烫伤后IL-6和IL-1α对大鼠外周血中性粒细胞凋亡的影响

目的:研究严重烫伤后血IL-6和IL-1α对中性粒细胞(PMN)凋亡的影响。方法:复制30%体表面积Ⅲ度烫伤大鼠模型;分离PMN,TUNEL荧光标记,流式细胞仪分析细胞凋亡;PMNcaspase3活性以荧光免疫吸附酶法测定;血清IL-6和IL-1α水平以酶联免疫法测定。结果:血清IL-6水平(μg/L)在伤后各组(3、6、12、24、48h依次分别为9.14±1.16、12.49±1.14、3.01±0.75、1.41±0.28和1.56±0.43)和IL-1α水平(ng/L)在伤后3、6、12h组(90.08±8.39、320.93±14.48和47.84±5.19)均分别显著高于伤前对照组IL-6(0.24±0.07)和IL-1α(27.65±4.86)水平(P<0.05);伤后各组PMN凋亡率(%)按时点依次为9.89±2.00、4.98±1.35、1.31±0.72、2.49±1.87和6.88±1.13显著少于伤前组13.66±3.88(P<0.05);PMNcaspase-3的活性测定结果与PMN的凋亡表现相一致。结论:大鼠烫伤后外周血PMN凋亡明显延迟;IL-6和IL-1α等细胞因子是重要的影响因素,减少细胞内caspase-3的激活可能是其机制之一。     

去甲肾上腺素诱导严重烧伤大鼠脑组织VEGF表达的实验研究

目的：观察去甲肾上腺素（NE）诱导严重烧 伤后24h大鼠脑组织血管内皮细胞生长因子(VEGF)的表达变化。方法:(1 )采用40%全身总体表面积（TBSA）Ⅲ°烧伤大鼠模型，用干、湿重法检测NE刺激烧伤24h大 鼠脑组织含水量；(2)用高效液相色谱法，检测烧伤大鼠脑组织去甲肾上腺素活性水平的变 化;(3) 用免疫蛋白印迹法（Western blotting）检测NE诱导脑组织VEGF蛋白表达变化。 结果：(1) 烧伤大鼠和NE刺激后的烧伤大鼠脑组织水肿明显；(2)烧伤后2 4 h大鼠脑组织NE活性增加，而NE刺激后的烧伤大鼠，脑组织NE的活性增加显著;(3) NE刺 激剂量增大时，脑组织VEGF的蛋白表达逐渐增加，烧伤后VEGF的蛋白表达增加明显，随NE刺 激剂量增大，烧伤后VEGF的蛋白表达明显增强。结论:NE可诱导严重烧 伤大鼠脑组织VEGF的蛋白表达，提示烧伤后NE水平增高是脑水肿形成的一个重要因素。     

Immune deficiency following thermal trauma is associated with apoptotic cell death

Thermal injury-associated specific immune deficiency occurs despite indicators of systemic activation of the lymphoid compartment. We investigated the possibility that postburn immune failure and T cell activation are causally related through activation-induced (apoptotic) cell death. The relationship between the cellular immune response and cell mortality was examined in cultures of peripheral blood mononuclear cells (PBMC) from 14 immunosuppressed patients with extensive burns (35–90% total body surface area). Impaired cellular immunity coincided with significantly reduced cell viability as ascertained by propidium iodide staining and dye reduction assays. Following stimulation with the mitogenic lectin, phytohemagglutinin (PHA), the majority of DNA in patient cultures was fragmented, suggesting the occurrence of apoptotic cell death. Even without stimulation a portion of patient cells was apoptotic as indicated by oligonucleosomal bands on agarose gel electrophoresis. Exogenous interleukin-2 or phorbol ester markedly reduced constitutive as well as PHAinduced DNA fragmentation.In situ demonstration of DNA strand breaks in freshly isolated patient PBMC, by a TdT-based labeling technique, confirmed that a larger fraction (up to 60%) of circulating lymphocytes was undergoing apoptosis on the periphery. These novel observations suggest that apoptosis may play a major role in thermal injury-related cellular immunodeficiency.     

碱性成纤维细胞生长因子在治疗吸入性损伤中的疗效观察

目的：观察碱性成纤维细胞生长因子（BFGF）对吸入性损伤后气道粘膜及肺泡上皮的修复作用。方法：依据纤支镜结果将中、重度吸入性损伤分别随机分为BFGF治疗组与对照组。在相应时段进行纤支镜支气管肺泡灌洗术,摄像记录纤支镜所见及检测支气管肺泡灌洗液（BALF）中蛋白质含量、胶体渗透压（COP）与细胞分类计数。结果：在中、重度吸入性损伤中,其气道修复时间BFGF治疗组比对照组平均提前4．5天与3．3天;发生出血、气管支气管狭窄等并发症的机率平均降低64．65及31．9％。BFGF治疗组的BALF中总蛋白（TP）、白蛋白（ALb）、COP以及细胞总数、中性粒细胞、淋巴细胞数量均比对照组明显降低（P＜0．05）。结论：BFGF治疗中、重度吸入性损伤,能促进气道粘膜及肺泡上皮的修复。     

板层角膜移植联合球结膜唇粘膜移植治疗烧伤重症睑球粘连

目的 观察角膜移植治疗烧伤后睑球粘连的效果。方法 应用板层角膜移植联合自体球结膜、唇粘膜移植术治疗28例（29眼）重症睑球粘连,将角结膜假性胬肉分离至穹窿部,保留板层角膜及胬肉上皮层并反转作为睑结膜或移植粘膜作为睑膜,用新鲜板层角膜作供体更替浑浊角膜,用同侧或对侧眼球结膜修补巩膜表面结膜创面。结果 一次手术者25眼,二次手术3眼,三次手术1眼,治愈20眼,明显好转6眼,复发3眼。结论 板层角膜移植联合球结膜、唇粘膜 后重症睑球粘连是一种良好的手术方法。     

Analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds

BackgroundThe aim of this study was to assess the analgesic efficacy of sufentanil in dressings after surgical treatment of burn wounds.Patients and methodsTwenty adult patients, who underwent surgical treatment of third–degree burn wounds under general anesthesia, were included. Two of the patients underwent surgery twice. During surgery, patients received 50–100 μg fentanyl every 20–30 min and, after surgery, patients received 100 mg ketoprofen twice daily. Additionally, ten patients (group 1) received 50 μg sufentanil added to the burn wound dressings soaked in octenidine and phenoxyethanol while 10 patients (group 2) received 25 μg sufentanil added to the same dressings. The rescue analgesic, which was administered when pain intensified, was 5 mg subcutaneous morphine. Plasma sufentanil concentrations were assayed at 1, 2, 3, and 6 h after surgery completion and when pain was reported, along with pain intensity evaluation.ResultsSufentanil was not detected in the serum of any patients. Rescue morphine was given during the postoperative period (24 h) in one patient in group 1 (who underwent surgery twice) and three patients in group 2. The mean sufentanil concentration in dressings was higher in group 1 (0.13 ± 0.03) than group 2 (0.06 ± 0.03 μg/mL; p < 0.001). The group 1 patient who received rescue morphine had a sufentanil concentration of 0.10 μg/mL, which was the lowest concentration in group 1. Group 2 patients who received rescue morphine had sufentanil concentrations of at least two–fold lower (0.03–0.05 μg/mL). No adverse effects were observed.ConclusionsSufentanil in dressings after burn wound surgery provides effective and safe analgesia and the sufentanil concentration in dressings should be ≥0.10 μg/mL in a solution of octenidine and phenoxyethanol.     

The implementation of an infection control bundle within a Total Care Burns Unit

AimTo evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit.BackgroundBurn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them.MethodsAn interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice.ResultsDuring the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013.ConclusionThe implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.     

Trends in burn injury mortality in Spain (1979–2018): Sex-specific age-cohort-period effects

BackgroundPrevious studies about burns mortality are often exclusively based on hospital and burn centre data. National population-based reports on this topic are rather limited. The aim of this study was to analyse sex- and age-specific mortality rates of burns in Spain during the period 1979–2018.MethodsAge-standardised burns mortality rates were calculated from death records and mid-year population data were provided by the Spanish National Statistics Institute. Joinpoint regression analyses were used to identify significant points of change in trends over time and to compute average annual per cent change (AAPC). Age, period and cohort effects were also analysed.ResultsMortality due to burn injury decreased in both sexes between 1979 and 2018: from the first quinquennium of this period up to the last one age-adjusted mortality rates decreased from 1.37 to 0.49 per 100,000 in men and from 0.96 to 0.26 per 100,000 in women.ConclusionsBurns mortality rates in Spain have been decreasing during the last decades. Promotion of primary prevention measures should continue.