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[Clinical effects of free perforator propeller myocutaneous flap from buttock in repairing complex wounds in the buttock with deep dead cavity]. 【臀部游离穿支螺旋桨肌皮瓣修复臀部深腔复杂创面的临床疗效】。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20221115-00488
L M Chen, G Wang, H Liu, R M Zhao, X H Liu, G T Cao, Z J Yao, Z Y Li, Y Liu

Objective: To investigate the feasibility and clinical effects of using free perforator propeller myocutaneous flap from buttock in repairing complex wounds in the buttock with deep dead cavity. Methods: A retrospective observational study was conducted. From June 2020 to June 2022, 9 patients with complex wounds in the buttock with deep dead cavity who met the inclusion criteria were admitted to Lanzhou University Second Hospital, including 6 males and 3 females, aged 26 to 62 years, with original wound area ranging from 4.0 cm×3.0 cm to 8.0 cm×7.0 cm and dead cavity depth of 7 to 11 cm. All the wounds were repaired with free perforator propeller myocutaneous flap from buttock, with flap area of 6.0 cm×2.5 cm to 13.0 cm×7.0 cm and muscle flap length of 6 to 11 cm. All the wounds in the donor area were closed and sutured directly. Postoperative myocutaneous flap survival, complications, as well as donor and recipient wound healing were observed, and the shape of donor and recipient areas were followed up. Results: Congestion occurred under the myocutaneous flap of one patient due to poor drainage on post surgery day 2, which was healed after 15 days of drainage and dressing change. The myocutaneous flaps of other patients survived successfully after surgery. The wounds in the donor and recipient areas were all well healed. During the follow-up of 3 to 10 months, the donor and recipient areas were full in shape, with little difference from the healthy side, and were able to bear pressure. Conclusions: The free perforator propeller myocutaneous flap from buttock can repair the deep dead cavity and surface wounds at the same time. The use of this myocutaneous flap in repairing complex wounds in the buttock with deep dead cavity results in minimal damage to the donor area, allows pressure-bearing of the donor and recipient areas after surgery, and ensures a full buttock shape.

目的:探讨应用臀部游离穿支螺旋桨肌皮瓣修复臀部深腔复杂创面的可行性及临床效果。方法:采用回顾性观察研究。2020年6月至2022年6月,兰州大学第二医院收治了9例符合纳入标准的臀部复杂伤口伴深死腔患者,其中男6例,女3例,年龄26~62岁,原伤面积4.0cm×3.0cm~8.0cm×7.0cm,死腔深度7~11cm。所有创面均采用臀部游离穿支螺旋桨肌皮瓣修复,皮瓣面积6.0cm×2.5cm~13.0cm×7.0cm,肌皮瓣长度6~11cm,供区创面均直接缝合。观察术后肌皮瓣的存活率、并发症以及供受体伤口的愈合情况,并随访供受体区域的形状。结果:1例患者术后第2天因引流不畅,肌皮瓣下出现充血,经引流换药15天后痊愈。其他患者的肌皮瓣在术后均成功成活。捐赠者和接受者的伤口都愈合得很好。在3至10个月的随访中,供体和受体区域形状饱满,与健康侧差异不大,能够承受压力。结论:臀部游离穿支螺旋桨肌皮瓣可同时修复深部死腔和体表创面。该肌皮瓣用于修复具有深死腔的臀部复杂伤口,对供体区域的损伤最小,允许手术后供体和受体区域承受压力,并确保完整的臀部形状。
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引用次数: 0
[Influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit]. [护士工作投入和自我效能感对烧伤重症监护室临床实践能力的影响]。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20220905-00379
H X Chen, W J Liu, B Liu, Z F Huang, Q P Zhang, X L Xiao, W Lai, S Y Zheng
<p><p><b>Objective:</b> To analyze the influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit (BICU), and to explore its potential pathways of action. <b>Methods:</b> A cross-sectional survey was conducted. From May to October 2020, a total of 30 hospitals with BICU in China were selected by stratified sampling method. Among BICU nurses who met the inclusion criteria, their clinical practice ability, work engagement, and self-efficacy were evaluated by self-evaluation scale of oriented problem-solving behavior in nursing practice (OPSN), Utrecht work engagement scale (UWES), and general self-efficacy scale (GSES), respectively. The total scale scores of each index and the average item scores were recorded. The self-designed general data questionnaire was used to investigate the nurses' gender, age, marital status, education background, working years, professional title, and the economic region of the hospital that they belonged to. The total scale scores of the above-mentioned three evaluation indexes were compared after the classification of nurses according to general data, and the data were statistically analyzed with independent sample <i>t</i> test or one-way analysis of variance. Pearson correlation analysis was used to analyze the correlation between the total scale scores of the three evaluation indexes. Based on the total scale scores of the above-mentioned three evaluation indexes, a structural equation model was established, the mediation analysis of the relationship among the three evaluation indexes and the pathway analysis of the structural model were conducted, and the Bootstrap method was used to verify the pathways of action. <b>Results:</b> A total of 401 questionnaires were distributed, and 337 valid questionnaires were returned, with a valid return rate of 84.04%. The total scale scores of clinical practice ability, work engagement, and self-efficacy of 337 nurses were 98.2±11.7, 67.7±18.6, and 26.6±5.6, respectively, and the average item scores were 3.9±0.5, 4.5±1.2, and 2.7±0.6, respectively. Among the 337 nurses, the majority were female, aged 40 or below, married, and had a bachelor's degree with work experience of ≤10 years; both nurses with professional nurse title and nurses from the Southeast region accounted for about 50%. There were statistically significant differences in the total scale score of clinical practice ability among nurses with different ages, education backgrounds, working years, and professional titles (with <i>F</i> values of 3.26, 4.36, 3.12, and 2.80, respectively, <i>P</i><0.05). There was statistically significant difference in the total scale score of work engagement among nurses with different working years (<i>F</i>=4.50, <i>P</i><0.05). There were statistically significant differences in the total scale score of self-efficacy among nurses with different ages, working years, and professional titles (with <i>F</i> values of 4.91, 4.50, a
目的:分析护士工作投入和自我效能感对烧伤重症监护室临床实践能力的影响,探讨其潜在的作用途径。方法:采用横断面调查。2020年5月至10月,采用分层抽样方法,共选取了中国30家设有BICU的医院。在符合纳入标准的BICU护士中,他们的临床实践能力、工作投入和自我效能分别采用护理实践中定向解决问题行为自评量表(OPSN)、乌得勒支工作投入量表(UWES)和一般自我效能量表(GSES)进行评估。记录各指标的量表总分和项目平均分。采用自行设计的通用数据调查表,对护士的性别、年龄、婚姻状况、教育背景、工作年限、职称以及所属医院的经济区域进行调查,采用独立样本t检验或单因素方差分析对数据进行统计学分析。采用Pearson相关分析法分析三个评价指标的量表总分之间的相关性。基于上述三个评价指标的量表总分,建立了结构方程模型,对三个评价指数之间的关系进行了中介分析,并对结构模型进行了路径分析,采用Bootstrap方法验证了作用路径。结果:共发放问卷401份,回收有效问卷337份,有效回收率84.04%。337名护士的临床实践能力、工作投入和自我效能感总分分别为98.2±11.7、67.7±18.6和26.6±5.6,平均项目得分分别为3.9±0.5、4.5±1.2和2.7±0.6。337名护士中,女性居多,年龄40岁及以下,已婚,本科学历,工作经验≤10年;具有护士职称的护士和来自东南地区的护士均占50%左右。不同年龄、不同学历、不同工作年限的护士临床实践能力总分差异有统计学意义,和职称(F值分别为3.26、4.36、3.12和2.80,PF=4.50,PF值分别为4.91、4.50和2.91,Pr值分别为0.30和0.51,Pr=0.37,Pβ值分别为0.54和0.16,Pβ=0.29,PPC)lf疗效与临床实践能力呈正相关。工作投入可以直接影响临床实践能力,也可以通过自我效能感的中介作用间接影响临床实践力。
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引用次数: 0
[Clinical application of combination of different types of free perforator flaps in the repair of complex wounds in extremities]. 【不同类型游离穿支皮瓣联合应用于四肢复杂创伤修复的临床应用】。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20220720-00300
H Li, S E Xiao, C L Deng, B H Wu, X K Wu, T H Zhang, Z Y Liu, Z R Wei
<p><p><b>Objective:</b> To investigate the clinical application effects of combination of different types of free perforator flaps in the repair of complex wounds in extremities. <b>Methods:</b> A retrospective observational study was conducted. From January 2018 to June 2022, 11 patients with complex wounds in extremities who met the inclusion criteria was admitted to the Affiliated Hospital of Zunyi Medical University, including 8 males and 3 females, aged 28 to 55 years. The wounds in the upper extremities in 4 cases and in the lower extremities in 7 cases were repaired with different combination of free perforator flaps. After debridement, the wound area was 7.0 cm×6.0 cm-28.0 cm×12.0 cm. A combination of different types of perforator flaps were applied, including the perforator tri-leaf flap of the descending branch of the lateral femoral circumflex artery in 6 cases, the descending branch of lateral femoral circumflex artery combined with oblique branch perforating branch flap in 2 cases, the lobulated flap of the descending branch of the lateral femoral circumflex artery combined with the contralateral medial plantar artery perforator flap in 2 cases, and the bilateral perforator flap of the descending branch of lateral femoral circumflex artery combined with great toe nail flap in 1 case, with the size of a single flap ranged from 2.0 cm×2.0 cm-25.0 cm×6.0 cm. The donor site was repaired by direct suture, skin grafting, or flap transplantation. During free flap transplantation, the flap was cut and split according to the distribution of perforators, and end-to-end or end-to-side anastomosis was performed between the donor area and the recipient area. After surgery, the survival of transplanted flap in the primary recipient site, the occurrence of vascular crisis, the wound healing in the flap donor site, and the survival of transplanted skin or flap in the flap donor site were observed. During follow-up, the blood supply, appearance and texture of the transplanted flap in the primary recipient site were observed; and at the same time, the weight bearing of the plantar receiving area, the presence of sliding, ulcers, and sinus tracts of the flap, and the appearance and function of the hand were observed; the complications in the donor area were observed. <b>Results:</b> After surgery, one patient's transplanted flap in the primary recipient site had vascular crisis but survived after exploration+vein graft bridging; partial necrosis occurred in one lobe of anterolateral thigh lobulated flap transplanted to the primary recipient site in one patient and recovered after dressing change+skin grafting, and the different types of perforator flap transplanted to the primary recipient site in the other 9 patients all survived. After surgery, the wound with direct suture at the donor site healed well, and the skin or flap transplanted to the donor area survived well. During 3-24 months of follow-up, the blood supply, appearance, and texture of the
目的:探讨不同类型游离穿支皮瓣在四肢复杂创伤修复中的临床应用效果。方法:采用回顾性观察研究。2018年1月至2022年6月,遵义医科大学附属医院收治符合纳入标准的四肢复杂创伤患者11例,其中男8例,女3例,年龄28~55岁。采用不同组合的游离穿支皮瓣修复上肢创伤4例,下肢创伤7例。清创后创面面积为7.0cm×6.0cm~28.0cm×12.0cm。采用不同类型的穿支皮瓣组合,包括旋股外侧动脉降支穿支三叶皮瓣6例,旋股外侧血管降支联合斜支穿支皮瓣2例,旋股外侧动脉降支分叶状皮瓣联合对侧足底内侧动脉穿支皮瓣2例,旋股外侧血管降支双侧穿支皮瓣联合足趾甲皮瓣1例,单个皮瓣大小为2.0cm×2.0cm~25.0cm×6.0cm。供体部位通过直接缝合、植皮或皮瓣移植进行修复。在游离皮瓣移植过程中,根据穿支的分布对皮瓣进行切割和劈开,并在供体区域和受体区域之间进行端对端或端对侧吻合。术后,观察移植皮瓣在主要受体部位的存活率、血管危象的发生、皮瓣供体部位的伤口愈合情况以及皮瓣供体部位移植皮肤或皮瓣的存活情况。在随访过程中,观察移植皮瓣在主要受体部位的血液供应、外观和质地;同时,观察足底接受区的负重情况,皮瓣是否有滑动、溃疡和窦道,以及手的外观和功能;观察供区并发症。结果:术后,1例患者在原发受体部位移植的皮瓣出现血管危象,但在探查+静脉移植物桥接后存活;1例移植至主受体部位的股前外侧分叶皮瓣发生部分坏死,换药+植皮后恢复,其余9例移植至主要受体部位的不同类型的穿支皮瓣全部成活。手术后,供区直接缝合的伤口愈合良好,移植到供区的皮肤或皮瓣存活良好。在3-24个月的随访中,主要受体部位的移植皮瓣的血液供应、外观和质地良好。两例患者采用股前外侧皮瓣联合足底内侧皮瓣修复足底缺损。足底接受区能够承受重量,接受区的皮瓣质地接近正常足底皮肤,没有皮瓣滑动、溃疡或窦道形成。1例采用双侧股前外侧皮瓣联合足趾甲皮瓣修复手部合并前臂软组织缺损,手部尤其是拇指的外观和功能良好。供区仅留下线状瘢痕,无其他明显并发症。结论:不同类型的穿支皮瓣联合应用是修复四肢复杂创伤的一种可靠的临床方法,安全性高,疗效好,并发症少。
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引用次数: 0
[Expert consensus on the clinical treatment of burn patients complicated with Coronavirus infection (2023 version)]. 【烧伤合并冠状病毒感染患者临床治疗专家共识(2023年版)】。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20230519-00176

With China downgrading the management of Coronavirus infection (COVID-19) from Category A to Category B, a large number of COVID-19 patients have occurred in multiple waves across the country. Meanwhile, the long-term impact of Coronavirus on the body has gradually been noticed. However, the clinical treatment of burns complicated with COVID-19 is still a major challenge in Chinese burn centers. It is then essential to standardize the clinical treatment of such patients, improve the prognosis to the greatest extent, and provide valuable experiences for similar infectious diseases in future. Therefore, Chinese Burn Association, Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare, and Editorial Committee of Chinese Journal of Burns and Wounds jointly initiated and organized multidisciplinary experts to develop this expert consensus based on the current medical evidence, clinical practice, and authoritative guidelines of other disciplines, in order to standardize the clinical treatment of burn patients complicated with COVID-19.

随着中国将冠状病毒感染(新冠肺炎)的管理从A类降至B类,大量新冠肺炎患者在全国各地多次出现。与此同时,冠状病毒对身体的长期影响也逐渐引起人们的注意。然而,烧伤并发新冠肺炎的临床治疗仍然是中国烧伤中心面临的主要挑战。因此,有必要规范此类患者的临床治疗,最大限度地改善预后,并为未来类似传染病提供宝贵经验。因此,中国烧伤协会、中国国际医疗保健交流促进会烧伤医学分会、《中华烧伤与创伤杂志》编委会共同发起并组织多学科专家,结合当前医学证据、临床实践、,以及其他学科的权威指南,以规范烧伤合并新冠肺炎患者的临床治疗。
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引用次数: 0
[Prospective study on the influence of dobutamine on blood perfusion in free flap repair of diabetic foot wounds]. [多巴酚丁胺对糖尿病足创面游离皮瓣修复中血液灌注影响的前瞻性研究]。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20221220-00543
X J Dou, H Y Wang, W Chen, J Zhou, Z R Wei
<p><p><b>Objective:</b> To investigate the influence of clinical administration of dobutamine on blood perfusion in free flap repair of diabetic foot wounds. <b>Methods:</b> A prospective self-controlled study was conducted. From January to November 2022, 20 patients with diabetic foot who met the inclusion criteria were hospitalized in the Department of Burns and Plastic Surgery of Affiliated Hospital of Zunyi Medical University, including 9 males and 11 females, aged from 44 to 75 years, with the foot wounds area ranging from 5 cm×4 cm to 20 cm×10 cm, which were repaired by free anterolateral thigh flaps. Heart rate (HR) and mean arterial pressure (MAP) were recorded before anesthesia induction, 10 minutes after vascular recanalization, when the target blood pressure (i.e., MAP being 6-10 mmHg (1 mmHg=0.133 kPa) higher than that before anesthesia induction) was reached after infusion of dobutamine, and 10 minutes after tracheal catheter removal. Additionally, indocyanine green, a contrast agent, was injected intravenously at 10 minutes after vascular recanalization and when the target blood pressure was reached after infusion of dobutamine to assess flap blood perfusion using infrared imager, and the area ratio of flaps with hyperperfusion and hypoperfusion was calculated. Other recorded variables included flap harvesting area, surgical duration, total fluid infusion amount, infusion dose and total usage of dobutamine, intraoperative adverse events, postoperative flap complications, and follow-up outcomes. Data were statistically analyzed with paired sample <i>t</i> test, analysis of variance for repeated measurement, Bonferroni method, and generalized estimating equation. <b>Results:</b> Compared with those before anesthesia induction, HR and MAP of patients were significantly decreased at 10 minutes after vascular recanalization (<i>P</i><0.05), while HR and MAP of patients were significantly increased when the target blood pressure was reached after infusion of dobutamine (<i>P</i><0.05). Compared with those at 10 minutes after vascular recanalization, HR and MAP of patients were significantly increased when the target blood pressure was reached after infusion of dobutamine and at 10 minutes after tracheal catheter removal (<i>P</i><0.05). Compared with those when the target blood pressure was reached after infusion of dobutamine, HR and MAP of patients were significantly decreased at 10 minutes after tracheal catheter removal (<i>P</i><0.05). The area ratio of flaps with hyperperfusion of patients was 0.63±0.11 when the target blood pressure was reached after infusion of dobutamine, which was significantly higher than 0.31±0.09 at 10 minutes after vascular recanalization (<i>t</i>=-9.92, <i>P</i><0.05). The area ratio of flaps with hypoperfusion of patients was 0.12±0.05 when the target blood pressure was reached after infusion of dobutamine, which was significantly lower than 0.45±0.10 at 10 minutes after vascular recanalization (<i>t</i>=
目的:探讨多巴酚丁胺在糖尿病足创面游离皮瓣修复中的临床应用对血液灌注的影响。方法:采用前瞻性自我对照研究。2022年1-11月,遵义医科大学附属医院烧伤整形科收治符合入选标准的糖尿病足患者20例,其中男9例,女11例,年龄44~75岁,足部创伤面积5 cm×4 cm~20 cm×10 cm,采用股前外侧游离皮瓣修复。在麻醉诱导前、血管再通后10分钟、多巴酚丁胺输注后达到目标血压(即MAP比麻醉诱导前高6-10mmHg(1mmHg=0.133kPa))时以及气管导管移除后10分钟记录心率(HR)和平均动脉压(MAP)。此外,在血管再通后10分钟,当多巴酚丁胺输注后达到目标血压时,静脉注射造影剂吲哚青绿,以使用红外成像仪评估皮瓣血液灌注,并计算高灌注和低灌注皮瓣的面积比。其他记录的变量包括皮瓣收获面积、手术持续时间、总输液量、多巴酚丁胺的输注剂量和总使用量、术中不良事件、术后皮瓣并发症和随访结果。数据采用配对样本t检验、重复测量方差分析、Bonferroni方法和广义估计方程进行统计分析。结果:与麻醉诱导前相比,血管再通后10分钟患者的HR和MAP明显下降(PPPPt=-9.92,Pt=17.05,P结论:多巴酚丁胺用于糖尿病足创面游离皮瓣修复,可显著改善患者MAP,扩大高灌注面积,减少低灌注面积,增强皮瓣活力,短期随访效果良好,适合临床推广。
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引用次数: 0
[Exploration of functional reconstruction and rehabilitation strategies for patients with destructive electric burns]. 【破坏性电烧伤患者功能重建及康复策略探讨】。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20230506-00158
Y M Shen, Q Dai

Electric burn is a kind of three-dimensional destructive damage. It is necessary to attach great importance to the functional reconstruction and rehabilitation of patients with destructive electric burns. Wound repair and limb salvage are not the end of the treatment of destructive electric burns, but functional rehabilitation and reintegration into society of patients are the goals of treatment. This paper systematically discusses the early wound repair, late functional reconstruction and rehabilitation, limb salvage and amputation, minimized damage of donor area, psychological rehabilitation, and multi-disciplinary cooperation of destructive electric burns. Only by attaching great importance to the functional reconstruction and rehabilitation, and embedding these concepts in people's brains, perfect repair and rehabilitation of destructive electric burns can be realized.

电烧伤是一种三维破坏性损伤。有必要高度重视破坏性电烧伤患者的功能重建和康复。创伤修复和肢体挽救并不是破坏性电烧伤治疗的终点,但患者的功能康复和重返社会是治疗的目标。本文系统论述了破坏性电烧伤的早期创面修复、晚期功能重建与康复、肢体抢救与截肢、最大限度地减少供区损伤、心理康复以及多学科合作。只有高度重视功能重建和康复,并将这些概念嵌入人们的大脑,才能实现破坏性电烧伤的完美修复和康复。
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引用次数: 0
[Effects of advanced platelet-rich fibrin on deep partial-thickness burn wounds in nude mice]. [晚期富含血小板的纤维蛋白对裸鼠深部部分厚度烧伤创面的影响]。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20220804-00334
L J Tang, X M Li, X W Zhang, Y Luo, G Xu
<p><p><b>Objective:</b> To explore the effects of advanced platelet-rich fibrin (A-PRF) on deep partial-thickness burn wounds in nude mice and its mechanism. <b>Methods:</b> The experimental study method was adopted. Forty healthy volunteers in Subei People's Hospital were recruited, including 32 females and 8 males, aged 60 to 72 years. Leukocyte platelet-rich fibrin (L-PRF) and A-PRF membranes were prepared after venous blood was extracted from them. The microstructure of two kinds of platelet-rich fibrin (PRF) membranes was observed by field emission scanning electron microscope. The number of samples was 3 in the following experiments. The L-PRF and A-PRF membranes were divided into L-PRF group and A-PRF group and cultured, and then the release concentrations of platelet-derived growth factor-AB (PDGF-AB) and vascular endothelial growth factor (VEGF) in culture supernatant were determined by enzyme-linked immunosorbent assay on culture day 1, 3, 7, and 14. Mice L929 fibroblasts (Fbs) were divided into L-PRF group and A-PRF group, and cultured with L-PRF or A-PRF conditioned medium, respectively. On culture day 1, 3, and 7, the cell proliferation activity was detected by thiazole blue method. The cell migration rate was detected and calculated at 24 h after scratching by scratch test. Thirty-six male BALB/c nude mice aged 6-8 weeks were selected to make a deep partial-thickness burn wound on one hind leg, and then divided into normal saline group, L-PRF group, and A-PRF group, according to the random number table, with 12 mice in each group. The wounds of nude mice in normal saline group were only washed by normal saline, while the wounds of nude mice in L-PRF group and A-PRF group were covered with the corresponding membranes in addition. The wounds of nude mice in the 3 groups were all bandaged and fixed with dressings. On treatment day 4, 7, and 14, the wound healing was observed and the wound healing rate was calculated. Masson staining was used to observe the new collagen in wound tissue, and immunohistochemical staining was used to detect the percentage of CD31 positive cells in the wound. Data were statistically analyzed with independent sample <i>t</i> test, analysis of variance for repeated measurement, analysis of variance for factorial design, one-way analysis of variance, and least significant difference test. <b>Results:</b> L-PRF membrane's dense network structure was composed of coarse fibrin bundles, with scattered white blood cells and platelets with complete morphology. A-PRF membrane's loose network structure was composed of fine fibrin bundles, with scattered small amount of deformed white blood cells and platelets. On culture day 1, the release concentration of PDGF-AB in PRF culture supernatant in A-PRF group was significantly higher than that in L-PRF group (<i>t</i>=5.73, <i>P</i><0.05), while the release concentrations of VEGF in PRF culture supernatant in the two groups were similar (<i>P</i>>0.05). On culture day 3,
目的:探讨晚期富血小板纤维蛋白(A-PRF)对裸鼠深部局部烧伤创面的影响及其作用机制。方法:采用实验研究方法。在苏北人民医院招募了40名健康志愿者,其中女性32名,男性8名,年龄在60至72岁之间。从富含白细胞血小板的纤维蛋白(L-PRF)和A-PRF膜中提取静脉血后制备它们。用场发射扫描电镜观察了两种富血小板纤维蛋白(PRF)膜的微观结构。在以下实验中,样品的数量为3。将L-PRF和A-PFF膜分为L-PRF组和A-PRF组并培养,然后在培养第1、3、7和14天通过酶联免疫吸附测定培养上清液中血小板衍生生长因子AB(PDGF-AB)和血管内皮生长因子(VEGF)的释放浓度。将小鼠L929成纤维细胞(Fbs)分为L-PRF组和A-PRF组,分别用L-PRF或A-PRF条件培养基培养。在培养第1、3和7天,通过噻唑蓝法检测细胞增殖活性。在划痕试验后24小时检测并计算细胞迁移率。选择36只6-8周龄的雄性BALB/c裸鼠,在一只后腿上制作深部部分厚度烧伤伤口,然后根据随机数表将其分为生理盐水组、L-PRF组和a-PRF组,每组12只。生理盐水组裸鼠伤口仅用生理盐水冲洗,而L-PRF组和A-PRF组裸鼠伤口还覆盖有相应的膜。3组裸鼠的伤口均用绷带包扎并用敷料固定。在治疗第4、7和14天,观察伤口愈合并计算伤口愈合率。Masson染色观察伤口组织中新胶原的形成,免疫组织化学染色检测伤口中CD31阳性细胞的百分比。采用独立样本t检验、重复测量方差分析、析因设计方差分析、单向方差分析和最小显著性差异检验对数据进行统计分析。结果:L-PRF膜的致密网状结构由粗纤维蛋白束组成,分布有形态完整的白细胞和血小板。A-PRF膜松散的网状结构由细小的纤维蛋白束组成,并有少量分散的变形白细胞和血小板。培养第1天,A-PRF组PRF培养上清液中PDGF-AB的释放浓度显著高于L-PRF组(t=5.73,PP>0.05),A-PRF组培养上清液中PDGF-AB和VEGF的释放浓度明显高于L-PRF组(t值分别为6.93、7.45、5.49、6.97、8.97和13.64,PPt值分别是8.38、5.14和6.16,Pt=11.74,PPPPC结论:A-PRF稳定的纤维蛋白网络结构可以维持生长因子的持续释放,加速细胞增殖,促进细胞迁移,从而缩短深部偏厚的愈合时间,提高愈合质量裸鼠烧伤。
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引用次数: 0
[Research advances on the role of cell senescence in chronic wound healing]. 【细胞衰老在慢性伤口愈合中的作用研究进展】。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20220928-00424
S Y H Fang, D W Liu

Chronic wounds bring huge pressure and difficulties to patients, their families, and society due to their long-term refractory characteristics and serious poor prognosis. Recently, more and more evidences have proven that cell senescence exists in chronic wounds and affects wound healing. This article reviews the characteristics of cell senescence in chronic wounds, discusses the relationship between cell senescence and chronic wound healing, and summarizes current series of anti-senescence strategies to bring out the possibility of treating chronic wounds with cell senescence as a potential target.

慢性创伤由于其长期难治性特点和严重的不良预后,给患者、家属和社会带来了巨大的压力和困难。近年来,越来越多的证据表明,细胞衰老存在于慢性伤口中,并影响伤口愈合。本文综述了慢性伤口细胞衰老的特点,探讨了细胞衰老与慢性伤口愈合的关系,总结了目前一系列的抗衰老策略,为以细胞衰老为潜在靶点治疗慢性伤口提供了可能。
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引用次数: 0
[Establishment and validation of a risk prediction model for disseminated intravascular coagulation patients with electrical burns]. [电烧伤弥散性血管内凝血患者风险预测模型的建立和验证]。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20230419-00132
Q Li, T Ba, S J Cao, Q Chen, B Zhou, Z Q Yan, Z H Hou, L F Wang
<p><p><b>Objective:</b> To establish and validate a risk prediction model of disseminated intravascular coagulation (DIC) by the screening independent risk factors for the occurrence of DIC in patients with electrical burns. <b>Methods:</b> The retrospective case series study was conducted. The clinical data of 218 electrical burn patients admitted to Baogang Hospital of Inner Mongolia from January 2015 to January 2023 who met the inclusion criteria were collected, including 198 males and 20 females, with the age of (38±14) years. The patients were divided into DIC group and non DIC group based on whether they were diagnosed with DIC during the treatment period. The following data of patients of two groups were collected and compared, including age, gender, total burn area, full-thickness burn area, injury voltage, whether osteofascial compartment syndrome occurred within 1 day after injury, duration of stay in burn intensive care unit, total length of hospital stay, whether combined with inhalation injury and multiple injuries, whether shock occurred upon admission, the abbreviated burn severity index score, and the acute physiology and chronic health evaluation Ⅱ score. The laboratory examination data of the patients within 24 hours after admission were also collected, including blood routine indexes: white blood cell count (WBC), hemoglobin level, platelet count (PLT), and neutrophil count; coagulation indexes: activated partial thromboplastin time (APTT), prothrombin time, thrombin time, and levels of D-dimer and fibrinogen (FIB); blood biochemistry indexes: aspartic transaminase, alanine transaminase, direct bilirubin, total bilirubin, total protein, albumin, blood glucose, creatinine, and urea nitrogen; blood gas analysis indexes: blood pH value, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, bicarbonate, and base excess; and cardiac zymogram indexes: levels of myoglobin, troponin, lactate dehydrogenase, creatine kinase (CK), and α-hydroxybutyrate dehydrogenase. Data were statistically analyzed with chi-square test, Fisher's exact probability test, independent sample <i>t</i> test, and Mann-Whitney <i>U</i> test. For the variables with statistically significant differences in single factor analysis, the least absolute value selection and shrinkage operator (LASSO) regression was used to reduce the dimension, and the predictive factors for DIC in 218 patients with electrical burns were screened. The above-mentioned predictors were included in multivariate logistic regression analysis to find out the independent risk factors for DIC in 218 patients with electrical burns, and to draw the prediction model nomograms. The performance of the prediction model was evaluated by the receiver operating characteristic (ROC) curve and the area under the ROC curve, and the prediction model was validated by the calibration curve and clinical decision curve analysis (DCA). <b>Results:</b> Compared with those in non DIC gro
目的:通过筛选电烧伤患者发生弥散性血管内凝血(DIC)的独立危险因素,建立并验证DIC的风险预测模型。方法:采用回顾性病例系列研究。收集2015年1月至2023年1月入住内蒙古宝钢医院的218例符合纳入标准的电烧伤患者的临床资料,其中男性198例,女性20例,年龄(38±14)岁。根据患者在治疗期间是否被诊断为DIC,将其分为DIC组和非DIC组。收集并比较两组患者的以下数据,包括年龄、性别、总烧伤面积、全层烧伤面积、损伤电压、损伤后1天内是否发生骨筋膜室综合征、在烧伤重症监护室的住院时间、总住院时间、是否合并吸入性损伤和多发性损伤,入院时是否发生休克,简称烧伤严重程度指数评分,急性生理和慢性健康评估Ⅱ评分。还收集了患者入院后24小时内的实验室检查数据,包括血常规指标:白细胞计数(WBC)、血红蛋白水平、血小板计数(PLT)、中性粒细胞计数;凝血指标:活化部分凝血酶原时间(APTT)、凝血酶原时间、凝血酶时间、D-二聚体和纤维蛋白原(FIB)水平;血液生化指标:天冬氨酸转氨酶、丙氨酸转氨酶、直接胆红素、总胆红素、总蛋白、白蛋白、血糖、肌酐、尿素氮;血气分析指标:血液pH值、动脉氧分压、动脉二氧化碳分压、碳酸氢盐分压、碱过量;心肌酶谱指数:肌红蛋白、肌钙蛋白、乳酸脱氢酶、肌酸激酶(CK)和α-羟基丁酸脱氢酶水平。采用卡方检验、Fisher精确概率检验、独立样本t检验和Mann-Whitney U检验对数据进行统计分析。对于单因素分析具有统计学显著差异的变量,采用最小绝对值选择和收缩算子(LASSO)回归降维,筛选218例电烧伤患者DIC的预测因素。将上述预测因素纳入多变量逻辑回归分析,找出218例电烧伤患者DIC的独立危险因素,并绘制预测模型列线图。预测模型的性能通过受试者工作特性(ROC)曲线和ROC曲线下的面积进行评估,预测模型通过校准曲线和临床决策曲线分析(DCA)进行验证。结果:与非DIC组相比,总烧伤面积、全层烧伤面积、总住院时间、高压致伤比例、伤后1天内骨筋膜室综合征的发生率、吸入性复合损伤、,DIC组患者入院时休克发生率显著增加/延长(Z值分别为-2.53、-4.65和-2.10,χ2值分别为11.46、16.00、7.98和18.93,PZ值分别为2.02、-4.51和-3.82,t值分别为-3.84、-2.34、-2.77、-2.70和-2.61),总蛋白水平和血液pH值显著降低(t=-2.85,Z=-2.03),PPC结论:损伤电压、入院时休克的发生、伤后1天内骨筋膜室综合征的发生、入院后24小时内D-二聚体水平是电烧伤患者发生DIC的独立危险因素。基于上述指标建立的预测模型可以为这些患者DIC的发生提供早期预警。
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引用次数: 0
[Curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers]. [足部无微型皮瓣移植修复手指肌腱甚至骨深部全层电烧伤创面的疗效]。
Q3 Medicine Pub Date : 2023-08-20 DOI: 10.3760/cma.j.cn501225-20230323-00094
J D Xue, H P Di, Y Liang, P P Xing, H N Guo, X K Zhao, L M Wang, C D Xia
<p><p><b>Objective:</b> To explore the curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers. <b>Methods:</b> A retrospective observational study was conducted. From July 2017 to February 2022, 20 patients with full-thickness electric burn wounds deep to tendon or even bone in fingers who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, including 19 males and 1 female, aged 18 to 64 years. Among the 20 wounds, 15 wounds were located on the palm side, including 8 on the thumb, 5 on the index finger, and 2 on the middle finger; 5 wounds were located on the back, including 1 on the index finger and 4 on the middle finger. After debridement, the wound area ranged from 4.5 cm×2.0 cm to 7.0 cm×3.0 cm. According to the principle of tissue structure similarity, 10 wounds were repaired with plantar medial flaps, 5 wounds were repaired with hallux peroneal flaps, and 5 wounds were repaired with dorsalis pedis artery flaps, with flap area of 5.0 cm×2.5 cm-8.0 cm×3.5 cm. The flaps were transplanted freely and arteries and veins and/or nerves were anastomosed at the same time. The wound in the donor site was repaired with thigh medium-thick skin graft. The survival of flaps and skin grafts were observed after surgery. The appearance of flap, temperature and color of the distal end in the affected finger were observed during follow-up. At the last follow-up, the joint function and flap sensory recovery of the affected finger were evaluated with the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association; the two-point discrimination distance of skin in the area of flaps with nerve anastomosis was measured; the satisfaction of patients with the curative effect was investigated by using the curative effect satisfaction rating scale, and the very satisfied rate was calculated; the repair effect of flap was evaluated by the comprehensive evaluation scale, and the excellent and good rate was calculated. <b>Results:</b> All the flaps and skin grafts survived after surgery. During the follow-up of 10-18 months after surgery, the appearance of flap was natural and not bloated; the temperature and color of the distal end in the affected finger were basically the same as that of normal finger skin. At the last follow-up, the function recovery of the affected finger joints was as follows: 11 affected fingers were within the normal range of motion, 6 affected fingers had their total active range of motion recovered to 85% of the healthy side, and 3 affected fingers had their total active range of motion recovered to 75% of the healthy side; the flap sensory recovery was as follows: the sense of 15 flaps with nerve anastomosis all recovered to grade S3<sup>+</sup>, and the two-point discrimination distance of skin in the flap area was 7.0-9.0 mm; the sense of 1 flap without n
目的:探讨足部游离微型皮瓣移植修复手指肌腱甚至骨深部全层电烧伤创面的疗效。方法:采用回顾性观察研究。2017年7月至2022年2月,郑州市第一人民医院收治符合纳入标准的20例手指深至肌腱甚至骨头的全层电烧伤患者,其中男19例,女1例,年龄18~64岁。在20处伤口中,15处伤口位于手掌侧,其中拇指8处,食指5处,中指2处;背部有5处伤口,其中食指1处,中指4处。清创后创面面积为4.5cm×2.0cm~7.0cm×3.0cm,根据组织结构相似原则,用足底内侧皮瓣修复10处,用拇腓皮瓣修复5处,用足背动脉皮瓣修复5例,皮瓣面积为5.0cm×2.5cm~8.0cm×3.5cm。皮瓣自由移植,同时吻合动脉、静脉和/或神经。供体部位的伤口用大腿中厚皮片修复。术后观察皮瓣和皮片的成活情况。随访期间观察皮瓣的外观、患指远端的温度和颜色。在最后一次随访时,采用中华医学会手外科学会上肢功能评价试验标准对患指的关节功能和皮瓣感觉恢复进行评价;测量皮瓣神经吻合区皮肤两点判别距离;采用疗效满意度量表对患者的疗效满意度进行调查,并计算出非常满意率;采用综合评定量表对皮瓣修复效果进行评定,并计算出优良率和优良率。结果:术后皮瓣及皮片全部成活。术后随访10-18个月,皮瓣外观自然,不臃肿;患指远端的温度和颜色与正常手指皮肤基本相同。在最后一次随访中,患指关节的功能恢复情况如下:11个患指在正常活动范围内,6个患指的总活动范围恢复到健康侧的85%,3个患手指的总活动幅度恢复到健康方的75%;皮瓣感觉恢复情况:15例神经吻合皮瓣感觉均恢复到S3+级,皮瓣区皮肤两点判别距离为7.0-9.0mm;1个无神经吻合皮瓣的感觉恢复到S2级,4个皮瓣的感觉则恢复到S1级。20例患者对疗效的满意度:非常满意16例,中度满意4例,非常满意率80%;20个皮瓣修复效果优16例,良2例,尚可2例,优良率90%。结论:由于供区和受区组织结构相似,足部微型无皮移植修复手指肌腱甚至骨深的全层电烧伤创面,可以获得良好的外观和功能,在神经吻合的情况下,受影响手指的功能和感觉恢复更好。患者对疗效的满意度较高,值得推广。
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引用次数: 0
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Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns
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