会阴部烧烫伤暴露疗法与包扎疗法的临床效果分析

目的探讨会阴部烧烫伤后经济、实用的治疗方法。方法选取2008年5月-2012年4月本院治疗的会阴部烧烫伤患者90例,随机分为两组,对照组采用紫花油纱布包扎,试验组采用磺胺嘧啶银联合碘伏暴露治疗。结果试验组和对照组的愈合时间分别为（16±5）、（17±6）d,两组比较差异有统计学意义,愈合率均为100％。试验组和对照组的治疗费用分别为（480±50）元和（800±100）元,试验组明显低于对照组,两组比较差异有统计学意义。结论采用磺胺嘧啶银联合碘伏治疗会阴部烧烫伤,方法简单,操作方便,效果满意,且费朋低廉,经济实用。     

重组人粒细胞巨噬细胞集落刺激因子喷雾剂的制备及药效研究

目的研制重组人粒细胞巨噬细胞集落刺激因子喷雾剂,探索其治疗溃疡、烧伤和烫伤的有效性。方法使用合理比例的保护剂、透皮吸收促进剂、抑菌剂和缓冲体系等,将重组人粒细胞巨噬细胞集落刺激因子制备成喷雾剂,通过动物药效实验探索其治疗溃疡、烧伤和烫伤的效果。结果重组人粒细胞巨噬细胞集落刺激因子喷雾剂通过2～8℃条件24个月长期稳定性考察,理化性质和生物活性没有明显变化。通过豚鼠溃疡模型和家兔烧伤和烫伤模型显示,药效非常显著。结论重组人粒细胞巨噬细胞集落刺激因子可制备成喷雾剂,为临床治疗溃疡、烧伤和烫伤等创面疾病提供了依据。     

Biobrane versus topical agents in the treatment of adult scald burns

Background

Limited data is available for treatment of scald lesions in adults. The use of the biosynthetic matrix Biobrane^® has been suggested as treatment option with more benefits over topical dressings. Application of Biobrane^® in scalds in our center led to a perceived increase of infection, secondary deepening, surgery and length of stay. We therefore assessed the effect of different treatment options in adult scalds in our center.

浅谈护架烤灯治疗小儿大面积烫伤的护理体会

目的：总结基层医院使用护架烤灯治疗小儿子大面积烫伤的护理体会.方法：通过31例躯干及四肢大面积浅Ⅰ°、Ⅱ°、深Ⅱ°烫伤患儿在使用护架烤灯照射,创面使用消毒紫草油的正确全程护理,认为加强烫伤患儿的基础护理,创面护理,营养支持,可促进创面恢复,减少并发症的发生,提高治疗效果.结果：30例烫伤患儿治愈率达100%,1例转上级医院进一步治疗.     

烫伤大鼠下丘脑-垂体-肾上腺皮质轴激素动态变化的观察

目的: 动态观察烫伤大鼠下丘脑-垂体-肾上腺皮质轴激素水平的变化,为临床治疗和预后提供理论依据. 方法: 将雄性SD大鼠60只随机分对照组、烫伤1组(造模1天)、烫伤2组(造模5天)、烫伤3组(造模10天)、烫伤4组(造模15天)和烫伤5组(造模20天)共6组.取血浆用于检测促肾上腺皮质激素(ACTH)、皮质醇和醛固酮.结果: 与对照组相比,烫伤模型1,2,3,4组血浆ACTH、皮质醇和醛固酮含量明显升高(P＜0.05),尤在10天左右达到最高峰,但到达15天已开始下降,而烫伤模型5组即造模后20天ACTH、皮质醇和醛固酮趋于正常水平,与对照组相比无显著性差异(P＞0.05).结论: 大鼠烫伤早期下丘脑-垂体-肾上腺皮质轴激素水平出现应激性的持续性上升,对机体具有重要的保护作用,而到烫伤后期由于肾上腺皮质功能的减退而开始下降,应引起高度重视.     

丁酸钠对严重烫伤大鼠肾血流量和微血管通透性的影响

 目的 研究丁酸钠对50%TBSA Ⅲ度烫伤大鼠肾血流量和微血管通透性的影响。方法 雄性SD大鼠48只,体重250～270 g,随机分为假烫组、烫伤组和丁酸钠组,每组16只。丁酸钠组和烫伤组分别采用100 ℃烫伤背部15 s、腹部8 s,造成50%总体表面积(TBSA)Ⅲ度烫伤,伤后立即腹腔注射丁酸钠(400 mg/kg)或等体积生理盐水。假烫组采用37 ℃温水浸泡。于伤后3 h和6 h采用多普勒血流仪测定肾脏血流量;心脏穿刺取血检测血浆肌酐(Cr);留取肾脏组织检测肾微血管通透性及肾组织含水率。结果 烫伤后3 h,烫伤组与假烫组比较,血管通透性[(9.53±1.86)μg/ml vs (7.61±0.85)μg/ml]、组织含水率[(78.72±2.07)% vs (61.71±1.86)%]、血Cr[(50.96±5.15)μmol/L vs (23.62±3.06)μmol/L]均增高,血流量明显降低[(39.18±6.28)BPU vs (140.6±21.18) BPU](均P<0.05);丁酸钠组与烫伤组比较,组织含水率[(66.95±2.26 )% vs (78.72±2.07)%]、血Cr[(33.50±6.82)μmol/L vs (50.96±5.15)μmol/L]均显著降低,血流量明显升高[(47.38±7.59) BPU vs (39.18±6.28 )BPU](均P<0.05)。烫伤后6 h,烫伤组与假烫组比较,血管通透性[(15.63±1.93)μg/ml vs (7.83±0.92)μg/ml]、组织含水率[(84.92±2.19)% vs(62.78±1.94)%]、血Cr[(87.37±10.11)μmol/L vs (24.25±2.81)μmol/L]均增高,血流量明显降低[(23.89±7.43) BPU vs (142.40±23.73)BPU](均P<0.05);丁酸钠组与烫伤组比较,血管通透性[(11.59±1.77)μg/ml vs (15.63±1.93)μg/ml]、组织含水率[(70.55±1.94)% vs (84.92±2.19)%]、血Cr[(46.00±12.35)μmol/L vs (87.37±10.11)μmol/L]均明显降低,血流量明显升高[(61.80±5.75) BPU vs (23.89±7.43) BPU](均P<0.05)。结论 丁酸钠能增加严重烫伤后肾血流量,降低肾微血管通透性和组织含水率,对严重烫伤大鼠的肾脏功能损伤有明显的保护作用。     

第十届全国烧伤康复明星病例介绍

<正>病例1,男,2岁因沸水烫伤21 d于2012年10月12日入院,烫伤面积为59%TBSA,均为Ⅲ度浅型。烫伤后采用其他疗法治疗21 d效果不佳而转入本院,入院后即全程给予烧伤创疡再生医学与疗法治疗,所有创面均未植皮,治疗30 d后创面愈合出院。愈     

Increased hsp70 of glucocorticoid receptor complex induced by scald and heat stress and its possible effect on the affinity of glucocorticoid receptor

Background Glucocorticoid （GC） insensitivity/GC resistance is an important etiological and prognostic factor in multiple diseases and pathophysiological processes such as scald, shock and asthma. The function of GC was mediated by glucocorticoid receptor （GR）. Scald not only decreased the expression of GR but also reduced the affinity of GR, which played an important role in GC resistance in scalded rats. Whereas the molecular mechanism responsible for the decrease of GR affinity resulted from scald remains unclear. Recent studies showed that the changes of heat shock proteins （hsp） especially hsp90 and hsp70 of GR heterocomplex were associated with GR low affinity in vitro. Methods The affinity of GR in hepatic cytosols and in the cytosols of SMMC-7721 cells were determined by radioligand binding assay and scatchard plot. GR heterocomplex in cytosols were captured by coimmunoprecipation and the levels of hsp90 and hsp70 of GR complex were detected by quantitative Western blotting. Results Similar with that of hepatic cytosol of scalded rats, a remarkable decrease of GR affinity was also found in the cytosol of heat stressed SMMC-7721 cells. The level of hsp70 of GR complex in hepatic cytosol of scalded rats （30% total body surface area immersion scald） and in cytosol of heat stressed human hepatocarcinoma cell line SMMC-7721 were both increased by 1.5 fold, whereas no change of hsp90 in GR heterocomplex was found. According to the correlation analysis, there may be a positive relationship between increased hsp70 of GR complex and decreased GR affinity in the cytosols. Conclusions The primary results indicated that the level of hsp70 of GR heterocomplex was increased in the hepatic cytosol of scalded rats and the cytosol of heat stressed SMMC-7721 cells. The increase of hsp70 of GR complex might be associated with the decrease of GR affinity.     

大豆异黄酮酊干预Ⅱ度烫伤模型小鼠创面的愈合

背景：雌激素具有促进创面愈合的作用,大豆异黄酮能与雌激素受体结合,具有明显的雌激素样效应。 目的：探索大豆异黄酮酊的制备、观察其对小鼠烫伤创面愈合的影响。 方法：用冷浸渍法制备大豆异黄酮酊,筛选最佳有效浓度。用昆明小鼠造Ⅱ度烫伤模型,随机分为6组。药物组分别应用0.100,0.361,1.000,3.610 g/L的大豆异黄酮酊局部涂抹;溶剂对照组应用体积分数75%乙醇局部涂抹;空白对照组不作任何处理。从第 3 天起,隔天记录创面面积、计算未愈合创面占原始创面的百分比,于造模后第 3,9,14 天取创面组织做病理切片,观察形态学改变和创面愈合情况。 结果与结论：大豆异黄酮酊的最佳效应浓度是3.61 g/mL。在创伤后第 5,7,9,11,13 天,大豆异黄酮酊组的未愈合创面占原始创面的百分比明显小于溶剂对照组和空白组(P < 0.05)。病理组织切片显示,第 9 天,大豆异黄酮酊组的成纤维细胞明显多于溶剂对照组和空白组,第 14 天,大豆异黄酮酊组的表皮生长情况比溶剂对照组和空白组好。表明以75%乙醇为溶剂制备大豆异黄酮酊是可行的;  3.61 g/L的大豆异黄酮酊对小鼠创面的愈合具有明显的促进用。