瘢痕治疗现状

伤口愈合后瘢痕的形成与增生,一直困扰着人们,是整形美容外科急需解决的难题.增生性瘢痕或瘢痕疙瘩在临床上较常见,发病率越来越高,其产生的内因,形成的机理尚不完全清楚,目前比较一致的看法是瘢痕组织内成纤维细胞增多和胶原纤维沉积,但缺乏有效、可靠的治疗方法,未从根本上解决防治瘢痕的问题.现对瘢痕的治疗现状作一综述.     

Saline irrigation and wound infection in abdominal gynecologic surgery.

OBJECTIVE: To evaluate whether saline wound irrigation decreases the incidence of wound infection following abdominal gynecologic surgery. METHOD: In this prospective randomized study, 104 patients underwent wound irrigation before wound closure following abdominal gynecologic surgery and 102 patients did not. RESULTS: There were no significant differences between the 2 groups in patient characteristics or in factors influencing the incidence of wound infection after abdominal gynecologic surgery. The incidence of wound infection was 10.6% among women who underwent wound irrigation and 9.8% among those who did not, and the difference was not statistically significant. CONCLUSION: Saline wound irrigation before abdominal wall closure is not helpful in decreasing the incidence of wound infection after abdominal gynecologic surgery.     

重组人酸性成纤维细胞生长因子促进烧伤与创伤愈合作用研究

目的观察重组人酸性成纤维细胞生长因子(rhaFGF)对小型猪创伤修复和家兔烫伤创面修复的促进作用。方法建立小型猪创伤模型，其中3组分别按90，60，30 AU·(cm2) 1的剂量给予人碱性成纤维细胞生长因子（haFGF），阳性对照组按60 AU·(cm2) 1的剂量给予rhbFGF，阴性对照组给予等量基质，空白对照组不给予任何药物，采用创面照像和透明膜描记称量法记录伤后第4，8，14天创面面积，用注水法测量伤腔容积。观察伤后第8天和第14天创面肉芽组织生长与再上皮化变化，评价修复效果。另建立家兔烫伤创面模型，分组与给药方法同上。观察伤后3，7，14，21 d创面面积，以及伤后14，21 d创面肉芽组织生长与再上皮化变化情况，评价修复效果。结果各组小猪创面面积随伤后时间的延长逐渐缩小，其中rhaFGF 90 AU·(cm2)^-1组和hbFGF 60 AU·(cm2)^-1组小猪的疗效更显著。各组小猪创面伤腔容积随伤后时间的延长而逐渐缩小，其中rhaFGF 90 AU·(cm2)^-1组和hbFGF 60 AU·(cm2)^-1组更为明显（P＜0.05）。组织学检查，可见经rhaFGF和rhbFGF治疗8 d后小猪的创面成纤维细胞生长活跃，数量多，毛细血管胚芽与成纤维细胞数量显著多于对照组。伤后第14天，各组家兔创面均已愈合，但各rhaFGF治疗组和阳性对照组家兔的创面表皮层较厚。各组家兔烫伤创面面积随伤后时间的延长而逐渐缩小，其中以rhaFGF 90 AU·(cm2)^-1组和hbFGF 60 AU·(cm2)^-1组的效果更明显。组织学检查，可见rhaFGF 90 AU·(cm2)^-1组家兔的创面在伤后14 d大部分已被新生表皮覆盖，表面附着少量坏死组织，创面基本愈合。结论rhaFGF对小型猪背部刀伤创面有促修复作用，可促进创面肉芽组织生长、毛细血管胚芽形成与再上皮化。rhaFGF对家兔背部烫伤创面有促修复作用，可促进创面肉芽组织生长，还可以促进坏死组织脱落与再上皮化。     

Risk Factors for Wound Infections after Vascular Surgery: Kuwait Experience

IntroductionWound infections represent a serious complication after vascular surgery particularly after vascular reconstructive procedures. We aimed to identify risk factors predisposing patients to these complications.MethodsThis was a retrospective review of open vascular surgical procedures performed between April 2014 and March 2019 in Kuwait. Patient demographics, procedures performed and their indications, and post-operative outcomes were collected and analyzed. Patients with pre-operative active infections were excluded from the analysis. Statistical analysis was performed, and odds ratios (ORs) and relative risks were calculated for the outcomes of interest. Fisher''s exact test and two-tailed t test were used where appropriate.Results391 patients were identified. The majority (54%) presented with chronic limb threatening ischemia. The mean age was 58 (±10) years, with a male predominance (76%). Wound infection occurred in 53 (14%) patients. The most commonly isolated organism was Staphylococcus aureus (47%). Diabetes (OR 8.03, 95% CI: 1.9142–33.7439, p = 0.0044), hypertension (OR 2.38, 95% CI: 1.2960–4.3684, p = 0.0052), ischemic heart disease (OR 2.30, 95% CI: 1.4349–4.6987, p = 0.0016), hyperlipidemia (OR 2.12, 95% CI: 1.0305–4.3620, p = 0.0412), and chronic renal failure (OR 2.55, 95% CI: 1.0181–6.4115, p = 0.0457) were all found to be significantly associated with the development of post-operative wound infections in vascular surgery patients.ConclusionDiabetes, hypertension, ischemic heart disease, hyperlipidemia, and chronic renal failure were associated with post-operative wound infections. Anticipation of wound complications in patients with these risk factors may aid early diagnosis and treatment.     

清热解毒方联合封闭负压引流治疗手外伤感染临床研究

目的 评价清热解毒方联合封闭负压引流治疗手外伤感染的疗效.方法 将符合纳入标准的108例手外伤创面感染患者采用随机数字表法分为2组,每组54例.对照组采用封闭负压引流治疗,观察组在对照组基础上加用清热解毒方.2组均治疗14d.分别于治疗前后对创面分泌物与肉芽组织进行评分,采用ELISA法检测血清IL-6含量,采用免疫量度法检测血清TNF-α含量,记录患者治疗后创面愈合情况及愈合时间.结果 治疗后,观察组分泌物评分[(1.6±0.4)分比(2.2±0.4)分,t=4.659]、肉芽组织评分[(1.7±0.2)分比(2.2±0.3)分,t=4.541]均低于对照组(P<0.01);血清IL-6[(64.89±2.31)μg/L比(72.18±3.02)μg/L,t=9.562]、TNF-α[(318.67±15.21)μg/L比(397.49±17.63)μg/L,t=15.611]水平均低于对照组(P<0.01);观察组创面愈合率为96.3%(52/54)、对照组为55.6%(30/54),2组比较差异有统计学意义(χ2=24.518,P<0.001);观察组创面愈合时间[(15.2±3.0)d比(25.2±4.7)d,t=11.551]较对照组缩短(P<0.01).结论 清热解毒方联合封闭负压引流可有效促进手外伤感染患者创面修复及愈合,降低炎性细胞因子水平.     

脱管散对创伤修复影响的实验研究

目的:以脱管散为载体,通过观察脱管散对大鼠创伤修复模型创面肉芽组织中相关生长因子及细胞外基质表达的影响,试图从分子水平探讨中药外用制剂促进创伤修复的机制。方法:采用经典创伤修复模型,收集创面肉芽组织中不同时期的肉芽组织,经过组织芯片技术处理后,用SABC法检测创面中bFGF、Fn的表达,高倍镜下病理切片观察,采用BI-2000图像分析系统进行定量灰度分析。结果:大鼠创面肉芽组织生长旺盛,创面肉芽组织中细胞所表达的生长因子分布存在差异,在造模后6d治疗组(脱管散组)bFGF表达与阳性对照组、空白对照组存在组间显著性差异(P<0.01);造模后6、14d治疗组Fn表达与阳性对照组、空白对照组存在组间差异(P<0.05)。结论:脱管散能够通过刺激创面内源性bFGF、Fn增加,进而促进创伤的修复。     

某基层医院切口术后感染增加原因与相应对策探讨

目的：分析我院切口术后感染增加的原因,并针对原因进行整改。方法：药师深入病房与手术室了解情况,查阅国内外文献,分析导致感染的原因,并对发现的问题采取相应对策。结果：通过药师对患者进行营养评估、劝导患者戒烟等工作,我院切口术后感染数量减少。结论：药师向患者提供药学服务可以减少患者术后感染的几率。     

胸部创伤致大量血胸的急救及护理体会

胸部创伤致大量血胸在胸外科较为常见,而胸膜腔内积血是胸外伤后常见的并发症,易造成有效循环血量骤减甚至休克,病情危急凶猛,常导致死亡。我们认为,在胸部创伤致大量血胸患者的急救过程中,护理人员要做到早期准确评估伤情和出血量,及时纠正休克,能为手术抢救和后继治疗争取时间并创造有利条件。而规范化、程序化的护理措施,能够使急救工作急而有序,行之有效;快速、敏捷的应急能力与急救技术是提高急救效果的根本保证,护士应根据病情制订规范化的预检抢救程序,保证护理工作准确无误,确保抢救成功。     

复方芩柏颗粒对大鼠放射性皮炎创面的影响

目的探讨复方芩柏颗粒治疗大鼠放射性皮炎的机制。方法建立大鼠度放射性皮炎模型,随机分为3组,分别给予复方芩柏颗粒喷雾伤口(实验组)、地塞米松软膏外涂(传统组)及生理盐水喷雾处理(对照组)。通过免疫组化染色及图像分析,测定各组伤后2、6、10、18、24d的创面肉芽组织、创面愈合率及创面组织中碱性成纤维细胞生长因子(bFGF)的表达。结果实验组肉芽组织平均数及创面愈合率在伤后6、10、18、24d各时间点均较对照组及传统组高,差异有统计学意义(P0.01或P0.05);bFGF的表达在6、10、18d时亦高于对照组及传统组(P0.05)。结论复方芩柏颗粒对大鼠度放射性皮炎有一定治疗作用,其机制之一可能与促进创面组织的bFGF表达有关。