颌面部中、小手术后负压引流的应用

目的 探讨颌面部中、小手术后合理有效的创腔引流方式.方法 将80例颌面部中、小手术患者随机平均分为橡皮条引流组(A组)和负压引流组(B组),每组40例,观察术后创腔积液、血肿、感染等并发症发生情况,记录B组术后引流量,分析比较两种引流方式对患者术后外观和护理影响.结果 B组术后第1天引流量占总引流量的83.57％,第2～3天占16.43％.A组患者术后创面敷料渗透,甚至渗透患者衣物,而B组术后创面清洁,便于术后护理.两组患者术后创面渗出量及并发症发生情况经统计学分析无明显差异.结论 颌面部中、小手术术后应用负压引流比橡皮条引流具有保持创面清洁、操作简便等优点.     

重组人酸性成纤维细胞生长因子（rh-aFGF）在激光治疗创面修复的效果评价

目的：对应用重组人酸性成纤维细胞生长因子(rh-aFGF)对接受激光治疗的患者实施创面修复治疗的临床效果进行研究。方法抽取该院于2013年11月-2014年11月收治的激光治疗患者82例,以就诊时间先后顺序分成对照组与治疗组,对照组采取百多邦与红霉素联合方式,观察组采取rh-aFGF方式,而后对这两组患者的治疗效果进行对比分析。结果治疗组患者创面愈合时间（5.10±1.67）d、创面皮肤外观复常时间（35.48±4.26）d、创面修复治疗计划实施总时间（10.32±3.65）d明显短于对照组(8.69±2.44）、（46.93±5.67）、（13.28±3.41）d;激光治疗创面修复治疗效果(总有效率92.7%)明显优于对照组（总有效率70.7%）;创面修复治疗期间出现水肿、渗出、红斑及疼痛灼烧的人数明显少于对照组。结论应用重组人酸性成纤维细胞生长因子(rh-aFGF)对接受激光治疗的患者实施创面修复治疗的临床效果非常明显。     

中药治疗糖尿病难愈性创面愈合的研究进展

摘 要 难愈性创面是糖尿病的常见并发症,目前糖尿病难愈性创面及其治疗手段引起人们的广泛关注。本文就中药对糖尿病创面愈合的影响从促进成纤维细胞的增殖、促进肉芽组织生成、增加生长因子分泌、减少创面瘢痕及临床研究等方面进行了系统综述,以期为中药治疗难愈性创面愈合提供科学依据。     

生肌化瘀方不同溶剂提取物对大鼠深Ⅱ度烧伤创面的治疗作用

目的：：探讨生肌化瘀方不同溶剂提取部位对伤口愈合的影响,阐明其在深II度烧伤创面愈合过程中所起的重要作用。方法：大鼠随机分成6组(每组10只)：空白组(生理盐水组)、阳性对照组(积雪草苷组)、生肌化瘀方石油醚、氯仿、乙酸乙酯和正丁醇提取物组。将生肌化瘀方不同溶剂提取部位应用于大鼠背部深Ⅱ度烫伤模型,通过不同时间点创面愈合情况、计算机图像分析,活检标本的细胞DNA周期分析及创面组织病理切片等方法观察了上皮愈合的情况。结果：生肌化瘀方氯仿部位创面平均愈合时间为(15.67±1.12)d,空白组为(22.87±1.01)d(P<0.01);氯仿部位创面羟脯氨酸及S期细胞百分比明显高于对照组(P<0.01)。结论：生肌化瘀方氯仿提取部位有明显的促进创面愈合的作用,为主要活性部位。     

Episiotomy healing assessment: Redness,Oedema, Ecchymosis,Discharge, Approximation (REEDA) scale reliability

OBJECTIVE:

to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy.

METHOD:

observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale.

RESULTS:

the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators.

CONCLUSION:

the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process.     

火器伤合并海水浸泡后的愈合过程观察

目的:建立大鼠肢体火器伤合并海水浸泡模型,观察伤后愈合过程并分析影响愈合因素。方法:利用小型点爆源制造小鼠肢体火器伤模型,随机选取20只雄性Wistar大鼠,分为对照组及实验组,每组10只。制造肢体火器伤模型后对照组不浸泡,实验组伤后海水浸泡30min。观察记录伤后愈合过程,检测愈合过程中愈合时间、伤口面积、体重等指标变化及伤口愈合后的病理形态。结果:实验组伤口愈合时间较对照组晚;伤后相同时间点两组伤口面积存在差异;实验组创后早期显著体重下降,晚期体重平均增加量显著低于对照组;实验组伤口愈合后真皮层及皮下存在特殊病理学变化。结论:与单纯火器伤相比,火器伤合并海水浸泡可导致伤口延迟愈合。     

碱性成纤维细胞生长因子对皮肤软组织撕脱伤创面修复效果及肝肾功能影响

目的:观察碱性成纤维细胞生长因子(basic fibroblastic growth factor,bFGF)与常规换药对皮肤软组织撕脱伤创面的修复效果以及肝肾功能的影响.方法:临床纳入皮肤软组织撕脱伤患者70例,根据临床治疗方案的不同分为研究组与对照组,研究组给予bFGF药液喷雾剂喷洒后纱布覆盖,对照给予生理盐水清理常规换药.观察两组患者的创面愈合率、创面炎症反应等,同时观察治疗前后两组患者肝肾功能的变化.结果:研究组术后3、5、7d创面愈合率分别为(29.1±12.9)％、(61.4±18.7)％、(96.3±7.0)％,对照组分别为(19.9±12.1)％、(41.2±17.5)％、(71.6±22.1)％,差异均有统计学意义(P＜0.05);研究组治疗后3、5、7d创面炎症评分分别为(1.62±0.34)、(1.24±0.30)、(0.99±0.29)分,对照组分别为(1.86±0.48)、(1.82±0.45)、(1.60±0.39)分,差异均有统计学意义(P＜0.05);治疗后,两组患者肝肾功能指标未见异常,差异无统计学意义(P＞0.05).结论:bFGF治疗皮肤软组织撕脱伤具有较好的临床效果,能够促进创面的修复,减轻炎症反应,且安全性较高,值得推广.     

Inhalable tranexamic acid for haemoptysis treatment

PurposeAn inhalable dry powder formulation of tranexamic acid (TA) was developed and tested in a novel high-dose Orbital® multi-breath inhaler. The formulation was specifically intended for the treatment of pulmonary haemorrhage and wound healing associated with haemoptysis.MethodsInhalable TA particles were prepared by spray drying and the powder characterised using laser diffraction, electron microscopy, thermal analysis, moisture sorption and X-ray powder diffraction. The aerosol performance was evaluated using cascade impaction and inline laser diffraction and interaction with epithelia cells and wound healing capacity investigated using Calu-3 air interface model.ResultsThe spray dried TA particles were crystalline and spherical with a D_0.5 of 3.35 μm. The powders were stable and had limited moisture sorption (0.307% w/w at 90% RH). The Orbital device delivered ca. 38 mg powder per ‘inhalation’ at 60 l · min⁻¹ across four sequential shots with an overall fine particle fraction (⩽6.4 μm) of 59.3 ± 3.5% based on the emitted mass of ca. 150 mg. The TA particles were well tolerated by Calu-3 bronchial epithelia cells across a wide range of doses (from 1 nM to 10 nM) and no increase in inflammatory mediators was observed after deposition of the particles (a decrease in IL-1β, IL-8 and INFγ was observed). Time lapse microscopy of a damaged confluent epithelia indicated that wound closure was significantly greater in TA treated cells compared to control.ConclusionA stable, high performance aerosol of TA has been developed in a multi-breath DPI device that can be used for the treatment of pulmonary lesions and haemoptysis.     

抗菌薇乔缝线在预防胃肠急诊手术切口感染中的应用研究

目的探讨抗菌薇乔缝线在胃肠急诊外科手术切口感染预防中的作用,为减少胃肠急诊手术治疗切口感染提供参考。方法选取2010年1月-2014年1月收治的160例胃肠急诊手术患者作为观察对象,根据住院号随机分为观察组和对照组,每组各80例,观察组采用抗菌薇乔缝线缝合,对照组采用传统丝线缝合,比较影响两组患者切口愈合的危险因素及切口感染率。结果术后3~20d,观察组切口感染2例,感染率2.50%,对照组切口感染9例,感染率11.25%,观察组切口感染率明显低于对照组,差异有统计学意义(P<0.05);Ⅲ类切口的感染率观察组为1.25%、对照组为8.75%,差异有统计学意义(P<0.05),Ⅱ类切口感染率两组比较,差异无统计学意义;患者手术时间>120 min的感染率观察组为1.25%、对照组则为10.00%,差异有统计学意义(P<0.05),<120min时,两组患者切口感染率差异无统计学意义。结论抗菌薇乔缝线与普通缝线相比,可降低手术时间≥120min和Ⅲ类切口胃肠急诊手术患者的切口感染率。     

湿润烧伤膏在肛肠术后的应用现状及机制探讨

【摘要】 随着人们生活水平的提高以及饮食习惯的改变, 肛肠疾病的发病率呈逐年上升趋势。手术是肛肠 疾病最常用的治疗手段, 但肛门周围神经及血运丰富、细菌含量较高, 术后切口易伴随剧烈疼痛以及诱发创面感染等而延缓切口愈合。近年来大量临床研究证实, 湿润烧伤膏能够有效缓解混合痔、肛裂、肛周脓肿以及肛瘘等肛肠疾病术后创面疼痛, 促进创面愈合, 提高患者预后, 疗效显著。该文主要针对湿润烧伤膏在肛肠术后的应用现状及作用机制进行综述, 以期为湿润烧伤膏在肛肠术后创面的临床应用提供理论依据。