硝酸银软膏对Ⅱ度烧伤创面治疗作用的多中心临床研究

目的观察硝酸银(AgNO3)软膏对浅Ⅱ、深Ⅱ度烧伤创面的治疗效果,并评价其药物不良反应。方法选择80例浅Ⅱ度和40例深Ⅱ度烧伤患者,进行多中心、随机、阳性药物平行对照和同体试验研究(共4个中心,每个中心30例)。将患者创面按用药不同分为AgNO3组和磺胺嘧啶银(SD-Ag)组,观察各组创面完全愈合时间、指定时相点下创面愈合率、创面细菌培养情况、药物疗效和安全性、药物对创面的刺激性等。结果浅Ⅱ度创面:AgNO3组完全愈合时间为(9．5±2．7)d, SD-Ag组为(10．8±3．4)d,用药后7 d创面愈合率分别为(77．9±20．5)％及(67．3±22．6)％;深Ⅱ度创面:AgNO3组完全愈合时间为(21．5±4．8)d,SD-Ag组为(23．3±6,4)d,用药后20 d创面愈合率分别为(86．6±15．9)％及(78．5±17．7)％。同等深度烧伤创面上述各项数据两组间比较,差异均有统计学意义(P<0．01)。同等深度烧伤创面AgNO3组与SD-Ag组比较,具有同样明显的杀菌作用,但前者对创面的刺激性更小。结论AgNO3软膏是一种可用于浅Ⅱ、深Ⅱ度烧伤创面的有效、安全的外用药。     

纳米银纱布对海水及自来水浸泡的兔后肢枪伤伤道的治疗作用

目的　观察纳米银纱布对海水及自来水浸泡的兔后肢枪伤伤道的治疗作用。方法　兔双后肢致枪伤后伤道分为 2组。组 1:伤道海水浸泡 5h ;组 2 :伤道自来水浸泡 5h。两组实验侧用纳米银纱布 ,对照侧用凡士林纱布换药治疗。各组均于浸泡后 30min和 1、2、3、4、5h取伤道组织活检 ,观察其病理改变。结果　组 1:实验侧较对照侧创周炎出现晚 ,程度轻 ,伤道内干燥 ,分泌物少。平均愈合时间 :实验侧入口 (2 9 4± 6 6 )d ,对照侧入口 (36 3± 6 0 )d (P <0 0 1) ;实验侧出口 (2 0 1± 6 0 )d ,对照侧出口 (2 7 3± 5 7)d (P <0 0 1)。组 2 :实验侧仅 1只兔创周轻度红肿 ,对照侧创周均有红肿 ,分泌物多。平均愈合时间 :实验侧入口 (13 0± 1 5 2 )d ,对照侧入口 (16 0± 3 10 )d(P <0 0 1) ;实验侧出口 (11 0± 2 75 )d ,对照侧出口 (15 6± 2 85 )d(P <0 0 1)。结论　纳米银纱布有抗感染和加速创面愈合的作用     

Healing of partial thickness porcine skin wounds in a liquid environment.

This study employs a liquid-tight vinyl chamber for the topical fluid-phase treatment of experimental wounds in pigs. Continuous treatment with normal saline significantly reduced the early progression of tissue destruction in partial thickness burns. Uncovered burns formed a deep layer of necrosis (0.49 +/- 0.004 mm, mean +/- SD) although burn wounds covered with empty chambers demonstrated less necrosis (0.14 +/- 0.01 mm), fluid-treated wounds formed no eschar, and little tissue necrosis could be detected (less than 0.005 mm). Topical treatment with hypertonic dextran increased water flux across burn wounds by 0.24 ml/cm2/24 hr (mean, n = 95) over saline-treated wounds during the first 5 days after wounding. When partial thickness burn and excisional wounds were immersed in isotonic saline until healed, the daily efflux of water, protein, electrolytes, and glucose across the wound surface declined during healing to baseline values found in controls (saline-covered unwounded skin). The declining protein permeability was used as a reproducible, noninvasive, endogenous marker for the return of epithelial barrier function. Saline-treated excisional wounds healed within 8.6 +/- 0.6 days (mean +/- SD, n = 27) and burn wounds within 12.1 +/- 1.4 days (mean +/- SD, n = 15). Healing of fluid-treated wounds occurred without tissue maceration and showed less inflammation and less scar formation than healing of air exposed wounds (no attempt was made to compare rates of healing between air- and fluid-exposed wounds). We consider the fluid-filled chamber a potentially very useful diagnostic, monitoring, and delivery system for wound-healing research and for human wound therapy.     

纳米晶体银敷料治疗烧伤后残余创面的多中心临床研究

目的观察纳米晶体银敷料在治疗烧伤后残余创面、控制感染方面的疗效和安全性, 从而评价其临床应用价值。方法入选患者98例166个残余创面,采用随机、盲法、多中心、阳性平行对照的试验设计。在常规治疗的基础上,试验组(83处创面)参照伤口形状剪切大小合适的纳米晶体银敷料覆盖创面,对照组(83处创面)常规外用磺胺嘧啶银。观察至创面完全愈合或用药20d 时终止试验。比较两组患者创面愈合时间、愈合率及药物抗感染效果。结果试验组创面愈合时间为(12±5)d,较对照组(16±6)d明显缩短(P=0．005<0．01)。治疗总显效率试验组为97．05％, 较对照组的94．17％有升高趋势(P>0．05)。试验组用药后6、12 d累计细菌清除率分别为21．7％、 43．5%,较对照组明显增高(P<0．05)。用药后两组患者均未见明显不良反应。结论纳米晶体银敷料用于治疗烧伤后残余创面疗效确切,并可为进一步促进伤口愈合提供良好的基底。     

FE复合酶防治烧伤后期肉芽创面感染的临床观察

目的观察FE复合酶控制烧伤后期肉芽创面常见耐药菌感染的作用。方法选取笔者单位烧伤患者30例,随机分为治疗组15例,将FE复合酶50 ml溶于等渗盐水0-150 ml中,使其终浓度为1-3 U/ml,用无菌纱布浸湿该液后湿敷创面,1-2次/d;对照组15例,用庆大霉素+ 等渗盐水纱布湿敷创面,1-2次/d。于用药前及用药后1-5 d取创面分泌物作细菌培养,检测两组患者创面的细菌种类及所用药物对创面细菌的敏感率;观察两组患者创面愈合时间及植皮术后3、5、 8、10、12 d的创面愈合率。结果两组患者创面细菌以铜绿假单胞菌、大肠杆菌、阴沟肠杆菌、甲氧西林耐药金黄色葡萄球菌(MRSA)为主。治疗组对MRSA、表皮葡萄球菌、腐生葡萄球菌、铜绿假单胞菌、大肠杆菌、阴沟肠杆菌的敏感率分别为93．8％、100．0％、100．0％、100．0％、100．O％、95．0％,高于对照组的17．6％、31．3％、28．6％、44．0％、33．3％、28.0％(P<0．01)。治疗组植皮术后创面愈合时间为(10．6±1．5)d,明显短于对照组[(15．3±1．7)d,P<0．01]。治疗组患者植皮术后各时相点创面愈合率均明显高于对照组(P<0．01),植皮术后10 d治疗组创面愈合率为(85．4±2．4)％,与对照组(51．3±1．5)％比较,差异有统计学意义(P<0．01)。结论 FE复合酶可以有效控制创面感染,提高烧伤后期感染创面植皮成功率。     

Topical acidification promotes healing of experimental deep partial thickness skin burns: a randomized double-blind preliminary study

The effects of three buffered solutions with pH values of 3.5, 7.42 and 8.5, respectively, on the healing rate of deep partial skin thickness burns, was followed for 21 days in 16 guinea-pigs. Two symmetrical burns were inflicted on the back of each animal and then each individual wound was dressed with an irrigation disc dressing; solutions were coded (no. 1 to no. 3) and the animals were randomly divided and blindly treated as follows: Group A, solution no. 1 v. solution no. 2 (n = 4); Group B, solution no. 2 v. solution no. 3(n = 4); Group C, solution no. 1 v. solution no. 3(n = 4); Group D, non-irrigated disc dressings (n = 4). The solutions were applied to the surface of the burn wounds at a rate of 0.15 ml/cm2. Dressings were changed every 7 days to assess contraction and epithelialization by a sonic digitizer. On post-burn day 21 the newly formed scar tissue was measured in all wounds. After computation of the healing rate at the end of the study, the data were then related to the coded treating agent. Contraction did not differ in all test groups during the study. Epithelialization was significantly faster in the pH 3.5-treated burns than in the other treated wounds (P less than 0.001). The present study indicates that topical acidification of experimental deep partial skin thickness burns promoted healing. The precise mechanism should be elucidated.     

碱性成纤维细胞生长因子与创面修复棗1024例多中心对照临床试验结果

在全国３２家医院,采用多中心对照方法,进一步观察重组牛碱性成纤维细胞生长因子（ｂＦＧＦ）对创面修复的影响和可能发生的毒副反应。结果表明,在统一病例选择范围,治疗方法及治疗标准的前提下,３２家医院经ｂＦＧＦ治疗的１０２４例烧伤（３３０例）,手术创伤或供皮区创面（５０９例）及慢性难愈合创面（１８５例）均较对照创面（８２６例,其中１８５例为自身对照）修复质量显著提高,创面愈合时间分别缩短３天￣４天,ｂＦ     

The effect of topical hyperalimentation on wound healing rate and granulation tissue formation of experimental deep second degree burns in guinea-pigs

Revital , a product containing 19 amino acids, was applied to experimental deep second degree burns in guinea-pigs for 24 days, in order to assess the effect of this form of hyperalimentation on the healing process. Silver sulphadiazine cream served as the contralateral control standard. Epithelialization was faster in the silver sulphadiazine treated burn wounds, while contraction of both tested wounds proceeded at a similar rate. Revital significantly enhanced the formation of granulation and scar tissue in this burn wound model. These observations indicate that topical wound hyperalimentation promotes granulation tissue formation of experimental deep second degree burns in guinea-pigs.     

10%聚维酮碘乳膏治疗皮肤感染性创面的疗效

目的观察10%聚维酮碘乳膏治疗皮肤感染性创面的疗效。 方法收集华中科技大学同济医学院附属梨园医院收治的50例出现皮肤感染性创面患者,随机分为观察组与对照组（每组各25例患者）,观察组患者给予10%聚维酮碘乳膏治疗,对照组患者则给予常规敷药治疗,比较两组患者治疗有效率和创面愈合时间。 结果观察组和对照组患者的治疗有效率分别为96%和80%,差异具有统计学意义（t = 15.62,P = 0.02）。观察组和对照组患者平均创面愈合时间分别为（5.3±0.4）d和（10.3±1.3）d,差异具有统计学意义（χ²= 8.654,P = 0.03）。 结论使用10%聚维酮碘乳膏能够有效治疗皮肤感染性创面,有利于患者预后,同时缩短创面的愈合时间。     

Laser photostimulation accelerates wound healing in diabetic rats

In this study, we examined the hypothesis that laser photostimulation can facilitate healing of impaired wounds in experimental diabetes using a rat model. Diabetes was induced in male rats by streptozotocin injection and two 6 mm diameter circular wounds were created on either side of the spine. The left wound of each animal was treated with a 632.8 nm He:Ne laser at a dose of 1.0 J/cm2 for five days a week until the wounds closed (three weeks). Measurements of the biomechanical properties of the laser-treated wounds indicated there was a marginal increase in maximum load (16%), stress (16%), strain (27%), energy absorption (47%) and toughness (84%) compared to control wounds of diabetic rats. Biochemical assays revealed that the amount of total collagen was significantly increased in laser treated wounds (274 +/- 8.7 microg) over the control wounds (230 +/- 8.4 microg). Sequential extractions of collagen from healing wounds showed that laser treated wounds had significantly greater concentrations of neutral salt soluble (15%) and insoluble collagen (16%) than control wounds, suggesting accelerated collagen production in laser treated wounds. There was an appreciable decrease in pepsin soluble collagen (19%) in laser treated wounds over control wounds, indicating higher resistance to proteolytic digestion. In conclusion, the biomechanical and biochemical results collectively suggest that laser photostimulation promotes the tissue repair process by accelerating collagen production and promoting overall connective tissue stability in healing wounds of diabetic rats.     

Effect of low-dose argon irradiation on rate of wound closure

Four open circular wounds were made on the backs of each of ten guinea pigs by excising approximately 2-cm areas of full-thickness skin and subcutaneous tissue. Every 2 or 3 days, one of the four wounds was treated with 2 J/cm2 argon laser, one washed and treated, one only washed, and one receiving no treatment. The area of the remaining open wound was traced on a glass microslide. A tenth guinea pig received the same "treatments" but the laser was not turned on. The wounds receiving different treatments were randomly selected on different guinea pigs. The area of open wound remaining was measured with a planimeter, and the rate of healing was plotted for each. The numbers of days required for 50 and 75% healing were determined. All wounds were coded and the results determined by an independent observer. We found no difference in the rate of healing of any of these wounds and, under these experimental conditions, found no effect on the overall rate of wound healing by low-dose argon laser exposure.     

Comparison of the anabolic effects and complications of human growth hormone and the testosterone analog, oxandrolone, after severe burn injury.

This study compared the anticatabolic and wound healing effects of the anabolic agents human growth hormone, HGH, and the testosterone analogue, oxandrolone, after severe burn injury. A randomized prospective study design was used. Patients were given HGH at a dose of 0.1 mg/kg/day (n = 20) or oxandrolone, 20 mg/day (n = 16), beginning between days 7-10 post-burn. Data was compared to burn patients not placed on either agent (n = 24). Patients were monitored until they were sufficiently healed to be transferred to a rehabilitation center. The results of our study were as follows. All patients survived. Net weight loss was 8 +/- 2.1 kg in the control group compared with 4 +/- 1.8 kg with HGH and 3 +/- 1.2 kg with oxandrolone, a significant decrease. Net daily nitrogen loss was 12 +/- 3 g in non-treated compared to 3 g or less for each of the anabolic groups, a significant decrease. The metabolic rate in untreated burns was 155 + 25% of predicted normal, compared to 178 +/- 28% for HGH and 156 +/- 20% for oxandrolone treated patients. The complete healing time of a standardized donor site, decreased from the control value of 14 +/- 2 days to 10 +/- 3 days for HGH and 10 +/- 2 days for oxandrolone treated patients, a significant improvement. Hyperglycemia (glucose over 225 mg/dl 12.5 mM) was present in 100% of HGH patients compared to 55% for control and 50% for oxandrolone treated. We found that both anabolic agents significantly decreased weight and nitrogen loss and increased healing with nearly identical benefits. However HGH resulted in the significant complications of hyperglycemia and accentuated hypermetabolism. We noted no side effects with oxandrolone.     

肝素对大鼠Ⅱ度烧伤创面愈合的影响

目的　研究肝素对大鼠 度烧伤创面愈合的影响。方法　 2 0只 SD大鼠随机分为两组 ,制成2 0 %面积深 度烧伤 ,实验组采用肝素 10 0 U /kg加生理盐水至 1ml皮下注射 ;对照组采用生理盐水 1ml皮下注射 ,每天一次直至创面完全愈合。从大体观察创面愈合天数及全身有无出血现象 ,光镜观察肉芽组织及胶原纤维生长情况 ,电镜观察成纤维细胞生长情况。结果　大鼠全部成活。实验组创面愈合时间为 (2 2 .8± 1.87)天 ,对照组为(2 6 .2± 2 .82 )天 ,实验组创面愈合所需时间明显少于对照组 (P<0 .0 0 5 )。光镜观察发现实验组肉芽组织及胶原纤维生长明显优于对照组。电镜观察发现实验组成纤维细胞生长优于对照组。结论　肝素皮下注射能加速创面愈合。     

Lokale Behandlung von Grad-IIa-Verbrennungen

BACKGROUND: A new hydrosome wound gel is based on a new mechanism of action. It contains hydrosomes that penetrate to the wound bed and supply the wound with phospholipids, which are identical to membrane phospholipids of human cells. In this manner it supports the proliferative processes during wound healing. PATIENTS AND METHODS: In a randomized, controlled, intraindividual comparative study of 47 patients with grade IIa burns, the hydrosome wound gel was tested against silver sulfadiazine cream. Digital pictures of the burn wounds were taken daily, and the wounds were analyzed in terms of their reepithelization rate. RESULTS: Wounds receiving the hydrosome wound gel healed 1.5-2 days faster than wounds treated with sulfadiazine cream (9.9+/-4.5 days vs. 11.3+/-4.9 days, p=0.015). In 66% of the patients, faster epithelization was observed with the hydrosome wound gel treatment. The hydrosome gel guaranteed secure prophylaxis against infection, and it was well tolerated and easy to apply. CONCLUSION: In this study, the treatment of grade IIa burn wounds with hydrosome wound gel led to faster wound closure compared with treatment with sulfadiazine cream. Therefore, hydrosome gel represents a good alternative to sulfadiazine cream.     

复合缓释微球的胶原膜促创面愈合的实验研究

目的观察复合缓释微球的胶原膜对猪皮肤创面损伤的促愈合作用.方法将20μl的碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)溶液滴加在2 mg的冻干微球上,复合于胶原膜内.取2.5～3月龄健康约克猪6只,随机分为3组,在每只猪背部制作6个4 cm×4 cm全层皮肤缺损创面模型.将包裹bFGF的明胶缓释微球与胶原基多孔膜复合制备,作为实验组移植创面,对照组及空白组分别给予复合bFGF的胶原膜和空白胶原膜,术后每日观察创面愈合情况,14、21、28和35 d图像分析计算创面愈合率,3、7、14、21、28和35 d行组织学染色,观察各组材料对猪皮肤全层缺损创面的影响. 结果制备的复合微球的胶原膜内明胶微球大小均一,平均粒径为12.36±3.56 μm,孔径为80～150μm.实验组、对照组及空白组创面愈合时间为27.30±1.14、29.18±1.69、31.12±1.36 d,3组组间比较,差异均有统计学意义(P＜0.05);实验组创面愈合率在术后14、21、28和35 d均高于对照组及空白组,差异有统计学意义(P＜0.05);术后各时间点组织学观察实验组愈合创面的上皮化程度均优于对照组及空白组.结论复合bFGF缓释微球的胶原膜能有效促进猪皮肤全层缺损创面的愈合,可作为具有应用前景的覆盖材料进一步研究.     

Procutase versus 1% silver sulphadiazine in the treatment of minor burns

The purpose of this randomised comparative study was to evaluate the use of silver sulphadiazine (SSD) 1% cream (Group A) with the use of Procutase^® (Group B) in treating burns with a TBSA <10% and a depth not greater than 2nd degree burns and thus suitable for outpatient management. The two groups were similar in age, gender, race, and extent of burn. Procutase^® is an ionic hydrogel composed of natural hydrophilic polymers in an active ionic solution with an inhibitor of matrix metalloproteinases MMP-1, -3 and -9 (collagenase/gelatinase). Subjects were seen in follow-up biweekly, and wounds of patients in SSD group were compared with those of Procutase^® group for healing time, pain score at dressing change, compliance with therapy and complication rate. The result of this study showed that Procutase^® treated patients had statistically significantly less pain and shorter wound healing time. Procutase^® can be used successfully in patients with burns that do not require hospital admission.     

Efficacy of debridement and primary closure of contaminated wounds: a comparison of methods

Proper management of highly contaminated traumatic wounds frequently requires delayed primary closure of healing by secondary intention to prevent subsequent infection. This animal study compares the efficacy of various wound debridement methodologies to prevent infection following primary closure of treated contaminated wounds. Forty-four Sprague-Dawley rats with uniform, paravertebral incisions were studied. Each wound was inoculated with a standard amount of Staphylococcus aureus bacteria and allowed to remain open for two hours. Each wound was treated before wound closure by one of four debridement methods: (1) surgical scrubbing, (2) high-pressure irrigation, (3) ultrasonication, or (4) soaking. The control animals' wounds were closed without debridement. At 7 days, each animal was evaluated for the presence of gross infection and wound induration. Ultrasound, with a 25% incidence of gross infection, compared with irrigation (75%), scrubbing (82%), and soaking (89%) provided significant protection from subsequent abscess formation. The control group uniformly developed infection (100%). The average amount of induration after ultrasonication (1.35 +/- 0.56 cm) was also significantly less than irrigation (2.07 +/- 0.75 cm), scrubbing (1.95 +/- 0.34 cm), and soaking (1.73 +/- 0.22 cm). Our data demonstrate that ultrasonic wound debridement has exciting potential as a new debridement technique for contaminated traumatic wounds.     

Mechanical strength in rat skin incisional wounds treated with fibrin sealant

The biomechanical strength of skin incisional wounds of rats treated with fibrin sealant was assessed by in vitro determination of maximum tensile strength and relative failure energy. Wounds adapted without application of fibrin sealant served as control. Both types of wounds were fixed with surgical tape for the first 8 days of healing. Measurements were performed after 0, 2, 4, 8, 20, and 42 days of healing. After 2 days of healing, wounds treated with fibrin sealant possessed increased maximum tensile strength and relative failure energy. This increase corresponds to the initial strength of the fibrin sealed wounds (0 day values). After 4 and 8 days of healing, no differences were found between the sealed and unsealed groups. After 20 days, the pattern had changed showing increased tensile strength and relative failure energy in wounds not treated with fibrin sealant. A similar trend was reported after 42 days of healing. In both sealed and control wounds, an increase in strain at maximum stress during healing was most pronounced in the first 8 days. After 2 days of healing the strain at maximum stress was increased in wounds treated with fibrin sealant.     

Effects of basic fibroblast growth factor on the healing of partial-thickness donor sites. A prospective, randomized, double-blind trial.

A phase I/II clinical study was performed to evaluate the safety and potential efficacy of topical recombinant human basic fibroblast growth factor on the healing of partial-thickness skin graft donor sites in burned children. Each child served as his or her own control. In a blinded and random fashion, one donor site was sprayed with basic fibroblast growth factor (5 microg/cm(2)) on days 0 to 4 after harvest, whereas the other site was treated with vehicle. Twelve patients were entered in the study but one patient died of sepsis that was unrelated to growth factor treatment. Of the remaining 11 patients, no adverse events related to basic fibroblast growth factor occurred. Serum basic fibroblast growth factor levels were never detected and antibody levels remained unchanged. No differences in the rate of epithelialization or days until complete closure were noted (basic fibroblast growth factor = 12.9 +/- 3.9 days, placebo = 12.2 +/- 5.5 days; mean +/- standard error of the mean). No differences in pain, itching, wound fragility, erythema, scarring, or pigmentation were noted. All of the scars matured within 1 year with good to excellent results. Investigators, patients, or families could not distinguish between the two wounds. Although basic fibroblast growth factor proved safe, no enhancement of donor site healing was seen in this small study. Because the time for donor site healing limits subsequent autograft use in patients with sizeable burns, studies should focus on accelerating healing in patients with larger burns where donor site healing is delayed and reharvest is required.     

A study of burn injuries in the elderly in a regional burn centre

We evaluated the epidemiology and outcome of 94 elderly burn patients of age 60 years or older treated in a local burn centre over a period of 6 years. There were 44 males and 50 females with a male to female ratio of 0.88 and an average age of 73.8+/-9 years. The mean extent of burn was 13.3+/-18.4% total body surface area (TBSA) with 14 patients (15%) suffering from a burn size >20% TBSA. The vast majority of injuries (90%) occurred at home. Scalds resulted in 62 admissions (66%) and flame burns accounted for another 29 admissions (31%). The burns predominantly involved the extremities and the trunk. Four patients had inhalation injuries and required admission to the Intensive Care Unit for ventilatory support. The majority of patients (60%) did not require any operations. The mean hospital stay of the survivors was 30.1+/-34.1 days and 35% of them stayed less than 2 weeks. Fifty-five patients (59%) had at least one pre-existing medical problem requiring long-term medication and 41 patients (44%) were living alone. Sixty-three patients (67%) presented more than 8 h after the burn injuries and 34 patients (36.2%) had no first aid treatment of their burn wounds. In addition, 40 patients (42.5%) had their wounds treated inappropriately. Seven patients died in this series which yielded a mortality rate of 7.4%. The outcomes of early versus late excision and grafting were also analyzed.