额部皮瓣和上臂皮瓣移植修复鼻缺损

目的:观察额部扩张皮瓣和上臂带蒂皮瓣在鼻缺损修复中的应用效果。方法:选择1990-09/2005-09中南大学湘雅医院整形烧伤整形外科收治的鼻缺损患者24例,均知情同意。采用额部扩张皮瓣修复12例,主要为全鼻缺损和鼻大部分缺损;上臂带蒂皮瓣修复12例,主要为鼻下段鼻翼、鼻小柱缺损,其中一期皮管成形同时转移修复较小范围鼻下段鼻翼、鼻小柱缺损4例。术后定期随访,观察皮瓣成活情况、鼻修复后外形、鼻部皮肤颜色与质地及供区瘢痕情况。结果:鼻缺损患者24例全部进入结果分析,无脱落。随访3个月至两年,其中3-6个月8例,6个月至1年10例,1-2年6例。皮瓣全部成活,修复效果基本满意。额部扩张皮瓣修复者鼻部质地、颜色优于上臂带蒂皮瓣,上臂带蒂皮瓣修复者供区瘢痕较隐蔽。结论:额部扩张皮瓣和上臂带蒂皮瓣对鼻缺损患者的修复效果基本满意。     

金黄色葡萄球菌侵袭烫伤家兔致淋巴细胞蛋白质组的变化

Objective To study the proteomic change in Iymphocytes of rabbits with scald injury and Staphylococcus aureus (SA) invasion. Methods Twenty-four rabbits were divided into four groups as follows: control group, scald group, scald with SA invasion 2 hs group, and scald with SA invasion 6 hs group, according to random number table, with 6 rabbits in each group. Except for rabbits in control group (sham scald at 37 ℃ ) , rabbits in the other 3 groups were subjected to 30% TBSA full-thickness scald. Rabbits in SA invasion 2 and 6 hs groups were injected with 2 mL (1.0×108 CFU/mL) SA suspension, which was in the log growth phase, via auricle vein 18 hs and 22 hs after injury. Whole blood samples were collected from carotid artery of rabbits in 4 groups 24 hs after scald. Lymphocytes were isolated and its ex-tracted proteins were analyzed by two-dimensional gel electrophoresis coupled with mass spectroscopy. Re-suits About 1030 protein spots of lymphocytes were detected in each group. Compared with that of control group, 19 protein spots were found to be differentially expressed in the other 3 groups, and 11 spots (10 pro-teins) were identified. Expression levels of cofilin, cyclophilin A, ubiquitin, nucleoside diphosphate ki-nase, glutamate dehydrogenase and annexin 1 were down-regulated, but expression level of peroxiredoxin was up-regulated obviously. Conclusions There is obvious proteornic change in lymphocytes of scalded rabbits or of scalded rabbits invaded by SA, and it may relate to immune suppression and sepsis after injury.     

金黄色葡萄球菌侵袭烫伤家兔致淋巴细胞蛋白质组的变化

Objective To study the proteomic change in Iymphocytes of rabbits with scald injury and Staphylococcus aureus (SA) invasion. Methods Twenty-four rabbits were divided into four groups as follows: control group, scald group, scald with SA invasion 2 hs group, and scald with SA invasion 6 hs group, according to random number table, with 6 rabbits in each group. Except for rabbits in control group (sham scald at 37 ℃ ) , rabbits in the other 3 groups were subjected to 30% TBSA full-thickness scald. Rabbits in SA invasion 2 and 6 hs groups were injected with 2 mL (1.0×108 CFU/mL) SA suspension, which was in the log growth phase, via auricle vein 18 hs and 22 hs after injury. Whole blood samples were collected from carotid artery of rabbits in 4 groups 24 hs after scald. Lymphocytes were isolated and its ex-tracted proteins were analyzed by two-dimensional gel electrophoresis coupled with mass spectroscopy. Re-suits About 1030 protein spots of lymphocytes were detected in each group. Compared with that of control group, 19 protein spots were found to be differentially expressed in the other 3 groups, and 11 spots (10 pro-teins) were identified. Expression levels of cofilin, cyclophilin A, ubiquitin, nucleoside diphosphate ki-nase, glutamate dehydrogenase and annexin 1 were down-regulated, but expression level of peroxiredoxin was up-regulated obviously. Conclusions There is obvious proteornic change in lymphocytes of scalded rabbits or of scalded rabbits invaded by SA, and it may relate to immune suppression and sepsis after injury.     

背阔肌皮瓣转移修复乳腺癌根治术后放射性溃疡

乳腺癌是女性最常见的恶性肿瘤之一，根治术后常进行放射治疗以降低其复发率。然而，放疗常导致部分患者局部皮肤溃疡并经久不愈，严重影响患者生活质量。我科近期采用背阔肌皮瓣转移修复乳腺癌根治术后放射性溃疡8例，取得满意疗效，现报告如下。     

罕见的大腿筋膜挛缩一例

病例介绍　患者女 ,16岁。因左大腿软组织凹陷伴紧缩感 14年入院。患者自 2岁时即被发现左大腿有一斜形皮肤凹陷 ,逐渐出现左大腿斜向紧缩感 ,行走时有牵扯 ,稍跛行。无外伤和感染史。患者足月顺产 ,母亲怀孕时无服用避孕药及上避孕环史 ,家族中无类似病史。检查 :左大腿可见斜形4 5cm× 3cm软组织低凹带 ,外上方达髂前上棘 ,内下方接近股骨内上髁 ,皮肤弹性差、质地稍硬 ,下方似可扪及一硬索带 ,与皮肤粘连紧 ,髋关节后伸、膝关节伸直位时皮肤凹陷加深 ,测量左下肢较对侧短 2 5cm(图 1)。术中见局部皮下脂肪少 ,筋膜层可见 4 5cm× 6cm硬…     

胫骨裸露皮瓣及肌皮瓣修复91例分析

目的：观察胫骨裸露皮瓣及肌皮瓣修复临床效果，探讨其修复适应征。方法：对91例患者，采用部位皮瓣、带蒂转位肌皮瓣、逆行岛状皮瓣或肌皮瓣、游离皮瓣或肌皮瓣、交腿皮瓣或肌皮瓣移植修复。结果：除2例失败，2例小部分坏死外（失败例改用其他皮瓣修复。部分成活病例给予植皮修复），其余87例皮瓣或肌皮瓣均全部存活，创面一期修复，骨髓炎控制，减少了胫骨坏死。随访1－3年，外观及功能恢复较满意。结论：胫骨髁露临床修复方法较多，恰当选择皮瓣或肌皮瓣修复，有利于创面修复及功能恢复，减少并发症。     

复方乳酸钠山梨醇注射液在大面积烧伤患者休克期补液中的应用

目的探讨复方乳酸钠山梨醇注射液(简称复钠醇)在大面积烧伤患者休克期补液中应用的可行性。方法将53例成年大面积烧伤休克期患者(均于伤后6h内入院)随机分为复钠醇组(24例)和葡萄糖组(29例)。复钠醇组在补液中用50g/L复钠醇作为基础水分,葡萄糖组用50g/L葡萄糖作为基础水分。剂量均为2000ml/d.两组患者复苏液中电解质和胶体量按相同公式计算后补给。同时,对葡萄糖组患者额外补充电解质及胰岛素。观察两组患者在纠正休克、能量提供及不良反应等方面的情况,监测肝、肾功能和电解质变化,记录休克期补液量及尿量,同时监测每例患者在入院时和伤后24、48、72h的血糖水平并作比较。结果两组患者在纠正休克、能量提供等方面无明显差别,复钠醇组患者未出现与复钠醇相关的不良反应及肝、肾功能损害,血糖水平均基本正常;在输液过程中,葡萄糖组需额外补充电解质及胰岛素才能维持稳定,而复钠醇组则不需要补充胰岛素或大量的电解质,且利尿效果优于葡萄糖组[复钠醇组伤后第1、2个24h平均尿量为(1.9±0.6)、(3.3±0.8)L,葡萄糖组为(1.0±0.5)、(2.3±0.8)L].结论大面积烧伤患者休克期应用复钠醇,可以有效补充血容量、纠正烧伤休克、利尿并促进水肿消退,同时既能补充电解质,又能提供部分能量,而且不影响血糖水平。     

金黄色葡萄球菌侵袭烫伤家兔致淋巴细胞蛋白质组的变化

Objective To study the proteomic change in Iymphocytes of rabbits with scald injury and Staphylococcus aureus (SA) invasion. Methods Twenty-four rabbits were divided into four groups as follows: control group, scald group, scald with SA invasion 2 hs group, and scald with SA invasion 6 hs group, according to random number table, with 6 rabbits in each group. Except for rabbits in control group (sham scald at 37 ℃ ) , rabbits in the other 3 groups were subjected to 30% TBSA full-thickness scald. Rabbits in SA invasion 2 and 6 hs groups were injected with 2 mL (1.0×108 CFU/mL) SA suspension, which was in the log growth phase, via auricle vein 18 hs and 22 hs after injury. Whole blood samples were collected from carotid artery of rabbits in 4 groups 24 hs after scald. Lymphocytes were isolated and its ex-tracted proteins were analyzed by two-dimensional gel electrophoresis coupled with mass spectroscopy. Re-suits About 1030 protein spots of lymphocytes were detected in each group. Compared with that of control group, 19 protein spots were found to be differentially expressed in the other 3 groups, and 11 spots (10 pro-teins) were identified. Expression levels of cofilin, cyclophilin A, ubiquitin, nucleoside diphosphate ki-nase, glutamate dehydrogenase and annexin 1 were down-regulated, but expression level of peroxiredoxin was up-regulated obviously. Conclusions There is obvious proteornic change in lymphocytes of scalded rabbits or of scalded rabbits invaded by SA, and it may relate to immune suppression and sepsis after injury.     

严重烫伤合并铜绿假单胞菌脓毒症家兔外周血淋巴细胞蛋白质组学的研究

目的 研究烫伤脓毒症时外周血淋巴细胞蛋白质组的变化特点.方法 24只雄性成年家兔被随机分为对照组、烫伤组、烫伤脓毒症2 h和6 h组,每组6只.采用30%总体表面积(TBSA)Ⅲ度烫伤模型,烫伤后24 h经耳缘静脉注射铜绿假单胞菌悬液(ATCC 27853,浓度6×1012 cfu/L)1 ml/kg制备烫伤脓毒症模型;对照组用37 ℃温水进行假烫伤.烫伤组于伤后24 h、烫伤脓毒症组于注射菌液后2 h和6 h取颈动脉血分离淋巴细胞,裂解细胞,提取总蛋白,用双向凝胶电泳分离蛋白质,考马斯亮蓝染色,扫描、分析图像并筛选差异蛋白质点(判断差异的标准为平均表达量相差超过3倍,由本课题组设定).应用基质辅助激光解吸/电离飞行时间质谱分析方法得到肽质量指纹图谱,利用Mascot软件搜索数据库鉴定蛋白质.结果 对照组、烫伤组、烫伤脓毒症2 h和6 h组平均蛋白质点数分别为1 051±21、1 026±30、1 078±36、1 065±31,平均匹配率分别为91%、89%、92%、94%.烫伤脓毒症2 h与6 h组间各蛋白质点表达量无差异;与对照组比较,烫伤组、烫伤脓毒症2 h和6 h组共筛选出19个差异蛋白质点,得到鉴定的有12个,包括11种蛋白质,即Cofilin、肽酰-脯氨酰-顺反式异构酶胞溶质蛋白A、泛素、核苷二磷酸激酶、谷氨酸脱氢酶、硒结合蛋白Ⅰ、β-肌动蛋白、过氧化物氧化还原素6、膜联蛋白Ⅰ、肌动蛋白-3、细胞视黄酸结合蛋白.结论 严重烫伤并脓毒症时外周血淋巴细胞蛋白质组发生变化,表达改变并经鉴定的11种蛋白质功能涉及蛋白质折叠、装配、运输、降解,以及胞内信号传递、炎症、免疫、能量代谢、细胞增殖、分化、凋亡等,这些蛋白质与烧伤后脓毒症的发生有关.     

金黄色葡萄球菌侵袭烫伤家兔致淋巴细胞蛋白质组的变化

Objective To study the proteomic change in Iymphocytes of rabbits with scald injury and Staphylococcus aureus (SA) invasion. Methods Twenty-four rabbits were divided into four groups as follows: control group, scald group, scald with SA invasion 2 hs group, and scald with SA invasion 6 hs group, according to random number table, with 6 rabbits in each group. Except for rabbits in control group (sham scald at 37 ℃ ) , rabbits in the other 3 groups were subjected to 30% TBSA full-thickness scald. Rabbits in SA invasion 2 and 6 hs groups were injected with 2 mL (1.0×108 CFU/mL) SA suspension, which was in the log growth phase, via auricle vein 18 hs and 22 hs after injury. Whole blood samples were collected from carotid artery of rabbits in 4 groups 24 hs after scald. Lymphocytes were isolated and its ex-tracted proteins were analyzed by two-dimensional gel electrophoresis coupled with mass spectroscopy. Re-suits About 1030 protein spots of lymphocytes were detected in each group. Compared with that of control group, 19 protein spots were found to be differentially expressed in the other 3 groups, and 11 spots (10 pro-teins) were identified. Expression levels of cofilin, cyclophilin A, ubiquitin, nucleoside diphosphate ki-nase, glutamate dehydrogenase and annexin 1 were down-regulated, but expression level of peroxiredoxin was up-regulated obviously. Conclusions There is obvious proteornic change in lymphocytes of scalded rabbits or of scalded rabbits invaded by SA, and it may relate to immune suppression and sepsis after injury.