大肠杆菌脂多糖对皮肤成纤维细胞数量及增殖周期的影响

目的:观察大肠杆菌脂多糖(lipopolysaccharide,LPS)刺激后,皮肤成纤维细胞数量和增殖周期的变化规律。方法:体外培养正常人皮肤成纤维细胞,加入不同浓度(0.005~1.0μg/m l)的大肠杆菌LPS(E.coli055:B5),通过细胞计数法连续观察1~9 d细胞数量的变化;于LPS加入后第6天细胞处于对数生长期时,采用流式细胞术观察细胞增殖周期。结果:LPS刺激浓度在0.005~0.1μg/m l时,细胞数量和S期细胞比例随着刺激浓度增加而增高,且呈浓度依赖性;当LPS浓度为0.5μg/m l时,上述作用开始降低,但仍高于对照组;当浓度达到1.0μg/m l时,细胞数量和S期细胞比例均低于对照组。结论:在一定浓度范围内LPS促进皮肤成纤维细胞增殖,而过高浓度LPS则呈现抑制效应。     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

猪脱细胞真皮基质在体内转归的动物实验与临床观察

一、资料与方法1．猪脱细胞真皮基质(ADM)的制备:健康白色家猪(解放军军事医学科学院动物所)16只,雌雄不限,体重(53±6) kg。处死后取断层皮片(厚度为0．3-0．4 mm),采用2．5 g／L胰蛋白酶消化30 min,再用体积分数0．5％的TritonX-100持续振荡24 h后,置于体积分数0．5％的戊二醛溶液中浸泡10 min以及氯己定溶液中浸泡30 min,洗净。以1:2的比例拉网(3 cm×3cm)后于4℃下保存待用。     

卡巴胆碱对烧伤延迟复苏大鼠免疫功能的影响

Objective To explore the changing trend of Ia on monocyte, lymphocyte apoptosis rate, TNF-α and IL-6 in abdominal aorta of burned rats with delayed resuscitation and the influence of application of carbachol on them. Methods Adult male Wistar rats were randomly divided into normal control group(n =8), scald group(n =48) and scald with carbachol treatment group(n =48). In latter two groups, rats were inflicted with 30% total body surface area (TBSA) full-thickness scald and delayed fluid resuscitation. All scald rats were sacrificed at the 6th hours or 1st, 2nd, 3rd, 7th, 14th day after scald, with 8 rats at each time point. Expression of Ia antigen on monocyte and lymphocyte apoptosis rate were determined by direct immunofluorescence on a flow cytometer, and TNF-α and IL-6 was measured by ELISA. Results Expression of la on monocyte was obviously lower than that of controls. The lowest levels were recorded on the 6th hours and 1st day after scald. Subsequently, Ia was elevated gradually, but still lower than that of normal rats(P <0. 01). After administration of carbachol, Ia expression was obviously promoted, compared with the simple scald group (P <0. 01). Lymphocyte apoptosis rate, TNF-α and IL-6 was higher than that of controls(P <0. 01). After administration of cavachol, , lymphocyte apoptosis rate and TNF-α and IL-6 was obviously down-regulated on the 6th hours, 1st day, 2nd day and 3rd day after scald injury, compared with the simple scald group (P < 0. 01 or 0. 05). Conclusion After severe burn with delayed fluid resuscitation, there is a low la expression, high lymphocyte apoptosis rate and increased releasing of proinflammatory cytokine. Immune function was suppressed. Carbacho] could improve the immune function of scald rats with delayed fluid resuscitation.     

两批危重烧伤患者转入院后的早期救治体会

目的本文介绍2批共13例危重烧伤病人,伤后3～4天经长途转运至我科的早期救治体会.方法 2001年6月27日和2002年6月9日先后收治两批13例伤后3～4天经长途转运入院的烧伤患者,男性4例,女性9例,年龄20～43岁,平均31.1±6.2岁,烧伤总面积74.3%±24.7%,Ⅲ度面积53.7%±31.2%.其中,特重度烧伤10例,烧伤总面积86.0±11.5%,Ⅲ度面63.9±26.3%,合并有重度吸入性损伤4例,中度吸入性损伤6例;重度烧伤3例,烧伤总面积35.3%±10.0%,Ⅲ度面积15.3%±5.0%,均合并有中度吸入性损伤.13例患者都已气管切开,四肢或胸腹部切开减张.13例患者中,有的高热或体温不升;有的心率、呼吸增快;有的腹胀或肠鸣音消失;有的白细胞、血小板低下.13例患者均有不同程度的肝、肾功能、心肌酶和凝血功能异常.结果除2例伤前分别患有心肌炎、慢性肝炎的危重烧伤患者,最终因心肌炎于伤后29天,肝功能衰竭于伤后45天死亡外,其余11例患者全部救治成功.结论成批烧伤转入院后的特点是,伤情重,并发症多,救治难度大.严密组织,责任明确;救治力量前伸机场;入院过程中尽快确定伤情;尽快处理危及生命的并发症;综合治疗措施得当、及时是挽救病人生命的先决条件;重视代谢和凝血功能的调理是后续治疗的重要组成部分.     

氟罗沙星葡萄糖注射液与乳酸环丙沙星注射液随机对照治疗细菌性感染69例

目的：评价国产氟罗沙星葡萄糖注射治疗细胞性感染的有效性和安全性。方法：随机对照治疗呼吸系统,泌尿系统、烧伤创面感染６９例,试验药ｑｄ,ｉｖ,每次２００ｍｇ,对照药ｂｉｄ,ｉｖ,每次２００ｍｇ,两药疗程均为５～１４ｄ,结果：试验药与且总有效率分别为７８．３９％与８１．２５％,细菌阳性率为９７．３０％和９３．７５％,细菌清除率为８４．６２％与８０．００％,药物不良反应发生率分别为８．１１％与９．３８％。结论：氟罗沙星葡萄糖注射可作为临床上常见致病菌所致中轻度感染的选择用药。     

创面修复科医师职业标准的全国专家共识

随着我国社会的发展和人口老龄化的加速,体表慢性难愈合创面已经成为国家卫生和经济事业发展的沉重负担。国家卫生健康委员会就此发布文件,大力推动创面修复科体系建设。全国近百名创面修复领域专家在广泛征求意见、建议的基础上,经过多次讨论和反复修改,制定了创面修复科医师职业标准。该标准重点对创面修复科医师职业和技能要求以及专科培训进行了规范,就专科医师的定义、从业人员的基本素质、考试考核及认证等方面达成了共识,并希望通过发布以进一步完善。     

烧伤科医师职业标准的全国专家共识

烧伤是一种急性疾病。近年来,烧伤事件频发,烧伤救援已成为突发公共卫生事件的主要救援内容之一。烧伤科医师在烧伤救治过程中发挥着主要作用。本共识对烧伤科医师的定义、分级、通用条件、职业要求、技能要求,对各级烧伤科医师的培训要求,以及各级烧伤科医师的培训、考试、颁证等进行了相关的阐述及规定。希望全国同行参考共建,以便更好地规范和加强烧伤科医师队伍的能力和体系建设,进一步提高烧伤救治能力。     

丙泊酚持续小剂量镇静对大面积烧伤患者CD14~+单核细胞HLA-DR表达的影响

目的 探讨大面积烧伤患者CD14+单核细胞HLA-DR抗原的表达规律及丙泊酚持续小剂量镇静对HLA-DR抗原表达的影响.方法 选取2010年3月-2011年11月收治的烧伤而积大于30％ TBSA的严重烧伤患者30例,其中17例给予常规治疗(常规治疗组),13例除常规治疗外还应用丙泊酚持续小剂量镇静治疗(丙泊酚治疗组),分别于镇静治疗前及治疗后第1、3、5、7天抽取外周静脉血,流式细胞仪检测CD14+单核细胞表面HLA-DR抗原表达情况.另取20例健康体检者作为健康对照.结果 大面积烧伤患者入院24h内CD14+单核细胞表面HLA-DR抗原表达率(25.07％±14.83％)显著低于健康对照组(76.45％±7.96％,P＜0.01).常规治疗组治疗后第3、5天CD14+单核细胞表面HLA-DR抗原表达率(分别为27.76％±11.36％、27.11％±14.49％)明显低于丙泊酚治疗组(分别为35.44％±11.55％、37.47％±15.46％),差异有统计学意义(p＜0.05),治疗前及治疗后第1、7天两组比较无统计学差异.结论 丙泊酚可能通过抑制应激激素的过度释放而减轻烧伤患者的过度应激反应,进而改善大面积烧伤患者的免疫功能.     

严重烧伤延迟复苏与主要并发症发生发展关系的统计分析

严重烧伤延迟复苏与主要并发症发生发展关系的统计分析杨红明，郭振荣，盛志勇，朱兆明随着对创伤后内脏并发症病因学研究的深入，伤后早期休克复苏时间及其质量对大面积烧伤病人的影响已愈来愈引起人们的重视。然而，这种影响的范围和程度如何，尚缺乏详细的临床统计资料...