精氨酸对烧伤创面愈合的影响

目的 探讨精氨酸对烧伤创面愈合的影响和量效关系。方法 通过大鼠深Ⅱ度烫伤模型,伤后肠道站充不同剂量精氨酸,观察烧伤创面愈合时间,测定烧伤创面愈合面积百分比,创面Ｉ型／Ⅲ型胶原比例,羟脯氨酸（ＯＨＰ）含量和真皮细胞增殖周期,结果 每天补充１００－４００ｍｇ／ｋｇ精氨酸可缩短烧伤创面愈合时间,增加烧伤创面中ＯＨＰ含量,降低烧伤创面Ｉ／Ⅲ型胶原比例,加速真皮细胞ＤＮＡ复制。比较喂不同剂量精氨酸各组,发现     

烧伤创面愈合

本文重点阐述有关原理。并讨论组织修复和创面愈合。有关热力损伤内容原则上各种原因烧伤。     

烧伤创面愈合的信号转导机制

After 50 years of development in science of bums care in China, we have basically solved coverage of deep wounds of burn trauma, as well as role of multiple growth factors and stem cell in wound healing, making great contribution to improving the treatment of patients with large area of deep bums. Surgeons are paying close attention to problems of wound healing, especially in the fields of starless healing and rehabilitation. To solve these problems, we need to do further investigation on multiple growth factors as well as proliferation/differentiation of stem cells in regulation of cell growth and differentiation in wound healing. Therefore ,we are facing a even more serious challenge.     

积极开展烧伤创面愈合研究

创面愈合问题对于烧伤来说主要是及早、永久性覆盖创面和防治瘢痕过度增生。创面愈合的基础研究进展很快 ,从细胞因子、细胞间粘附分子、细胞内信号传导到基因组学、蛋白质组学方法筛选愈合相关基因和功能蛋白。但临床应用性研究仍局限于细胞生长因子 ,且药物剂型、给药途径及经济疗效学部分限制了临床探索性应用。而创面覆盖物的研究由于近年来人工真皮、脱细胞真皮基质 (ａｃｅｌｌｕｌａｒｄｅｒｍｉｓｍａｔｒｉｘ ,ＡＤＭ )、复合皮乃至组织工程化皮肤的大量研发又趋热门。有关创面愈合后的瘢痕过度增生 ,近年来研究热点转向瘢痕相关基…     

角朊细胞与创面愈合

烧伤是以皮肤及软组织损伤为主要特点的外伤 ,创面愈合的速度及质量是评价治疗水平高低的惟一可靠指标。在创面愈合过程中起主导作用的细胞是表皮细胞 ,它包括角朊细胞、黑色素细胞、朗格罕细胞及未分型树突状细胞 ,其中角朊细胞在数量上占绝大多数[1] 。因此 ,烧伤创面愈合的关键在很大程度上取决于角朊细胞的功能[2 ] 。一、角朊细胞培养1.历史 :2 0世纪 5 0年代 ,随着组织培养技术的迅速发展 ,角朊细胞的培养也进入了新阶段 ,Ｂｉｌｌｉｎｇｈａｎ和Ｒｅｙｕｏｌｄ用胰酶分离角朊细胞获得成功 ,Ｃｒａｉｃｋｓｈａｎｋ实现了在体外培养角…     

Ⅲ度烧伤后肉芽切除断层皮下组织创面自体皮移植对创面愈合的影响

目的探讨对Ⅲ度烧伤后肉芽切除断层皮下组织创面,采用自体皮移植修复的机制,并评价其疗效.方法采用肉眼、病理组织学、免疫组织化学、电镜和流式细胞术,动态观察成年Ⅲ系小型猪Ⅲ度烧伤后肉芽切除断层皮下组织创面自体植皮术(A组)后,移植皮片活性与结构,移植床肉芽组织、胶原纤维、微血管、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)蛋白表达和成纤维细胞超微结构变化,并与Ⅲ度烧伤后传统的肉芽刮除纤维板创面自体植皮术(B组)进行比较,另设对照组,皮肤仅剃毛(C组). 结果术后3天,移植皮片成活,A组较B组皮片损伤轻、皮肤细胞增殖指数高、移植床血管内皮细胞及肉芽组织增生,bFGF表达明显.5天,两组血管内皮细胞及肉芽组织增殖旺盛,成纤维细胞呈蛋白合成旺盛和功能活跃象,新生胶原纤维出现,但B组增殖更加明显.7～14天,A组表皮结构及真皮毛细血管密度逐渐恢复正常,移植床肉芽组织逐渐成熟为纤维结缔组织,而B组则延后2天左右.21天后,A组愈合创面病理改变轻于B组.30～60天,A组创面收缩及改容程度明显轻于B组,且触之较软、移动度尚可. 结论Ⅲ度烧伤后肉芽切除断层皮下组织创面自体皮移植术的疗效优于传统手术.     

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度烧伤创面的情况，结果表明：（１）大鼠接受２Ｇｙ＾６０Ｃｏ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，创面愈合百分率低下正常大鼠，由此证实了免疫功能低下对创面愈合的抑制作用。     

重视创面愈合研究提高烧伤救治水平

创面愈合是机体通过自身的再生能力，为恢复其表面的连续性和完整性、维持内环境稳定所进行的一系列修复活动。在这个复杂的生物学过程中，有多种组织和修复细胞、细胞外基质(ECM)以及各种调控因素参与。近20年来，随着分子生物学、细胞生物学的不断发展，特别是医学材料、组织     

透明质酸与创面愈合

创面愈合是一个复杂的生物学过程，而胶原代谢又贯穿于组织修复的整个过程中，影响胶原代谢的因素很多，实验证明作为细胞外基质重要组成成分的透明质酸，在其中起着重要作用。     

重视烧伤后补锌,促进创面愈合

烧伤创面始终是烧伤治疗的焦点，创面愈合一直是烧伤治疗的目标。影响创面愈合的诸多因素己被普遍关注，但有关微量元素锌与创面愈合的关系论述欠丰。近年来大量研究证实，严重烧伤后普遍缺锌，除对整体产生不良影响外，还使创面愈合延迟。补锌确有改善锌营养状态，促进创面修复之功效。 一、锌在创面愈合中的作用 成人体内约含锌１．４－２．３ｇ，在各微量元素含量中仅次于铁，居第二位［１］。其中皮肤锌即占体内锌总量的２０％，表皮含锌量明显多于真皮，表皮为７０．５ ｇ／ｋｇ干重，真皮为 １２．６ ｇ／ｋｇ干重，表明锌是维持皮肤…     

人创面愈合过程中同源异形框基因的表达及意义

目的 探讨人胎儿及成人皮肤创面愈合过程中，几种同源异形框基因的表达及在胎儿无瘢痕愈合中的作用。方法 采用原位杂交方法，对正常成人和胎儿皮肤及创面愈合过程中PRX—2、H0XBl3、H0X2．2和H0X2．3的表达进行观察。结果 (1)在正常胎儿和成人皮肤中可见PRX—2阳性表达，以前阳性程度为强。分布部位有所不同，在正常胎儿皮肤中，阳性表达主要见于真皮乳头层毛干部周围细胞，表皮中也可见阳性表达；而在正常成人皮肤中，表皮基底层细胞呈弱阳性表达，真皮组织中未见阳性表达。胎儿皮肤创伤后，接近切口的组织中阳性表达明显增强，而成人皮肤创伤后，阳性表达未见明显变化，仍局限于表皮基底层细胞；(2)在正常胎儿及成人皮肤均可见H0XBl3阳性表达，真皮部分主要集中在毛囊细胞，表皮部分主要集中在基底层细胞，创伤后其表达明显减弱，尤其是胎儿皮肤；(3)在正常胎儿皮肤中H0X2．2和H0X2．3阳性表达主要见于表皮全层，表皮基底层阳性表达比较强，真皮中可见弱阳性表达，创伤后近切口的组织中，表达增强。在正常成人皮肤及其创面，未见到阳性表达。结论 同源异形框基因作为与发育生物学密切相关的基因，在人胎儿及成人皮肤创面愈合过程中的表达有所不同，这可能是二创面愈合差异的根本原因。     

Stem cells in burn wound healing: A systematic review of the literature

IntroductionSevere burns are often associated with high morbidity and unsatisfactory functional and esthetic outcomes. Over the last two decades, stem cells have generated great hopes for the treatment of numerous conditions including burns. The aim of this systematic review is to evaluate the role of stem cell therapy as a means to promote burn wound healing.MethodsComprehensive searches in major databases were carried out in March 2017 for articles on stem cell therapy in burn wound healing. In total 2103 articles were identified and screened on the basis of pre-determined inclusion and exclusion criteria.ResultsFifteen experimental and two clinical studies were included in the review. The majority of studies reported significant improvement in macroscopic burn wound appearance as well as a trend toward improved microscopic appearance, after stem cell therapy. Other parameters evaluated, such as re-vascularization, collagen formation, level of pro- and anti-inflammatory mediators, apoptosis and cellular infiltrates, yielded heterogeneous results across studies.ConclusionStem cell therapy appears to exert a positive effect in burn wound healing. There is, therefore, justification for continued efforts to evaluate the use of stem cells as an adjunct to first-line therapies in burns.     

烧伤创面用药

For bum patients, topical treatment is as important as systemic treatment. Reasonable and timely wound treatment will influence the homeostatic equilibrium, and the progression, the prognosis, and the outcome of the disease. The therapeutic principle should be varied for wounds with different depth of injury. But avoiding or at least alleviating infection, and accelerating healing period, were the common principles. In common, the medication for local wound treatment includes: topical antiseptic, surgical dressing products, artificial skins, and so on.Ideal topical antiseptic should have the following zcharacteristics: the antimierobial spectrum is broad, including Pseudomonas aeruginosa and MRSA; be able to penetrate necrotic tissue; does not induce drug resistatance easily; no local irritating effect and not painful; no side effect to body; can be applied easily; low cost. The functions of surgical dressing in clude: protect the wounds, keep the microcirculation open, and accelerate wound healing. Artificial skin has been used as the autoskin carrier in skin transplantation operation for large burn area to protect the autoskin grafts, accelerate wound healing, and cover the wounds temporarily. Bums therapy has developed for 50 years in China, the study of local treatment for burn wounds has also experienced a tortuous path of trial and error. This review might contribute some ideas future research.     

金属蛋白酶组织抑制因子与皮肤创伤愈合

基质金属蛋白酶 (ｍａｔｒｉｘＭｅｔａｌｌｏｐｒｏｔｅｉｎａｓｅｓＭＭＰｓ)是参与细胞外基质 (ＥＣＭ)降解的主要蛋白酶 ,金属蛋白酶组织抑制因子 (ＴｉｓｓｕｅＩｎｈｉｂｉｔｏｒｏｆＭｅｔａｌｌｏｐｒｏｔｅｉｎａｓｅｓＴＩＭＰｓ)是一族内源性抑制因子 ,可以高度地、有选择地抑制ＭＭＰｓ或其前体而表现出许多生物学活性。ＴＩＭＰｓ和ＭＭＰｓ的平衡失控可导致创伤延迟愈合和其它许多疾病。现就有关ＴＩＭＰｓ的种类、结构和生物学作用及在皮肤创伤愈合中作用等研究综述如下。1　ＴＩＭＰｓ的产生和结构目前已知ＴＩＭＰｓ家族有…     

不同浓度法舒地尔促进皮肤创面愈合作用的研究

目的：观察法舒地尔（HA1077）促进创面愈合的效果,并探讨HA1077与创面愈合的量效关系,寻找出促进创面愈合的最佳剂量。方法：18只Wistar大鼠背部左右两侧致直径为2cm的圆形皮肤缺损。随机3只动物6个创面为一组,分为6组,分别给予10、20、40、80和160μmol/L盐酸法舒地尔和生理盐水（对照组）创面喷洒,每个创面0.5ml,隔日创面追加喷洒。实验3、7、10d计算伤口面积,实验10d取创面组织,观察组织学变化。结果：各组大鼠创面面积随伤后时间延长而逐渐缩小,20μmol/L组创面面积明显小于同时间点其他各组,除实验7d与80μmol/L组创面面积比较差异无显著性外,其余各时间点差异均有显著性（P〈0.05）。病理学变化显示,创伤后10d,应用20μmol/L法舒地尔组创面新生肉芽组织生长及新生表皮生长速度明显优于其他各组。结论：HA1077可促进皮肤缺损创面愈合,以20μmol/LHA1077效果更为明显。     

Nerve growth factor and burn wound healing: Update of molecular interactions with skin cells

Burn wound healing is a very intricate and complex process that conventionally includes three interrelated and overlapping stages of hemostasis/inflammation, proliferation and remodeling. This review aims to explore the molecular interactions of NGF with the most prominent cell types in the skin and their respective secretory products during wound healing, particularly burn wound healing. Different types of cells such as, nerve cells, endothelial cells, mast cells, macrophages, neutrophils, keratinocytes and fibroblasts all come into play through a plethora of cytokines and growth factors including nerve growth factor (NGF). NGF is a pleiotropic molecule that exerts its effects on all the aforementioned cells using two types of receptors (TrkA and p75) and affects wound healing by decreasing healing time and improving the quality of the scar. Both receptors mediate cellular proliferation, survival and apoptosis through complex signaling molecules. During the inflammatory phase, macrophages and mast cells secrete ample cytokines and growth factors, including NGF, which participate in the inflammatory reaction and induction of other cells targeting a homeostatic state. The proliferative phase follows, and NGF promotes angiogenesis through VEGF and FGF expression in endothelial cells. NGF also stimulates keratinocyte proliferation and neurite extension through the TrkA-PI3K/Akt pathway. Other molecules such as TGF-β1, IL-1β and TNF-α increase NGF expression in fibroblasts through dynamic interactions with Smads and MAPK molecules. Stimulated fibroblasts induce new collagen production to form the granulation tissue. In the remodeling phase, NGF regulates fibroblasts and induces their differentiation into myofibroblasts ultimately leading to wound contracture. In addition, NGF stimulates melanocytes and enhances hair growth and pigmentation. Such data depict the mechanisms of action of NGF implicated in the various stages of the healing process and support its applicability as a new targeted therapeutic molecule effective in burn wound healing but with some limitations.     

透明质酸含量在兔正常皮肤及皮肤创伤愈合过程的变化

目的　分析透明质酸在创伤愈合过程中的含量变化以及胎儿型愈合和成人型愈合的机理。方法　通过胎兔创伤模型及皮肤均化的方法，提取游离及结合的透明质酸（ＨＡ） ，应用透明质酸结合蛋白（ ＨＡＢＰ） 技术，对胚胎兔、成年兔皮肤在正常及创伤愈合过程中用放射免疫法测定游离、结合及ＨＡ 的总量。结果　⑴不同孕期正常胎兔皮肤的游离ＨＡ 及ＨＡ 总量的差异均无显著意义，结合ＨＡ 有显著的波动，而且均比正常成兔增高（ Ｐ＜ ０ ．０１） ；⑵胎兔皮肤创伤后不同愈合时间的游离ＨＡ 及ＨＡ 总量的差异均无显著意义，结合ＨＡ 的组成亦有显著变化；⑶创伤胎兔与正常胎兔相比，各组分ＨＡ 均增高（ Ｐ＜ ０ ．０５） ；⑷创伤成年兔游离ＨＡ 及ＨＡ 总量均比正常成年兔显著增高（ Ｐ＜ ０ ．０１） ，而在创伤成年兔内部游离ＨＡ 及ＨＡ 总量呈“山峰型”变化；⑸胎兔、成年兔皮肤创伤后对应比较发现，ＨＡ 总量均为胎兔高（ Ｐ＜ ０ ．０１） ，而游离ＨＡ 则第２ 、３ 天差异无显著意义。结论　ＨＡ 的增高是胎儿型愈合不可缺少的内部机制，其中游离ＨＡ 起主导作用，但结合ＨＡ 随孕期的延长以及在创伤后不同愈合时间所发生的显著变化，对于临床控制瘢痕形成具有很重要的意义     

血浆冷沉淀物在深度烧伤创面应用的实验及临床研究

目的　观察血浆冷沉淀物应用烧伤创面的治疗效果。方法　通过对 4 0只豚鼠烧伤模型及 4 6例临床烧伤患者创面应用血浆冷沉淀物与创面应用磺胺嘧啶银对照观察伤后创面愈合率、愈合时间。结果　应用血浆冷沉淀实验组创面愈合率、愈合时间优于应用磺胺嘧啶银对照组 ,表明血浆冷沉淀具有促进烧伤创面愈合作用。结论　血浆冷沉淀中所含的主要成分纤维连接蛋白 ,具有很强的生物活性 ,它能促进上皮细胞生长     

更进一步提高深度烧伤创面修复质量

This article summarizes methods of repair of massive and deep wounds, elucidates how to improve wound healing quality and avoid scar deformity after deep hum. A part of denatured dermis (non-necrotic)in deep partial-thickness burn, "mixed degree" burn, even in full-thickness burn wounds before forming eschar can be preserved and covered with autolo-gous skin, thereby to avoid secondary damage to the structure of subcutaneous tissue and the junction of dermis-adipose, thus to result in good functions, appearance, and survival rate. After skin grafting, wound healing quality and appearance are im-proved, joint function and elasticity of skin are enhanced, the degree of scar contracture is relieved due to preservation of nor-mal adipose tissue after escharectomy. The study of composite artifical skin will be actively developed in the future. Tissue-en-gineering skin and stem cells can be successfully used in pa-tients with deep burns for starless healing with restoration of physiological functions in a short period.