烧伤瘢痕癌12例临床治疗分析

目的：探讨烧伤瘢痕癌的临床特点与防治方法.方法：回顾性分析12例烧伤瘢痕癌患者的临床资料.结果：12例烧伤瘢痕癌10例为鳞状细胞癌,2例为基底细胞癌.其中溃疡型9例,菜花型3例.手术植皮或皮瓣均成活.12例患者分别于术后3个月～12年获得随访,2例术后3～6个月复发,1例行二次手术植皮,另1例放弃治疗,5月后死亡,其余10例局部无复发,目前仍健在.结论：病理检查结果结合临床表现是确定诊断与治疗方案的重要依据,手术是烧伤瘢痕癌的首选治疗方法,烧伤瘢痕癌是可以预防的.     

龙虎烧伤膏治疗深度烧伤38例临床报告

1995～1997年,我科自制了中药龙虎烧伤膏,应用于深度烧伤创面的治疗。采用同时自身对照法,经38例临床疗效观察,疗效满意,现予报告。1　临床资料11　一般资料　38例中男性28例,女性10例;年龄最小3个月,最大78岁,平均为32岁;四肢烧烫伤32例,其它部位6例;烧烫伤面积12%～30%,其中平均深Ⅱ度烧烫伤面积8%,Ⅲ度烧烫伤面积3%。12　病例选择　选择全身有2处以上创面的面积、形状及创面的深度大致相同的病例,深度选择深Ⅱ度或以深Ⅱ度创面为主,间有Ⅲ度的创面。采用同时自身对照法,在同一病例身体的不同部位设立治疗组及对照组。13　烧伤膏的制备　…     

深化对烧伤脓毒症诊断体系与治疗策略的认识

烧伤患者由于大面积皮肤缺损引起创面感染、大量体液流失、高代谢状态等,导致序贯性多系统功能紊乱,极易诱发全身性感染甚至脓毒症。目前,脓毒症已成为严重烧伤患者死亡的首要原因,早期诊断和及时治疗是患者救治成功的关键。烧伤脓毒症具有独特的病理生理特点,一般脓毒症诊断标准对其缺乏特异性。因此,理解烧伤脓毒症的发病机制,有助于深化...     

烧伤脓毒症的诊断标准与防治

烧伤脓毒症是大面积烧伤患者的严重并发症之一 ,也是诱发脓毒性休克、多器官功能障碍综合征(ＭＯＤＳ)的重要原因。烧伤脓毒症来势凶猛 ,病情进展快 ,病死率高 ,如何及时诊断及有效预防和治疗烧伤脓毒症 ,是提高烧伤救治成功率的关键。笔者就烧伤脓毒症的诊断标准和防治策略谈几点看法 ,供同道参考。一、烧伤脓毒症的诊断标准提出脓毒症诊断标准的目的 ,是在其发展为ＭＯＤＳ前及时发现并予以阻止。而作为诊断标准 ,首先不应太复杂 ,以免因不能开展某些检查项目而无法应用 ;其次应以客观指标为依据 ,能够真正反映烧伤患者的病情变化 ,有助于…     

Ⅳ度烧伤诊断的思考及治疗体会

烧伤深度的诊断标准，已实行Ⅳ度五分法。这是烧伤医学发展的一个里程碑，需在今后的医疗、教学、科研中贯彻执行。20世纪80年代后期，积水潭医院曾提出诊断Ⅳ度烧伤的建议；90年代，常致德等在专中明确称电烧伤可致Ⅳ度烧伤，并认为其治疗方法及预后与Ⅲ度烧伤差异较大。军队烧伤整形专业组曾提出“毁损性烧伤”的名称，其实质就是Ⅳ度烧伤。笔认为，颅骨裸露及其深部烧伤，眼睑、耳廓、鼻翼、唇等全层烧毁，颜面骨裸露及洞穿性缺损，毁及胸锁乳突肌和颈动脉鞘，     

小儿烧伤并发脓毒症的早期诊断及防治

脓毒症 (sepsis)是小儿烧伤最常见的并发症和死亡的最主要原因之一。资料显示 ,小儿烧伤脓毒症的发生率为 6 .4 % ,死亡率为 5 3% ,占总死亡率的6 0 % [1] 。由于烧伤后存在高分解代谢、免疫功能受损等因素 ,儿童又正处于生长发育阶段 ,各组织、器官的功能尚不完全 ,极易感染引起脓毒症 ,进一步导致多器官功能衰竭而死亡。因此 ,脓毒症的早期诊断及防治具有重要意义。一、预警指标脓毒症一旦发生 ,病情演进迅速 ,治疗难度大 ,因此近年来有很多关于脓毒症预警指标的研究 ,期望能够进行早期诊断和防治。1.血清C反应蛋白 (CRP)浓度测定 :CRP…     

苯丙酸诺龙治疗严重烧伤患者的临床观察

资　料　与　方　法1.观察对象及停药指征 :年龄 18岁以上 ,伤后 2 4ｈ内入院 ,烧伤面积大于 30 %ＴＢＳＡ ,深Ⅱ度和Ⅲ度烧伤为主 ,肝功能正常 ,无妊娠、哺乳、前列腺肥大情况者。本组 45例患者分为 2组 ,治疗组 :女 2 4例 ,男 19例 ,年龄 2 6～ 40岁 ,深度烧伤面积为 35 4%～ 5 6 8%ＴＢＳＡ ,供皮区面积为 2 7%～16 1% ;对照组 :女 4例 ,男 17例 ,男 17例 ,女 4例 ,年龄为2 5～ 35岁 ,深度烧伤面积为 2 9 1%～ 5 3 7%ＴＢＳＡ ,供皮区面积为 3 3%～ 13 3 % ,两间的差异无显著性意义 (Ｐ <0 0 5 )。治疗组患者在用药期间若出现以下情…     

Effect of small burn injury on physical, social and psychological health at 3–4 months after discharge

Comparatively little attention has been given to the impact of smaller burns (less than 20% body surface area) on patients' health status after their return to normal life. The objective of this study was to investigate patients' own assessment of their physical and psychological health 3–4 months after discharge from in-patient treatment. A postal survey was employed which utilised: (a) personal and employment status questions; (b) a short health status questionnaire which was developed for use with this group of patients; (c) the hospital anxiety and depression scale (HAD); (d) the impact of event scale (IES). The response rate to the survey was 71%. Physical and social function were reported to be affected at the follow-up point in a minority of patients. The greatest impact of the injury was on levels of anxiety and response to trauma-related stress, as measured by the HAD and IES instruments — almost one third of the responders (15 patients) had clinically significant scores on either or both dimensions of the IES. Factors which may be associated with the response to trauma-related stress are discussed.     

Procalcitonin kinetics early after severe burn injury and its value in diagnosis of sepsis

PurposeTo investigate the clinical significance of procalcitonin (PCT) kinetics early after burn and the perioperative period, and to assess its diagnostic performance for sepsis in major burn patients.MethodsThis retrospective study on major burn patents (≥40% total body surface area) admitted from 2014 to 2019 was conducted in Southwest Hospital, Chongqing, China. A total of 321 patients were included. The kinetics of PCT was analyzed during the 1st week after burn, the perioperative period, and at the onset of clinical suspected sepsis.ResultsSerum PCT concentration rose immediately after burn injury. Factors associated with increased PCT level in the 1st week after burn include greater burn area (>70% TBSA) and lower age (≤14 years). Correlations between PCT kinetics after burn and the risk of early development of sepsis and mortality were observed. At the onset of sepsis, serum PCT increased significantly compared to its basal level in the 48 h before diagnosis. The area under the receiver operating characteristics curve of PCT concentration and its kinetic changes was 0.788 and 0.826, respectively. PCT kinetics showed better accuracy than PCT concentration in discrimination of Gram-positive sepsis. The optimal diagnostic thresholds for PCT concentration and its kinetics were 1.41 ng/mL, and a 1.34-fold elevation compared to the baseline level.ConclusionsPCT kinetics in the early stage after burn was a prognostic factor for sepsis and mortality among major burn patients. Serum PCT levels could be a diagnostic biomarker for sepsis in major burn patients.     

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。     

残余胆囊的诊治

目的 探讨残余胆囊的诊治及预防。方法 残余胆囊切除4例，残余胆囊切除、胆总管探查、T管引流术10例，残余胆囊切除、肝胆管空肠Roux-Y吻合术2例，EST3例，EST后残余胆囊切除1例。结果 近远期疗效佳19例，欠佳1例，无手术死亡。结论 ERCP是诊断残余胆囊及并存病的最佳检查方法，无结石和胆囊管梗阻的残余胆囊并非一定需切除，重视每一例胆囊切除术、精细解剖、必要时经胆囊管胆道造影检查可以预防残余胆囊及残留结石发生。     

糖代谢障碍与极化液治疗对创伤后器官损害及预后的影响

目的：探讨糖代谢障碍与极化液治疗对创伤后器官损害及预后的影响,为极化液辅助改善创伤后器官损伤提供依据。方法：2002年1月至2004年1月我院创伤ICU病房收治的患者,随机分为极化液辅助治疗组和常规治疗组,制订创伤患者个体化极化液临床干预理论和经验公式,观察不同治疗组创伤患者空腹血糖、空腹乳酸、血CRP、TNFα和IL-1β水平变化,以及器官损伤发生率、器官损伤患者病死率和器官损伤死亡患者在创伤整体患者的百分比变化。结果：极化液辅助治疗组空腹血糖、空腹乳酸、血CRP、TNFα和IL-6水平变化,以及器官损伤发生率和器官损伤死亡患者在创伤整体患者的百分比均明显低于常规治疗组(P＜0．01或0．05),极化液治疗组器官损伤患者病死率虽然下降,但与常规治疗组无显著差别。结论：糖代谢障碍在创伤后器官损伤中发挥重要作用,极化液个体化治疗通过改善糖代谢障碍和降低炎症细胞因子水平,对创伤后器官损伤有辅助治疗和预防作用,值得临床推广。     

Sustained bone mineral density changes after burn injury

BACKGROUND: Body-composition changes have been observed after burn injury. In particular, several studies have shown that bone mineral density (BMD) in burn patients is decreased when compared to the normal population. Little is known about the frequency, severity, or duration of these changes. The purpose of this study was to describe body-composition changes over time after burn injury. MATERIALS AND METHODS: Twenty-nine burn patients participated in this study. Portable dual-energy X-ray absorptiometry (pDEXA) measuring forearm BMD, fat, and lean mass was obtained as soon as possible after admission and repeated bi-weekly until discharge and, when possible, for 2 years post-injury. The scan showing the greatest change in BMD, fat, or lean mass was compared to the baseline scan for each individual. RESULTS: Although lean and fat mass did not change significantly after injury, BMD decreased significantly. The greatest change in BMD did not occur during the acute burn hospitalization, but rather 131 days after burn injury. Changes in post-burn BMD inversely correlated with % total body surface area (TBSA) and % 3rd-degree TBSA. The magnitude of change was similar between adults and children. CONCLUSIONS: These results confirm earlier studies, suggesting that BMD can be negatively altered post-injury, with the greatest changes occurring after patients are discharged from the hospital. Although the clinical significance of these changes is not known, this study supports the need for long-term musculoskeletal assessments in burn patients and for further research to elucidate the mechanisms of burn-induced body-composition changes.     

重型颅脑损伤并发低钠血症的临床诊治

目的 探讨重型颅脑损伤后并发低钠血症的病因、临床特点及诊治措施.方法 回顾分析51例重型颅脑损伤(其中38例需要手术治疗)后并发低钠血症的临床资料,分析其原因,总结其临床特点及治疗方法和效果.结果 重型颅脑损伤并发低钠的51例患者,低钠血症治愈47例,因脑损伤严重死亡2例,需长期高钠饮食以维持血钠正常1例,家属放弃治疗...     

New fluid therapy protocol in acute burn from a tertiary burn care centre

Background

Ringer lactate is the main fluid for resuscitation of acute burns. However it is not a complete fluid alone, as it does not take care of sugar and electrolyte balance adequately. This study has been carried out to compare the use of Ringer lactate (RL) alone and combination of RL with Dextrose Normal Saline (DNS) as fluid replacement therapy in acute burn.