Objective To explore the clinical significance of serum hyaluronic acid detection in patients with psoriasis. Method Randomly selected from November 2013 to November 2014, 144 cases of patients with psoriasis as experimental group, selected 126 healthy adults as control group. All research objects adopted radioimmunoassay to measure the serum hyaluronic acid concentration, compared the serum hyaluronic acid concentration of patients with psoriasis and healthy adults and serum hyaluronic acid concentration in patients with psoriasis vulgaris and specific types of psoriasis. Result Serum hyaluronic acid concentration of experimental group patients was higher than that of control group, there was statistical difference between the two groups (P<0.05). Serum hyaluronic acid concentration in patients with psoriasis vulgaris and speciifc types of psoriasis, was not statistically signiifcant difference (P > 0.05). Conclusion Serum hyaluronic acid concentration detection can be used to diagnose psoriasis, but it is inapplicability to identify the type of psoriasis.

Objective To investigate the clinical therapeutic effect of the vacuum-sealing drainage (VSD) combining with skin graft in a deep burn wound.Methods Sixty one patients were divided into two groups according to treatment method.Thirty tree patients were assigned as the VSD treatment group,which was treated by VSD after debridement; their wounds were transplanted by the split thickness skins binding up by VSD when they were fitted.Twenty eight patients were assigned as the routine treatment group,which was treated by means of traditional regular dressing change to remove necrotic tissue and promote granulation tissue; their wounds were transplanted by the split thickness skins binding up by packing when they were fitted.Results After treatment by VSD,there are no systemic hypersensitivity reactions and abnormal bleeding.Thirty three cases of VSD treatment group were treated by VSD for 7 ～ 10 days,the other 2 cases were treated by VSD for another 7 ～ 10 days because of granulation tissue badly.Until their granulation was fresh,skin grafting technique was used and the skin survived well.The treatment time before skin grafts,the pain score,and the cost of ablative therapy for wound were ( 8 ± 0.9) day,(5.7 ± 1.6) point,and ( 1.5 ± 0.4) ten thousand yuan in VSD group vs.( 14 ± 1.2) day,(3.1 ± 1.1 ) point,and (0.6± 0.2)ten thousand yuan in control group.The survival rate and the wound germiculture positive rate were 97.0％ and 6.5％ in the VSD group vs 75.0％ and 28.6％ in the control group.The differences between groups were statistically significant ( P ＜ 0.05 ).Conclusions VSD is a simple method that is easy to grasp,and that can promote granulation tissue growth,reduces the wound germiculture positive rate,shortens the wound healing period,increases the survival rate of skin grafts,and relieves patients 'pain.It is worth popularizing and applying in the deep burn wound therapy.

2004年7月～2007年3月,我院共对27例左半结肠癌性梗阻患者实施结肠一期切除吻合手术,效果满意.现报告如下.

1991～2007年,我们共收治恶性肿瘤引起的食管气管支气管瘘患者15例,现将诊治情况报告如下.

目的探讨电视纵隔镜手术对胸部疾病的诊断价值。方法回顾性分析21例行电视纵隔镜手术患者的临床资料。结果20例获得病理诊断结果。无手术死亡。结论电视纵隔镜手术是诊治纵隔疑难疾病及对肺癌根治术前进行病理分类的有价值的方法。

目的探讨应用复方五味大黄酊剂对小型猪烧伤创面愈合的作用。方法选择20只中国实验用小型猪制作成深Ⅱ°烧伤动物模型,随机分成实验组和对照组,按伤后24h、3d、6d、9d、12d大体及组织细胞学切片观察,评价各组治疗效果。结果伤后9d实验组较对照组创面面积明显缩小(P<0.01),伤后12d实验组和对照组间差异无显著意义(P>0.05);伤后9d组织学检查实验组创面已被新生表皮覆盖,伤后12d实验组和对照组均被表皮覆盖,实验组表皮生长好于对照组。结论复方五味大黄酊剂是一种有效的治疗烧伤外用制剂,具有抗感染、减少渗出、迅速成膜的作用。

2003～2007年,我们采用自行研制的复方五味大黄酊治疗烧伤1 200例,疗效较好.现报告如下. 临床资料:本组1 200例患者中,男832例,女368例;年龄2～62岁.其中浅Ⅱ度烧伤915例,深Ⅱ度烧伤285例.烧伤面积占体表面积的5%～72%.致伤原因分别为火焰烧伤、热液烫伤、化学烧伤、电弧烧伤、放射线烧伤.

目的观察应用中草药浸浴烧伤患者康复期微循环的变化。监测其对烧伤后期康复治疗、功能恢复、创面修复、改善微循环的治疗效果。方法采用WX-753B型微循环显微镜及图像处理系统进行观测,应用法国产REF1254型自动调温浴缸。对50例烧伤康复期患者应用中草药浸浴,使其渗出和渗血减少,血流速度加快(P<0.01)。结果浸浴前烧伤康复期患者的足甲襞微循环最显著的变化管襻畸形率高(P<0.01),汗腺导管增多(P<0.01),血管管襻周围渗出等。浸浴前与治疗组比较经过中草药浸浴的烧伤病人足甲襞微循环血管管襻畸形明显改善,管襻周围的渗出、渗血减少。结论虽然严重烧伤经治疗伤面愈合,但是烧伤后微循环的紊乱长期存在,影响病人的康复。中草药浸浴可直接作用于全身治疗,一定时间内发挥药物作用,迅速改善微循环。具有时间短、作用快、效果显著的独特作用,最适合烧伤康复期病人的治疗。浸浴、浸浴前后进行足甲襞微循环襻动态观测,患者本组既往平均烧伤面积为(54.59±17.30)%,平均年龄为17～45岁,伤面愈合时间1～6个月。

目的:烧伤康复期患者应用中草药浸浴观察微循环的变化,对烧伤后期康复治疗是一种有效的治疗方法和监测手段.方法:采用WX-753B型微循环显微镜及图像处理系统进行观测,应用法国产REF1254型自动调温浴缸.观测烧伤康复期患者应用中草药浸浴足甲襞微循环及未经中草药浸浴的烧伤康复期患者的足甲襞微循环.结果:未经中草药浸浴烧伤康复期患者的足甲襞微循环与经过中草药浸浴的烧伤康复期病人足甲襞微循环比较,最显著的变化:管襻畸形率高(P<0.01),汗腺导管增多(P<0.01),血管管襻周围渗出等.结论:严重烧伤经治疗伤面愈合,但是烧伤后微循环的紊乱长期存在,影响病人的康复.经中草药浸浴治疗可明显改善烧伤康复期患者的微循环,适合烧伤康复期病人的治疗.

40例康复期烧伤患者,均予中草药(中药组方为荆芥、双花、野菊花、大黄、水蛭)浸浴。用微循环显微镜及图像处理系统观测其足甲襞微血管循环变化结果患者足甲襞微循环血管管襻畸形明显改善,管襻周围的渗出、渗血减少。认为用本方浸浴可迅速改善烧伤患者微循环,是烧伤患者康复治疗的有益补充。

Objective To investigate optimal time for early escharectomy after severe scald in minipigs. Methods Minipigs inflicted with 35% TBSA full thickness burn were employed in the study, and they were randomly divided into A (n=7, with escharectomy at 6PSH), and B (n=7, with escharectomy at 24 PSH) groups. The hemodynamics indices, hemorrheology, and the serum levels of cytokines in the two groups were determined before burns and at 6, 8, 16, 24 and 72PSH. Results The hemodynamics indices in A group obviously improved compared with those in B group. The cardiac output (CO, 2.28±0.03 L/min) and right arterial pressure (RAP, 4.54±0.04 mmHg) in A group recovered to the pre-injury levels at 48 PSH. There was no difference of the hemorrheology indices between the two groups (P0.05). The serum contents of cytokines in A group declined to the pre-injury level on 1 PBW, while those in B group were significantly higher than those before injury and those in A group (P0.05 or P0.01). Conclusion Escharectomy during 6 PBH might be safe and feasible, thus preventing long-term complications effectively.

严重烧伤后体液丧失,可因组织缺血、缺氧和能量代谢障碍而发生休克,单纯的体液复苏不能纠正血容量不足及改善机体缺氧情况.2001年10月至2002年4月,我们对20只严重烧伤小型猪行等容量血液稀释疗法治疗,并观察了其血流动力学变化.现报告如下.

OBJECTIVE:To investigate optimal time for early escharectomy after severe scald in minipigs. METHODS:Minipigs inflicted with 35% TBSA full thickness burn were employed in the study, and they were randomly divided into A (n = 7, with escharectomy at 6PSH), and B (n = 7, with escharectomy at 24 PSH) groups. The hemodynamics indices, hemorrheology, and the serum levels of cytokines in the two groups were determined before burns and at 6, 8, 16, 24 and 72PSH. RESULTS:The hemodynamics indices in A group obviously improved compared with those in B group. The cardiac output (CO, 2.28 +/- 0.03 L/min) and right arterial pressure (RAP, 4.54 +/- 0.04 mmHg) in A group recovered to the pre-injury levels at 48 PSH. There was no difference of the hemorrheology indices between the two groups (P > 0.05). The serum contents of cytokines in A group declined to the pre-injury level on 1 PBW, while those in B group were significantly higher than those before injury and those in A group (P < 0.05 or P > 0.01). CONCLUSION:Escharectomy during 6 PBH might be safe and feasible, thus preventing long-term complications effectively.

Aim: To investigate the effect of hemodilution therapy on hemorrheologic characteristics by using the therapy on the experimental Chinese mini pigs after severe burn, and provide a theoretical basis for clinical application of hemodilution therapy. Methods: Twenty experimental Chinese mini pigs were selected to establish the severe burn animal models, and then randomly divided into two groups: control group and experimental group. The levels of viscosity of whole blood, hematocrit(Hct), erythrocytic deformation index and erythrocytic aggregation index were measured before and 6, 8, 16, 24 and 48 hours after burn. Results: The hemorrheologic indexes such as the viscosity of whole blood, Hct and erythrocytic aggregation index in the experimental group were obviously lower than those in the control group, but the erythrocytic deformation index significantly increased. Conclusion: The application of hemodilution therapy in burn shock stage and perioperative stage can obviously relieve the concentration of blood, erythrocytic aggregation and viscosity in burn shock stage, and also promote the ability of erythrocytic deformation and improve the blood volume effectively. So it is a feasible and effective treating measure in burn shock stage and perioperative stage. It has an important significance on the early rehabilitation of burn wound with a large area and the promotion of clinical healing rate.

严重烧伤后由于体液丧失,有效循环血容量明显下降引起组织缺血、缺氧和能量代谢障碍而发生休克.目前认为休克是机体供氧量(DO2)不足以产生维持组织功能和结构完整所必需的ATP.因此,休克复苏的目的不仅是纠正血容量不足,更重要的是改善机体缺氧情况,使组织氧输送量和氧耗量达到正常,以满足机体代谢的需要.等容量血液稀释疗法可以通过降低血细胞比容,使机体血流动力流变学及微循环发生改变,改善氧供,从根本上纠正休克.

Aim: To investigate the feasibility of escharectomy in mini pigs within 6 hours after severe burn(super early escharectomy), so as to benefit to the early rehabilitation for severe burn wound. Methods: Chinese experimental mini pigs were selected to establish the badly burn animal models, and were randomly divided into two groups: experimental group and control group. The hemodynamics indexes[cardiac output(CO) and right atrial pressure(RAP)] and hemorheology indexes(the low shear viscosity of whole blood and the erythrocytic aggregation index) were detected before and 6, 8, 16, 24, 48 and 72 hours after burn. Results: The changes of hemodynamics: The CO and RAP of both groups dropped rapidly after burn. The CO and RAP of the experimental group began to recover at 8 hours after burn and returned to the normal level at 48 hours after burn. The CO of the control group kept dropping continuously, and then regained to the level of preinjury at 48 hours after burn, and then it still kept rising. The RAP of the control group decreased to the lowest point at 8 hours after burn, and then came to the normal level at 72 hours after burn. The changes of hemorheology: The statistical process indicated that there was no significant difference in the low shear viscosity of whole blood and the erythrocytic aggregation index between the two groups. Conclusion: The super early escharectomy will provide a more steady hemodynamics in perioperative stage and it has no harm to hemorheology. From the view of the animal experiment, the super early escharectomy is feasible. It has an important significance on the early rehabilitation of burn wound with a large area and the promotion of clinical healing rate.

37例手部损伤患者清创后应用腹部真皮下血管网薄皮瓣修复缺损,创面愈合后即开始手功能康复治疗.结果皮瓣全部成活,随访 0.5～ 2年手部外观及功能恢复好.

目的通过在严重烧伤早期应用血液稀释疗法,研究机体血液流变学特性的改变.方法选择伤后6h内住院的成年男性严重烧伤患者30例,随机分为对照组与观察组.对照组患者常规进行体液复苏治疗,观察组患者体液复苏治疗同对照组,并于伤后24h内在血流动力学监测下进行血液稀释.二组患者分别于伤后8,16,24,48h测定全血粘度、血细胞比容、红细胞变形指数、红细胞聚集指数等血液流变学指标.结果①观察组患者进行血液稀释后,心输出量(CO)、中心静脉压(CVP)、平均动脉压(MAP)、肺动脉楔嵌压(PAWP)等反映血流动力学的指标有所改善.②对照组患者全血粘度、血细胞比容、红细胞聚集指数等血液流变学指标伤后显著增加,红细胞变形指数显著下降.虽经补液治疗,上述指标仍于伤后24h达峰值,伤后48h才接近正常范围;而观察组患者进行血液稀释后上述指标明显改善,伤后24h基本达正常水平.结论严重烧伤早期应用血液稀释疗法是安全的,能有效地改善血液流变学指标,从而大大提高体液复苏的效果,尽快恢复循环血容量,有效防治休克.

Aim: To explore the practicability of repair of full skin loss of swine with composite artificial skin. Methods: Sixteen swines were grafted 3 surface of wound from full thickness skin to deep fascia on the back. The 3 surfaces were divided into compound skin grafting group and razor-thin grafts group(control Group 1) and full skin grafting group(control Group 2), respectively. The wound healing conditions were observed regularly after operation. Simultaneously, wound tissue samples were harvested for histological examination. Results: The artificial skin was composed of dermis and epidermis under light microscope. The epidermic cells proliferated, differenciated and developed into basal cell layer, prickle cell layer, granular layer and cuticula during healing. Conclusion: Composite skin, combined by epidermic cell suspension and acelluar dermal matrix, has double-deck structure of dermis and epidermis, so its histological form and ultrastructure are similar to skin. The source of skin can be increased by cultivation of epidermic cell, which can be provided for patients of large area deep burn. Tissue engineering skin equivalent has potential prospects in application of repairing skin defect.