应用超频叠加治疗化学灼伤后色素沉着15例效果观察

应用超频叠加治疗化学灼伤后色素沉着１５例效果观察上海市化工职业病防治研究所（２０００４１）陈德荣王教梅王柯各种化学物质灼伤后均会引起不同程度的色素沉着。我们自１９９５年以来，应用电脑超频叠加治疗化学灼伤后色素沉着１５例，取得良好效果。１对象与方法１．...     

5例眼化学灼伤的治疗体会

５例眼化学灼伤的治疗体会云南省寻甸化肥厂医务室邱述文眼化学灼伤颇常见，多因防护不周、操作不当、思想麻痹，或设备突然破损，造成化学物质喷洒外漏所致。１９９１年８月至１９９３年１０月，本厂相继有５名职工因硫酸等化学物灼伤眼部。男性４例，女性１例，均系硫酸...     

化学灼伤131例临床分析

化学灼伤１３１例临床分析张天贵化学灼伤是职业病临床常见病，现将１９８５～１９９５年收治的１３１例化学灼伤病例总结如下。１临床资料１．１一般情况１３１例化学灼伤中，男７４例，女５７例。年龄１８～５８岁，平均年龄２８．８岁。工龄最短者６个月，最长者３０年...     

化学灼伤原因分析及体会

1993～1994年,我所收治28例化学灼伤。灼伤程度Ⅰ°～深Ⅱ°,灼伤面积0.5％～24％。引起灼伤的化学物质以硫酸最多,其次为硫酸二甲酯、溴素、     

眼化学灼伤合并急性中毒的诊断和治疗——附359例病例分析

眼化学灼伤合并急性中毒的诊断和治疗——附３５９例病例分析韩玫王敬钦张凤林本文分析了３５９例职业性眼化学灼伤及合并急性中毒的病例资料，并提出其诊断分级和处理原则。现报道如下。１临床资料１．１一般资料本组３５９例中男２９５例（８２．２％），女６４例（１７...     

氢氟酸灼伤25例治疗与体会

自１９９３年１０月以来,我科共收治氢氟酸灼伤病人２６例。除１例已被报道猝死于伤后 ４ｈ外 ［１］,余均获满意疗效。现就２５例诊治分析如下。１ 临床资料 本组 ２５例,男 ２０例,女 ５例。年龄 １９～４３岁,平均 ２３岁。均为氟化工段从业工人。灼伤部位：肢体２０例,面颈部１６例,其他部位 ５例。灼伤面积＜０．５％１２例,０．５％～１．０％８例,＞１．０％～５．０％４例,３ ０％０％ｌ例;现场氢氟酸浓度３．０％１例,５９．０％１６例,９５．０％８例。２ 急救与治疗 现场均用自来水冲洗创面超过１０ｍｉｎ。来院后…     

手术治疗Ⅲ度化学灼伤的探讨

手术治疗Ⅲ度化学灼伤的探讨魏云鹏孙凡伟１９９７年３月２５日８时许,某药厂硝化反应罐发生爆炸,罐内装有ＨＮＯ３、Ｈ２ＳＯ４、乙苯等,主要反应生成硝基乙苯、邻硝基乙苯。爆炸后起火,数名工作人员受伤。我院收治多名患者,现将１例重症化学性灼伤经手术治疗成功病...     

头面部化学灼伤的治疗体会

头面部在生产作业中容易受到化学腐蚀性物质的伤害,由于组织结构的特点,损伤往往较重,并发症较多,治疗困难。现拟就我院收治的头面部化学灼伤病员的情况总结报告如下。１临床资料我院自１９９０年１月至１９９６年５月间共收治头面部化学灼伤病员９７例,其中男性６３...     

40例职业性化学碱灼伤救治体会

回顾分析40例职业性化学碱灼伤患者的临床资料和救治经过。碱灼伤创面进行性加深,常合并眼部及呼吸道灼伤,给予及时清创、保持呼吸道通畅、保证氧供、补液扩容、抗感染、营养支持、手术封闭创面等治疗后痊愈。提示化学碱灼伤患者应尽早实施综合救治,减少呼吸道灼伤、创面脓毒症等并发症。     

中西医结合治疗输卵管阻塞性不孕疗效分析

笔者对６２例单纯用输卵管通液治疗失败的患者,用强的松递减口服,配合活血祛瘀中药及下腹部音频理疗等综合治疗,有效率９２％;矫正妊娠率４５％,无明显毒副作用。１临床资料１．１一般资料１９９５年１月～１９９７年１２月,我科共收治输卵管阻塞性不孕患者６２例。...     

2013-2017年安徽某医院1737例小儿烧伤的预后及影响因素分析

  目的   了解小儿烧伤的预后及影响治愈的危险因素。   方法   回顾性分析安徽医科大学第一附属医院烧伤科2013年1月至2017年12月1 737例住院烧伤患儿的病历资料, 总结其人口学特征、临床特征及影响预后的相关因素。   结果   Log-binominal回归分析模型显示, 1~岁、3~岁相比于7~12岁的患儿治愈率更高(均有P < 0.05);夏季烧伤(RR=0.861, 95% CI:0.690~1.074)未愈率较冬季烧伤高; 开水烫伤治愈率高于电击、火焰烧伤(均有P < 0.05);相比于特重度烧伤, 中度和重度烧伤的治愈率高(均有P < 0.05);相比于伴随并发症的患儿, 无并发症患儿的治愈率高(RR=4.58, 95% CI:2.642~7.941, P < 0.001), 农村患儿(RR=0.713, 95% CI:0.618~0.824)的未愈率较城市患儿高。   结论   小儿烧伤的治愈率为51.1%, 影响治愈的主要危险因素是7~12岁、夏季烧伤、电击及火焰烧伤(包括化学烧伤)、特重度烧伤、伴随并发症及农村烧伤患儿。     

严重烧伤患者外周血高迁移率族蛋白B-1水平的检测及其临床意义

目的 检测严重烧伤后患者血浆高迁移率族蛋白B-1 (HMGB1)水平的变化并探讨其临床意义.方法 用酶联免疫吸附试验法检测77例严重烧伤患者血浆HMGB1水平,同步检测肿瘤坏死因子-α(TNF-α)含量,并与30名健康对照组进行比较.结果 77例严重烧伤患者按烧伤面积分为3组,A组31例,烧伤总面积30％～49％,B组25例,烧伤总面积50％～69％,C组21例,烧伤总面积70％～95％；烧伤患者血浆HMGB1及TNF-α水平在A组为(22.15±6.34) ng/ml、(89.26±21.41)pg/ml,B组为(26.24±9.71)ng/ml、( 132.45±76.32)pg/ml,C组为(36.45±11.63)ng/ml、(213.61±87.45) pg/ml,对照组为(2.17±1.13)ng/ml、(45.32±13.84)pg/m1,烧伤各组HMGB1及TNF-α水平明显高于对照组(P＜0.01);24例特大面积烧伤患者根据预后情况分为生存组和死亡组进行动态观察,两组患者血浆HMGB1水平在伤后第1天即显著升高(P＜0.01),在伤后3～21 d,死亡组明显高于生存组(P＜0.05),而TNF-α含量在伤后第3～7 d达高峰,以后逐渐下降,到21d时生存组与死亡组相比已差异无统计学意义.结论 严重烧伤后HMGB1的表达异常升高,HMGB1作为重要的晚期炎症介质和TNF-α相互诱生相互作用,参与严重烧伤后全身炎症反应综合征的病理生理过程,动态观察其水平变化有助于烧伤患者病程监测及预后判断.     

严重烧伤患者血清瘦素水平的改变

目的 分析不同烧伤面积的严重烧伤患者血清瘦素水平改变规律并初步探讨其意义。方法 20例男性严重烧伤患者根据烧伤面积分为30％-50％（n=11）及〉70％总体表面积（n=9）二组，分别于烧伤后第1、3、5、7、14、21、28天采集空腹静脉血，采用放射免疫法检测患者血清瘦素水平。并在入院时记录身高、体重，计算体重指数（BMI）。8例男性健康体检者作为正常对照组。结果 严重烧伤患者血清瘦素水平在烧伤后呈不同程度的降低，烧伤面积〉70％组瘦素水平下降幅度最大（P〈0．01）；死亡患者瘦素水平下降最显著；对照组的血清瘦素水平与BMI呈正相关（r=0．7568，P=0．049），烧伤患者血清瘦素水平与BMI无相关性。结论 大面积烧伤后血清瘦素水平下降，测定烧伤患者血清瘦素水平对判断患者伤情和预后有重要意义。     

Infections in a burn intensive care unit: experience of seven years

The objective of this study is to describe infections in a specialized burns intensive care unit from 1993 to 1999. The criteria for admission to the unit are: children with burns involving at least 10% or adults with burns involving at least 20% of total body surface; burns affecting face, perineum or feet; suspected or proven airway injury; electric or chemical burns; age less than one year or above 50; or pre-existing disease with any extent of burns. Surveillance of hospital-acquired infection was prospective. Hospital-acquired infection criteria used were those modified from the Centers for Disease Control and Prevention. Diagnosis of infection using skin biopsy was not done. Over the study period, 320 patients were admitted to our burns intensive care unit. One hundred and seventy-five (55%) developed 388 hospital-acquired infections. The rate for vascular catheter-associated bloodstream infections was 34 per 1,000 central line-days. The rate of ventilator associated pneumonia was 26 infections per 1,000 ventilator-days. Primary bloodstream was the most common infection with 189 episodes (49%); followed by 83 burn wound infections (21%) and 56 pneumonias (14%). In 76% of these infections and in 97% of the primary bloodstream infections, aetiological agents were identified. The micro-organisms causing infections were S taphylococcus aureus (24%), Pseudomonas aeruginosa (18%), Acinetobacter spp. (14%) and coagulase-negative staphylococci (12%). Candida spp. caused 8% of infections. Gram-positive and Gram-negative organisms exhibited resistance to most antimicrobial agents used for therapy. During the first three days of hospitalization in the burns intensive care unit there were eight infections caused by S. aureus and three of these were resistant to oxacillin. These data provide background information regarding extensive burn patients on which decisions for control and prevention of hospital-acquired infections can be made.     

Hydrofluoric acid burns of the eye

A case of hydrofluoric acid (HF) burns of the eye is reported and a review is presented of our investigation into the mechanism of HF toxicity in ocular tissues. A number of therapeutic procedures that have been successful in the treatment of HF skin burns were studied in the rabbit for use in the eye. Immediate single irrigation with water, normal saline or isotonic magnesium chloride solution is the most effective therapy for ocular HF burns. Extrapolation of other skin burn treatments to use in the eye is unacceptable due to the toxicity of these agents in normal eyes and the additive damage caused in burned eyes.     

Differential effects of three enteral dietary regimens on selected outcome variables in burn patients

A modular tube feeding recipe (MTF) was designed to meet the unique nutritional needs of burn patients, applying principles previously documented in our burned guinea pig model. MTF, a high-protein, low-fat, linoleic acid-restricted formulation is enriched with omega-3 fatty acids, arginine, cysteine, histidine, vitamin A, zinc, and ascorbic acid. Fifty patients, 3 to 76 years of age with burns ranging from 10 to 89% total body surface area were prospectively randomized into three groups which blindly compared MTF to two enteral regimens widely utilized in the nutritional support of burns. Age, percent total and third-degree burn, resting energy expenditure, and calorie and protein intake were similar in all groups. Data analysis demonstrated significant superiority of MTF in the reduction of wound infection (p less than 0.03) and length of stay/percent burn (p less than 0.02). MTF was also associated with a decreased incidence of diarrhea, improved glucose tolerance, lower serum triglycerides, reduced total number of infectious episodes and trends toward improved preservation of muscle mass, although statistical significance was not achieved. Seventy percent of deaths occurred in the group supported with an inherently large dose of fat and linoleic acid. Combining these observations, it is believed that MTF is effective in modulating an improved response to burn injury.     

ICU患者抗菌药物使用的调查分析

目的 通过对ICU患者使用抗菌药物情况的调查分析,为指导临床合理用药提供依据.方法 对医院2011年1-6月ICU患者进行回顾性调查分析.结果 所调查的151例患者中,使用抗菌药物128例,抗菌药物使用率为84.8％,其中治疗性用药占81.3％,预防性用药占18.8％;送检104例细菌学标本,送检率为81.3％,细菌培养阳性结果98例,分离出病原菌122株.结论 医院ICU抗菌药物的使用基本合理,但仍存在使用率偏高、无细菌学证据使用抗菌药物比例偏大等问题,应切实采取有效干预措施,加强ICU抗菌药物合理应用的管理.     

Burn-related physical impairments and disabilities in Ghanaian children: prevalence and risk factors.

The prevalence, and risk factors for childhood burn-related physical impairments and disabilities in Ghana were determined with data from mothers of burned children. Of 650 identified burns 113 (174%) resulted in physical impairments, 5 (1%) resulted in physical disabilities. After multivariate adjustment, the odds of developing burn-related physical impairments were increased by burns with protracted healing (odds ratio [OR] = 5.80), burns to the head/neck (OR = 344), burns involving skin removal (OR = 3.04), and wound infection (OR = 2.03) and decreased by first aid (OR = 0.51) and maternal education (OR = 0.54). Education on the proper care of burns may prevent burn-related physical impairments. The results also underscore the link between maternal education and child morbidity.     

Burn mortality during 1982 to 1997 in Kuwait

The study group is comprised of 234 patients (6.4%) who died out of 3680 patients treated for burn injuries during the period January 1982 to December 1997 in Kuwait. There were 112 (47.9%) males and 122 (52.1%) females and their mean age was 30 years (range 1–93) when compared with 24 years among survivors. The high mortality amongst two age groups 0–5 years (39 deaths, 16.7%) and 16–35 years (109 deaths, 46.6%) shows their vulnerability in the society. In 190 patients (81.2%) the burn injuries occurred at home. A total of 216 patients (92.3%) sustained flame burns mainly due to clothes on fire (40.6%) and cooking gas accidents (25.2%), and in 18 patients (7.7%) the burns were due to scalds. The suicidal burns occurred in 22 female and 5 male patients mainly of younger age groups. The mean percentage of burns was 71% (range 9–100%) as against 20% amongst survivors, and 195 patients (83.3%) had 50% total body surface area (TBSA) burn. Four patients (1.7%) had superficial dermal burns, 94 (40.2%) had full thickness and 136 (58.1%) had mixed with full thickness burns predominance. The associated inhalation injury was diagnosed in 132 patients (56.4%). A total of 61 patients (26.1%) had either single or multiple pre-existing diseases and 51 of them sustained flame burns. The day of death varied from 1 to 103 days (mean 16 days) but 58 patients (24.8%) died within 48 hours of post burn. A total of 120 patients (51.3%) died due to septicaemia, 83 (35.5%) due to renal failure, 28 (10.2%) due to multi-organ failure, and 7 (3.0%) due to bronchopneumonia. The overall mortality rate was 6.4%, but this has significantly lowered to 4.4% (p= < 0.01) during last four years probably due to better burn care. The study thus shows that age group 0–5 and 16–35 years, domestic accidents, flame burn, inhalation injury, and pre-existing diseases are risk factors and septicaemia as the dominant cause of death in our patients.     

苯酚灼伤并发中毒的处理

目的 探讨苯酚灼伤并发中毒患者的治疗及护理.方法 回顾我院1998至2010年收治的42例苯酚灼伤患者临床救治资料,对其一般临床表现、治疗与护理方法、治疗结果等进行分析.结果 42例苯酚灼伤患者中22例灼伤总面积≤5%,10例为6%～10%,5例为11%～20%,5例＞20%.36例患者伤后1～2 h即有全身中毒症状,其严重程度和持续时间与灼伤面积有关,灼伤面积＞10%者出现较明显肝肾功能损害.治疗方法包括创面处理、补液利尿、碱化尿液、大剂量维生素C和糖皮质激素、早期手术、血液净化等.治愈39例,死亡3例.结论 苯酚灼伤常并发全身中毒,治疗上宜尽早阻断苯酚吸收,促进已吸收的毒物排出,并予全身重要脏器功能支持的综合性治疗和护理.

Abstract：

Objective To explore the therapeutic processing and nursing for phenol bum patients combined with poisoning. Methods The clinical data of 42 phenol bum cases admitted in our hospital from 1998 to 2010 were reviewed retrospectively. The general clinical manifestations, treatment and nursing methods, and the treatment results of these cases were analysed. Results Out of 42 phenol burns patients, the total burn surface area(TBSA) of 22 cases were ≤5%, 10 cases' TBSA were 6%～10%, and 5 cases' ＞ 20%. 36 patients showed systemic poisoning symptoms 1～2 hours after injury, the severity and enduring period of which correlated with TBSA. Patients whose TBSA＞10% appeared obviously dysfunction of the liver and kidney. The therapeutic methods included wound management, compensation of fluid, diuresis, alkalized urine, large dose of vitamin C and glucocorticoid, early surgery, blood purification, etc. 39 of 42 cases were successful cured,while the other 3 cases died. Conclusions Phenol burn often complicates systemic poisoning. In the treatment of patients with this special chemical burn, it is key scheme to block phenol absorption and promote elimination of already absorbed poison as early as possible. The comprehensive management and nursing should be necessary for supporting functions of important organs.