ABSTRACT
Objective@#To summarize the measures and experience of treatment in mass extremely severe burn patients.@*Methods@#The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment.@*Results@#Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients.@*Conclusions@#Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.
ABSTRACT
Objective The mechanism of delaying flap with the minimal invasive surgery was approached to understand its effects on the whole delayed survival of skin flaps thoroughly so as to provide the rationale for its clinical use.Methods 80 male or female Wistar rats were randomly subdivided into two groups:delayed by the minimal invasive surgery,and immediately transfer without delay.Flaps in each group delayed were cut at 1,2,3 and 4 weeks,respectively.The flap was designed at the lower back of rat,with the size of 5 cm × 1 cm,crossing the middle area for 2.5 cm and including stem of iliac branch from iliolumbar artery.2 weeks after second operation,the survival area,capillary density and content of lactic acid of the flaps in each group were examined,and the survival of the falps delayed by the minimal invasive surgery was compared.Results The longer delaying time,and the higher survival rate were observed in the experimental group.Delaying for 3 weeks and 4 weeks,the survival rate was (86.13 ±1.13) ％,(93.49 ± 1.15) ％,respectively,in the experimental group.While in control group,the survival rate was no more than 63％.The longer delaying time,the higher the capillary density were noted in two groups,but 3 weeks delayed group equally matched to the 4 weeks delayed group.In the experimental group,the content of lactic acid increased peaked in 1 week delayed group,then fell-down gradually,but kept steady in 3 and 4 weeks delayed group.The content of lactic acid in the control group kept steady.Conclusions The experimental model is selected as cross-area axial flap on the lower back of rats.The minimal invasive surgery plays the same role as in delaying flaps,which causes vasoconstriction,resulting in disorder of internal environment,ischemia and hypoxia,finally vasodilatation.The more ramus anastomosis,the more survival rate of the flap.
ABSTRACT
Objective To investigate the mechanism of mastoparan-1 (MP-1) antagonizing lipopolysaecharide (LPS) in vitro. Methods The affinity of MP-1 for lipid A was assayed by biosensor, and the neutralization of MP-1 on LPS (2 μg/L) was detected by kinetic turbidimetric limulus test. After exposing fluorescin isothiecyanate (FITC) labeled LPS (FITC-LPS) to MP-1 at different concentrations (5, 10, 20, 40 μmol/L), the binding of FITC-LPS to murine RAW264.7 cells was analyzed by laser scanning confocal microscopy. The influence of MP-1 on TLR4 expression in RAW264.7 cells stimulated by LPS (100 μg/L) was detected by immunoeytochemieal staining. The expressions of TLR4, TNF-α and IL-6 at the gene and protein level were detected by RT-PCR and ELISA after exposing LPS (100 μg/ L) stimulated RAW264.7 cells to MP-1 at different concentrations. The effect of MP-1 on the viability of RAW264.7 cells was detected by MTT assay. Results MP-1 had high affinity to lipid A and could neutralize LPS. MP-1 at 10 μmol/L significantly inhibited not only binding of FITC-LPS to RAW264.7 (P < 0.05), but also protein and gene expressions of TLR4, TNF-α and IL-6 in LPS stimulated RAW264.7 cells in a dose-dependent manner (P < 0.05). No toxic effect of MP-1 on the viability of RAW264.7 cells was found (P > 0.05). Conclusions MP-1 inhibits cell viability mediated by LPS, which may be related to its neutralization of LPS and inhibition of binding of LPS to RAW264.7 cell membrane receptors.
ABSTRACT
<p><b>OBJECTIVE</b>To explore the effects of fluid resuscitation during the shock stage of mass burn patients.</p><p><b>METHODS</b>Eleven major burn patients out of 25 were rescued at spot and were resuscitated. The treatment results were analyzed and concluded.</p><p><b>RESULTS</b>The eleven patients were all cured by smoothly living through the shock stage.</p><p><b>CONCLUSION</b>The approaching of medical personnel to the site might be the guarantee of correct and timely fluid resuscitation during shock stage, which could be effective on the prevention of burn shock development.</p>
Subject(s)
Adult , Humans , Burns , Therapeutics , Resuscitation , Shock , TherapeuticsABSTRACT
<p><b>OBJECTIVE</b>To investigate the application of tourniquet in burn patients during tangential excision on the extremities.</p><p><b>METHODS</b>Seventy - nine burn patients who were arranged to receive tangential excision and skin grafting on the extremities were randomly divided into A and B groups. The patients in A group (n = 41) underwent the operation with the tourniquet applied continuously throughout the operation, while those in B group (n = 38), only with tourniquet applied during tangential excision. The amounts of blood loss and blood transfusion, the operation time and the take rate of grafted skin and the incidence of complications were investigated and recorded.</p><p><b>RESULTS</b>The amounts of blood loss and blood transfusion during operation in A group were 42% and 50% less than those in B group, respectively (P < 0.001). Moreover, the operation time on the upper and lower extremities in A group was much shorter (for 41% and 37%, respectively) than those in B group (P < 0.001). In addition, there was no difference of the take rate of skin graft and the incidence of subcutaneous hematoma between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Continuous tourniquet application during tangential excision on the extremities in burn patients was proved to be effective in reducing operational blood loss, blood transfusion and in shortening operation time.</p>
Subject(s)
Adult , Humans , Blood Loss, Surgical , Blood Transfusion , Burns , General Surgery , Extremities , General Surgery , Skin Transplantation , TourniquetsABSTRACT
Objective To assess the protective effect of mastoparan-1(MP-1) on acute lung injury in mouse model with endotoxemia(ETM) induced by lipopolysaccharide(LPS),and to investigate the possible mechanism of protcetive effect.Methods The endotoxemia murine model was reproduced by tail vein injection of LPS(5mg/kg) in mice.Animals were randomly divided into normal control group(n=8),endotoxemia group(n=48) and MP-1-treatment group(MP-1 was injected in 3mg/kg at the same time of LPS injection,n=48).Animals of the latter two groups were sacrificed at 2,6,12,24,48 and 72 hours after injection,and then the blood and lung tissue samples were collected.Plasma LPS was assayed using kinetic turbidimetric limulus test,TNF-? and IL-6 were measured by appropriate ELISA kits,TLR4,TNF-? and IL-6 mRNA expressions in lung tissues were analyzed by real-time RT-PCR,myeloperoxidase(MPO) activity of lung tissues was determined by spectrophotometric method,and the pathological changes in lung tissues were observed under microscope.Result The plasma levels of LPS,TNF-? and IL-6 in the mice of endotoxemia group were increased at 2-48 hours after LPS injection(P
ABSTRACT
Objective To investigate the dynamic features of high-density lipoproteins(HDL) in burn patients and the relationship between the changes and infectious complications.Methods One hundred and twenty patients,aged from 18 to 59 years and admitted within 24 hours of with thermal injury,were involved in present study including mild-moderate,severe and extensive burns groups each of 40 cases.Empty stomach blood samples were drawn on admission and at day 1,2,3,5,7,14 and 21 after burn injury.Serum triglyceride(TG),total cholesterol(TC),high-density lipoproteins(HDL),low-density lipoproteins(LDL),apolipoprotein A1(apoA1) and apolipoprotein B(apoB) were measured in all patients and compared with those of 40 healthy volunteers(control group).The infectious complications and outcome were monitored.Results In 120 patients,a total of 51 identifiable nosocomial infection episodes occurred in 32 patients.Of 6 dead cases,5 were related to infections.The incidence of infection in mild-moderate,severe and extensive burn groups were 7.5%,20.0% and 52.5%,respectively,with statistically significant difference(P0.05) on admission and day 1;from day 2 to day 21,the concentrations of TC,HDL and apoA1 in infection patients were lower than those in non-infection patients(P
ABSTRACT
Objective To explore the protective effect of high density lipoprotein on the liver function of rats with severe burns. Methods 135 Wistar rats employed in present study were randomly divided into control group (n=15, without treatment), burn group (n=60, with 30%TBSA full-thickness burn on the back) and experimental group (n=60, with the injection of 80mg/kg HDL via the caudal vein immediately after burns). The rats in the groups with burns injury were resuscitated with intraperitoneal isotonic saline (50ml/kg) 30 minutes after burn. The serum content of AST, ALT, ICAM-1 and TNF-? of the rats were determined with corresponding methods. The histological changes in the liver tissue of the rats in all groups were observed under light microscope and electronic microscope. Results The serum content of AST, ALT, ICAM-1 and TNF-? in the rats of control group were significantly lower than those in burn group (P
ABSTRACT
To investigate the effective principles of early management in extensively burned patients,162 patients (from 1990 to 1999) with extensive burn were treated according to the following principles: ① prompt and rapid fluid resuscitation during shock stage for delayed resuscitation patients; ② early tracheostomy,air way humidification and lavage for moderate and severe inhalation injury;③ escharectomy and grafting performed during early stage, presenting the experiences of escharectomy during shock stage in grassroot hospitals ; ④ undergoing enteral nutritional support in early stage; ⑤ emphasizing the importance of functional excise in early stage to stress that rehabilitation therapy should be implemented throughout that whole course of treatment. The results showed that the successful rate of treatment was raised and the incidence of complications and disability decreased after implementing the aforementioned treatment principles in extensively burned patients. It is suggested that the application of “Five early Principle” on extensively burned patients is effective and feasible