糜蛋白酶治疗颅内出血的临床分析

目的:评价糜蛋白酶对颅内血肿的治疗效果.方法:38例颅内出血患者分两组:对照组采用常规综合治疗,治疗组常规综合治疗加肌注糜蛋白酶.结果:治疗组颅内血肿吸收时间明显缩短.结论:使用糜蛋白酶大大提高了血肿的吸收速度,缩短了血肿在脑内残留时间,减少了住院费用和住院时间.     

改良瘢痕跟腱骨膜瓣治疗烧伤后马蹄内翻足

小腿和足部深度烧伤或创伤后易继发瘢痕挛缩性足下垂，局部不但存在皮肤软组织缺损，同时也存在跟腱潜在缺损。临床上一般采用矩形瘢痕跟腱瓣技术及“z”形瘢痕跟腱瓣技术进行整复。为使手术更加简便，于2000年1月-2008年12月，我们应用改良瘢痕跟腱骨膜瓣治疗烧伤后瘢痕性足下垂18例26侧，取得比较满意的效果，报道如下。     

双歧杆菌活菌制剂治疗烧伤伤员的菌群失调症

大面积烧伤伤员应用了大剂量的广谱抗菌素后可使其肠道内菌群失调,其主要症状表现是腹泻。自1994年5月至今,我们使用了双歧杆菌活菌制剂治疗此种腹泻,收到明显效果,现报告如下:1 临床资料1.1 一般资料。本组15例伤员的年龄是8个月～34岁,患者均在应用先锋霉素Ⅴ、先锋霉素Ⅵ、先锋必或益保世灵3～5天后出现腹泻,鹅口疮等。腹泻每日5～6次,最多的每     

原发性右额骨尤文氏肉瘤术后2年颅内转移1例

1临床资料 患者，男性，50岁。因“右额骨尤文氏肉瘤术后2年，头昏、头痛、恶心15天，左上肢活动受限1周”于2007年3月20日入院。既往于2年前因右额骨肿瘤行手术治疗，切除病变颅骨。     

腰背部皮肤大面积纤维组织瘤样增生一例

患者女,21岁.7年前即发现腰部有一约2cm大小的肿物,但无疼痛及瘙痒等症状,未做特殊治疗.逐渐发展呈片状,经多家医院治疗,均无效果.其后渐蔓延分布于整个背部及臀部,于2006年7月经活检后考虑为纤维瘤,行腰部纤维瘤切除及自体皮片移植术,术后创面无复发.现患者自感未切除的瘤体有进一步扩展,并有向头颈部延伸趋势(图1),遂入院.检查:全身发育正常,背部可见明显的肿物呈菜花状突起,瘤体全部分布在背侧面,呈散在或片状.     

严重延迟复苏烧伤休克患者血浆脑钠肽的变化

Objective To observe the early change in plasma brain natriuretic peptide (BNP) level in burn patients with long delayed fluid resuscitation of burn shock and its clinical significance.Methods Thirty-six burn patients with second and third degree of burn covering 32%- 92% total body surface area were enrolled for the study, among them 10 patients were complicated with serious heart failure (heart failure group), and 26 patients rallied from shock after delayed fluid resuscitation without heart failure (stable group).The level of plasma BNP, lactate dehydrogenase (LDH), MB isoenzyme of creatine kinase (CK-MB), and left ventricle ejection fraction (LVEF) were determined at admission and 3 hours after hospitalization, and 24, 48, 72, 168 hours after the injury in both groups with electrochemiluminescence (ECL).Results Compared with stable group, the plasma BNP level (ng/L) of heart failure group at 3 hours after hospitalization, and 24, 48, 72 hours after the burn injury increased significantly (3 hours after hospitalization: 1 521.38±121.11 vs.391.36±63.27, 24 hours after burn: 2 516.86±193.25 vs.360.79±146.56, 48 hours after burn: 1 587.76±169.23 vs.398.92±77.46, 72 hours after burn: 974.45±166.33vs.283.43 ± 68.15, all P＜ 0.01), the level of LVEF lowered significantly (3 hours after hospitalization;0.33±0.03 vs.0.58±0.09, 24 hours after burn: 0.36±0.09 vs.0.60±0.10, 48 hours after burn: 0.35±0.08 vs.0.62±0.11, 72 hours after burn: 0.39±0.10 vs.0.64±0.10, all P＜0.05).The levels of LDH (μmol·s-1·L-1)in stable group were 2.87±0.50 at admission,3.02±0.43 3hours after hospitalization,4.02±0.87 24 hours after burn, 6.90±0.87 48 hours after burn, 3.64±0.75 72 hours after burn, 2.670.45 168 hours after burn while in heart failure group, they were 2.97±1.40, 3.84±0.37, 4.29±0.45,8.50±0.38, 3.84±0.62, 2.30±0.38, respectively;and CK-MB (U/L) in stable group were 59.12±13.75at admission, 70.39 ±10.72 3 hours after hospitalization, 79.29 ±17.27 24 hours after burn, 67.44 ±12.7748 hours after burn, 30.28± 7.13 72 hours after burn, 21.44 ±3.15 168 hours after burn while in heart failure group, they were 65.76 ± 16.38, 81.46 ± 7.92, 86.43 ± 14.19, 72.53 ± 11.27, 36.39 ± 6.18,22.85±7.26, respectively.No statistically significant difference was found in changes in both LDH and CK-MB between two groups (all P＞0.05).Conclusion Determination of the plasma BNP is a simple and useful method in detecting heart failure during resuscitation of shock after a serious burn injury.     

严重延迟复苏烧伤休克患者血浆脑钠肽的变化

Objective To observe the early change in plasma brain natriuretic peptide (BNP) level in burn patients with long delayed fluid resuscitation of burn shock and its clinical significance.Methods Thirty-six burn patients with second and third degree of burn covering 32%- 92% total body surface area were enrolled for the study, among them 10 patients were complicated with serious heart failure (heart failure group), and 26 patients rallied from shock after delayed fluid resuscitation without heart failure (stable group).The level of plasma BNP, lactate dehydrogenase (LDH), MB isoenzyme of creatine kinase (CK-MB), and left ventricle ejection fraction (LVEF) were determined at admission and 3 hours after hospitalization, and 24, 48, 72, 168 hours after the injury in both groups with electrochemiluminescence (ECL).Results Compared with stable group, the plasma BNP level (ng/L) of heart failure group at 3 hours after hospitalization, and 24, 48, 72 hours after the burn injury increased significantly (3 hours after hospitalization: 1 521.38±121.11 vs.391.36±63.27, 24 hours after burn: 2 516.86±193.25 vs.360.79±146.56, 48 hours after burn: 1 587.76±169.23 vs.398.92±77.46, 72 hours after burn: 974.45±166.33vs.283.43 ± 68.15, all P＜ 0.01), the level of LVEF lowered significantly (3 hours after hospitalization;0.33±0.03 vs.0.58±0.09, 24 hours after burn: 0.36±0.09 vs.0.60±0.10, 48 hours after burn: 0.35±0.08 vs.0.62±0.11, 72 hours after burn: 0.39±0.10 vs.0.64±0.10, all P＜0.05).The levels of LDH (μmol·s-1·L-1)in stable group were 2.87±0.50 at admission,3.02±0.43 3hours after hospitalization,4.02±0.87 24 hours after burn, 6.90±0.87 48 hours after burn, 3.64±0.75 72 hours after burn, 2.670.45 168 hours after burn while in heart failure group, they were 2.97±1.40, 3.84±0.37, 4.29±0.45,8.50±0.38, 3.84±0.62, 2.30±0.38, respectively;and CK-MB (U/L) in stable group were 59.12±13.75at admission, 70.39 ±10.72 3 hours after hospitalization, 79.29 ±17.27 24 hours after burn, 67.44 ±12.7748 hours after burn, 30.28± 7.13 72 hours after burn, 21.44 ±3.15 168 hours after burn while in heart failure group, they were 65.76 ± 16.38, 81.46 ± 7.92, 86.43 ± 14.19, 72.53 ± 11.27, 36.39 ± 6.18,22.85±7.26, respectively.No statistically significant difference was found in changes in both LDH and CK-MB between two groups (all P＞0.05).Conclusion Determination of the plasma BNP is a simple and useful method in detecting heart failure during resuscitation of shock after a serious burn injury.     

还原型谷胱甘肽对严重延迟复苏烧伤患者肝功能损害的治疗作用

目的 探讨还原型谷胱甘肽(GSH)对严重延迟复苏烧伤患者肝功能损害的影响.方法 选择40例严重延迟复苏烧伤患者,随机分为两组,治疗组20例静脉滴注GSH;对照组20例给予能量合剂,均连续治疗7～14 d.于治疗前及治疗后7 d、14 d抽取患者静脉血,检测血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、r-谷氨酰转肽酶(r-GT)、碱性磷酸酶(ALP)、总胆红素(TBIL)及直接胆红素(DBIL),并进行对比分析.结果 治疗组治疗后7 d各指标即显著下降,14 d时进一步下降,与治疗前比较差异均有统计学意义(P＜0.05或P＜0.01);对照组治疗后7 d虽较治疗前有所下降,但差异无统计学意义,14 d时各指标均显著下降(P均＜0.05).与对照组14 d时比较,治疗组ALT、AST、7-GT、TBIL、DBIL下降显著(P均＜0.05),而ALP差异无统计学意义.结论 早期给予GSH对改善严重延迟复苏烧伤患者肝功能损害的疗效显著.     

超短波电疗烧伤创面促进上皮再生

超短波电疗多被用于治疗各种急慢性炎症或软组织损伤,而用于治疗烧伤创面促进表皮再生则少有报道。1990年1月至1993年12月我院对159例需行植皮处理的创面应用了超短波电疗。现报道如下。1 临床资料1.1 一般资料 超短波治疗组(80例,男51例,女29例;年龄:4个月～65岁,其中15岁以下54例)。创面的部位:上肢26例,下肢15例,躯干29例,臀部10例。火焰烧伤27     

逆行胫后动脉皮支蒂隐神经-大隐静脉复合瓣修复足底创面11例

2006年5月-2008年5月,笔者应用逆行胫后动脉皮支蒂隐神经-大隐静脉复合瓣修复足底部软组织缺损患者11例,均取得满意效果,现报告如下.