血清抗角蛋白自身抗体滴度消长对皮肤烫伤的影响

作者对家兔血清抗角蛋白自身抗体(AK auto Ab)滴度低下(实验组)及滴度正常(对照组)的皮肤烫伤进行了对比观察,并对烫伤后分界性炎症、表皮修复、表皮角朊细胞胞浆AK auto Ab含量进行检测。结果显示,实验组损伤明显、结痂较晚,分界性炎症出现较迟、程度较轻,表皮修复迟缓、愈合较慢,而角朊细胞胞浆内IgG AK auto Ab含量较低。提示,正常滴度的血清AK auto Ab在皮肤烫伤发展及修复的过程中,可能对机体起着重要的保护作用。     

表没食子儿茶素-3-没食子酸酯抑制烫伤诱导的小鼠皮肤巨噬细胞炎症蛋白-2的表达

目的 探讨表没食子儿茶素-3-没食子酸酯(EGCG)对局部烫伤诱导的小鼠皮肤组织巨噬细胞炎症蛋白-2（MIP-2）表达的影响 方法将
52只昆明种小鼠随机分为空白对照组、烫伤组和烫伤EGCG处理组,其中48只小鼠进行局部皮肤烫伤。利用实时定量PCR和ELISA法检测皮肤组织
MIP-2 mRNA和MIP-2蛋白水平。结果 局部烫伤可引起受损部位皮肤组织的MIP-2 mRNA和MIP-2水平升高,而涂敷0.2g/kg EGCG膏剂可使MIP-2表
达水平下降。结论 0.2g/kg EGCG膏剂抑制局部烫伤诱导的皮肤组织MIP-2表达,减弱由MIP-2引起的炎症反应,促进受损皮肤修复。     

大鼠烫伤后肠壁微血管通透性和肠组织含水量的变化

目的:观察大鼠烫伤后12h肠壁微血管通透性和肠组织含水量变化,探讨烫伤早期肠粘膜损伤的可能机制。方法:制作成年大鼠严重烫伤模型(Ⅲ度,30%TBSA),在未烫伤鼠及烫伤后12h应用分光光度法测量肠壁微血管通透性,测量回肠组织含水量。结果:对照组肠壁微血管对伊文思蓝有一定的通透性(12.39±5.062μg/g),烫伤后12h肠壁微血管对伊文思蓝通透性较对照组低(10.50±2.031μg/g),但无统计学意义(t=0.923,P>0.05);对照组回肠含水量为83.3±3.8%,烫伤后12h肠组织含水量比对照组稍低(82.9±1.5%),也无统计学意义(t=0.278,P>0.05)。结论:烫伤早期肠壁微血管通透性和肠组织含水量无显著变化,提示炎症介质在烫伤早期肠粘膜损伤中可能不是主要致病因子。     

Reduction in skin grafting after the introduction of hydrofiber dressings in partial thickness burns: A comparison between a hydrofiber and silver sulphadiazine

Aim/purpose

The aim of this study was to compare clinical outcome of children with scald burns treated with a hydrofiber dressing (Aquacel^®, Convatec Inc.) with the former standard of care with silver sulfadiazine (Flammazine^®; Solvay Pharmaceuticals), considering surgical intervention and length of stay (LOS).

Methods

A retrospective study of all consecutive children from zero to four years with primary scald burns up to 10% admitted to the Burn Centre of the Maasstad Hospital Rotterdam between January 1987 and January 2010 were reviewed. For data collection a prospective computerized database was used. For comparison the study period was divided into two periods representing the period before and after the introduction of the hydrofiber dressing (HFD), respectively 1987–1999 (period 1) and 1999–2010 (period 2).

Results

Over the whole study period 27.3% of 502 patients treated with silver sulfadiazine (Ag-SD) underwent surgery, while before the introduction of HFD 30.5% of 338 Ag-SD treated patients were operated upon. After the introduction of the HFD 20.7% of 164 patients treated with Ag-SD eventually underwent skin grafting, a significant difference with the 11.6% of 302 patients whose wounds were dressed with HFD (p < 0.01).

Conclusions

Compared to silver sulfadiazine treatment a reduced number of surgical interventions was observed in mixed partial thickness scald burns up to 10% TBSA burned in children aged 0–4 years after the introduction of hydrofiber dressings. The mode of treatment with this wound dressing also limited hospital length of stay.     

Use of Suprathel for partial thickness burns in children

We evaluated the use of Suprathel^®, a synthetic skin substitute, for partial thickness burns in children. Thirty-three children (20 females, 13 males; mean age 29 months, range 5 months to 11 years) with burns were treated with Suprathel^®. The burns were superficial partial thickness (n = 24) or mid-dermal (n = 19); the median %TBSA was 4% (range 1–13%).     

Patient reported facial scar assessment: directions for the professional

Background

The face is central to our identity and provides our most expressive means of communication. Currently, the role of facial scarring in relation to self-esteem is unclear and the value of self-reported scar assessment is insufficiently understood. The aim of this study was twofold: (1) to assess the extent of agreement between patients’ ratings and observers’ ratings of facial scar characteristics; and (2) to examine if patients’ and observers’ scar characteristics ratings, or the differences, are associated with the patients’ self-esteem.

Methods

A prospective study was conducted including patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale (POSAS) and the Rosenberg Self-Esteem Scale 3 months post-burn.

Results

Ninety-four subjects were included, 76 (81%) men and mean percentage TBSA burned was 12.4 (SD 10.4; range 1–50). Subject's and observer's assessment were significantly positively correlated and were identical in 53% of the cases. Subjects’ assessments and discrepancy scores on the scar characteristic surface roughness were associated with self-esteem in multiple regression analysis.

Conclusions

The majority of the patients scored the quality of facial scars in a similar way as the professionals. Furthermore, facial scarring appeared only moderately associated with self-esteem. However, our study suggests that using both patients’ and professionals’ scar assessments provides more useful information regarding the patients’ well-being relative to focussing on the separate assessments only. In particular a discrepancy between the patients’ and professionals’ view on surface roughness might be an early indication of psychological difficulties and a call for further clinical attention.     

复方薰衣草油膏治疗实验性豚鼠烫伤、抗炎及镇痛的效果观察

目的从炎症反应的角度探讨外用复方薰衣草油膏对烫伤豚鼠创面愈合的影响并观察其抗炎和镇痛作用。方法建立浅Ⅱ度烫伤豚鼠模型,将60只雄性豚鼠随机分为正常组、模型组、京万红组、复方薰衣草油膏高、中、低剂量组,分别外用生理盐水、京万红软膏、复方薰衣草油膏治疗,观察创面的大体变化及愈合情况,取治疗后的创面组织和血液标本,进行组织病理学检查和酶联免疫法测定血清TNF-α、IL-6、IL-8浓度;采用二甲苯耳肿胀模型和扭体法观察复方薰衣草油膏的抗炎、镇痛作用。结果外用复方薰衣草油膏使创面肿胀、渗出减轻,可能与局部组织中促炎细胞因子水平的降低有关(P0.01),并显著促进豚鼠浅Ⅱ度烫伤创面的愈合(P0.01),未见任何副作用;高剂量对二甲苯所致小鼠耳肿胀有抑制作用(P0.01);扭体法实验显示高剂量具有一定的镇痛作用(P0.01)。结论复方薰衣草油膏对烫伤皮肤创面有促愈合作用,同时具有一定的抗炎、镇痛作用。     

丁酸钠对重度烫伤大鼠心脏保护作用的研究

目的:探讨丁酸钠对重度烫伤大鼠心脏的保护作用.方法:雄性SD大鼠48只,随机分为假烫组、烫伤组和丁酸钠组(n=16).烫伤组和丁酸钠组采用沸水水浴法制作50％TBSA Ⅲ度烫伤动物模型,并于制模完成后即刻皮下分别注射丁酸钠400 mg/kg(丁酸钠组)或等体积生理盐水(烫伤组).假烫组以37℃水代替沸水.各组动物于烫伤后2.5 h和5.5 h从尾静脉注射异硫氰酸荧光素标记的葡聚糖蓝2.5 mg.伤后3h和6h,每组各取8只动物经腹主动脉穿刺取血,测定血浆肌酸激酶同工酶(CK-MB)水平;同时取心肌组织标本,测定葡聚糖蓝含量,以反映心脏微血管通透性的变化,干/湿重法测定心肌组织含水率.结果:与假烫组相比,烫伤组大鼠伤后3h和6h,血浆CK-MB水平明显升高(P＜0.05);心脏微血管通透性和心肌组织含水率明显增加(P均＜0.05).丁酸钠组大鼠在烫伤后3h和6h,血浆CK-MB水平、心脏微血管通透性和心肌组织含水率虽然高于假烫组,但较烫伤组均明显降低(P均＜ 0.05).结论:丁酸钠能够降低大鼠心肌微血管通透性和组织含水率,对于严重烫伤引起的心肌损害有显著保护作用.     

黄芪提取物联合重组人表皮生长因子对大鼠烫伤创面愈合和血管形成的影响

目的:观察黄芪提取物联合重组人表皮生长因子(rhEGF)对大鼠烫伤创面组织愈合和血管形成的影响.方法:Wistar大鼠80只,于背部2处制备直径2.8 cm深Ⅱ度烫伤创面,将大鼠随机分为:生理盐水对照组、黄芪提取物组、rhEGF组、黄芪提取物+ rhEGF组,每组20只.分别于创面形成后当日和第3、7、14、21天,观察创面并计算创面愈合率;计算微血管密度以及痂下组织pH,组织学检查大鼠创面皮肤并进行新生血管评分.结果:与黄芪提取物组及rhEGF组比较,黄芪提取物+ rhEGF组大鼠皮肤创面愈合时间显著缩短(P＜0.05),微血管密度、痂下组织的pH和新生血管的形成也明显增加(P＜0.01或0.05).结论:黄芪提取物联合rhEGF能显著增加创面愈合过程中的血管形成,显著缩短创面愈合时间.     

四君子汤加味防治烫伤后大鼠肠道损伤和细菌移位实验研究

目的　研究中药四君子汤加味对减轻烫伤后肠道损伤的影响。　方法　Wistar大鼠随机分为 3组 :烫伤治疗组 (简称治疗组 )管饲党参、茯苓、白术、甘草、大黄中药煎剂 2ml,2次 d ,烫伤对照组 (简称对照组 )和正常组管饲同量蒸馏水。根据指标设定于伤后不同时相点 ,分别处死大鼠检测肠粘膜和血浆中肿瘤坏死因子 (TNF)、一氧化氮 (NO)、丙二醛 (MDA)、ATP酶活性及肠粘液中S IgA含量 ,观察肠粘膜病理变化 ,行脏器组织细菌培养、血培养。　结果　中药四君子汤加味可明显降低烫伤大鼠血浆和肠粘膜TNF、NO和MDA含量 ,维持肠粘膜细胞分泌S IgA的功能 ,恢复T细胞数量 ,减轻肠粘膜屏障损害 ,减少脏器细菌检出率。　结论　中药四君子汤加味能够减轻肠粘膜损伤 ,防止肠道细菌移位