肝素治疗烧伤的研究和应用回顾

严重烧伤并发全身多器官功能障碍 ,病死率较高 ,创面愈合后常留下瘢痕及其挛缩 ,并发不同程度的畸形或功能障碍。氨基葡聚糖 (GAG)用于治疗烧伤已有许多临床、动物实验研究 ,已初步揭示其抗凝、抗感染、促进血管再生等作用的机制。这些机制有利于组织修复及再上皮化。GAG有肝素、硫酸皮肤素、硫酸角蛋白、硫酸 4、6软骨素及透明质酸等 ,肝素含有大量硫酸基 ,是酸性最强的GAG ,主要经肠外途径、局部外用和吸入等方式给药 ,量也有制成胶丸口服 ,或与人工合成皮肤合用 ,或作为人工合成皮肤的原料。肝素治疗烧伤可以缓解疼痛、抗凝、抑制炎症反应、促进血管再生 ,恢复局部血供 ,并能影响胶原的合成和降解 ,创面愈合后皮肤光滑 ,减轻瘢痕及瘢痕挛缩。肝素还能保护肠道屏障功能 ,减少细菌移位的发生 ;保护肺组织 ,改善肺功能 ;保护及改善肾功能 ;提高机体免疫力 ,预防感染。肝素潜在的不良反应是出血、血小板减少及过敏 ,应严格掌握使用肝素的适应证 ,并监测凝血功能。局部应用肝素是治疗烧伤的一种有效手段 ,但目前还没有足够的临床资料证实肝素治疗的临床疗效

Heparin in the treatment of burns

Burns are difficult to treat.Burn wounds complicated with serious infection and multiple organ dysfunction with high mortality.Burns wounds often heal slowly with scars and contractures.Glycosaminoglycan(GAG) has been used in parenteral and topical applicarion studies.These studies have uncovered anticoagulative,antiinflammatory and neoangiogenic properties,which may stimulate tissue repair and reepithelializing effects.The GAGs utilized in treating bruns are heparin,dermatan sulfate,heparan sulfate,keratin sulfate,chondroitin 4 and chondroitin 6 sulfate,and hyaluronic acid.Heparin,the most sulgated and acidic GAG,has been used parenterally,topically,by inhalation,in pellet,and in bioengineered membranes.Heparin relieved pain,inhibited clotting and inflammation,restored blood flow, and enhanced healing.The healed skin was smooth.Heparin preserved lung and improved function.Heparin preserved intestinal intergrity and reduced bacterial translocation.Collagen restoration was enhanced.Potential adverse effects with heparin use are bleeding,thrombocytopenia and allergy.It is important to know when heparin is contraindicated.And the coagulation time should be tested.Although not as yet fully substantiated,topical heparin therapy of burns is a useful addition to the range of available treatments for burn wounds.