湿润烧伤膏治疗烧伤面积《30%TBSA主要并发症分析

笔对本单位1991年6月-2001年6月收治的336例经湿润烧伤膏治疗的中小面积烧伤患进行回顾性分析，结果表明：创面恶化、电解质紊乱、营养不良、脓毒症、肝肾功能不全、消化道应激性溃疡出血等7种并发症与湿润烧伤膏直接相关。     

湿润烧伤膏疗效观察

自 1993年 5月～ 2 0 0 0年 5月 ,我们收治 110例中重度烧伤病人 ,分别采用中药湿润烧伤膏 (ＭＥＢＯ)和磺胺嘧啶银 (ＳＤ -Ａｇ)进行治疗 ,结果表明ＭＥＢＯ治疗烧伤疗效优良。1　临床资料治疗组 80例 ,男 5 9例 ,女 2 1例 ;平均年龄(2 4 16± 16 2 7)岁。对照组 30例 ,男 2 4例 ,女 6例 ;平均年龄 (2 5 18± 14 4 2 )岁。主要致伤原因为火焰和开水蒸汽烧烫伤 ,分别占所有致伤原因的 4 1 8%(46例 )和 4 0 0 % (44例 )。化学烧伤中以酸碱烧伤比例较高 ,分别占总致伤原因的 5 5 % (6例 )和6 4 % (7例 )。电弧烧伤 3 6 % (4例 )。聚氯…     

湿润烧伤膏、碘伏、磺胺嘧啶银糊及雷夫诺尔治疗115例深Ⅱ度烧伤的效果比较

对115例深Ⅱ度烧伤分别使用湿润烧伤膏、0.25％碘伏、磺胺嘧啶银糊及0.1％雷夫诺尔液进行治疗,结果表明:深Ⅱ度烧伤使用湿润烧伤膏在创面愈合、抑菌效果、治疗费用及瘢痕增生等方面存在明显不足。因此,建议深Ⅱ度烧伤应慎重使用湿润烧伤膏。     

湿润烧伤膏、碘伏、磺胺嘧啶银糊及雷夫诺尔治疗115例深Ⅱ度烧伤的效果比较

对１１５例深Ⅱ度烧伤分别使用湿润烧伤膏、０．２５％碘伏、磺胺嘧啶银糊及０．１％雷夫诺尔液进行治疗，结果表明：深Ⅱ度烧伤使用湿润烧伤膏在创面愈合、抑菌效果、治疗费用及瘢痕增生等方面存在明显不足。因此，建议深Ⅱ度烧伤应慎重使用湿润烧伤膏。     

美宝湿润烧伤膏再生疗法与磺胺嘧啶银霜抗炎疗法治疗大面积烧伤的比较研究

目的：比较美宝湿润烧伤膏再生疗法与磺胺嘧啶银霜抗炎疗法治疗大面积烧伤的疗效.方法：选择62例大面积烧伤病人,随机分为两组,烧伤创面分别采用美宝湿润烧伤膏再生疗法（实验组）与磺胺嘧啶银霜抗炎疗法（对照组）治疗,观察两组病人休克期情况、不同深度烧伤创面的愈合时间、感染发生率、手术植皮例数及瘢痕发生率.结果：实验组病人休克期补液量明显比对照组少、尿量多于对照组（P＜0.05）;休克征象发生率比对照组少,但差异无显著性（P＞0.05）.实验组创面愈合时间、感染率、手术植皮比例及瘢痕出现率均明显低于对照组（P＜0.05）.结论：在大面积烧伤治疗中,美宝湿润烧伤膏再生疗法疗效优于磺胺嘧啶银霜抗炎疗法.     

湿润烧伤膏治疗烧伤患者的临床疗效及安全性

目的 探讨湿润烧伤膏用于治疗烧伤患者的疗效及安全性。方法 选择河北省沧州中西医结合医院东院区2020年1月-2021年12月收治的40例烧伤患者,根据治疗方法的不同将其分为观察组和对照组,各20例。对照组采用磺胺嘧啶银乳膏治疗,观察组采用湿润烧伤膏治疗,比较两组临床疗效、恢复时间、疼痛程度以及瘢痕情况。结果 观察组治疗总有效率为95.00%,高于对照组的70.00%（P＜0.05）;观察组创面愈合时间、肉芽生长时间均短于对照组（P＜0.05）;两组治疗后VAS疼痛评分均降低,且观察组低于对照组（P＜0.05）;观察组瘢痕发生率及瘢痕严重程度低于对照组（P＜0.05）。结论 为烧伤患者提供湿润烧伤膏进行治疗,可提升临床疗效,缓解疼痛程度,缩短患者创面愈合时间和肉芽生长时间,降低瘢痕发生率,其疗效及安全性均得到保障。     

湿润烧伤膏的临床疗效观察及评价

１９９０年３月至１９９３年２月收治在院外经湿润烧伤膏治疗的患者共２３例，大部分为中小面积灼伤。入院时除１例已成瘢痕畸形外，余２２例均为感染创面，其中１７例伴有全身中毒症状。本组并发败血症７例，其中３例死亡，死亡时间均在入院后４８ｈ以内，死亡率为１３％。１４例行扩创并自体皮移植术。１５例在不同的部位留有瘢痕，瘢痕发生率为６５％。因此，我们认为，湿润暴露疗法并非良好的治疗方法。     

湿润烧伤膏的临床疗效观察及评价

1990年3月至1993年2月收治在院外经湿润烧伤膏治疗的患者共23例,大部为中小面积灼伤。入院时除1例已成瘢痕畸形外,余22例均为感染创面,其中17例伴有全身中毒症状。本组并发败血症7例,其中3例死亡,死亡时间均在入院后48h 以内,死亡率为13％。14例行扩创并自体皮移植术。15例在不同的部位留有瘢痕,瘢痕发生率为65％。因此,我们认为,湿润暴露疗法并非良好的治疗方法。     

湿润烧伤膏的临床疗效观察及评价

１９９０年３月至１９９３年２月收治在院外经湿润烧伤膏治疗的患者共２３例，大部为中小面积灼伤。入院时除１例已成瘢痕畸形外，余２２例均为感染创面，其中１７例伴有全身中毒症状。本组并发败血症７例，其中３例死亡，死亡时间均在入院后４８ｈ、以内，死亡率为１３％。１４例行扩创并自体皮移植术。１５例在不同的部位留有瘢痕，瘢痕发生率为６５％。因此，我们认为，湿润暴露疗法并非良好的治疗方法。     

我国烧伤免疫的研究

The electric burn is a kind of special injury, in which the injured areas are not big, but deep tissues and organs are often injured, resulting in higher rates of mortality and amputation than thermal injury. In the process of management, besides the treatment for systemic and pathologic changes, wound repair is also emphasized for restoration of function. In the past 50 years, ten thound patients with electric burn were cured in our country, including hundreds of severe electric burn patients with extensive injury. Lots of operative regimes for electric burn were developed, and the scope of experimental research was broadening. As aresult, six monographs concerning electric burns were published. However, clinical management of severe electric burn to give a satisfactory result is still difficult, therefore further indepth research is necessary, especially in the field of the use of artificial skin, vessels, nerves, muscular tendon, etc. from gene and tissue engineering to improve quality of wound repair.     

Clinical characteristics and treatment of burn wound sepsis in extensive burn patients: successful experience with eight cases

Eight burn wound sepsis patients, in which 6 cases were diagnosed as MODS and two as septic shock, were treated consecutively in our hospital from September 1997 to October 1998. The plasma concentration of IL-6, IL-8, TNFα and LPS were assayed before and after surgical intervention, as well as when the patients' vital signs became stable. The results showed: ①The patients' conditions abruptly deteriorated when the burn wound sepsis emerged;②The major cause related to burn wound sepsis was extensive burn injuries, with large areas of deep burn remaining open; ③Although wound swabs taken on admission revealed the presence of colonization by many pathogenic bacteria, Pseudomonas aeruginosa was one of the most frequent bacteria isolated from the subeschar tissue; ④The plasma concentrations of IL-6, IL-8, TNF and LPS before surgical intervention were significantly higher than that after surgical intervention (P＜0.05) ;⑤The lowest level of the inflammatory mediators was observed when the patients' conditions became stable, as compared with before surgical intervention (P＜0. 001).These findings suggest that the clinical characteristics of burn wound sepsis are abrupt deterioration of the general condition and prominent septic symptoms, often complicated by MODS. The main cause of burn wound sepsis is the presence of a large area of open deep burn wounds, which should be excised and covered early. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn wound sepsis. Although success in treating these patients is the result of appropriate application of multiple treatments, early, aggressive and thorough surgical excision of invasive burn infectious tissue and closure of wound play a crucial role in the successful treatment of patients complicated by burn wound sepsis. Other treatments are adjuvant but also important.     

Experience in the treatment of patients with burns covering more than 90% TBSA and full-thickness burns exceeding 70% TBSA

OBJECTIVE: The objective of this study was to explore our experience in the treatment of serious burn patients (total burn surface area [TBSA] > 90% and full thickness burns > 70% TBSA). METHODS: Thirty patients who were admitted to our unit over a period of 12 years were analyzed retrospectively; 23 cases (76.7%) were successfully treated. RESULTS: There were seven out of 12 cases (58.3%) in the first 5 years and 16 out of 18 cases (88.9%) in the latter 7 years of the study period. CONCLUSIONS: It is concluded that: 1) giving electrolyte-free fluids (around 3700 ml) and the maintenance of hourly urine output at 70 ml or more appear to be beneficial in resuscitation therapy; 2) the first operative procedure should be undertaken early, at about the third day after injury; 3) a higher percentage area of eschar to be excised in the first operation is encouraged and eschar excision of up to 40% or more is preferable; 4) controlling the area of exposed wound under 5% in the entire therapeutic course is essential in the prevention of burn infection; 5) emphasis should be placed on the vital role of a dehumidifier in reducing the incidence of fungal infection; and 6) early enteral nutrition with the use of growth hormone in correcting the nutritional state of the patient is also emphasized.     

The antimicrobial efficacy of silver on antibiotic-resistant bacteria isolated from burn wounds

The antibiotic‐resistant bacteria are a major concern to wound care because of their ability to resist many of the antibiotics used today to treat infections. Consequently, other antimicrobials, in particular ionic silver, are considered ideal topical agents for effectively helping to manage and prevent local infections. Little is known about the antimicrobial efficacy of ionic silver on antibiotic‐resistant bacteria at different pH values. Consequently, in this study our aim was to evaluate the effect of pH on the antimicrobial efficacy of a silver alginate (SA) and a silver carboxymethyl cellulose (SCMC) dressing on antibiotic‐resistant bacteria isolated from burn patients. Forty‐nine antibiotic‐resistant bacteria, including Vancomycin‐resistant Enterococcus faecium, meticillin‐resistant Staphylococcus aureus, multidrug‐resistant (MDR) Pseudomonas aeruginosa, MDR Vibrio sp, MDR Stenotrophomonas maltophilia, extended‐spectrum ß‐lactamase (ESBL) producing Salmonella sp, ESBL producing Klebsiella pneumoniae, ESBL producing Proteus mirabilis, ESBL producing Escherichia coli and MDR Acinetobacter baumannii, routinely isolated from burn wounds were used in the study and evaluated for their susceptibility to two silver containing wound dressings using a standardised antimicrobial efficacy screening assay [corrected zone of inhibition (CZOI)]. The mean overall CZOI for the Gram‐positive isolates at a pH of 5·5 were very similar for both dressings. A mean CZOI of 5 mm was recorded for the SCMC dressing, which was slightly higher, at 5·4 mm for the SA dressing. At a pH of 7·0 both dressings, in general, showed a similar activity. However, at a pH of 8·5 the mean CZOI of the SCMC dressing was found to be significantly (P < 0·05) higher than the SA dressing for a select number of isolates. The mean overall CZOI for the Gram‐negative bacteria followed a similar pattern as observed with the Gram‐positive bacteria. Susceptibility to silver ions did vary significantly between genera and species of bacteria. Interestingly, when pH was changed from 8·5 to 5·5 antimicrobial activity for both dressings in general increased significantly (P < 0·05). Overall, all forty‐nine antibiotic‐resistant bacteria isolated from burn wounds showed susceptibility to the antimicrobial activity of both silver containing wound dressings over all pH ranges. In addition, the study showed that the performance of both dressings apparently increased when pH became more acidic. The findings in this study may help to further enhance our knowledge of the role pH plays in affecting both bacterial susceptibility and antimicrobial activity of silver containing wound dressings.     

Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis

The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p < 0.0001; MD 3.83; 95% CI 2.03–5.62) and dressings without silver (p < 0.007; MD 2.9; 95% CI 0.81–5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p > 0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p < 0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.     

应用异种皮作微粒皮移植覆盖物治疗深度烧伤的临床观察

目的探讨异种(猪)皮作为微粒皮移植覆盖物的可行性。方法选择10例深度大面积烧伤患者,于患者行切痂植皮术前1 d,将1只50 kg左右的纯白猪处死后清洗、剃毛、消毒,切取2张含少量脂肪的皮片,用鼓式取皮机反取成全厚或中厚皮。先播散自体微粒皮,再将猪皮打孔覆盖其上加压包扎。观察患者术后猪皮排异、微粒皮成活情况,以及创面愈合时间和术后1年患者的功能恢复情况。结果术后2周猪皮完整、与创面粘贴好;术后4～5周猪皮呈干痂状,逐渐与微粒皮分离,微粒皮已生长融合,创面基本愈合;术后6～8周猪皮全部脱落,创面愈合。10例患者创面愈合时间为42～56 d[(50±5)d]。术后1年见患者术区虽有表浅瘢痕,但其弹性和功能均恢复正常。结论用猪皮替代同种异体皮覆盖自体微粒皮修复深度烧伤创面可行。     

休克期切痂对烧伤并发症防治作用的临床分析

目的 探讨烧伤休克期切痂可行性及对并发症的防治作用。方法 对37例大面积烧伤休克期切痂植皮及42例非休克期切痂植皮患者，在脓毒症发生率，内脏并发症，多器官功能障碍（MODS）的发生率，死亡率及愈合时间多个方面进行比较分析。结果 37例休克期切痂植皮患者术后病情均稳定。脓毒症发生率，内脏并发症，MODS的发生率，死亡率低于非休克期切痂植皮组；休克期切痂植皮组较非休克期切痂植皮组愈合时间缩短。结论 休克期切痂植皮是治疗大面积烧伤的一种有效可行的方法，对大面积烧伤的严重并发症有明显防治作用。     

湿润烧伤膏在CO2点阵激光治疗浅表性瘢痕术后创面护理中的效果观察

目的：观察美宝湿润烧伤膏在CO2点阵激光治疗浅表性瘢痕术后创面护理中的应用效果。方法：将40例浅表性瘢痕患者随机分成实验组和对照组,用CO2点阵激光治疗。激光治疗后实验组使用美宝湿润烧伤膏护理创面,对照组使用莫匹罗星软膏护理创面,比较两组患者的疼痛指数、创面愈合时间、温哥华瘢痕量表评分和色素沉着发生率。结果：实验组患者的疼痛指数、创面愈合时间、温哥华瘢痕量表评分和色素沉着发生率四项指标均优于对照组,P〈0．05,差异均有统计学意义。结论：CO2点阵激光治疗浅表性瘢痕后使用美宝湿润烧伤膏护理创面可减轻创面疼痛,促进创面愈合,加强瘢痕治疗效果,减少色素沉着的发生。     

小切口真皮深层剪除大汗腺配合美宝外敷治疗腋臭

目的:探讨小切口真皮深层剪除大汗腺配合美宝外敷治疗腋臭的效果。方法:53例腋臭患者采用小切口真皮深层剪除大汗腺配合美宝外敷治疗腋臭,沿三等分标记切开皮肤皮下至脂肪层,以卵圆剪分离形成完整的皮下腔隙,轻轻翻开皮瓣,在直视下剪除大汗腺,间断分层缝合皮肤,选外侧切口处留置柱状橡皮条引流,在术前标记范围内涂布美宝烧伤膏,疏松纱块填盖腋窝,再以纱布绷带"8"字包扎,应用止血药2天,抗生素3天,术后第3天换药,去除引流条,再次给予术区涂布美宝烧伤膏同前一样纱布、绷带稍加压包扎,一般换药2～3次后即10～14天拆线。结果:53例患者,经术后6～12月随访,治愈者49例,显效4例,无无效者。部分病例在第1次换药时出现瘀血及皮瓣颜色深暗,给予加用TDP理疗灯照射处理后恢复。6例术后1月出现切口瘢痕增生给予外用康瑞宝等对症处理后恢复。结论:小切口真皮深层剪除大汗腺配合美宝外敷治疗腋臭操作简便,效果满意。