烧伤植皮术后早期康复介入对肢体及功能的影响

Background: Recovery of movement function of affected limbs after burn is an important topic of treatment and rehabilitation of burn.Both heat and non- heat factors can injure body and lead to permanent disability.We treated 36 burn dermatoplasty cases with early rehabilitation intervention from February 1999 to February 2002 and gained satisfactory effects.     

Experience of rehabilitation treatment on 234 cases of burn

BACKGROUND: At present, treatment of bum is not only to save life and promote healing of wound surface, but lateral rehabilitation and problems about returning to society are included. Rehabilitation treatment of bum should be performed through the entire therapeutic course.OBJECTIVE: To explore the effects of rehabilitation treatment on burn.UNIT: Department of Burn, Affiliated Second Hospital of Kunming Medical CollegeSUBJECTS: From October 1985 to October 2001,234 patients with burn received rehabilitation including 146 males and 88 females aged 10 months to 68 years (mean: 23. 4 years). Among all cases, comprehensive therapy was performed for 230 times, support and slit therapy was performed for 141 times.INTERVENTION: Affected limbs were laid at function posi-     

脱细胞异体真皮加自体薄皮复合移植减少瘢痕形成

BACKGROUND:Autogenous skin graft is a common method in treatment of deep burn,late survive effect of grafted skin flap is directly related to its thickness.In clinic,therapeutic effect of full thickness graft is the best.However,due to large skin providing area that can't be sutured directly and survive rate of graft at infected wound surface is very low,its clinical application is limited,especially in deep burn with large area.This study is to search a best material repairing wound surface of deep burn,reduce proliferation of scar and protect limbs function.     

手部深度烧伤后畸形防治体会

INTRODUCTION How to prevent hand deformity caused by burn, restore appearanceand working ability has been alwaya the main problem, the follow-ing is the report about causes of deformity and experience of pre-vention and treatment.     

The replacement strategies of the fluid resuscitation for burn shock in an austere environment

It is universally recognized that excessive depletion of fluid from the circulation after severe burn injury result in burn shock.This initial hypovolemic phase is a potentially fatal condition coincides with early death and serves as a predisposing cause of many life-threatening complications such as tissue edema and multiple organ dysfunctions(MODS).Prompt and sufficient fluid resuscitation as early as possible is widely used to restore effective intravascular volume and improve organ perfusion as the standard treatment regime for this hypovolemic phase post severe burn injury.Unfortunately,conventional fluid resuscitation is inevitable delayed and even impossible when mass victims occur in austere environments such as battlefield,earthquake,or accidents.In such circumstance,severe burn injury is associated with high mortality for the lack of sufficient medical support.At present,oral fluid resuscitation and HDACI in early period of burn shock are important measures in the treatment of casualties in the battlefield as well as in mass casualties in lieu of the means of establishing a venous line.     

Effect of cocolyster on defecation function of patients with rectal carcinoma after operation

Background:Deep burn of hands can cause severe dysfunction.Early plerosis to the hands will play an important role to the functional exercise and the recovery.Objective:To observe the effect of early treatment of deep burn of hands to the functional reservation and prevention of scar proliferation.Unit:Department of Burn,People‘s Hospital of Gansu Province.Subjects: 1118 burned patients were recruited during December of 1998 to December of 2001.In them 252 patients were complicated with burn of hands,in which 129 hands were deep burns (96 males and 33 females,aged from 1 to 67,most of them were yound).The causes of burns were flame burn,scald by hot fluid,electric burn,chemical burn and hot crush injuries.Intervention:Excise the eschar of 59 hands with burns of deep Ⅱ to superficial Ⅲ and 21 hands with burn of Ⅲ degree.Perform dermatoplasty of local skin flap,abdominal flap,dorsolateral flap of index finger,reticular thin flaps with pedical containing subdermal vessels and fascial flaps to the 15 hands with injuries of tendons,bones and joints;Cut off granular wound surface and transplant large piece of intermediate split thickness skin graft and full split thickness skin graft to 5 hands;transplant postage stamp-shaped razor-thin graft or intermediate split thickness skin graft to 14 hands.Results:In the 129 hands,103 hands could keep the functios in maximal degrees 1-2 weeks after burning,most of them could begin to move after taking out stitches and could care themselves in the end.After 4-5 weeks,the hands with deep Ⅱ burn could recovery functions after dressing change,new skin excision,transplantation of large piece of intermediate of full split thickness skin graft,All of Hands Could resume the functions.In 14 patients with transplantation of stamp-shaped skin flaps on granular wound surfaces of hands‘ bank and fingers,the contracture were prominent and claw hands were formed in the late phase.11 hands of mixed burns of deep Ⅱ and Ⅲ were self-healed after repeated dressing change,proliferative scars appeared 4-5 weeks after burn.Although local medication and active and passive training,the hands were still with dysfunctions and take operative plerosis in late phase.Conclusion:Deep burn of hands should be treated with corresponding methods 1-2 weeks after the burning,which could reserve the functions,decrease mutilation rate and prevent contracture of scars in greatest degrees.     

Compound graft with acellular exoge-nous dennis and autogenous thin skin reducing formation of scar

BACKGROUND: Autogenous skin graft is a common method in treatment of deep bum, late survive effect of grafted skin flap is directly related to its thickness. In clinic, therapeutic effect of full thickness graft is the best. However, due to large skin-providing area that can't be sutured directly and survive rate of graft at infected wound surface is very low, its clinical application is limited, especially in deep burn with large area. This study is to search a best material repairing wound surface of deep burn, reduce proliferation of scar and protect limbs function.     

严重烧伤病人的综合康复疗效分析

Background:Appearance and function damage after burn are caused by scar hyperplasia after wound repair.So main task of burn rehabilitation is prevention and treatment of hypertrophic scar. Pressure therapy can promote scar maturation;decrease itching,consistency and thick of scar.     

脾脏调节性树突细胞对烫伤小鼠炎症反应及预后的影响

Objective To observe the effect of regulatory dendritic cells (DCregs) on burn injury induced proinflammatory cytokine production and mortality rate after a single intraperitoneal injection of CD11clowCD45RBhigh DCs to injured mice. Methods DCregs were isolated and purified from spleen of 100 normal BALB/c mice to procure CD11clowCD45RBhigh DCs by MiniMACS. Mice were subjected to a 15% total body surface area (TBSA) burn injury on the back. Twenty mice were used, and splenic DCregs (1×105/ml, 5×105/ml, 10×105/ml) were given to them to investigate the protective effect of DCregs against lethality at postburn hours (PBH) 48, and to decide the optimal dosage of intervention. Another group of 70 mice were used, and they were divided into normal control group (n=7), sham burn injury group (n= 21), burn injury group (n = 21), and DCregs treatment group (n = 21). The mice in burn injury group received intraperitoncally 1 ml of Ringer solution for resuscitation. 10×105/ml of CD11clowCD45RBhigh DCs were added to lactated Ringer solution for intraperitoneal injection in DCregs treatment group. Seven animals of each group were sacrificed at PBH 12, 24 and 48, respectively, and blood samples were collected aseptically for measurement of cytokine levels in plasma and phenotype expressions on DCs by flow cytometry. Results Treatment with 10×105/ml DCregs showed a significant decrease in mortality rate compared with burn injured mice and burn injured mice given lower doses of DCregs (1×105/ml, 5×105/ml DCregs, 0% vs. 80%, 80% and 60%, all P＜0. 01). A single intraperitoneal injection of 10×105/ml DCregs to burn injury mice showed a significant decrease in plasma interleukin-6 (IL-6, ng/L: 98. 76 ±10.02, 57. 83 ±6. 83, 13.29 ±1.07) compared with burn injury mice (156.32 ± 12. 85, 84. 50 ±9. 29,23.04±2. 53) at PBH 12, 24 and 48 (all P＜0. 01). Similarly, in 10×105/ml DCregs treatment group,plasma macrophage chemoattractant protein-1 (MCP-1) levels (ng/L: 102.79 ±9. 88, 42. 56 ±5. 90,12. 96±1. 34) were markedly lower than those in burn injury group (168. 23±23. 85, 83. 39±8. 41, 42. 92±4. 96) at PBH 12, 24 and 48 (all P＜0. 01). A single intraperitoneal injection of 10×105/ml DCregs to burn injury mice showed significant reduction in plasma tumor necrosis factor-α (TNF-α) levels (ng/L: 16. 84±1.92, 16. 62±1.28, 10. 26±1. 10) compared with burn injury mice (24. 16±4. 93, 24.25±4. 01, 17. 91±1.82) at PBH 12, 24 and 48 (all P＜0. 01). Conclusion DCregs may effectively improve the outcome of mice with severe burn injury through a single intraperitoneal injection of DCregs accompanied by lowering excessive inflammatory reaction.     

烧伤后肠黏膜免疫组织细胞增殖分化的特征性研究

BACKGROUND: The descent of intestinal mucous membranous immune barrier will cause the translocation of opportunistic pathogen, which will lead to enterogenous infection that will affect the rehabilitation of patients‘ organisms and relevant functions, but the mechanism is still not well established.OBJECTIVE: To observe the transition of mIgA in peyer patch lymphocytes (PPL) and the conditions of proliferations in vitro of lamina properia lymphocytes(LPL) in intestinal mucous membranous immune tissues after burn,in order to increase mucous membranous immune barriers, to prevent enterogenous infections and to provide a clinical gist in speeding up rehabilitations in burn patients.DESIGN: A random control vertical study.SETTING and PARTICIPANTS; This study was completed in the Central Laboratory and Department of Burn Surgery, General Hospital of Chinese People‘s Armed Police Forces. Subjects were 20 SPF mice.INTERVENTION: The mice were randondy grouped into control group (n= 10) and burn group/n = 10). Mice in burn group were burnt with 20% of total body surface area(TBSA) in III degree burn and executed after 3-day of injury together with the mice in control group.MAIN OUTCOME MEASURE; IgA plasmoeytes in intestinal lamina propria(LP) were observed by in vivo imnmnohistochemical staining; IgA on the surface of lymphocytes in PP were counted by flow cytometry; in vitro proliferations of LP lymphocytes were assayed after burn; IL-6 in intestinal tissue was assayed b) ELISA.RESULTS: The positive rate of IgA in PP after 3-day of burn was lower than that of control group: the numbers of IgA ptasmocytes in LP after burn were significantly less than the level before burn, in vitro proliferation of the lymphocytes in LP was distinctly decreased after burn; the level of IL-6 in intestinal tissue had no significant difference compared with that of control group.CONCLUSION: Burn irffdbits the proliferation and differentiation of lymphocytes in intestinal mucous membranous immune tissues, which will lead to the depression of mucous membranous immune barrier.     

组织成批烧伤病人的护理管理

目的总结及探讨成批烧伤病人的系统化、规范化护理要点。方法对2000～2004年烧伤科收治的成批烧伤病人的护理措施及方法进行总结、分析。结果 2000年1月～2004年11月,烧伤科共收治7批成批烧伤病人,各批烧伤病人均得到了系统化、条理化及规范化的护理,提高了成批烧伤病人的救治水平。结论系统化、条理化、规范化的护理可以提高成批烧伤病人的救治水平。     

院内应急处置流程在批量烧伤伤员早期救治中的应用

目的 探讨院内应急处置流程在批量烧伤伤员早期救治中的作用.方法 制订院内应急处置流程,成立应急抢救小组,并组织烧伤知识学习及批量伤员应急救治流程演练,在批量烧伤伤员早期救治中启动院内应急处置流程.结果 有效缩短抢救时间、伤员来院至开展救治的时间(P＜0.01),抢救成功率达到100.00％.结论 在批量烧伤伤员早期救治...     

特重烧伤患者的集束化治疗

目的 总结2例特重烧伤患者在ICU的救治经验和体会,旨在进一步提高特重烧伤患者的救治水平.方法 回顾分析2009年6月2例重症烧伤患者的诊治经过程和临床资料.结果 1例患者病情好转,转出ICU继续治疗,1例患者伤后37 d因消化道出血死亡.结论 特重烧伤患者的治疗需要整体计划和多科协作.     

Effects of high-dose vitamin C administration on postburn microvascular fluid and protein flux.

The effects of vitamin C treatment (14 mg/kg/hr) on burn injury were evaluated in the hind paws of 12 mongrel dogs. A lymph duct above one hind paw of each dog was cannulated. Hourly lymph flow rates (QL) and plasma and lymph total protein concentrations were measured before the burn injury and for 6 hours after the burn injury. Data from 24 paws were divided into four groups: nonburn without treatment, nonburn with treatment, burn without treatment, and burn with treatment. The nonburn groups showed no significant differences in QL or in total protein flux. In the burn groups the postburn hourly QL increased by sevenfold in the nontreatment group and only by threefold in the treatment group, whereas the postburn hourly total protein flux increased by fifteenfold and fivefold, respectively. We conclude that administration of high-dose vitamin C reduces early postburn microvascular leakage of fluid and protein.     

张氏烧伤抗瘢痕秘药发掘的现实意义与临床研究

目的：为临床选择有效的烧伤治疗药物。方法：分析烧伤机制及豫垲中药传世秘方“张氏烧伤（抗瘢痕）秘药“的方剂组成，药理，炮制及临床疗效。结果：张氏烧伤（抗瘢痕）秘药外敷配合应用抗生素，具有缓解剧痛，抗休克明显减少瘢痕形成，创造无痛烧伤治疗新理念的特点，结论：“张氏烧伤（抗瘢痕）秘药”治疗烧伤效果比单用西药好，宜于临床推广。     

提高烧伤患者自尊水平的心理干预

目的:制定一套临床可行、有效的烧伤患者心理干预训练模式以提高烧伤患者自尊水平.方法:120例烧伤患者分为干预组和对照组各60例,均给予常规治疗和护理,干预组并配合心理干预训练2个月.参照自尊量表36个项目对2组患者治疗前后自尊水平进行评分.结果:治疗2个月后,干预组患者自尊水平与对照组比较有显著提高,其中轻度患者自尊水平改善比中、重度患者更明显;不同性别、文化程度患者在自尊改善项目上存在差异.结论:有效的心理干预模式能显著改善烧伤患者的心理素质,提高自尊和健康水平.     

批量烧伤全程护理体系的研发与应用

目的探讨全程护理体系在成批烧伤患者救治中的应用效果。方法通过对批量烧伤患者从院前急救,院内救护、手术护理、康复护理、心理干预等全程护理体系,规范批量烧伤的应急处置流程,优化院外及院内救护各个环节,早期进行全程心理干预、实施专业化功能锻炼等方法。结果通过全程、规范、专业的护理,有效缩短院前急救时间,缩短住院周期,提高批量烧伤伤员的抢救成功率,降低并发症及死亡率。结论批量烧伤全程护理体系的应用,能够优化护理流程,可确保救治流程的畅通,提高批量烧伤伤员救治成功率。     

A survey of attitudes of burn unit nurses

The staff of a burn unit was surveyed concerning attitudes about their patients and the treatment procedure. Previous research indicates that in such medical settings paradoxical interactions (double binds) may occur among staff, patient, and family. We hypothesized that the paradoxical environment of burn care units facilitates individuals who can change their perspective (or reframe these situations) and that this ability is related to attitudes and feelings about burn patients and their treatment. Contrary to expectation, however, reframing ability and attitudes about burn care were not related. Staff members are quite positive about burn treatment and agree that the staff instills hope. The staff's endorsement of providing accurate information, while behaving optimistically even if pessimistic about the patient's condition, does represent possible double-binding communication patterns. Nursing managers with high reframing ability may facilitate staff coping with these issues.     

Management of burn wounds in the emergency department

This article makes some introductory comments on the histology of the skin and the pathophysiology of burn injury as these topics pertain to the estimation of the depth of the burn injury. The definition of a major burn and the salient points of its treatment are covered. In addition, some general comments are made about several special injuries for which burn center referral usually is sought. Finally, guidance is given in the selection and treatment of patients who have burns that may be treated on an outpatient basis.     

大面积烧伤合并创面脓毒症40例临床分析

目的:总结烧伤合并创面脓毒症的临床特点和防治措施。方法:回顾性分析我科2007年1月至2012年12月收治的烧伤合并创面脓毒症40例的临床资料。结果:治愈32例,死亡8例。结论:烧伤早期休克渡过不平稳及创面早期处理不当易致创面脓毒症,预防强调积极有效的液体复苏、早期肠道营养、加强代谢与免疫调理、尽早封闭创面及加强多器官功能保护与支持,治疗强调以创面处理为核心的综合治疗策略,尽早手术覆盖封闭深度创面是救治成功的关键。