The article reviews the development history of burn rehabilitation of China,to understand its current situation and analyze the constraining matter of rehabilitation therapy.To compare it with the rehabilitation therapy overseas,and introduce the good methods and experiences of the domestic institutions that offer rehabilitation therapy.The rehabilitation concept are proposed-prevention first.Rehabilitation therapy should not start from the appearance of hypertrophic scars,but from the admission of a patient.It is a combined therapy throughout the process of the burn treatment, including body position, physical therapeutic massage, active and passive exercises, compression therapy, drug injection in scar, plasticity splints,hydrotherapy, drugs for external use, skin care, psychological counselling, and the like, all of which play an important role in reducing hepertrophic scars and improving functions.Burn rehabilitation in China has achieved obvious progress in recent years, but there is still a long way to go for future development.All the medical workers should continue to work hard for the development of medical science of burn rehabilitation.

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.

眼睑皮肤的深度烧伤常会引起眼睑的瘢痕挛缩，导致明显的睑外翻，影响外观和引起不同程度的视力损害。我们对8例面部深度烧伤患者采取烧伤早期眼睑切痂全厚植皮，取得良好的效果。

慢性创面已成为外科临床较为常见的疾病.皮肤软组织损伤流行病学的变化趋势和随之而来的医疗资源的调整应对,在近几年来出现了显著的变化.随着创面修复专科单位和医师队伍的建立,慢性创面临床诊疗新理念新技术正如雨后春笋般快速发展.

Objective:To investigate the effect of rehabilitation therapy in form of physical exercise in children with burn injury. Methods:Ninety-six children with deep Ⅱ degree burns involving (19.0±16.5)% TBSA,were admitted from January to October in 2014 to the Fifth Hospital of Harbin,were included in this study. After heal-ing of the wound,they were randomly divided into treatment group (n=48)and control group (n=48). In the control group,children received topical drug dressing and wore elastic body suit. In the treatment group,on the bases of the treatment of the control group,they also received physical training with apparatus,massage,and ac-tive and passive joint movement therapy for 8 weeks. The Vancouver Scar Scale (VSS),pruritus degree,pain se-verity,ability of daily life activities (Barthel index),and deformity incidence were compared between the two groups. Results:After active and passive rehabilitation therapy,the VSS and scores of pruritus degree,pain sever-ity as well as deformity incidence in the treatment group were lower than those of the control group,while the a-bility of daily life activities was significantly higher than that of the control group (P<0.05).Conclusions:Rehabil-itation therapy in form of exercise could effectively reduce the scar formation and deformities in burn children with burn inj ury.

<正>烧伤专业作为一个新兴独立的学科,始建于全民大炼钢铁的1958年,烧伤患者的骤然增多,催生了烧伤专科建立与发展。虽然起步较晚但发展迅速,独具特色的烧伤治疗与研究已蜚声于国内外,烧伤救治的成功率达国际领先水平。中国工程院评选出的20世纪我国25项重大工程技术成就中,由烧伤和显微外科组成的"外科诊疗"是医学专业惟一获此殊荣的学科。

To retrospect the development of fluid resuscitation for burn shock and to look to the future. The main achievements in burn care in the past fifty years and existing problems are summarized, and the appropriate regime of fluid resuscitation for burn shock is suggested. Numerous achievements in burn care have been made, including the estimation of burn area, fluid replenishment formula, delayed resuscitation, fluid resuscitation for burn shock complicated by inhalation injury, covert compensatory shock and research on mechanism of burn shock etc. We had established and improved fluid resuscitation formula, and we had made clear how to properly resuscitate burn shock. However how to tide over the patient form burn shock smoothly had not yet reached a consensus. Effective treatment to alleviate hypoxic injuries as a result of severe shock had not been properly defined. Although significant achievements in fluid resuscitation for burn shock have been made, there is still a long way to go to attain a perfect regime. Therefore it is still utterly necessary to carry on in-depth research on this problem both in the laboratory and bedside.

感染是烧伤患者最常见的并发症,70%左右的死亡病例与烧伤感染密切相关,防治感染是烧伤救治工作的主要内容.诚然,抗生素的应用是抗感染的重要手段,但不是惟一也并非最重要的方法.过分看重抗生素的"黄金时代"已过去,"后抗生素时代"当把烧伤患者的抗感染策略定位在"预防为主,防治结合"的综合治疗体系上.

营养支持绝不仅仅是烧伤患者的饱腹手段和维持生命之所需,更重要的是应作为综合治疗手段之一,必须予以充分重视.

烧伤死亡病例的50%～70%死于烧伤感染.烧伤感染的主要途径是创面,尤其是深度烧伤创面更与烧伤病人的安危密切相关.

Objective To explore the feasibility of elastic bandages in prevention and treatment of post-burn scars.Methods Elastic bandages and cuff were used continuously for 1985 patients in the wound more than deepⅡburn after healing.895 nonpressure therapeutic cases served as control group.Histological changes were observed.Results In pressure group,scar was gracile and flat,soften earlier and rates of hy- pertrophic scar its functional rehabilitation was better.Nonpressure therapeutic cases formed uneven scars that were lower,occurred earlier,thicker and harder.The functional rehabilitation was worse.Conclusions Pressure therapy for just healed wound has significant effect on prevention and treatment for scar prolifera- tion,and has important significance for functional recovery.

Objective To investigate the effects nonnutritive chewing on gastrointestinal function in severely burned patients at early stage, and to explore its possible mechanism. Methods Altogether 21 severely burned patients (TBSA30%) were enrolled and randomly divided into two groups, with 9 patients in nonnutritive chewing group (NTC group) and 12 patients in control group (NNTC group). For both groups, liquid food was given through nasogastric feeding tubes. Patients in NTC group chewed glucose-free gums 4-12 hours (mean: 8.22±1.75 hours) after burn injury, 4-6 times a day, 10-15 minutes each time. Those in NNTC group received the same treatment except for gum chewing. Another 10 plastic patients were selected as normal control group. The level of serum gastrin, plasma motilin, plasma endotoxin, and the ratio of lactulose to mannitol in urine(L/M ratio) were measured on the 1st, 3rd, 7th, and 10th day after burn injury. The transport time of gastrointestinal tract was measured by carmine red on the 3rd and 7th day after burn injury. Results The levels of serum gastrin and plasma motilin in both NTC and NNTC group were significantly lower than those innormal control group. The transport time of gastrointestinal tract was prolonged in both study groups compared with normal adults. The levels of serum gastrin and plasma motilin in NTC group were not significantly different from those in NNTC group on the 1st and 10th day (P0.05); while these two values in NTC group recovered more rapidly than those in NNTC group on the 3rd and 7th day after burn injury(P0.05). And nonnutritive chewing resulted in significant decrease of plasma endotoxin level compared with that in NNTC group on the 3rd and 7th day after burn injury. The L/M ratio in NTC group was significantly lower than that in NTC group on the 3rd day (P0.05), but the difference on the 7th day had no statistical significance. Conclusion Early nonnutritive chewing is an effective auxiliary therapy to protect gastrointestinal function for severely burned patients receiving nasogastric feeding.

烧伤休克是严重烧伤病人最常见的并发症之一,多发生在伤后48小时之内的休克期,不仅发展快会危及生命,而且缺氧对机体的损害大,甚至影响到后续治疗,关系到抢救的成败.烧伤休克是属于体液渗出所致的渐进性血容量减少造成的低血容量性休克,因此,休克期输液就是最重要的治疗手段.然而,一些基层单位仍然对休克期补液心中无数,循常规走老路常感液入量不足,入量少,难以纠正缺氧,不能摆脱休克损害;若超常规补液,入量过多亦有害,不仅会加重组织水肿,甚至还可能引发急性肺水肿、脑水肿、腹腔间隙综合征或胸腔积液.究竟休克期应如何输液,全面提高休克期复苏水平,有必要重申休克期为什么要输液、输什么、怎样输,以求更符合实际的休克期输液方案.

Objective To study the effects of zinc deficiency and supplements on serum and tissue zinc contents,zinc-dependent enzyme activity,hormone level,and protein synthesis in scalded rats. Methods Among 112 Sprague-Dawley rats,56 rats were fed with 40 μg/g zinc diet and other 56 rats with 4 μg/g zinc diet for one week. Eight rats were respectively selected from each group; those from the group fed with 40 μg/g zinc were regarded as normal control group (NC group), and those from the group fed with 4 μg/g zinc were as deficiency control group (DC group). These 16 rats were sacrificed, and their vein blood and tissue specimen were harvested. The remaining 96 rats were subjected to 15% TBSA. Among them,48 rats from the group fed with 40 μg/g zinc were randomly divided into normal burn group (NB group,fed with 40 μg/g zinc continuously) and NH group (fed with 80 μg/g zinc diet). Other 48 rats of 4 μg/g zinc diet were randomly divided into DB group (fed with 10 μg/g zinc diet) and DH group (80 μg/g zinc diet),with 24 rats in each group. One,3 and 7 days after having been scalded,8 rats from each group were sacrificed. The samples of blood,liver tissues,thigh bone,and scalded skin were harvested,the zinc levels in the serum and tissues were determined,and the content of serum alkaline phosphatase (ALP) activity,growth hormone (GH) level,and liver metallothioneine (MT) content were also assayed. Results The rats were fed with zinc deficient diet for a week,and then zinc deficiency condition was successfully produced. In DC group,serum zinc, bone zinc, and wound tissue zinc levels, and ALP activity declined obviously compared with NC group. After burn the zinc levels in liver and wound tissue,and GH level and liver MT content showed increasing tendencies in NB group and DC group.However, the zinc levels in serum and bone, and ALP activity decreased. After zinc supplementation,the zinc levels in serum,liver,and wound elevated in NH and DH group. Among them,the increase extent of the zinc levels in serum and wound were prominent; ALP activity, GH level in serum, and liver MT also showed increasing tendencies,while most obvious increase occurred in BH group. Conclusion With zinc deficiency condition,the contents of zinc in serum and tissue decrease; meanwhile,the functions and activities of zinc-dependent enzymes,hormones,and proteins are also affected. These problems can be resolved by zinc supplementation.

Objective: To study the effects of zinc supplementation by different ways on zinc level in serum and tissues in scalded rats.Methods:80 SD rats were divided randomly into C(control group,no scald),N(scald control group),W(zinc supplemented by wound) and H group(zinc supplemented by diet).All rats had been fed with diet containing zinc 40μg/g for a week and then the rats of C group were skilled.The other rats were scalded on their dorsal skins covering 15% of the total body surface area by boiling water for 10 seconds and fed continuously with diet containing zinc 40μg/g in N and W groups,80μg/g in H groups.A cream containing zinc 761.1μg/g was applied on the scalded skin in W group daily.The level of zinc in serum,liver,bone and scalded skin of N,W and H groups were measured on day 1,3 and 7 after they were scalded,respectively.Results: The level of zinc in serum,bone and scalded skin decreased in the first day after scalded in N and W groups,but it increased in H group.The zinc level in liver increased in all groups.The zinc level in the scalded skin of W group was higher in the seventh day than that at other days.Conclusion: After scalded,the zinc levels in serum and tissues except liver decreased and there was re-distribution of zinc in the body.Zinc supplementation by diet and wound is necessary and can elevate quickly zinc level in serum and wound tissue,which can promote wound healing

目前关于创面愈合的研究下随着相关领域的研究进展不断拓展和完善着.创伤修复的侧重点也从单纯追求愈合速度逐渐转变为重视愈合质量,并更加重视功能的恢复与组织的重建.随着人们对脂肪组织研究的不断进展,脂肪组织在创面愈合方面所起的作用下被人们不断地认识和利用.

OBJECTIVE:To explore the effects of zinc supplementation on zinc and calcium levels in serum and tissue in burned rats.METHODS:Eighty SD rats were randomly divided into C group (control group without scald, n = 8), and N, W, H groups (each consisting of 24 rats), in which the rats were exposed to scalding resulting in partial thickness burns covering 15% of the total body surface area on the back, and then they were fed with diets containing zinc 40 microg/g in N and W groups, and 80 microg/g in H group. A cream containing zinc 761.1 microg/g was applied on the wound in W group at the same time. Eight rats of each group were sacrificed on day 1, 3 and 7 after scald respectively. Venous blood and samples of liver, femur and scald skin were harvested. Zinc and calcium contents in serum and tissues were determined with atomic absorption spectrophotometer.RESULTS:The serum Zn(2+) levels in N, W groups were lower than C group, however, it was obviously higher in H group (up to 16.2 micromol/L) on day 1 after scald. The liver Zn(2+) showed an increasing tendency in all groups, while Ca(2+) level declined in H group, but increased in N, W group. The bone Zn(2+) and Ca(2+) levels showed a progressive declination in all groups from day 1 to 7 after scald. The changes were more obviously in N group than H group (P < 0.05). The Zn(2+) content of the scalded skin increased obviously in H group on first day after scald and in W group on 7th day after scald. The Ca(2+) contents of scalded skin showed marked increases in all groups, especially in N group, but least in W group.CONCLUSION:There are obvious changes in Zn(2+) and Ca(2+) contents of serum and tissues after scald injury and zinc supplementation. The effects of zinc supplementation on calcium level in the tissue need to be further studied.

目的探讨压力疗法在烧伤瘢痕防治中的可行性。方法深Ⅱ度以上创面愈合后即刻进行弹力绷带或弹力套连续加压包扎治疗1985例;并以未施加压组895例愈合的创面进行对照和组织学观察。结果应用压力治疗的烧伤愈合创面瘢痕薄而平坦,软化时间早,瘢痕增生发生率低,功能恢复满意。而未用加压治疗组创面不同程度出现凹凸不平瘢痕、瘢痕发生早、厚而硬、软化时间明显延长、功能恢复差。结论持续压力疗法用于烧伤刚愈合之创面,对防治瘢痕增生疗效显著,对功能康复将起到十分重要的作用。

Objective To analyze the changes in plasma leptin levels after major burns and its significance. Methods Twenty male burned patients were divided into 2 groups according to the total burn surface areas (TBSA): 30%-50% TBSA group and 70% TBSA group,respectively. Blood samples were collected at 1,3,5,7,14,21,and 28 days after burns. Leptin levels were detected with radioimmunosorbent assay,and the body height and body weight were measured to calculate body mass index (BMI). Results Leptin levels decreased after burns,which were more obvious in the 70% TBSA group (P 0.01),especially in patients who died. There was no correlation between leptin levels and BMI after burn. Conclusion Serum leptin levels decrease in the severely burned patients. Measurement of leptin levels may be useful in determining the severity of the injury and outcome of severely burned patients.

切除深度烧伤创面的坏死组织,植以自体皮或异体(种)皮加自体皮,是救治危重烧伤患者的关键环节之一.临床经验证明实施早期切痂植皮比晚期脱痂植皮创面封闭早,全身反应轻,治疗效果好.几十年来绝大多数单位把首次切痂手术的时间定在伤后4d～7d,三O四医院认为大面积烧伤伤员在全身状况稳定的前提下,可以开展休克期(伤后48 h内)切痂植皮手术.