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1.
目的观察牛羊膜覆盖烧伤创面联合应用牛碱性成纤维细胞生长因子(rb-bFGF)对烧伤创面的临床治疗效果。方法选择以Ⅱ度烧伤创面为主的中小面积热力烧伤病人43例,试验创面面积为1%~2%。将每例病人相同性质的创面等分为3份,分别应用有孔牛羊膜(治疗组)、牛羊膜(对照组1)、凡士林油纱布(对照组2)覆盖烧伤创面,3组均联合应用rb-bFGF。结果治疗组与对照组1和对照组2相比,以深Ⅱ度烧伤创面为主的病人的创面愈合时间明显缩短(F=25.36,q=7.25、3.46,P〈0.01);在治疗以浅Ⅱ度烧伤创面为主的病人过程中,治疗组与对照组2相比创面愈合时间明显缩短(F=12.29,q=5.21,P〈0.01),而与对照组1相比没有明显差别(q=2.60,P〉0.05)。结论有孔牛羊膜覆盖烧伤创面及联合应用rb-bFGF能加速烧伤创面的愈合。  相似文献   

2.
A silver sulfadiazine-impregnated poly-L-leucine wound dressing, AgSD-medicated wound dressing, was evaluated for antibacterial capacity against Pseudomonas aeruginosa and cytotoxicity to human fibroblasts and human epidermal keratinocytes. This wound dressing contained 0.4 mg AgSD/cm2. Antibacterial capacity was examined on experimentally infected wound surfaces (3.4 x 10(4) P. aeruginosa organisms/gm) on the dorsum of mice. The AgSD-medicated wound dressing showed effective bacterial control. Cytotoxicity was examined on a monolayer of cells formed in culture dishes. Cellular damage was reduced by the controlled release of AgSD from the hydrophobic poly-L-leucine sponge matrix of the AgSD-medicated wound dressing. Cytotoxicity of the AgSD-medicated wound dressing was much lower than that of 1% AgSD cream.  相似文献   

3.
Despite recent improvements in analgesia, pain control during dressing changes continues to be a major challenge in patients with burns. We investigated two different dressing modalities to compare how much pain the patient experienced during and after the dressing change. Patients with partial-thickness burns that required only topical wound care were assigned randomly to treatment with Acticoat (Smith and Nephew USA, Largo, FL) or silver sulfadiazine (AgSD). The outcome variable was pain during wound care, which was measured using visual analog pain scores. The mean visual analog pain scores for the wounds treated with Acticoat or AgSD wounds were 3.2 and 7.9, respectively (P < .0001; paired Student's t-test). In 41 of the 47 paired pain score observations, the pain in the wound treated with AgSD was perceived as greater than in the wound treated with Acticoat. Burn wound care with Acticoat is less painful than burn wound care with AgSD in patients with selected partial-thickness burns.  相似文献   

4.
To prevent wound dehydration and bacterial penetration, a wound dressing should be occlusive, but on the other hand it should also be permeable for wound exudate to prevent bullae formation. To meet these requirements a new type of polyurethane wound dressing which consists of a microporous top layer (pore size less than 0.7 mum) supported by a sublayer with a highly porous sponge-like structure containing micropores (pore size less than 10 mum) as well as macropores (pore size: 50-100 mum) was designed. The pores of both layers are interconnected and form a continuous structure in the membrane. Membranes according to this design were prepared either by means of a two-step or by means of a one-step casting process. Both fabrication methods are based on phase inversion techniques. Asymmetric polyurethane Biomer membranes prepared by the two-step casting process were tested in vivo as full thickness skin substitutes using guinea pigs. Neither wound dehydration nor infections were observed while the drainage capacity of the wound dressing was effective in preventing bullae formation. Furthermore the wound dressing remained firmly adhered to the wound surface during the whole process of wound healing. In contrast to all other commercial wound dressings currently available the polyurethane wound dressing applied on excised clean wounds did not need to be replaced during healing but could be left on the wound until full regeneration of the skin had taken place after which it was spontaneously repelled.  相似文献   

5.
In the present study, Aloe vera gel (AVG) was applied to experimental second-degree burns in guinea pigs, and its effects on epithelialization, wound contraction, newly formed granulation tissue, and regeneration of hair follicles was compared with that effected by 1% silver sulfadiazine cream (AgSD). Epithelialization (%mean +/- SEM) on postburn day 8, 16, and 24 of the AVG-treated wounds was 38.72% +/- 2.71%, 60.34% +/- 3.28%, and 92.46% +/- 2.26%, respectively, while that of the AgSD-treated burns was 53.35% +/- 2.65%, 94.84% +/- 2.65%, and 100%, respectively (P less than .001). Contraction of the AVG-wounds was significantly higher than that of the AgSD-treated burns during 24 days of the study (P less than .001). The thickness of the newly formed granulation tissue was higher in the AVG-treated wounds (P less than .001), while the hair follicles count was significantly lower (P less than .001) compared with the AgSD-treated burns. It is concluded that this preparation of Aloe vera gel hindered the healing process of the present burn wound model when compared with 1% silver sulfadiazine cream.  相似文献   

6.
Lal S  Barrow RE  Wolf SE  Chinkes DL  Hart DW  Heggers JP  Herndon DN 《Shock (Augusta, Ga.)》2000,14(3):314-8; discussion 318-9
A synthetic bilaminar membrane used as a skin substitute (Biobrane) has been shown to decrease pain and hospitalization in superficial second-degree burns. Despite these benefits, it has not been utilized universally, particularly in young children, due to a perceived increase in related infections. We propose that when this synthetic membrane is applied to superficial scald burns <25% of the total body surface area (TBSA), decreased healing times are expected without increased risk of infection. Between 1994-1999, 89 children treated within 48 h after receiving superficial partial thickness scald burns covering 5-25% TBSA with no indication of infection were seen at our hospital. Forty-one were assigned randomly to receive treatment with the skin substitute Biobrane and 48 to receive conservative treatment with topical antimicrobials and dressing changes. Comparisons of treatment were made between groups for length of hospitalization, wound healing times, and infectious complications. Children treated with Biobrane or topical antimicrobials were similar in age, race, sex, %TBSA burned, and location of burn. Those receiving Biobrane had shorter hospitalizations and healing times, which was significant for both infants and toddlers and older children. Treatment groups were not different in the use of systemic antibiotics or readmissions for infectious complications. Biobrane was removed in 5.9% of cases for non-adherence. The application of Biobrane within 48 h of superficial burns provides for shorter hospitalizations and faster healing times in children of all ages without increased risk of infection.  相似文献   

7.
This study compared the healing characteristics of expanded autografts on wounds with interstices that were closed with cryopreserved cadaver homograft split-thickness skin and wounds with interstices that were closed with the synthetic skin substitute, Biobrane temporary wound dressing. Nine paired wounds in four patients with large burns were used in this study. When Biobrane temporary wound dressing adhered to a wound, epithelial migration did not proceed until it was removed. Although wounds covered with homograft immediately had the appearance of healed wounds, biopsy specimens showed evidence of a delay in epithelial migration. Although these results indicate impaired epithelial migration with the use of both materials, we concluded that homograft offered an advantage because the wounds that were covered with it remained closed during the entire reepithelialization process.  相似文献   

8.
This clinical trial prospectively evaluates the potential beneficial effects of antimicrobial drug delivery from a synthetic dressing (Hydron-AgSD) formed on second-degree burn wounds. A paste composed of polyethylene glycol-400, poly 2-OH ethylmethacrylate, and silver sulfadiazine (AgSD 1%-3%) matured within one hour to form a solid dressing. In 27 patients, comparable areas of second-degree wounds on the same patient were selected at random for test and control (silver sulfadiazine 1% only) sites. The mean total time of the synthetic dressing application per patient was about nine days, and each dressing remained in place for nearly four days. During this interval the control sites required four dressings changes. In 17 tests for infections, the control areas were contaminated but no bacteria were detected under the synthetic dressing; in three tests, the controls had no bacteria, whereas the synthetic dressing did. Healing of burns was similar under both types of dressing. Benefits of Hydron treatment included increased patient comfort because of the reduced number of dressing changes and, in some cases, greater freedom from contaminating bacteria.  相似文献   

9.
目的:分析比较削痂和电动磨痂在治疗深Ⅱ度烧伤创面的应用。方法:93例深Ⅱ度烧伤住院患者随机分成两组,一组进行削痂手术,另一组行磨痂手术,观察比较两组患者手术治疗效果。结果:与削痂组创面比较,磨痂组创面愈合时间提前5~6d,且愈合质量好,瘢痕增生轻。从病理上看,磨痂手术能最大限度地保留有活力的组织和皮肤附件。结论:用电动磨痂仪施行的磨痂手术操作简单,易于掌握;对组织损伤小,能充分地保留有活力的真皮组织及皮肤附件;创面再上皮化迅速,缩短愈合时间,减轻病人的负担;创面愈合质量好,瘢痕形成轻或无瘢痕。  相似文献   

10.
背景:中国应用表皮生长因子治疗烧伤创面的临床研究较为广泛,但缺少大样本随机对照研究。目的:对中国应用表皮生长因子治疗深Ⅱ度烧伤创面的疗效进行系统评价。方法:应用计算机检索中国生物医学文献数据库(CBM,1979/2010)、万方数据库(1982/2011)、重庆维普中文科技期刊全文数据库(VIP,1989/2010)和中国期刊全文数据库(CNKI,1979/2010),以"表皮生长因子"和"深Ⅱ度烧伤"为检索词,收集有关表皮生长因子治疗深Ⅱ度烧伤与不采用表皮生长因子治疗相比较的随机对照实验。评价纳入研究的方法学质量并进行资料提取后,采用RevMan5.0软件进行Meta分析。结果与结论:共纳入10个随机对照研究,包括536例深Ⅱ度烧伤患者。Meta分析结果显示:表皮生长因子治疗组创面愈合时间少于对照组(P〈0.01);第2周和第3周创面愈合率表皮生长因子治疗组与对照组差异有显著性意义(P=0.0002,P=0.01);表皮生长因子治疗组瘢痕增生与对照组比较明显减少(P〈0.00001);而在减少烧伤创面疼痛方面两者差异无显著性意义(P=0.16)。表明应用表皮生长因子能明显促进烧伤创面的愈合和减少瘢痕增生的形成,但对缓解创面疼痛程度无明显优势。  相似文献   

11.
Scalds are one of the most common injuries and the 4th cause of trauma globally. Alginate has emerged as a promising scald wound dressing. Herein, we present a facile applicable strategy for electron beam (EB) radiation crosslinking gelatin, alginate, and carboxymethyl cellulose (CMC) into an injectable three-dimensional (3D) porous hydrogel (3D-PH) with a double crosslinked network for reliable deep second-degree scald wound healing. In addition, the injectable 3D-PH stimulated proliferation and migration of dermal fibroblasts in vitro and the deep second-degree scald wound healing process is accelerated in vivo. Most importantly, in vitro results revealed that the injectable 3D-PH stimulated cell proliferation via inducing the expression of Ki-67, and suppressed inflammatory signals as indicated by the downregulation of inflammatory factors (IL-6, TNF-α) in L929 cells. We further demonstrated that the 3D-PGH accelerated the wound healing process of deep second-degree scald in vivo. This study indicated the injectable 3D-PH with a double crosslinked network could be applied as a multifunctional injectable scald wound dressing material for anti-inflammation, necrotic tissue-removal, and wound closure. These findings suggest that the injectable 3D-PH may be conducive to the evolution of new pharmaceuticals for burn wound healing.

The injectable 3D porous hydrogel with a double crosslinked network could be applied as a multifunctional injectable scald wound dressing material for anti-inflammation, necrotic tissue-removal, and wound closure.  相似文献   

12.
背景:大面积烧伤往往需要削痂清除痂皮,但削痂手术往往会导致人为因素除去过多的残留再生皮肤组织.目的:观察磨痂治疗深Ⅱ度烧伤创面对残留皮肤组织中表皮干细胞标记物角化蛋白19表达的影响.设计、时间及地点:随机分组对比观察,于2002-10/2004-01在广西医科大学完成.对象:烧伤整形外热烧伤科患者40例,年龄18~37岁,平均烧伤面积为15%~45%,深Ⅱ度烧伤面积为15%~30%.随机分组方法分为磨痂组(n=20)、削痂组(n=20).方法:磨痂组采用电动磨痂仪对创面进行磨痂,由浅入深磨去坏死组织,至创面基底呈现红色充血,有珠状的小出血点为止.削痂组采用滚轴削痂刀对创面进行削痂,削至创面基底呈瓷白色、组织致密,湿润面有光泽,无网状血管栓塞和呈灰暗棕色的无光泽组织,放松止血带后可见密集点状出血较均匀,但有时因操作原因削痂过深,基底露出脂肪组织.两组创面术后用辐照猪皮覆盖.主要观察指标:取术前、术后小块创面组织以免疫组织化学SP法检测标皮肤再生组织中标记物角化蛋白19的表达,在100倍光学显微镜下,任意选取5个视野计数细胞团的表达数;观察两组创面愈合时间,记录超过4周不愈合的肉芽创面,需要再次手术植皮修复创面.结果;磨痂保留了较多的真皮组织,毛囊,汗腺,皮脂腺等皮肤附件.削痂后创面基底组织有薄层网状组织残田及部分毛囊及汗腺,有些标本视野中可见无真皮组织,为脂肪组织.细胞团的表达数比较结果显示,两组前及术后创面均有创面残留皮肤组织中标记物角化蛋自19表达,磨痂组术前、术后数量无明显变化(P>0.05),削痂组术后较术前数量减少(P<0.05);磨痂组创面较削痂组提前愈合(P<0.05).需要手术植皮创面磨痂组2处,削痂组8处(P<0.05).结论:应用磨痂术治疗烧伤深Ⅱ度创面能有效掌握磨痂深度,对组织损伤小,与削痂比较保留更多的再生皮肤组织,通过表皮干细胞的再生,利于创面再上皮修复,缩短创面愈合时间.  相似文献   

13.
Epi-Lock, a 1-mm-thick semipermeable sheet of modified polyurethane dressing material, was compared with silver sulfadiazene cream (Silvadene) in a prospective, randomized, cross-over-controlled study in which 50 patients alternated changing antibiotic cream daily with leaving the polyurethane sheet in place for a week. Overall, patient and physician preference for Epi-Lock was statistically significant (P less than 0.004), based on less pain, easier care, and faster healing. The collection of fluid under the polyurethane dressing and the necessity of leaving the wound covered for a week were less well accepted. Epi-Lock represents a major advance in wound dressing materials and should eventually gain wide application in outpatient treatment of partial thickness burns and abrasions.  相似文献   

14.
BackgroundPartial thickness burns are the most common form of thermal burns. Traditionally, dressing for these burns is simple gauze with silver sulfadiazine (SSD) changed on a daily basis. Foam dressings have been proposed to offer the advantage of requiring less frequent dressing change and better absorption of exudates.ObjectiveTo compare the impact of silver-containing foam dressing to traditional SSD with gauze dressing on wound healing of partial thickness burns.MethodsWe performed a systematic literature search using PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library database and Google Scholar for trials comparing traditional SSD dressings to that of silver-containing foam dressing on wound healing in partial thickness burns <25% of the body surface area. We excluded studies that enrolled burns involving head, face, and genitals; burns older than or equal to 36 h, non-thermal burns, and immunocompromised patients. Quality of trials was assessed using the GRADE criteria. The main outcome, complete wound healing, is reported as percentages of wound with complete epithelialization after the follow up period. Relative risks of complete healing are also reported with respective 95% CI. Time to healing and pain score before, during, and after dressing change at each follow up visit are compared between the groups (means with standard deviation or medians with quartiles).ResultsWe identified a total of 877 references, of which three randomized controlled trials (2 combined pediatric and adult trials and 1 adult trial) with a total of 346 patients met our inclusion criteria. All three trials compared silver-containing foam dressing to SSD and gauze on partial thickness burns. Moderate quality evidence indicated no significant difference in wound re-epithelialization between the groups across all three trials as confidence intervals for the relative risks all crossed 1. Although pain scores favored foam dressing at the first dressing change (7 days), there was no significant difference between the groups at the end of the treatment period at 28 days. Time to wound healing was also similar across the three trials with no statistical difference. Infection rates favored the foam-dressing group, but data were inconsistent.ConclusionModerate quality evidence indicates that there is no significant difference in wound healing between silver-containing foam dressing and SSD dressing. However, foam has the added benefit of reduced pain during the early treatment phase and potentially decreased infection rates.  相似文献   

15.
目的观察重组人表皮生长因子凝胶在浅Ⅱ度烧伤创面护理中的应用效果。方法选择50例浅Ⅱ度烧伤患者,采用同体对照法,将同一创面不同区域或同体对称部位的创面分为观察组和对照组。观察组采用重组人表皮生长因子凝胶加医用硅酮凝胶膏混合后湿敷创面;对照组采用医用硅酮凝胶膏湿敷创面。观察两组创面愈合时间、换药次数、疼痛状况及渗液情况的差异。结果观察组的创面平均愈合时间(8.6±1.6)d较对照组(11.8±1.7)d明显缩短,差异有统计学意义(t=-9.834,P〈0.05)。观察组换药次数(4.5±0.9)次较对照组(6.1-I-0.9)次明显减少,差异有统计学意义(t=-9.336,P〈0.05)。两组患者的换药疼痛程度相似,差异无统计学意义(x^2=0.272,P〉0.05)。两组在第2次换药时的渗液程度相似,差异无统计学意义(x^2=0.205,P〉0.05);而在第3和4次换药时,观察组渗液程度较对照组明显改善,差异有统计学意义(x2分别为8.988,5.316;P〈0.05)。结论重组人表皮生长因子凝胶能减少浅Ⅱ度烧伤创面的渗液量,减少换药次数,可明显促进表皮生长,加速创面愈合。  相似文献   

16.
Minor burns are common but require early and appropriate care to avoid infection and scarring. Damage can be arrested by immersing the burn in cold water as soon as possible. The goals of care are then to remove dead tissue and protect viable tissue during healing. Very superficial burns require only application of an emollient to limit inflammation and pain and prevent desiccation. Partial-thickness burns that are clean and superficial may benefit from use of a biosynthetic bilaminar membrane dressing, which forms a skin substitute while protecting the wound. A patient with an infected wound or one on a primary area (hands, feet, face, or perineum) may have to be hospitalized to ensure proper care.  相似文献   

17.
背景:国内外应用纳米银治疗烧伤创面较为广泛,但临床研究报道多为小样本随机对照研究,缺乏循证医学方面的依据和说服力。目的:对纳米银与磺胺嘧啶银治疗烧伤创面疗效进行系统评价。方法:计算机检索PubMed、Sciencedirect(SD)数据库、重庆维普中文科技期刊全文数据库(VIP,1989/2010)和清华同方数据库(CNKI,1979/2010),收集有纳米银制剂治疗烧伤与磺胺嘧啶银治疗相比较的随机对照实验。评价纳入研究的方法学质量并进行资料提取后,采用RevMan5.1软件进行Meta分析。结果与结论:共纳入8个随机对照实验,包括513例Ⅱ度烧伤患者。Meta分析结果显示:创面愈合时间纳米银治疗组少于磺胺嘧啶银组(P<0.001);第15天创面愈合率纳米治疗组与对照组差异无显著性意义,结果为(MD=7.10,95%CI=-2.29~16.50,P=0.14);纳米银治疗组和磺胺嘧啶银组相比,在减少烧伤创面疼痛方面两者差异有显著性意义(P<0.00001)。提示应用纳米银与应用磺胺嘧啶银相比能明显促进烧伤创面的愈合,对缓解创面疼痛程度优势明显,但尚需大样本高质量随机对照研究去进一步证实。  相似文献   

18.
This case study describes a pivotal intervention associated with improved wound appearance and healing rate in a young, active woman with extensive venous stasis ulcers. These extensive ulcerations were heavily exudative and covered by a layer of yellow eschar. Yellow eschar and drainage were successfully managed with a capillary dressing (Vacutex), which promoted therapeutic compression as applied by standard dressings. This case provides data in favour of wound care protocols featuring Vacutex, specifically designed to address the consequences that wound drainage and eschar have in dramatically large venous stasis ulcers.  相似文献   

19.
In this report a novel antibacterial wound dressing was prepared and then characterized for required testing. We loaded silver sulfadiazine (AgSD) for the first time by electrospinning. AgSD was added in zein (0.3%, 0.4%, 0.5%, and 0.6% by weight) and was electrospun to fabricate nanofiber mats for wound dressings. Nanofiber mats were characterized by Fourier transform infrared spectroscopy (FTIR) to check if there was any chemical reaction between AgSD and zein. Morphological properties were analyzed by Scanning Electron Microscopy (SEM), which showed uniform nanofibers without any bead formation. The diameter of the nanofibers gradually decreased with an increase in the amount of AgSD, which can be associated with strong physical bonding between zein and AgSD. Thermal properties of nanofiber mats were analyzed by Thermogravimetric Analysis (TGA). X-Ray Diffraction (XRD) further demonstrated the crystalline structure of the nanofiber mats, and X-ray Photoelectron spectroscopy (XPS) was performed to confirm Ag and S contents in the prepared wound dressings. In order to investigate antibacterial properties, a disc diffusion method was employed. Bacillus and E. coli bacteria strains were used as Gram-positive and Gram-negative strains respectively. The antibacterial effectiveness of AgSD released from zein nanofibers was determined from the zone inhibition of the bacteria. The antibacterial activity of zein nanofibers loaded with drug was observed with both strains of bacteria in comparison to a control. Excellent antibacterial efficacy was attributed to the sample with 0.6% AgSD. Excellent release properties were also associated with the sample with 0.6% AgSD in zein nanofibers. Keeping in mind the abovementioned characteristics, prepared nanofiber mats would be effective for application in wound dressings.

In this report a novel antibacterial wound dressing was prepared and then characterized for required testing. We loaded silver sulfadiazine (AgSD) for the first time by electrospinning.  相似文献   

20.
背景:已证实单层人羊膜覆盖对浅度烧伤创面有一定的治疗作用,但仍存在很多不足。目的:观察自制复层辐射人羊膜覆盖治疗对鼠深Ⅱ度烫伤创面的效果。设计、时间及地点:随机分组,自身及组间对照动物实验,于2006-12/2007-05在哈尔滨医科大学第一临床医学院动物实验中心进行。材料:成年清洁级Wistar大鼠50只,随机分为伤后4,6,8,10,12d组5组,每组10只。复层辐射人羊膜为自制,将新鲜人羊膜去除绒毛膜后,将羊膜层干燥,制成无孔及有孔的复层薄膜,再经γ射线辐射后塑膜包装。方法:所有动物背部脱毛,麻醉后浸入沸水中8s致背部烫伤,制备深Ⅱ度烫伤模型。将每组创面积2等分,分别贴敷复层辐射人羊膜和油纱进行对照观察。主要观察指标:在伤后4,6,8,10,12d取材,观察创面大体愈合情况,光镜、扫描电镜、透射电镜观察创面组织学变化,并进行创面细菌学检查。结果:50只大鼠全部进入结果分析。①贴敷油纱的创面:可见坏死物和痂皮,伤后12d时肉眼仍见灶性小溃疡,光镜下见生真皮层少量毛囊、毛根、毛发再生,扫描电镜下见创面中心为坏死结痂,周边见少量毛发,大量炎性渗出物及白细胞存在,透射电镜显示细胞结构模糊不清。细菌学检查结果显示创面细菌生长明显。②贴敷复层辐射人羊膜创面:伤后10,12d时创面愈合,肉眼见毛发规则丛生,和正常皮肤无区别,光镜、扫描电镜、透射电镜观察均显示伤后12d时表皮各层均为正常皮肤组织。细菌学检查结果显示创面无细菌生长。结论:复层辐射人羊膜能能有效地保护鼠烫伤创面,促进创面的上皮生长,避免创面感染,缩短鼠深Ⅱ度烫伤创面的愈合时间。  相似文献   

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