表皮生长因子对大鼠深Ⅱ度烧伤创面愈合的影响

目的　进一步观察重组人表皮生长因子 (rhEGF)对深Ⅱ度烧伤创面愈合的促进作用。方法　采用大鼠深Ⅱ度烫伤模型 (以下称烧伤 ) ,创面分别外用rhEGF、肝素加rhEGF及等渗盐水。比较不同方式处理创面后的愈合时间 ,测定创面愈合率、创面含水量、羟脯氨酸 (OHP)含量及Ⅰ /Ⅲ型胶原比例 ,进行细胞DNA周期分析和组织学检查。　结果　外用rhEGF可使烧伤创面愈合时间缩短 2d,增加创面OHP含量 (P <0.0 5),降低Ⅰ /Ⅲ型胶原比例 (P <0.0 5),促进肉芽组织形成 ,加速细胞DNA复制 (P <0.0 5 )。加用肝素后可使创面愈合时间进一步缩短 2d,促进肉芽组织生长。伤后第 7天用药各组间比较 ,差异无显著性意义 (P >0.0 5)。　结论　外用rhEGF能明显促进深Ⅱ度烧伤创面愈合 ,加用肝素后效果更加显著 ,但早期使用rhEGF效果不明显     

银锌霜与重组人表皮生长因子联合治疗深Ⅱ度烧伤的疗效分析

笔者等自1999年12月至2003年12月，采用银锌霜与重组人表皮生长因子（recombinant humar epidermal growth factor, rhEGF）联合治疗深Ⅱ度烧伤患者，获得较好的效果，现将其疗效分析如下。     

纳米银抗菌凝胶联合重组人表皮生长因子凝胶对深Ⅱ度烧伤刨面的疗效观察

目的：观察纳米银抗菌凝胶联合重组人表皮生长因子凝胶对深Ⅱ度烧伤创面的疗效。方法：将85例深2度烧伤创面分为治疗组（n=47）和对照组（n=38）,其中治疗组应用纳米银抗菌凝胶联合重组人表皮生长因子凝胶,对照组应用磺胺嘧啶银乳膏。于7天、14天、21天、28天比较创面愈合率。结果：自14天起,治疗组创面愈合率大于对照组（P〈0．05）。结论：纳米银抗菌凝胶联合重组人表皮生长因子凝胶可以促进深Ⅱ度烧伤创面。     

应用钢丝球磨削术治疗深Ⅱ度烧伤创面

以往治疗深Ⅱ度烧伤主要采用药物溶痂、干燥结痂或早期削痂植皮。近年来笔者采用钢丝球磨削术加喷洒碱性成纤维细胞生长因子 (bFGF),治疗 76例深Ⅱ度烧伤患者 ,取得良好疗效。方法 :清洁钢丝球浸泡于器械消毒液中 30min或戊二醛液中 15min,使用前用等渗盐水冲洗。在基础麻醉或分离麻醉后 ,用消毒钢丝球在深Ⅱ度烧伤创面上反复磨擦 (图1) ,若钢丝球上沾有粘滑的烧伤腐皮 ,用 5 %碳酸氢钠加等渗盐水刷洗。磨擦至去除坏死组织 ,创面呈粉红色、有点状出血、压之褪色又很快泛红为止。如有干硬痂皮可应用滚轴刀削去表层硬痂后 ,磨擦基底部残余坏…     

重组人表皮生长因子凝胶联合纳米银抗菌凝胶治疗深Ⅱ度烧伤创面临床分析

目的观察基因重组人表皮生长因子凝胶((recombinant human epidermal growth factor gel,rh EGF)联合纳米银抗菌凝胶治疗深Ⅱ度烧伤的临床效果。方法将64例深Ⅱ度烧伤患者随机分为2组.每组32例。对照组采用磺胺嘧啶锌软膏换药治疗,治疗组采用rh EGF凝胶联合纳米抗菌凝胶换药治疗。在治疗后7 d、14 d、21 d、28 d分别对2组患者进行创面分泌物的细菌培养和鉴定,并观察记录2组创面的愈合率和愈合时间。结果治疗组烧伤创面总体细菌培养阳性率低于对照组,2组差异有统计学意义(P0.05);治疗组烧伤创面在治疗7 d后及28 d后愈合率比较,差异无统计学意义(P0.05),但治疗组在治疗14 d后,21 d的愈合率均高于对照组,2组差异有统计学意义(P0.05);治疗组愈合时间短于对照组,2组差异有统计学意义(P0.05)。结论应用rh EGF凝胶联合纳米银抗菌凝胶治疗深Ⅱ度烧伤创面愈合率高,愈合时间短,不良反应少,效果满意。     

碘伏治疗Ⅱ度烧伤创面的临床观察

碘伏是碘与表面活性剂、无菌增效剂的络合物，为高效低毒杀菌广谱的新型消毒剂。我科自2002年10月至2003年10月采用碘伏湿敷治疗中小面积Ⅱ度烧伤患者40例，取得满意效果，现介绍如下。     

表皮生长因子溶液配合负压封闭引流技术治疗深Ⅱ度烧伤创面的疗效观察

目的：：观察应用表皮生长因子溶液冲洗封闭负压引流装置和创面治疗深Ⅱ度烧伤创面的疗效。方法：四肢深Ⅱ度烧伤患者60例,年龄18~60岁,烧伤创面面积5%~10%,随机分为治疗组和对照组。两组均采用负压封闭引流技术治疗,分别以表皮生长因子溶液(治疗组)或生理盐水(对照组)每日2次冲洗负压装置。伤后第5、10、15天更换负压装置,并观察体温变化、创面愈合率及创面完全愈合时间。结果：①治疗组11例(36.7%)患者出现发热,较对照组(12例,40.0%)差异无统计学意义(χ2=0.071,P =0.791)。②治疗组第10、15天创面愈合率[0.47670±0.02783和0.78070±0.02599]明显高于对照组[0.42570±0.02445比0.73130±0.02945],创面总体愈合时间[(19.27±1.82)d]短于对照组[(23.10±2.07)d],差异均有统计学意义(P 均<0.05)。④治疗前,治疗组和对照组分别有5例和6例患者创面分泌物细菌培养阳性,治疗后两组均有2例未愈创面,其分泌物细菌培养结果均为阴性。结论：表皮生长因子溶液配合密闭式负压吸引作为负压装置冲洗剂,能促进深Ⅱ度烧伤创面愈合,提高负压封闭引流技术在深Ⅱ度烧伤创面的疗效。     

重组人表皮生长因子凝胶联合黄连紫草膏治疗小面积深Ⅱ度烧伤创面的效果观察

目的:观察黄连紫草膏联合重组人表皮生长因子(rhEGF)凝胶局部应用治疗小面积深Ⅱ度烧伤创面的效果及对患者疼痛程度和创面细菌感染的影响.方法:选取河南省鹤壁市人民医院急诊科2018年7月—2020年11月收治的89例小面积深Ⅱ度烧伤患者作为研究对象,创面面积4％～11％TBSA.采用抽签法将患者分为两组.对照组44例给...     

纳米银敷料联合重组人表皮生长因子凝胶治疗烧伤创面疗效观察

目的:观察纳米银敷料联合重组人表皮生长因子凝胶治疗深Ⅱ度烧伤患者的临床疗效.方法:选取2017年5月-2020年5月笔者医院收治的180例深Ⅱ度烧伤患者,随机分为联合组、凝胶组和敷料组,每组各60例.凝胶组给予重组人表皮生长因子凝胶治疗,敷料组给予纳米银敷料治疗,联合组给予重组人表皮生长因子凝胶联合纳米银敷料干预治疗....     

Short- and long-term results of application of allogeneic cultured keratinocytes on burn wounds and burn scar

Hypertrophic scarring is still a crucial problem in burn care, especially in large burn victims who now survive more frequently. Preventative measures are needed at different time points in order to avoid further damage to residual epidermal remnants. Stimulation of reepithelialization has been carried out since 1987 in our burn centre using a combined technique of placing keratinocyte cultures on top of split-thickness meshed skin autografts. In vitro results showed that cultured keratinocyte cell extracts inhibit collagen lattice contraction. In two patient studies, an approximately two-fold stimulation of reepithelialization of meshed skin transplants was found when covered by fresh or lysated allogeneic keratinocyte cultures. No long-term effect on scar formation was found using this combined technique.     

Nano-silver modified porcine small intestinal submucosa for the treatment of infected partial-thickness burn wounds

Background and aimSilver has been widely used as a topical antimicrobial agent in burn wound care. In a previous study, we demonstrated the introduction of nano-silver particles to porcine small intestinal submucosa (NS-PSIS) led to significant enhancement in antibacterial property in repairing contaminated abdominal defect. In this study, we explored the efficacy of NS-PSIS in the treatment of Pseudomonas aeruginosa-infected partial-thickness burn wounds.Methods48 male Sprague-Dawley rats were divided into four groups of equal number. Standardized and reproducible Pseudomonas aeruginosa-infected partial-thickness thermal burns wound model were created using these rats. NS-PSIS, PSIS (porcine small intestinal submucosa) or lipido-colloid dressingss (Urgotul?) were tested for 14 days to assess their ability to heal the rats’ burn wounds. Control group was without any treatment after the establishment of infected burn-wound. The wound contraction rate, animal body weight change, histological examination, and the quantification of IL-6 and C-reactive protein (CRP) were measured to evaluate the healing effects.ResultsNS-PSIS significantly promoted wound healing and recovered the normal growth of rats. There were significantly lower expression levels of pro-inflammatory cytokine (IL-6) and CRP in NS-PSIS group as compared with the PSIS or Urgotul group in the treatment of infected partial-thickness burn wounds. Histological exams revealed significant less inflammatory cells infiltrating, more re-epithelization and neovascularization in NS-PSIS group. There were also less inflammatory cells infiltrations in the major organs in NS-PSIS group.ConclusionsNano-silver modified porcine small intestinal submucosa (NS-PSIS) can be used as a biological derivative dressing for the treatment of infected partial-thickness burn wounds.     

碱性成纤维细胞生长因子对大鼠烫伤创面中基质金属蛋白酶及其抑制剂的影响

目的　观察大鼠深Ⅱ度烫伤创面愈合过程中基质金属蛋白酶 (MMP) 2、MMP 7与金属蛋白酶组织抑制因子 2 (TIMP 2 )的变化以及创面外用碱性成纤维细胞生长因子 (bFGF)对其的影响。　方法　制作 30 %TBSA深Ⅱ度烫伤大鼠模型 ,分为单纯烫伤组和bFGF治疗组。于伤后 3、6h和 1、3、7、14d取创面皮肤标本 ,检测再上皮化率及胶原含量 ,并采用免疫组织化学染色法检测创面组织真皮内成纤维细胞MMP 2、MMP 7和TIMP 2的表达变化。另取 6只正常大鼠作为假烫组 ,分别检测上述各项指标。　结果　 (1)伤后 3～ 14d ,bFGF治疗组再上皮化率高于单纯烫伤组。 (2 )伤后 3h～ 3d ,bFGF治疗组和单纯烫伤组胶原含量持续下降 ,7～ 14d开始回升 ,但仍低于假烫组 (P<0 .0 5 )。 (3)伤后 1d ,单纯烫伤组MMP 2、MMP 7和TIMP 2表达增多 ,7d时达到高峰 ,持续到 14d。(4 )伤后 3～ 6h,bFGF治疗组MMP 2、MMP 7的表达与单纯烫伤组相似 ;伤后 1～ 14d ,3者的阳性表达强于单纯烫伤组。　结论　烫伤大鼠创面中细胞外基质的活动会影响皮肤的胶原沉积 ;MMP 2、MMP 7、TIMP 2的表达变化是组织修复的重要步骤 ,与bFGF加速创面愈合的过程密切相关。     

转Endostatin基因角朊细胞移植对烧伤深Ⅱ°创面愈合及瘢痕增生的影响

目的探讨转内皮生长抑制素(ES)基因角朊细胞移植对烧伤深Ⅱ°创面愈合及瘢痕增生的影响。方法将人体皮肤移植于裸鼠并造成深Ⅱ°烧伤创面。实验分为对照组(11只)、单纯角朊细胞移植组及转ES基因角朊细胞移植组(各10只)。对照组不行细胞移植,创面自行愈合;单纯角朊细胞移植组创面移植培养人角朊细胞;转基因移植组移植转ES基因角朊细胞。观察各组裸鼠创面愈合特点、瘢痕增生情况,并对愈合区组织进行病理切片检查、检测愈合区皮肤组织ES 蛋白表达、I、Ⅲ型前胶原含量。结果转基因移植组裸鼠创面愈合时间(13±5)d与单纯移植组 (14±5)d差异无统计学意义(P>0．05),但明显短于对照组[(25±7)d,P<0．01]。对照组裸鼠创面愈合后瘢痕增生明显,伤后100 d厚度≥0．22 cm,单纯移植组瘢痕增生厚度≥0．17 cm,转基因移植组仅有轻度瘢痕增生,愈合区皮肤组织ES蛋白检测阳性。单纯移植组、转基因移植组愈合区组织前胶原I含量(65．3±8．5)μg／g,(61．4±7．0)μg／g、前胶原I／前胶原Ⅲ比例(0．66±0．15,0．57± 0．13)明显低于对照组(1．51±0．37,P<0．01),而前胶原Ⅲ含量显著高于对照组(P<0．01)。结论转ES基因移植既可加速创面封闭,又能抑制愈合后瘢痕形成。     

重组人粒细胞/巨噬细胞集落刺激因子联合水凝胶敷料治疗深Ⅱ度烧伤创面临床观察

目的:观察外用重组人粒细胞/巨噬细胞集落刺激因子(rhGM-CSF)联合水凝胶敷料治疗深Ⅱ度烧伤创面的临床效果.方法:选择四肢部位有深Ⅱ度烧伤创面的住院患者24例,48处研究创面,每例患者2个创面,分别位于不同肢体.研究分为4组.随机选取12例患者,每例患者随机选取一个创面作为rhGM-CSF联合外用水凝胶敷料治疗组(联合治疗组,创面清创后外涂外用重组人粒细胞巨噬细胞刺激因子凝胶,覆盖医用水凝胶敷料),另一个创面作为rhGM-CSF联合外用凡士林油纱治疗组(rhGM-CSF对照组,创面清创后外涂外用重组人粒细胞巨噬细胞刺激因子凝胶,覆盖凡士林油纱);余12例患者每例随机选择一处创面作为水凝胶敷料治疗组(水凝胶对照组,创面直接覆盖医用水凝胶敷料);另一处创面作为凡士林油纱对照组(凡上林对照组,创面直接覆盖凡士林油纱).每组12处创面.观察各组创面愈合时间及创面感染情况,创面分泌物行细菌培养,比较创面细菌感染阳性率.结果:联合治疗组创面愈合时间较其他3组明显缩短(P＜0.05);rhGM-CSF对照组和水凝胶对照组创面愈合时间较凡士林对照组缩短(P＜0.05).rhGM-CSF联合外用水凝胶敷料治疗组创面洁净,细菌检出率低(16.7％):rhGM-CSF治疗组感染状况也较轻,细菌检出率较低(25.0％),凡士林对照组感染状况重,细菌检出率最高(83.3％,P＜0.01).结论:深Ⅱ度烧伤创面外用rhGM-CSF联合水凝胶敷料治疗,可以明显减少创面细菌感染概率,缩短创面愈合时间.     

微管失稳剂oncoprotein18/stathmin基因在深Ⅱ度烧伤愈合前创面及增生性瘢痕中的表达

目的观察深Ⅱ度烧伤创面愈合前及愈合后增生性瘢痕组织中微管失稳剂oncoprotein18/stathmin(Op18)基因的表达. 方法提取临床深Ⅱ度烧伤愈合前与愈合后不同时期增生性瘢痕中的总RNA,以GADPH基因表达为内参照,采用逆转录酶-多聚酶链式反应(RT-PCR)方法,半定量检测上述基因表达水平. 结果与正常组织比较,伤口愈合前Op18基因表达显著降低(P<0.05),愈合后表达迅速增高(P<0.05),在4～32个月增生性瘢痕中Op18基因稳定高表达. 结论在伤后早期Op18基因的表达水平降低与细胞增殖、组织修复的需要相适应,在增生性瘢痕组织中通过Op18基因高表达来抑制瘢痕增生.     

Recombinant human granulocyte-macrophage colony-stimulating factor hydrogel promotes healing of deep partial thickness burn wounds

Objective

To assess the effects of recombinant human granulocyte/macrophage colony-stimulating factor (rhGM-CSF) hydrogel on the healing of deep partial thickness burn wounds.

Methods

Ninety three wounds of 65 burn patients who suffered from a deep partial thickness burn of <5% TBSA and could not heal over 3 weeks were included in this study. The patients were randomly assigned to use rhGM-CSF hydrogel (GC group, n = 32) or hydrogel without rhGM-CSF (control group, n = 33). rhGM-CSF hydrogel or hydrogel without rhGM-CSF was topically applied to the wounds, the dressing was changed once a day. Wound healing time and percentage, wound discharge, periwound inflammation, the positive wound swabs culture count, and adverse drug reactions were observed and compared between two groups.

Results

Healing time was 12.2 ± 5.0 days after the application of rhGM-CSF hydrogel. This was significantly shorter than that of control wounds (15.5 ± 4.7 days). Healing percentage at 14 days in the rhGM-CSF-treated wounds was 97.5 ± 7.7%, which was markedly higher than the control (85.9 ± 6.8%). At 3, 6, 12, 14 day, the GC group was significantly superior to the control group with respect to the score of periwound inflammation, wound purulence and discharge. The positive wound swabs culture count of the GC group on the 7th and 14th day post-treatment was 14 and 4, respectively, which was significantly lower than the control.

Conclusion

rhGM-CSF hydrogel promotes the healing process of deep partial thickness burns effectively. No adverse reaction of the drug was observed during the study.     

深Ⅱ度烧伤创面伤后24小时内削痂的临床观察

目的　探讨深Ⅱ度烧伤患者伤后 2 4h内创面行削痂术的安全性和临床疗效。　方法12例有削痂手术指征并在伤后 2 4h内行削痂术的深Ⅱ度烧伤患者为A组 ;14例削痂条件相似并按常规在伤后 4～ 6d行削痂术的深Ⅱ度烧伤患者为B组。比较两组休克期补液量、休克征象发生率、回吸收期的生命体征、尿量及愈合时间。　结果　两组患者在休克期补液量、休克征象发生率方面差异均无显著性意义 (P >0 .0 5 ) ;A组休克期尿量明显增多 ,回吸收期的体温、心率与B组明显不同(P <0 .0 5～ 0 .0 1) ;A组创面平均愈合时间较B组短 (P <0 .0 1)。　结论　深Ⅱ度烧伤创面于伤后2 4h内削痂是安全的 ,并能缩短创面愈合时间。     

早期保守去痂延期植皮治疗颜面深度烧伤

目的：探讨颜面部深度烧伤后,预防局部瘢痕增生和畸形的最好治疗方法。方法：颜面部深度烧伤早期,采用保守削痂,延期植皮和双眼睑早期减张,扩张创面立即植皮的处置方式,结果：本组12例患于伤后3周内创面全部愈合。随诊未发现明显瘢痕增生和畸形,面部表情自然,情绪表达充分。结论：应用早期保守去痂延期植皮的方法,可促进全颜面创面尽快修复,减少瘢痕增生和颜面畸形的发生。