickness burn, n = 18) and B (inflicted with deep partial-thickness burn, n = 18) groups according to the random number table. Rats in both groups were treated in accordance with method of preliminary experiment. Immediately after burn, 0. 1 mL of liquid containing 1 × 109, 1 × 107, 1 × 105 CFU Pseudomonas aeruginosa (PA) ATCC 27853 was respectively inoculated to the wounds on one side (with 6 rats for each amount) ,while the wounds on the other side were treated with the same volume of normal saline as control. Inflammatory reaction of wounds was examined with HE staining on post inoculation day (PID) 1. On PID 1, 2, 3,5, 7, and 14, the number of subeschar bacteria was respectively counted and the bacteria were identified with Gram stain and biochemical reaction. Wound healing time was recorded. Data were processed with t test. Results (1) Burn for 6, 8 s was respectively identified as injury time resulting in superficial or deep partial-thickness injury according to histological observation and wound healing time. (2) Obvious inflammatory cell infiltration was observed in the wounds in B group which were inoculated with 1 × 107 , 1 ×109 CFU PA, and the infiltration was less marked in A group with inoculation of 1 × 109 CFU PA. (3) The bacteria isolated from wounds of A and B groups was identified as PA. The subeschar bacteria count within PID 14 in A group, in which different amount of PA was inoculated, was mostly less than 1 × 105 CFU/g of tissue, while that in B group in which 1 × 109 CFU PA was inoculated was more than 1 × 105 CFU/g of tissue. (4) There was no obvious difference in wound healing time between wounds inoculated with different amount of PA and wounds treated with normal saline in A group ( with t value respectively 1.26, 0. 29, 1.07,P values all above 0.05 ). Wound healing time of wounds in B group, in which 1 × 109 CFU PA was inoculated, was longer as compared with that treated with normal saline [(22.5 + 1.0) d vs. ( 19.4 + 1.6) d, t =2.73, P ＜0. 05]. Conclusions In rat, deep partial-thickness burn wound inoculated with 1 × 109 CFU PA ATCC 27853 is a reliable model with high reproducibility for the study of infection of burn wound.     

大面积烧伤患者微粒皮移植术后异体皮占位三例

微粒皮移植术已广泛应用于大面积深度烧伤的治疗.为了有利于所移植自体微粒皮在创面的成活、生长及扩展,常需应用异体(种)皮覆盖以保证治疗效果.优良的异体皮是烧伤创面自体微粒皮移植后较佳覆盖物,但移植后的免疫排斥反应往往使异体皮在短时间内被排斥,使微粒皮失去良好的生长微环境,从而导致手术失败[1].另一方面,临床上又常因所移植异体皮生长良好出现占位现象,导致微粒皮生长欠佳,难以达到预期效果.2007年8月-2008年8月,我们已发现3例占位病例,现报告如下.     

Role of Lipid Peroxidation in Bacterial Translocation from the Small Intestine after Thermal Injury in Rats

Oxygen-derived free radicals have bran proved to play a role in the intestinalmucosa damage induced by ischemic reperfusion after burns,but their role in thebacterial translocation from the intestine to other organs is not documented so far.Theauthors intended to investigate this problem on 186rats,which were randomized into 5groups:the normal control group,the group receiving oral Pseudomonas,the group ofsimple burn injury,and the groups of combined oral Pseudomonas and burn injury withor without superoxide dismutase(SOD)treatment.The burn injury was 30% TBSA fullthickness scalding.The oral administered Pseudomonas was labdled with isothiocyanatefor tracing.The animals were killed in the 4th,12th,24th,48th,or 72nd hour afterinjury respectively.The changes of malondialdehyde(MDA)in the ilcal mucosa were ob-served with optical and electron microscope,and bacterial translocation from the intes-tine to the liver and blood stream was traced .The animals with combined injury and simple burns showed a marked increase ofileal mucosal MDA with the peak in the 12th hour accompanied with intense pathologicalchanges in the small intestine;the incidence of bacterial translocation from the intestineto other organs also increased.With SOD treatment,the MDA levd in the ileal mucosawas significantly lower,the pathological changes in the intestinal mucosa were allevia-ted,and the incidence of bacterial translocation from the intestine was lowered with nolabdled Pseudomonas isolated from the blood stream.In this study,it was demonstrated that free radicals are one of the factors ofintestinal mucosal damage and bacterial translocation from the intestine after burns,andSOD could protect the intestinal mucosal barrier from being injured and inhibit thebacterial translocation from the intestine.     

6例特重度高压热蒸汽烫伤病员病例救治报告

目的 对6名同时因高温硅水溅入水中所产生蒸汽烫伤特重度烧伤病员的基本情况进行分析，以探讨大面积烧伤救治的有效措施。方法 对6例病员的一般情况、烧伤面积、手术时间、手术面积，细菌学检查，治疗结果，死亡时间、死亡原因加以分析。结果 本类高压热蒸汽烫伤患者全身感染，呼吸功能障碍占首位，死亡患者均死于严重感染和多器官功能衰竭。结论 加强烧伤救治网络的完善，早期正确处理、转运，吸入伤的治疗，早期切痂封闭创面，营养及脏器功能支持，有效控制感染等综合措施，能明显增加延长患者存活时间，增加其救治成功机会。     

HPLC法测定烧伤患者透析排出液中去甲万古霉素的含量

目的　测定连续肾替代治疗的烧伤患者肾脏透析排出液中去甲万古霉素的含量。方法　采用HPLC法 ,色谱条件 :μBondapak -C18柱 ,流动相乙腈 -磷酸二氢钾 (0 .0 5mol·L-1) (9∶91,v/v) ,流速 1.4ml/min ,检测波长 2 36nm。结果　本法在 1～10 0 μg·ml-1的范围内线性关系良好 ,r =0 .9999。日内、日间精密度的RSD <2 % ,平均回收率 99.6 5 %。结论　本法简便、快速、可靠     

伊米配能在烧伤病人体内的药代动力学研究

目的：研究伊米配能／西司他丁在烧伤病人中的药代动力学特点。方法：通过高效液相色谱分析技术测定6例烧伤急性期病人（APP组）和9例高代谢期病人（HPP组）首剂和稳态的血浆中伊米配能浓度,计算药代动力学参数;另选10名健康志愿者为对照组（C组）。结果：同C组相比,APP组的半衰期明显延长（P＜0．01）、分布容积增大（P＜0．05）,HPP组分布速率加快（P＜0．05）;两组病人比较,APP组较HPP组半衰期明显延长（P＜0．01）、分布容积增大（P＜0．05）;各组内首剂和稳态的药代动力学参数改变不明显（P＞0．05）。结论：伊米配能在APP组体内的药代动力学明显不同,提示急性期用负荷剂量的伊米配能时应延长用药间隔时间。     

热休克蛋白与抗感染免疫

热休克蛋白(heatshockproteins,HSPs)又称为应激蛋白,由多基因家族及相关基因产物诱导产生,参与高度保守的细胞防御机制.作为细胞内分子,HSPs参与蛋白成熟必要的生化途径,对于正常细胞自稳状态的维持起重要作用.除上述分子伴侣功能外,HSPs还具有另一种重要的生物特性--免疫原性.在感染引起的免疫性疾病的发生和发展中,HSPs具有防止感染应激引起的细胞损害和促进受损细胞恢复等重要作用.作为感染过程中体液和细胞免疫的重要靶目标,HSPs用于感染性疾病的疫苗研究日益受到人们的关注.     

CCR7基因修饰未成熟树突状细胞诱导小鼠皮肤移植免疫耐受的研究

目的 研究CCR7基因重组腺病毒体外转染未成熟树突状细胞(imDCs)对小鼠同种异体皮肤移植免疫耐受的影响.方法 小鼠骨髓细胞经梯度离心及rmIL-4、rmGM-CSF诱导培养未成熟树突状细胞;CCR7重组腺病毒经增强离心法转染未成熟树突状细胞;体外观察转染细胞混合淋巴细胞反应;取CCR7修饰imDCs于皮肤移植前2d、移植后第5天,经腹部注入受体小鼠,观察皮肤移植物存活时间和病理变化.结果 CCR7基因成功转染入imDCs;腺病毒转染后imDCs刺激T细胞增殖的能力较imDCs组增强但弱于mDCs组,IL-10可以明显降低刺激能力;CCR7腺病毒转染组皮肤存活时间长于转染前,IL-10能显著延长皮肤存活时间.结论 CCR7重组腺病毒转染imDCs后,imDCs刺激T细胞增殖的能力部分增强,皮肤移植物存活时间明显延长.     

烧伤患者真菌感染分析

目的 了解烧伤患者真菌感染情况.方法 2003年1月-2006年12月,笔者单位共收治3909例烧伤患者.根据临床表现,对其中怀疑有真菌感染的467例患者,采集血液、痰液、气道灌洗液、动静脉导管、尿管、尿液、大便、创面分泌物等标本2271份,行真菌培养、鉴定及药物敏感试验.1例患者多个标本培养结果为同一真菌时计为1个阳性标本.并以创面分泌物、大便、尿液、痰液及气道灌洗液、动静脉导管或尿管、血液标本为升序,仅计最高级别标本为阳性;如同时查出2种以上不同真菌时,按不同标本计算.结果 在送检的2271份标本中,有61份标本真菌培养阳性,阳性率2.69%.3909例患者中有36例(38份阳性标本)发生真菌感染,总阳性病例发生率为0.92%.36例真菌培养阳性患者中烧伤面积大于80%TBSA 18例,50%～79%TBSA 12例,30%～49%TBSA 4例,小于30%TBSA 2例.其真菌培养阳性时间为:烧伤后1周内发生2例,第2周发生6例,第3周发生16例,3周后发生12例.在36例真菌感染患者中有8例死亡,病死率为22.22%.在38份阳性标本中,培养检出最多的为热带假丝酵母菌及白色念珠菌.所检出的真菌除光滑球样酵母菌耐药较严重外,其他真菌对多数抗真菌药物如两性霉素B、氟康唑、伊曲康唑等敏感.念珠球样酵母菌对所有药物敏感,热带假丝酵母菌对氟康唑、酮康唑、5-氟胞嘧啶等敏感性较好.结论 烧伤患者常有真菌感染,当临床怀疑有真菌感染时,应进一步检查确诊,并尽早开始抗真菌治疗.