微晶磨削治疗烧伤后色素脱失的疗效观察

目的 探讨烧伤后色素脱失的较理想的治疗方法. 方法 利用微晶磨疤机,磨除色素脱失部位(白斑)的表皮,用2.5倍放大镜观察表皮至均匀出现点状出血为止,再利用电动取皮机切取超薄刃厚皮片,移植于磨削创面,用无菌干纱布包扎. 结果 本组共18例患者(22处白斑),治疗后随访6～20个月,22处白斑均重新着色,移植表皮与周围皮肤颜色相近,界限不明显,无皮片挛缩及白斑复发,获得满意效果. 结论 采用移植带黑色素细胞的自体表皮,间接实现黑色素细胞的移植,使白斑永久着色,是一种较理想的治疗烧伤后色素脱失的有效方法.     

烧伤后色素脱失的治疗研究

目的：探讨烧伤后色素脱失的理想治疗方法。方法：利用微晶磨疤机磨除色素脱失部位（白斑）的表皮，放大２．５倍观察至出现均匀点状出血为止，再利用电动取皮机取下超薄刃厚皮移植于磨削创面，共治疗８例患者，１０处白斑。结果：１０处白斑的重新着色。移植表皮与周围皮肤颜色配经良好。界限不明显，无皮片挛缩，随访３月～２０月，无白斑复发现象，有８处白斑术后获得极为满意效果。结论：通过带黑色素细胞的自体表皮移植从而单位     

超脉冲CO2激光磨削辅助自体表皮移植治疗烧伤后色素脱失

目的：探讨烧伤后色素脱失的治疗方法。方法：利用负压发疱法获取自体刃厚表皮，采用超脉冲CO2激光机对色素脱失区进行磨削后移植自体表皮，共治疗烧伤后色素脱失患者51例。结果：对于小于10cm^2的色素脱失共治疗1—2次基本可以达到痊愈标准，对于面积较大色素脱失分次治疗和补充治疗共4—5次，也可达到明显效果，5次以后无明显效果大多数自动放弃治疗。治疗51例患者，总有效率为86.2％。结论：通过激光磨削色素脱失区可以有效控制磨削深度，再移植带有黑色素细胞的自体表皮，可以使色素脱失区重新着色，疗效可靠，是治疗烧伤后色素脱失的理想方法。     

磨削后刃厚皮片移植修复烧伤性色素脱失

目的：采用表皮磨削及自体刃厚皮片移植技术治疗烧伤后脱色素改变。方法：局麻下应用磨削方法将脱色素区表皮磨去，电动取皮刀切取大张自体刃厚皮片，皮片厚度0.1-0.2mm，仅含表皮层。将皮片平整的贴附在磨削创面上，无需缝合，以凡士林油纱布和无菌敷料包扎，术后1周供植皮区分别予以暴露和半暴露。结果：本组35例患者术后1周拆除供、植皮区敷料，移植表皮全部存活，经2月观察，移植皮片的色素较周围正常皮肤略有加深，无色素减退现象出现，供植皮区均无瘢痕增生。结论：磨削后移植大张自体刃厚皮片是治疗烧伤后脱色素改变的理想方法。     

表皮移植治疗外伤性色素脱失的疗效观察和护理体会

目的:观察表皮移植治疗创伤后色素脱失的疗效及总结护理要点。方法:我院门诊表皮移植治疗外伤性色素脱失的患者40例,按照随机原则分为治疗组和对照组各20例。每组使用皮肤磨削机磨掉外伤引起的色素脱失区瘢痕上皮,使用表皮移植仪获取自体表皮,将获得的表皮移植于瘢痕色素脱失区创面。总结围手术期护理要点,通过提高护理质量,进一步获得更好的疗效。治疗组表皮移植时创面使用生长因子,对照组使用生理盐水。结果:治疗组色素脱失治愈率为98%,高于对照组82%,差异具有统计学意义(P0.05)。结论:生长因子能够显著提高表皮移植治疗创伤后瘢痕性色素脱失的疗效,提升围手术期护理质量能够进一步稳定疗效。     

连续三次表皮移植和光疗快速治疗烧伤后色素脱失1例

目的：探索使用疱皮移植和光疗简便快速治疗烧伤后色素脱失的可行性。方法：选取大面积烧伤后色素脱失的患者,机械磨削除去白斑区表皮,使用表皮（疱皮）移植法,在患者腹部正常皮肤区域用负压加温吸疱的方法制造多个水疱,剪下疱皮,仔细贴附到磨去表皮的白斑移植区,妥善加压包扎。等待敷料脱落后1周左右开始用窄谱中波紫外线照射,促进色素恢复。如果效果好,则继续修补其他部位白斑。结果：1例患者45天内先后接受了3次疱皮移植治疗,术后2周可看到明显颜色恢复,用窄谱中波紫外线照射后4周左右,白斑移植区肤色已经接近正常皮肤,可达到痊愈水平。结论：表皮（疱皮）移植和窄谱中波紫外线光疗能治疗烧伤后色素脱失,颜色恢复快,有可重复性。     

切磨术加表皮移植治疗色素脱失的方法改进

深Ⅱ度烧伤或浅Ⅱ度烧伤感染创面愈合后常伴有色素缺失，表现为瘢痕中心区域呈白色，位于面部或手背部时常影响美观，以往没有特效的治疗方法。近年来虽然发现了一些治疗方法．但有诸多不足，需继续改进和完善。为此，我们经过多次改进。形成了一项具有简单、实用的治疗烧伤后色素脱失的方法。     

磨削术联合自体韧厚皮片移植治疗重度烧伤色素脱失性瘢痕

目的:探讨磨削术+自体韧厚皮片移植治疗重度烧伤后色素脱失瘢痕的临床疗效。方法:选取笔者医院2015年6月-2018年6月收治的重度烧伤后色素脱失瘢痕患者70例作为研究对象,按照随机数表法分为对照组(n=35)和研究组(n=35)。对照组给予磨削术+自体水疱皮移植治疗,研究组给予磨削术+自体韧厚皮片移植治疗。观察两组患者的效果评分、临床疗效、愈合时间及治疗时间、生活质量评分。结果:研究组的效果评分、临床疗效、生活质量评分均明显高于对照组,差异有统计学意义(P<0.05);研究组的愈合时间以及治疗时间明显少于对照组,差异有统计学意义(P<0.05)。结论:磨削术+自体韧厚皮片移植治疗重度烧伤后色素脱失瘢痕临床疗效显著,对患者的生活质量具有积极影响,临床价值突出,值得在临床上进一步推广应用。     

表皮移植术在烧伤后色素脱失性瘢痕中的应用

目的：观察表皮移植术在烧伤后色素脱失性瘢痕中的治疗效果。方法：将色素脱失性瘢痕表皮去除,保留瘢痕基底,再用电动取皮刀切取健康自体表皮移植,共治疗26例患者。结果：26例患者移植皮片完全成活,随访2个月～3年,色素缺失改善满意,无继发畸形和功能障碍。结论：表皮移植术是治疗烧伤后色素脱失性瘢痕的较理想方法。     

微晶磨削治疗面部瘢痕疗效观察

自2004年4月～11月，笔者采用SA2型秀诺微晶祛疤仪先后给26例面部瘢痕患者进行微晶磨削治疗，均取得了满意疗效，现将结果报道如下。     

Peripheral antinociceptive effects of morphine after burn injury

In a double–blind study, 2 mg of morphine in saline, or saline only, was given subcutaneously into a seconddegree bilateral leg–burn injury in 12 volunteers. Heat–pain thresholds and pressure–pain thresholds were significantly increased by local morphine administration. These results confirm experimental data demonstrating a peripheral antinociceptive effects of opioids in inflamed tissue.     

白癜风自体表皮移植术后移植区遗留白斑复色规律的研究

目的：观察白癜风自体表皮移植术后移植区遗留白斑的复色规律。方法：利用负压吸疱自体表皮移植术治疗白癜风,并在术后痂皮完全脱落后开始行窄谱UVB照射,在临床复诊时摄像并记录术后移植区遗留白宽大小的变化。结果：接受自体表皮移植术资料完整的白癜风患者33例,共接受手术移植的皮损为141片,移植后受皮区炎症消退后共出现内部遗留白斑1179片,其中面部411片,躯干768片;外部遗留白斑1836片,其中面部768片,躯干1068片。在内部、外部遗留白斑中,面部皮损的总有效率（97．57％,94．92％）均明显高于躯干部位的皮损（83．33％,79．21％）（P均〈0．05）。白斑宽度在相同范围时,面部内部和外部自斑的有效率分别火于躯干部（P均〈O．05）;在面部和躯干部自斑中,宽度≤lmm的内、外部白斑的有效率均分别大于该部位宽度〉1mm的内、外部白斑（P均〈0．05）;当白斑宽度在相同范围时,面部内部遗留白斑的有效率与该部位外部白斑没有明显的差异（P〉0．05）;当白斑宽度≤1mm时,躯干部内部遗留白斑的有效率与该部位外部白斑没有明显的差异（P〉0．05）,当白斑宽度〉1mm时,躯干内部白斑的有效率大干该部位外部白斑（P〈0．05）。结论：白癜风自体表皮移植术术后移植区遗留白斑复色与遗留白斑所在部位、遗留白斑的位置和遗留白斑面积密切相关。     

The effects of ketamine and propofol on bacterial translocation in rats after burn injury

BACKGROUND: Bacterial translocation (BT) occurs after thermal injury and may result from an ischemic intestinal insult. The aim of the study was to investigate the effects of ketamine and propofol as anesthetic agents on BT in an animal model of burn injury. METHODS: Sixty male Wistar Albino rats were randomly assigned to six groups of 10 rats each. Anesthesia was induced and maintained with ketamine in groups 1, 2 and 3 and with propofol in groups 4, 5 and 6 during 6 h. Groups 2, 3, 5 and 6 received 30% total body surface area (TBSA) third-degree burns. Groups 1 and 4 had no burn injury. Then, they were allowed to recover from the anesthesia at the end of 6 h. Mean arterial pressure (MAP) was monitored continuously and maintained within 10% of baseline (before burn injury) levels in all animals. Animals in groups 3 and 6 had a laparotomy to obtain a tissue sample from the terminal ileum for determination of intestinal lipid peroxidation by-product malondialdehyde (MDA) before (baseline) and 6 and 24 h after burn injury (ABI). So these animals were not included in the BT studies. At postburn 24 h, animals in groups 1, 2 and 4, 5 were sacrified and samples were taken from the mesenteric lymph nodes (MLN), liver and spleen for bacteriologic cultures. RESULTS: The incidence of BT was found to be significantly higher in group 2 than in all the other groups. Bacterial translocation incidence of group 5 was not significantly different from that of groups 4 and 1. Group 5 was associated with a significantly reduced number of enteric organisms per gram of tissue compared to group 2. Baseline MDA contents of groups 3 and 6 were similar. Ileal MDA levels were increased in group 3, but there were no significant changes in group 6 at 6 and 24 h ABI compared to baseline. CONCLUSION: Our results suggest that propofol as an anesthetic agent may prevent BT by scavenging reactive oxygen species and inhibiting lipid peroxidation in an animal model of burn injury.     

术中自体血液回收对体外循环术后全身性炎性反应的影响

目的　探讨在体外循环手术中使用洗涤式自体血液回收机 (ATS)对术后全身性炎性反应的影响。方法　将择期体外循环冠状动脉旁路移植术 (CABG)的 12例患者随机分为两组 (每组 6例 ) ,实验组 :将手术野渗血和停机后机血混合经 ATS处理后回输 ;对照组 :将停机后机血直接回输。于围手术期测定两组补体终末复合物(s C5b- 9)、白细胞介素 - 6 (IL - 6 )等炎性因子指标。实验组分别测定 ATS处理前后炎性因子指标。　结果　实验组回收血经 ATS处理后红细胞压积 (HCT)明显升高 (P<0 .0 1) ,s C5b- 9、肿瘤坏死因子 - α(TNF- α)和 IL- 6水平显著降低 (P<0 .0 5 )。停机 6小时、2 4小时和 4 8小时 ,实验组 s C5b- 9变化率均低于对照组 (P<0 .0 5 ) ,停机 4 8小时 ,实验组 IL - 6变化率低于对照组 (P<0 .0 5 ) ,术后两组 TNF- α水平以及变化率差别无显著性意义 ;停机 4 8小时 ,实验组中性粒细胞(PMN)显著低于对照组 (P<0 .0 1)。　结论　在体外循环手术中使用 ATS回收术野渗血和停机后机血可以去除绝大部分炎性介质 ,回输后可以降低术后部分炎性介质的水平 ,减轻体外循环术后的炎性反应。     

强脉冲光治疗烧伤后面部色素沉着疗效观察

目的：探讨强脉冲光治疗烧伤后面部色素沉着的疗效。方法：采用意大利GP公司的光子嫩肤仪对37例面部烧伤后色素沉着患者实施治疗,波长590～1200nm,治疗5～8次,每次治疗间隔20天,治疗过程中不采用任何麻醉,治疗完成后面部无需包扎。结果：所有患者均能耐受,经治疗后面部色素基本恢复正常。其中3例治疗区皮肤出现红斑和疼痛,均自行缓解,1例出现水疱,给予清创换药后愈合,后期继续行强脉冲光治疗,无色素沉着及瘢痕形成。随访3～6个月,面部皮肤色泽如常,患者比较满意。结论：采用强脉冲光治疗面部烧伤后色素沉着疗效可靠、操作简单、治疗耗时短,不影响日常工作和生活,无严重并发症发生,是一种较理想的治疗烧伤后色素沉着的方法,而且应在伤口愈合后早期应用。     

The effects of early excision and grafting on myocardial inflammation and function after burn injury

BACKGROUND: Sepsis is a frequent complication of burn injury despite absence of confirmed infection. Numerous investigators have proposed that the burn wound itself is a primary stimulus for postburn inflammation, and that early excision of the burn wound attenuates the hypermetabolic and inflammatory responses to burn injury. However, others have suggested that aggressive fluid resuscitation and correction of postburn fluid and electrolyte deficits should be the primary focus of intervention in the first 24 hours postburn. This present study determined whether excision and grafting of the burned wound within 30 minutes after injury abrogated myocardial inflammation and contractile defects that occur after burn injury. METHODS: In group 1, Sprague Dawley rats were given a third-degree burn over 20% total body surface area (TBSA), whereas rats in group 2 had burns over 30% TBSA and no wound excision. Rats in groups 3 and 4 had burn over 20% and 30% TBSA, respectively, followed by-wound excision and grafting (WE/G) within 30 minutes after completing burn injury. Group 5 included sham burn with no excision, whereas rats in groups 6 and 7 included shams that had either 20% or 30% normal skin excised and grafted to provide appropriate surgical controls. All rats received lactated Ringer's (4 mL/kg/% burn or percent wound excision). Twenty-four hours postburn, hearts were perfused (Langendorff) to assess ventricular function; myocytes were isolated to examine cytokine secretion and Ca2+/Na+ homeostasis. RESULTS: Burn in the absence of wound excision produced myocardial inflammation and contractile defects as indicted by a lower left ventricular pressure and lower rate of left ventricular pressure rise (+dP/dt) and fall (-dP/dt) response to maximal increases in preload or perfusate Ca2+ compared with responses measured in sham hearts. WE/G within 30 minutes after burn injury reduced myocyte secretion of proinflammatory cytokines and improved left ventricular pressure and +/-dP/dt responses to inotropic challenge. CONCLUSION: Cutaneous burn injury and the loss of the skin barrier function contribute, in part, to the myocardial inflammation which, in turn, contributes to myocardial contractile dysfunction that is characteristic of major burn injury.     

The effects of propofol and ketamine on gut mucosal epithelial apoptosis in rats after burn injury

BACKGROUND AND OBJECTIVES: Apoptosis occurs after thermal injury and may result from either ischaemic intestinal insult or inflammatory mediators released after burn injury. The aim of the study was to investigate the effects of propofol and ketamine on gut epithelium apoptosis after burn injury. METHODS: Sixty male Wistar Albino rats were randomly assigned into four groups. Anaesthesia was induced and maintained with propofol in Groups 1 and 2, and ketamine in Groups 3 and 4 over 12 h. Groups 2 and 4 received 30% total body surface area burn. Groups 1 and 3 had no burn injury. Mean arterial pressure was maintained within 10% of baseline levels in all animals. At 12 h postburn, animals were sacrificed and tissue samples were taken from small intestine for determination of lipid peroxidation, apoptosis and proliferation. Also blood samples were taken for measurement of serum tumor necrosis factor-alpha (TNF-alpha) levels. RESULTS: Ileal malondialdehyde (MDA) concentration (extent of lipid peroxidation) increased significantly in Group 4 (112.4 +/- 10.2 nmol g-1) compared to Group 3 (48.4 +/- 5.6 nmol g-1) and Group 2 (59.8 +/- 3.2 nmol g-1). The mean TNF-alpha level in Group 4 (118.9 +/- 10.5 pg mL-1) at 12 h postburn was significantly higher than the mean in Group 2 (56.4 +/- 4.3 pg mL-1). Group 4 had the highest mean TUNEL index (terminal deoxyuridine nick-end labelling--an index of extent of apoptosis) of all the groups (265/10). Also the mean TUNEL index value in Group 2 (53/10) was higher than that of Group 1 (3/10) and Group 3 (5/10). The proliferating cell nuclear antigen index (extent of proliferation) remained unchanged among groups. CONCLUSIONS: Propofol could offer a protection against apoptosis of enterocytes with a stable tissue MDA and serum TNF-alpha level compared to ketamine anaesthesia in an animal model of burn injury.