早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

自体刃厚皮加猪脱细胞真皮基质修复头部肉芽创面五例

1 临床资料与治疗方法 2001年10月-2009年1月,笔者单位收治全头皮撕脱伤在外院首次处理失败后转入的肉芽创面患者5例,均为女性,年龄18～35(24±3)岁.其中2例颅骨外露,面积分别为6 cm×3 cm、2 cm×2 cm.术前肉芽创面使用含1 g/L庆大霉素的生理盐水纱布湿敷,术中切除坏死头皮,刮除肉芽创面至有新鲜出血创基,使用5 g/L碘伏冲洗,电凝彻底止血,采用自体刃厚皮+猪ADM支架(启东市东方医学研究所有限公司)复合移植.     

外周血中CD4~-CD8~-T细胞的分离及生物学特性检测

目的分离和培养外周血中CD4-CD8-T细胞,检测其生物学活性。方法应用免疫磁珠法分离CD4-CD8-T细胞,流式细胞仪检测CD4-CD8-T细胞纯度,ELISA法检测CD4-CD8-T细胞分泌的IL-4、IFN-γ含量。结果CD4-CD8-T细胞分离后纯度为82.77%,CD4-CD8-T细胞分泌IFN-γ的量为(159.28±38.16)pg/ml,而IL-4含量未能检测出。结论CD4-CD8-T细胞可分泌IFN-γ,基本不分泌IL-4。     

遗传基因与颅脑创伤预后的研究

随着现代交通工具的发展,颅脑创伤逐年呈增高趋势,目前已成为34岁以下青壮年人群最主要的死亡原因。脑损伤演变过程是复杂的,近年来,关于遗传因素对脑损伤及其预后的影响越来越受医学界重视,关于影响脑外伤预后相关基因的研究也可见报道,现     

重症急性胰腺炎患者实施早期肠内营养的重要性

重症急性胰腺炎(severe actue pancreatitis,SAP)营养支持研究一直存在争议,重症急性胰腺炎是严重营养消耗及分解代谢增加的疾病,营养支持是治疗重症急性胰腺炎的重要环节。肠外、肠内营养治疗是争论焦点,长期以来肠外营养曾一度是标准治疗方法,而肠内营养被认为是禁忌。近年来     

粒细胞巨噬细胞集落刺激因子在创面愈合中的应用进展

粒细胞巨噬细胞集落刺激因子（granulocyte／macmphage colony—stimulating factor，GM—CSF）是近几十年来医学研究的一热门细胞因子。1977年它由Burgess等在鼠的肺条件培养液中首次发现。因能刺激造血前体细胞形成粒细胞巨噬细胞集落．故而得名。1985年，人类GM．CSF基因（human GM—CSF．hGM．CSF）被首次克隆表达．此后重组人GM—CSF（recombinant human GM—CSF，rhGM—CSF）渐应用于临床。GM．CSF有多种功能，可刺激造血前体细胞增殖、分化及促进其向外周转移，又可诱导多种细胞如巨噬细胞、角质细胞等的分化、增殖．并活化、增强其功能。rhGM．CSF已成功应用于多个临床领域，如改善放化疗、严重感染等原因导致的骨髓抑制．增强疫苗的免疫原性，促进创面愈合等     

提高胰腺神经内分泌肿瘤诊断水平的方法分析

胰腺是神经内分泌肿瘤(neuroendocrine neoplasm,NEN)的好发部位,近年来胰腺神经内分泌肿瘤(pancreatic neuroendocrine neoplasms,P-NENs)的发病率呈不断上升趋势[1].P-NENs因其总的发病率低、生物学行为独特、临床表现多样化,常难与具有相同临床症状的其他疾病鉴别,早期确诊难度大,但是部分P-NENs恶性程度低,如能及早确诊、及时治疗,预后较好[2-4].现将提高P-NENs的诊断水平的方法介绍如下.     

腕踝部埋针法治疗急慢性痛症

目的：观察腕踝部埋针24小时治疗疼痛病证的效果。方法：100例疼痛为主诉的患者,随机分为单纯针刺组50例和单纯针刺结合腕踝部埋针组50例。观察两组的疗效。结果：针刺结合埋针组有效率为74％,单纯针刺组有效率为68％,两组比较有统计学意义（P〈0．05）。结论：腕踝部埋针24小时治疗疼痛病证能提高疗效。