大鼠严重烫伤并发心肌损害时肿瘤坏死因子的变化

目的：探讨炎症介质在严重烧伤后心肌损害中的作用。方法：采用大鼠３０％ 体表面积Ⅲ度烫伤模型,随机分为对照组（１０ 只）和烫伤组（５０ 只）,于烫伤后１、３、６、１２ 和２４ 小时检测大鼠血浆肿瘤坏死因子（ＴＮＦ）和肌钙蛋白Ｔ（ＴｎＴ）及心肌组织中ＴＮＦ的含量。结果：烫伤后６ 小时血浆ＴＮＦ水平〔（３．３８±０．９０）μｇ／Ｌ〕较正常对照组〔（１．０８±０．０１）μｇ／Ｌ〕显著升高（Ｐ＜ ０．０１）,１２ 小时达峰值〔（８．０２±１．０５）μｇ／Ｌ〕,伤后２４ 小时〔（６．４４±１．４３）μｇ／Ｌ〕虽有所下降,但仍显著高于正常对照组（Ｐ＜ ０．０１）。心肌组织ＴＮＦ含量伤后１２ 小时〔（２．１５±０．０９）ｎｇ／ｍ ｇ〕显著高于正常对照组〔（０．８８±０．０１）ｎｇ／ｍ ｇ,Ｐ＜ ０．０１〕。血浆ＴＮＦ水平与反映心肌损伤的敏感指标血浆ＴｎＴ的变化密切相关。结论：炎症介质ＴＮＦ在烧伤后心肌损害的发生发展中起重要作用     

生脉注射液对大鼠烧伤后心肌细胞凋亡的影响

目的 探讨生脉注射液对大鼠烧伤后心肌细胞凋亡的影响.方法 SD(Sprague-Dawley)大鼠72只,随机分成单纯烫伤组(B组,n=36)和烫伤并应用生脉注射液治疗组(S组,n=36),制成30%TBSA Ⅲ度烫伤模型,伤后B组按Parkland公式补液,S组在B组的基础上伤后即刻按4 ml/kg给予生脉注射液,并相应减少补液量,两组均于不同时相点,取左室心肌组织切片,做病理形态学观察,并采用DNA切口末端标记法(TUNEL)和心肌组织caspase-3活性双指标联合检测细胞凋亡.结果 病理切片显示S组较B组心肌组织损伤有所减轻;两组心肌细胞TUNEL显示烫伤后6 h呈阳性,伤后12 h达高峰;caspase-3活性变化早于凋亡形态学变化,于伤后3、6 h达峰值;S组较B组在伤后6、12、24 h心肌细胞凋亡指数显著降低(P＜0.01),左心室心肌组织caspase-3活性在伤后3、6、12 h也显著降低(P＜0.05).结论 烧伤后早期心肌细胞凋亡参与了烧伤病理损伤过程.早期应用生脉注射液治疗可以有效地减少心肌细胞的凋亡,进而减轻心肌的损伤,起到保护心肌的作用.     

美宝创疡贴对小儿Ⅱ度烧（烫） 伤创面愈合过程的影响

目的　观察美宝创疡贴（MEBO wound and ulter Dressing） 对小儿Ⅱ度烧（烫） 伤创面（浅Ⅱ度～深Ⅱ度）愈合过程的影响。方法　对2008年5月～2012年3月接诊的200例小儿Ⅱ度烧（烫） 伤患者创面用美宝创疡贴外敷处理,观察创疡贴与创面的黏着程度,患儿是否配合,创面有无渗液、感染等表现,记录创面愈合时间。结果　创疡贴与Ⅱ度烧（烫）伤创面黏着良好,在适度压力包扎固定的情况下不易移位或脱落。本组Ⅱ度烧（烫）伤创面均于伤后3周内愈合,最短愈合时间为伤后1周,此类创面属于浅Ⅱ度创面;深Ⅱ度创面换药处理3d～5d,坏死组织层基本脱落,逐渐出现散在新生皮岛,最终相互融合,覆盖创面,且这类创面均在2～3周愈合,创面无渗液,新生皮肤生长良好。愈合3个月后复诊检查,新生皮肤平整,未见色素沉着。结论　美宝创疡贴在及时清创后的Ⅱ度烧（烫） 创面上有良好的黏着力,可控制创面渗出,减轻创面疼痛,促使创面一期愈合。     

Trauma and burns in children

Trauma is the leading cause of death and disability in children, most often resulting from blunt trauma. An immediate co-ordinated and pathology-focussed resuscitation will contribute to improved morbidity and mortality outcomes. This article discusses the principles of the primary and secondary survey in injured children and outlines the management of children suffering from burns. A multi-professional approach to the treatment of critically injured children should be adopted; where the primary survey aims to identify and manage catastrophic haemorrhage followed by management of life-threatening injuries to airway, breathing and circulation. The secondary survey includes a detailed examination to identify and manage other subtle or less severe injuries. Attention to fluid therapy, analgesia, thermoregulation, blood coagulation and glucose homeostasis form important aspects of this secondary survey. Children injured in fires may have suffered from smoke inhalation or sustained burns to the upper airway, with rapid swelling of mucosal tissue, which can make immediate control of the airway very challenging. Both flame burns and scalds can cause significant fluid losses and are associated with a significant risk of mortality.     

Epidermal growth factor receptor in corneal damage: update and new insights from recent reports

Agonist and antagonist drugs acting on epidermal growth factor receptor (EGFR) signaling are emerging as a new possibility for pharmaceutical study and clinical manipulation of some skin and corneal disorders. EGFR activation appears to be effective in reducing the time of reepithelialization after corneal wound healing, with potential uses in penetrating keratoplasty, refractive surgery, alkali burns, diabetic keratopathy, keratopathy following chemotherapy, cornea transplantation, and dry eye. Most of the studies show therapeutic advantages of human recombinant epidermal growth factor (hrEGF) eye drops without showing adverse effects. In contrast, EGFR inhibition delays epithelial cell proliferation and stratification during corneal regeneration.The aim of this review is to summarize the most seminal discoveries and recent advances so as to clarify the role of the EGFR system in corneal physiology and pharmacology. Epidermal growth factor eye drops could be a first-choice treatment for promoting regeneration in numerous epithelial defects in the medium to long term.     

Burns related to sunbed use

The quest for a year round tan has led to an increase in the use of artificial tanning devices, namely sunbeds. There has been much debate in the press recently regarding the dangers of sunbed use and calls for tighter regulation of the industry, particularly the licensing of unmanned tanning salons. The dangers of sunbed use have long been recognised and the body of evidence linking sunbed use to skin malignancy is growing, in fact this month the Lancet published a review from the International Agency for Research on Cancer classifying UV emitting tanning devices as carcinogenic to humans. At the Welsh Centre for Burns and Plastic Surgery we noticed a rise in the number of patients presenting with burns related to sunbed use and present our data surrounding this injury over the last 6 years.     

自我效能干预对暴露部位烧伤整形患者应对方式及综合健康状况的效果评价

目的探讨自我效能干预对暴露部位烧伤整形患者应对方式及生存质量的影响及效果。方法将在我院烧伤整形科住院的80例暴露部位烧伤整形患者随机分为观察组和对照组，各40例，对照组采取常规护理方法和皮瓣修复手术治疗，观察组在常规护理和皮瓣手术的基础上给予增强自我效能的护理干预措施，应用一般自我效能量表（GSES）和中文版精简烧伤健康量表（BSHS-A）及医学应对方式问卷（MCMQ）进行测评。比较两组患者自我效能、应对方式、生活质量的差异。结果干预后观察组患者自我效能高于对照组（P〈0．05），患者的综合健康水平高于对照组（P〈0．05），应对方式转变高于对照组（（P〈0．05）。结论自我效能干预增强了暴露部位烧伤整形患者术后解决问题、应付突发事件的自信心，改变了对应激事件的应对方式，提高了自我管理能力和综合健康水平。     

Psychological adjustments made by postburn injury patients: an integrative literature review

Title.  Psychological adjustments made by postburn injury patients: an integrative literature review.
Aim.  This paper is a report of a review examining the variables that predispose individuals to significant psychological maladjustment following burn injury.
Background.  The psychological sequelae of burn injury are well documented; however, the variables that influence individuals' adjustment following burn injury lack consideration.
Data sources.  MEDLINE, Cumulative Index of Nursing and Allied Health, and Psychological Abstracts were searched using the keywords burn injury, psychological, psychosocial, rehabilitation, premorbid psychopathology, adjustment, reintegration, body image, post-traumatic stress disorder, depression, coping. Other sources were found from a manual search of nursing, medical and psychological literature and references of identified and related papers. The search strategy was limited to English-language research published between 1997 and 2008.
Review methods.  An integrative review of the studies was conducted over a 6-month time period during 2007–2008.
Results.  Burn patients are a heterogeneous group and typically have comorbidities. While preburn personality and coping strategies can influence long-term psychological adjustment, the relationship between postburn adjustment and burn size and severity, and gender are poorly understood. Much of the literature focuses on the prevalence of psychological maladjustment rather than on identifying variables that influence psychological adjustment.
Conclusion.  The diversity and complexity that characterize burn patients lead to unique adjustment difficulties. Recognizing these difficulties is the first step to offering appropriate intervention and treatment for this unique patient group.     

Initial experience with cultured epithelial autografts in massively burnt patients

Background: Prognosis in patients with severe burns is improved by early debridement and coverage with skin. The limiting factor in these patients is the lack of unburnt skin for harvesting. Cultured epithelial autograft (CEA) sheets provide an alternative means of covering debrided skin. This is a report on an initial experience with using CEA sheets. Methods: The two patients in this study had their medical records examined retrospectively. Results: The effective take of the CEA sheets was zero in both patients. One of the patients died approximately 6 weeks after admission. Conclusions: Because of the poor graft take seen in the patients in the present study, the use of CEA sheets only as a form of temporary biological dressing is recommended.