目的 研究2015—2019年解放军总医院第四医学中心烧伤整形医学部危重烧伤患者创面微生物年份变化趋势,以指导危重烧伤患者的抗感染治疗.方法 收集2015年1月至2019年12月解放军总医院第四医学中心收治的烧伤面积≥50％体表总面积的83例危重烧伤患者临床资料,统计创面微生物培养情况.结果 83例患者共分离出微生物2235株,其中革兰氏阴性菌占71.94％ (1608株),以铜绿假单胞菌、肺炎克雷伯菌及鲍曼不动杆菌为主要优势菌.铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌检出菌株数分别居第1～4位.铜绿假单胞菌为烧伤病房的常见病原菌,肺炎克雷伯菌检出率呈急剧上升趋势,鲍曼不动杆菌检出率呈逐渐下降趋势,金黄色葡萄球菌检出率趋于下降,真菌检出率有所上升.结论 2015—2019年烧伤病房危重烧伤患者创面微生物中以铜绿假单胞菌及肺炎克雷伯菌为主,需要重点防治.

From July 2018 to April 2019, 10 patients (8 males and 2 females, aged 5 to 53 years) who need skin grafting with 17 hands were admitted to the Fourth Medical Center of PLA General Hospital. The method of glove bandaging was used for wound hemostasis in skin grafting. After the initial hemostasis, sterile latex gloves were used as the inner cover of hand, and then pressure-wrapped with gauze. After 20 minutes, the gauze and gloves were removed in order from the near to the far, then thorough hemostasis was conducted again, and finally skin grafting was performed. The use of gloves as inner cover can avoid the adhesion of gauze fibers to the wound surface, so that it will not cause small blood vessels to re-bleed when the gauze is removed, therefore reducing the excessive use of electrocoagulation and secondary damage to the wound. As a result, blood loss can be reduced and hemostatic time can be shortened.

目的 观察饮用强化钙锌奶后士兵骨质指标、疲劳度指标及神经行为能力的变化.方法 选择某部男性士兵103名,年龄18～ 25岁,按照班建制整群随机分为2组,高钙锌奶组55名,普通奶组48名,均从事技术工作并正常参加体能训练,采用随机双盲对照研究,高钙锌奶组每日饮用强化钙锌奶(含Ca 150 mg/100 g,Zn 1.2 mg/100g),普通奶组每日饮用普通奶(含Ca 100 mg/100 g,Zn 0.4 mg/100g),均为每日2袋(每袋227 ml),连续干预12周后,收集血标本指标(血常规、血生化、维生素、骨钙素)、人体成分、骨密度等数据,行疲劳量测评和神经行为学能力评定,并与干预前进行比较.结果 共有94名受试者完成研究(高钙锌奶组51名、普通奶组43名),脱落率为8.74％.干预后两组血清骨钙素浓度较干预前均有升高,高钙锌奶组升高幅度更大[(0.59±0.36) ng/ml vs (0.41±0.38) ng/ml,P=0.037];干预后两组骨密度均有提高,但干预前后两组间差异无统计学意义(P＞0.05);两组骨质量较干预前均有提高,高钙锌奶组提高幅度显著高于普通奶组(4.25±6.69 vs 2.03±3.21,P=0.042);主观疲劳评定结果显示,高钙锌奶组疲劳评定总分值在干预后有所下降(4.25±3.12 vs 5.14±3.36,P=0.013).神经行为能力测试中,两组数字译码正确分值在干预后均有提高,高钙锌奶组提升幅度更为显著(7.41±9.53 vs 3.42±9.61,P＜0.001).高钙锌奶组目标追踪平均分值在干预后有所提高,普通奶干预后下降,两组间差异有统计学意义(9.23±24.60 vs-8.92±22.60,P＜0.001).结论 每天饮奶可以提高士兵骨质,而强化钙锌奶在骨钙素、骨质量指标上更具优势,并对缓解士兵训练疲劳、提高神经行为能力有一定作用.

We used Excel program to compile nutrition calculation program. A nutrition database for daily diet of patients with critical burns is established based on data sources of Chinese food composition table (2002 edition) , Chinese food culture academic symposium collection and common food nutrition table of the sports nutrition research center of Sports Medical Research Institute of General Administration of Sports of China, and label values of nutrition components of packaged food. According to the proportion of food net content, the formulas are adopted for calculating the dietary nutrition composition of patients with critical burns. An electronic scale is used to weigh the quality of food ingested through the mouth and gastric tube. After recording the weight into Excel scale, the value of nutrition content in patients' diet can be quickly and accurately generated automatically. It is convenient to calculate the water intake and output, which can quickly and accurately provide the dietary status assessment for patients with critical burns. It can not only calculate the total energy and water intake amount, but also calculate the daily protein intake and proportions of the three major nutrients in energy supply. Therefore, it provides a credible basis for further strengthening and improving nutritional support.

Objective: To observe the clinical effects of stage-Ⅱ Meek skin grafting on adipose tissue after tangential excision in patients with extensive deep burns, and to explore the functional mechanism. Methods: The medical records of 26 extensively burned patients who met the inclusion criteria and were admitted to the Department of Burns and Plastic Surgery of the Fourth Medical Center of PLA General Hospital from May 2015 to December 2017 were retrospectively analyzed. According to the treatment methods, 14 patients were enrolled in stage-Ⅰ skin grafting group (10 males and 4 females, aged 27 to 75 years), and 12 patients were enrolled in stage-Ⅱ skin grafting group (10 males and 2 females, aged 31 to 76 years). Patients in the 2 groups all underwent debridement of tangential excision, and their healthy adipose tissue was preserved. Meek skin grafting was performed just after tangential excision in patients in stage-Ⅰ skin grafting group. In patients in stage-Ⅱ skin grafting group, porcine acellular dermal matrix (ADM) was applied to cover the wound after tangential excision, and 3 days later, it was removed and Meek skin grafting was performed. The times of complement skin grafting and the wound basic healing time of patients in the 2 groups were observed and recorded. In the stage-Ⅱ skin grafting group, the adipose tissue of patients were taken from the wound center immediately after tangential excision and immediately after the removal of porcine ADM, for the observation of structure of the fault surface of adipose tissue through hematoxylin and eosin staining and microvessel density (MVD) through immunohistochemical staining. Data were processed with independent sample t test and Fisher's exact probability test. Results: (1) The times of complement skin grafting of patients in stage-Ⅱ skin grafting group was (1.83±0.17) times, which was obviously less than (3.36±0.63) times in stage-Ⅰ skin grafting group (t=2.19, P<0.05). The wound basic healing time of patients in stage-Ⅱ skin grafting group was (35.1±2.3) d, which was obviously shorter than (48.8±4.9) d in stage-Ⅰ skin grafting group (t=2.27, P<0.05). (2) Immediately after tangential excision, the intercellular substance was few between the adipose cells in adipose tissue of patients in stage-Ⅱ skin grafting group. Immediately after the removal of porcine ADM, there was regenerated granulation tissue in the intercellular space of adipose cells of adipose tissue of patients in stage-Ⅱ skin grafting group. Immediately after tangential excision, the MVD of adipose tissue of patients in stage-Ⅱ skin grafting group was 20.2±1.3 under per 400-time field, which was obviously less than 32.2±1.9 under per 400-time field immediately after the removal of porcine ADM (t=-5.38, P<0.01). Conclusions: Meek skin grafting on the adipose tissue in stage-Ⅱ surgery after tangential excision could reduce the times of complement skin grafting and shorten wound healing time of patients with extensive deep burns. The mechanism may be related to the improvement of the recipient condition of adipose tissue.

Objective To explore the surgical methods for children with contracture deformity on hands after burn.Methods From January 2014 to January 2018,33 pediatric patients,a total of 42 hands with scar contracture deformities were reviewed.There were 24 males and 9 females,aged from 11 months to 6 years and 7 months.Among them,20 hands were volar metacarpophalangeal joint contractures,9 were volar interphalangeal joint contractures,7 were dorsal metacarpophalangeal joint contractures (3 claw-shaped hands),3 were hand back contractures,and 3 were palm contractures.Of the 42 hands,36 hands were repaired with full-thickness skin grafts or split-thickness skin grafts,after the removal of contracted scar,and 6 hands were repaired with abdominal skin flaps,due to the tendon or bone exposure after the scar removal.Results Skin grafts on 31 hands were all survived after 2 weeks.However,the survival area of 3 skin grafts was about 90％,and 2 skin grafts survived about 80％.All of them healed well after dressing changing.The 6 hands repaired with abdominal skin flap healed well too.After 1-2.5 years of follow-up,finger scar contracture occurred in 4 hands with skin grafting,and they were performed scar excision and sheet skin grafting.Three hands were treated with Z-plasty,due to web space contracture.The function of other hands were normal,without contracture or deformity.The skin color and texture were similar to the surrounding skin,with limited pigmented.Scars on the edge of skin grafts was not obvious.Patients and their families were satisfied.Conclusions The sheet skin graft is the main method for postburn scar contracture in children's hands.The abdominal skin flap should be considered,if tendon or bone is exposed,especially for large wound or multiple sites.

综述中链脂肪酸和α-亚麻酸的来源、生理功能及应用与其对阿尔茨海默病(AD)的改善作用及其机制,旨在为相关研究提供科学依据.

Objective To observe the effects of oral probiotics supplementation (Lactobacilluscasei strain Shirota, LcS) on inflammatory response, upper respiratory-tract infection, and immune function of soldiers in military training. Methods This was a randomized controlled trial. We recruited 100 male volunteers from soldiers in Chinese PLA General Hospital. The volunteers were randomly divided into experimental group (n=50, received 100 ml of fermented milk beverage containing LcS twice a day) and control group (n=50, received 100 ml of ordinary milk twice a day). The dietary intake, upper respiratory tract infection and gastrointestinal reaction were investigated and the NK cell activity, serum inflammatory factors, and immune indicators and saliva IgA levels were measured at 0, 2 and 4 months, respectively. Results A total of 87 subjects completed the intervention (45 in experimental group and 42 in control group), with the lost to follow-up rate of 13％. At 2 months, the levels of serum lgG, CD3 and CD4 were significantly higher in the experimental group than those of control group [IgG, (1 268.24土290.81) mg/dl vs (1 124.53 ±272.79) mg/dl; CD3, (0.72 ± 0.07) vs (0.66±0.05); CD4, (0.38±0.07) vs (0.35±0.05); all P ＜ 0.05]; At 4 months, the levels of serum lgE, lgG, CD3, CD4, CD4/CD8, saliva IgA, neutrophils and lymphocytes were significantly higher in experimental group than control group [lgE, (231.14±177.71)mg/dl vs (142.74±112.08) mg/dl; lgG, (1 243.22±290.58) mg/dl vs (1 036.23±228.71) mg/dl; CD3, (0.70 ±0.05) vs (0.65 ± 0.04); CD4, (0.41 ±0.06) vs (0.34 ±0.04); CD4/CD8, (1.68 ±0.43) vs (1.31 ±0.32); saliva IgA, (181.67±39.12) μ g/ml vs (147.38±33.53) μ g/ml; neutrophils, (0.57±0.06) vs (0.53±0.08); lymphocytes, (0.53 ± 0.08) vs (0.33 ±0.06); all P ＜ 0.05], while serum C-reactive protein, IL-1 level and white blood cell count were significantly lower in experimental group than control group [serum C-reactive protein, (0.31 ±0.02) mg/dl vs (0.51 ±0.25) mg/dl; IL-1, (9.96 ± 4.44) pg/ml vs(14.51±6.67) pg/ml; white blood cell, (5.10 ± 0.35)109/L vs (7.12±0.93)109/L; all P ＜ 0.05]; The incidence of gastrointestinal disease in experimental group was significantly lower than that of control group (2 months, 4.45％ vs 23.80％; 4 months, 4.45％ vs21.43％; P ＜ 0.05, respectively); The incidence of upper respiratory tract infection in the two groups showed no significant difference (2 months, 8.89％ vs 11.90％; 4 months, 8.89％ vs 11.90％; P ＞ 0.05, respectively), but it showed a downward trend. Conclusion Long-term oral LcS supplementation can reduce the inflammatory response and improve the immune function, which may be beneficial to preventing upper respiratory tract infection.

结合多年来我院烧伤外科带教进修医师的教学经验,初步探讨分析了烧伤外科进修医生的个体特征,调研进修医生的学习需求,以及他们对带教老师的个人期望;认为以下方面,对提高烧伤外科进修医生的教学水平极为有益:充分利用多媒体光影技术,重视直观形象教学;积极组织科室定期小讲课,增加交流学习心得治疗体会;建立微信专业公众号,合理利用网络学术交流平台增加教学手段;重视危重疑难病例讨论与术前讨论,提倡问题式教学.通过上诉举措,开拓教学了手段,营造良好的教学氛围,积极倡导个体化的教学思路,强化对进修医生的科学教学和管理,对教学医院把握医疗质量、维护自身品牌有重要意义.

Burn rehabilitation in China started from compression therapy in the mid-1970s, which showed the dual effects of prevention and treatment of hypertrophic scars. It not only promoted functional rehabilitation but also strengthened the confidence of patients in rehabilitation treatment. Thereafter, more therapies were brought into practice, such as intra-scar injection of triamcinolone acetonide, application of plastic splints, hydrotherapy, exercises with equipment, skin care, local therapeutic massage, active and passive exercises, as well as external use of drugs for inhibiting scars and pigments. Since the beginning of the 21st century, rehabilitation therapies have been gradually increasing. Psychological rehabilitation, occupational therapy, external use of silicone gel, wax therapy and sound, light, electricity, and radiation therapy have been carried out. Many hospitals have established foundations and held summer camps for children. As far as the whole country is concerned, compared with the huge demand, we still face a number of problems such as shortage of working staff, limited working space, capital chain rupture, lack of multi-disciplinary cooperation, untimely treatment, and incomplete rehabilitation. Nowadays, with increasing knowledge of burn rehabilitation and number of practitioners, improvement of equipment and economic situation, the pace of rehabilitation has accelerated, and the overall implementation of burn rehabilitation therapy has shown great vitality. Patients with burn injury involving over 80% total burn surface area (TBSA) of total burn area or full-thickness burn over 60% TBSA were cured and recovered in different levels of hospitals nationwide, which not only reflects the superb level of burn treatment in China but also reflects the overall improvement of rehabilitation level of the country.

Objective: To observe the effects of minimally invasive tangential excision in treating deep partial-thickness burn wounds on trunk and limbs in pediatric patients in the early stage post burn. Methods: Clinical data of 40 children with deep partial-thickness burn wounds on trunk and limbs, admitted to our burn ward from January 2016 to June 2017, conforming to the study criteria, were retrospectively analyzed. They were divided into conventional treatment group (CT, n=19) and minimally invasive tangential excision group (MITE, n=21) according to the different treatments. The patients in group CT were treated with eschar-reserving therapy firstly. When tangential excision was performed, the roller knife was used, and no necrotic tissue left on the wound bed was considered the proper depth of excision. Razor-thickness skin grafting was performed to cover the wound when adipose tissue exposed markedly after tangential excision. Dressing change was performed within 48 h after the operation and repeated every 2 days. Unhealed wounds were covered by razor-thickness skin grafting. The patients in group MITE were treated with tangential excision in the early stage post burn. The tangential excision was operated with electric dermatome, and the thickness was set at 0.1 mm to excise the surface of eschar until the sporadic punctate hemorrhage on wound surface was observed and some necrotic tissue was left on the wound bed. Porcine acellular dermal matrix was applied after tangential excision. The first dressing change was often performed about 1 week after the operation. Razor-thickness skin grafting was performed to cover the unhealed wounds. The length of wound healing, high fever, antibiotic usage, and hospital stay, times of later operation, and hospitalization expenses of patients in the 2 groups were recorded. The excisional eschar and wound bed tissue of patients in group MITE were harvested for pathological observation. Data were processed with t test and Fisher's exact probability test. Results: (1) There were no statistically significant differences in length of high fever and length of hospital stay and hospitalization expenses between patients in the 2 groups (t=-1.67, -1.93, 0.31, P>0.05). The lengths of wound healing [(24.8±2.5) d] and antibiotic usage [(4.4±0.7) d] of patients in group MITE were significantly shorter than those in group CT [(33.3±2.5) and (7.0±0.7) d, t=-2.44, -2.44, P<0.05], and times of later operation of patients in group MITE [(0.29±0.14) times] were significantly less than those in group CT [(0.79±0.21) times, t=-2.03, P<0.05]. (2) The thickness of the excisional eschar of patients in group MITE was about 150 μm. The eschar has epidermis and upper dermis. Some necrotic tissue was left on the wound bed. Conclusions: The treatment for pediatric deep partial-thickness burn wounds on trunk and limbs with minimally invasive tangential excision using electric dermatome in the early stage post burn can accelerate wound healing, shorten length of antibiotic usage, and reduce times of later operations.

There are many experimental parameters used in diagnosis and assessment of sepsis and infective diseases.As a proven technique,blood routine test could not be replaced by these new techniques.In recent years,the parameters of blood routine test have been deeply explored.It has been found that many parameters have much significance in assessment of sepsis and infective diseases,especially platelet,lymphocyte counts and neutrophil-lymphocyte ratio.These parameters reflect the conditions of sepsis and infective diseases from different aspects,which further improves the value of blood routine test.

Objective To observe the effect of Maca or compound Maca on symptoms of menopause syndrome (as well as fatigue,depression and anxiety,hormone levels and antioxidant indexes).Methods This was a randomized controlled double-blind trial.Eighty subjects with menopausal syndrome were recruited and randomly assigned into compound Maca group (compound Maca,6 tablets/day,n=40) and Maca group (Maca,7 tablets/day,n=40).The intervention lasted for 3 months,and then the changes of Kupperman score,FS-14 score,PHQ-9 score and GAD-7 score,serum estrogen level and antioxidant index between two groups and self-contrast were compared.Results Seven subjects were lost to follow-up (8.75％),and the rest of subjects (compound Maca group,n=37;Maca group,n=36) were included in analysis.Comparison between pre-intervention and post-intervention revealed that Maca and compound Maca were both able to enhance memory,improve insomnia,alleviate symptoms of urinary system and reduce serum malondialdehyde (MDA) level (P ＜ 0.05 respectively);Compared with Maca group in post-intervention,compound Maca could improve memory and insomnia more significantly (P ＜ 0.05,respectively).Conclusion Oral supplement of Maca or compound Maca can improve memory and insomnia,alleviate symptoms of urinary system,and enhance the ability anfioxidation in the menopausal women,and the effect of compand Maca in improving memory function is more significant.

OBJECTIVETo assess nutritional status and define gender- and age-specific handgrip strength (HGS) cut-point values for malnutrition or nutritional risk in elderly inpatients.METHODSA cross-sectional study of 1,343 elderly inpatients was conducted in the Chinese PLA General Hospital. Nutrition Risk Screening (NRS 2002) and Subjective Global Assessment (SGA) were administered. Anthropometric measurements and blood biochemical indicators were obtained using standard techniques. The gender- and age-specific receiver operating characteristic (ROC) curves were constructed to evaluate the HGS for nutritional status by SGA and NRS 2002. Sensitivity, specificity, and areas under the curves (AUCs) were calculated.RESULTSAccording to NRS 2002 and SGA, 63.81% of elderly inpatients were at nutritional risk and 28.22% were malnourished. Patients with higher HGS had an independently decreased risk of malnutrition and nutritional risk. The AUCs varied between 0.670 and 0.761. According to NRS 2002, the optimal HGS cut-points were 27.5 kg (65-74 years) and 21.0 kg (75-90 years) for men and 17.0 kg (65-74 years) and 14.6 kg (75-90 years) for women. According to SGA, the optimal HGS cut-points were 24.9 kg (65-74 years) and 20.8 kg (75-90 years) for men and 15.2 kg (65-74 years) and 13.5 kg (75-90 years) for women.CONCLUSIONElderly inpatients had increased incidence of malnutrition or nutritional risk. HGS cut-points can be used for assessing nutritional status in elderly inpatients at hospital admission in China.

Objective: To investigate the changes of immune function of regulatory T cells (Tregs) in peripheral blood of patients with severe burns, and explore its correlation with the complicated sepsis. Methods: Forty patients with burn area ≥ 30％ total body surface area (TBSA) were enrolled in present study, and divided into sepsis group (n=26) and non-sepsis group (n=14). The peripheral venous blood samples were collected on 1, 3, 7, 14, 21 and 28 days after injury to separate CD4+CD25+Tregs. The expressions of FOXP3 and CTLA-4 on the surface of CD4+CD25+Tregs were measured by flow cytometry, and the levels of mean fluorescence intensity (MFI) of interleukin-10 (IL-10) as well as transforming growth factor-β (TGF-β) in CD4+CD25+Tregs were further determined by flow cytometry after stimulation in vitro. Results: The expressive levels of FOXP3 in CD4+CD25+Treg increased significantly 7 and 14 days after injury, and of CTLA-4 markedly enhanced 14 days after injury in sepsis group than in non-sepsis group (P<0.05). The MFI of IL-10 in CD4+CD25+Tregs at the 1st day after injury was significantly higher than the health controls (P<0.01), and the IL-10 MFI level on day 21 after injury was markedly higher in sepsis group than in non-sepsis group (P<0.05). Likely, TGF-β MFI levels in CD4+CD25+Tregs on day 14 and 21 were significantly higher in sepsis group than in non-sepsis group (P<0.05). Conclusions: The immune response of Tregs shows dramatic enhancement in patients with severe burns, which further down-regulates the cell-mediated immunity by releasing immunosuppressive cytokines including IL-10 and TGF-β. Dynamic monitoring the expression and function of Tregs might be helpful for assessment of the clinical course as well as septic complications in patients following extensive burns.

Objective To compare the treatment effect of autologous blister skin grafting with ReCell autologous chromocyte grafting on cicatricial depigmentation caused by deep burn.Methods Thirty-four patients with cicatricial depigmentation caused by deep burn who were admitted into hospital from May 2012 to February 2015 were included in this study.The total 61 depigmentation areas were randomly divided into two groups;32 areas from 18 patients were treated with autologous blister skin grafting,and the other 29 areas from 16 patients were trea-ted with ReCell autologous chromocyte grafting.In the autologous blister skin grafting treated group,epidermis from the depigmentation area was removed by grinding with a BY-II AM type epidermal graft vitiligo treatment equipment.Then the autologous blister skin was harvested with the suction blistering method and grafted onto the wound of depigmentation area.In the ReCell autologous chromocyte grafting treated group,split-thickness skin flap was harvested by electric dermatome.Then the donor skin was processed into chromocyte suspension with the ReCell assay kit and evenly sprayed onto the depigmentation areas.The wound healing time and the pigment recovery 3 months after surgery were observed.Results The wound healing time of autologous blister skin grafting treated group was significantly shorter than that of ReCell autologous chromocyte grafting treated group (P <0.05 ).The effective rate of pigment recovery 3 months after surgery in autologous blister skin grafting treated group was markedly higher than that of ReCell autologous chromocyte grafting treated group(P <0.05 ). Conclusion The autologous epidermal grafting treatment using grinding and suction blistering method is simple and easy to perform,marked-ly effective,with no suture scar and low surgical risk,thus serving as a promising and ideal therapeutic method for burn scar depigmentation.

血竭(dragon’s blood)是中医常用的活血散瘀药，主要分为两类：一类是进口血竭，是由东南亚热带地区棕榈科黄藤属植物果实分泌的树脂；另一类是国产血竭，产于海南、广西、云南等地，是来自于龙舌兰科植物剑叶龙血树的树脂，即龙血竭。二者在化学成分上存在较大差异，但在药理和临床疗效上基本一致。

目的：探讨危重烧伤患者发生非甾体抗炎药不良反应的临床特点、致病机制。方法回顾分析7例次（6例）危重烧伤患者发生急性肾损伤、急性血小板减少、急性肝功能损伤和上消化道大出血与应用非甾体抗炎药的关系、发生特点、治疗与结局。结果7例次危重烧伤患者发生的急性肾、肝损伤、血小板减少及上消化道大出血的发生均与应用非甾体抗炎药有关；急性肾、肝损伤、急性血小板减少患者在停药后均治愈，4例上消化道大出血患者治愈3例，死亡1例。结论由非甾体抗炎药引起的不良反应往往混杂于危重烧伤复杂多样的临床表现当中，应仔细鉴别，特别是除消化道之外的较少见的不良反应；危重烧伤患者应慎用该类药物并积极寻求减低损伤的策略。

<正>1病例资料患者男性,18岁,因"右足破溃伴发热5 d"急诊入院。入院前5 d感右足瘙痒,抓破后逐渐出现右足肿痛,形成水疱,破溃后即出现发热,体温最高39.7℃,当日全身不适加重急到我院就诊,局部穿刺未见脓液,以"糖尿病足部感染"收入

OBJECTIVE To investigate the distribution and antimicrobial resistance of the pathogens causing chronic refractory dermal ulcer so as to guide the clinical anti-infection treatment.METHODS The clinical data of 70patient with chronic refractory dermal ulcer who were hospitalized from Mar 2011to Apr 2012 were retrospectively analyzed,then the identification of the pathogens isolated from the wound secretions was carried out with the use of automatic biochemical analyzer(VITEK),and the drug susceptibility testing was performed by using K-B disk diffusion method.RESULTS A total of 79strains of pathogens were isolated,including 24(30.4%)strains of gram-positive bacteria and 54(68.4%)strains of gram-negative bacteria;the Staphylococcus aureus was the predominant species among the gram-positive bacteria,accounting for 21.5%;the Pseudomonas aeruginosa and Escherichia coli were dominant among the gram-negative bacteria,accounting for 25.3% and 16.5%,respectively.The gram-negative bacteria were highly drug resistant,however,the drug resistance rates to imipenem,meropenem,amikacin,and piperacillin/tazobactam were relatively low,and the drug resistance rates of P.aeruginosato the four antibiotics were 5.0%,0,20.0%,and 10.0%respectively;the gram-positive bacteria showed low drug resistance,and the drug resistance rate of S.aureus to oxacillin was 35.3%.CONCLUSIONSIt is an necessary way to reasonably use antibiotics combined with debridement based on the full understanding of the distribution and drug resistance of the pathogens causing chronic wound infections so as to control the chronic refractory wound infections.