同一设计的骨水泥和非骨水泥BF全髋假体置换术后2～5年的随访结果(英文)

目的：观察同一设计的骨水泥和非骨水泥 Ｂ Ｆ全髋假体置换术后２ ～５ 年的随访结果。方法：２４６ 髋全髋术后随访２ ～５ 年。骨水泥组１１７ 髋,非骨水泥组１２９ 髋,两组均应用同一设计的可组换 Ｂ Ｆ 全髋系统。结果：两组 Ｍｅｒｌｅ○ｄ Ａｕｂｉｇｎｅ 评分和日常行为评分优良率为８９ ％ ／９５ ％ ,非骨水泥组稍优于骨水泥组,但无明显差异。两组均无确切的假体松动。３６ 髋（２７９ ％ ） 出现股骨远端皮质肥厚,均位于３ 区和／ 或５ 区。结论：新设计的可组换 Ｂ Ｆ 全髋系统具有良好的临床效果,尤其可根据不同的适应证施行个体化的全髋置换。     

烧伤病人细菌学调查

本文对我科自１９９５年８月建科以来烧伤病人创面分泌物，血液１９５份标本的细菌生态学和药物敏感进行调查，结果细菌培养阳性１３３份（６８．２％）其中创面分泌物送检１５５份，阳性１３１份（８４．５％）血液送检４０份，阳性２份（５％），共检出细菌２８种１４２株，金黄色葡萄球菌高居第一位，占１８．７％，常见的绿脓杆菌在本组中退居第八位，药敏结果提示，金黄色葡萄球菌对万古霉素最敏感（９６．２％），其次为氟哌酸     

干、湿疗法治愈1178例面部烧伤的疗效分析

目的：比较ＭＥＢＴ／ＭＥＢＯ和干性暴露疗法对面部不同深度烧伤创面的疗效。方法：将采用ＭＥＢＴ／ＭＥＢＯ和干性暴露疗法治愈的１１７８例面部浅Ⅱ度、深Ⅲ度和Ⅲ烧度伤创面分为相应二组,比较二组的临床疗效并进行统计学分析。结果：与干性暴露组比较,ＭＦＢＴ／ＭＥＢＯ组治疗的面部浅Ⅱ度、深Ⅱ度和Ⅲ度伤创面愈合快,止痛效果好,疤痕增生不明显。结论：ＭＥＢＴ／ＭＥＢＯ对面部浅Ⅱ度、深Ⅱ度和Ⅲ度烧伤面的疗效优于干燥     

Effect of early wound excision on changes in plasma nitric oxide and endothelin-1 level after burn injury: an experimental study in rats

The purpose of this study was to evaluate effects of early wound excision on changes in NO and endothelin-1 (ET-1) level in the plasma after extensive burn injury. The effects on vascular permeability and hepatic blood flow (HBF) were also assessed. Male Wistar rats were used for this study. A 30% total body surface area (TBSA) third-degree burn was made on the back. Then animals were divided into four groups. Burn group (n = 13), burn alone; infusion group (n = 13), burn injury and fluid resuscitation; early excision group (n = 13), burn injury, total wound excision at 30 min after the injury followed with immediate allogenic skin graft and fluid resuscitation; and the sham group (n = 15). The sham group and the early excision group did not show significant changes in the NO and ET-1 level in plasma during experimental period, while the burn group and the infusion group showed significant increase in the NO and ET-1. The early excision group also did not show hypovolemia, and the significant decrease in the HBF. These data suggest that the increased NO and ET-1 in plasma following thermal injury were originated from burned tissue and the removal of these injured tissue has beneficial effect on the vascular permeability and the changes in HBF.     

Evidence supporting a role of glucocorticoids in short-term bone loss in burned children

Children burned 40% total body surface area suffer acute bone loss. The reason(s) for this is uncertain. In order to determine whether high endogenous glucocorticoid production can contribute to the bone loss, we sequentially studied a total of 14 pediatric burn patients for bone histomorphometry; 7 of these patients and 4 controls were studied for characteristics of corticosteroid-induced bone loss, including decreased osteoblasts and down-regulation of the glucocorticoid receptor in bone. We then studied 4 of the burn patients and three controls for a decrease in markers of osteoblast differentiation, another feature of glucocorticoid toxicity. Bone biopsies were taken from each of the 14 burn patients a mean of 3 weeks post-burn. Histomorphometry was performed on one specimen (n=7) and either glucocorticoid and mineralocorticoid receptor, collagen and alkaline phosphatase expression by RT-PCR (n=7) or marrow stromal cell culture (n=4) on the other. Patients were permitted a maximum of two biopsies for study. One biopsy was obtained intra-operatively from normal subjects during elective iliac crest alveolar bone grafting and compared with burn specimens for glucocorticoid receptors and marrow stromal cell culture. A 24-h urine specimen was obtained for free cortisol (n=7). Histomorphometry revealed low osteoblast and osteoid surfaces and few detectable osteoblasts. Resorptive surfaces were also reduced. Glucocorticoid receptor mRNA (GR) was not decreased; however, there was a trend toward inverse relationships between urine free cortisol and GR and type-1 collagen mRNA, r=–0.61 and –0.64, respectively, and a significantly lower mRNA for type-1 collagen in bone in burn vs control patients by the median test, ²=7.6 (p<0.01). Markers of osteoblast differentiation, core-binding factor (cbf)a1, bone morphogenetic protein (BMP)-2, type-I collagen, and alkaline phosphatase were reduced in burn cell cultures compared with controls (p<0.05). The eightfold elevation of urinary free cortisol excretion, low osteoblast number, decreased resorptive surface, and reduced markers of osteoblast differentiation are all consistent with an acute glucocorticoid effect on bone.     

复方红景天参芪花粉制剂防治高原大鼠严重烧伤后早期肝损害的实验研究

目的：观察大鼠高原烧伤后，复方红景天参芪花粉制剂（RACC）对早期肝损害的防治作用，方法：在3480m高原成功复制大鼠30％Ⅲ度烧伤模型，104只大鼠随机分为试验组，对照组和正常组，实验组伤后采用RACC灌胃，对照组则用生理盐水灌胃，在伤后不同时相点测定血清GPT，GOT和总胆红素变化。结果：伤后3h，试验组，对照组血清GPT，GOT及总胆红素水平均显著高于正常组（P＜0．01），伤后48h和72h上述指标均接近正常，但试验组较对照组各项指标明显偏低，结论：RCC可对烧伤后肝功能损害成功一定的保护作用，具有一定的临床意义。     

延迟复苏对烫伤大鼠小肠上皮细胞凋亡及相关基因表达的影响

目的：探讨延迟复苏对烫伤大鼠肠粘膜上皮细胞凋亡百分率（ap%）及凋亡相关基因表达的影响。方法：Wistar大鼠30只，随机分为立即复苏组（ER）和延迟复苏组（DR）；30％体表面积Ⅲ度烫伤，采用DNA片段百分率测定、电泳和RT-PCR 观察伤后小肠粘膜上皮细胞ap%和ICE、bcl-2基因表达。结果：大鼠烫伤后小肠上皮ap%显著高于伤前（P＜0.01）；DR组肠上皮ap%显著高于ER组（P＜0.05-0.01）。DNA电泳可见明确梯形条带。烫伤后肠上此ICE基因表达明显增强，DR组ICE基因表达显著高于ER组（P＜0.01）。Bcl-2基因伤前在肠粘膜不表达，伤后极弱表达，两组比较无显著性差异。结论：烫伤延迟得苏后小肠上皮凋亡显著增加；促凋亡基因ICE和抑凋亡基因bcl-2的表达失衡可能是其凋亡剧增的重要原因之一。     

成批烧伤病人的抢救处理原则(附54例病例报告)

目的：探讨成批烧伤病人早期抢救与处理方法，商榷成批烧伤病人的数量。方法：本科1996年至2000年抢救成功的4批烧伤病人共54例，全部应用烧伤湿性医疗技术（MEBT/MEBO）治疗。对早期抢救治疗提出了7条处理原则。结果：治愈52例（治愈率96.30%）；死亡2例（病死率3.70%）；创面少量植皮4例（占7.70%），其余均为生理性愈合；创面平均愈合天数为26.61天，愈合创面无明显瘢痕及功能障碍。结论：成批烧伤病人早期严格执行MEBT/MEBO操作规程，坚持7条处置原则及中后期综合治疗方案，可提高成批烧伤病人的救治成功率。     

艾滋病病毒感染者罹患皮肤烧伤治疗体会

目的：总结艾滋病病毒HIV感染罹患皮肤烧伤的治疗和预防措施。方法：对1997年1月-2001年10月收治的两例烧伤前伴有艾滋病病毒感染病人隔离治疗，同时上报主管部门。结果：两例患烧伤创面均治愈出院，未发生并发症。建议到国家指定医疗单位采取强制性隔离治疗。结论：加强对入院烧伤病人HIV检测，避免HIV感染扩散。     

中药烧伤膏I号联合削痂治疗小面积Ⅲ度烧伤的疗效观察

目的　探讨中药烧伤膏1号联合削痂治疗小面积Ⅲ度烧的疗效。方法　常规清创和削、切痂后,局部贴敷中药烧伤膏Ⅰ号,创面溶脱,液化前隔日换药,以后每日换药直至创面愈合。结果　全部病例均未植皮,创面愈合良好,愈合时间25-48d,82％(59/72)病例在5周内治愈。结论　该法不需植皮,愈合快,瘢痕轻,不失为是治疗小面积深度烧伤的有效方法之一。