间甲酚化学烧伤实验性治疗

目的 开展间甲酚化学烧伤动物实验研究，为临床治疗提供理论依据。方法 将间甲酚原液涂在家兔背部，并随机分为对照、手术切痂、ＳＤ－Ａｇ涂药、饱和硫酸钠湿敷及自来水冲洗组。检测血液中ＢＵＮ、ＡＬＴ、ＡＳＴ、ＧＧＴ、ＡＫＰ５种生化指标。观察心、肝、脑、肺、肾的病理变化及超微结构变化。结果 间甲酚不仅可对皮肤造成深度烧伤，而且经过皮肤渗透还可引起全身主要脏器的４种不同治疗方法均有效，其中以手术切痂、外涂ＳＤ     

Impaired cell-mediated immunity in the first week after burn injury: investigation of spontaneous blastogenic transformation, PHA, IL-2 response and plasma suppressive activity

This study investigated alterations of cell-mediated immunity induced by trauma, operative treatment and infections in a group of 19 burned patients with a mean burn size of 42 +/- 22 per cent of the body surface area. We tested peripheral mononuclear blood cells (PMBC) for spontaneous blastogenic transformation (SBT), phytohaemagglutinin (PHA) and interleukin-2 (IL-2) responsiveness. Plasma samples were also assayed for inhibition of mitogen stimulation of control PMBCs. Mean values were calculated for the acute postburn period (days 0-3) and the following 4 days, before the development of septic complications. SBT was significantly increased in all patients during the second period of investigation (days 4-7) in comparison to normal controls and during the acute phase. The response to mitogen stimulation (PHA) was significantly suppressed during days 0-7 and the plasma samples showed high suppressive activities following PHA stimulation of control lymphocytes during the course of the study. No significant differences in rates of SBT, PHA responsiveness and plasma suppressive activity were found between those patients who developed bacteraemia and those with negative blood cultures. The latter group showed higher reactivity to added IL-2 in comparison to normal controls. Surgical treatment immediately after trauma (fasciotomy; day 0 or 1) resulted in further increased immunosuppression (PHA and IL-2 response), whereas after necrectomy (days 4-7) the immunological parameters showed no significant differences. It can be concluded that neither rates of SBT nor response to PHA can be used to identify patients at high risk for infection during the first week postburn.(ABSTRACT TRUNCATED AT 250 WORDS)     

家兔氢氟酸烧伤心肌损害的实验研究

目的　研究氢氟酸烧伤对心肌的影响 ,提高对氢氟酸导致氟中毒的认识。　方法　采用新西兰白兔 2 %TBSAⅢ度氢氟酸烧伤模型 ,观察各时相点心肌和相关酶谱指标的改变 ,以及病理形态学变化。　结果　 ( 1)伤后心肌各项酶含量较伤前明显增高 (P <0 .0 1)。 ( 2 )血清心肌酶含量增高峰值均在 48h以内出现。各时相点心肌酶谱含量的差异均有非常显著性意义 (P <0 0 1)。( 3)血清心肌酶含量以CPK增幅最大 ,增加了 97.5 %。而LDH、AST、CK -MB分别增加了 81.9%、76 .1%和 6 0 .3%。 ( 4)病理形态学检查发现 ,光镜下见心肌纤维颗粒变性、灶性坏死 ,心肌间质出血 ,并伴有中性粒细胞、淋巴细胞浸润。电镜观察心肌细胞内肌原纤维减少或消失 ,细胞水肿严重 ,线粒体肿胀、嵴消失 ,血管内皮细胞肿胀 ,电子密度极低 ,呈大泡状 ,肌细胞核变形。　结论　氢氟酸烧伤后对心肌有一定程度损害 ,心肌和心肌相关酶谱含量的改变 ,反映了氢氟酸致伤后的心肌损伤程度 ,在抢救氢氟酸烧伤、氟中毒时应监测心肌酶谱及心电图等指标 ,注意保护心脏的功能     

间甲酚化学烧伤实验性治疗

目的开展间甲酚化学烧伤动物实验研究，为临床治疗提供理论依据。方法将间甲酚原液涂在家兔背部，并随机分为对照、手术切痂、ＳＤＡｇ涂药、饱和硫酸钠湿敷及自来水冲洗组。检测血液中ＢＵＮ、ＡＬＴ、ＡＳＴ、ＧＧＴ、ＡＫＰ５种生化指标。观察心、肝、脑、肺、肾的病理变化及超微结构变化。结果间甲酚不仅可对皮肤造成深度烧伤，而且经过皮肤渗透还可引起全身主要脏器的损害。结果显示：血液中５种生化指标均出现异常，光镜和电镜观察组织细胞均有异常变化。结论４种不同治疗方法均有效，其中以手术切痂、外涂ＳＤＡｇ最好，饱和硫酸钠湿敷次之，用自来水冲洗可减轻间甲酚对皮肤的直接损伤。由于间甲酚对内脏器官影响较大时间较长，因此在治疗烧伤创面的同时，应用保护心脏、肝脏、肾脏药物的时间也要适当延长。     

间甲酚化学烧伤实验性治疗

目的开展间甲酚化学烧伤动物实验研究,为临床治疗提供理论依据。方法将间甲酚原液涂在家兔背部,并随机分为对照、手术切痂、SD-Ag 涂药、饱和硫酸钠湿敷及自来水冲洗组。检测血液中 BUN、ALT、AST、GGT、AKP 5种生化指标。观察心、肝、脑、肺、肾的病理变化及超微结构变化。结果间甲酚不仅可对皮肤造成深度烧伤,而且经过皮肤渗透还可引起全身主要脏器的损害。结果显示:血液中5种生化指标均出现异常,光镜和电镜观察组织细胞均有异常变化。结论4种不同治疗方法均有效,其中以手术切痂、外涂 SD-Ag 最好,饱和硫酸钠湿敷次之,用自来水冲洗可减轻间甲酚对皮肤的直接损伤。由于间甲酚对内脏器官影响较大时间较长,因此在治疗烧伤创面的同时,应用保护心脏、肝脏、肾脏药物的时间也要适当延长。     

烧伤后肠黏膜细胞外基质与细胞凋亡关系的实验研究

目的　探讨烧伤后大鼠肠黏膜细胞凋亡与细胞外基质的关系。　方法　 30只Wistar大鼠随机分为烧伤后 6、12h,1、3、5d组及正常对照组 ,每组 5只。检测肠黏膜上皮细胞凋亡数、cas pases 3酶活性、细胞外基质成分 (层粘连蛋白、Ⅳ型胶原 )含量 ,并作相关分析。　 结果　烧伤后大鼠肠上皮凋亡细胞数、caspases 3的活性较正常对照组明显升高 (P <0.0 5或 0 .0 1) ,大鼠肠黏膜层粘连蛋白、Ⅳ型胶原含量较正常对照组下降 ( P <0.0 5或 0 .0 1)。直线相关分析结果 :烧伤后肠黏膜层粘连蛋白、Ⅳ型胶原含量变化与细胞凋亡数呈显著的负相关 (r =- 0.5 75, - 0.6 13,P <0 0 5 )。　 结论　烧伤后大鼠肠黏膜细胞凋亡增加 ,且与细胞外基质的变化相关。     

大鼠严重烫伤后睾丸的病理变化

对大鼠严重体表烫伤后睾丸组织的病理变化进行了动态观察。大鼠体表３０％ＩＩ度烫伤后睾丸出现明显病变，其病理变化出现早、程度较重、形态变化多样，生精细胞、支持细胞、曲细精管界膜、间质细胞及血管内皮细胞均有不同程度的损伤性改变。生精细胞的病变以精母细胞及精细胞为重，精原细胞无明显损伤，伤后３０天生精上皮基本恢复正常。曲细精管界膜内纤维连接蛋白（Ｆｎ）于伤后早期减少。认为曲细精管界膜及支持细胞的损伤，特别是后者的损伤，改变了生精细胞生长、发育的微环境而可能导致或加重生精细胞的损伤。     

An experimental study on elongation injury of peripheral nerve]

The sciatic nerve of rabbits was indirectly elongated by lengthening the femur to clarify the pathology of elongation injury of the peripheral nerve. Electrophysiologic and morphologic changes and the blood flow in the nerve due to nerve elongation were evaluated in this model. No significant changes were observed when the nerve was elongated by 5.01%. Conduction disturbances, however, developed and the blood flow in the nerve was markedly reduced by sustained 11.8% elongation. In the latter case, the blood-nerve barrier was disrupted after 6-12 hours, endoneurial edema was observed after 48 hours, and extensive degeneration of nerve fibers was noted after 5 days. When the nerve was returned to the original length after 11.8% elongation for 2 hours, degeneration of the nerve fibers followed only partially. These findings suggest that circulatory impairments as well as mechanical damages are closely involved in elongation injury of peripheral nerves. The results also indicate that the duration of elongation plays an important role in determining the severity of elongation injury of peripheral nerves.     

An experimental study for diagnosis of burn depth

The histopathological findings in 42 experimental and 8 clinical burns are reported. The percentage clinical diagnostic error was determined for each type of burn. The current literature on the subject is reviewed.     

糖皮质激素在烧伤大鼠骨骼肌蛋白降解中的作用及其与蛋白酶体亚基表达的关系

目的 观察烧伤早期大鼠骨骼肌蛋白降解率和蛋白酶体亚基RC2的表达变化，探讨烧伤后骨骼肌大量消耗的分子机理。方法 采用大鼠背部30％TBSAⅢ度烧伤模型，应用骨骼肌离体孵育系统和氨基酸自动分析仪测定伸趾长肌蛋白降解率，同时应用Northern blot方法测定伸趾长肌蛋白酶体亚基RC2转录表达，采用放射免疫方法测定血浆糖皮质激素水平。结果 烧伤后大鼠伸趾长肌蛋白降解率显著增加，以肌纤维蛋白降解增加显著(P＜0．01)，蛋白酶体亚基RC2 mRNA水平表达上调，且与肌纤维蛋白降解率间呈显著正相关(r=0．9237，P＜0．01)。血浆糖皮质激素水平烧伤后显著增加(P＜0．01、0．05)，与RC2 mRNA表达和肌纤维蛋白降解率间高度正相关(r＝0．8540、0．8010，P＜0．05)。结论 烧伤后骨骼肌蛋白降解增强，以肌纤维蛋白降解最为显著，其与蛋白酶体亚基RC2转录表达增强关系密切，糖皮质激素在调节烧伤后骨骼肌蛋白降解中具有重要作用。     

Septicaemia after burn injury: a comparative study

Seventy-nine (8.4%) patients during June 1992–May 1996 (Group-1) and 68 (7.2%) patients from June 1996 to May 2000 (Group-2) who developed septicaemia at the burns unit of Al-Babtain Centre for Plastic Surgery and Burns, Kuwait, were retrospectively studied and compared. The mean age of 26 years, male predominance, flame burns as main aetiology and mean burn percentage of ≥40% was observed in both the groups. Both groups revealed extensive flame burn, inhalation injury, intubation and difficult resuscitation as the risk factors. The proportion of satisfactory resuscitation increased significantly (P<0.001) in Group-2. The septicaemia commonly occurred within 2 weeks postburn but the number of episodes during 5 days postburn was less in Group-2. The surface wound was found to be the likely source of entry of the organisms into the blood stream in both the groups. The gram positive organisms were dominant aetiologic factor in both groups but an increase frequency of Acnetobacter was found in Group-2. The proportion of MRSE and Pseudomonas septicaemia was significantly higher (P<0.01) in the Group-1. The rate of survivors, in both the groups was higher among operated patients but it was significantly higher (P<0.001) in the Group-1. A mortality rate 20.6% in Group-2 decreased against Group-1, which can be attributed to better resuscitation, nutritional care, early detection of septicaemia, appropriate antibiotics and early wound excision and skin grafting. MOF was the cause of death of 60.9% in Group-1 and 85.7% in Group-2. There was no role of prophylactic antibiotic in burn patients in the incidence of septicaemia and mortality.     

Study of the abnormal plasma proteins after burn injury]

In our previous study at least 4 abnormal bands were found in burned sera when analyzed by SDS-PAGE. In this paper further exploration of the characteristics of these abnormalities of burned sera were presented. By way of western blotting, 12 kinds of antisera against different human proteins as detecting antibodies were used. Results showed that bands developed by anti-haptoglobin antiserum corresponded well with the abnormal bands in SDS-PAGE. If the burned serum was separated by ion-exchange chromatography and its collected eluates containing protein peaks were tested for the immunosuppressive activities on normal murine spleen lymphocytes, the immunosuppressive eluates were usually found in the 6th protein peak. When these immunosuppressive eluates were further analyzed by SDS-PAGE and Western blotting, bands stained with anti-haptoglobin antiserum still coincided with the abnormal bands found in SDS-PAGE of burned serum. Result of this study suggests that one of the immunosuppressive factors found in burned serum may be a haptoglobin-like substance.     

凝血酶敏感蛋白2在小鼠角膜碱烧伤后修复过程中的表达

目的观察小鼠角膜碱烧伤后修复过程中凝血酶敏感蛋白2(TSP2)的表达情况。方法制作小鼠角膜碱烧伤模型(实验组,35只)。采用HE染色、免疫组织化学和逆转录聚合酶链反应(RT-PCR)等方法,观察对照组(正常小鼠5只)及实验组小鼠碱烧伤后3、6、12、24、48、96、192h(每时相点5只)角膜组织的形态学改变和TSP2、tsp2的表达情况。结果HE染色显示,实验组小鼠伤后24h起角膜内有明显的血管生成。免疫组织化学和RT-PCR检测结果一致显示,TSP2及tsp2在对照组及实验组小鼠角膜组织中均有表达,多见于上皮层的基底层。与对照组的TSP2表达水平(0.48±0.15)比较,实验组小鼠伤后3h TSP2的表达水平即上升(P<0.05),即6h达第1个峰值1.54±0.45,24h降至低谷0.73±0.19,随后又回升,96h时达第2个峰值1.79±0.63,此后下调,至伤后192h降至对照组水平(P>0.05).tsp2的表达趋势与之相似。结论小鼠角膜碱烧伤后TSP2的表达量随时相点的变化呈波动的趋势,这一变化可能属于应激条件下的代偿性增高。     

大鼠烫伤后肠道免疫屏障损伤的实验研究

为探索烧伤后肠道免疫屏障损伤的规律及其与肠道细菌移位的关系，我们对烫伤大鼠肠道免疫屏障的损伤进行了比较全面的动态观察，结果表明，伤后早期动物肠道内容物ＩｇＡ（免疫球蛋白Ａ）含量明显降低，肠固有层及上皮内ＣＤ３＋（Ｔ细胞总数）和ＣＤ４＋（辅助／诱导Ｔ细胞）Ｔ淋巴细胞明显减少，上皮内ＣＤ４＋与ＣＤ８＋（抑制／杀伤Ｔ细胞）Ｔ细胞数量的比值倒置；伤后肠道细菌ＩｇＡ包被率亦明显降低，且在整个实验过程中均明显低于伤前组；与上述改变相对应，肠道细菌移位率在伤后早期明显升高。提示，伤后肠道免疫屏障损伤是多方面的，而这一损伤对烧伤后肠道细菌移位和脓毒症的发生、发展可能起着重要作用。     

Direct quantification of autologous serum albumin leakage after burn injury in mice

The current technique determining the extent of capillary leakage after injury is to measure the leakage of dye-labeled foreign albumin. A recent report, however, demonstrated that albumin leakage is dependent upon the type of fluorescent dye used for labeling. We chose to develop and test a technique for determining the extent of vascular albumin leakage after burn injury without the use of dyes. Skin and blood samples were harvested at 3h and 7 days after burn injury in mice. Total skin lysates and extracts as well as sera were analyzed for albumin leakage. Coomassie staining and Western blot analyses of skin preparations followed by the densitometric measurement revealed increased levels of albumin, suggesting that the leakage of serum albumin started within 3h after burn injury. Instead of employing dye-labeled foreign albumin, the use of SDS-polyacrylamide gel electrophoresis of tissue extracts followed by Coomassie staining will allow for a simple and direct quantification of autologous albumin leakage due to burn as well as other types of injury.     

严重烧伤早期心肌收缩性与钙转运动能变化

研究烧伤早期心肌肌浆网钙转运动能变化，探讨其在烧伤后心肌收缩功能下降发病中的作用。方法 采用３０％ＴＢＳＡⅢ度烧伤大鼠模型，离体心脏灌流，测定伤前及伤后心肌室内压最大变化速度变化，制备心肌肌浆网，应用微孔滤膜过滤技术测定心肌ＳＲ＾４５Ｃａ＾２＋转运活性及ＳＲ＾５Ｃａ６２＋摄取初速度，摄取容量均明显降低，偶联率比对照值大幅度下降。     

Parallel self-induction of TNF-alpha and apoptosis in the thymus of mice after burn injury

BACKGROUND: Burn injury often causes multiple organ failure as well as skin damage. Several studies suggest that TNF-alpha plays an important role in postinjury immunosuppression by altering lymphoid tissues. We investigated the regulation of TNF-alpha expression and apoptosis in the spleen and thymus of mice after burn injury. MATERIALS and METHODS: C57BLKS/J mice were subjected to 18% TBSA full-thickness burn and the spleen and thymus were harvested at various time points (3 h to 29 days). The expression of TNF-alpha mRNA and protein in tissue extracts was analyzed by RT-PCR and ELISA. Apoptosis was measured by flow cytometry using annexin V staining. RESULTS: Burn injury induced TNF-alpha mRNA expression in the thymus at Day 1 and it returned to the basal levels at Day 14 and thereafter. Similarly, TNF-alpha mRNA up-regulation peaked between Day 1 and Day 3 in the spleen. Induction of TNF-alpha protein peaked at Day 1 in the thymus, whereas, TNF-alpha protein was unchanged in the spleen after burn injury. There was a twofold increase in apoptotic cells at Day 1 in the thymus, which is consistent with mRNA and protein data. In contrast, burn injury did not change apoptotic events in the spleen. CONCLUSIONS: The parallel induction of TNF-alpha mRNA, TNF-alpha protein, and apoptosis suggests that TNF-alpha may contribute to immunosuppression after burn injury by inducing apoptosis in the thymus.     

脊髓损伤早期及制动后大鼠股骨远端骨量丢失的实验研究

目的:建立大鼠脊髓损伤及后肢废用模型,观察建模早期两种模型大鼠股骨远端骨密度及远端破骨细胞数量的改变。方法:24只SD大鼠随机分为3组(每组8只),对照组(A组),行T10椎板切除,不损伤硬膜及脊髓;脊髓损伤(SCI)组(B组):切除T10椎板后用Allen′s法(60g.cm势能)造成脊髓损伤;制动组(C组):采用大鼠双侧腿-尾缝合,造成双下肢制动。分别于造模后第1、7天采用BBB(Basso,Beattie and Bresnahan)评分评估脊髓损伤大鼠后肢运动功能,确定模型建立成功。建模第10天后处死,取一侧尺、桡骨及股骨远端,行骨密度检测。取另一侧股骨远端行TRAP染色,观察大鼠股骨远端破骨细胞数量的变化。结果:A、B、C 3组股骨远端骨密度值分别为0.114、0.096、0.108g/cm2,B组骨密度值最低,其次为C组,A组最高(P<0.05)。尺、桡骨骨密度3组比较无差异(P>0.05)。与A组比较,B组大鼠股骨干骺端破骨细胞数量增加显著,其次为C组,A组最少(P<0.01)。结论:脊髓损伤后,股骨远端破骨细胞数量大量增多,活性增强,骨吸收加强,引起脊髓损伤平面以下肢体骨量的迅速丢失,比废用性骨量丢失的程度更重。