Postoperative intensive therapy in penetrating gunshot wounds of the abdomen]

The authors show that application of anticipated postoperative intensive care gives the possibility ot obtain more complete effect of compensation. The basic components of this therapy are the following: removal of hypovolemia and anemia, combined (central and regional) anesthesia, prevention of pneumonia, normalization of salt and water exchange, removal of excessive catabolism, adequate ensuring of organism with energy and plastic material for long-time compensation, prophylaxis and treatment of paresis of digestive tract, chemoprophylaxis of wound infection. The proposed program of intensive therapy gives the possibility to minimize the lethality among wounded with penetrating abdominal gunshot injuries and can be used as a basic one for the development of various schemes of intensive therapy for other categories of wounds.     

颅脑火器伤的急救措施

目的探讨颅脑火器伤患者的治疗效果。方法前瞻与回顾性分析我院２７年间诊断为颅脑火器伤的９３例患者。全组均系急性颅脑火器伤,其中男８１例（８７．１％）,女１２例（１２．９％）;年龄３个月～５８岁（平均２４．６岁）。损伤类型为颅脑穿透伤,包括：切线伤１６例,盲管伤５８例和贯通伤１９例。损伤特点是：伤情急、创伤重、病情变化快。本组病例均行手术治疗及加强神经外科监护（包括复苏）等围手术期处理。结果经急救和手术处理后,９例死亡（９．７％）。于３个月时随访研究发现,５６例恢复良好（６６．７％）;中残、重残及植物生存率分别为１９．０％,１０．７％和３．６％。长期随访研究（平均５．５年）表明,４２例（５０．０％）恢复了工作能力。结论颅脑火器伤者伤情多较危重,需行紧急救治。在创伤早期采取及时、适度和彻底的清创术,是避免神经系统功能迅速恶化的重要措施。     

MEBO在激光祛斑创面中的治疗作用

目的 观察美宝湿润烧伤膏(MEBO)对激光祛斑术后创面愈合的效果.方法 将120例激光祛斑术后的患者,随机分为治疗组和对照组,各60例,治疗组术后在创面涂抹MEBO,每天4次～6次,保持创面呈湿润状态直至创面愈合;对照组创面涂以红霉素软膏,每天4次～6次,直至创面愈合.观察2组在术后的止痛效果、创面愈合时间、色素沉着及其消退等方面的疗效.结果 治疗组术后疼痛和创面愈合时间与对照组比较有显著差异(P<0.01);术后创面色素沉着情况两组相比差异无统计学意义,但在创面色素沉着的消退时间上,治疗组比对照组明显缩短,差异显著(P<0.01).结论 MEBO对激光祛斑术后创面具有快速止痛、缩短创面愈合时间、促进色素沉着消退的作用,是处理激光术后创面的理想方法.     

MEBO在外科手术切口感染的治疗

目的 观察外科手术后感染切口采用湿润烧伤膏(MEBO)治疗的疗效.方法 2002年1月～2008年12月共收治65例外科手术后切口感染创面,全程使用MEBO换药方法治疗,观察感染创面愈合情况.结果 应用MEBO换药治疗,术后切口感染创面全部愈合,愈合时间最短7 d,最长50 d.结论 MEBO对术后切口感染创面具有一定的抗感染作用,可促进创面愈合,方法简便.     

The characteristics of the course of suppurative complications of gunshot wounds in Afghanistan and the unresolved problems of their prevention and treatment]

The article describes the reasons and the frequency of purulent complications in gunshot wounds in Afghanistan. The authors stress the role of primary surgical management of wounds in the prophylaxis of wound infection, show the trends towards the improvement of the first aid and primary medical care. The article studies the efficiency of physical methods in the management of wounds, such as treatment by the pulsed stream of liquid, active drainage, treatment in regulated air environment. The results of studies make it possible to recommend these methods for complex treatment at the phase of the secondary medical care.     

Relaparotomy in abdominal gunshot wounds]

Clinical signs of postoperative complications were studied in 642 patients with abdominal wounds, including 102 (15.9%) cases with relaparotomy features. The article makes a comparison between the frequency of various complications on the one hand, and the character of internal lesions, size of the first surgical intervention and the time of the secondary surgical care on the other hand. The authors determine the basic trends of complex intensive therapy taking into account metabolic disorders in patients with gunshot abdominal injuries.     

ICU患者皮肤受损的护理体会

目的:探讨ICU患者压疮及皮肤受损的护理措施及体会.方法:对本组患者创面采用预防及加强护理与美宝创疡贴换药治疗法相结合进行综合治疗.结果:Ⅱ度创面平均5天～7天愈合,Ⅲ度创面平均7天～10天愈合,Ⅳ度创面平均12天～30天愈合.结论:通过加强预防措施及基础护理,结合美宝创疡贴换药治疗,可有效防控创面感染,减少创面的再次损伤和疼痛,是创面愈合的重要保障.     

皮瓣修复下肢慢性创面24例临床体会

目的探讨皮瓣修复下肢慢性创面的术式选择及临床疗效。方法对2013年1月—2017年3月嘉峪关市酒钢医院烧伤整形科收治的24例下肢慢性创面患者采用皮瓣修复治疗,其中5例患者予以随意型皮瓣修复,3例患者予以膝降动脉隐支皮瓣修复,12例患者予以腓肠神经小隐静脉营养血管皮瓣修复,4例患者予以足底内侧岛状皮瓣修复,观察创面治疗效果。结果 24例患者中创面一期愈合者19例,经术后换药或二次植皮手术愈合者5例。结论术前做好创基准备,并根据创面具体情况合理选择适宜的皮瓣修复下肢慢性创面,可提高皮瓣成活率及创面修复成功率,值得临床推广应用。     

美宝湿润烧伤膏治疗大面积深度烧伤102例临床探讨

目的:探讨美宝湿润烧伤膏在大面积深度烧伤创面的应用效果.方法:将我院 102例大面积深度烧伤患者,随机分为美宝湿润烧伤膏治疗组(简称治疗组)和磺胺嘧啶银软膏治疗组(简称对照组).两组根据病情,采用相同的全身治疗原则,不同的创面治疗方法.治疗组:烧伤创面规范使用美宝湿润烧伤膏,对部分有严重感染或器官功能不全的患者,在创面液化期使用时,更要加强耕耘薄化技术和全身综合治疗,必要时配合手术治疗及时覆盖创面;实验组:烧伤创面外用磺胺嘧啶银软膏,创面较深病例待痂皮脱落形成肉芽创面后,手术植皮覆盖.结果:美宝湿润烧伤膏治疗组平均治疗天数优于对照组,且手术治疗者明显少于对照组(P＜0.05).结论:美宝湿润烧伤膏的使用,减少了手术的次数,减轻了供皮的压力,为基层医院救治大面积烧伤患者提供了条件.     

难愈性创面的MEBT/ MEBO临床应用

难愈性创面的治疗是一个非常棘手的临床难题.目前的治疗方法为：1.手术治疗：植皮、皮瓣移植、肌皮瓣移植等整形外科手段; 2.非手术治疗：负压真空吸引、局部应用各种药物等.手术治疗存在着创面愈合率低、风险高、费用高、愈合质量差等缺点.MEBT/ MEBO 作为一种非手术治疗方法,强调利用创面自身的再生潜能,通过为创面提供原位再生复原的生理湿润环境和再生营养物质,实现创面的原位再生复原,即生理性的创面愈合.通过应用MEBT/ MEBO 对烧伤残余创面、外伤后皮肤缺损坏死创面、末节指骨离断创面等的治疗,取得了创面生理性愈合、患者痛苦小、费用低的良好疗效.     

腹主动脉瘤的外科诊疗

目的：总结腹主动脉瘤的诊断和外科治疗方法.方法：回顾性分析2003-01～2005-04我院治疗的23例肾下型腹主动脉瘤的临床资料.男21例,女2例,年龄54～76岁.均为肾动脉下型腹主动脉瘤,瘤体直径4.0～7.5 cm.采取常规的腹主动脉瘤切除和原位人造血管移植术20例,腔内人造血管移植术3例.结果：全组无术后早期死亡,无严重出血、肾功能衰竭和下肢动脉栓塞等,术后并发心律失常2例,腹泻2例,切口裂开1例.全组患者随访1～27个月,无晚期死亡和肾功能衰竭.结论：常规外科手术和腔内人造血管移植治疗腹主动脉瘤均获得良好效果.早诊断、合理选择手术时机和手术方式是提高手术成功率、减少术后并发症和死亡率的关键.     

MEBT/MEBO治疗面部皮肤擦挫伤的疗效观察

目的：寻找面部皮肤软组织擦挫伤的最佳治疗方法。方法：随机将面部皮肤软组织擦挫伤在Ⅱ～Ⅲ度之间的160例病人分为两组：90例创面采用烧伤湿润医疗技术（MEBT／MEBO）方法换药治疗（治疗组）；70例创面采用传统外科方法换药治疗（对照组）。观察两组治疗方法在换药过程中病人的痛苦程度、感染发生率、创面愈合时间、瘢痕发生率以及皮肤色素沉着等。结果：治疗组在创面愈合时间、瘢痕生长，皮肤色素沉着及感染发生率等方面都明显少于对照组。结论：在治疗面部皮肤软组织擦挫伤中，MEBT／MEBO法明显优于传统外科治疗方法，是目前治疗面部皮肤软组织擦挫伤的良好方法之一，值得推广应用。     

The time-dependent rearrangement of the epithelial basement membrane in human skin wounds —immunohistochemical localization of Collagen IV and VII

Summary In 62 human skin wounds (surgical wounds, stab wounds and lacerations after surgical treatment) we analyzed the immunohistochemical localization of collagen IV in the epithelial basement membrane. In 27 of these wounds the distribution of collagen VII, which represents a specific component of the basement membrane of stratified epithelia, was also analyzed. We were able to demonstrate a virtually identical co-distribution of both collagen IV and VII in the wound area with no significant time-dependent differences in the appearance of both collagen types. Fragments of the epithelial basement membrane could be detected in the wound area from as early as 4 days after wounding and after 8 days a complete restitution of the epithelial basement membrane was observed. In all cases with a wound age of more than 21 days the basement membrane was completely reformed over the former lesional area. The period between 8 and 21 days after wounding was characterized by a wide variability ranging from complete restitution to deposition of basement membrane fragments or total lack of the epidermal basement membrane. This study was supported by a grant from the “Deutsche Forschungsgemeinschaft” (grant Ei 209/3-1) as well as by a grant from the “Friedrich-Baur-Stiftung”, University of Munich     

两起85例炸伤病人的早期救治

目的：探讨成批炸伤病人的伤情特点与早期救治方法。方法：回顾性分析两起85例重大炸伤病人的临床救治。结果：爆炸伤一般伤情复杂、污染重；受伤组织和器官多，损伤以头颈部和四肢破片伤为主；盲管伤、多发伤、合并伤多；一般较枪弹伤损伤复杂。结论：批量爆炸伤早期积极救治和清创可降低感染，伤残和死亡率。     

胸部伤口Ⅱ期愈合的综合处理措施探讨

目的对各类延迟愈合的胸部伤口的非手术处理经验进行总结探讨。方法按伤口原因和病理分类,分别给予不同的综合处理,对愈合过程进行分组分析。结果８０．７２％的胸部Ⅱ期愈合伤口中只需要非手术处理,１５３．３０％需要适时手术达到Ⅱ期愈合,约３．９２％属于难愈性胸部伤口。结论（１）感梁对Ⅱ期愈合具有明显影响,而各种剖胸手术切口的感染部位具有一定规律。（２）适时手术干预对难愈性胸部伤口的处理具有促进作用。     

湿润烧伤膏治疗腋臭术后切口愈合不良的疗效体会

目的观察湿润烧伤膏治疗腋臭术后切口愈合不良的疗效。方法将汕头市中心医院2010年1月-2014年6月收治的22例(31处)腋臭术后切口愈合不良患者随机分为湿润烧伤膏组(16处)和碘伏组(15处),湿润烧伤膏组患者采用外科清创联合湿润烧伤膏换药治疗,每日1次;碘伏组患者采用外科清创联合碘伏纱布包扎换药治疗,每日1次,对比观察两组患者换药时的疼痛情况及切口愈合时间。结果湿润烧伤膏组患者的切口平均愈合时间为7.375 d±1.586 d,碘伏组患者的切口平均愈合时间为9.267 d±1.624 d,两组对比,P=0.003,差异具有统计学意义;湿润烧伤膏组患者换药时有9例无疼痛、7例轻微疼痛,碘伏组患者换药时有2例无疼痛、12例轻微疼痛、1例中度疼痛,两组对比,P=0.02,差异具有统计学意义。结论湿润烧伤膏对腋臭术后切口愈合不良的疗效显著,换药时的疼痛程度及创面愈合时间均优于碘伏组,值得临床推广应用。     

MEBO在面部瘢痕磨削术中的应用

目的:观察美宝湿润烧伤膏(MEBO)在瘢痕磨削术中的辅助作用.方法:48例面部疤痕患者随机分为治疗组与对照组,治疗组在瘢痕磨削术后涂抹湿润烧伤膏(MEBO),对照组术后涂抹红霉素软膏,两组进行对比研究.结果:治疗组患者术后庝痛持续时间2小时±1小时、创面愈合时间5天±2天,均短于对照组,P <0.05;治疗组患者色素沉着发生率为10.71%,亦低于对照组,P<0.05.结论:瘢痕磨削术后创面外用湿润烧伤膏(MEBO),有止痛效果明显,创面愈合快,色素沉着轻等优点.     

烧伤皮肤再生修复的临床治疗观察

目的：总结各种深度烧伤创面再生修复的临床演变过程。方法：对我院1987年至2002年救治的12500例入院与出院病人登记资料统计，结合以往所进行的阶段性资料总结，阐述病人的基本情况与湿润烧伤膏（MEBO）治病下的创面愈合过程．结果：全国最大烧伤面积99.8％TRSA，最大患病年龄88岁，最小初生两天；深Ⅱ度浅型创面伤后2周愈合，无瘢痕增生；深Ⅱ度深型3周内愈合，瘢痕发生率15％；浅Ⅲ度创面应辅以皮肤耕耘减张处理，瘢痕发生率为25％；深Ⅲ度烧伤需借助外科技术封闭创面，所有创面的主体治疗药物为MEBO。结论：深度烧伤在MEBO治疗前提下，辅以耘耘疗法或借助外科技术可促进创面再生修复，降低瘢痕发生率。     

肠内营养对ICU创伤患者术后感染并发症的影响

目的探讨肠内营养(enteral nutrition,EN)对ICU创伤患者术后感染并发症的影响。方法回顾性分析2012年1月—2017年12月陆军军医大学大坪医院重症医学科收治的110例创伤患者临床资料,男性93例,女性17例;年龄17~88岁,平均50.0岁。根据是否术后48h内开展EN分为早期EN组(68例)和延迟EN组(42例)。对两组患者ISS评分、致伤机制、EN、术后感染并发症(伤口感染、吻合口裂开、肺部感染、菌血症、尿路感染)、病死率等进行分析。结果早期EN组无死亡病例,延迟EN组5例死亡。早期EN组在减少伤口感染、降低病死率、缩短住院时间上较延迟EN组差异有统计学意义(P<0.01)。EN达标时间超过术后1周,往往存在腹腔感染、肠漏、感染性休克等问题,腹腔感染为菌血症的危险因素。两组患者从入院至血培养阳性时间为15d左右,差异无统计学意义(P>0.05)。结论较少的伤口感染、低病死率、住院时间较短与早期EN相关。手术后的创伤患者延迟EN需除外腹腔感染、肠漏、感染性休克并发症的存在。     

Hospital costs for elective endovascular and surgical repairs of infrarenal abdominal aortic aneurysms

PURPOSE: To determine and compare the average in-hospital costs of elective open surgical and endovascular repairs of infrarenal abdominal aortic aneurysms. MATERIALS AND METHODS: Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal aortic aneurysms between 1997 and 1999 were retrieved. The mean total hospital cost (including stent-graft costs and excluding attending physician fees) and mean postoperative length of stay were calculated for each treatment group. Costs were expressed in 1999 U.S. dollars. RESULTS: Endovascular repair yielded a shorter postoperative length of stay than did open surgery (mean stay, 3.4 vs 8.0 days; P <.001) and a lower proportion of patients who were admitted to the intensive care unit for 1 full day or longer (2.8% vs 36.3%; P <.001). The mean total hospital cost was significantly higher for endovascular repair than for open surgery ($20,716 vs $18,484; P <.001). CONCLUSION: Hospital costs were higher for endovascular repair than for open surgical repair. However, endovascular repair was associated with a decreased length of stay and fewer intensive care unit admissions. The increased mean hospital cost for endovascular repair was smaller than one would expect, considering the higher costs of endovascular grafts, as compared with those for surgical grafts (approximately $6,400 according to literature data).