特重度烧伤患者绿脓杆菌感染的临床特点与护理

目的 探讨特重烧伤患者绿脓杆菌感染的特点与护理治疗方法。方法 回顾分析本院64例特重烧伤患者绿脓杆菌感染的救治与护理过程。结果 本组44例特重烧伤合并绿脓杆菌感染患者，除8例因经济原因无法救治外，4例死于各种并发症。其成功救治除了临床上对绿脓杆菌感染的早期预防和高敏感性抗生素的使用外，护理中严格控制交叉感染、注重日常护理常规以及红外线辐射床等辅助措施也起重要作用。结论 特重烧伤患者绿脓杆菌感染的救治重在预防交叉感染、及时应用有效抗生素和加强常规护理措施。     

耐甲氧西林金黄色葡萄球菌感染特重烧伤并发出血性脑梗死2例

本院收治2例耐甲氧西林金黄色葡萄球菌(MRSA)感染特重烧伤并发出血性脑梗死患者,救治无效死亡,报告如下.     

密闭性燃烧致重度吸入性损伤患者的护理

目的总结密闭性燃烧致重度吸人性损伤患者的护理。方法2009年6月-2009年8月,针对2例密闭性燃烧致重度吸人性损伤患者,成立多学科医护人员救治小组,以特别的治疗和针对性的护理,予以全力抢救。结果1例患者38d后因病情突变死亡,另1例患者病情平稳,转回普通病房继续治疗。结论多学科护理合作是吸人性损伤合并特重烧伤患者救治的一项重要措施。     

11例群体性特重烧伤患者围手术期低体温的护理体会

总结11例群体性特重烧伤患者围手术期低体温的护理体会。对11例群体性特重烧伤患者围手术期采取术前预加温,加强术中、术后、肠内营养、连续肾脏替代治疗时保温护理措施,认为有效地降低了患者围手术期低体温的发生,减少了并发症发生率,提高了患者的救治效果,改善了患者的远期生活质量。     

群体煤尘爆炸伤患者手术室救护管理体会

我院成功救治煤尘爆炸事故中大面积烧伤及其它合并伤患者22例,现将手术室救护管理体会报告如下。1临床资料本组煤尘爆炸伤22例,均为男性;特重烧伤12例,重度烧伤4例,中度烧伤2例,轻度烧伤1例,其他单纯伤3例;烧伤合并颅脑外伤4例,血气胸2例,颈椎、股骨、肱骨、尺桡骨、锁骨、肩胛     

救治一例特重烧伤合并多种并发症的体会

救治一例特重烧伤合并多种并发症的体会刘晓雪，黄广孚，何仕蓉，岑瑛华西医科大学附属第一医院烧伤整形科重度烧伤患者易发生并发症。特别在年龄大、院外处理不及时、创面污染重者，更易继发多种并发症，处理非常困难。现将我院救治一例特重烧伤合并多种并发症的临床体会...     

成批特重烧伤救护失败分析

特重烧伤患者治愈困难 ,而成批特重烧伤死亡率更高。我科近 5 a收治的成批 2 5例 ,治愈率比报道的有明显下降 ,本文从护理角度分析如下。1　对象和方法1995 - 0 3～ 2 0 0 0 - 0 4我科收治 6批特重烧伤患者 2 5例 ,皆为男性 ,年龄 18～ 40岁 ,烧伤总面积全部≥ 6 8% TBSA, 度面积≥ 40 % ,一般情况见表 1。表 1　 6批 2 5例特重烧伤患者的一般情况致伤原因批数人数死亡数死亡率 (% )瓦斯爆炸 2 1 0 880钢水、汽水 2 86 75氧气火焰 1 3 1 2 77汽油火焰 1 4 2 50合　　计 6 2 5 1 872　　本组有 2 0例是在伤后 4h左右入院 ,最晚 1例在伤后 2…     

特重烧伤后急性肺损伤/急性呼吸窘迫综合征12例分析

目的:探讨特重烧伤后急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的临床特点及治疗方法。方法:回顾分析12例入院时不伴明显呼吸功能障碍的特重烧伤病例发生ALI/ARDS的原因及其治疗效果,分别给予氧疗或机械通气、抗炎、补充胶体、抗感染、手术等治疗。结果:5例经吸氧、药物治疗后痊愈,未行机械通气;7例行机械通气,其中6例痊愈,1例并发肺部感染后死于MODS。结论:特重烧伤可致ALI/ARDS,积极的抗休克、抗感染、手术、抗炎、机械通气等治疗可较有效救治ALI/ARDS。     

成批特重烧伤病人空中转运的护理

现代科技、工业条件下群体烧伤病人增加,成批重度烧伤病人的救治需要一个技术力量雄厚和医疗设备条件好的烧伤治疗中心.飞机转运病人是最快捷的方法之一.国内有关空中转运成批危重烧伤病人过程中的护理特点及措施少有报道.我院2005年6月3日接收特重烧伤病人16例,根据上级指示及救治需要,分三批次利用救护车及飞机等运输工具成功转运10例伤员于千里之外的烧伤专科医院.现将转运过程中的护理报告如下.     

成批特重烧伤伴吸入性损伤的救治

目的:总结成批特重烧伤伴吸入性损伤的治疗经验。方法:回顾分析我科2001年收治一批共16例特重烧伤伴吸入损伤病人的临床资料,总结治疗经验。结果:16例患者中治愈14例,死亡2例,治愈率为87.5%。结论:应用综合治疗措施,如早期预防性气管切开、早期切痂微粒皮肤移植、雾化、气道灌洗及生长激素的应用等,能明显提高成批特重烧伤病人的抢救成功率。     

连续血液净化治疗重度烧伤并发高钠高氯血症疗效评估

目的连续血液净化治疗重度烧伤并发高钠高氯血症的临床疗效及意义,为临床治疗重度烧伤并发高钠高氯血症提供理论依据。方法选取我院2010年3月~2013年3月收治的30例采用连续血液净化治疗重度烧伤并发高钠高氯血症的病例为观察组,选取同期收治的采用常规治疗方法治疗的患者30例为对照组,对两组患者疗效进行评估分析。结果观察组的治疗效果更具有优越性,观察组总有效率明显高于对照组(P0.05)。结论连续血液净化治疗重度烧伤并发高钠高氯血症副作用低,病人回复快,不良反应少。     

严重烧伤患者部分血液指标变化的检验分析

目的探讨重度烧伤患者部分血液指标的变化,为临床治疗方案的选择提供参考。方法选择2012年2月至2016年10月在该院接受治疗的152例重度烧伤患者作为观察组,对其凝血指标活化部分凝血酶时间(APTT)、血浆凝血酶原时间(PT)、凝血酶时间(TT)、国际标准化比值(INR)、纤维蛋白原水平(FBg)、血小板(PLT),以及清蛋白(ALB)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总蛋白(TP)、NO浓度、红细胞沉降率(ESR)、血液CO2、尿酸(UA)、高密度脂蛋白胆固醇(HDL-C)、血清胆固醇(CHOL)、红细胞计数(RBC)、血红蛋白(HGB)、红细胞比容(HCT)血液生化指标进行检测。并选择92例轻中度烧伤患者作为对照组,比较两组患者的同类指标水平差异。结果重度烧伤组心率、呼吸频率、舒张压及收缩压均明显高于对照组,差异均有统计学意义(P0.05)。重度烧伤组APTT、PT、TT、INR、FBg及PLT水平均明显高于对照组,差异均有统计学意义(P0.05)。重度烧伤组AST、ALT、NO水平均较对照组明显升高,差异均有统计学意义(P0.05);而ALB、TP、CO2、UA、HDL-C、CHOL、HGB、RBC及HCT水平均较对照组明显降低,差异均有统计学意义(P0.05)。结论通过检测重度烧伤患者部分血液指标,可以根据血液凝血和生化指标的变化判断患者的伤情特点,辅助医生对患者的诊治,及时予以补液、营养支持,改善凝血状态,提高患者免疫力。     

A clarion to recommit and reaffirm burn rehabilitation.

Burn rehabilitation has been a part of burn care and treatment for many years. Yet, despite of its longevity, the rehabilitation outcome of patients with severe burns is less than optimal and appears to have leveled off. Patient survival from burn injury is at an all-time high. Burn rehabilitation must progress to the point where physical outcomes parallel survival statistics in terms of improved patient well-being. This position article is a treatise on burn rehabilitation and the state of burn rehabilitation patient outcomes. It describes burn rehabilitation interventions in brief and why a need is felt to bring this issue to the forefront. The article discusses areas for change and the challenges facing burn rehabilitation. Finally, the relegation and acceptance of this responsibility are addressed.     

碳素钓鱼杆致高压电烧伤5例报道

文章总结了科室自2001年5月至8月连续收治的5例由于钓鱼杆致高压电烧伤患者的诊治情况，这5例患者皆合并有电流损伤和电弧光烧伤。其中4男1女，年龄8－61岁，致伤电压1－1．1万伏。平均烧伤面积54％TBSA，深度为深2－3度，其中一例70％烧伤均为3度创面，伴深处肌肉，神经和血管严重损伤，有4例合并轻至重度吸入性损伤，3例特重度烧伤患者早期出现肝肾，消化道功能异常及电解质紊乱，1例经削痂后换药治疗痊愈，2例经早期双上肢切开减压，气管切开插管抢救成功存活，早期切痂植皮后经后期补植及皮瓣转移痊愈。2例由于重度吸入性损伤，G^-败血症合并多器官功能衰竭死亡，由于在一些高压电线周围缺乏应有的标记，许多钓鱼者也缺少必要的安全知识，往往导致这类严重损伤的发生，因此预防非生产性高压电烧伤的发生还有赖于各方面的共同努力。     

Ornithine alpha-ketoglutarate improves wound healing in severe burn patients: a prospective randomized double-blind trial versus isonitrogenous controls

OBJECTIVE: To compare the effectiveness on wound healing time in severe burn patients of ornithine alpha-ketoglutarate supplementation of enteral feeding vs. an isonitrogenous control. Previous clinical and experimental studies suggest a beneficial effect of enterally administered ornithine alpha-ketoglutarate supplementation on protein metabolism in burn patients, but few data deal with clinical outcome. DESIGN: Prospective double-blind randomized trial. SETTING: Burn treatment center of an army hospital. PATIENTS: Forty-seven severe burn patients with total burned body surface areas of 25% to 95% and presence of full thickness burn who were prescribed early exclusive enteral nutrition. Either ornithine alpha-ketoglutarate or isonitrogenous control (soy protein mixture, Protil-1) were administered twice a day as a bolus (2 x 10 g) at 9 am and 9 pm for 3 wks. The patients were evaluated for wound healing time (primary end point), antibiotic use, tolerance, duration of enteral nutrition, and nutritional status. INTERVENTIONS: Serial blood samples were collected in each patient for determination of serum transthyretin and plasma phenylalanine, and urine sampling was performed for determination of 3-methylhistidine excretion at day 4 and day 21 after burn injury. MEASUREMENTS AND MAIN RESULTS: Wound healing times in patients receiving ornithine alpha-ketoglutarate or Protil-1 were 60 +/- 7 and 90 +/- 12 days, respectively (p < .05) for similar grafted surfaces. Based on increased serum transthyretin concentrations, both groups showed an improvement of nutritional status at day 21 after burn. Taking a cut-off value of 110 unit burn standard for severity of injury, plasma phenylalanine concentrations, and urinary 3-methylhistidine/creatinine ratio were significantly reduced (p < .05) in the less severe burn patients (<110 unit burn standard) supplemented with ornithine alpha-ketoglutarate. CONCLUSIONS: Ornithine alpha-ketoglutarate supplementation of enteral feeding significantly shortens wound healing time in severe burn patients. In addition, ornithine alpha-ketoglutarate administration was safe and well tolerated and decreased protein hypercatabolism in the less severe burn patients.     

Range of motion of the shoulder performed while patient is anesthetized

Significant loss of shoulder range of motion (ROM) in the early stages of burn recovery is a common and frustrating complication of burn injury. Pain is a primary reason for decreased motion: it prevents the patient from cooperating in an aggressive therapy program that could minimize contracture formation. To combat loss of movement without inflicting severe pain, the performance of ROM exercises and gentle passive stretching while patients were anesthetized was used as a treatment. A total of 59 treatments were performed on 14 patients who had limited unilateral or bilateral shoulder motion. A significant gain in shoulder ROM was attained when this treatment was performed and resulted in an increase in shoulder ROM when the patient was alert after anesthesia compared with preanesthesia measurements.     

Urinary excretion patterns of cyclic AMP and cyclic GMP following thermal injury

Measurement of 24-h urinary cyclic AMP and cyclic GMP levels in 19 patients for up to nine days after thermal injury has revealed differences in cyclic nucleotide excretion patterns between "severe" and "mild to moderate" groups of burned patients, classified according to a predictive index of burn mortality. Cyclic AMP excretion fell significantly from a high initial level in the "severe" group, but showed no significant change in the "mild to moderate" group. Differences in cyclic AMP excretion between the two groups of patients were only significant on the second day following burn injury. There was no correlation between cyclic AMP output averaged for each patient over the first nine days and percentage body surface area of the burn or the predictive index. In contrast to the results for cyclic AMP excretion, cyclic GMP output rose significantly over the 9-day period in severely burned patients, while levels reached a plateau on days four to six for the moderate to mild group. When cyclic GMP excretion was averaged over the first nine days for each patient, a significant correlation with both percent body surface area of burn and the predictive index of burn mortality was found. The tissue source or sources which are responsible for increased cyclic GMP excretion are as yet unknown.     

早期心理干预对中重度烧伤患者生活质量的影响

目的探讨早期心理干预对中重烧伤患者生活质量的影响。方法便利抽样法选择2012年10月至2015年10月上海交通大学医学院附属瑞金医院灼伤急诊收治住院的135例患者为研究对象,按入院先后将其分为对照组67例、观察组68例,对照组患者给予系统护理,观察组患者在对照组的基础上进行早期心理干预,采用生活质量综合评定量表(generic quality of life inventory-74,GQOLI-74)、自制的患者治疗依从性评价问卷、焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)对两组患者进行调查。结果治疗前,两组患者的GQOLI-74量表各维度得分及总分差异均无统计学意义(均P0.05);治疗后,两组患者GQOLI-74量表各维度得分及总分均优于治疗前(均P0.05),且观察组患者的GQOLI-74量表得分、治疗依从性均优于对照组患者(均P0.05),SAS及SDS评分均低于对照组患者,差异均有统计学意义(均P0.05)。结论在常规护理的基础上,对中重度烧伤患者进行早期心理干预,有利于提高其治疗依从性,改善患者的不良情绪及生活质量。     

Haloperidol complications in burn patients

Neuropsychiatric complications are commonly seen in major burn patients. Haloperidol is frequently used to treat severe psychopathic behavior. We have noted severe muscle rigidity-an extrapyramidal side effect of the agent-in a number of burn patients. Haloperidol causes a relative imbalance of dopaminergic and cholinergic neuronal activity in the basal ganglia with a relative increase in cholinergic activity being responsible for EPS. The burn patient may be more prone to extrapyramidal symptoms because of increased sensitivity of skeletal muscle neuromuscular junctions to acetylcholine after thermal injury.     

Downregulation of immune signaling genes in patients with large surface burn injury.

We sought to evaluate the temporal pattern of expression of important immune signaling genes in patients with varied TBSA burn injury during the first week after burn. Peripheral blood mononuclear cell fractions were collected from each patient (N = 10) at two time points, one immediately following burn injury, and the other 1 week later. The change in gene expression was correlated with all clinical data including burn size. It was found that gene expression was indirectly proportional with burn size. Smaller burns (<30%) TBSA resulted in an up-regulation of several genes measured, while larger burns (>30%) TBSA resulted in significant down-regulation. In conclusion, a larger burn establishes conditions for severe immunosuppression by down-regulating key immune signaling genes and could be one explanation for the increased susceptibility of major burns to infection. These data shed light on the etiology of burn-induced immune dysfunction in humans and support a more comprehensive genomic profile study in burn patients.