富林蜜与重组人表皮生长因子凝胶联合使用治疗面部深Ⅱ度烧伤

颜面部烧伤后色素沉着、瘢痕形成均影响美观,给患者工作、生活、社交及心理带来障碍,故在治疗中应尽可能减少色素沉着、瘢痕形成,提高愈合质量.自2006年12月至2008年6月,笔者采用富林蜜+重组人表皮细胞生长因子(rhEGF)凝胶治疗面部深Ⅱ度烧伤创面,取得满意的临床效果.现报告如下.     

The potential receptor for high mobility group box-1 protein （HMGB1） on immune function of peritoneal macrophages in mnice

Objective To investigate the potential receptor for high mobility group box-1 protein （HMGB1） on immune function of peritoneal macrophages in mice. Methods The peritoneal macrophages were obtained from female Balb/C mice. After stimulation with 100μg/L HMGB1 for 48 h,the receptor for advanced glycafion end products （RAGE） expression in macrophages was detected by flow cytometry and laser scanning confocal microscopy,respectively.     

Application of vacuum sealing drainage technique in poor healing wounds after heart valve surgery

Background: Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement surgery. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. It becomes a really troublesome and complicated case when a poor healing occurs in midsternal incision after the heart valve surgery and a higher medical cost may be needed. Methods From January 2009 to February 2013, 162 patients who underwent heart valve surgery through midsternal incision approach and had a poor healing of wound were observed for prospective randomized controlled trial. The patients were randomly assigned to a vacuum sealing drainage group (n = 81) who received vacuum sealing drainage for healing of the wound or a control group (n = 81) who received traditional treating for the infected wound. Their therapeutic effects, healing time and treatment costs, etc were compared. Results Two patients from the vacuum sealing drainage group came back to hospital for repair due to dehiscence of the incision after discharge, and no patient died. Six patients from the control group came back to hospital for repair due to dehiscence of the incision after discharge, two came back to hospital for surgery due to chronic osteomyelitis, and one patient died two weeks later after surgery due to severe chest infection. Wound healing time for vacuum sealing drainage group was 14.6 ± 3.6 days, which was significantly shorter than that of the control group (21.2 ± 7.8 days, P < 0.05), while the medical costs showed no significant difference between the two groups (P > 0.05). Seventy-eight patients (96.29%) in the vacuum sealing drainage group showed a good healing of the wound and sternum after a six-month follow-up. Conclusion The use of vacuum sealing drainage technique in poor-healing wounds after heart valve surgery through midsternal incision approach could achieve good therapeutic efficacy, with shorter wound healing time and similar costs as traditional treatment.     

烧伤患者血浆NT-proBNP和预后的关系分析

目的探讨烧伤患者血浆N-末端脑利钠肽(NT-proBNP)的变化对患者预后的评估价值。方法对39例严重热烧伤患者的临床资料进行回顾性分析。其中男33例,女6例;烧伤面积30%⁹8%体表面积,平均(65.5%±23.68%);年龄1998%体表面积,平均(65.5%±23.68%);年龄19⁷2岁,平均(36.8±16.8)岁。观察39名患者心力衰竭情况、血浆NT-proBNP、肌钙蛋白I(cTnT)、心功能和患者的预后情况。结果 9例出现心力衰竭的烧伤患者NT-proBNP是(1 676.03±2 190.41)pg/L,其中3例患者死亡。30例没有出现心力衰竭的烧伤患者NT-proBNP是(196.97±104.39)pg/L,其中1例患者死亡。心衰组与无心衰组两组死亡率差异有显著性意义(p<0.01)。结论严重烧伤患者合并出现心力衰竭死亡率高,NT-proBNP能很好地评估严重烧伤患者的预后。     

体外持续培养对瘢痕成纤维细胞胶原合成的影响

目的探讨人瘢痕成纤维细胞在体外持续培养时,其胶原合成能力的变化。方法体外持续培养人瘢痕成纤维细胞,检测不同代次细胞的大体形态、羟脯氨酸含量及超微结构的变化,并对比分析。结果第1、6、12、18代瘢痕成纤维细胞的羟脯氨酸(HPr)含量分别为(0.1460±0.0066)、(0.1020±0.0095)、(0.0700±0.0061)、(0.0540±0.0035)mg/L。随着体外培养细胞代次的增多,HPr呈下降趋势,并有相应的超微结构的变化。结论人瘢痕成纤维细胞在体外持续培养时,胶原合成能力逐渐下降,可能与其局部微环境的刺激因子有直接关系。第1～6代为最适实验细胞。     

层流洁净技术在烧伤治疗中的应用

目的 探索层流洁净技术治疗大面积烧伤的价值。方法 对室内空气及创面进行细菌培养;监测病房使用时间的细菌微粒数比较,各洁净级别杀菌率。不同级别地点细菌培养结果比较。结果 千级以上层流病房细菌培养为“0”,与普通病房对照有较大差别,患者死亡率明显降低,疗程缩短,医疗费用下降,手术植皮及其他伤口均达Ⅰ期愈合,无交叉感染。结论 层流洁净病房应用于烧伤治疗,疗效非常满意。     

骨髓基质干细胞与微粒皮组织促进皮肤缺损创面愈合的实验研究

目的 探讨骨髓基质干细胞(BMSCs)与微粒皮组织移植对皮肤缺损创面愈合的影响.方法 分离、培养、鉴定雄性F344大鼠骨髓基质干细胞;在大鼠背部形成4cm×4cm皮肤全层缺损创面;48只雌性F344大鼠随机均分为4组,A组行骨髓基质干细胞注射+微粒皮组织创面移植,B组仪行微粒皮组织创面移植,C组仅注射骨髓基质干细胞,D组仅行生理盐水(0.5ml)创面注射.移植的微粒皮组织占1/4创面面积,注射5×106个BMSCs细胞.雌性Wistar大鼠异体皮覆盖创面.观察术后14d创面愈合率、创面愈合时间、创面收缩率,并行Y染色体检测,以观察骨髓基质干细胞在创面的成活增殖情况.结果 A、B两组创面愈合率(分别为85.8%±3.5%、62.2%±4.4%)远高于C、D组(分别为30.4%±1.7%、30.0%6±1.3%),且A组显著高于B组(P<0.01),但C、D两组间比较没有显著性差异(P=0.898).A、B两组愈合时间(分别为17.2±1.6、20.3±2.4d)明显短于C、D组(分别为23.1±1.3、25.2±1.5d),且A组明显短于B组,C组明显短于D组(P<0.01).A、B两组收缩率(分别为36.9%±1.9%、39.6%±2.9%)明显小于C、D组(分别为92.5%±1.4%、92.4%±1.9%),且A组明显小于B组,而C、D两组的创面收缩率比较没有显著性差异.在A组、C组组织标本中可检测到数量不等的Y染色体阳性细胞.结论 BMSCs可在移植创面成活,能够与微粒皮组织相互作用,促进创面愈合.     

烫伤大鼠不同深度创面组织中表皮干细胞分布的初步研究

目的初步观察烫伤大鼠不同深度创面组织中表皮干细胞的分布情况。方法将32只SD大鼠分别造成Ⅰ、浅Ⅱ、深Ⅱ和Ⅲ度烫伤，伤后24h取创面组织标本，制作切片。采用细菌蛋白一生物素标记法(LSAB)进行免疫组织化学染色，以α2、β1整合素及角蛋白10(K10)作为一抗，观察不同创面组织中表皮干细胞的表达和分布情况。结果Ⅰ度烧伤创面组织中，K10阳性细胞分布于表皮的棘细胞层、颗粒层、透明层，α2、β1整合素阳性细胞分布于表皮基底层，数量多。浅Ⅱ度创面中，α2、β1整合素阳性细胞位于残留的基底层和皮肤附属器(主要是毛囊)中，数量较少。深Ⅱ度创面中，α2、β1整合素阳性细胞仅存在于真皮深层健存的皮肤附属器中，数量很少。Ⅲ度创面中，罕见α2、β1整合素阳性细胞。结论表皮干细胞在烧伤创面中的分布与烧伤深度有关，残存的表皮干细胞可能是创伤修复过程中再上皮化的细胞来源。     

渗透性扩张器动物体内应用的安全性研究

背景：渗透性扩张器是内含甲基丙烯酸甲脂和N-乙烯基吡咯烷酮吸水性凝胶的自膨胀扩张器,植入机体后可通过吸附体液而缓慢膨胀。目的：通过大鼠皮下包埋实验,探讨渗透性扩张器在动物体内的近远期变化规律及组织相容性。方法：设计Wistar大鼠自身对照实验,将渗透性扩张器（样品）和高密度聚乙烯（对照品）分别植入大鼠皮下,观察术后创面愈合情况,渗透性扩张器植入不同时间的扩张情况及其在大鼠体内的炎症反应。结果与结论：所有大鼠术后创面均Ⅰ级甲等愈合;渗透性扩张器植入大鼠体内第1周膨胀速度最快,4周时可膨胀至原始体积的9倍,4周后膨胀速度逐渐减慢,至12周体积约为原始体积的10倍,而后维持此体积不变;病理切片显示,渗透性扩张器植入后的炎症反应与高密度聚乙烯组比较差异无显著性意义（P〉0.05）,说明渗透性扩张器具有缓慢持久的吸水膨胀能力及良好的组织相容性。