Objective:To investigate the application effect of early enteral nutrition to severe burn patients and nursing methods.Methods:30 severe burn patients were randomly divided into observation group and control group(15 cases for each group).The early enteral nutrition was given to the patients in the observation group and parenteral nutrition support was given to the patients in the control group.The blood biochemical indices and the change of immune function were observed and compared on the 3nd and 9th day after injury between the two groups.Results:The level of pre-albumin and transferrin on the 9th day after injury was higher in the observation group than the control group(P<0.05);TNF-α was lower in the observation group than the control group(P<0.05);IgG,lgA,CD4+ cells and NK cells were higher in the observation group than the control group(P<0.05).Conclusion:The early enteral nutrition support can improve biochemical indices and immune status of severe burn patients and it is worthy of being applied clinically.

Objective To study the effects of hyperoxic fluid treatment on the of lymphatic tumor necrosis factor(TNF-α),interleukin-6(IL-6)、interleukin-8(IL-8) levers of burn shock goats.Methods 20 female adult goats were randomly divided into the hyperoxic fluid resuscitation group(group A,n=10),and the control(group B,n=10).After both groups were inflicted with 30% TBSA full-thickness skin burns,the concentrations of TNF-α,IL-6,IL-8 in lymph were measured at 6,24,48 hours post burn.Results The levers of TNF-α,IL-6,IL-8 in lymph in group A were decreased than group B.Conclusion In the burn shock stage,the hyperoxic fluid resuscitation could improve the lymph circulation and decrease the levers of TNF-α,IL-6,IL-8 in lymph.

为探讨十二指肠营养管在重度烧伤合并吸入性损伤行气管切开插管患者中的应用和护理方法,将39例重度烧伤合并吸入性损伤行气管切开插管患者按入院时间分为A组18例和B组21例,分别给予经内镜十二指肠营养置管和普通胃管,观察比较两置管成功率、并发症情况、带管时间及堵管、脱管情况。结果A组置管成功率高于B组(P<0.01)。认为对于吸入性损伤行气管切开插管的患者,经内镜十二指肠营养管置放术是一种有效、简便、安全的胃肠营养方法。

目的 探讨高氧液对特重烧伤休克期肾功能的保护作用.方法 30例大面积烧伤患者随机分成两组,A高氧液组(15人)和B对照组(15人),分别输入高氧液和平衡盐水液,观察两组休克期第1、2个24h的总尿量及平均尿量,检测其伤后24、48h的尿素氮(BUN)、肌酐(Scr).采用放射免疫分析法分别测定伤后24、48h血浆TNF-α和IL-6含量.结果 与对照组比较,治疗组第1、2个24h尿量均明显增加;(P均<0.01).烧伤休克期A组各时相点血浆TNF-α、IL-6水平显著低于B组.(P<0.01).结论 大面积烧伤病人早期复苏中静脉应用高氧液可明显减轻全身性炎症反应,对严重烧伤休克期患者的肾功能有保护作用.

吸入性损伤的病死率比较高,国外报道的重度烧伤合并吸入性损伤的病死率为80%,国内有学者报道中、重度烧伤合并吸入性损伤的病死率为43.75%[1],三军医大的报道为50.0%～71.5%.对于烧伤合并吸入性损伤患者,除早期积极抗休克、氧疗、减少全身炎症对肺的损伤外,应及时行气管切开术,必要时机械辅助通气.术后加强呼吸道管理以减少并发症发生、提高吸入性损伤治愈率.我科自2001-03～2005-03收治吸入性损伤行气管切开患者27例.

将38例烧伤总表面积(TBSA)达30%~90%的烧伤患者随机分为高压氧(HBO)组28例(烧伤后3d内行HBO治疗)和非HBO组10例(不给HBO治疗)。两组于烧伤后16h和1、2、4、7d抽静脉血,用火箭免疫电泳法测定血浆白细胞介素-8(IL-8)。并与30例正常对照者进行比较。结果,非HBO组IL-8水平在伤后各时间点均明显高于正常对照组(P<0.01),下降缓慢;HBO组血浆IL-8水平明显低于非HBO组(P<0.01或P<0.05),随时间呈下降趋势,至伤后7d接近正常(P>0.05)。表明严重烧伤能诱导机体产生大量IL-8;HBO治疗可明显降低严重烧伤患者血浆IL-8水平。

超声雾化吸入是治疗吸入性损伤的有效措施之一,但有的患者在超声雾化治疗中,突然烦躁不安,胸闷不适,严重者引起呼吸改变甚至紫绀等低氧血症表现.

重度烧伤患者补液量大、种类多,尤其在休克期,易发生低血容量性休克,输液的量及速度直接决定着患者的安危,静脉通路可靠持久的建立尤为重要.而大面积烧伤病人由于组织水肿、皮肤破坏、微循环障碍等,使用周围静脉抢救患者,扩容输液十分困难.

磨削术是应用各种快速旋转的工具如金属丝刷、钻石钻或锯齿轮等刨平或擦平皮肤,通过去除表皮和浅层真皮治疗各种皮肤疾病[1].1998年7月至2000年4月,我科采用早期创面磨削术处理深Ⅱ度烧伤创面62例,效果较好,报告如下.

混合感染是多种细菌同时存在相互协同引起的非特异性化脓性感染[1].1999年8月我科收治1例"双小腿、左髋部大片皮肤及软组织多种细菌混合感染"的患者,经精心治疗护理,治愈出院.现将病情及护理报道如下.

手是人类最重要的劳动器官,手部烧伤后,由于深度创面的治疗护理不当,常遗留瘢痕挛缩畸型和功能障碍,甚至丧失自理生活和劳动的能力,所以手部烧伤后正确的护理相当重要,其目的在于减轻或避免手部致残,竭力争取恢复手部功能.现将笔者对手部烧伤患者的护理体会总结如下.