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腋周瘢痕瓣修复腋胸瘢痕粘连 总被引:1,自引:0,他引:1
目的 探讨烧伤患者腋胸瘢痕粘连的修复方法。方法 2001年1月~2005年12月,应用腋周瘢痕瓣修复腋胸瘢痕粘连52例(57例次),其中男31例,女21例;年龄1~44岁,中位年龄15岁。采用腋窝后份瘢痕瓣44例次,腋窝前份瘢痕瓣10例次,上臂内侧瘢痕瓣3例次。19例次供瓣区周围皮瓣推进直接缝合,其余38例次行中厚皮片植皮修复。结果 术后54例次瘢痕瓣完全成活,伤口Ⅰ期愈合,3例次瘢痕瓣远端部分坏死,经换药等处理后伤几愈合,且术后获得较好的腋窝形状及肩关节功能。供瓣区直接缝合者伤口均Ⅰ期愈合,中厚皮片移植者皮片均成活。术后均获随访1个月~5年,患者腋窝形态良好,肩关节活动基本不受限,外展平均150°。结论 腋周局部瘢痕瓣是修复腋胸瘢痕粘连、重塑腋窝形状及功能的一种有效途径。 相似文献
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目的:探讨N-乙酰半胱氨酸对烫伤大鼠炎症反应的影响。方法:48只Wistar大鼠随机分为实验组和对照组,制作烫伤休克模型,伤后1小时腹腔注射生理盐水40ml/kg抗休克,实验组于抗休克盐水中加入N-乙酰半胱氨酸160mg/kg,其后足量饮水。分别于烫伤前、烫伤后8小时、16小时及24小时,处死每组各6只大鼠并立即心脏取血,采用ELISA法检测大鼠血清中TNF-a含量,于创周近头侧0.5cm处取皮肤全层组织,在显微镜下进行中性粒细胞计数。结果:两组大鼠血清TNF-a含量伤后显著升高,8小时达到高峰,其后逐渐下降,两组各时点比较有显著差异(P<0.05);创周组织中性粒细胞计数于伤后随时间延长逐渐增多,两组比较有显著性差异(P<0.05)。结论:N-乙酰半胱氨酸有助于降低烫伤大鼠血浆中TNF-a含量及创周组织中的中性粒细胞计数量,减轻烫伤大鼠的全身及局部炎症反应。 相似文献
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病例报告男,15岁,学生。因双眼视力进行性下降半年于1991年3月29日初诊。检查:远视力右0.1、左0.2~(+1);近视力右1.5,左1.5。双眼角膜透明,瞳孔圆、直径约3毫米、对光反应敏感,晶状体透明,眼底正常。按双眼近视嘱每日3次用“近视明”眼药水滴眼。次日上午9时,患者诉右眼视力提 相似文献
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Objective To investigate the appropriate extubation time and treatment of late complications after early tracheotomy in patients with moderate or severe inhalation injury. Methods One hundred and fifty patients ( 105 males and 45 females) with inhalation injury were admitted to our hospital from January 2000 to January 2009. Among them, 109 out of 129 cases with moderate inhalation injury received early tracheotomy, and all 21 cases with severe inhalation injury received early tracheotomy. Data were collected for analysis as follows: ( 1 ) incidence of re-intubation due to suffocation and pneumonia incidence after extubation within 2 weeks or after 2 weeks post inhalation injury (PⅡ), and mortality rate within the first week after injury were recorded. (2) Conservative treatments including expectorant, oral antibiotics, and absolute bedrest were recommended for patients who had severe cough, hoarseness or poor pulmonary function after late extubation and closure of tracheostomy wound. Fiberoptic bronchoscopy findings ( tracheostenosis degree, granuloma formation rate, vocal cord paralysis rate) and pulmonary function index ( FEV1 ) data were collected and analyzed in 30 cases with moderate inhalation injury and 10 cases with severe inhalation injury within 3 months after injury for follow-up. Data were processed with t test or chi-square test. Results There was no obvious difference in the rate of re-intubation after extubation in patients with moderate inhalation injury between those done within 2 weeks PⅡ ( 15/70, 21.4% ) and those done after 2 weeks PⅡ (2/25, 8.0% ) ( x 2 = 1.52, P > 0.05 ). Pneumonia incidence in patients of moderate inhalation injury with extubation within 2 weeks PⅡ (21/70, 30.0% ) was lower than those with extubation after 2 weeks PⅡ (15/25, 60.0% ) (x 2= 7.04, P < 0.05). Levels of above-mentioned indexes in patients with severe inhalation injury extubated in diffferent stages were similar to those of patients with moderate inhalation injury.Within the first week after injury, mortality rate of patients with severe inhalation injury was higher than that of patients with moderate inhalation injury ( x 2 = 11.90, P < 0.05 ). During follow-up, tracheostenosis rate in patients with moderate or severe inhalation injury was 100.0%; granuloma formation rate and vocal cord paralysis rate in patients with severe inhalation injury were higher than those of patients with moderate inhalation injury ( with x 2 value respectively 4.59, 13.47, P values all below 0.05 ). The FEV1 value of patients with moderate inhalation injury in the 1st, 2nd, 3rd month after injury was respectively higher than that of patients with severe inhalation injury ( with t value respectively 5.48, 12. 10, 6.25, P values all below 0.05). The values recovered to normal level in the 3rd month after injury. Conclusions Extubation time of tracheotomy for patients with moderate or severe inhalation injury within 2 weeks or after 2 weeks PⅡ has its own advantage and disadvantage, and it should be performed according to specific conditions of each patient. Conservative treatment is optional for late complications of respiratory system. 相似文献
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小儿手指掌侧瘢痕屈曲畸形矫正术后早期挛缩原因分析 总被引:2,自引:0,他引:2
目的 回顾性分析小儿手指掌侧瘢痕屈曲畸形矫正术后早期挛缩的原因. 方法 2002年1月-2006年1月,收治98例347指掌侧瘢痕屈曲畸形,行掌侧瘢痕切除松解中厚皮片植皮术.男52例185指,女46例162指.年龄9个月~6岁.病程3个月~2年,平均7个月.烫伤80例,火焰烧伤18例.每例为1~7个伤指不等.瘢痕切除后,采用1.2 cm×0.7 cm~6.0 cm×2.2 cm中厚皮片修复. 结果 术后5例12指伤口Ⅱ期愈合,余均Ⅰ期愈合.患儿获8~12个月随访,术后早期挛缩9例20指,发生率占患儿9.2%,占术指5.8%.发现早期挛缩后,积极加强防瘢痕处理及功能锻炼.余患儿皮片成活良好,手指活动正常. 结论 小儿手指掌侧瘢痕屈曲畸形一旦影响功能,应尽早手术.术前仔细准备,掌握手术要领和技巧,术后坚持长期有效的防瘢痕治疗及功能锻炼,有助于减少术后早期皮片挛缩的发生. 相似文献
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背景:研究表明,通过转染反义基质金属蛋白酶2(matrix metalloproteinase-2,MMP-2)基因抑制增殖期血管瘤组织中MMP-2的分泌将成为增殖期血管瘤治疗的重要手段。
目的:观察反义MMP-2cDNA基因感染对人增殖期血管瘤裸小鼠移植瘤生长的影响。
设计、时间及地点:随机分组设计,对比观察,实验于2003-08/2004-09在四川大学华西临床医学院完成。
材料:BALB/c-nu/nu裸小鼠(简称为裸鼠)18只,体质量20 g左右;取1名出生52 d女性患儿左胸壁的海绵状血管瘤, 病理诊断证实为增殖期血管瘤。
方法:将手术切除的人增殖期血管瘤新鲜标本切分为5 mm×4 mm×3 mm小块,于1 h内移植于18只裸小鼠双侧腋部皮下,制备荷瘤裸小鼠血管瘤移植模型。将移植瘤块成活后(45 d)15只裸鼠进行分组治疗,Ad-GFP组,Ad-aMMP-2组分别沿肿瘤长径多方向瘤内注射重组腺病毒液Ad-GFP和Ad-aMMP-2,对照组注射等量的PBS,每组5只。隔日瘤内注射1次,共注射4次。
主要观察指标:①大体观察肿瘤体积的变化及各组裸鼠肿瘤块坏死面积的比较。②绿色荧光蛋白在各组裸鼠体内的表达。③肿瘤组织形态学变化(大体、苏木精-伊红染色及透射电镜观察)。④免疫组织化学检测MMP-2 cDNA基因及微血管密度的表达。⑤流式细胞仪检测肿瘤细胞的生长周期和凋亡。
结果:①Ad-aMMP-2能抑制体内血管瘤的生长,没有观察到明显的毒副作用。3组肿瘤均有不同程度的坏死,其中Ad-aMMP-2组面积坏死率明显高于对照组和Ad-GFP组(P < 0.01)。②组织学切片可见Ad-GFP组绿色荧光蛋白基因的表达。③大体观察对照组和Ad-GFP组瘤组织大;Ad-aMMP-2组瘤组织相对较小。苏木精-伊红染色可见对照组和Ad-GFP组内皮细胞密集,细胞呈条索状或团块状排列;Ad-aMMP-2组肿瘤有多处出血和凝固性的片状坏死灶。透射电镜观察对组血管内皮细胞形态正常;Ad-GFP组瘤细胞大,核仁明显;Ad-aMMP-2组部分血管内皮细胞核内染色质固缩,聚积成团块状形成凋亡小体。④Ad-aMMP-2组MMP-2和微血管密度较对照组和Ad-GFP组明显下降(P < 0.05)。⑤Ad-aMMP-2组G0/G1期百分率大于其他两组(P < 0.05),增殖指数降低;Ad-aMMP-2组细胞凋亡率大于对照组和Ad-GFP组(P < 0.05),凋亡指数明显增加。
结论:通过反义MMP-2基因阻断人增殖期血管瘤的生长是可行的,其机制主要是通过抑制血管内皮细胞分泌MMP-2导致局部缺血起作用的。 相似文献