烧伤创面应用硝酸铈的实验研究

为探讨硝酸铈的应用价值,比较了烧伤创面行硝酸铈湿敷和早期切痂对严重烧伤后大鼠存活率和 T 细胞亚群变化的影响。结果表明:大鼠30%TBSA Ⅲ度烧伤后第14天,存活率低,外周血 Th/Ts 比值显著降低,而烧伤后早期手术切痂或创面硝酸铈湿敷则能明显提高大鼠存活率和外周血 Th/Ts比值。认为,早期切痂或创面硝酸铈湿敷均有防止烧伤后 T 细胞 Th/Ts 比值下降和提高存活率的作用。烧伤休克期,如不具备早期手术切痂的条件,用硝酸铈湿敷是一种简便有效的治疗方法。     

烧伤创面应用硝酸铈的实验研究

为探讨硝酸铈的应用价值，比较了烧伤创面硝酸铈湿敷和早期切痂对严重烧伤后大鼠存活率和Ｔ细胞亚群变化的影响。结果表明：大鼠３０％ＴＢＳＡⅢ度烧伤后第１４天，存活率低，外周血Ｔｈ／Ｔｓ比值显著降低，而烧伤后早期手术切痂或创面硝酸铈湿敷则能明显提高和大鼠存活率和外周血Ｔｈ／Ｔｓ比值。     

严重烧伤大鼠精氨酸治疗的实验研究

为探讨精氨酸在严重烧伤治疗中的意义，采用大鼠３０％ＴＢＳＡⅢ度烧伤模型，观察并分析了严重烧伤大鼠外周血Ｔｈ／Ｔｓ比值的变化及精氨酸对该变化的调节作用和对大鼠存活率的影响，结果表明：（１）严重烧伤后第３天起即有Ｔｈ／Ｔｓ比值的下降，第１０天下降最为明显；（２）精氨酸能防止烧伤后Ｔｈ／Ｔｈ比值下降，这种作用在伤后第５天起就比较显著，（３）精氨酸能提高后动物的存活率，提示严重烧伤后补充精氨酸是增强机体免     

严重烧伤大鼠精氨酸治疗的实验研究

为探讨精氨酸在严重烧伤治疗中的意义,采用大鼠30%TBSAⅢ度烧伤模型,观察并分析了严重烧伤大鼠外周血 Th/Ts 比值的变化及精氨酸对该变化的调节作用和对大鼠存活率的影响。结果表明:①严重烧伤后第3天起即有 Th/Ts 比值的下降,第10天下降最为明显。②精氨酸能防止烧伤后 Th/Ts 比值下降,这种作用在伤后第5天起就比较显著。③精氨酸能提高伤后动物的存活率。提示严重烧伤后补充精氨酸是增强机体免疫力和抗感染能力,提高存活率的有效的治疗手段。     

严重烧伤大鼠精氨酸治疗的实验研究

为探讨精氨酸在严重烧伤治疗中的意义，采用大鼠３０％ＴＢＳＡⅢ度烧伤模型，观察并分析了严重烧伤大鼠外周血Ｔｈ／Ｔｓ比值的变化及精氨酸对该变化的调节作用和对大鼠存活率的影响。结果表明：①严重烧伤后第３天起即有Ｔｈ／Ｔｓ比值的下降，第１０天下降最为明显。②精氨酸能防止烧伤后Ｔｈ／Ｔｓ比值下降，这种作用在伤后第５天起就比较显著。③精氨酸能提高伤后动物的存活率。提示严重烧伤后补充精氨酸是增强机体免疫力和抗感染能力，提高存活率的有效的治疗手段。     

神经生长因子调控烧伤创面的实验研究

目的 研究神经生长因子（ＮＧＦ）在烧伤创面愈合的作用,探索烧伤创面愈合机制。方法２０ｋｇ小白家猪６只为实验对象。用控温控压电烫仪在每只猪背部制成２４个直径为２．５ｃｍ的圆形深Ⅱ度烧伤创面。分为四组,分别为创面局部应用１、２．５和５μｇ／ｍｌ的ＮＧＦ实验组和不含ＮＧＦ的生理盐水对照组。在用药后３、５和９天分别取创面组织进行表皮生长因子（ＥＧＦ）受体,ＥＧＦ,ＮＧＦ受体,ＮＧＦ,ＣＤ６８,ＣＤ３免疫组     

细胞免疫与烧伤创面愈合的实验研究

为探讨免疫低下对烧伤创面愈合的影响，设计了用低剂量钴源照射的方法建立的免疫抑制模型，并在该模型的基础上观察了免疫抑制大鼠Ⅱ度烧伤创面的情况，结果表明：（１）大鼠接受２Ｇｙ＾６０Ｃｏ照射后２０天内，Ｔｈ／Ｔｓ比值和Ｔ细胞肿瘤花环率持续下降，照射皮肤组织ＤＮＡ含量及细胞周期均无明显改变；（２）免疫抑制大鼠胶原修复能力下降，创面愈合百分率低下正常大鼠，由此证实了免疫功能低下对创面愈合的抑制作用。     

微波热调节肢体慢性淋巴水肿免疫紊乱的实验研究

对２０例肢体慢性淋巴水肿患者，在烘绑治疗前后，取外周血，用直接荧光标记单克隆抗体染色技术和流式细胞仪法检测Ｔ细胞亚群和ＨＬＡ－ＤＲ表型变化，并与正常健康人对照，结果表明：肢体慢性淋巴水肿患者外周血ＣＤ４明显下降，ＣＤ４／ＣＤ８比值明显下降（Ｐ（０．０１），ＨＬＡ－ＤＲ水平增高。患者经微波烘疗两疗程后，ＣＤ４／ＣＤ８比值明显提高，ＣＤ４明显增高，ＨＬＡ－ＤＲ和ＣＤ８ＨＬＡ－ＤＲ明显下降。提示微波对肢     

Experimental and clinical studies on the absorption and toxicity of cerium nitrate

Summary In this publication we present the results of three studies concerning the toxicity and absorption of cerium. In the first experimental study in rats, following the application of a 2.2% solution of cerium nitrate on dorsal wounds for five weeks, delayed healing was demonstrated and histological examination revealed richly vascularized granulation tissue in which microcalcifications and foreign-body type giant cells were found. A high concentration of cerium was found in the liver. The second experimental study employing rat enterocytes demonstrated an immediate cellular toxicity after exposure to a 2.2% cerium nitrate solution. Correction of pH and/or osmolarity did not play a protective role. In the clinical evaluation, significant levels of cerium were found in six blood samples and four urinary specimens, following the application of a 2.2% cerium nitrate solution on burn wounds. Liver biopsies were performed in two cases. There were no abnormal histological findings, but cerium levels were elevated.     

Methemoglobinemia by cerium nitrate poisoning

Cerium nitrate is a topical antiseptic used with silver sulfadiazine (Flammacerium^®) for the treatment of serious burns. This topical agent can induce methemoglobinemia, but no cases have been reported in the recent literature. In this article, we present the case of a 16-year old girl, with third-degree burns over 95% of her body. After daily dressings of Flammacerium^®, on the sixth day she developed a bluish skin coloring. When tested for methemoglobinemia, levels of 31.8% were found. These returned to normal after classic treatment with Methylene blue.     

Comparison of silver nylon wound dressing and silver sulfadiazine in partial burn wound therapy

The study aims to perform a comparative assessment of two types of burn wound treatment. To do the assessment, patients with partial thickness burn wounds with total body surface area <40% were simple randomised to treat with nanocrystalline silver nylon wound dressing or silver sulfadiazine cream. Efficacy of treatment, use of analgesics, number of wound dressing change, wound infection and final hospitalisation cost were evaluated. The study showed silver nylon wound dressing significantly reduced length of hospital stay, analgesic use, wound infection and inflammation compared with silver sulfadiazine.     

Evaluation of a bi-layer wound dressing for burn care I. Cooling and wound healing properties

Severe burns remain a significant cause of morbidity and mortality despite the availability of numerous therapies. We assessed the wound healing and skin-cooling properties of a DRDC hydrogel/polyurethane wound dressing using different pre-clinical models. Our results show that 85% of partial-thickness, non-contaminated porcine wounds treated with our dressing healed within 6 days. In contrast, 85% of the wounds treated with commercial dressings healed within 8 days. Application of a moist DRDC dressing (to simulate a condition of exudate absorption) on a scald burn covering 25% of the dorsal area in rats reduced skin temperature by 1.70 +/- 0.14 degrees C for 5 min, the skin temperature being comparable to that of control burned rats after 20 min. The application of a moist DRDC dressing did not induce significant differences in body temperatures compared with that of burned animals without dressing coverage throughout the 90-min experiment. While no change in body temperatures were observed when standard dressings (i.e., not pre-moistened) were applied, skin temperature increased gradually. These data show that our dressing is effective in promoting faster healing of the treated wound; and providing a transient, but beneficial cooling effect to the skin contact-site, without the adverse effect of inducing whole-body hypothermia.     

乌司他丁对严重烧伤小型猪肠黏膜损伤的影响

目的探讨蛋白酶抑制剂乌司他丁(Ulinastatin,UTI)对大面积烧伤后早期炎性介质、氧自由基产生和肠黏膜通透性改变的保护作用. 方法贵州三系雄性小型猪12只,造成背部35%TBSAⅢ度烧伤模型, 随机分为烧伤对照组(A组,6只)、UTI治疗组(B组,6只).B组动物于伤后1 h给予UTI 5 000 U/kg,缓慢静脉滴入;A组动物给予等量等渗盐水,3次/d,直至动物处死.分别于动物烧伤前(A、B两组各随机选取4只动物抽取静脉血作为正常对照)、伤后6、24、48、72 h抽血检测血清肿瘤坏死因子α(TNFα)、白细胞介素6(IL-6)、丙二醛(MDA)、超氧化物歧化酶(SOD)、血清二胺氧化酶(DAO)、D-乳酸含量. 结果伤后6 h,各组动物血清TNFα含量较伤前显著升高,尤以A组明显,高峰为伤后24 h,随后呈下降趋势.B组各时相点TNFα含量均低于A组,差异有显著性意义(P<0.05). IL-6的改变与TNF-α基本一致.A组动物伤后6～72 h血清MDA较伤前显著升高,SOD消耗明显增多.B组各时相点MDA含量均低于A组,SOD消耗明显减少,两组比较差异有显著性意义(P<0.05).伤后小肠黏膜屏障功能受损明显,血清DAO活性及D-乳酸含量显著升高.B组肠道功能明显改善,功能特异性酶含量明显减少. 结论 UTI能显著抑制过度的炎性反应,减少氧自由基释放,降低SOD消耗,从而减轻对肠黏膜屏障的损伤和肠通透性增高的程度.     

Evaluation of a bi-layer wound dressing for burn care. II. In vitro and in vivo bactericidal properties

We have recently designed a medicated bi-layer wound dressing to address the key requirements for treating external, contaminated war wounds. This study assessed the in vitro and in vivo bactericidal efficacies of the DRDC hydrogel/polyurethane wound dressing. Chloramphenicol- and chlorhexidine-loaded DRDC dressings produced significantly larger zones of inhibition against Pseudomonas aeruginosa than the other medicated dressings for 4 d. Chlorhexidine-loaded Allevyn and Hydrasorb remained bactericidal for 48 h only. Chloramphenicol-loaded Hydrasorb and Allevyn remained bactericidal for 1 and 3 d, respectively. Ps. aeruginosa and Staphylococcus epidermidis counts in wounds treated with chlorhexidine- and chloramphenicol-loaded DRDC dressings for 24 h were 1-3-log lower than those of control wounds. While Ps. aeruginosa counts in the wounds on day 4 were comparable following daily changes of either antiseptic-loaded dressings, chlorhexidine showed a 75% greater bactericidal efficacy against Staph. epidermidis than chloramphenicol. Though increasing the frequency of dressing changes led to a greater reduction in the wound bacterial load, the contamination levels of all antiseptic-treated wounds remained below 10(5) CFU/g of wound. Cerium nitrate-loaded dressings did not exert any bactericidal effect, irrespective of the experimental conditions. These data show that the DRDC dressing is effective in delivering medications, such as an antimicrobial agent, to the wound bed.     

影响碱性成纤维细胞生长因子促进烧伤创面愈合因素的探讨

采用大白鼠１５％Ⅲ度烧伤模型，探讨了影响碱性成纤维细胞生长因子（ｂＦＧＦ）促进烧伤创面愈合的因素。结果发现，烧伤创面早期切痂可保持ｂＦＧＦ的活性。４０天创面愈合率达８４．０％，而未切痂组愈合率仅９，Ｏ％。肝素可增强ｂＦＧＦ促进创面肉芽组织生长、毛细血管增生、纤维母细胞增殖及细胞ＤＮＡ合成。创面感染的控制有利于保护ｂＦＧＦ的活性。伤后１周开始使用ｂＦＧＦ为适宜时期。     

Hematogenous cervical spondylodiscitis after severe burn injury

A 47-year-old man sustained a 31% TBSA burn injury. In spite of early escharectomy and mesh-graft-transplantation the patient suffered a septicaemic phase in the first week, which was treated by a specific antibiotic. Five weeks after the burn injury a cervical spondylodiscitis was diagnosed. Immediate wound debridement, ventral and dorsal spondylodesis with a tricortical bone-graft from the left iliac crest and titanium plates and specific antibiotic therapy led to the stabilization and healing of the cervical spinal column. The spondylodiscitis was microbiologically proved to be hematogenous after spread of Staphylococcus aureus from the blood in the early septicaemic phase. Swab culture from the burn surface wound, infected vertebrae and blood during the septicaemic phase revealed coagulase positive S. aureus. The aetiology, predisposing factors and management of this rare, but recognized, complication of major burns are discussed. Case features of this patient are compared with the single site's reported case of hematogenous cervical spondylodiscitis after severe burn injury.     

Effects of cerium nitrate bathing and prompt burn wound excision on IL-6 and TNF-alpha levels in burned rats

The physiopathological events following thermal injury are not limited to the surface effects of heat but are also related to acute inflammatory reactions. Both tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are important mediators of the acute and severe inflammatory reaction in thermal injury. Surgical manipulation of the burn wound is known to prevent excessive release of cytokines. Cerium nitrate--a rare earth element--has been reported to have a protective effect against postburn immunosuppression. The aim of this study was to compare the effects of burn wound debridement and treatment with cerium nitrate bathing on the serum levels of TNF-alpha and IL-6 in rats. Treatment by cerium nitrate bathing prevented the elevation of TNF-alpha levels in the early period after thermal injury. The experimental study showed, as in other studies, that high levels of IL-6 appear to inhibit TNF-alpha elevation. High levels of IL-6 and, as a result, relatively low levels of TNF-alpha in the early period of thermal injury may limit the severity of the inflammatory reaction, which is caused by TNF, the most potent inflammatory cytokine. Since similar levels of IL-6 and TNF-alpha were achieved by both cerium nitrate bathing and burn wound debridement, cerium nitrate may be considered as equivalent to prompt excision of burn eschar.