一种新的创面覆盖物——丝素膜

目的检测丝素膜的物理及生物学性能,并且评价其临床效果。方法①实验室检测:应用各种先进仪器分别测定丝素膜及断层猪皮的含水率、断裂强度、柔韧性、透水性、创面粘合力等物理及生物学特性指标。②临床观察:于同一个体选深度相似的两块创面分别应用丝素膜及1％SD-Ag 冷霜,然后对比观察两块创面的变化。结果该膜具有与断层猪皮相近的物理及生物学特性。无毒,无刺激性及抗原性。具有一定的透水性,并能与创面产生良好的初期粘合。由于其完全透明,故可直接观察到膜下创面的变化,有助于临床治疗及实验研究。临床观察结果该膜具有良好的保护创面作用,其应用可明显减轻创面疼痛,创面愈合时间较对照组提前3～5天。结论该膜是较为理想的创面覆盖物,值得推广。     

一种新的创面覆盖物—丝素膜

OBJECTIVE: This study was aimed at determining the physical and biological properties of fibroin membrane and evaluating its clinical effects. METHODS: 1. The physical and biological properties of fibroin membrane and partial thickness porcine skin were determined with various instruments. The determinations included water ratio, tensile strength, flexibility, water permeability, adhesive force and so on. 2. Clinical observation: Two wounds with same depth in the same patient were selected. One was covered by fibroin membrane. The other one was treated with 1% SD-Ag cream. The changes in these wounds were observed and compared. RESULTS: This membrane had nearly same physical and biological properties compared with partial thickness porcine skin. It had no toxicity, irritation, and antigenicity. It possessed certain amount of water permeability and could adhere to the wound. Because of its good transparency, any change in underlying wound could be directly observed. It was helpful not only in local therapy but also in study of wound healing. Clinical observations showed that this membrane had good protecting effect to wound. Its application could obviously relieve pain of wound and the healing time was 3-5 days ahead than that of the control wound. CONCLUSION: This membrane was an ideal wound covering and was worth being popularized.     

无细胞真皮基质与自体皮片复合移植的临床应用

目的：改善烧伤创面移植皮片愈合后皮肤的外形和功能,并减轻供皮区瘢痕增生。方法：应用自制的无细胞真皮基质与自体刃厚皮片复合移植于4例切（或削）痂后的烧伤创面。结果：未发现对复合移植皮片的排异反应。创面愈合后,大体观察发现移植自体网状皮片及自体小皮片的轮廓界面变得不明显或基本消失,自体大张皮片与真皮基质复合移植区出现较厚而特殊的脱屑,均反映了愈合过程的特殊性。光镜和电镜观察发现复合皮片移植区棘细胞间桥粒清晰,基底膜连续而完整等。与对照部位相比,复合皮片移植区瘢痕增生减轻,未见明显挛缩,皮肤弹性较好。结论：在3－4个月的观察期内,自体刃厚皮片与无细胞真皮基质复合移植后,功能和形态等同或优于单纯自体刃厚皮片移植。     

无细胞真皮基质与自体皮复合移植愈合过程的观察

目的 :为改善植皮区外观和功能 ,并同时减轻供皮区瘢痕增生。方法 :应用自制的无细胞真皮基质与薄的刃厚自体皮复合移植应用于 2例切削痂后的烧伤创面。结果 :未发现对复合移植物的排异反应。创面愈合后 ,大体观察发现移植网状自体皮的网状形式已变得不明显 ,自体小皮片的轮廓基本消失 ,均反应了愈合过程的特殊性。光镜和电镜观察发现复合移植区基底膜清晰、连续且完整等。与对照部位相比 ,复合移植区瘢痕增生减轻 ,未见明显挛缩 ,皮肤弹性较好。结论 :至少到目前为止的观察期 (3～ 4个月 )内 ,较薄的刃厚自体皮与无细胞真皮基质复合移植后外观和功能等同或优于单纯刃厚自体皮移植     

多发性损伤早期应用生长激素治疗对氮代谢的阻制

尽管肠道及肠道外薄养技术的改进、ICU设备及有效抗生索的熟练应用,瘦组织群的维持,仍然是脓毒症、多发性损伤、烧伤等分解代谢状况的主要临床问题。一些研究结果显示中等分解代谢状况的手术后或创伤病人应用重组人类生长激素(r-hGH)能改善氮平衡。本研究报道多发性损伤早期应用r-hGH对氮及氨基酸代谢的影响。14例需ICU监护的多发性损伤病人,平均每天氮丢失13.2±1.8g,伴有高     

冬眠药物对兔烧伤早期血浆皮质酮和儿茶酚胺水平的影响

目的探讨烧伤早期液体复苏同时给予冬眠药物是否能削弱神经内分泌的过度反应。方法用兔15％TBSAⅢ度烫伤模型。冬眠药物组在液体复苏的同时给予冬眠合剂,而对照组仅液体复苏。分别于伤后4,8,24,48和72小时测定血浆皮质酮和儿茶酚胺水平。结果冬眠药物组血浆皮质酮和血浆去甲肾上腺素水平显著低于对照组(P<0.05),而肾上腺素水平差异无显著意义。结论冬眠药物可以削弱烧伤早期的神经内分泌反应对机体的损害。     

创面覆盖物丝素膜的透湿性研究

目的旨在对创面覆盖物透湿性进行量化探讨。方法以ＳｅｒｖｏＭｅｄ双探头蒸发测定仪测定烧伤早期浅度创面覆盖丝素膜前后的蒸发失水,同时对覆盖后的创面进行临床观察。结果临床观察证明丝素膜透湿性较好时,创面蒸发失水量为１５１．３±４０．１ｍｇ·ｍ２·ｈ－１,覆盖前后蒸发失水量之差为３６．１±７．２ｍｇ·ｍ２·ｈ－１,该差值与健康志愿者正常皮肤不显性失水比较,Ｐ＞０．０５。结论创面覆盖物透湿性应明显大于正常皮肤透湿性,覆盖前后创面蒸发失水量之差与正常皮肤不显性失水相近时较理想。     

1998～2000年954株烧伤感染菌耐药性调查分析

目的调查烧伤创面分离菌对抗菌药物的耐药状况.方法收集临床分离的致病菌,采用纸片扩散法进行药敏试验. 结果在检出的954株细菌中,金黄色葡萄球菌居首位,检出率为27.5%;其次为铜绿假单胞菌,检出率为19.5%;以后依次为表皮葡萄球菌、粪肠球菌、肺炎克雷白杆菌和阴沟肠杆菌,检出率分别为10.4%、6.8%、4.1%和2 6%.万古霉素对金黄色葡萄球菌100%敏感;铜绿假单胞菌对第三代头胞菌素和亚胺培南耐药性显著增加;除铜绿假单胞菌外,其它细菌对阿米卡星的耐药率都有不同程度的降低. 结论细菌耐药性日益严重,随时进行细菌耐药性监测、合理应用抗生素是控制和延缓细菌耐药性的关键.