SD—Zn或SD—Ag涂抹创面与切痂植皮时机对放烧复合伤大…

采用６Ｇｙ照射复合１５％Ⅲ度烧伤模式，探讨了ＳＤ－Ｚｎ或ＳＤ－Ａｇ涂抹创面与切痂植皮时机对复合伤大鼠的疗效作用，结果表明伤后ＳＤ－Ｚｎ或ＳＤ－Ａｇ涂抹创面并于１５天后切痂植皮及单用ＳＤ－Ｚｎ涂抹组，伤后１５天存活率分别为６３％，６９％和７５％，均高于对照组（４２％），创面面积缩小速度明显加快，血细胞数也低于对照，用ＳＤ－Ｚｎ涂抹后７天植皮组，术后２０天内动物全部死亡，而１５天后植皮者术后动物全部存     

SD-Zn或SD-Ag涂抹创面与切痂植皮时机对放烧复合伤大鼠的疗效观察

采用6Gy 照射复合15%Ⅲ度烧伤模型,探讨 SD-Zn 或 SD-Ag 涂抹创面与切痂植皮时机对复合伤大鼠的疗效作用。结果表明伤后 SD-Zn 或 SD-Ag 涂抹创面并于15天后切痂植皮及单用 SD-Zn涂抹组,伤后15天存活率分别为63%、69%和75%,均高于对照组(42%);创面面积缩小速度明显加快,血细胞数也低于对照。用 SD-Zn 涂抹后7天植皮组,术后20天内动物全部死亡,而15天后植皮者术后动物全部存活。提示:SD-Zn 或 SD-Ag 涂抹对复合伤创面有较好疗效,而放射伤极期应禁做手术治疗,若恢复期机体状况较好者可进行切痂植皮。     

几种抗绿脓杆菌药物疗效筛选的实验研究

采用大鼠ＴＢＳＡ１５％Ⅲ度烧伤模型，伤后创面涂绿脓杆菌后共分６组。其中５个组的创面分别涂以不同药物，对照组不涂药。通过对各组创面外观、痂下细菌定量与病理组织学观察，皆证实ＡｇＳＤ－ＺｎＳＤ－Ａ霜组效果最好，是满意的烧伤外用药。     

几种抗绿脓杆菌药物疗效筛选的实验研究

采用大鼠ＴＢＳＡ１５％Ⅲ度烧伤模型，伤后创面涂绿脓杆菌（１０~９／ｍｌ）后共分６组。其中５个组的创面分别涂以不同药物，对照组不涂药。通过对各组创面外观、痂下细菌定量与病理组织学观察，皆证实ＡｇＳＤ－ＺｎＳＤ－Ａ霜组效果最好，是满意的烧伤外用药。     

成功治愈大面积烧伤合并毛霉菌创面脓毒症一例

成功治愈大面积烧伤合并毛霉菌创面脓毒症一例唐殿成，贺建民病例女，４０岁。液化气火焰烧伤，总面积８５％，Ⅲ度６０％，伴中度吸入性损伤，于伤后２小时入院。入院后给予抗休克补液治疗，四肢外用辐照猪皮后包扎，躯干外用ＳＤ－Ａｇ。因成痂不良，３天后全身外涂碘伏...     

严重烧伤后休克期切痂对肠道细菌和内毒素移位的影响

为探讨严重烧伤休克期切痂与肠源性细菌感染的关系，作者采用ＳＰＦ大鼠１５０只，随机分成三组：休克期切痂组（Ｂ组）与常规切痂组（Ｃ组）均致３０％ＴＢＳＡⅢ度烫伤，伤后１小时开始补液治疗，分别于伤后２４小时、５天切痂植皮。另设单纯植皮组（Ａ组），不烫伤，仅植皮对照。结果显示，Ｂ组切痂前、后血浆ＬＰＳ及ＴＮＦ含量均明显低于Ｃ组，但高于Ａ组（Ｐ＜０．０５～０．００１），痂下菌量（１．５×１０３±０．３×１０ｃｆｕ／ｇ组织）也明显低于Ｃ组（４．３×１０６±１．７×１０ｃｆｕ／ｇ组织）（Ｐ＜０．００１）。Ｂ组内脏细菌检出率显著低于Ｃ组（Ｐ＜０．０５～０．０１）。结果表明，休克期切痂可以减轻肠源性内毒素血症，及其细菌和毒素移位。内毒素在肠道内细菌和毒素移位中起重要作用。     

ATP－MgCl_2对烫伤大鼠肠粘膜保护作用的实验观察

为研究ＡＴＰ－ＭｇＣｌ２对创伤应激动物肠粘膜的保护作用，采用３０％ＴＢＳＡⅢ度烫伤大鼠模型，观察了腹腔注射ＡＴＰ－ＭｇＣｌ２复合液对回肠粘膜丙二醛（ＭＤＡ）含量及回肠组织形态学改变的影响。结果显示：烫伤后６～２４小时，ＭＤＡ含量明显升高，并伴有形态学病理改变。经ＡＴＰ－ＭｇＣｌ２注射治疗的大鼠伤后２４小时内ＭＤＡ含量维持于正常对照水平，且回肠粘膜病理改变减轻。提示：ＡＴＰ－ＭｇＣｌ２能够保护烫伤大鼠肠粘膜，其作用机理可能与降低肠粘膜的脂质过氧化反应有关。     

中药烧伤膏460例临床疗效观察

创面应用中药烧伤膏治疗４６０例与应用磺胺嘧啶银（ＳＤ－Ａｇ）－磺胺嘧啶锌（ＳＤ－Ｚｎ）２５０例疗效对照观察，结果显示：前者对浅Ⅱ度，深Ⅱ度及混合度创面疗效大于后者，而Ⅲ度创面需手术治疗者，后者控制创面感染效果较好。     

中药烧伤膏460例临床疗效观察

创面应用中药烧伤膏治疗４６０例与应用磺胺嘧啶银（ＳＤ－Ａｇ）＋磺胺嘧啶锌（ＳＤ－Ｚｎ）２５０例疗效对照观察，结果显示：前者对浅Ⅱ度、深Ⅱ度及混合度创面疗效大于后者，而Ⅲ度创面需手术治疗者，后者控制创面感染效果较好。     

磺胺嘧啶银霜治疗手指损伤

近３年来，在动物实验的基础上，用２％磺胺嘧啶银（ＳＤ－Ａｇ）霜封套治疗手指损伤４８例。伤指创面最大１．５ｃｍ×２．５ｃｍ，最小０．３ｃｍ×０．３ｃｍ。平均随访５．６个月，所有伤指创面完全愈合，无感染及坏死等并发症。伤指愈合时间最短７天，最长２５天，平均１４．２５天。实验及临床资料表明，ＳＤ－Ａｇ霜有降低感染，减少炎症反应及瘢痕形成，促进肉芽及表皮生长作用。该法有简便、经济、复工时间短等优点。     

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度烧伤创面愈合的情况。结果表明：①大鼠接受２Ｇｙ６０Ｃｏ照射后２０天内，Ｔｈ／Ｔｓ比值和Ｔ细胞肿瘤花环率持续下降。照射后皮肤组织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，创面愈合百分率低于正常大鼠。由此证实了免疫功能低下对创面愈合的抑制作用。     

银锌霜在大面积烧伤中的应用

目的总结１９９１年１月至１９９５年１１月银锌霜在４８例ＴＢＳＡ大于３０％的烧伤病人创面的应用。方法将同期应用碘络醚的３５例病人作为对照，两组病人的平均年龄、烧伤面积、Ⅲ度面积无显著差别，用药方式均以半暴露为主。结果银锌霜组能显著增加细菌转阴率，减少抗生素应用时间及植皮手术次数，缩短愈合时间。结论银锌霜具有较强的抗感染能力，是大面积烧伤病人的良好外用药。     

不同烧伤面积血清、尿、水泡液中Zn、Cu、Fe、Ca、Mg的动态比较

为探讨烧伤病人伤后血清、尿和水泡液中Ｚｎ、Ｃｕ、Ｆｅ、Ｃａ、Ｍｇ的含量，观察了１０６例烧伤病人（Ｌ组烧伤≥３０％ＴＢＳＡ，５７例；Ｓ组烧伤＜３０％ＴＢＳＡ，４９例）伤后１，２，３，７，１４，２１，２８天血清、尿和水泡液中Ｚｎ、Ｃｕ、Ｆｅ、Ｃａ、Ｍｇ的动态变化。发现除血清Ｆｅ第１天高于正常值外，其它各元素都减低，Ｌ组比Ｓ组减低明显。尿Ｚｎ、Ｃｕ、Ｆｅ排出明显增多，尿Ｃａ、Ｍｇ排出减少。水泡液Ｚｎ、Ｆｅ、Ｃａ与血清正常值近似，Ｃｕ、Ｍｇ略低于血清正常值。说明烧伤后血Ｚｎ、Ｃｕ、Ｆｅ、Ｃａ、Ｍｇ的降低与从尿液及创面丢失有关。     

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。     

The rate of re-epithelialization across meshed skin grafts is increased with exposure to silver

The objective in this study was to determine whether exposure to pure silver increases the rate of re-epithelialization across a partial thickness wound. A meshed skin graft, placed on an excised burn wound was used as a healing model. Methods: The rate of meshed skin graft epithelial closure on an exposed burn using a moist healing environment was shown. A moistened silver delivery system (Acticoat) was compared with a standard xeroform and eight ply gauze dressing continually moistened with a 0.01% neomycin and polymyxin solution (NP). Twenty burn patients with deep burns of over 15% of TBS were excised and grafted with 2:1 meshed grafts. One graft area was treated with the antibiotic solution and another with the silver delivery. The meshed graft was performed within 3 days of injury. Results: No infections were noted and quantitative swab cultures gave less than 10(2) bacteria in all cases at wound closure. At day 7, re-epithelialization was complete with silver and 55% closed with NP solution. Wound closure was complete in the NP solution group at day 10. Silver increased re-epithelialization rate by over 40%, a significant increase. Graft take was over 95% in both groups. Conclusion: Silver released in a moist wound surface environment significantly increases the rate of re-epithelialization compared to a standard antibiotic solution.     

烧伤后期特大未愈创面伴脓毒症患者的救治

This article analyzed the medical records of a patient with 90％ TBSA unhealed wound accompanied with wound sepsis 50 days post burn (PBD) and to discuss the ideal strategies of treatment for such patients in such condition.This was a 24-year-old male patient suffering from flame burn with 95％ TBSA wound and severe inhalation injury.Meek skin grafting with autologous scalp was performed once to the thoracic and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limbs within PBD 31.The patient was transferred to our hospital on PBD 50 with 90％ TBSA wound unhealed,leaving a vast amount of necrotic tissue and allografts.Furthermore,he was complicated by sepsis,pulmonary infection,and gastric ulcer.Debridement and allogenic skin grafting were performed on the first day after hospitalization.When the condition of wounds was improved,transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin,intermingled skin grafting of autologous and allogenic skin,and small pieces of autologous skin grafting were performed.Because of the shortage of donor area,the exposed wounds were temporarily covered with allogeneic skin.Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness bum wound.Autologous skin grafting was performed whenever source of healthy skin was available.Systemic use of effective antibiotics,nutritional support and therapy,and other comprehensive measures also contributed to the success of treatment of this patient suffering from wound sepsis.The patient was cured and discharged on PBD 145.     

组织工程皮肤修复烧伤后残余创面的临床观察

目的：观察创面直径为5-7cm的烧伤后残余创面应用组织工程皮肤治疗的效果。方法：笔者单位2008年5月-2012年7月的12例烧伤后残余创面患者,采用同体对照的研究方法,每例患者选择2处直径为5-7cm的残余创面,随机分为组织工程皮肤治疗组和对照组。两组创面细菌培养阳性菌株均相同。两组受试创面面积比较差异无统计学意义（P〉0．05）,具有可比性。患者均进行浸浴治疗后,受试创面给予外用莫匹罗星软膏,每日换药1次。在局部感染控制后组织工程皮肤治疗组创面清创后移植组织工程皮肤,对照组继续换药治疗,同时予以全身抗感染治疗。结果：本组12例患者组织工程皮肤治疗组创面均在移植组织工程皮肤后1-2周愈合,均未进行自体皮移植,愈合质量良好;对照组创面在相同时间内均未愈合,最终均给予自体皮移植而愈合。结论：经充分创面准备后移植组织工程皮肤可用于修复直径较大的烧伤后残余创面,以替代传统的自体皮移植。     

Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: A two-year retrospective study

IntroductionDeep partial-thickness and full-thickness burn wounds often undergo tangential excision or escharectomy to expose healthy tissue, combined with skin grafting to promote wound healing. However, conventional tangential excision with the humby knife leads to inevitable damage to the dermis while excising burn tissue due to the lack of precision. Indeed, the preservation of dermal tissue is a key factor in determining wound healing and scar quality. The precision and tissue selectivity of the Versajet Hydrosurgical System has been established for excising burn tissue while preserving dermal tissue. In this study, we retrospectively compared the efficacy of "Hydrosurgical excision combined with skin grafting" and "Conventional tangential excision combined with skin grafting" in treating deep partial-thickness and full-thickness burn wounds to demonstrate that hydrosurgery improved the treatment of deep partial-thickness and full-thickness burns.MethodsA total of 86 patients with deep partial-thickness and/or full-thickness burns with a total burn surface area (TBSA) ≤ 25% from July 2018 to July 2020 were included in this study and were divided into experimental (hydrosurgical excision combined with skin grafting, n = 43) and control (conventional tangential excision combined with skin grafting, n = 43) groups. Parameters were analyzed, including the intraoperative blood loss volume per unit area of grafted skin, surgery duration, wound healing time, skin graft survival, and the treatment costs per unit of burned area. Scar assessment was performed at 1 year with the modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA).ResultNo significant difference was found in male to female ratio, age, weight, TBSA, burn depth, skin grafting area (SKA), skin grafting methods, cases treated with carbon dioxide fractional laser or incidence of inhalation injury, and the incidence of hypovolemic shock between two groups(p > 0.05). Compared with the control group, patients treated with hydrosurgical excision combined with skin grafting experienced less intraoperative blood loss volume per unit area of grafted skin (p < 0.05). The mVSS-TBSA of patients that underwent hydrosurgical excision combined with skin grafting was significantly improved in comparison to the control group (p < 0.01). No significant difference was found in surgery duration, wound healing time, skin graft survival and treatment costs per unit of burned area between the two groups (p > 0.05).ConclusionHydrosurgical excision combined with skin grafting reduced intraoperative blood loss volume per unit area of grafted skin, improved scarring 1-year after injury, and did not increase the treatment costs per unit of burned area. This technique provides a novel alternative for managing deep partial-thickness and full-thickness burn wounds.