硅酮弹力绷带治疗增生性瘢痕的研究

目的：探讨治疗烧伤后增生性瘢痕的理想方法和材料。方法：依据压力疗法和有机硅治疗增生性瘢痕的作用原理,研制成硅酮弹力绷带,选择３２例烧伤后肢体有增生性瘢痕的患者,进行随机自身对照研究,比较应用硅酮弹力绷带与单独使用硅酮弹力绷带或弹力绷带的效果。结果：硅酮弹力绷带治疗增生性瘢痕的有效率治疗２个月时为５３％,４个月时为８４％,６个月时为９４％,硅酮气雾剂治疗组为２５％,５６％和６９％,而弹力绷带治疗组分别为１９％,５０％和６２％,组间差异有显著性（Ｐ＜０．０５）。结论：硅酮弹力绷带治疗增生性瘢痕的效果明显优于单纯硅酮治疗组或弹力绷带治疗组,可作为一种理想的方法和材料。     

压力疗法治疗瘢痕增生的护理指导

目的探讨压力疗法治疗瘢痕增生的护理指导。方法成立健康教育组、建立烧伤健康教育手册、教会病人采用弹力绷带或弹力套持续加压包扎创面，定时与出院病人联系，了解病人用弹力绷带或弹力套的情况，以利于正确指导病人。结果加压组1985例治疗效果满意，瘢痕增生少。结论正确的护理指导，可使患者较好地配合治疗，提高疗效。     

加压疗法在防治烧伤后瘢痕增生的疗效观察

加压疗法是烧伤科防治瘢痕增生最常用的方法,现将该疗法在本院临床观察结果进行总结,报告如下。1 对象与方法观察对象是1996年1月～2000年1月在本院烧伤科治疗120例病人,男87例,女33例,196个部位( 均在四肢),年龄15～54岁。方法：应用弹力套、弹力绷带,对自行愈合或须植皮修复的深Ⅱ度、Ⅲ度烧伤创面持续压迫。为使体表凹陷部位能均匀受压,需在弹力套(绷带)下放置压力垫。根据本院经验,内层压力以2.66～3.33kPa比较适合。疗程2～8个月。选择对侧伤情相同的瘢痕,不用任何治疗作为对照区域,开始治疗的前两周,每周随访, 以后每月…     

硅凝胶膜加弹力绷带联合应用治疗增生性瘢痕

目的硅凝胶膜加弹力绷带联合应用治疗烧伤后增生性瘢痕的临床疗效和机制探讨。方法随机选择43例烧伤后双侧肢体有增生性瘢痕产生的病例,采用同体对照研究的方法,研究探讨硅凝胶膜加弹力绷带联合应用治疗增生性瘢痕的疗效,并分别以单纯弹力绷带应用、单纯硅凝胶膜应用作为对照。结果在治疗3个月和6个月时,硅凝胶膜加弹力绷带联合应用治疗增生性瘢痕的效果明显优于单纯应用硅凝胶膜或单纯应用弹力绷带治疗组(P<0.01);在治疗12个月时,3组在治疗增生性瘢痕方面差异无显著性意义(P>0.05)。结论硅凝胶膜加弹力绷带联合应用治疗烧伤后增生性瘢痕的效果在治疗6个月时优于单纯硅凝胶膜治疗组和单纯弹力绷带治疗组,可以明显缩短疗程,是一种较好的治疗方法。     

硅凝胶膜加弹力绷带联合应用治疗增生性瘢痕

目的 硅凝胶膜加弹力绷带联合应用治疗烧伤后增生性瘢痕的临床疗效和机制探讨。方法 随机选择43例烧伤后双侧肢体有增生性瘢痕产生的病例，采用同体对照研究的方法，研究探讨硅凝胶膜加弹力绷带联合应用治疗增生性瘢痕的疗效，并分别以单纯弹力绷带应用、单纯硅凝胶膜应用作为对照。结果 在冶疗3个月和6个月时，硅凝胶膜加弹力绷带联合应用冶疗增生性瘢痕的效果明显优于单纯应用硅凝胶膜或单纯应用弹力绷带治疗组(P&;lt;0．01)；在治疗12个月时，3组在治疗增生性瘢痕方面差异无显著性意义(P&;gt;0．05)。结论硅凝胶膜加弹力绷带联合应用治疗烧伤后增生性瘢痕的效果在治疗6个月时优于单纯硅凝胶膜治疗组和单纯弹力绷带治疗组，可以明显缩短疗程，是一种较好的治疗方法。     

弹力加压时间对大腿供皮区瘢痕形成的影响

目的观察分组弹力加压包扎时限对大腿供皮区瘢痕形成的影响。方法选择2002-10/2003-09河北医科大学第三医院手外科住院植皮患者256例。选择患者大腿前内侧、中厚层未感染皮片,年龄、性别不限。随机分为实验组132例和对照组124例。实验组用自黏性弹力绷带分别持续加压包扎3个月(41例),6个月(53例),12个月(38例)。对照组伤口愈合后不再加压包扎。按“增生性瘢痕治疗效果的判断标准”评定瘢痕是否形成。结果按意向处理分析,256例患者均进入结果分析。实验组瘢痕形成率明显低于对照组(28.79%,54.03%,χ2=16.84,P<0.05),实验组弹力加压12个月瘢痕形成率显著低于3个月(18.42%,46.34%,χ2=17.12,P<0.05)。结论弹力加压时间延长,术后应用6～12个月时能显著降低瘢痕形成。     

稀土弹力绷带在瘢痕防治中的临床应用

目的观察稀土弹力绷带对瘢痕的临床疗效。方法增生性瘢痕34例,男15例,女18例,用稀土弹力绷带含有药物的平整面贴敷患处,并将绷带拉紧粘扣,保持一定压力。结果随访1～13个月,34例中17例显效,总有效率为88.2%。结论稀土与弹力绷带联合应用防治瘢痕,效果明显。     

乳腺癌术后皮下积液预防及护理

目的:探讨乳腺癌根治术后皮下积液的预防及护理方法.方法:将103例宫颈癌患者随机分为观察组52例和对照组51例,对照组患者进行常规护理,观察组患者给予弹力绷带加压包扎、手法挤压、腋下夹毛线球等方式,同时强化其他护理流程,实施护理干预.结果:观察组患者皮下积液发生率显著低于对照组 (P<0.05).结论:术后给予弹力绷带加压包扎+手法挤压、腋下夹毛线球等方式,同时强化其他护理流程,可有效预防皮下积液的发生.     

疤痕敌与弹力绷带联合防治烧伤后疤痕增生的疗效观察

目的观察疤痕敌与弹性绷带联合治疗烧伤后瘢痕增生的效果。方法选择烧伤后创面愈合1周的120例患者作为研究对象,按照患者住院号随机分为观察组66例,使用疤痕敌与弹力绷带联合治疗;对照组54例,使用疤痕敌防治方法。2组患者均采用相同的护理方案,观察并比较2组患者的自觉症状和临床疗效。结果观察组患者的自觉症状和临床疗效均优于对照组,比较差异有统计学意义(P<0.05)。结论正确的护理指导联合使用疤痕敌与弹力绷带防治烧伤后瘢痕增生比单纯使用疤痕敌效果更好,其在一定程度上减轻了烧伤后瘢痕增生及痒痛等不适感,值得临床推广应用。     

兔耳增生性瘢痕与血管内皮抑制素的抑制

目的:从外观形态、微血管计数、微循环血流灌注、组织形态学方面观察血管内皮抑制素对兔耳增生性瘢痕的抑制作用。方法:实验于2003-08/11在第四军医大学西京医院整形外科实验室完成。日本大耳白兔10只,随机将每只兔子的一只耳归入实验组,另一只归入对照组,每组10只兔耳。两组均进行增生性瘢痕动物模型的复制。兔耳创面上皮化后10d,实验组瘢痕组织局部多点注射血管内皮抑制素,对照组瘢痕组织局部多点注射生理盐水,两组注射剂量及频率为0.2mL/次,1次/隔日,连续6次。30d后观察两组瘢痕组织外观形态、微血管计数、微循环血流灌注以及病理组织形态学的差异。结果:20只兔耳全部进入结果分析。①外观形态变化:实验组瘢痕明显萎缩,略高出兔耳皮肤表面,颜色接近兔耳正常肤色,触之质软;对照组瘢痕呈增生期表现,明显高出兔耳皮肤表面,淡红色,质地坚硬。②微血管计数结果:实验组瘢痕组织表面微血管数量明显减少,散在分布;对照组瘢痕组织表面微血管数量丰富,相互交织成网状;40倍显微镜下微血管计数实验组明显低于对照组[(17.63±3.34),(51.23±5.54)个,P<0.01]。③微循环血流灌注变化:实验组明显低于对照组[(21.16±3.12),(64.27±4.28)个,P<0.01]。④病理组织形态学差异:实验组瘢痕组织真皮层变薄,血管及成纤维细胞数量明显减少,胶原纤维较细致,排列有序,呈成熟期表现;对照组瘢痕组织可见大量成纤维细胞,血管分布丰富,其间可见较多的炎细胞浸润,胶原纤维粗大,排列紊乱,呈增生期表现。结论:血管内皮抑制素对兔耳瘢痕增生及瘢痕组织的血管生成、微循环血流有明显的抑制作用,提示血管的发生与增生性瘢痕的形成有着密切关系,在增生性瘢痕形成早期有针对性的进行血管靶向治疗可有效抑制增生性瘢痕的形成。     

周期性压力培养对兔骨髓间充质干细胞增殖的影响

背景：各种外界应力对细胞增殖有重要作用,但涉及骨髓间充质干细胞最佳压力及加载时间的力学研究尚少。目的：探讨周期性压力培养对兔骨髓间充质干细胞增殖活性及细胞周期的影响。设计、时间及地点：细胞学体外对照实验,于2008-01/08在南昌大学重点分子生物实验中心完成。材料：健康6周龄雄性新西兰大白兔4只,由南昌大学实验动物中心提供。自行改制的细胞压力加载装置专利号ZL2006-2-0097266.3。方法：使用密度梯度离心法体外分离培养兔骨髓间充质干细胞,取生长良好的第3代细胞,按4×104个/孔接种于6孔板,设立5组：5.32,10.64,21.28,29.26kPa压力组分别给予对应的压力,每日加压6h×3d;正常培养组细胞只接受正常大气压力学刺激,不予额外加压。主要观察指标：力学干预后,观察细胞形态及生长状况,MTT法检测细胞增殖,流式细胞仪测量细胞周期变化。收集细胞培养上清液,检测基质金属蛋白酶2的质量浓度。结果：6h/d压力干预骨髓间充质干细胞,3d后细胞形态无异常变化,呈集落样生长。随着周期性压力的增加,细胞吸光度值逐渐升高,以21.28kPa压力组为佳,但升高至29.26kPa压力时吸光度值明显降低（F=3.731,P=0.008）。与正常培养组比较,5.32,10.64,21.28kPa压力组细胞周期发生改变,增殖指数均明显升高（P〈0.05或0.01）,但29.26kPa压力组增殖指数则明显下降。细胞培养上清液基质金属蛋白酶2质量浓度21.28kPa压力组最低,29.26kPa压力组最高,组间比较差异有显著性意义（t=213.214,P〈0.001）。结论：5.32～21.28kPa周期性压力可以提高骨髓间充质干细胞的增殖能力,特别是21.28kPa压力刺激促增殖作用尤为明显,但压力过强则抑制细胞增殖。     

经桡动脉冠状动脉介入术致前臂血肿的护理研究

目的 比较经桡动脉冠脉介入术致前臂血肿时两种处理方法的疗效,为临床护理前臂血肿寻求一种安全有效的方法。方法 将冠脉介入术后前臂血肿的患者随机分配至单纯前臂弹力绷带加压组(A组)和前臂弹力绷带加压联合肱动脉非阻断性加压组(B组),并比较两种方法疗效的差异。结果 经过处理,B组25例前臂血肿患者与A组24例比较,前组患肢疼痛程度显著低于后组,差异有统计学意义(P = 0.011)。术后24小时相对健侧的前臂肿胀程度,B组显著小于A组(P = 0.018)。两组间大水疱(直径>1cm)的数量无显著差异(P = 0.725)。结论 前臂弹力绷带加压包扎联合肱动脉非阻断性加压较单纯前臂弹力绷带加压处理疗效更好,且方法简便、安全。     

Tissue oxygenation and perfusion in patients with systemic sepsis.

OBJECTIVE: Multiple organ dysfunction is associated with systemic sepsis. To investigate whether this is attributable to peripheral tissue hypoperfusion and/or cellular hypoxia, simultaneous measurements of tissue perfusion and oxygenation were made in patients with severe sepsis and in controls. DESIGN: Prospective, observational study. SETTING: Adult intensive care unit, tertiary referral center. PATIENTS: Volunteers (group C, n = 7), patients undergoing cardiopulmonary bypass (group B, n = 6), and patients with severe sepsis (group S, n = 6). INTERVENTIONS: Limb ischemia and reperfusion. MEASUREMENTS AND MAIN RESULTS: Tissue oxygenation and microvascular flow were measured by using microelectrodes inserted into brachoradialis muscle and overlying subcutaneous tissue. Forearm cutaneous red cell flux and regional blood flow were measured simultaneously. Responses to 20 mins of limb ischemia and subsequent reperfusion were observed. Baseline muscle tissue oxygenation was greater in sepsis (1.7 +/- 0.2, 1.5 +/- 0.7, and 4.4 +/- 0.6 kPa for groups C, B, and S, respectively, mean +/- sem, p <.05), although baseline subcutaneous tissue oxygenation did not vary between groups. During ischemia tissue oxygenation, values decreased in muscle (to 1.3 +/- 0.2, 1.0 +/- 0.4, and 1.5 +/- 0.4 kPa for groups C, B, and S, respectively) and subcutaneous tissue (to 2.0 +/- 0.3, 1.7 +/- 0.5, and 2.3 +/- 0.2 kPa for groups C, B, and S, respectively). Decline in tissue oxygen tension was initially more rapid in septic muscle compared with controls (25% decrease, 68 +/- 23 vs. 176 +/- 38 for group S vs. group C, p <.05, and 50% decrease, 126 +/- 34 vs. 398 +/- 72 secs for group S vs. group C, p <.01). However, overall rate of tissue decline was similar (95% decrease, 444 +/- 122 vs. 614 +/- 96 for group S vs. group C, p >.05). After reperfusion, significant differences in muscle tissue oxygenation reappeared between groups (2.0 +/- 0.3, 1.5 +/- 0.7, and 4.0 +/- 0.4 kPa for groups C, B, and S, respectively, p <.05). There were no differences in time to 25%, 50%, or 95% tissue oxygen recovery. Whole limb reperfusion was significantly less in patient groups compared with controls (10.6 +/- 0.9, 4.5 +/- 1.2, and 4.3 +/- 1.6 mL x 100 mL(-1) x min(-1) for groups C, B, and S, respectively, p <.05). CONCLUSIONS: Significant differences in tissue oxygenation distribution between muscle and subcutaneous tissues occur in patients with severe sepsis. High baseline muscle tissue oxygen levels are accompanied by rapid extraction of oxygen during stagnant ischemia.     

坐位下体负压对人体大脑中动脉血流速度及血氧饱和度的影响

背景高过载致空中意识丧失的预防和监控,是当前航空航天医学研究的重要课题之一.目的探讨坐位下体负压(U-LBNP)对人体大脑中动脉血流速度(VMCA)和血氧饱和度(SaO2)的影响.设计非随机自身对照实验研究.地点和对象实验地点在本系脑功能实验室,实验对象为15名健康青年男性,均系本校大学二年级学员.干预每名被试者均受到-4.00,-6.67 kPa下体负压的作用.主要观察指标分别测试负压前、下体负压暴露于-4.00,-6.67 kPa的0.5,1,2,3,4,5 min和卸压后1,3,5 min的VMCA和SaO2.结果在-4.00kPa U-LBNP作用4,5 min时,VMCA减慢(P＜0.05);SaO2无明显改变.在-6.67 kPa U-LBNP作用2,3 min时,VMCA减慢(P＜0.05),在4min和5 min时显著减慢(P＜0.01),卸压后1 min尚未恢复(P＜0.05),随后恢复至对照水平;SaO2在负压暴露5 min时显著下降(P＜0.05).结论坐位下体负压造成血液在下肢淤积,VMCA减慢,引起大脑血供减少,为空中晕厥和立位耐力不良的医学鉴定提供了人体实验依据.     

Effect of cerebral perfusion pressure augmentation on regional oxygenation and metabolism after head injury

OBJECTIVE: In this study we have used O positron emission tomography, brain tissue oxygen monitoring, and cerebral microdialysis to assess the effects of cerebral perfusion pressure augmentation on regional physiology and metabolism in the setting of traumatic brain injury. DESIGN: Prospective interventional study. SETTING: Neurosciences critical care unit of a university hospital. PATIENTS: Eleven acutely head-injured patients requiring norepinephrine to maintain cerebral perfusion pressure. INTERVENTIONS: Using positron emission tomography, we have quantified the response to an increase in cerebral perfusion pressure in a region of interest around a brain tissue oxygen sensor (Neurotrend) and microdialysis catheter. Oxygen extraction fraction and cerebral blood flow were measured with positron emission tomography at a cerebral perfusion pressure of approximately 70 mm Hg and approximately 90 mm Hg using norepinephrine to control cerebral perfusion pressure. All other aspects of physiology were kept stable. MEASUREMENTS AND MAIN RESULTS: Cerebral perfusion pressure augmentation resulted in a significant increase in brain tissue oxygen (17 +/- 8 vs. 22 +/- 8 mm Hg; 2.2 +/- 1.0 vs. 2.9 +/- 1.0 kPa, p < .001) and cerebral blood flow (27.5 +/- 5.1 vs. 29.7 +/- 6.0 mL/100 mL/min, p < .05) and a significant decrease in oxygen extraction fraction (33.4 +/- 5.9 vs. 30.3 +/- 4.6 %, p < .05). There were no significant changes in any of the microdialysis variables (glucose, lactate, pyruvate, lactate/pyruvate ratio, glycerol). There was a significant linear relationship between brain tissue oxygen and oxygen extraction fraction (r = .21, p < .05); the brain tissue oxygen value associated with an oxygen extraction fraction of 40% (the mean value for oxygen extraction fraction in normal controls) was 14 mm Hg (1.8 kPa). The cerebral perfusion pressure intervention resulted in a greater percentage increase in brain tissue oxygen than the percentage decrease in oxygen extraction fraction; this suggests that the oxygen gradients between the vascular and tissue compartments were reduced by the cerebral perfusion pressure intervention. CONCLUSIONS: Cerebral perfusion pressure augmentation significantly increased levels of brain tissue oxygen and significantly reduced regional oxygen extraction fraction. However, these changes did not translate into predictable changes in regional chemistry. Our results suggest that the ischemic level of brain tissue oxygen may lie at a level below 14 mm Hg (1.8 kPa); however, the data do not allow us to be more specific.     

大黄对危重症患者胃肠粘膜血流灌注的影响

目的　研究大黄对胃肠粘膜血流灌注的影响。方法　选用激光多普勒血流监测仪和胃肠粘膜内pH(pHi)值作为评估失血性休克动物模型和脓毒症患者胃肠粘膜血流灌注的指标。结果　动物实验显示 :失血性休克大鼠尽管予以充分复苏 ,但胃肠粘膜的血流量仅是对照组的一半 ,给予大黄治疗 (5 0mg/kg)后 ,胃肠粘膜的血流量接近正常对照组 (P <0 0 1VS休克组 )。此外正常大鼠喂服大黄后胃肠粘膜的血流量显著提高 (P <0 0 1VS正常对照组 )。临床研究显示 :脓毒症患者胃和直肠粘膜内pHi明显低于对照组 (P <0 0 0 1)。多器官功能障碍综合征 (MODS)患者 ,其pHi显著低于非MODS患者 (P <0 0 0 1VS治疗前 )。另外 ,大黄对应激性胃粘膜病变有效率达 73%。结论　大黄能提高失血性休克大鼠和危重症患者胃肠粘膜内血流灌注。     

压力治疗及硅酮敷料治疗对增生性瘢痕疗效的短期研究

目的　采用客观的测试来比较硅酮敷料和压力治疗增生性瘢痕 2个月后的效果。方法　将96例具有增生性瘢痕的患者随机分为压力治疗组、硅酮敷料 (cicacare)组、压力及硅酮敷料综合治疗组 (综合治疗组 )和对照组。除对照组外 ,所有患者接受为期 2个月的治疗。结果　温哥华瘢痕量表总分显示 ,只有压力治疗组治疗前、后的差异有显著性意义。超声测量仪和色谱仪所测结果的双因素重复方差分析显示差异无显著性意义。配对t检验显示 ,与对照组相比 ,压力治疗组、硅酮敷料组以及综合治疗组在 2个月后瘢痕厚度的治疗差异均有显著性意义 ,但 3个治疗组之间的差异无显著性意义。在颜色参数方面 ,压力治疗组瘢痕的亮度 (P <0 .0 1)和红色 (P <0 .0 5 )改变的差异有显著性意义 ;硅酮敷料组瘢痕黄色 (P <0 .0 1)变化的差异有显著性意义。结论　根据初步的结果 ,压力治疗及综合治疗对减低增生性瘢痕厚度有较好效果。硅酮敷料治疗对改善瘢痕的血管增生和色素较为有效     

氯沙坦及氨氯地平对肾移植患者24 h尿蛋白及血、尿转化生长因子β_1的影响

目的:观察氯沙坦和氨氯地平对肾移植患者24 h尿蛋白及血、尿转化生长因子β_1的影响.方法:选择佛山市第一人民医院初次肾移植后伴轻、中度高血压(收缩压140～170 mm Hg,舒张压85～100 mm Hg, 1 mm Hg=0.133 kPa)患者40例,男23例,女17例,年龄(38.6±19.2)岁,随机数字表法分为氯沙坦组和氨氯地平组,每组20例.氯沙坦组口服氯沙坦50 mg/d治疗,氨氯地平组口服氨氯地平5 mg/d治疗,要求患者血压控制在130/80 mm Hg以下,治疗6个月后检测血压、肾功能、24 h蛋白尿与血、尿转化生长因子β_1水平.结果:40例患者均进入结果分析.患者用药后收缩压、舒张压均显著下降(P < 0.05),治疗6个月后,收缩压、舒张压均降至正常水平 (P < 0.01).治疗期间,2组血压下降值及平均动脉压比较差异无显著性意义 (P > 0.05).2组治疗总有效率比较差异无显著性意义 (P > 0.05).2组患者治疗前后血尿素氮、肌酐和血尿酸差异无显著性意义 (P > 0.05).治疗6个月后,氯沙坦组24 h尿蛋白与血、尿转化生长因子β_1水平较治疗前显著下降 (P < 0.05),氨氯地平组24 h尿蛋白与血、尿转化生长因子β_1水平无明显变化 (P > 0.05).氯沙坦组24 h尿蛋白与血、尿转化生长因子β_1水平均低于氨氯地平组 (P < 0.05).结论:氯沙坦与氨氯地平均可有效地控制肾移植患者的高血压状态,但氯沙坦可明显降低肾移植患者24 h尿蛋白与血、尿中转化生长因子β_1水平,氨氯地平的作用不明显.     

Magnetic Resonance Imaging is Superior to Cardiac Scintigraphy to Identify Nonresponders to Cardiac Resynchronization Therapy

Background: Left ventricular (LV) postero-lateral scar and total scar burden are factors responsible for a poor response to cardiac resynchronization therapy (CRT). Contrast-enhanced magnetic resonance imaging (CMR) and ^99mTc-2-methoxy isobutyl isonitrile single photon emission computed tomography (SPECT) perfusion imaging are widely used to detect myocardial scar tissue; however, their ability to detect regional scars and predict a positive response to CRT has not been fully evaluated.
Methods: CMR and SPECT were performed in 17 patients with dilated cardiomyopathy (DCM) and seven patients with ischemic cardiomyopathy (ICM) before CRT. All images were scored, using a 17-segment model. To analyze the LV scar regions by CMR, we assessed the transmural delayed enhancement extent as the transmural score in each segment (0 = no scar, 4 = transmural scar). Similarly, a perfusion defect score was assigned to each segment by SPECT (0 = normal uptake, 4 = defect).
Results: By both SPECT and CMR imaging, the total scar score was significantly higher in the ICM than in the DCM group. An LV postero-lateral wall scar region was detected using both imaging modes. By SPECT imaging, the percentage of regional scar score in the LV inferior wall was significantly higher in the DCM than in the ICM group.
Conclusions: By SPECT imaging in the DCM group, severe perfusion defects, due to attenuation artifacts, were frequently observed in the LV inferior wall, resulting in the overestimation of scar tissue. CMR identified nonresponders to CRT more reliably than SPECT in patients with DCM.