BACKGROUND:Oxygen-generating alginate plays an important therapeutic role in wound treatment. In several studies, oxygen-generating alginate synthetic dressings have been shown to promote wound healing. METHODS:We conducted a multicenter, open-label, phase III randomized clinical trial of split-thickness skin graft donor site treatment. We recruited patients with a burn size of less than 30 % total body surface area (TBSA) who required skin grafting. Patients were randomized into two groups: one group received treatment with polymer oxygenated alginate (POA) dressing (n = 69), and the other group received conventional Vaseline gauze dressing (n = 70). All patients were followed up for a predefined period until the primary outcome was assessed. The primary end point was the wound healing time. RESULTS:A total of 141 adult patients underwent randomization and 137 completed the trial. Wounds healed faster in the POA group than in the Vaseline gauze group (P < 0.0001). At the first five visits, wound healing rates in the POA group were higher than those in the Vaseline gauze group (P < 0.01). Pain scores were lower ( P = 0.011), and the satisfaction scores were higher (P < 0.05) in the POA group. No significant differences in wound infections and inflammation were detected between the two groups. Two adverse events occurred, but neither was related to the study products or procedures. CONCLUSIONS:Our results demonstrate that POA dressing is safe and clinically effective for treating split-thickness skin graft donor site wounds. It may be effective in controlling wound infection and inflammation; however, further validation is required.

Objective:To investigate the surgical treatment methods of femoral artery pseudoaneurysm combined with infectious wounds and to evaluate the clinical effects.Methods:The retrospective observational research method was used. Twelve patients with femoral artery pseudoaneurysm combined with infectious wounds who met the inclusion criteria were admitted to Nanjing University of Chinese Medicine Wuxi Integrated Traditional Chinese and Western Medicine Hospital (Affiliated Hospital of Jiangnan University) from October 2014 to September 2022, including 6 males and 6 females, aged from 46 to 78 years. In the primary operation, debridement, tumor resection, and artery suture/venous grafting to repair the artery/artery ligation were performed, and the wound area after tumor resection ranged from 4.0 cm×1.5 cm to 12.0 cm×6.5 cm. Wounds that could be sutured were treated with tension reduction suture and extracutaneous continuous vacuum sealing drainage (VSD), while large wounds that could not be sutured were treated with VSD to control infection. In the secondary operation, tension reduction suture was performed to repair the wounds that could be sutured; large wounds were repaired with adjacent translocated flaps with area of 9.0 cm×5.0 cm to 15.0 cm×7.0 cm. Additionally, when the length of the exposed femoral artery was equal to or over 3.0 cm, the wounds were repaired with additional rectus femoris muscle flap with length of 15.0 to 18.0 cm. The donor areas of the flaps were directly sutured. The wound with artery ligation was treated with stamp skin grafting and continuous VSD. The bacterial culture results of the wound exudate samples on admission were recorded. The intraoperative blood loss, the location of femoral artery rupture, the artery treatment method, and the wound repair method in the primary operation were recorded, and the durations of catheter lavage, catheter drainage, and VSD treatment, and the drainage volume after the operation were recorded. The repair method of wounds in the secondary operation, the durations of catheter drainage and VSD treatment, and the total drainage volume after the operation were recorded. The survivals of flap/muscle flap/stamp skin grafts were observed, and the wound healing time was recorded. Follow-up after discharge was performed to evaluate the quality of wound healing and the walking function and to check whether the pulsatile mass disappeared. B-ultrasound or computed tomography angiography (CTA) was performed again to observe potential pseudoaneurysm recurrence and evaluate the patency of blood flow of the femoral artery.Results:The bacterial culture results of wound exudate samples of all the patients were positive on admission. The blood loss was 150 to 750 mL in the primary operation. The arterial ruptures were located in the femoral artery in 8 cases, in the external iliac artery in 2 cases, and in the femoral arteriovenous fistula in 2 cases. Six cases received direct artery suture, 4 cases received autologous great saphenous vein grafting to repair the artery, 1 case received autologous great saphenous vein bypass surgery, and 1 case received artery ligation. The primary wound suture was performed in 4 cases, along with catheter lavage for 3 to 5 days, catheter drainage for 4 to 6 days, VSD treatment for 5 to 7 days, and a total drainage volume of 80 to 450 mL after the surgery. In the secondary operation, the wounds were sutured directly in 3 cases along with catheter drainage for 2 to 3 days, the wound was repaired with scalp stamp skin graft and VSD treatment for 5 days in 1 case, the wounds were repaired with adjacent translocated flaps in 2 cases with catheter drainage for 2 to 3 days, and the wounds were repaired with rectus femoris muscle flaps+adjacent translocated flaps in 2 cases with catheter drainage for 3 to 5 days . The total drainage volume after the secondary operation ranged from 150 to 400 mL. All the skin flaps/muscle flaps/skin grafts survived after operation. The wound healing time ranged from 15 to 36 days after the primary operation. Follow-up of 2 to 8 months after discharge showed that the wounds of all patients healed well. One patient who underwent femoral artery ligation had calf amputation due to foot ischemic necrosis, and the rest of the patients regained normal walking ability. The pulsatile mass disappeared in inguinal region of all patients. B-ultrasound or CTA re-examination in 6 patients showed that the blood flow of femoral artery had good patency, and there was no pseudoaneurysm recurrence.Conclusions:Early debridement, tumor resection, and individualized artery treatment should be performed in patients with femoral artery pseudoaneurysm combined with infected wounds. Besides, proper drainage and personalized repair strategy should be conducted according to the wound condition to achieve a good outcome.

目的:探讨复方黄柏涂剂治疗糖尿病足溃疡的临床效果.方法:选取60例2018年9月-2020年12月于江南大学附属医院治疗的糖尿病足溃疡患者作为研究对象进行回顾性分析,根据溃疡创面治疗方法不同分为观察组(30例)和对照组(30例).对照组使用生理盐水及双氧水冲洗溃疡创面,观察组在生理盐水、双氧水冲洗的基础上给予复方黄柏涂剂治疗.比较两组创面愈合情况、中医症候积分、炎性因子水平及足部血供.结果:治疗1、2个月后,两组创面面积明显缩小,观察组面积较对照组明显小(P<0.05);两组治疗后中医症候积分降低,观察组较对照组低(P<0.05);两组治疗后白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平明显降低,观察组水平较对照组低(P<0.05);两组治疗结束后6个月踝肱压力指数(ABI)及趾肱压力指数(TBI)明显提高,观察组较对照组高(P<0.05).结论:糖尿病足溃疡患者使用复方黄柏涂剂治疗,能够促进创面愈合,改善临床症状,降低炎性因子水平,改善足部血供,值得临床借鉴.

Nerve injury leads to the accumulation of white blood cells derived from the bone marrow in the lesioned nerve, but it is still unknown whether there are similar responses in unlesioned nerves. To address this question, sciatic nerves of mice expressing enhanced green fluorescent protein (EGFP) in their bone marrow were crushed unilaterally to observe the invasion of bone marrow-derived cells into the contralateral unlesioned nerve. Two days after surgery, EGFP+ cells began to infiltrate both the damaged and undamaged nerves. These cells gradually amplified to the highest point within 14 days and slowly lowered. In ipsilateral (lesioned) and contralateral (unlesioned) nerves, the time course of infiltration of EGFP+ cells was similar, but the magnitude was much less for the unlesioned one. Through CD68 staining, some cells were identified as macrophages. Transmission electron microscopy revealed slight demyelination and phagocytosing macrophages in the contralateral nerve. The data showed that infiltration by white blood cells is a response to nerve injury, even in uninjured nerves.

Objective:To investigate the clinical efficacy of abdominal multiple wide pedicled ultra-thin flaps for repair of multiple finger wounds.Methods:From January 2016 to December 2020, 20 patients (51 fingers) with multi finger wounds were treated, all of which were volar or dorsal wounds of unilateral multi finger hands. There were 8 cases of volar digital wounds and 12 cases of dorsal digital wounds. Among them, 11 cases had wounds in 3 fingers and 9 cases had wounds in 2 fingers. The single wound area ranged from 1.0 cm×2.0 cm to 3.0 cm×7.0 cm. The ipsilateral abdominal multiple wide pedicled ultra-thin flaps were used to repair the wound of multiple fingers, and the pedicle was broken in 14 to 18 days.Results:After operation, one of the flaps was cured after dressing change because of large suture tension and partial necrosis of the distal end. The flaps of other cases survived completely. The flap was follow-up for 3 to 20 months. The appearance of the flap was not bulky and the texture was good. According to the evaluation standard of hand tendon repair issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 35 fingers, good in 9 fingers, fair in 5 fingers and poor in 2 fingers.Conclusion:The application of abdominal multiple wide pedicled ultra-thin flaps can repair the wound of multiple fingers at the same time. The survival rate of the flap is high, the appearance and texture are good, and the recovery of hand function is satisfactory.

Background: A monitoring method is needed to further guide fluid resuscitation in severe burn injury. This study was performed to investigate the effects of pulse contour cardiac output (PCCO) monitoring on the prognosis of adult severe burns patients. Methods: We conducted a retrospective study enrolling patients from January 2015 to December 2020, who were divided into a control group receiving conventional monitoring and a study group receiving PCCO monitoring. The primary outcomes were 28-day mortality and total mortality, and the secondary outcomes included burn-related complications and the length of hospital stay and ICU stay. Multivariable logistic regression analysis and linear regression analysis were performed to determine the risk factors of burns related complications and length of hospital stay in enrolled patients. Results: A total of 109 patients in the control group and 82 patients in the study group were enrolled. While the area of full thickness burn was much higher in the control group than in the study group (P=0.021), no significant difference was found in other characteristics between the two groups. During fluid resuscitation, the fluid volume ratio of the study group was significantly different from that of the control group, and both in the first 24 hours and the second 24 hours, the resuscitation fluid volume ratio and colloid volume ratio was significantly higher in the control group than in the study group (all P<0.001). Eight patients died during treatment, and there were more patients experiencing AKI and ARDS in the control group than in the study group (P=0.029 and 0.016). The lengths of hospital stay and ICU stay in the study group was much shorter than in the control group (P<0.001 and 0.005). In addition, TBSA was an important risk factor for both AKI and ARDS, and the existence of inhalation injury and older age increased the incidence of ARDS. Higher TBSA, inhalation injury, and burn-related complications were related to longer hospital stay in enrolled patients. Conclusions: Fluid resuscitation according to PCCO monitoring can effectively reduce the volume of colloid and overall fluid volume and reduce the incidence of burns-related complications and shorten the length of hospital stay.

92 cases of second degree burn wounds treated in our hospital from January 2019 to December 2019 were selected as the research objects, and the clinical effect of eCASH concept treatment combined with nano silver dressing on the second degree burn wounds was studied. The patients were randomly divided into control group (n = 46) and observation group (n = 46). The control group was treated with conventional treatment combined with eCASH concept nursing, and the observation group was treated with eCASH concept combined with nano silver dressing. We found that the effective rate of the observation group was 95.65% higher than that of the control group (76.09%); the wound healing time of the observation group was significantly lower than that of the control group; the average VAS pain score of the observation group during wound treatment was significantly lower than that of the control group The total positive rate of bacterial detection in the observation group was 8.70%, which was lower than 28.26% in the control group; the incidence of complications in the observation group was 2.17% lower than that in the control group (17.39%); the differences were statistically significant (all P < 0.05). These results indicate that eCASH concept combined with nano silver dressing in the treatment of second degree burn wounds has a significant effect, which can accelerate the recovery, reduce the pain, and effectively reduce the total positive rate of bacterial detection and the incidence of complications.

The nursing care of patients with extensive burns by using multifunctional intelligent suspension treatment beds was studied. 40 patients, including 30 males and 10 females, with extensive burns were nursed using multifunctional intelligent suspension treatment beds. First of all, the patients were given psychological care, which was patiently explained, so that they can overcome their fears and be treated with peace of mind. Second, the room temperature and bed temperature were closely monitored. Finally, special attention was paid to the adjustment of rehydration volume, regular detection of plasma electrolytes, prevention of electrolyte disorder, and dehydration. Besides, disinfection and isolation should be performed when using. The results showed that 4 cases (20%) were positive in group A and 8 cases (40%) were positive in group B on the 10th day after injury (X2=4.005), and the incidence of wound infection in group A was significantly lower than that in group B. The use of suspension beds in patients with extensive burns makes them safe and comfortable, and the whole body wound scabs healed faster, as well as the infection was minimized. A suspended bed is especially suitable for the clinical treatment of patients with extensive burns. The advantages of suspended bed can be fully realized by summarizing clinical experience.

Objective: To explore the clinical efficacy of different modes of continuous negative pressure wound therapy (NPWT) on venous ulcer wounds of lower limbs, and to analyze the influencing factors. Methods: From January 2018 to December 2019, 53 patients with venous ulcer of lower limbs who met the inclusion criteria and hospitalized in the Affiliated Hospital of Jiangnan University were recruited in this prospective randomized controlled study. According to the random number table, the patients were divided into single negative pressure therapy (SNPT) group (19 patients, 11 males and 8 females), cyclic alternating negative pressure therapy (CANPT) group (17 patients, 12 males and 5 females), and routine dressing change (RDC) group (17 patients, 10 males and 7 females), aged (47±11), (49±10), and (47±10) years respectively. After admission, patients in SNPT group were given continuous NPWT with the single negative pressure setting at -13.3 kPa, patients in CANPT group were also given continuous NPWT but with the cyclic alternating negative pressure setting from -16.0 to -10.7 kPa, while patients in RDC group were given dressing change with vaseline gauze soaked with iodophor. The wound healing rate was calculated on treatment day 7 and 14. Transcutaneous oxygen pressure (TcPO(2)) around the wound was detected by TcPO(2) meter before treatment and on treatment day 7 and 14. The wound exudate/drainage fluid was collected on treatment day 1, 4, 7, 10, and 14, with the pH value measured using a pH meter, and the volume of exudate/drainage fluid recorded. Before treatment and on treatment day 7 and 14, venous blood was collected to detect the serum levels of interleukin 1β (IL-1β), IL-6, tumor necrosis factor α(TNF-α), transforming growth factor-β(1) (TGF-β(1)), vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Before treatment and on treatment day 7 and 14, wound exudates were collected for bacterial culture, and Visual Analogue Scale and Hamilton Anxiety Scale were used to evaluate the degree of wound pain and anxiety of patients respectively. The length of hospital stay and the total treatment cost were counted. Analysis of variance for repeated measurement, one-way analysis of variance, least significant difference test, Kruskal Wallis H test, Mann Whitney U test, chi-square test, Fisher's exact probability method test, and Bonferroni correction were used to analyze the data. According to the wound healing rate on treatment day 14, the efficiency of patients were divided into two grades of significant healing with wound healing rate≥70% and non significant healing with wound healing rate<70%. According to the two categories of wound healing rate as dependent variables, the levels of TcPO(2), IL-1β, IL-6, TNF-α, TGF-β(1), VEGF, bFGF levels and bacterial detection, wound pain and anxiety before treatment, wound exudate/drainage fluid volume and pH value on treatment day 1 were taken as covariates, and binary classification multifactor logistic regression analysis was used to analyze the risk factors of significant wound healing. Results: (1) On treatment day 7, the wound healing rate of patients in SNPT group was (33±10) %, which was significantly higher than (24±9) % of RDC group (P<0.05). On treatment day 14, the wound healing rates of patients in SNPT group and CANPT group were (71±15)% and (66±18)%, respectively, which were significantly higher than (45±19)% of RDC group (P<0.01). (2) Compared with those of RDC group, the TcPO(2) value around the wound of patients was significantly increased in SNPT group on treatment day 14 and in CANPT group on treatment day 7 and 14 (P<0.05 or P<0.01), the pH value of wound drainage fluid of patients was significantly decreased in SNPT group on treatment day 10 and 14 and in CANPT group on treatment day 7 and 14 (P<0.05), the volume of wound drainage fluid of patients was significantly reduced in SNPT group on treatment day 10 and 14 and in CANPT group on treatment day 7, 10, and 14 (Z=-4.060, -4.954, -2.413, -4.085, -4.756, P<0.05 or P<0.01), the serum levels of IL-1β, IL-6, and TNF-α of patients were significantly decreased in SNPT group and CANPT group on treatment day 7 and 14 (P<0.01), the serum level of TGF-β(1) of patients was significantly increased in CANPT group on treatment day 14 (P<0.05), the serum levels of VEGF and bFGF were significantly increased in SNPT group and CANPT group on treatment day 14 (P<0.01), the bacteria detection proportion of wound exudate, wound pain, and anxiety scores of patients were significantly decreased in SNPT group and CANPT group on treatment day 7 and 14 (P<0.01). Compared between the negative pressure therapy two groups, except the wound pain score of patients in CANPT group was significantly lower than that in SNPT group (P<0.01) on treatment day 7, the other indicators mentioned above were similar. (3) The length of hospital stay of patients in SNPT group was similar to that in CANPT group (P>0.05), which were significantly shorter than the time in RDC group (P<0.01). The total treatment cost of patients among the three groups was similar (F=1.766, P>0.05). (4) Before treatment, the serum levels of TNF-α and bFGF, TcPO(2) around the wound, and the degree of wound pain were risk factors for significant wound healing (odds ratio=1.109, 0.950, 1.140, 2.169, 95% confidence interval=1.012-1.217, 0.912-0.988, 1.008-1.290, 1.288-3.651, P<0.05 or P<0.01). Conclusions: Clinical application of continuous NPWT under single negative pressure mode and cyclic alternating negative pressure mode has a positive effect on improving the wound base and healing rate of venous ulcer of lower limbs. But cyclic alternating negative pressure mode is significantly more effective than single negative pressure mode in improving TcPO(2) around the wound, reducing wound pH value, reducing exudate volume and relieving pain. The serum levels of TNF-α and bFGF, TcPO(2) around the wound and the degree of wound pain were the risk factors that affect the wound healing significantly.

Abstract Previous studies and the concentration-dependent antibacterial actions of daptomycin suggested that a high dose would be needed for difficult-to-treat infections in burn patients. Here, we evaluated the effects of administration of low and high doses of daptomycin in patients with severe burn injuries. The study retrospectively analyzed 10 patients with severe burn injuries, using pharmacokinetic (PK) and pharmacodynamic (PD) evaluations of daptomycin doses given to combat serious infections. Daptomycin was administered as a single dose or by multiple doses intravenously at a standard dose of 6 mg/kg/d or a high dose of 12 mg/kg/d for 7 to 14 days. The serum concentrations of daptomycin from patients were analyzed by liquid chromatography–mass spectrometry/mass spectrometry (LC-MS/MS). Burn injury patients treated with high-dose daptomycin had a linear PK profile and a negative correlation between the AUC0–24 and Baux score (R2 = .953 and R2 = .801). The Cmax, AUC0–24, and t(h)½ increased significantly compared with patients given a standard dose. The efficacy of daptomycin against Staphylococcus aureus showed significantly higher rates of (AUC0–24)/MIC and Cmax/MIC after high-dose daptomycin compared with the standard dose, reflected in a significant correlation between a high dose and the Baux score (r = .976, P < .001). Positive S. aureus cultures from two of three high-dose and none of two daptomycin low-dose patients converted from positive to negative after therapy. No serious adverse events or discontinuation of the drug occurred during the treatment period. Daptomycin doses up to 12 mg/kg/d were well tolerated in Chinese patients with severe burn injuries, which were complicated by infections with S. aureus.

Fifteen patients with sinus-type pressure ulcer in ischial tuberosity were admitted to our unit from April 2013 to April 2017, including 12 patients of unilateral pressure ulcer and 3 patients of bilateral pressure ulcer. The wounds were with infection of different degrees. The outer wound area of pressure ulcer before debridement ranged from 1.5 cm×1.0 cm to 6.0 cm×5.0 cm. Fifteen patients with 15 pressure ulcers were treated with vacuum sealing drainage for 3 to 13 days after debridement and sinus wall resection. Unilateral pressure ulcer was repaired with posterior femoral bilobed flap. One side of bilateral pressure ulcer was repaired with posterior femoral bilobed flap, and the other side was repaired with gluteus maximus muscle flap combined with local flap. The size of flaps ranged from 11.0 cm×7.5 cm to 15.0 cm×10.0 cm. Epidermis of the distal part and edge of the main flap was removed to make complex dermal tissue flap to fill the deep cavity. The other part of the main flap was applied to cover wound, and another flap of the bilobed flap was applied to cover the donor site where main flap was resected. The donor sites were sutured directly. The posterior femoral bilobed flaps in 15 patients survived after operation. Pressure ulcers of 12 patients were healed well. Incision of 2 patients ruptured and healed 15 days after second sewing. One pressure ulcer with infection under the flap healed on 16 days post second completely debridement. During follow-up of 3 to 18 months, flaps were with soft texture, good appearance, and no recurrence.

This paper rounded up the resources and advantages leveraged by the hospital′s burn and plastic surgery department as a national key discipline. The department practiced medical services for chronic wounds in the regional hierarchical medical system for chronic wounds to promote the development medical alliances. IT development of the hierarchical medical network has achieved disease information sharing, namely centralized patients screening, patients referral confirmation, mutual recognition of test results, online consultation and treatment follow-up. Other achievements include standardization of medical criteria for chronic wounds by means of effective integration of resources imbalance within the network and improvement of internal medical regulations; elevation of primary level innovation capacity and services by means of high-caliber specialists working at primary institutions and mutual exchanges in between; effective medical cost control via guarantee system building, thus enhancing the public benefit nature of public hospitals. The paper also probed into problems and solutions expected in the way of promoting the chronic wound hierarchical medical system. Key words: Progressive patient care; Chronic wound; Medical model; Medical alliances

目的 探讨负压封闭引流(VSD)联合生物蛋白海绵在各类创伤后深度创面修复的治疗效果.方法 采用VSD联合生物蛋白海绵修复各类创伤后深度创面患者7例.手术清创后,创面外敷生物蛋白海绵,经医用VSD吸引6～11 d后,行Ⅱ期植皮修复术.结果 7例患者创面移植皮片均存活,其中1例手部热压伤患者因依从性差,导致Ⅰ期术后VSD反复漏气,创面愈合不良,后予以去除VSD,经积极换药培养肉芽,使用敏感抗生素后,感染控制,定期换药2周后痊愈.所有患者创面愈合后予以抗瘢痕及功能锻炼,出院后随访2～6个月,患者创面未出现破溃、感染等并发症.结论 采用VSD联合生物蛋白海绵治疗各类创伤后深度创面的临床效果较好.

Objective: To investigate the effects of application of citrate anticoagulation in bedside continuous blood purification (CBP) of severe burn patients with sepsis, so as to provide reference for choosing anticoagulants in CBP of these patients. Methods: Thirty severe burn patients with sepsis, conforming to the study criteria, were admitted to our burn intensive care unit from January 2014 to July 2017. Patients were divided into heparin group and citrate group according to computer randomization method, with 15 cases in each group. Patients in two groups all received bedside CBP treatment. Patients in heparin group used local heparin anticoagulation, while patients in citrate group used local citrate anticoagulation. Time of predicted single-time CBP treatment, time of single-time CBP treatment, time of accumulative CBP treatment, and rate of reaching the standard of CBP treatment time were counted. Changes of prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, serum procalcitonin, and C-reactive protein (CRP) of patients before and after treatment were monitored. Hemorrhage in wounds, incision on trachea, and arteriovenous intubation point, and other complications during and after CBP treatment were observed. Data were processed with independent sample t test and chi-square test. Results: (1) Time of predicted single-time CBP treatment of patients in the two groups was equal. Time of single-time CBP treatment and time of accumulative CBP treatment of patients in citrate group were longer than those in heparin group. Rate of reaching the standard of CBP treatment time of patients in citrate group was significantly higher than that in heparin group (χ(2)=16.655, P<0.01). (2) There was no statistically significant difference in PT, APTT, INR, fibrinogen, serum procalcitonin, and CRP of patients in the two groups before CBP treatment (t=0.203, -1.006, 0.203, 0.039, -1.591, -0.824, P>0.05). PT and APTT of patients in citrate group after CBP treatment were (14.2±1.6) and (45±7) s, respectively, significantly shorter than (15.5±1.4) and (53±6) s in heparin group (t=2.395, 3.321, P<0.05 or P<0.01). INR of patients in citrate group after CBP treatment was 1.13±0.12, significantly lower than 1.24±0.12 in heparin group (t=2.395, P<0.05). Fibrinogen of patients in citrate group after CBP treatment was (3.5±0.6) g/L, significantly higher than (3.0±0.6) g/L in heparin group (t=-2.427, P<0.05). Serum procalcitonin and CRP of patients in citrate group after CBP treatment were significantly lower than those in heparin group (t=2.520, 2.710, P<0.05). Decreased degree of serum procalcitonin and CRP of patients in citrate group after CBP treatment were (1.8±0.6) ng/mL and (143±69) mg/L, respectively, significantly higher than (0.9±0.6) ng/mL and (95±50) mg/L in heparin group (t=-4.033, -2.170, P<0.05 or P<0.01). (3) During CBP treatment, patients in heparin group experienced 21 times of exacerbation of wound hemorrhage and 10 times of new hemorrhage, including 2 times of hemorrhage at incision on trachea and 8 times of hemorrhage at arteriovenous intubation point. No exacerbation of hemorrhage or new hemorrhage happened in patients of citrate group. After CBP treatment, no electrolyte disturbance happened in patients of heparin group, but 1 patient in citrate group experienced hypocalcemia. Conclusions: Application of citrate anticoagulation in bedside CBP of severe burn patients with sepsis shows light impact on systematic coagulation status, and can effectively decrease inflammation reaction of burn sepsis with low rate of hemorrhage.

目的探讨气管切开术后不良事件的发生率、发生原因及补救措施。方法回顾性分析115例大面积烧伤或单纯吸入性损伤行气管切开术术后不良事件发生情况及其结局。结果共20例(17.3%)患者术后发生不良事件,其中2例死亡,18例对治疗无明显影响。结论烧伤患者特殊生理病理改变使气管切开后不良事件发生率较高,积极预防、合理治疗可尽量避免不良事件发生。

目的 了解在四肢深Ⅱ度及以上烧伤创面切削痂术中对穿支血管进行预见性止血的效果. 方法 选择2011年11月-2012年10月江苏省丹阳市人民医院烧伤科收治的26例深Ⅱ度及以上烧伤住院患者,其中22例为单纯双上肢或双下肢烧伤,4例为四肢烧伤.按同体对照设计原则,以患者某侧上肢或下肢创面为穿支组(穿支血管重点止血),对侧上肢或下肢创面为对照组(常规电凝止血),共30对,其中上肢18对、下肢12对.观测和比较1％ TBSA创面手术时间和出血量及术后情况.对数据行配对t检验. 结果 穿支组与对照组1％ TBSA创面手术时间分别为(5.7±0.6)、(6.2±0.7)min,差异有统计学意义(t=-3.014,P＜0.01)；1％ TBSA手术面积出血量分别为(31±4)、(40±6)mL,差异有统计学意义(t=-7.227,P＜0.01).穿支组创面术后未出现需手术治疗的再次出血和需清除的淤血或血肿.对照组1处创面出现需清除的血肿2个；1处创面术后出血,手术缝扎后止血. 结论 在四肢深Ⅱ度及以上烧伤创面切削痂术中对穿支血管进行有预见性的止血,可缩短手术时间,减少术中出血量.

腹股沟部及大粗隆部软组织缺损,常因褥疮或电击伤所致,深部组织或骨关节外露,且常合并感染,治疗上较困难,必需用皮瓣或肌皮瓣修复.我科于2006年5月-2010年11月应用阔筋膜张肌肌皮瓣修复同侧腹股沟部及大粗隆部软组织缺损1 1例,临床效果满意.

<正>随着人们生活水平的逐年提高以及安全防范意识的不断增强,尤其是产业结构的不断优化和调整,以及重工业基地和化工企业的外迁等因素,无锡地区烧伤的整体发病率有逐年下降的趋势。但随着社会老年化趋势的加速,老年烧伤患者的发病率反而呈上升趋势[1]。本组统计分析了我院2007年1月-

OBJECTIVE:To observe the effect of salvia miltiorrhiza and ligustrazine injection on the early myocardial damage of severely burned patients.METHODS:Twenty severely burned patients hospitalized from January 2010 to August 2011, with burn area equal to or more than 50% TBSA, were divided into two groups following hospitalization sequence, with odd number patients entering treatment group (T, n = 10) and even number patients entering control group (C, n = 10). Patients in C group were treated with routine methods, including fluid resuscitation based on the Third Military Medical University formula, anti-infection treatment, support treatment, and organ-protection treatment, etc. In addition to routine treatment methods, patients in T group received intravenous infusion of 250 mL glucose injection (50 g/L) containing 10 mL salvia miltiorrhiza and ligustrazine concoction, once a day, and continued for three days. Venous blood of patients was drawn at post burn hour (PBH) 12, 24, 48, and 72 to determine the plasma levels of cardiac troponin I (cTnI), creatine kinase isozyme MB (CK-MB), and atrial natriuretic peptide (ANP). Data were processed with t test.RESULTS:At each time point, levels of cTnI, CK-MB, and ANP were lower in T group than in C group. Differences in contents of these parameters between two groups were statistically significant at most time points, with t values from 2.136 to 2.918, P < 0.05 or P < 0.01. Plasma levels of cTnI, CK-MB, and ANP in both groups peaked at PBH 12, which were respectively (28 ± 10) ng/mL, (76 ± 13) U/L, (430 ± 87) pg/mL in T group, and (38 ± 11) ng/mL, (87 ± 10) U/L, (453 ± 91) pg/mL in C group. From PBH 24 to 72, contents of above-mentioned parameters decreased gradually in both groups.CONCLUSIONS:Early use of salvia miltiorrhiza and ligustrazine injection in severely burned patients can effectively reduce myocardial damage, thus protect the myocardium from injury.

Sepsis commonly occurs in severe post-burn patients, often resulting in death. We aimed to evaluate the influence of early enteral feeding on outcomes in patients with extensive burns, including infection incidence, healing and mortality. We retrospectively reviewed 60 patients with extensive burns, 35 who had received early enteral nutrition and 25 who had received parenteral nutrition. Average healing time, infection incidence and mortality were clinically observed. Hemoglobin and serum albumin were monitored weekly in both groups during treatment. Causative organisms were identified in patients with sepsis. Infection incidence was significantly less in the enteral nutrition group than the parenteral nutrition group (17.1% vs 44.0%; p = 0.023); and latency duration was longer in the enteral nutrition group than in the parenteral nutrition group (30.5 ± 4.7 days vs 14.5 ± 2.3 days; p<0.001). Duration of antibiotic therapy of the enteral nutrition group was significantly shorter than that of the parenteral nutrition group (12.5 ± 3.0 days vs 19.8 ± 3.6 days; p<0.001). Mean hemoglobin results (10.1 ± 1.3 g/L vs 8.3 ± 1.5 g/L; p<0.001) and serum albumin results (44.7 ± 5.7 g/L vs 36.2 ± 6.9 g/L; p<0.001) of enteral nutrition and parenteral nutrition groups, respectively, provided an overview of systemic nutrition and protein metabolism, suggesting higher systemic nutrition and protein synthesis in enteral nutrition group than in parenteral nutrition group. Risk of post-burn infection is reduced in burn patients who are supported by earliest possible enteral nutrition.