安信医用抗菌贴加速慢性难愈合创面愈合

目的 观察安信医用抗菌贴对慢性难愈合创面（溃疡）的促修复作用并探讨其修复机制。方法 34例共44个慢性难愈合创面,其中创伤性溃疡15例（23个创面）,压迫性溃疡9例（11个创面）,糖尿病溃疡5例,放射性溃疡5例。所有创面经清创后用安信医用抗菌贴外敷于创面,每2－3天更换一次。结果 所有经安信医用抗菌贴治疗的创面都明显愈合,其中2周内愈合26个创面,3周内愈合7个创面,4周内愈合9个创面,超过4周愈合2个创面。4周内总愈合率炎95．5％。结论 安信医用抗菌贴可以显著地加速慢性难愈合创面的愈合,其机制为广谱速效杀菌,改善局部微循环,有效激活并促进组织细胞生长。     

碱性成纤维细胞生长因子与创面修复——1024例多中心对照临床试验结果

在全国３２家医院，采用多中心对照方法，进一步观察重组牛碱性成纤维细胞生长因子（ｂＦＧＦ）对创面修复的影响和可能发生的毒副反应。结果表明，在统一病例选择范围、治疗方法及治疗标准的前提下，３２家医院经ｂＦＧＦ治疗的１０２４例烧伤（３３０例）、手术创伤或供皮区创面（５０９例）及慢性难愈合创面（１８５例）均较对照创面（８２６例，其中１８５例为自身对照）修复质量显著提高，创面愈合时间分别缩短３天～４天。ｂＦＧＦ对烧伤、手术创伤、供皮区创面及慢性难愈合创面促修复的有效率分别为９５．２％、９６．５％和９３．５％，且无不良和毒副反应发生     

碱性成纤维细胞生长因子与创面修复棗1024例多中心对照临床试验结果

在全国３２家医院,采用多中心对照方法,进一步观察重组牛碱性成纤维细胞生长因子（ｂＦＧＦ）对创面修复的影响和可能发生的毒副反应。结果表明,在统一病例选择范围,治疗方法及治疗标准的前提下,３２家医院经ｂＦＧＦ治疗的１０２４例烧伤（３３０例）,手术创伤或供皮区创面（５０９例）及慢性难愈合创面（１８５例）均较对照创面（８２６例,其中１８５例为自身对照）修复质量显著提高,创面愈合时间分别缩短３天￣４天,ｂＦ     

创面愈合过程中内源性FGF含量变化的研究

为探讨创面愈合的机制，本实验通过免疫组织化学方法，对大鼠断层供皮区创面愈合过程中伤后４天，８天，１２天和１６天创面内源性成纤维细胞生长因子（ＦｉｂｒｏｂｌａｓｔＧｒｏｗｔｈＦａｃｔｏｒ．ＦＧＦ）变化进行了研究。结果表明：创面愈合过程中内源性ＦＧＦ有规律性变化，以伤后８天时相对含量最多，伤后早期和伤后晚期次之，创面愈合后其内源性含量进一步减少。结论：创面愈合过程中，内源性ＦＧＦ的变化促进了创面愈合，是创面愈合的机制之一，结合内源性ＦＧＦ变化，合理外用ＦＧＦ对促进创面愈合可能会取得更好的效果。     

创面愈合过程中内源性EGF变化的研究

为探讨创面愈合的机理，本实验采用免疫组织化学方法，对大鼠中厚皮片供皮区创面愈合过程中第４、８、１２和１６天创面内源性表皮生长因子（Ｅｐｉｄｅｒｍａｌｇｒｏｗｔｈｆａｃｔｏｒ，ＥＧＦ）的变化进行了研究。结果表明，创面愈合过程中内源性ＥＧＦ含量表现有规律性变化，以伤后第８天含量最多，伤后早期和晚期次之，创面愈合后其含量进一步减少。结论：创面愈合过程中，内源性ＥＧＦ的变化促进了创面愈合，是创面愈合的机理之一，结合内源性ＥＧＦ变化，合理外用ＥＧＦ对创面愈合可能会取得促进的效果。     

创面愈合过程中内源性FGF含量变化的研究

为探讨创面愈合的机制，本实验免疫组织化学方法，对大鼠断层供应区创面愈合过程中伤后４天，８天，１２天和１６天创面内源性成纤维细胞生长因子（ＦｉｂｒｏｂｌａｓｔＧｒｏｗｔｈＦａｃｔｏｒ，ＦＧＦ）变化进行了研究。结果表明：创伤愈合过程中内源性ＦＧＦ有规律性变化，以伤后８天时相对含量最多，伤后早期和伤后晚期之，创面愈合后其内源性含量进一步减少，结论：创面愈合过程中，内源性ＦＧＦ的变化促进创面愈合，是创面愈     

多种生长因子促糖尿病患者难愈合性创面愈合的临床研究

目的　观察多种生长因子治疗糖尿病难愈合性创面的临床效果,并探讨其可能的机制。方法　将７８ 例糖尿病患者分为三组,即生理盐水对照组、表皮细胞生长因子（ Ｅ Ｇ Ｆ）治疗组、血小板源伤口愈合因子（ Ｐ Ｄ Ｗ Ｈ Ｆ）治疗组。观察治疗后１～８ 周创面闭合指数、创面治愈率及组织形态学变化。结果　 Ｅ Ｇ Ｆ组、 Ｐ Ｄ Ｗ Ｈ Ｆ组的创面闭合指数、创面治愈率较对照组明显增加,其肉芽组织毛细血管与成纤维细胞增生、胶原沉积和表皮覆盖明显,尤以溃疡与正常组织交界处明显。组间比较发现, Ｐ Ｄ Ｗ Ｈ Ｆ的促愈合作用优于 Ｅ Ｇ Ｆ。结论　局部应用多种生长因子可治疗糖尿病难愈合性创面,生长因子单独或配伍使用是改善糖尿病患者创面愈合受阻的有效措施。     

影响碱性成纤维细胞生长因子促进烧伤创面愈合因素的探讨

采用大白鼠１５％Ⅲ度烧伤模型，探讨了影响碱性成纤维细胞生长因子（ｂＦＧＦ）促进烧伤创面愈合的因素。结果发现，烧伤创面早期切痂可保持ｂＦＧＦ的活性。４０天创面愈合率达８４．０％，而未切痂组愈合率仅９，Ｏ％。肝素可增强ｂＦＧＦ促进创面肉芽组织生长、毛细血管增生、纤维母细胞增殖及细胞ＤＮＡ合成。创面感染的控制有利于保护ｂＦＧＦ的活性。伤后１周开始使用ｂＦＧＦ为适宜时期。     

基因重组碱性成纤维细胞生长因子促进猪深Ⅱ度烧伤创面愈合的实验研究

将基因重组的碱性成纤维细胞生长因子（ｂＦＧＦ）作为外源性生长因子来观察比较不同浓度的ｂＦＧＦ对猪深Ⅱ度烧伤创面愈合的影响。结果表明连续用药３～５天后，创面外观及电脑图像分析显示，ｂＦＧＦ对猪深Ⅱ度烧伤创面的愈合有一剂量效应。创面活检标本经用流式细胞计数仪做细胞ＤＮＡ的周期分析表明，用ｂＦＧＦ后创面细胞的Ｇ１期比例下降，Ｓ期和Ｇ２＋Ｍ期比例增多；其变化规律与创面所用的ｂＦＧＦ浓度有关，并与电脑图像分析所得的数据相一致。提示浓度合适的ｂＦＧＦ能明显地促进创面的愈合。     

表皮生长因子促进皮肤创面愈合的研究

为了观察外源性表皮生长因子对创面愈合的影响，在３０例大鼠皮肤创面愈合模型中，局部外用表皮生长因子（ＥＧＦ），以软膏基质作为对照，分别于１，２周测量创面面积，测定创面组织中的ＤＮＡ、蛋白质及羟脯氨酸含量，记录创面完全愈合时间。结果表明，实验组与对照组创面完全愈合的时间分别为（１４．６±１．２）天和（１８．５±２．０６）天（Ｐ＜０．０１），ＥＧＦ能显著增加组织中的ＤＮＡ、蛋白质及羟脯氨酸含量（Ｐ＜０．０１）。结果提示，ＥＧＦ能显著加速创面的修复，缩短愈合时间。     

Time course study of delayed wound healing in a biofilm‐challenged diabetic mouse model

Bacterial biofilm has been shown to play a role in delaying wound healing of chronic wounds, a major medical problem that results in significant health care burden. A reproducible animal model could be very valuable for studying the mechanism and management of chronic wounds. Our previous work showed that Pseudomonas aeruginosa (PAO1) biofilm challenge on wounds in diabetic (db/db) mice significantly delayed wound healing. In this wound time course study, we further characterize the bacterial burden, delayed wound healing, and certain aspects of the host inflammatory response in the PAO1 biofilm‐challenged db/db mouse model. PAO1 biofilms were transferred onto 2‐day‐old wounds created on the dorsal surface of db/db mice. Control wounds without biofilm challenge healed by 4 weeks, consistent with previous studies; none of the biofilm‐challenged wounds healed by 4 weeks. Of the biofilm‐challenged wounds, 64% healed by 6 weeks, and all of the biofilm‐challenged wounds healed by 8 weeks. During the wound‐healing process, P. aeruginosa was gradually cleared from the wounds while the presence of Staphylococcus aureus (part of the normal mouse skin flora) increased. Scabs from all unhealed wounds contained 10⁷ P. aeruginosa, which was 100‐fold higher than the counts isolated from wound beds (i.e., 99% of the P. aeruginosa was in the scab). Histology and genetic analysis showed proliferative epidermis, deficient vascularization, and increased inflammatory cytokines. Hypoxia inducible factor expression increased threefold in 4‐week wounds. In summary, our study shows that biofilm‐challenged wounds typically heal in approximately 6 weeks, at least 2 weeks longer than nonbiofilm‐challenged normal wounds. These data suggest that this delayed wound healing model enables the in vivo study of bacterial biofilm responses to host defenses and the effects of biofilms on host wound healing pathways. It may also be used to test antibiofilm strategies for treating chronic wounds.     

短波紫外线治疗老年人慢性难愈合创面的疗效观察及剂量分析

目的：观察短波紫外线（UVC）疗法对老年人慢性难愈合创面的疗效,并初步分析影响其剂量和疗效的相关因素。方法：选择老年慢性难愈合创面患者58例共106个创面,患者年龄73～91岁。紫外线治疗剂量为36～1800mJ／cm^2,每日或隔日1次,直至创面完全上皮化。观察不同部位和不同分期创面的愈合情况和愈合时间,分析UVC治疗剂量和创面部位与创面愈合状态的关系。结果：经UVC治疗后,创面愈合77例,显效25例,无效4例,总有效率96．2％。不同部位创面UVC治疗剂量差异显著,手足区〉肛周会阴区〉头颈区〉四肢区〉躯干区（P〈0．01）;不同部位创面愈合总有效率差异不显著（P=0．4724）,但不同部位治疗次数和创面愈合时间差异显著,肛周会阴区〉躯干区〉手足区〉四肢区〉头颈区（P〈0．01）。在93个压力性溃疡创面中,52个Ⅱ期创面治疗次数[（2．71±0．68）次]及愈合时间[（7．78±2．12）d]均少于41个Ⅲ期创面[分别为（4．09±0．84）次和（13．96±2．38）d],创面愈合率（92．3％）和总有效率（100．0％）也均高于Ⅲ期创面（愈合率为61．0％,总有效率为90．2％,P〈0．01）。结论：UVC治疗老年人慢性难愈合创面疗效显著,病灶部位是影响UVC治疗剂量的重要因素,而病变分期是影响创面愈合效果和时间的主要因素。     

应用人工真皮和自体皮移植修复难愈性创面

目的 了解人工真皮联合自体皮移植修复难愈性创面的可行性并评价其治疗效果.方法 选择20例住院患者共25处持续8周以上的难愈性创面,分为慢性溃疡组9例11处创面,为创伤、烧伤后瘢痕溃疡创面;骨外露组11例14处创面,骨外露面积为0.8～77.0 cm~2(最大面积为22.0 cm×3.5 cm).手术方法 为I期扩创移植人工真皮,2～6周后局部血管化良好,外露肌腱和骨质被类真皮组织覆盖,Ⅱ期移植自体薄断层皮片. 结果 慢性溃疡组9例患者的11处创面中,9处愈合优良,2处经换药后愈合.骨外露组11例患者的14处创面中,12处愈合优,外露骨质得到有效覆盖;2处创面因感染人工真皮未成活,随后行皮瓣修复手术.随访5-24个月,未见创面复发,外观满意,无明显增生性瘢痕,供皮区亦无明显瘢痕形成. 结论 人工真皮联合自体皮移植修复难愈性创面,方法 简便、创面愈合质量高、供皮区损失轻微,为难愈性创面的修复提供了新的选择.     

bFGF在面部皮肤擦伤治疗中的应用

目的：临床应用外源性碱性成纤维细胞生长因子（bFGF）,促进面部皮肤擦伤创面的愈合,减少后遗症的发生。方法：24例52个创面均常规外科清创,其中24个创面应用bFGF外涂,150AU/cm^2,1次／日,7天一疗程,结果：用药创面较未用药对照创面平均提前愈合天数为4天（P＜0．01）,无明显的色素赏赐着及疤痕形成。结论：bFGF能促进创面上皮生长,伽速面部皮肤擦伤创面愈合。养活后遗症的形成。     

多发性压力性溃疡的外科治疗

目的 总结多发性压力性溃疡的治疗经验. 方法 2001年1月-2007年5月,笔者应用多种皮瓣转移联合皮肤移植治疗21例患者的56处压力性溃疡创面,其中骶尾部21处、坐骨结节14处、股骨大转子部13处、其他部位8处.围手术期行全身支持治疗,尽早清创,依据扩创后创面大小、深度、部位及邻近皮肤软组织条件,选用皮瓣、肌皮瓣或游离植皮修复创面.术后对伤口行连续灌洗与负压吸引,卧翻身床定期翻身. 结果 25处创面以筋膜皮瓣或肌皮瓣修复,愈合率为92%;13处创面以邻近局部皮瓣修复,愈合率为85%;8处创面直接缝合,其中6处一次性愈合;10处创面游离植皮,其中7处一次性愈合.在延期愈合的创面中,4处经再次清创缝合或植皮愈合,4处经短期换药愈合,1例遗留慢性窦道.随访6个月时,3例患者复发压力性溃疡. 结论加强围手术期全身支持治疗,合理、有效地利用臀部及其周围健康组织形成多个筋膜皮瓣或肌皮瓣同时修复多个创面,术后对伤口行连续灌洗与负压吸引,采用翻身床定期翻身等等,是多发性压力性溃疡手术成功的有效措施.     

Ratios of activated matrix metalloproteinase-9 to tissue inhibitor of matrix metalloproteinase-1 in wound fluids are inversely correlated with healing of pressure ulcers

Previous analyses of fluids collected from chronic, nonhealing wounds found elevated levels of inflammatory cytokines, elevated levels of proteinases, and low levels of growth factor activity compared with fluids collected from acute, healing wounds. This led to the general hypothesis that chronic inflammation in acute wounds produces elevated levels of proteinases that destroy essential growth factors, receptors, and extracellular matrix proteins, which ultimately prevent wounds from healing. To test this hypothesis further, pro- and activated matrix metalloproteinases (MMP-2 and MMP-9), tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2), and the ratios of MMPs/TIMPs were assayed in fluids and biopsies collected from 56 patients with chronic pressure ulcers. Specimens included ulcers treated for 0, 10, and 36 days with conventional therapy or with exogenous cytokine therapies. Quantitative assay data were correlated with the amount of healing. The average MMP-9/TIMP-1 ratio in fluids from 56 ulcers decreased significantly as the chronic pressure ulcers healed. Furthermore, the average MMP-9/TIMP-1 ratio was significantly lower for fluids collected on day 0 from wounds that ultimately healed well (> or =85% reduction in initial wound volume) compared with wounds that healed poorly (< 50% wound volume reduction). These data show that the ratio of MMP-9/TIMP-1 levels is a predictor of healing in pressure ulcers and they provide additional support for the hypothesis that high levels of MMP activity and low levels of MMP inhibitor impair wound healing in chronic pressure ulcers.     

Noncontact low‐frequency ultrasound therapy in the treatment of chronic wounds: A meta‐analysis

Our objective was to summarize and quantify the effects of a noncontact low‐frequency ultrasound (NLFU) therapy on healing of chronic wounds. We performed a meta‐analysis of eight published studies reporting effects of NLFU on wound size and healing rate of chronic wounds in 444 NLFU‐treated patients. A search of the PubMed database was conducted in January 2010 and updated in October 2010. We used random‐effects linear regression models to estimate the proportional reductions in wound area and volume and the proportion of wounds healed from baseline to last follow‐up. In four studies (N=188) reporting change in wound area from baseline, NLFU was associated with 85.2% area reduction (95% CI 64.7%–97.6%) over a mean 7 weeks. In four studies (N=278) reporting reduction in wound volume, NLFU was associated with 79.7% volume reduction (95% CI 46.1%–98.8%) over a mean 12 weeks. In seven studies (N=429) reporting proportion of wounds healing by study end (mean time to healing 8.2 weeks; median 6.8 weeks), meta‐analyzed healing rates over time suggest 32.7% of wounds healed on average by 6 weeks (95% CI 23.3%–42.1%) and 41.7% by 12 weeks. NLFU for treatment of chronic wounds was associated with consistent and substantial wound size reductions, as well as favorable rates of healing.     

Negative pressure wound therapy as an adjunct in healing of chronic wounds

Negative pressure wound therapy (NPWT) has emerged as a cutting‐edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2 years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT, none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36 ± 4·24 days. Complete healing of wounds occurred by 33·1 ± 10·22 days. There was a statistically significant difference in the volume of the wounds before and after the intervention (P = 0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement.