手背深度烧伤后指蹼外形与功能修复的美学探讨

目的：改进手背深度烧伤后指蹼区域的植皮方式,最大限度地恢复指蹼的外形及功能。方法：手术切除手背深度烧伤创面,取自体中厚皮分区移植,手背与指背区所植皮片的连接点位于第一指节的中段,使指蹼区皮片呈自然弧形与残存指蹼皮肤连接。术后10天左右拆线,出院后给予相应康复训练以保持手部及指蹼的外形和功能。结果：本组病例共40例,计48只手,植皮成活率均在95％以上,术后随访3月～2年,手背及指蹼外形良好,功能基本正常。结论：改进后的植皮方式在保证指蹼功能的基础上更有利于恢复指蹼的自然外形。     

Aesthetic pubic reconstruction after electrical burn using a portion of hair-bearing expanded free-forehead flap

Background  Electrical burn in the pubic region usually results in a severe and contractive scar with pubic hair loss. The aesthetic restoration of this area often has become very difficult. Methods  A 22-year-old male electrical engineer experienced severe pubic scarring with hair loss after electrical burn. He was treated successfully with an expanded free-forehead flap including a portion of hair-bearing scalp after microsurgical vascular anastomoses between the bilateral superficial temporal vessels and the bilateral deep inferior epigastric vessels. The donor forehead site was closed directly in the frontal hairline without visible scarring. Results  The pubic area was repaired functionally and cosmetically with the flap, and the pubic hair was growing well after a 1-year following-up period. Conclusions  This successful case strongly indicates that a microsurgical tissue transfer can be a good option for reconstruction of a pubic defect and that the expanded forehead flap could fulfill the high cosmetic demands of pubic reconstruction with minimal donor morbidity.     

贝复济喷剂外用对深Ⅱ度烧伤创面愈合时间的影响

目的：通过对深Ⅱ度烧伤创面愈合时间的临床观察及相关对比分析,探讨贝复济喷剂（b-FGF）外用对创面愈合时间的影响。方法：选择本院1999年1月至2006年6月188例单纯小面积深Ⅱ度烧伤患者,以不同时期应用的烧伤创面外用药作为对照,并分A、B、C三组,观察并分析贝复济喷剂外用对烧伤创面愈合时间的影响。结果：2005年7月-2006年6月,合理使用贝复济组,深Ⅱ度烧伤创面愈合时间缩短为（16.76±1.61）d,未使用贝复济组,深Ⅱ度烧伤创面愈合时间为（21.79±3.93）d。结论：单纯深Ⅱ度烧伤创面外用贝复济喷剂能明显缩短创面愈合时间,疗效确切。     

下丘脑GABA和烫伤大鼠心血管功能改变的关系

目的：首先观察烫伤早期大鼠下丘脑γ－氨基丁酸及其受体的改变，进一步通过阻断烫伤大鼠下丘脑室旁核γ－氨基丁酸的作用，观察其心血管指标和存活时间的改变。方法：采用脑组织游离氨基酸自动分析法测定烫伤大鼠下丘脑氨基酸递质相对含量；运用神经元突膜结合受体法测定核γ－氨基丁酸受体功能；制备大鼠30％总体表面积Ⅲ度烫伤模型；借助脑立体定向仪行室旁核内注射；运用四导生理仪记录血压和心肌力学指标。结果：烫伤早期大鼠下丘脑γ－氨基丁酸含量明显增加，谷氨酸减少，其它氨其酸递质含量无明显变化；γ－氨基丁酸受体最大结合容量明显增加，平衡解离常数无明显改变。烫伤大鼠下丘脑室旁核γ－氨基丁酸作用的阻断可明显回升其血压、左心室收缩压、左心室内压最大变化速率和延长存活时间。结论：提示中枢γ－氨基丁酸对大鼠烫伤早期心血管功能有影响，部位可能在下丘脑室旁核。     

槲皮素等对烫伤后小鼠肠粘膜损伤的保护作用

目的　研究槲皮素、芸香苷、黄色素母酮 3种黄酮类化合物对烫伤所致小鼠肠粘膜损伤的保护作用。方法　观察小肠肠粘膜损伤指数的变化 ,检测肠粘膜中蛋白质、DNA含量变化 ,DTNB法测定肠粘膜中GSH的含量 ,并应用DNA解旋的荧光检测法测定DNA损伤程度。结果　槲皮素等三种黄酮类化合物连续 3d灌胃可不同程度的改善烫伤所致肠粘膜损伤状况 ,使肠粘膜损伤指数降低 ,蛋白质、DNA、GSH含量增加 ,DNA损伤程度减轻。其中尤以槲皮素作用较为明显。结论　槲皮素、芸香苷、黄色素母酮 3种黄酮类化合物可明显改善烫伤所致小鼠肠粘膜损伤 ,其机制可能与其抗氧化作用有关。     

MEBO治疗碱烧伤的体会

根据MEBT和MEBO作用原理，应用MEBO治疗碱烧伤21例，与20例非MEBO治疗从临床症状和感染率进行对比，结果经统计学处理，差异有非常显著意义，并对MEBO的疗效进行分析和肯定。     

严重烧伤并发SIRS时生长激素的治疗

目的探讨重组人生长激素（r－hGH）对严重烧伤合并全身炎症反应综合症（SIRS）或脓毒症的疗效和作用环节。方法52例严重烧伤患者，根据应用或未应用r－hGH分成应用组和非应用组，比较二组患者的体温、前白蛋白（PALB）、呼吸机应用时间（VENTD）、创面愈合情况、ICU病房治疗时间（SICUD）及其生存率等与治疗有关的因素。结果二组患者伤后并发症发生无显著差异。但从其并发症的治疗结果看，r－hGH治疗组患者的WBC异常时间、平均PALB值及异常时间、胃肠营养不耐受时间、成人呼吸窘迫综合征（ARDS）救治结果及其供皮区创面和单次植皮愈合时间、SICU时间显著较短，生存率明显增高。结论r－hGH对烧伤后并发SIRS和脓毒症有显著治疗作用。     

Morphological parameters for assessment of burn severity in an acute burn injury rat model

Determination of burn severity (i.e. burn depth) is important for effective medical management and treatment. Using a recently described acute burn model, we studied various morphological parameters to detect burn severity. Anaesthetized Sprague–Dawley rats received burns of various severity (0- to14-s contact time) followed by standard resuscitation using intravenous fluids. Biopsies were taken from each site after 5 h, tissues fixed in 10% neutral-buffered formalin, processed and stained with haematoxylin and eosin. Superficial burn changes in the epidermis included early keratinocyte swelling progressing to epidermal thinning and nuclear elongation in deeper burns. Subepidermal vesicle formation generally decreased with deeper burns and typically contained grey foamy fluid. Dermal burns were typified by hyalinized collagen and a lack of detectable individual collagen fibres on a background of grey to pale eosinophilic seroproteinaceous fluid. Intact vascular structures were identified principally deep to the burn area in the collagen. Follicle cell injury was identified by cytoplasmic clearing/swelling and nuclear pyknosis, and these follicular changes were often the deepest evidence of burn injury seen for each time point. Histological scores (epidermal changes) or dermal parameter depths (dermal changes) were regressed on burn contact time. Collagen alteration ( r ² = 0.91) correlated best to burn severity followed by vascular patency ( r ² = 0.82), epidermal changes ( r ² = 0.76), subepidermal vesicle formation ( r ² = 0.74) and follicular cell injury was useful in all but deep burns. This study confirms key morphological parameters can be an important tool for the detection of burn severity in this acute burn model.     

Emerging technologies for the thorax: Indications,management and complications

The field of interventional pulmonology has rapidly expanded to include the management and treatment of complex diseases of the chest. The management of central airway obstruction, pleural disease diagnosis, treatment and palliation, advanced bronchoscopic techniques to aid in the diagnosis of lung cancer and innovative therapies to treat asthma and COPD have all emerged over the past decade. As astute clinicians, we are all aware of the risks and benefits of using these therapies to treat our patients. In order to appropriately treat and manage these often complex medical situations, the physician should have an expert knowledge of all available modalities, the expertise to safely perform the procedure and the ability to minimize the risk of and manage the associated complications that may arise. In this chapter we review and update some of the bronchoscopic and pleural interventions offered by interventional pulmonologists as well as the associated complications and management.     

Providing psychosocial and physical rehabilitation advice for patients with burns

Title.  Providing psychosocial and physical rehabilitation advice for patients with burns.
Aim.  This paper is a report of a study evaluating the perceived skills of nursing and allied healthcare professionals in providing psychosocial and physical rehabilitation advice, including the effect of years of burn injury experience.
Background.  Recovery from burn injuries is a complex mix of physical and psychosocial rehabilitation, yet research in the UK has demonstrated that healthcare professionals feel more competent at giving advice to patients on issues of physical rehabilitation than psychosocial rehabilitation.
Methods.  This was a replication study with a cross-sectional design. A questionnaire survey was conducted with a convenience sample of healthcare professionals in a large urban hospital with specialist burn and plastic services in New Zealand. The data were collected in 2005.
Results.  Consistent with the UK results, New Zealand healthcare professionals rated their skills in advising patients about physical items of burn rehabilitation higher than their skills for psychosocial items. Years of experience working with burns was related to greater perceived skill in advising patients on physical rehabilitation. In contrast, no relationship between years of experience and perceived skill in the provision of psychosocial rehabilitation advice was found.
Conclusion.  Strategies to enhance effective staff/patient communication should form an integral part of staff education. The psychosocial needs of patients must be incorporated as an essential part of such strategies.