富血小板血浆促进慢性难愈合伤口修复的研究进展

富血小板血浆（platelet-rich plasma,PRP）是一种血小板浓缩物,以离心的方法从自体血中提取。PRP中的血小板经激活后能释放出大量高浓度的生长因子,如血小板源性生长因子（platelet—derived growth factor,PDGF）、转化生长因子-β（transforming growthfactor—β,TGF—β）、     

Inhalation burn injury in children

With advances in burn care, many children are surviving severe burn injuries. Inhalation injury remains a predictor of morbidity and mortality in burn injury. Inhalation of smoke and toxic gases leads to pulmonary complications, including airway obstruction from bronchial casts, pulmonary edema, decreased pulmonary compliance, and ventilation–perfusion mismatch, as well as systemic toxicity from carbon monoxide poisoning and cyanide toxicity. The diagnosis of inhalation injury is suggested by the history and physical exam and can be confirmed by bronchoscopy. Management consists of supportive measures, pulmonary toilet, treatment of pulmonary infection and ventilatory support as needed. This review details the pathophysiology, diagnosis, and management options for inhalation injury.     

Long-term comorbidity of diabetes mellitus is a risk factor for perineal wound complications after an abdominoperineal resection

Background  This report is an attempt to clarify the effect of diabetes mellitus on perineal wound complications including infectious entities and delayed wound healing after abdominoperineal resection and also tried to show the risk factors for perineal wound complications. Material and methods  The data of 80 patients who underwent an abdominoperineal resection were reviewed from April 1996 to March 2006. Results  The rate of perineal wound complications is higher in diabetics (67%) than in nondiabetics (18%, p = 0.005). In a multivariate analysis, diabetes mellitus and operation time (≥420 min) were the risk factors for perineal wound complications (p = 0.040, p = 0.027, respectively). Infectious perineal wound complication was associated with diabetes mellitus (p < 0.001) but not with the operation time (p = 0.097). Furthermore, a longer comorbid duration of diabetes (≥10 years) was a significant predictor for perineal wound complications (p = 0.008). Conclusion  This study demonstrated diabetes mellitus to be independently associated with perineal wound complications, and when the patients have diabetes mellitus, especially with a longer comorbid duration and longer operation time, the clinical path should be changed to reduce perineal wound complications.     

坐标定位划痕法在研究“细胞创面”愈合率中的应用

目的：改良传统“细胞创面”模型的制备方法,提高对“细胞创面”愈合率的统计的精确性。方法：在6孔板每一孔外底面用刀尖划上横纵坐标轴,用绿色记号笔在横轴的上、下方平行于横轴各画5条等距离的绿带。接种目的细胞,待其长满内表面时用1000μl微量移液器的吸头在纵轴的左、右平行于纵轴各划2条等距离的细胞缺损带。在观察时间点观察绿带与细胞缺损带重叠形成的“矩形区域”的宽度或面积,计算愈合率。结果：可以特定追踪观察每个“矩形区域”内“细胞创面”愈合率情况,且“矩形区域”的例数可以符合统计学要求。结论：坐标划痕法是一种较精确统计“细胞创面”愈合率可行的方法。     

结直肠手术下腹正中切口全层与分层缝合技术比较

目的比较结直肠手术下腹正中切口全层缝合与分层缝合技术应用的切口愈合能力差异。方法回顾性比较1998-2000年和2007-2008年间两组各65例患者,分析丝线分层缝合关腹和可吸收双股缝线全层关腹组的数据源,比较两种材料和方法条件下切口愈合率和并发症。结果全层缝合组手术耗时明显比分层缝合少（6．31±0．58min vs9．58±0．95min）。切口一期愈合和甲级愈合率两组间无显著差异,脂肪液化（3．07％vs15．38％）、切口感染（3．07％vs9．24％）和切口裂开（1．54％vs13．85％）等近期并发症和慢性窦道（1．54％vs7．69％）等远期并发症比较差异显著（P〈0．05）。全层缝合组无切口疝发生,分层缝合组2例切口疝,两组间比较无统计学差异（P〉0．05）。结论全层连续缝合技术较之分层缝合对预防结直肠手术下腹正中切口感染和裂开等效果显著,“宽对合”是防止术后切口急性和后期并发症的关键技术。     

剖宫产术后切口感染的高危因素及护理对策

目的：探讨我院剖宫产术后切口感染发生的高危因素及针对性的预防措施。方法：剖宫产术后产妇132例,随机分为观察组74例与对照组58例。对剖宫产术后切口感染的原因进行调查,并采取有效护理措施。结果：两组患者在体重指数、血红蛋白水平、病房条件、阴道检查及肛查次数、胎膜早破、手术时间等方面的差异有统计学意义（P〈0.05）。结论：剖宫产手术后感染发生的主要高危因素多为肥胖、阴道检查及肛查次数过多、胎膜早破和手术时间较长等。临床上应针对这些因素采取预防性的护理。     

Effect of fenofibrate on microcirculation and wound healing in healthy and diabetic mice

Objective

Disturbances in wound healing in patients with hyperglycaemic blood sugar values are a common clinical problem. Recent studies identified PPARα-ligands as potential skin therapeutic agents. The aim of this study was to investigate the effects of oral fenofibrate treatment on dermal wound healing and micro-circulatory parameters in diabetic mice.

Methods

Dermal wounds were created in CD-1 mice. Mice were randomized into four treatment groups: diabetic mice treated (dbf) or not-treated with fenofibrate (dbnf). As controls served non-diabetic mice treated (ndf) or not-treated with fenofibrate (ndnf). At various points in time microcirculation was analyzed by intravital fluorescent microscopy to determine wound surface area, vessel diameter, plasma leakage, functional capillary density, and leukocyte/endothelium interaction.

Results

The dbf-mice showed a significantly increased diameter of the venules and the arterioles up to 3 days after wound creation compared to dbnf-mice. However, wound healing was not improved in dbf-compared to dbnf-mice. Surprisingly, all microcirculatory parameter (vessel diameter, plasma leakage and functional capillary density) were not deteriorated in dbnf-compared to ndnf-mice.

Conclusion

We confirm that high blood sugar values lead to a delayed wound healing, but this could not traced back to altered microcirculatory patterns. Furthermore, in dbf-mice an improved vasodilatatory function of small vessels could be detected, but with no substantial effect on wound healing. Further studies are needed to clarify, if topical application of fenofibrate might be beneficial.     

川芎嗪对轻度烧伤大鼠烧伤痛行为学影响研究

目的 探讨川芎嗪对轻度烧伤大鼠痛行为的影响,了解川芎嗪对烧伤痛的作用.方法 建立大鼠轻度烧伤模型,应用von Frey细丝法和热辐射法测定机械缩足反射阈值(mechanical withdrawal threshold,MWT)和热缩足反射潜伏期( thermal withdrawal latency,TWL),观察川芎嗪对烧伤大鼠MWT和TWL的影响.结果 烧伤后1 h,ⅢA组(生理盐水+Ⅰ度烧伤组)和ⅢB组(生理盐水+浅Ⅱ度烧伤组)MWT和TWL显著性下降,分别持续24 h和96 h(P<0.01).24 h之后,ⅡA组(TMP+Ⅰ度烧伤组)TWL和TWL和Ⅰ组相比无显著性差异,而ⅡB组(TMP+浅Ⅱ度烧伤组)24 h后明显增加,72 h后与Ⅰ组相比已没有显著性差异.结论 川芎嗪可以抑制烧伤大鼠的机械缩足反射阈值和热缩足反射潜伏期,从而对烧伤痛有抑制作用.     

TNF-α和IL-6在腹部肠管火器伤后血清中的变化

目的探讨腹部肠管火器伤后血清肿瘤坏死因子-α（TNF—α）、白介素-6（IL-6）的动态变化规律,为寻找有效的细胞因子拈抗剂来减轻腹部火器伤后机体的损伤以促进机体康复提供理论依据。方法健康长白仔猪42头随机等分为对照组、伤后1、2、4、8、12h和24h组,每组6只,实验各组建立猪腹部肠管火器伤模型后,采用双抗体夹心ELISA法测定各组动物血清TNF—α、IL-6水平。结果实验组各组动物血清TNF—α、IL-6水平均明显高于对照组（P〈0．05）,TNF—α在伤后12h为（94．36±10．18）ng／L,IL-6在伤后12h为（1218．35±74．00）ng／L,二者均于伤后12h达到高峰。结论TNF—α、1L-6参与了腹部肠管火器伤后机体的病理生理过程,可能是引起腹部肠管火器伤后多器官功能障碍综合征（MODS）的重要因素之一。