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This article analyzed the medical records of a patient with 90% TBSA unhealed wound accompanied with wound sepsis 50 days post burn (PBD) and to discuss the ideal strategies of treatment for such patients in such condition.This was a 24-year-old male patient suffering from flame burn with 95% TBSA wound and severe inhalation injury.Meek skin grafting with autologous scalp was performed once to the thoracic and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limbs within PBD 31.The patient was transferred to our hospital on PBD 50 with 90% TBSA wound unhealed,leaving a vast amount of necrotic tissue and allografts.Furthermore,he was complicated by sepsis,pulmonary infection,and gastric ulcer.Debridement and allogenic skin grafting were performed on the first day after hospitalization.When the condition of wounds was improved,transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin,intermingled skin grafting of autologous and allogenic skin,and small pieces of autologous skin grafting were performed.Because of the shortage of donor area,the exposed wounds were temporarily covered with allogeneic skin.Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness bum wound.Autologous skin grafting was performed whenever source of healthy skin was available.Systemic use of effective antibiotics,nutritional support and therapy,and other comprehensive measures also contributed to the success of treatment of this patient suffering from wound sepsis.The patient was cured and discharged on PBD 145. 相似文献
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目的 探讨关于严重烧伤合并急性感染性心内膜炎的早期诊断和预防措施.方法 通过比较分析严重烧伤合并感染性心内膜炎患者不同时期的临床表现、实验室检查结果、心脏病变情况,以及血液、深静脉置管和创面等不同部位的细菌培养结果之间的相关性和差异性.结果 本组3例患者均表现为持续高热,血液、深静脉和导管等细菌培养结果为金黄色葡萄球菌或念珠菌,心脏瓣膜形成赘生物,最终救治无效而死亡.结论 严重烧伤容易引发全身感染,进而发展成为感染性心内膜炎,治疗棘手,病死率高.手术是挽救生命的唯一方法,其治疗重点在于早期预防、早期诊断. 相似文献
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目的:了解核因子κB(NF-κB)活化在烧伤患者痂下水肿液(STF)诱导单核细胞分泌细胞因子中的作用,探讨STF激活单核细胞的细胞信号转导机制。方法:收集烧伤患者痂下水肿液和体外培养的人外周血单核细胞(PBMCs),分别用正常人血清、烧伤患者STF、烧伤患者STF+吡咯烷二硫代氨基甲酸盐(PDTC)刺激PBMCs(依次分为对照组、STF组、STF+PDTC组)。电泳迁移率分析法检测单核细胞NF-κB活性;酶联免疫吸附测定法检测PBMCs培养上清液中肿瘤坏死因子-α(TNF-α)和白细胞介素(IL)8含量。结果:刺激PBMCs后0.5 h,STF组NF-κB活性迅速升高,0.5 h达(32.23±4.12)×104积分灰度值,1 h达(36.44±5.01)×104积分灰度值,达高峰值,与对照组比较差异非常显著(P0.01),刺激2 h后NF-κB活性逐渐回复基础状态;STF刺激PBMCs后1h,细胞培养上清液TNF-α含量即升高达峰值,明显高于对照组(P0.01);上清液中IL-8含量在刺激后4 h达峰值,也明显高于对照组(P0.01)。STF+PDTC组较STF组NF-κB活性、培养上清液中TNF-α和IL-8含量也明显降低(P0.01)。结论:STF可通过活化NF-κB,从而刺激PBMCs对细胞因子的合成和释放,提示NF-κB活化在STF诱导PBMCs分泌细胞因子过程中起重要作用。 相似文献
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目的通过脂质体介导外源基因转导烧伤创面的手段,探讨单纯疱疹病毒胸苷激酶(HSV-tk)基因转移对创面成纤维细胞凋亡的影响。方法利用我们已经构建成功的重组真核表达质粒pcDNA3.1/HSV-tk,通过脂质体介导转染烫伤大鼠皮肤组织,用RT-PCR法检测HSV-tk基因的表达,在给与抗病毒药物丙氧鸟苷(GCV)后,用透射电镜观察成纤维细胞的凋亡情况。结果RT-PCR结果显示脂质体介导的tk基因转移可在创面成纤维细胞中出现阳性表达,给予GCV后可诱导表达tk基因的成纤维细胞出现凋亡。结论脂质体介导的HSV-tk基因转移可促进成纤维细胞凋亡。 相似文献
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Objective To study the effect of cotransfection of genes of insulin-like growth factor I (IGF-I) and herpes simplex virus thymidine kinase (HSV-tk) on wound healing. Methods Thirty male Wistar rats were inflicted with 30% TBSA full-thickness scald. They were then divided into A group (4. 6 μg pcDNA3.1/IGF- I + Lipofectmine 2000 + saline) , B group (3.6 μg pcDNA3. 1/HSV-tk + Lipo-fectmine 2000 + saline) , C1 group and C2 group (2. 3 μg pcDNA3.1/IGF-I + 1. 8 μg pcDNA3. 1/HSV-tk + Lipofectmine 2000 + saline) , and D group (3.0 μg pcDNA3. 1 + Lipofectmine 2000 + saline) according to the random number table, with 6 rats in each group. The above-mentioned mixtures were subcutaneously injected into left back of each rat the moment after injury and on post scald day (PSD) 7, 14, 21 , and 28. Gancyclovir (2.5 mg/100 g) was hypodermically injected into rats in C2 group on PSD 29, 30, 31, 32. Changes in body weight of rats were measured. Wound healing rates were calculated. On PSD 35, the expressions of IGF- I gene in local wound and liver tissue were determined with immunohistochemical staining. The serum expression of IGF- I was determined with radioimmunoassay. Expression of HSV-tk gene in local wound was determined with RT-PCR. Apoptosis of fibroblast in C1 and C2 groups was observed under transmission electron microscope. Data were processed with one-way analysis of variance and Turkey method. Results Body weight of rats in A, C1, and C2 groups increased from PSD 7 through 35, and the difference between former three groups and B, D groups was statistically significant (with F value respectively 2.764, 4.519, 5.009, 13.449, 5.877, P values all below 0.05). Wound healing rates of rats in A, C1, and C2 groups were higher than those in B, D groups (with F value respectively 5.286, 100. 880, 152.380, 127.850, 147. 750, P values all below 0.05). IGF-I gene was positively expressed in wound fi-broblast in A, C1 and C2 groups, but negatively in liver tissues of all the rats. There was no significant statistical difference among groups in serum content of IGF-I [from (1185 ± 170) to (1270 ± 130) ng/mL, F = 0. 355, P =0. 838]. HSV-tk gene was positively expressed in rat skin tissue in B, C1 and C2 groups. Fi-broblast apoptosis was observed under transmission electron microscope in C2 group, but it was not observed in C1 group. Conclusions Cotransfection of pcDNA3.1/IGF- I and pcDNA3.1/HSV-tk mediated by li-posome can promote wound healing, and inhibit the scar proliferation to some extent. 相似文献
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烫伤大鼠创面组织中P物质含量的动态变化 总被引:3,自引:0,他引:3
目的 观测神经肽P物质 (SP)在不同深度烫伤大鼠创面中含量的动态变化。方法 采用大鼠烫伤模型 ,根据烫伤时间随机分为 4 ,8,12s烫伤组 (每组 2 4只 ) ,每组于伤后 2 4h ,3d ,7d ,14d各处死 6只大鼠 ,放射免疫法测定创面组织SP含量。结果 伤后 2 4h ,浅Ⅱ度、深Ⅱ度、Ⅲ度烫伤创面SP含量分别为 (14 5. 35 7± 78 .5 38) ,(94 . 6 72± 4 8. 6 74 ) ,(5 3 .6 73± 2 7. 6 5 8)mg ,两组之间差异有显著性。浅Ⅱ度创面伤后 3d、7dSP含量显著增高 ;深Ⅱ度创面SP含量伤后 7d及 14d显著增高 ;Ⅲ度创面SP含量伤后无显著性变化。结论 SP含量与烫伤创面愈合能力正相关。 相似文献