中华烧伤杂志
Chinese Journal of Burns 중화소상잡지
- 主管单位： 中国科学技术协会
- 主办单位： 中华医学会
- 影响因子： 1.18
- 审稿时间： 1-3个月
- 国际刊号： 1009-2587
- 国内刊号： 50-1120/R
- 论文标题 期刊级别 审稿状态
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头皮轴型血管网皮瓣或带阔筋膜的股前外侧穿支皮瓣修复患者头皮恶性肿瘤根治性切除术后缺损的效果
目的 观察头皮轴型血管网皮瓣或带阔筋膜的股前外侧穿支皮瓣修复患者头皮恶性肿瘤根治性切除术后缺损的效果. 方法 2006年2月-2015年12月,笔者单位收治21例头皮恶性肿瘤患者,肿瘤侵犯颅骨外板或全层、硬脑膜.完善术前检查后,于入院后3～4d切除肿瘤及距肿瘤边缘3 ～5 cm范围内头皮组织,凿除颅骨外板或全层,硬脑膜有侵犯者切除局部硬脑膜,并行肿瘤周围前哨淋巴结清扫,术后形成ll cm ×8 cm～22 cm×18 cm缺损.将切除的头皮肿瘤切缘组织、颅骨、硬脑膜切缘及基底组织、前哨淋巴结送快速冰冻病理检查,其结果显示全为阴性后,同期行皮瓣移植术.3例高龄患者采用单个或多个头部轴型血管网皮瓣修复,皮瓣切取面积12 cm ×7 cm～19 cm×14 cm.另1 8例患者游离移植带阔筋膜的股前外侧穿支皮瓣修复,皮瓣切取面积13 cm×10 cm～23 cm×l9 cm,阔筋膜切取面积8cm×7cm ～ 10 cm×10 cm.头部供瓣区取头部或背部中厚皮片修复,大腿供瓣区取同侧大腿中厚皮片修复.患者术后均放弃放射治疗、化学治疗等后续治疗. 结果 本组所有患者术后皮瓣和皮片均完全成活,未出现血管危象等.随访6个月～9年,所有患者除头部术区秃发外,外形可,头部供瓣区和取皮区无明显畸形,脑组织无膨隆外疝,未出现肿瘤局部复发或远位转移.大腿供瓣区和取皮区外形可,肌力正常,下肢活动正常. 结论 头皮恶性肿瘤患者行肿瘤根治性切除术,并应用头皮轴型血管网皮瓣或带阔筋膜的股前外侧穿支皮瓣修复术后缺损,头部术区外形较佳,肿瘤无局部复发或远位转移.
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逆行足背外侧皮神经营养血管皮瓣修复第5足趾皮肤软组织缺损八例
第5足趾外伤后皮肤软组织缺损创面常伴有肌腱、关节囊和骨外露,易引发肌腱、骨坏死及骨髓炎,传统方法移植皮片修复皮片很难成活,治疗比较棘手,需要质地佳、耐磨的皮瓣修复.笔者采用逆行足背外侧皮神经营养血管皮瓣修复第5足趾皮肤软组织缺损8例,效果良好,现介绍如下.1 临床资料2009年3月-2016年7月,笔者单位收治第5足趾皮肤软组织缺损患者8例,其中男7例、女1例,年龄18～55岁.致伤原因为撕脱伤1例、电击伤6例、热压伤1例,创面均有不同程度的肌腱、骨外露.入院时间为伤后2h～7d,平均75 h.
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危重烧伤患者围手术期低体温的处理11例
1 临床资料2013年5月-2016年5月,笔者单位收治11例围手术期出现低体温的危重烧伤患者.患者均为男性;年龄21～52岁,平均37.5岁;烧伤总面积62％ ～98％TBSA,Ⅲ度烧伤面积35％ ～77％TBSA.致伤原因:热蒸气烫伤2例、火焰烧伤9例.创伤性低体温按严重程度分类,34～ 36℃为轻度低体温,32～34℃为中度低体温,小于32℃为重度低体温[1].患者中出现轻度低体温6例、中度低体温3例、重度低体温2例.
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游离背阔肌肌皮瓣修复电烧伤后头部巨大缺损六例
头部高压电烧伤往往伴有大面积头皮全层坏死和颅骨外露,甚至伴有颅骨部分坏死,给修复带来困难.传统的颅骨钻孔肉芽创面植皮术及局部皮瓣转移修复,效果欠佳.2010年1月-2015年12月,笔者单位采用游离背阔肌肌皮瓣修复6例高压电烧伤患者头部巨大缺损创面,效果良好,现介绍如下.1 临床资料本组患者均为男性,年龄18 ～ 32岁,均为接触高压电(电压10 ～300 kV)致头部及全身多处深度烧伤,烧伤总面积为10％～35％TBSA,深度为深Ⅱ～Ⅳ度.肢体及躯干合并伤情况为:3例患者双下肢及躯干Ⅲ度烧伤,2例患者单侧上下肢Ⅲ度烧伤,1例患者腕部Ⅲ度烧伤.头部致伤情况如下:6例患者头部均为电烧伤入口;致伤部位为单纯枕部1例、枕顶部5例;深度为Ⅲ～Ⅳ度,均合并头皮缺损及颅骨外露.头部原始创面面积12 cm× 10 cm～ 18 cm×16 cm,颅骨外露面积8 cm ×6 cm～ 15 cm× 12 cm.入院时间为伤后3h～1周.
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高质量浓度过氧化氢致烧伤一例
患者男,27岁,不慎被容器中喷溅出的常温过氧化氢(质量浓度为270 g/L)烧伤面部、右手、右前臂,立即用温水冲洗约1 min,后渐感到创面疼痛,于伤后30 min来院就诊.门诊以过氧化氢烧伤面部、右手、右前臂,烧伤总面积为6％ TBSA,深度为浅Ⅱ度,收治入院.入院体格检查示患者意识清楚,体温36.5℃,脉搏101次/min,呼吸频率20次/min,血压130/95 mmHg(1 mmHg =0.133 kPa),全身检查未见明显异常.实验室检查示血常规、肝功能、肾功能、血气分析等检测指标在正常值范围.患者创面呈褐色、轻度肿胀、少见水疱,部分疱皮撕脱后可见创面基底红润,触痛敏感,伴血浆样渗液.
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粪菌移植治疗特重烧伤并发肠功能障碍一例
患者男,48岁,2016年12月23日被火焰烧伤全身,伤后30 min送至当地医院,予静脉输注平衡盐溶液2 000 mL,留置尿管导出酱油色尿液.伤后12 h转入笔者单位,体格检查示体温37℃、脉搏120次/min、呼吸频率30次/min、血压90/60 mmHg(1 mmHg =0.133 kPa)、经皮血氧饱和度0.90.患者意识清楚,精神差,声音嘶哑,其头部、腹部、右股部、双足部共有30％ TBSA正常皮肤;其余部位均为烧伤创面,其中四肢、背部创面基底苍白,四肢肿胀明显,肢端湿冷,远端血运欠佳.入院诊断:(1)全身多处火焰烧伤,烧伤总面积70％ TBSA,其中深Ⅱ度15％ TBSA、Ⅲ度55％ TBSA.(2)低血容量性休克.(3)中度吸入性损伤.
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双阔筋膜张肌肌皮瓣联合左股直肌肌皮瓣修复电烧伤后下腹壁巨大缺损一例
患者男,40岁,2015年5月11日在拆卸铝合金窗框时,脸部不慎接触带电侧窗框,随后下腹部触电.患者无昏迷史,于伤后1h入院.入院后体格检查示患者意识清楚,表情痛苦,生命体征正常.右面部可见上起鬓角、下至下颌角有一长约12 cm的爆裂状伤口,深至颧骨,呈焦黄色,无出血.下腹部全层皮肤及部分肌肉坏死,面积达40 cm×30 cm,表面呈黑褐色焦痂,肠鸣音正常.头颅CT提示右侧面部软组织缺损,颅脑未见明显异常.腹腔CT未见明显异常.白细胞计数12.58×109/L,AST 102 U/L,肌酸肌酶3 436 U/L,乳酸脱氢酶305 U/L,其余实验室检查结果正常.入院诊断:电烧伤总面积7％ TBSA,其中面部1％ TBSA、下腹部6％ TBSA,深度均为Ⅲ度.
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负压伤口疗法促进真皮替代物血管化的研究进展
In clinical practice,skin defects resulted from various acute and chronic diseases occur frequently.Dermal substitute (DS),known as dermal regenerative template,is used more and more widely,but the slow process of vascularization limits its clinical application.At present,there are many strategies developed to enhance the process of vascularization,such as modifying the structure of dermal scaffolds,prevascular ization by seeding stem cells and/or endothelial cells.Recently,negative-pressure wound therapy (NPWT) emerged and rapidly became popular in promoting wound healing due to its intrinsic advantages.Furthermore,some researchers introduced this tech nique to accelerate the vascularization process of DS.This paper represents a comprehensive overview on the efficiency of NPWT in different combination models,and the related mechanism.
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羊膜移植物的制备及临床应用研究进展
Amniotic membrane has been used as wound dressing for more than 100 years.With the development of the preservation and preparation techniques,amniotic membrane is widely used in opbthalmology,burns,plastic surgery,dentistry,and neurosurgery.In recent years,as more and more amuiotic membrane is used in chronic wounds,it will be a new treatment method for wounds.This paper is a brief review about advances in preparation and clinical application of amniotic membrane graft.
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热休克因子1与热休克蛋白对创面愈合的作用及机制研究进展
Heat-shock proteins (HSPs) are the protective proteins expressed by cells under stress.Heat-shock factors (HSFs) are the key factors to regulate HSPs.Researches about the effects of HSF1 and HSPs in cells after stress and the mecha nism have become the important entry point to explore the cell response in wound healing after trauma.This article reviews the effects of HSPs and HSF1 which regulate the proteins on wound healing and the mechanism,so as to deliver message for studying effects of intervening HSF1 on expression of HSPs and wound healing and the mechanism.
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循环成纤维细胞在创面修复中的作用研究进展
Wound repair is a complex process involving multiple disciplines,cell factors,cell types,and signaling path ways.In recent years,many researches showed that circulating fibroblasts (cFbs) deriving from bone marrow and residing in peripheral blood,played a role in wound repair by migrating to wound sites,differentiating into fibroblasts and myofibroblasts,and secreting cytokines,extracellular matrix,ehemokines,growth factors,and antigen-presenting molecules,etc.cFbs also involve in three phases of inflammation,proliferation,and re modeling in wound repair of diabetes,ulcers,burns and other wounds,which indicate that tbey could be a potential treatment for wound repair.This article aims to review the latest develop ment in circulating fibroblasts and wound repair.
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重视分子成像技术 推动烧伤精准诊断
The explosive growth and advancement of computer science in recent decades have prompted the rapid development and wide applications of imaging techniques in life science,which have brought about revolutionary changes in modern medicine.Nowadays,it is possible to visualize multiple physiological and disease processes,precisely and non-invasive ly,in a living human body.Modern medicine has even started " reading the mind",to diagnose psychology,behavior and degenerative disorders of human brain.The border between the organic and inorganic diseases in old dogma is disappearing because imaging techniques have " visualized" the neurological and tissue changes of inorganic disorders.Severe burn injury is asso ciated with very complicated pathological processes,which are always at the borderline between life and death.Complete recovery of patients with severe burn injury,if possible,may take years of time.Hence,a real-time monitoring of the disease process is of pivotal importance in early recognition and preven tion of life-threatening complications and in assessing the therapeutic efficacy for a less-eventful recovery.Here we review and introduce some potential applications of modern imaging techniques in burn care and research,which may benefit burn patients.Some techniques are still in their early or pre-clinical stage and some are mature techniques in other fields of medicine,which are potentially applicable in burn diagnosis and treatment through our research.We intend to bring your interest to this field which may eventually lead to new revenues improving our clinical work on burn victims.
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从杭州燃爆事故看应急医疗救援的主要工作与挑战
In order to ameliorate the prognosis of patients in burn disaster,national emergency medical rescue expert teams are usually dispatched to incident areas.This article dis cusses the major work and challenges of the medical rescue expert teams using example of rescuing gas explosion accident in Hangzhou in last few days and author's personal experience of previous mission.The foremost mission of medical rescue expert teams is to provide feasible strategic advice for burn disaster res cue and pivotal critical care support.The medical rescue expert teams always begin their work in hospitals lack of experience in disaster rescue.According to the characteristics of "7 · 21 " Hangzhou gas explosion accident,the medical rescue expert teams focus on reassessment of the severity and hidden injuries of all patients,referral of patients according to the homeostasis status in patients with different severity,developing medical safety strategies,medical-related public safety strategies,and nosocomial infection control measure for rescue work.Furthermore,the medical rescue expert teams join the treatment for some critically ill patients and sudden emergency cases.The main challenges of medical rescue experts faced are accumulation and improvement of personal medical skill and powerful psychological endurance.Psychological counseling can play beneficial role in rescue group.In addition,establishing coordinated relationship among national emergency medical rescue expert teams,local administration,and local medical group shall be beneficial to disaster rescue.
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浅论烧伤病的内环境平衡
The essential internal environment in human being involves water,electrolyte,and acid-base balance,which is the basis of balance and stability of internal environment in other systems.For burn patients,the balance of internal envi ronment,referring to metabolism,nutrition,inflammatory response,and immunoreaction,is one of the most important aspects in burn disease.This paper aims to briefly elaborate the balance of internal environment after burn,with the purpose to promote the basic and clinical research in this field.
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中华医学会创伤学分会组织修复专业委员会与欧洲创面管理学会双边会谈纪要
2017年5月3-5日,中华医学会创伤学分会组织修复专业委员会(Chinese Tissue Repair Society,CTRS),简称中国组织修复学会,应邀组团参加在荷兰阿姆斯特丹举行的欧洲创面管理学会(European Wound Management Association,EWMA)第27届年会.EWMA成立于1991年,是于欧洲注册的国际性创面修复学术组织,也是目前具影响力的国际创面修复专业学会之一.本次会议有超过4 000名注册代表参加,其中中国代表大约70人.CTRS从2012年开始正式组团参加EWMA每年年会,并于2014年与EWMA建立了伙伴学会关系,其后每年均正式受邀参加EWMA年会,CTRS代表也多次受邀做大会发言、担任分会场主席.作为双方合作内容之一,每次年会期间CTRS和EWMA都会举行双边会谈,就2个学会合作的要点和项目进行总结和商讨.本次年会期间,EWMA现任主席Severin L(a)uchli、项目执行主任Jan N.Kristensen、CTRS现任主席付小兵院士及CTRS领导层代表参加了双边会谈.
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2017年中国医师协会烧伤科医师分会年会第十三届全国烧伤救治专题研讨会《中华烧伤杂志》编委工作会纪要
2017年7月13-16日,2017年中国医师协会烧伤科医师分会年会、第十三届全国烧伤救治专题研讨会、《中华烧伤杂志》编委工作会在甘肃兰州成功召开.本着集约高效的原则,会议期间还召开了《中华烧伤杂志》主编工作会和其他3个会议.本次会议由中国医师协会烧伤科医师分会、中华医学会烧伤外科学分会、《中华烧伤杂志》编辑委员会共同主办,解放军兰州总医院承办.解放军兰州总医院刘毅教授主持开幕式,尹强院长致欢迎辞.中国医师协会常务副会长兼秘书杨民,中华医学会杂志社刘冰副社长,《中华烧伤杂志》第四届编辑委员会总编辑黄跃生教授,中国医师协会烧伤科医师分会会长彭毅志教授,以及中华医学会烧伤外科学分会主任委员胡大海教授在开幕式上致辞.
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重度烧伤小鼠脾脏凝溶胶蛋白含量和mRNA表达及T淋巴细胞增殖活性的变化
目的 研究重度烧伤小鼠脾脏凝溶胶蛋白(GSN)含量和mRNA表达及T淋巴细胞增殖活性的变化,选择GSN的佳干预时间. 方法 取80只雄性BALB/c小鼠,按随机数字表法分为假伤组和烧伤组,每组40只.烧伤组小鼠造成背部15％ TBSAⅢ度烫伤(下称烧伤),伤后即刻皮下注射生理盐水1 mL,背部涂适量碘伏防治感染,每日1次.假伤组小鼠致假伤,伤后不补液、不外涂碘伏.分别于伤后0(即刻)、8、24、48、72 h,每组各取8只小鼠,无菌留取脾脏,噻唑蓝比色法检测脾脏T淋巴细胞增殖活性,ELISA法检测脾脏组织中GSN含量,实时荧光定量RT-PCR法检测脾脏组织中GSN mRNA表达.对数据行析因设计方差分析、单因素方差分析、LSD检验及Bonferroni校正.结果 (1)2组小鼠伤后0h的脾脏T淋巴细胞增殖活性无明显差异(P＞0.05),假伤组小鼠伤后8、24、48、72 h脾脏T淋巴细胞增殖活性显著高于烧伤组(P值均小于0.05).假伤组小鼠伤后各时相点脾脏T淋巴细胞增殖活性无明显差异(F =0.756,P＞0.05);烧伤组小鼠伤后8h脾脏T淋巴细胞增殖活性为0.12 ±0.04,显著低于组内伤后0、24、48、72 h的0.73 ±0.07、0.56±0.07、0.51±0.09、0.59 ±0.07(P值均小于0.05).(2)2组小鼠伤后0h脾脏组织中GSN含量无明显差异(P＞0.05),假伤组小鼠伤后8、24、48、72 h脾脏组织中GSN含量显著高于烧伤组(P值均小于0.05).假伤组小鼠伤后各时相点脾脏组织中GSN含量无明显差异(F=1.083,P＞0.05);烧伤组小鼠伤后8h脾脏组织中GSN含量为(11.9±2.6) pg/mg,显著低于组内伤后0、24、48、72 h的(37.7±2.9)、(19.9±4.0)、(24.1±4.1)、(24.6±4.0) pg/mg(P值均小于0.05).(3)2组小鼠伤后0h脾脏组织中GSN mRNA表达量无明显差异(P＞0.05),假伤组小鼠伤后8、24、48、72 h脾脏组织中GSN mRNA表达量显著高于烧伤组(P值均小于0.05).假伤组小鼠伤后各时相点脾脏组织中GSN mRNA表达量无明显差异(F =0.413,P＞0.05);烧伤组小鼠伤后8h脾脏组织中GSN mRNA表达量为0.307±0.064,显著低于组内伤后0、24、48、72 h的0.944±0.023、0.625±0.091、0.744 ±0.104、0.821±0.072(P值均小于0.05). 结论 重度烧伤可导致小鼠脾脏GSN含量及mRNA表达、T淋巴细胞增殖活性显著下降,且三者均是在伤后8h降至低,可选择伤后8h之前作为重度烧伤后GSN的佳干预时间.
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ω-3多不饱和脂肪酸对严重烧伤大鼠早期肠黏膜损伤的影响及其机制
目的 观察ω-3多不饱和脂肪酸(PUFA)对严重烧伤大鼠早期肠黏膜损伤的影响,并探讨其机制. 方法 取120只SD大鼠,按随机数字表法分为假伤组、单纯烧伤组和ω-3 PUFA组,每组40只.假伤组大鼠仅模拟烫伤过程.单纯烧伤组和ω-3 PUFA组大鼠背部造成30％ TBSAⅢ度烫伤(下称烧伤).伤后5 min,假伤组和单纯烧伤组大鼠按1 mL/kg经尾静脉注射生理盐水,ω-3PUFA组大鼠通过同样的方式按1 mL/kg注射ω-3 PUFA溶液.伤后3、6、12、24、48 h,3组分别取8只大鼠,收集腹主动脉血及肠黏膜,分光光度法检测血清二胺氧化酶(DAO)含量,ELISA法检测血清TNF-α、IL-6含量,蛋白质印迹法检测肠黏膜NF-κB-p65蛋白表达.对数据行析因设计方差分析、单因素方差分析、x 2检验、LSD检验及Bonferroni校正. 结果 (1)伤后各时相点,单纯烧伤组与ω-3PUFA组大鼠血清DAO含量明显高于假伤组(P值均小于0.01),ω-3 PUFA组大鼠血清DAO含量明显低于单纯烧伤组(P值均小于0.01).(2)单纯烧伤组与ω-3 PUFA组大鼠伤后各时相点血清TNF-α、IL-6含量均明显高于假伤组(P值均小于0.01),ω-3 PUFA组大鼠伤后各时相点血清TNF-α、IL-6含量均明显低于单纯烧伤组(P值均小于0.01).(3)单纯烧伤组与ω-3 PUFA组大鼠伤后各时相点肠黏膜NF-κB-p65蛋白表达量明显高于假伤组(P值均小于0.01).伤后3、6、12、24、48 h,ω-3PUFA组大鼠肠黏膜NF-κB-p65蛋白表达量分别为1.398±0.016、1.999±0.948、2.803±0.065、1.739±0.602、1.484±0.645,明显低于单纯烧伤组的2.096±0.113、3.402±0.189、4.183±0.558、3.618 ±0.408、2.614 ±0.775,P值均小于0.01. 结论 ω-3 PUFA可能是通过降低烧伤后肠黏膜NF-κB-p65蛋白表达及血清DAO、TNF-α、IL-6含量,抑制机体炎症反应,从而减轻严重烧伤大鼠肠黏膜损伤.
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| 2019 | 01 02 |
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