湿润烧伤膏治疗压疮的临床疗效观察

目的探讨湿润烧伤膏(MEBO)治疗压疮的临床疗效。方法将60例不同原因导致的压疮患者随机分为治疗组和对照组,每组30例,治疗组创面采用湿润烧伤膏包扎换药治疗,每日2次,对照组创面采用负压封闭引流技术治疗,对比观察两组创面愈合效果。结果治疗组患者创面全部愈合,愈合时间最短为7 d,最长为91 d,对照组患者创面也全部愈合,但其中9例患者采用自体皮移植术封闭创面,愈合时间最短为12 d,最长为108 d,两组患者创面愈合时间经统计学对比,差异具有统计学意义(P0.05)。结论湿润烧伤膏治疗压疮具有疗效显著,方法简便,愈合时间快等优点,值得临床推广应用。     

烧伤创面愈合后瘢痕组织成纤维细胞DNA甲基化初步研究

目的研究探讨烧伤创面愈合后不同时期瘢痕组织中成纤维细胞DNA甲基转移酶1(DNMT1)的表达及意义。方法收集烧伤创面愈合后不同时期的瘢痕组织标本(早期、增生期、消退期、成熟期)和正常皮肤组织标本作为研究对象,采用免疫组织化学方法检测瘢痕组织及正常皮肤组织中成纤维细胞内DNMT1的表达,并比较各组之间的差异;采用RT-PCR技术检测瘢痕组织及正常皮肤组织中成纤维细胞内DNMT1 mRNA的表达,并比较各组之间的差异。结果瘢痕组织形成早期,成纤维细胞内DNMT1的表达水平逐渐升高(免疫组化评分:8.57±1.83),并于增生期达到高峰(10.41±1.58),消退期(7.17±1.19)及成熟期(4.90±0.88)逐步降低,而正常皮肤组织中成纤维细胞的表达呈阴性或弱阳性(0.81±0.87),组间差异具有统计学意义(P=0.000,P0.01);RT-PCR技术检测的:DNMT1 mRNA的表达水平在各组中的差异与免疫组织化学方法的检测结果一致(P=0.000,P0.01)。结论成纤维细胞DNMT1在烧伤创面愈合后瘢痕组织的形成过程中发挥着重要作用,DNA甲基化可能参与了烧伤创面愈合后瘢痕的发展与演变。     

湿润烧伤膏联合创疡贴治疗失禁相关性皮炎的疗效分析

目的探讨湿润烧伤膏联合创疡贴治疗失禁相关性皮炎的临床疗效。方法将2013年10月至2014年8月收治的34例失禁相关性皮炎患者随机分为两组,试验组(17例)采用湿润烧伤膏联合创疡贴治疗,对照组(17例)采用紫草油护理皮肤,观察两组患者皮炎创面的愈合效果及愈合时间。结果试验组治愈14例、好转3例、无效0例,对照组治愈7例、好转5例、无效5例,两组对比,差异具有统计学意义(P0.05);试验组创面平均愈合时间为轻度3.7 d±1.4 d、中度5.9 d±1.5 d、重度7.2 d±0.9 d,对照组创面平均愈合时间为轻度5.9 d±1.2 d、中度8.2 d±1.3 d、重度11.3 d±0.7 d,两组对比,差异具有统计学意义(P0.05)。结论湿润烧伤膏联合创疡贴治疗失禁相关性皮炎疗效显著,愈合时间明显短于紫草油治疗者,值得临床推广。     

美宝创疡贴治疗糖尿病足的疗效体会

目的总结、探讨创疡贴治疗早期糖尿病足溃疡创面的临床疗效。方法2009年1月至2013年5月收治的21例早期糖尿病足患者,除给予调控血糖、控制感染、营养支持等全身治疗外,创面采用创疡贴包扎治疗,每日换药1~2次,观察创面愈合时间和愈合效果。结果21例早划糖尿病足患者创面全部愈合,愈合时间为6~22 d,愈后均无明显瘢痕增生。结论创疡贴治疗早期糖尿病足溃疡创面,可缓解疼痛,预防感染,促进创面愈合,值得临床推广应用。     

MEBT/MEBO联合微粒皮种植治疗Ⅲ度深型烧伤的疗效观察

目的探讨烧伤湿性医疗技术(Moist Exposed Burn Therapy/Moist Exposed Burn Ointment,MEBT/MEBO)联合微粒皮种植治疗Ⅲ度深型烧伤的临床疗效。方法 10例Ⅲ度深型烧伤患者在全身治疗的基础上,采用MEBT/MEBO联合微粒皮种植治疗,观察创面愈合率、愈合时间及愈合质量。结果 10例患者创面均愈合,愈合率为100%,愈合时间为45~140 d,平均愈合时间为78 d,愈后皮肤有轻度瘢痕形成,但无功能障碍和畸形。结论 MEBT/MEBO联合微粒皮种植治疗Ⅲ度深型烧伤创面,操作简便,能有效缩短Ⅲ度深型烧伤创面的愈合时间,提高创面愈合率及愈合质量,疗效显著,值的临床推广应用。     

MEBO治疗慢性难愈性皮肤溃疡的临床疗效观察

目的观察湿润烧伤膏(Moist Exposed Burn Ointment,MEBO)治疗慢性难愈性皮肤溃疡的临床疗效。方法对2010年1月-2014年12月收治的344例慢性难愈性皮肤溃疡患者创面采用"药刀结合"的方法治疗,药即MEBO,刀即外科清创术、植皮术等。患者初诊时尽量清除创面坏死组织,不能耐受一次性清创者行蚕食疗法;清创后创面均匀涂抹MEBO并外敷MEBO药纱包扎治疗,存在潜腔的创面用MEBO药纱填塞引流,待肉芽组织填满创面后行肉芽创面游离植皮术。观察患者创面愈合时间及愈合情况。结果344例患者中除38例患者好转后自动出院,3例患者死于基础疾病外,其余303例患者创面均完全愈合,愈合率达88.1%,创面平均愈合时间为80.4 d±15.8 d。其中,193例患者经MEBO换药治疗后创面自行愈合(56.1%);48例合并趾骨坏死的糖尿病足患者进行了坏死组织剜除术(14.0%);34例骨外露创面进行了钻孔术(9.9%);54例患者进行了肉芽创面植皮术(包括接受趾骨剜除术及骨钻孔术后的创面)。89例烧伤残余创面愈合较快,最短为7 d,最长为29 d,平均愈合时间为18.8 d±4.9 d。结论MEBO可有效控制创面感染,促进坏死组织液化脱落及肉芽组织生长,缩短创面愈合时间,减轻患者疼痛,适时配合"刀法"还可进一步加速坏死组织脱落,促进肉芽组织生长,及时封闭创面,减少瘢痕增生,是治疗慢性难愈性皮肤溃疡的理想方法。     

湿润烧伤膏在皮肤科的临床应用

临床上,皮肤屏障功能受损贯穿于众多皮肤病的病因病理过程之中。而近年来有文献报道,湿润烧伤膏能有效治疗各种皮肤屏障功能异常性皮肤病,其机制可能为湿润烧伤膏对表皮的保湿作用和再生作用能促进皮肤屏障功能的修复。本文就湿润烧伤膏治疗各种皮肤屏障功能受损性皮肤病的研究现状与进展作一综述。     

The use of Suprathel(®) in deep dermal burns: first results of a prospective study

Introduction

While autologous skin grafting has been the standard for coverage of full-thickness areas, several options for deep-partial-thickness defects exist. With regard to economising donor sites, we compared a copolymer based on dl-lactid acid (Suprathel^®) as temporary wound dressing with autologous skin, and analysed time to healing and scar quality in matched areas of deep-partial-thickness burn.

Methods

We recruited 18 patients with a median age of 45 years (range: 25–83 years), for this prospective, non-blinded controlled non-inferiority study, suffering from deep-partial-thickness burns from November 2009 to July 2010. After early tangential excision, matched deep-partial-thickness areas were covered with 1:1.5 meshed autologous skin grafts and the copolymer for direct intra-individual comparison. Scars were evaluated by means of the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS) and suction cutometry (MPA 580, Courage and Khazaka Electronic GmbH, Cologne, Germany) on days 30 and 90, postoperatively.

Results

Fifteen days after surgery, complete wound closure was present in 44.4% (8/18) of all areas covered with copolymer and 88.9% (16/18) in the split-thickness skin graft (STSG) area (p = 0.008). Evaluation of the total VSS, POSAS and cutometry satisfied the criterion of non-inferiority for Suprathel^® on day 30. Ninety days after surgery, only the Observer Scar Scale showed that Suprathel is non-inferior to STSG, albeit the mean total VSS and Patient Scar Scale were better in Suprathel^® areas.

Conclusion

Suprathel^® represents a solid, reliable epidermal skin substitute with longer healing times in comparison to skin grafts but comparable results concerning early scar formation. Suprathel^® can serve as a tool in treatment portfolio for adult patients suffering from deep dermal burns. Especially in patients with extensive burns, Suprathel^® can be used to cover the deep dermal burn wounds to save STSGs and its donor sites for the coverage of full-thickness burned areas.     

A review on static splinting therapy to prevent burn scar contracture: Do clinical and experimental data warrant its clinical application?

Background

Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar contractures in the early phase of wound healing. However, scar contractures are still a common complication. In this article we review the information concerning the incidence of scar contracture, the effectiveness of static splinting therapy in preventing scar contractures, and specifically focus on the – possible – working mechanism of static-splinting, i.e. mechanical load, at the cellular and molecular level of the healing burn wound.

Method

A literature search was done including Pubmed, Cochrane library, CINAHL and PEDRO.

Results

Incidence of scar contracture in patients with burns varied from 5% to 40%. No strong evidence for the effectiveness of static splinting therapy in preventing scar contracture was found, whereas in vitro and animal studies demonstrated that mechanical tension will stimulate the myofibroblast activity, resulting in the synthesis of new extracellular matrix and the maintenance of their contractile activity.

Conclusion

The effect of mechanical tension on the wound healing process suggests that static splinting therapy may counteract its own purpose. This review stresses the need for randomised controlled clinical trials to establish if static splinting to prevent contractures is a well-considered intervention or just wishful thinking.     

复黄生肌愈创油膏对糖尿病大鼠创面肉芽组织中TGF—β1与smad3、smad7 mRNA

目的：探讨复黄生肌愈创油膏（简称复黄膏）对糖尿病创面愈合的促进作用及可能的作用机制。方法：将雄性Wistar大鼠随机分为正常创面对照组、糖尿病模型组、复黄膏治疗组。制备糖尿病合并皮肤创面模型,模型组给予生理盐水纱布外敷,治疗组给予复黄膏外敷,1次／d。造模后分别于第3天和第11天分批处死动物,采用实时荧光定量PCR技术,观察不同时段创面中TGF-β1与smad3、smad7 mRNA含量变化。结果：在创面修复的第3天,治疗组TGF—β1、smad3 mRNA表达均明显高于模型组（P〈0．05）,且与正常组比较无统计学差异;第11天,治疗组TGF-β1、smad3 mRNA表达均明显低于正常组（P〈0．05）,但与模型组比较无统计学差异。第3天时,smad7含量各组比较无统计学差异;而第11天时,治疗组明显高于模型组（P〈0．05）,虽然与正常组比较无统计学差异,但药物干预组smad7 mRNA含量高于正常组。结论：复黄生肌愈创油膏在糖尿病溃疡创面愈合过程中可能动态调节smad3、smad7及TGF—β1 mRNA的表达,从而起到促进创面愈合的作用,同时可一定程度上减少瘢痕形成。