烧伤败血症发病规律探讨

６６９例烧伤败血症患者的临床资料分析以探讨该病的发病规律。结果：本组共检出细菌１２４６株,其中Ｇ＋球菌４０．０％,Ｇ－杆菌占５７．７％,主要优势菌为金黄色葡萄球菌和绿脓杆菌。烧伤败血症发生率：小儿及老年组（１３．１％和１０．３％）明显高于中青年组（Ｐ＜０     

烧伤复合爆震伤的临床特点及救治体会

总结烧伤复合爆震伤的临床特点和救治经验,以提高其临床救治水平。方法 收集2015—2020年收治的68例烧伤复合爆震伤患者的临床资料。患者均采用休克补液、脏器功能保护、抗感染/连续性肾脏替代治疗及创面处理等个性化治疗,对其临床特点及预后等进行回顾性分析。结果 68例患者,男女比2.4:1,年龄(36.3±0.45)岁;轻度烧伤1例、中度烧伤4例、重度烧伤17例、特重烧伤46例。致伤原因中煤气爆炸占首位(42.65%,29/68),其次是工厂烟花爆竹(23.53%,16/68);平均烧伤面积56.89%;复合伤居多,以肺部爆震伤为主(58.82%,40/68),其次是脊柱及四肢骨折(27.97%,19/68)、颅脑爆震伤(8.82%,6/68)、腹部爆震伤(7.35%,5/68);并发症中肺脏发病率高,肺部感染/呼吸衰竭(70.59%,48/68)、休克(58.82%,40/68)、脓毒血症(57.35%,39/68)。血培养微生物阳性39例(57.35%,39/68)、阴性29例(42.65%,29/68);共培养出52株菌株,其中多重耐药菌44株(84.60%,44/52)。57例(83.82%,57/68)于伤后32～90 d创面愈合出院,11例死亡,病死率为16.18%(11/68)。结论 烧伤复合爆震伤常伴有严重的复合伤,伤势严重,病情复杂,并发症发生率及病死率高;早期及时发现并处理复合伤,综合分析病情,采取个体化治疗方案是提高疗效的关键。     

中药膳食防治严重烫伤大鼠肠道细菌移位研究

脓毒症是引起严重烧伤患者死亡的主要原因之一,其发生与肠道细菌移位及肠源性LPS的侵袭有关[1-2].因此,减少肠道细菌移位对预防脓毒症发生有重要意义.笔者应用药膳饮食喂饲烫伤大鼠,观察其对大鼠肠道细菌移位及LPS入侵的影响,探索防治肠道细菌移位的方法.     

药膳饮食对严重烧伤大鼠细胞免疫功能的影响

目的探讨药膳饮食对严重烫伤大鼠免疫功能紊乱的调节作用。方法将健康Wistar大鼠100只,随机分成烧伤药膳喂养组（药膳组,n=30）、烧伤肉汤喂养组（肉汤组,n=30）、烧伤常规喂养组（常规组,n=30）和正常对照组（对照组,n=10）。药膳组、肉汤组、常规组制作30%TBSAⅢ度烫伤模型,于伤后第3、7、14天各取10只,在无菌条件下取材用流式细胞仪检测,观察T淋巴细胞亚群及NK细胞活性的变化。结果药膳组、肉汤组、常规组伤后第3、7、14天的CD3＋、CD4＋、CD4＋/CD8＋比值与对照组比较明显降低,CD8＋T淋巴细胞明显增高,NK细胞活性明显下降（P〈0.05或P〈0.01）;与肉汤组、常规组比较,药膳组伤后第7、14天的CD3＋、CD4＋、CD4＋/CD8＋明显升高,CD8＋明显降低,NK细胞活性明显升高（P〈0.05或P〈0.01）。结论严重烫伤大鼠免疫状况发生了明显改变,药膳饮食可以改变烫伤大鼠T淋巴细胞亚群分布,提高NK细胞活性,从而改善严重烧伤后机体的免疫功能。     

高温环境热应激研究进展

环境温度（Ta）和环境湿度（Tw）、气体流速（V）的综合影响,可引起人体过热的环境,称为热环境。太阳辐射或在劳动环境中存在的热源放出的辐射热,除直接作用于人体外,还可使周围物体加热,再以辐射、传导、对流散热等方式作用于人体,因而太阳辐射和热辐射是热环境中的重要致热因素。劳动环境中,     

高温环境对烫伤大鼠免疫功能的影响

我国南方地区夏季漫长,极端气温达38～40℃甚至更高,在该环境下机体会产生一系列不同于常温环境下的改变.目前关于普通环境温度下烧伤免疫的研究报道较多[1-2],但对高温气候下烧伤免疫的变化了解较少.笔者对此进行动物实验研究,拟为高温气候下烧伤救治提供参考.     

休克期大面积切痂对烫伤大鼠T淋巴细胞亚群的影响

目的：观察休克期大面积切痂对严重烫伤大鼠外周血中T淋巴细胞亚群的影响，探索能改善严重烧伤后免疫紊乱的方法。方法：观察严重烫伤大鼠休克期大面积切痂和常规治疗组伤后第1、5、9天血中T淋巴细胞亚群的变化情况。结果：（1）与正常组比较，严重烫伤大鼠伤后外周血中CD^＋ 4下降，CD^＋ 8升高，CD^＋4／CD^＋8下降；（2）休克期大面积切痂组与常规治疗组比较外周血中CD^＋ 4升高，CD^＋ 8下降，CD^＋ 4／CD^＋ 8升高。结论：严重烫伤大鼠免疫状况发生了明显改变，休克期大面积切痂可以改变烫伤大鼠外周血T淋巴细胞亚群分布，从而改善其免疫功能。     

强化精氨酸肠内营养对烧伤患者营养状况和细胞免疫的影响

Objective To investigate the effects of arginine enriched enteral nutrition (EN) on nu-tritional status and cellular immunity of severely burned patients. Methods Randomized, single blind, parallel and positive control investigation was employed in the study. Thirty severely burned patients were di-vided into enteral immune nutrition (EIN) group and EN group. Sixteen patients in EIN group received en-teral nutrition enriched with arginine, while the other 14 patients in EN group received standard enteral nu-trition. Nutritional support was continued for 14 days. Gastrointestinal reaction of patients in 2 groups was observed. Fasting venous blood was drawn from patients of both groups before receiving nutrition treatment and on the morning of 7th, 14th day of treatment. Level of serum protein, hepatic function parameters, renal function parameters, fasting-blood glucose, and subpopulations of T lymphocytes in peripheral blood were determined. Results (1) Incidence of gastrointestinal side effect in EIN group (25.0%) was close to that of EN group (21.4% , P>0.05). (2) Compared with pre-treatment days, levels of prealbumin and transferrin in serum of patients in 2 groups on 7th and 14th post-treatment days were significantly increased (P<0.05 or P<0.01), but there was no significant difference between 2 groups. The level of total serum protein on 14th day of treatment of patients was significantly increased in both groups, and that of EIN group (66±7 g/L)was significantly higher compared with that in EN group (64 ± 11 g/L, P<0.05). The level of serum albumin (29±5, 32±5 g/L, respectively) of patients in EIN group on 7th and 14th day of treat-ment were significantly higher than that (26±4 g/L, P <0.05) in pre-treatment days, however there was no significant difference in EN group. (3) There was no significant difference in respect of hepatic function, renal function, and fasting-blood glucose between pre-treatment and post-treatment periods in both groups (P>0.05). (4) The ratio of CD4+ , CD8+ on 14th day of treatment in EIN group was close to that of pre-treatment level. In EN group, cell percentage of CD4+ significantly decreased, while that of CD8+ significantly increased (P<0.05), and CD4+ was significantly higher [(56±8) %] in EIN group than that in EN group [(55±12) % , P <0.05]. In both groups, cell percentage of CD3+ was significantly higher than that in pre-treatment days (P<0.05), while there was no obvious change in CD4+/CD8+. Conclusions Arginine enriched enteral nutrition can effectively improve nutritional status and cellular immune function of burn patients.     

高温复合烫伤对兔早期心肌损伤影响

研究表明,严重烫伤后常引起心肌缺血、缺氧,影响心脏泵血功能,不能给器官、组织提供充足的血流量而影响细胞正常代谢和功能,导致或加重烫伤本身所造成的组织器官损伤,并威胁患者生命.高温是烫伤发生的常见环境,高温对心血管系统损害的影响已有报道.本研究结合南方地区夏季高温特点,通过建立高温环境下烫伤动物模型,观察这一特殊环境下烫伤后动物心肌酶、心肌组织病理形态变化,探索高温复合烫伤对心肌损害特点、产生原因及可能机制,为研究高温对机体的损伤机制提供依据.     

CD_3AK细胞对烧伤患者免疫功能的影响

通过检测患者淋巴细胞转化功能及 NK细胞活性 ,调查 CD3AK细胞对烧伤患者免疫功能的影响。结果发现 :CD3AK细胞使 T细胞转化为母细胞能力增强 ,NK细胞活性升高 ,表明 CD3AK细胞能改善烧伤患者免疫功能低下的状态 ,促进细胞免疫功能的恢复。