“沙冬肉桂汤”治疗复发性口腔溃疡40例临床观察

目的:观察中药沙冬肉桂汤治疗复发性口腔溃疡的临床疗效。方法:80例复发性口腔溃疡患者随机分为治疗组和对照组各40例,治疗组使用沙冬肉桂汤煎服,对照组予康复新液含服及复合维生素B片口服,2组均治疗至口腔溃疡痊愈停药,疗程最长30d,观察并比较2组临床疗效。结果:治疗后治疗组总有效率为87.5%,明显高于对照组的70.0%,差异有统计学意义(P0.05)。结论:沙冬肉桂汤煎服治疗复发性口腔溃疡有较好的疗效。     

山羊烧伤和脓毒症中能量代谢动态变化的实验研究

目的观察和分析烧伤早期和脓毒症状态下的能量代谢动态变化及其影响因素.方法以山羊烧伤和脓毒症为模型检测血流动力学、静息能量消耗(REE)、血内毒素、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)水平及有关代谢激素的水平,监测血糖、血乳酸及氨基酸谱的动态变化.结果(1)烧伤早期充分复苏的情况下REE即显著升高,随着合并内毒素血症的确立,REE升高更为显著(352.5±17.6)J*h-1*m-2;(2)烧伤及烧伤合并内毒素血症的情况下,血中内毒素、TNF-α、IL-6、IL-8水平显著增高,在时相上与REE的升高相平行;(3)在烧伤后氧输送和氧耗量短暂下降,随休克复苏及脓毒症的确立逐渐升高,组织氧摄取率在烧伤早期短暂增高,之后则基本恢复正常水平;(4)血清胰岛素、胰高血糖素、皮质醇等代谢相关激素水平在伤后均高于伤前;(5)血乳酸、血糖、尿3-甲基组氨酸在烧伤后和脓毒症中均显著高于伤前水平.结论在烧伤尤其是合并脓毒症的情况下,机体存在显著的代谢增强过程.其与炎症介质(TNF-α、IL-6、IL-8的过度释放)有关,并受相关代谢激素的调控.该模型较好地反映烧伤和脓毒症中以高代谢为特征的机体代谢紊乱过程.     

MRI检查幽闭恐惧症患者时的应对措施

幽闭恐惧症是指进入狭小、黑暗、封闭的空间所表现出来的恐惧反应。该类患者在进行MRI检查时，由于MRI设备造型、检查室环境等因素，往往产生恐惧而不敢做或无法完成MRI检查。本研究探讨其处理措施。     

血液滤过对烧伤脓毒症病人血中炎性介质的清除作用

近年来有关研究表明血液滤过 (简称血滤 )可以滤除炎性介质 ,应用血滤治疗伴发肾功能衰竭 (简称肾衰 )的脓毒症和多器官衰竭的病人收到了满意的疗效[1,2 ] 。但应用血滤治疗单纯烧伤脓毒症病人的临床研究鲜有报道。现将我科对 7例重症烧伤脓毒症病人采用血滤治疗的情况报告如下。一、对象与方法1 对象 :大面积烧伤脓毒症病人 7例 (无肾衰 ) ,其一般资料见表 1。烧伤脓毒症诊断标准参见文献 [3]。2 血滤方法 :7例病人均采用Ｓｅｌｄｉｎｇｅｒ方法 ,于病人锁骨下或颈内静脉留置单针双腔导管 ,建立体外循环 ,采用ＰＲＩＳＭＡ型血滤机 (法国…     

烧创伤后免疫功能障碍识别研究进展

脓毒症是烧（创）伤后的严重并发症之一。欧洲一组临床流行病学资料显示，2527例全身炎性反应患者中，脓毒症发生率为26．0％，病死率16．0％。     

胸腺肽α1对烫伤延迟复苏大鼠单核细胞Ia抗原的影响

目的:研究烫伤延迟复苏后大鼠单核细胞表面Ia抗原变化规律及应用胸腺肽α1对单核细胞表面Ia抗原的影响。方法:将104只成年雄性Wistar大鼠随机分为正常对照组(8只)、单纯烫伤组(48只)和胸腺肽α1治疗组(48只)。正常对照组不作烫伤处理;其它组均造成30%TBSAⅢ度烧伤延迟复苏模型。分别于6h、1d、2d、3d、7d和14d处死动物,取血分离单核细胞,流式细胞仪检测Ia抗原表达率。结果:大鼠烫伤延迟复苏后单核细胞Ia抗原表达率降低,其中6h、和1d时间点Ia抗原表达率严重降低,3d、7d和14d时间点开始有所恢复,但明显低于正常大鼠(P均<0·01)。给予胸腺肽α1后3d、7d和14d时间点单核细胞Ia抗原表达率与单纯烫伤组比较明显提高(P均<0·01)。结论:严重烧伤延迟复苏后,单核细胞抗原递呈功能减弱,免疫功能障碍。胸腺肽α1作为一种免疫增强剂可明显改善烧伤延迟复苏后单核细胞抗原递呈功能。     

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.     

Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients' vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged;②The major cause related to burn wound sepsis was extensive burn injuries, with large areas of deep burn remaining open; ③Although wound swabs taken on admission revealed the presence of colonization by many pathogenic bacteria, Pseudomonas aeruginosa was one of the most frequent bacteria isolated from the subeschar tissue; ④The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than that after surgical intervention (P＜0.05) ;⑤The lowest level of the inflammatory mediators was observed when the patients' conditions became stable, as compared with before surgical intervention (P＜0. 001).These findings suggest that the clinical characteristics of burn wound sepsis are abrupt deterioration of the general condition and prominent septic symptoms, often complicated by MODS. The main cause of burn wound sepsis is the presence of a large area of open deep burn wounds, which should be excised and covered early. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn wound sepsis. Although success in treating these patients is the result of appropriate application of multiple treatments, early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wound play a crucial role in the successful treatment of patients complicated by burn wound sepsis. Other treatments are adjuvant but also important.     

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.     

重度烧伤并发消化道大出血四例

2002—2003年,笔者单位共收治重度烧伤并发消化道大出血患者 4例,均为男性,年龄 5 ~54岁。患者伤后曾在当地卫生所或医院行静脉补液治疗(成分及用量不详),创面外敷湿润烧伤膏 (北京光明创疡研究所 )或自制中草药,伤后2—9d转入笔者单位。烧伤总面积 25% ~92%,其中Ⅲ度15% ~