磨痂术治疗煤气烧伤的体会

目的 研究磨痂手术治疗煤气烧伤的临床效果。方法 采用前后对照的方法，选择1998年以前采用传统治疗的16例煤气烧伤患者为对照组，1998年以后采用磨痂治疗的16例煤气烧伤患者为磨痂组，对白细胞计数(入院后12—17天)、发热天数、手术情况、换药次数、平均治愈天数进行比较。结果磨痂组与对照组比较，白细胞能较快的恢复正常，发热天数、平均治愈天数大大缩短，换药次数、手术次数明显减少。结论经磨痂治疗的烧伤创面避免了感染的发生，损伤程度较轻，愈合明显加快，且瘢痕增生较轻。磨痂手术容易掌握，有利于创面的愈合，减少了病人的负担，是早期对煤气烧伤创面处理的好方法。     

猪深Ⅱ度烫伤早期磨痂术后创面组织学改变及CK和EGFR表达

目的 建立猪深Ⅱ度烫伤模型,观察早期磨痂术创面的组织学改变及细胞角蛋白(CK)和表皮生长因子受体(EGFR) 的表达.方法 选用实验用小型猪制备深Ⅱ度烫伤模型,于烫伤早期(烫伤后3h)分别实施磨痂术(磨痂组,n=96)、常规削痂术治疗(削痂组,n=96)和SD-Ag保痂处理(SD-Ag组,n=96).记录各组创面愈合时间;于烫伤后12h和1、2、3、5、7、10、20d分别采集创面皮肤样本,HE染色和免疫组化染色分别观察创面组织学变化及CK和EGFR表达.结果 磨痂组创面愈合时间明显短于削痂组和SD-Ag组(P<0.05).组织学观察发现,与削痂组和SD-Ag组比较,磨痂组烫伤后3、5 d真皮深层组织炎细胞浸润和毛细血管淤滞较轻,皮肤附件破坏较少.免疫组化染色显示,烫伤后5、7 d磨痂组CK和EGFR表达较削痂组和SD-Ag组显著,保留皮肤附件较多,创面上皮化快,新生表皮厚.结论 深Ⅱ度烫伤创面实施早期磨痂术可保留较多皮肤附件,通过提高局部CK和EGFR释放而使创面上皮化提前,加速创面愈合并改善愈合质量.     

中药排石汤治疗泌尿系结石40例

目的观察中药排石汤治疗泌尿系结石的疗效。方法采用排石汤（金钱草、滑石、车前子、牛膝等）治疗本病40例。结果总有效率95%。结论中药治疗泌尿系结石有确切疗效。     

兔股动脉和静脉预构轴型扩张皮瓣的实验观察

Objective To study the microcirculation and structural changes, surviving area of expanded prefabricated flaps. Methods A total of 40 New Zealand rabbits were divided randomly into expanded prefabricated, expender lined, simple prefabricated and free flap groups, each consisting of 10 rabbits. For the expanded prefabricated, expender lined and simple prefabricated groups, after the femoral artery and vein were transplanted into subcutaneous tissues of abdomen, and expanders were implanted into the deeper dartos. The free flap group was a blank control group. For the expanded prefabricated group, the expansion was carried out on 7th day postoperatively. On postoperative day 52, when the expander was fully expanded, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by laser Doppler flowmetry, light microscopy and digital re-cording of survival arca. Results When compared with the other groups, the perfusion volume of mi-crocirculation enhanced, flaps survival improved (97.54±2.73) %, blood capillary were stronger, to-gether with microscopic changes were significant in the expanded prefabricated groups (P<0.05). Conclusion Expandedprefabricated flaps can increase the survival size of the flaps and the safety of flap transplantation.     

中药结肠透析对慢性肾脏病人蛋白结合型毒素清除的影响

目的：观察中药结肠透析对蛋白结合型毒素硫酸吲哚酚的清除效果.方法：31例慢性肾脏病人随机分为治疗组和对照组.对照组采用基础治疗加中药汤剂口服,治疗组在对照组治疗基础上加用中药结肠透析,观察治疗后2组临床疗效及蛋白结合型毒素变化情况.结果：治疗组显效率33.33％,有效率93.33％;对照组显效率6.25％,有效率81.25％.治疗组总有效率明显优于对照组.2组硫酸吲哚酚（IS）含量比较,治疗组治疗前为9.63±6.30μg/mL,治疗后为7.66±5.31 μg/mL,治疗后下降均值为2.03±0.91 μg/mL;对照组治疗前为7.28±5.15μg/mL,治疗后为7.06±5.29μg/mL,下降均值为0.22±0.16μg/mL,治疗组明显优于对照组.结论：中药结肠透析能显著改善慢性肾脏病患者临床症状,降低蛋白结合型毒素硫酸吲哚酚的血清含量.     

兔股动脉和静脉预构轴型扩张皮瓣的实验观察

Objective To study the microcirculation and structural changes, surviving area of expanded prefabricated flaps. Methods A total of 40 New Zealand rabbits were divided randomly into expanded prefabricated, expender lined, simple prefabricated and free flap groups, each consisting of 10 rabbits. For the expanded prefabricated, expender lined and simple prefabricated groups, after the femoral artery and vein were transplanted into subcutaneous tissues of abdomen, and expanders were implanted into the deeper dartos. The free flap group was a blank control group. For the expanded prefabricated group, the expansion was carried out on 7th day postoperatively. On postoperative day 52, when the expander was fully expanded, island flaps with the prefabricated vessels as the pedicles were formed. The flaps were measured by laser Doppler flowmetry, light microscopy and digital re-cording of survival arca. Results When compared with the other groups, the perfusion volume of mi-crocirculation enhanced, flaps survival improved (97.54±2.73) %, blood capillary were stronger, to-gether with microscopic changes were significant in the expanded prefabricated groups (P<0.05). Conclusion Expandedprefabricated flaps can increase the survival size of the flaps and the safety of flap transplantation.     

休克期削刮术治疗深Ⅱ度烧伤创面的研究

烧伤深Ⅱ度创面的处理仍是一个棘手的难题。国内外一般采用磺胺嘧啶银(SD-Ag)保痂治疗或早期削痂或削痂植皮手术。SD-Ag虽有保痂作用,能预防创面细菌感染,但不能最终防止感染和防止创面加深坏死,以致影响创面愈合。削痂疗法虽祛除了坏死组织,减少了毒素吸收,但使组织再次损伤,且对深Ⅱ度烧伤创面削痂的深度难以掌握,常导致创面加深而延长创面愈合时间,甚至加重了瘢痕形成。为     

脱细胞真皮基质在胸部瘢痕疙瘩治疗中的应用

1998年～2004年,我们应用脱细胞真皮基质一期覆盖胸部瘢痕疙瘩切除后的创面12例,二期应用自体刃厚皮片移植于脱细胞真皮基质上,效果满意,报告如下.     

高压电烧伤对血清谷氨酸丙酮酸转氨酶(GPT)的影响及其机制探讨(附36例

本文对36例高压电烧伤者作回顾性分析,并着重从病理生理方面对GPT升高的机制进行探讨。一、临床资料36例均为高压电烧伤。男33例、女3例,年龄3～60岁。电烧伤最大体表面积75%、Ⅲ度55%,最小体表面积为0.2%。Ⅲ度体表面积9%以下者13例、10～19%者10例、     

早期磨痂术治疗深Ⅱ度烧伤的实验观察及机制初探

为探讨早期磨痂术治疗深Ⅱ度烧伤的疗效及其作用机制,选择家猪8只制成深Ⅱ度烧伤模型,随机分为磨痂组、削痴组和外用磺胺嘧啶银(SD-Ag)组。于烧伤早期分别实施磨痂、削痂及SD-Ag治疗,于治疗后不同时相取创面组织,分别检测其中白细胞介素-8(IL-8)含量、S期细胞百分比(SPE)、细胞角蛋白(CK)、表皮生长因子受体(EGFR)并观察创面坏死组织范围。结果显示,与削痂组、SD-Ag组相比,磨痂组创面IL-8含量峰值出现早,但下降快,SPF明显增高(P<0.05),CK、EGFR表达强,上皮化快,表皮厚,有较多的淤滞带向良性转归。提示磨痂术能加速深Ⅱ度烧伤创面愈合,其机制是减轻创面过度炎症反应,改善创面微循环障碍等。