目的:探究与分析湿性敷料联合物理治疗下肢静脉痛性溃疡治疗前后基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶-9(MMP-9)及相关基质金属蛋白酶抑制剂(TIMPs)的影响.方法:选取收治的下肢静脉痛性溃疡患者 80 例为研究对象,随机分为对照组与观察组各40 例,对照组给予湿性辅料治疗,观察组在对照组基础上增加物理治疗,比较两组临床疗效、治疗前后PUSH评分、治疗前与治疗后第 1 周、第 2 周及第 4 周的创面面积,渗出液当中的基质金属蛋白酶-9(MMP-9)、MMP-1、基质金属蛋白酶抑制剂-1(TIMP-1);同时观察两组患者肉芽组织出现时间、肉芽组织覆盖创面时间.结果:与对照组比较,观察组临床总有效率更高,差异有统计学意义(P<0.05).观察组治疗后第1 周、治疗后第2 周、治疗后第4 周分别与治疗前比较,PUSH评分较低,随着治疗时间的延长,PUSH评分开始呈现出不断降低的趋势,观察组治疗后第 1 周、治疗后第 2周、治疗后第4 周分别与对照组治疗后第 1 周、治疗后第 2 周、治疗后第 4 周比较,PUSH评分较低,差异有统计学意义(P<0.05).与对照组治疗后比较,观察组MMP-9、MMP-1、TIMP-1 水平均较低,差异有统计学意义(P<0.05).与对照组比较,观察组肉芽组织出现时间较短、肉芽组织覆盖创面时间均较短,差异有统计学意义(P<0.05).结论:湿性敷料联合物理治疗下肢静脉痛性溃疡的临床疗效突出,能够有效促进改善患者的症状及体征,改善MMP-1、MMP-9 及相关TIMP-1 的水平,缩短肉芽组织出现及覆盖时间.

Objective:To explore the clinical characteristics of 19 cases of Vibrio vulnificus infection in Humen area.Methods:The clinical data of 19 patients with Vibrio vulnificus infection admitted to Burn Plastic & Hand and Foot Surgery, Dongguan Binhai Bay Central Hospital from January 2018 to January 2023 were retrospectively analysed, observed the clinical characteristics and summarized the experience and lessons of treatment.Results:Vibrio vulnificus infection mostly occured in summer and autumn (13/19, 68.42%). The patients with metabolic disease or abnormal liver function were susceptible (11/19, 57.89%), and the prognosis of gout patients was relatively worse, the three deaths were all gout patients. There were 18 positive cases in bacterial culture of Vibrio vulnificus before the application of antibiotics on the day of admission, one positive case was found one day later. Afterwards, no Vibrio vulnificus was found in bacterial culture. The number of white blood cells were closely related to the percentage of neutrophils and the level of procalcitonin (r=0.972, P=0.000; r=0.861, P=0.006). The white blood cell levels gradually decreased along with the condition improved.Conclusion:The infection of Vibrio vulnificus in Humen area mostly occurs in summer and autumn. Patients with metabolic diseases are more susceptible, and gout patients have a poor prognosis. Vibrio vulnificus is sensitive to most antibiotics. The white blood cell and procalcitonin are good indicators for the severity and prognosis.

目的 探究封闭式负压引流技术(VSD)在难治性创面修复中的应用及护理.方法 70例难治性创面修复患者为研究对象,均应用VSD进行治疗,期间予以相应护理措施,观察VSD应用并护理后患者的临床指标情况(创面愈合时间、换药次数、住院时间)、疼痛及心理状态评分、并发症情况.结果 70例患者的创面愈合时间为(18.63±5.14)d,换药次数为(2.64±0.19)次,住院时间为(21.34±5.12)d.应用VSD后,患者的Wong-Banker面部表情量表法(FPS-R)评分(3.13±0.38)分、焦虑自评量表(SAS)评分(48.76±1.25)分、抑郁自评量表(SDS)评分(50.13±0.96)分均低于应用前[FPS-R评分(6.32±0.41)分、SAS评分(67.82±2.13)分、SDS评分(68.17±3.08)分],差异均具有统计学意义(P<0.05).治疗及护理过程中,新发感染4例(5.71%),引流管堵塞1例(1.43%),出血2例(2.86%),并发症总发生率为10.00%.结论 难治性创面修复过程中应用VSD治疗,并配合相应护理干预,能够有效改善患者创面状况,缓解患者疼痛感以及负面情绪,并发症发生率较低.

Objective To study and analyze the effect of moist therapy in promoting common clinical wound healing,and observe the changes of epidermal stem cells.Methods The 40 cases in our hospital from February 2010 to March2012 were selected as study objects and randomly divided into two groups,the control group was given conventional treatment,the test group was given moist therapy.Observe the wound healing situation and calculated healing days.Taken the test beginning,middle and end of the test wound tissue,made HE staining to observe the wound changes.Teste the changes of β1 integrin at the beginning,the middle and end of the test.Results The healed days of the test group was shorter,compared with the control group,it had significant difference(P<0.05);the β1 integrin of the test group was obviously higher than the control group,there were significant differences between the two groups(P<0.05).Conclusion Moist therapy has a role in promoting wound healing,it can promote the growth of epidermal stem cells,it is worthy for application.

Objective To discuss the application effect of vacuum sealing drainage (VSD) in the repairment of advanced refractory wounds. Methods Nineteen patients with deep tissue defects in our hospital from July 2010 to October 2011 were received vacuum sealing drainage treatment, the clinical effect were observed. Results The 19 patients used VSD 1-6 times, an average of 2.2 times; the treatment time was 2-7 weeks, an average of 3 weeks. Wound repair in patients were completely repaired, and no death and severe complications occurred. After 2 months of following-up, the wound appearance and function of 19 patients were recovered well. After using VSD, 11(57.89%) cases' wound and wound cavity were significantly reduced, and the wounds healed well after dressing change; the growth of granulation tissue in 5 cases (26.32%) was good, and the wounds healed well after free skin grafting; the cavity closed well in 3 cases (15.79%), and the wounds healed well after skin flap grafting. Conclusion Vacuum sealing drainage can effectively eliminate the local wound exudate and necrotic tissue, improve blood circulation, accelerate wound healing and the treatment of advanced refractory wounds is good, it has important value in clinical application.

Objective To explore the surgery treatment and efficacy of hand scar contracture deformity. Methods 34 cases with hand scar contracture deformity in our hospital from January 2008 to August 2012 were selected and treated by Z-word angioplasty,scar release, skin graft, skin flap and brace traction.observed the treatment effect. Results The 8 patients treated by Z-word angioplasty,there were 5 cases' hand function were completely returned normally(62.5%),3 cases'hand function were mostly returned normally(37.5%).The 12 patients treated by scar release,there were 7 cases'hand function were completely normal(58.33%).3 cases'hand function were mostly returned normally(25.0%),2 cases'hand function were basic recovery(16.67%).11 cases treated by skin flap,4 cases'hand function were completely returned normally(36.36%),5 cases'hand function were mostly returned normally((45.45%),2 cases'hand function were basic recovery(18.18%).3 cases treated by brace traction,their hand function were all completely returned normally. Conclusion The hands with different characteristics of scar contracture deformity should choose different surgical treatment options,the postoperative effective rehabilitation and physical therapy can restore hand function and morphology.

目的分析不同部位及创伤类型面部软组织损伤的整形修复方法及效果。方法回顾性分析133例面部软组织损伤患者为研究对象,分析其受伤部位、创伤类型等一般资料,分析整形修复方法及结果。结果所有患者均I期愈合,优42例,良58例,可18例,差15例,优良率为76.5%(101/133)。不同损伤部位愈合情况比较差异无统计学意义(P>0.05);不同损伤类型愈合效果不同(P<0.01),切割伤优良率最高(P<0.01),挫裂伤、撕裂伤、火器伤之间的优良率差异无统计学意义(均P>0.05)。结论面部软组织损伤的损伤类型对修复效果影响明显,在整形修复时应根据其类型及损伤的部位,遵循微创原则,按照相应解剖的要求修复创面,效果显著。

Objective To observe and analysis the clinical effect of Algplaque in the treatment of burn skin graft take on skin wound healing.Methods Selected 30 cases in Burn department of TaiPing People's Hospital of Dongguan during April 2009 to April 2010.Randomly divided them into two groups,Algplaque group and vaseline gauze group.Observed healing time of the two different dressings for skin graft.Results The donor site wounds average healing time of vaseline gauze group was(13.23±2.03)d,Algplaque group was(11.01±1.52)d,there were significant difference between the two groups(P 0.05).Conclusion Algplaque can relieve patients' pain,reduce wound healing time,it's worthy of clinical application.

Objective To investigate the clinical effect of nanocrystalline silver dressing to treat burns residual wound, and summary its clinical value. Methods Selected 133 cases of burn patients who were admitted to hospital in 2009 from June to December 2011, of which 66 cases of patients with residual burn wound, randomly divided into observation group and control group, 33 cases in the observation group using nanocrystalline silver dressing treatment and control group using conventional treatment, the therapeutic effect of two groups were observed and compared. Results Observation group to use nanocrystalline silver dressing treatment of burns residual wound its results significantly forward, which recovered the 19 cases accounted for 57.6%, markedly eight cases accounted for 24.2 percent, effective 4 cases accounted for 12.1%, the invalid two cases accounted for 6.1%, total effective rate was 81.8%, in the control group using conventional, which healed in 12 cases (36.4%), markedly 10 cases accounted for 30.3 percent, effective six cases (18.2%), invalid five cases accounted for 15.1%,the total effective rate was 66.7%, two groups of treatment difference was significantly (P 0.05). Conclusion The effect of residual burn wounds after the use of nanocrystalline silver dressing treatment of burns significantly superior to conventional treatment, recovery of patients with invasive department, complications, sequelae, has important clinical value, it is worth to promote reasonable clinical.

目的观察探讨尼莫地平防治危重烧伤脓毒症的临床效果,总结其临床价值。方法选取笔者所在医院2010年2月～2011年12月期间收治的烧伤患者97例,其中有32例为重度烧伤的患者,随机将其分为观察组和对照组各16例,观察组使用尼莫地平治疗,对照组使用常规治疗,观察对比两组治疗效果。结果观察组显效10例占62.5%,有效4例占31.5%,无效2例占12.5%,总有效率为87.5%;对照组显效6例占37.5%,有效5例占31.25%,无效5例占31.25%,总有效率为68.75%,两组治疗效果比较,差异有统计学意义(P<0.05)。结论使用尼莫地平防治危重烧伤脓毒症的效果显著,明显优于常规治疗,能够有效降低患者血浆内的炎性介质,同时使血浆抗氧化力TAC的升高,并发症低,后遗症少,值得临床推广使用。

目的探讨参麦注射液在治疗烧伤休克方面的临床疗效。方法选取2010年10月至2011年10月来本院进行治疗的56例烧伤休克的患者,随机分成观察组28例,对照组28例。对照组采取常规的治疗方法,观察组在进行常规治疗的基础上使用参麦注射液进行联合治疗,对比两组患者的临床治疗疗效。结果观察组治愈20例,好转6例,无效2例,治愈率92.86%;对照组治愈6例,好转14例,无效8例,治愈率71.43%,两组患者在治愈率方面具有显著性差异,(χ2=15.66,P<0.05),有统计学意义。结论参麦注射液在治疗烧伤休克方面具有十分确切的临床疗效,值得临床上进行推广使用。