重组人表皮生长因子对儿童面部非Ⅲ度烧伤创面的修复

目的:观察外用重组人表皮生长因子对面部Ⅱ度烧伤创面的治疗作用和安全性。方法:选择2004-06/2006-06广西医科大学第一附属医院烧伤整形康复中心14岁以下小儿面部浅Ⅱ度、深Ⅱ度烧伤患者各60例,进行随机、双肓、同体实验,纳入标准:无严重心、肺、肝、肾、血液等系统疾患;无严重并发症及全身感染。每例患者选择一块浅Ⅱ度、深Ⅱ度烧伤创面,并将其分为面积相近的两部分作为治疗组及对照组;伤后第3天起,治疗组采用含重组人表皮生长因子的等渗盐水纱布覆盖创面,对照组单用等渗盐纱布覆盖创面,每日换药1次至创面愈合。观察应用重组人表皮生长因子后面部浅Ⅱ度、深Ⅱ度烧伤创面中期愈合率、愈合时间、疼痛情况及Ⅱ度创面愈合后的瘢痕指数。结果:纳入患者(浅Ⅱ度及深Ⅱ度)各60例,均进入结果分析。治疗组与对照组相比创面愈合速度加快,愈合时间缩短[浅Ⅱ度:(8.83±2.48),(11.06±3.05)d;深Ⅱ度:(15.12±3.19),(19.06±3.07)d,P<0.01],同期愈合率提高[浅Ⅱ度:(79.18±13.36),(61.97±10.39)%;深Ⅱ度:(79.93±21.02),(60.26±18.25)%,P<0.01];未见疼痛加重;能明显减少瘢痕的形成;治疗过程未见明显毒副作用及不良反应。结论:外用重组人表皮生长因子能加快面部II度烧伤创面的愈合速度,缩短愈合时间,提高愈合质量,减少瘢痕的形成,无明显不良反应,安全性好。     

重组人表皮生长因子对面部Ⅱ度烧伤创面修复相关作用的比较

目的:观察外用重组人表皮生长因子对面部Ⅱ度烧伤创面修复过程中的治疗作用和安全性。方法:选择2002-06/2004-06广西医科大学第一附属医院烧伤整形康复中心收治的面部浅Ⅱ度烧伤、深Ⅱ度烧伤各60例。以面部左侧为治疗组,右侧为对照组。伤后第3天,治疗组将2000IU/mL的重组人表皮生长因子直接湿敷于创面上半暴露,换药1次/d,至创面愈合;对照组创面单用等渗盐水纱布覆盖半暴露,换药1次/d,至创面愈合。7和14d观察两组患者创面愈合率、愈合时间、疼痛及瘢痕情况及不良反应。采用目测类比评分法(VAS)评估疼痛情况(0分为无痛,10分为极痛);采用改良温哥华瘢痕测量法测定深Ⅱ度创面瘢痕增生情况(瘢痕指数)。结果:120例患者均进入结果分析。两组患者创面愈合率、愈合时间、疼痛及瘢痕情况的比较:浅Ⅱ度烧伤创面,治疗组7d愈合率显著高于对照组[(72.15±13.26)%,(59.28±11.35)%,t=5.7115,P<0.01],愈合时间较对照组明显缩短[(9.62±2.38),(11.27±2.95)d,t=3.3719,P<0.01];深Ⅱ度烧伤创面,治疗组14d愈合率显著高于对照组[(75.03±21.32)%,(61.24±18.29)%,t=3.8026,P<0.01],愈合时间较对照组明显缩短[(17.62±3.49),(20.86±3.97)d,t=4.7772,P<0.01],瘢痕指数低于对照组[(7.32±1.67),(8.78±1.95),t=4.2541,P<0.01];两组患者两种创面疼痛评分无明显差别。治疗组治疗过程未见明显毒副作用及不良反应。结论:外用重组人表皮生长因子能显著加快面部Ⅱ度烧伤创面的愈合速度,缩短愈合时间,提高愈合质量,减少瘢痕的形成,无明显不良反应,安全性好。     

自体富血小板血浆凝胶修复儿童面部Ⅱ度烧伤创面

背景:富血小板血浆可用凝血酶凝固成胶冻状,不仅可以黏合组织缺损处,还可以防止血小板流失,使血小板在局部长时间分泌生长因子,避免了目前广泛应用于临床的液态重组生长因子试剂在伤口及移植区易流失易蒸发的缺点.目的:观察外用自体富血小板血浆在儿童面部Ⅱ度烧伤创面修复过程中的治疗作用.方法:选择2008-01/2010-01在广西昭平县人民医院外科收治的14岁以下面部浅Ⅱ度烧伤、深Ⅱ度烧伤儿童各30例.均以左侧面部为治疗组,右侧为对照组.伤后第3天,治疗组将自体富血小板血浆凝胶直接湿敷于创面上半暴露,换药1次/d;对照组创面单用等渗盐水纱布覆盖半暴露,换药1次/d.干预7,14 d观察两组患者创面愈合率、愈合时间、疼痛与瘢痕情况及不良反应.采用目测类比评分法评估疼痛情况,改良温哥华瘢痕测量法测定深Ⅱ度创面瘢痕增生情况.结果与结论:在浅Ⅱ度烧伤创面患者中,治疗组7 d愈合率明显高于对照组(P < 0.05),愈合时间明显短于对照组(P < 0.05);在深Ⅱ度烧伤创面患者中,治疗组14 d愈合率明显高于对照组(P < 0.05),愈合时间显短于对照组(P < 0.05),瘢痕指数明显低于对照组(P < 0.05);两组患者创面疼痛评分无明显差别.说明外用自体富血小板血浆凝胶能显著加快儿童面部Ⅱ度烧伤创面愈合速度,缩短愈合时间,提高愈合质量,减少瘢痕形成,无明显不良反应.     

康肤霜治疗Ⅱ度烧伤创面临床观察

目的:观察康肤霜(Kangfushuang,KFS)治疗Ⅱ度烧伤创面疗效及安全性。方法:将病人分成KFS和重组人表皮细胞生长因子(rhEGF)、紫花烧伤膏(ZHSSG)、0.5%碘伏(0.5%ComplexIodine,COI)治疗组。比较四种药物体外抑菌环、创面愈合时间,观察康肤霜可能出现的不良反应(肝肾功能、白细胞记数、皮肤过敏反应及创面疼痛)。结果:KFS与COI相比各细菌抑菌环均无差异(P>0.05);KFS与ZHSSG、rhEGF相比,对金黄色葡萄球菌、大肠杆菌抑菌环均有差异(P<0.01);而四种药物对绿脓杆菌的抑菌环均无差异(P>0.05)。浅Ⅱ度创面愈合时间:KFS与rhEGF、ZHSSG差异无显著性(P>0.05),而短于COI(P<0.01);深Ⅱ度创面愈合时间:KFS与rhEGF差异无显著性(P>0.05),但短于ZHSSG(P<0.05)及COI(P<0.01)。治疗中未发现KFS不良反应。结论:KFS明显加速创面愈合且无不良反应。     

重组人表皮生长因子促进Ⅱ烧伤创面愈合的作用

目的观察重组人表皮生长因子(rhEGF,商品名金因肽)对烧伤Ⅱ度创面的愈合效果.方法在常规治疗的基础上,试验组加rhEGF,对照组不加,51例患者采用随机自身对照法,观察同一创面不同区域或同体对称部位创面的愈合效果.结果随机自身对照试验中,试验组浅Ⅱ度、深Ⅱ度创面的愈合时间分别为(9.92±2.40)d,(17.20±3.56)d;对照组愈合时间则分别为(13.10±3.44)d,(21.75±4.60)d.两组间差异均有显著意义(P＜0.01).结论外源性rhEGF具有促进烧伤Ⅱ度创面愈合的作用,rhEGF可以加速烧伤创面的愈合.     

保留部分真皮微粒皮浆移植对深Ⅱ度创面愈合的影响

深Ⅱ度烧伤创面愈合时间长,愈合后多产生不同程度的瘢痕及瘢痕挛缩而导致的功能障碍和外观异常。贾赤宇等[1]认为,能否明显地加速创面愈合和有效地控制后期瘢痕增生是目前烧伤治疗的重点和难点,同时也是烧伤治疗水平高低的质量指标。鉴此,作者设计了深Ⅱ度烧伤创面削痂保留部分自体真皮后行微粒皮浆移植对深Ⅱ度创面愈合时间、愈合瘢痕等进行了前瞻性研究,以寻找一种可解决深Ⅱ度创面愈合时间长及愈合后功能障碍和外观异常的方法。1临床资料与方法入选标准:①住院年轻病人;②热液烫伤或火烧伤;③烧伤后7 d内创面;④创面未感染或溶痂;⑤同侧…     

湿润暴露疗法治疗颜面部烧伤临床体会

对2010年8月~2013年5月在本院就诊的102例颜面部烧伤患者采用湿润暴露疗法治疗,着重观察患者伤口愈合时间、瘢痕形成发生率和治疗前后的疼痛程度比较。浅Ⅱ度烧伤患者愈合时间(8.32±2.19)d,深Ⅱ度烧伤患者愈合时间(20.56±3.27)d,均无瘢痕形成;Ⅲ度烧伤患者愈合时间(38.47±4.90)d,有6例出现瘢痕,均不影响功能;治疗后疼痛优良率明显高于治疗前,两组比较差异有统计学意义(P0.05)。湿润暴露疗法治疗颜面部烧伤具有减少创面愈合时间、瘢痕形成、疼痛的优势,临床疗效好、方法简单,值得临床推广使用。     

表皮细胞生长因子对烧伤后膝关节创面愈合和功能的影响

目的探讨人表皮细胞生长因子(rhEGF)对烧伤后膝关节的创面愈合和功能影响.方法44例膝关节部位深Ⅱ度烧伤患者分为治疗组(22例,27只)用rhEGF100IU/m2局部喷洒创面;对照组(22例,27只)用溶媒喷洒创面.结果治疗组平均创面愈合时间短,膝关节外观异常发生率和关节活动度(ROM)关节功能评分均明显优于对照组(P均<0.05).结论rhEGF有助于烧伤后膝关节的创面愈合和功能恢复.     

自体富血小板血浆凝胶修复儿童面部Ⅱ度烧伤创面

背景：富血小板血浆可用凝血酶凝固成胶冻状,不仅可以黏合组织缺损处,还可以防止血小板流失,使血小板在局部长时间分泌生长因子,避免了目前广泛应用于临床的液态重组生长因子试剂在伤口及移植区易流失易蒸发的缺点。目的：观察外用自体富血小板血浆在儿童面部Ⅱ度烧伤创面修复过程中的治疗作用。方法：选择2008-01/2010-01在广西昭平县人民医院外科收治的14岁以下面部浅Ⅱ度烧伤、深Ⅱ度烧伤儿童各30例。均以左侧面部为治疗组,右侧为对照组。伤后第3天,治疗组将自体富血小板血浆凝胶直接湿敷于创面上半暴露,换药1次/d;对照组创面单用等渗盐水纱布覆盖半暴露,换药1次/d。干预7,14d观察两组患者创面愈合率、愈合时间、疼痛与瘢痕情况及不良反应。采用目测类比评分法评估疼痛情况,改良温哥华瘢痕测量法测定深Ⅱ度创面瘢痕增生情况。结果与结论：在浅Ⅱ度烧伤创面患者中,治疗组7d愈合率明显高于对照组（P〈0.05）,愈合时间明显短于对照组（P〈0.05）;在深Ⅱ度烧伤创面患者中,治疗组14d愈合率明显高于对照组（P〈0.05）,愈合时间显短于对照组（P〈0.05）,瘢痕指数明显低于对照组（P〈0.05）;两组患者创面疼痛评分无明显差别。说明外用自体富血小板血浆凝胶能显著加快儿童面部Ⅱ度烧伤创面愈合速度,缩短愈合时间,提高愈合质量,减少瘢痕形成,无明显不良反应。     

酸性成纤维细胞生长因子治疗中小面积深Ⅱ°烧伤创面

目的 探讨酸性成纤维细胞生长因子(rhaFGF)治疗中小面积深Ⅱ°烧伤创面的疗效.方法 80例患者随机分成治疗组和对照组,治疗组创面使用rhaFGF(100u/0.1mL/cm2)湿纱布后再用凡士林覆盖,无菌纱布包扎,对照组创面直接用凡士林纱布覆盖后无菌纱布包扎.结果 治疗组创面平均愈合时间为16.56±3.36d,无一例瘢痕形成.对照组创面平均愈合时间为21.56±4.27d,有6例出现瘢痕增生.结论 rhaFGF治疗中小面积深Ⅱ°烧伤创面疗效满意.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.