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Abstract Objective: The aim of this study was to study the curative effect and the relative mechanism of modified photodynamic therapy combined with Taohong Siwu Decoction in the treatment of hyperplastic scar after severe burn, in order to provide a stable, safe and satisfactory scheme for scar repair. Methods: Forty cases with hyperplastic scars after severe burns admitted to the plastic surgery department from May 2021 to May 2022 were divided into a control group and an observation group by means of the random number table method. The control group was treated with ordinary laser therapy combined with Taohong Siwu Decoction, while the observation group was treated with modified photodynamic therapy combined with Taohong Siwu Decoction. The Vancouver Scar Scale (VSS) was assessed in both groups, and the clinical effectiveness of both groups was compared. HE-staining was performed on the scar tissue of the same patient before and after treatment to observe the changes in the arrangement of fibroblasts. The Vascular Endothelial Growth Factor (VEGF), β-Transforming Growth Factor (TGF-β), and Platelet-Derived Growth Factor (PDGF) in the tissue samples of both groups were detected by quantitative real-time PCR. The patients were followed up for 6 months, and their satisfaction, side effects, and scar recurrence were observed. Results: Compared with the control group, the VSS score in the observation group was lower (p < 0.05). The therapeutic effect of the observation group was superior to the control group after 3 months (p < 0.05). After 3-months of therapy, the arrangement of fibroblasts in the scar became looser in two groups, and the observation group was more looser. The VEGF, TGF-β and PDGF levels in tissue samples of the observation group were lower than those in the control group after 3 months of treatment (p < 0.05). The satisfaction of the observation group was higher than that of the control group (p < 0.05). The adverse reactions between the two groups showed no difference (p > 0.05), while the recurrence rate was lower in the observation group (p < 0.05). Conclusion: Modified photodynamic therapy combined with Taohong Siwu Decoction shows remarkable efficacy in patients with hyperplastic scars after severe burns. It can improve the color, thickness, vascular distribution, and softness of the scar, and reduce the level of cytokines related to tissue repair. At the same time, it can improve patients' satisfaction with the aesthetic appearance and reduce the recurrence rate, providing a new comprehensive therapy that is safer and more effective, simple and quick, and easy to promote in the clinic.
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Introdução: O Meropenem é um carbapenêmico de amplo espectro, prescrito na terapia do choque séptico nos pacientes graves adultos de UTI, com infecções graves causadas por patógenos Gram-negativos susceptíveis. Objetivo: Avaliar a efetividade do Meropenem em pacientes sépticos queimados, investigar a farmacocinética na fase precoce e na fase tardia durante o curso do choque séptico e o impacto no desfecho clínico. Ética, Casuística e Procedimentos: Aprovação ética, registro CAAE07525118.3.0000.0068; nenhum conflito de interesse declarado foi obtido dos autores. Após assinatura do TCLE pelo responsável legal, o paciente foi incluído no protocolo. Investigou-se a população de 15 pacientes sépticos grandes queimados, adultos de ambos os gêneros (10 M/ 5F) com função renal preservada (Clcr> 50 ml/min). As características demográficas da população de pacientes incluídos foram idade de 37(33 -41) anos, 71(59,5 - 80,0) kg e índice de massa corpórea de 24,3(20,6-24,7) kg/m2, medianas (interquartil). Registrou-se o escore SAPS*3 54(47-59) de admissão dos pacientes na UTI; a superfície corpórea total queimada foi de 33% (18,3-34,4), SCTQ medianas (interquartil). A lesão inalatória e o uso de vasopressores foram registrados em 12/15 pacientes após trauma térmico/ elétrico (10/5). Após intubação orotraqueal, a ventilação mecânica foi registrada em 13/15 pacientes. A terapia empírica do choque séptico com Meropenem no regime de 1g q8h, por infusão estendida de 3 horas, foi iniciada após a coleta das culturas. Realizou-se coleta seriada de amostras sanguíneas para dosagem sérica do antimicrobiano por cromatografia líquida. Aplicou-se o modelo aberto monocompartimental para estudo da farmacocinética e estimativa dos parâmetros, meia vida biológica, depuração total corporal e volume de distribuição. A abordagem farmacocinética-farmacodinâmica (PK-PD) foi baseada na dosagem sérica do Meropenem e na taxa de eliminação, para estimativa do índice de predição de efetividade (% ƒ Δ?T> CIM), considerando o novo alvo terapêutico de 100% ƒ Δ?T> CIM. Utilizou-se estatística não paramétrica pela aplicação do teste de Wilcoxon para dados pareados e testes de correlação linear. Resultados e Discussão: Registrou-se alteração dos parâmetros farmacocinéticos nos pacientes sépticos investigados frente aos dados reportados para voluntários sadios. Evidenciou-se redução na taxa de eliminação e da depuração total corporal; o prolongamento da meia vida biológica ocorreu pelo aumento do volume de distribuição. Estas alterações impactaram estendendo a cobertura do Meropenem, na fase precoce do choque séptico, contra os patógenos de susceptibilidade intermediária com CIM 4 mg/L. Conclusão: A cobertura do Meropenem foi garantida contra os patógenos isolados até CIM 2 mg/L para todos os pacientes. Adicionalmente, ocorreu a erradicação de patógenos de susceptibilidade intermediária CIM 4 mg/L, pela cobertura que foi atingida apenas na fase precoce do choque séptico. Então, a abordagem PK / PD contribui para a obtenção do resultado
Background: Meropenem is a carbapenêmic, agent largely prescribed to septic patients in the Intensive Care Units with severe infections caused by Gram-negative susceptible strains. Objective: To evaluate Meropenem effectiveness in ICU septic burn patients and to investigate pharmacokinetic changes that could impact the desired outcome by eradication of Gram-negative strains of intermediate susceptibility. Ethics, Casuistry and Methods: Ethical approval register CAEE 07525118.3.0000.0068was obtained; no conflicts of interest to declare were obtained from all authors. Fifteen burn adult patients of both genders (10 M/ 5F) with preserved renal function (Clcr> 50 ml/min) were investigated after TCLE signed. Demographic characteristics of patients included were: 37(33 -41) years, 71(59.5- 80.0) kg, 24.3 (20.6-24.7) kg/m2 body mass index, medians (quartiles). ICU patients admission was based on SAPS*3 score of 54(47-59), 33% (18.3-34.4) TBSA medians (quartiles). Inhalation injury and vasopressors requirements were in 12/15 patients after fire/electricity (10/5, proportion). Mechanical ventilation was necessary in 13/15 patients. Antimicrobial therapy of septic shock with meropenem 1g q8h 3 hours infusion started, after cultures collection. A serial of blood samples was collected from the central catheter after a minimum of 48 hours of Meropenem therapy for drug serum measurements by liquid chromatography. One compartment open model was applied to estimate PK data related to the elimination rate constant, biological half-life, total body clearance and volume of distribution PK/PD approach was based on serum trough levels and elimination rate constant to estimate the predictive index of drug effectiveness (% fΔT>CIM), based on the new PK/PD target 100% fΔT>CIM. Non parametric statistics was applied, Wilcoxon test for paired data and linear correlations. Results: Pharmacokinetic changes occurred in septic burn patients investigated by comparison with results reported in healthy volunteers as follows by the reduction on elimination rate constant and also on total body clearance, in spite of preserved renal function for all patients included. In addition, a prolongation of biological half-life occurred as a consequence of increases on volume of distribution. Pharmacodynamics was impacted by PK changes only at the earlier period of septic shock, once pathogens isolated of intermediate susceptibility up to MIC 4 mg/L were eradicated. Conclusion: Meropenem effectiveness was guaranteed against Gram-negative up to MIC 2 mg/L strains isolated for all patients. In addition, eradication of pathogens of intermediate susceptibility MIC 4 mg/L strains occurred only at the earlier period of septic shock. Then, PK/PD approach contributes to desired outcome achievement
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Humans , Male , Female , Adult , Patients , Wounds and Injuries/drug therapy , Burns/pathology , Pharmacokinetics , Meropenem/analysis , Shock, Septic/complications , Pharmaceutical Preparations/administration & dosage , Inhalation , Chromatography, Liquid/methods , Pharmacologic Actions , Intensive Care Units/classificationABSTRACT
Despite considerable advances in diagnosis and treatment of the critical illness-related corticosteroid insufficiency (CIRCI), it is still not clear that whether it is common in severe burn patients or not, and how clinical diagnosis, treatment, and research progress. Severe burn is a systemic disease involving the damage of multiple organs of the whole body. The course of the disease is relatively long, and there often exists persistent inflammation, immunosuppression, and catabolism. On the basis of CIRCI study, the epidemiological evidence, possible mechanism, suspicious clinical manifestations, diagnosis and treatment of severe burn-related corticosteroid insufficiency (SBRCI) were briefly reviewed in this article in order to help clinical diagnosis and treatment of SBRCI.
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Objective To explore the clinical value of Dynamic testing of serum cortisol (COR) and procalcitonin (PCT) in the prediction and prognosis of sepsis after burn.Methods 122adult patients with severe burns who were treated by our unit from September 2014to November 2017were selected and retrospective analyzed.According to the diagnosis criteria of sepsis and the prognosis, the patients were divided into nonsepsis group, sepsis survival group and sepsis death group.The serum COR and PCT level in 1-20days after burn were continuously and dynamically monitored and measured using an automated electrochemical method and immunofluorescence method respectively.Results The serum COR levels in sepsis patients were significantly higher than those in non-sepsis group from the sixth day after burns (P<0.05) , and the serum PCT levels were significantly higher than those in the non-sepsis group from the 7th day after burn (P<0.05) .From the 11th day after burn, the serum COR and PCT levels in the sepsis death group were significantly higher than those in the sepsis survival group (P<0.05);the serum PCT levels in the sepsis death group were significantly higher than those in the sepsis survival group from the 15th day after the burn (P<0.05) .The serum COR levels in the sepsis-dead group decreased linearly, and the serum COR levels were significantly lower than those in the sepsis survival group (P<0.05) .Conclusion The combined testing of serum COR and PCT can be used as an early predictor of post burn sepsis, The Dynamic testing of serum COR and PCT levels in the important clinical application value in the evaluation of prognosis of sepsis after burn.
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Objective To study the difference between multi-drug resistant bacteria in patients with severe bums under air isolation and non-air isolation measures.Methods Sixty severe burn patients were selected and randomly divided into non air isolation group and air separation group by random digits table method with 30 cases each.At 0 days and 14 days in the group,the sputum,the air and the material table in the ward were sampled in the two sets of warp,the multidrug resistant bacteria and the drug resistance were identified.Results At the time of enrollment,31.67％ (19/60) patients were infected with Acinetobacter baumannii and 33.33％ (20/60) with Klebsiella pneumoniae.There was no significant difference between the two groups (P ＞ 0.05).Acinetobacter baumannii and Klebsiella pneumoniae were multidrug-resistant bacteria.The results of group,air,surface and sputum culture had significant influence on the infection of multidrug-resistant bacteria (odds ratio:1.582,1.265,2.314,0.100,95％ confidence interval,P＜ 0.05).At the 14th day,the infection rate of drug-resistant bacteria cultured in sputum was 50.00％ (15/30) in air isolation group and 40.00％ (12/30) in non-air isolation group.The difference between the two groups was statistically significant (x2 =-3.962,P ＜ 0.05).Conclusions Air isolation measures can reduce multidrug-resistant bacteria in the surface and air of the ward,and air isolation measures can reduce the incidence of multidrug resistance in severe burn patients.
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Objective To study the Danshen Chuanxiong injection on the expression of serum inflammatory factors in patients with severe burn ,and the preventive effect on SIRS and multiple organ dysfunction syn-drome (MODS) .Methods 56 patients with the severe burn admitted in the hospital from January 2015 to Jan-uary 2016 were enrolled in the study ,and divided randomly into the control group and the observation group . The control group received routine treatment ,while the observation group received routine treatment as well as intra verous drip infusion treatment of Danshen Chuanxiong at the same time .The clinical efficacy in two groups and the incidence rates of SIRS and MODS were evaluated .The changes of the expression of serum C reactive protein (CRP) ,interleukin -10 (IL-10) and IL-6 before and after treatment ,and their correlations with the severity of SIRS and MODS was analyzed .Results The clinical efficacy of the observation group was better than that of the control group ,and the difference was statistically significant (P<0 .05) .The incidence rate of SIRS in the observation group was lower than that in the control group and the difference was statisti-cally significant (P<0 .01);the illness condition of the patients with SIRS in the observation group were less serious than those in the control group ,and the differences was statistically significant (P<0 .01) .There was no statistically significant difference in the incidence rates of MODS between the observation group and the control group (P>0 .05) ,but the conditions of MODS patients in the observation group were obviously lessheavier than those in the control group ,and the differences were statistically significant (P< 0 .05) .After treatment ,the indexes of IL-6 ,CRP and IL-10 were significantly improved ,and the differences were statistical-ly significant (P<0 .05) .After treatment ,IL-6 and CRP levels in the observation group were lower than those in the control group ,while the IL-10 level was higher than that in the control group ,and the differences were statistically significant ( P< 0 .05) .SIRS had a relatively high correlation with IL-6 ,CRP and IL-10 ( P<0 .05) ,and there was a relatively high correlation between MODS and IL-6 and CRP (P<0 .05) ,and there was a moderate correlation between MODS and IL-10 (P<0 .05) .Conclusion Danshen Chuanxiong injection can control the inflammatory response in patients with severe burns ,improve the expression level of serum IL-6 , CRP and IL-10 ,and it has a clear positive effect on preventing the occurrence of SIRS and MODS and allevia-ting the severity of SIRS and MODS ,which is worth of clinical attention .
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Objective To explore the clinical significance of N-terminal pro-brain natriuretic peptide(NT-proBNP)in the evaluation of cardiac function in patients with severe burns. Methods A total of 78 patients with severe burns in intensive care unit(ICU)in our hospital were selected. Patients were divided into a heart failure group(n = 31)and a non-heart failure group(n = 47)according to the heart failure complication condition. The changes of NT-proBNP level in different time ,heart function index ,relevant index and mortality were compared between the two groups. Results The levels of NT-proBNP ,troponin(CTnT),creatine kinase(CK),creatine kinase isoenzyme (CK-MB),stroke volume index (SVI),cardiac index (CI) and central venous pressure (CVP),and the score of acute physiologic and chronic health conditions(APACHE II)in the heart failure group were shown to be significantly increased than those of the non-heart failure group (P < 0.05). The mean arterial pressure(MAP)in the heart failure group was significantly lower than the non-heart failure group(P < 0.05). Mortality rate in the heart failure group was shown to be significantly higher than the non-heart failure group (P < 0.05). Conclusion Heart failure is a common complication in patients with severe burns. The mortality rate in the population with heart failure is relatively high ,for which NT-proBNP can effectively assess the conditions and prognosis.
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Objective:To investigate the protective effect of intratracheal transplantation of different dose of human umbilical cord mesenchymal stem cells (MSCs) in rats with acute lung injury induced by severe burns.Methods:Seventy-five male Wistar rats were randomly divided into five groups:Sham(group A),Saline group(group B) and different doses of hUMSCs transplantation groups(C,D and E).The dosage ofhUMSCs was 1 × 105,5 × 105 and 1 × 106 respectively.Rats inflicted by 50 ％TBSA Ⅲ degree scalding employed as the model.After modeling,rats in group B and transplantation groups were immediately fluid resuscitated.Transplantation groups were intratracheally administered different dose hUCMSCs (0.2 mL),and group B were given normal saline in the same dose intratracheally.The lung tissue samples were collected on day 1,day 3 and day 7 after administration.HE staining was used to observe the pathological changes of lung tissue.MPO and CD68 immunohistochemical staining were used to observe the positive expression of neutrophils and macrophages in lung tissue.Results:Lung pathology showed that alveolar cavity was clear,alveolar structure integrity,occasionally a small amount of inflammatory cells of group A at each time point.At 1 day after scald,group B and the transplantation group (group C,D,E)the alveolar septum was thickened,and there was visible pulmonary capillary hyperemia,as well as a large amount of inflammatory cell infiltrations in the pulmonary capillaries and alveolar space.At 3 day,group B and the transplantation group alveolar structural damage,pulmonary hemorrhage and inflammatory cell infiltrations were better than those in 1 day.Compared with group B,the alveolar structure was clear and the septum was thinner,but there was no significant difference between the transplantation groups.On the 7 day after scald,the lung injury in the transplanted group was significantly less than group B,and the recovery of the injured lung tissue in E group was the most obvious.The number of the MPO positive cells increased significantly on the first day after scald (P ＜0.05) compared with group A,but there was no significant difference between the two groups.Compared with B group,the number of positive cells in transplantation group was significantly reduced at 3 and 7 day after scald,(P＜0.05),and the number of positive cells in group E was significantly lower than other groups (P＜0.05).CD68 staining showed a significant increase in positive cells in each group on day 1 (P＞ 0.05).The number of positive cells decreased in 3 day after transplantation (P＜0.05),but there was no significant difference between the transplantation groups.The number of positive cells in transplantation group was significantly lower than group B (P＜0.05) after 7 day.Compared with group C and D,there was significant difference in group E (P＜0.05).Conclusions:Intratracheal transplantation of different dose hUCMSCs have protective on severe burns induced acute lung injury models;the protection mechanisms may be that the hUCMSCs transplantation can inhibit the invasion of the inflammatory cells in lung tissues,and the optimal dosage is 1 × 106.
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Severe burn is often accompanied by multiple organ damage. Acute lung injury (ALI) is one of the most common complications, and often occurs in the early stage of severe burns. If it is not treated in time, it will progress to acute respiratory distress syndrome (ARDS), which will be a serious threat to the lives of patients. At present, the treatment of ALI in patients with severe burn is still remained in some common ways, such as the liquid resuscitation, the primary wound treatment, ventilation support, and anti-infection. In recently, human umbilical cord mesenchymal stem cells (hUCMSCs) have been found having some good effects on ALI caused by various causes, but few reports on the efficacy of ALI caused by severe burns were reported. By reviewing the mechanism of stem cell therapy for ALI, therapeutic potential of hUCMSCs in the treatment of severe burns with ALI and a new approach for clinical treatment was provided.
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Objective To explore the application and nursing care of patients with severe burn patients with scar skin treated by ultrasound-guided PICC catheter placement. Methods Twelve patients with burn area of more than 95% were treated with intravenous catheter placement of PICC under the condition of scar hyperplasia skin with the help of ecg. Results Ten patients in elbow basilic vein catheterization by PICC disposable puncture, 1 cases of catheter in the right upper arm of the basilic vein into vascular sheath scar after guidewire dilating the skin in place leading to vascular sheath damaged anterior guidewire failed in bending catheter, to your left arm to venous catheter success, 1 cases of catheter for initial puncture puncture into the insufficient experience in successful puncture needle when the guide wire back because of scar skin relaxation will not needle guide wire fixing the wire with a lead to two times of puncture, 12 cases of catheter tip position by X-ray showed in the superior vena cava under 1/3, indwelling time ranged from-11 months of March, in the retention period without related complications. Conclusions It is feasible and advantageous for the application of PICC catheter in the treatment of severe burn patients with scar skin.
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Objective To explore the application and nursing care of patients with severe burn patients with scar skin treated by ultrasound-guided PICC catheter placement. Methods Twelve patients with burn area of more than 95% were treated with intravenous catheter placement of PICC under the condition of scar hyperplasia skin with the help of ecg. Results Ten patients in elbow basilic vein catheterization by PICC disposable puncture, 1 cases of catheter in the right upper arm of the basilic vein into vascular sheath scar after guidewire dilating the skin in place leading to vascular sheath damaged anterior guidewire failed in bending catheter, to your left arm to venous catheter success, 1 cases of catheter for initial puncture puncture into the insufficient experience in successful puncture needle when the guide wire back because of scar skin relaxation will not needle guide wire fixing the wire with a lead to two times of puncture, 12 cases of catheter tip position by X-ray showed in the superior vena cava under 1/3, indwelling time ranged from-11 months of March, in the retention period without related complications. Conclusions It is feasible and advantageous for the application of PICC catheter in the treatment of severe burn patients with scar skin.
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Objective To compare the traditional Chinese medicine enema and routine enema in the period of gastrointestinal dysfunction in patients with severe burn infection the clinical effect of treatment. Methods The control group weakened symptoms on gastrointestinal peristalsis began to appear fasting, gastrointestinal decompression, anal exhaust, saline enema, parenteral nutrition, antibiotic treatment. On the basis of routine treatment in the treatment group the enema for Chinese medicine prescription. Results The curative effect in the treatment group after enema 83.3%(30/36) compared with the control group 41.70% (15/36) had significant difference (P<0.05). At the time of borborygmus, abdominal distension disappeared time, anus Exhaust time, the treatment group were (7.0±0.8)d, (3.4±0.9)d, (7.3±0.8)d, the control group were (12.6±1.8)d, (7.1±1.2)d, (13.4±1.9)d, two sets of data were compared with statistical difference (P<0.05). Conclusion The traditional Chinese medicine enema for large surface gastrointestinal dysfunction during infection deposition burn patients is rapid, safe and reliable, convenient administration, significant curative effect on gastrointestinal functions in patients with motility.
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Objective To investigate the changes of blood biochemical indexes in patients with severe burn ,so as to improve the reference of clinical treatment plan .Methods Totally 152 patients with severe burn treated in the hospital from February 2012 to October 2016 were selected as the observation group ,the blood coagulation indexes of APTA ,PT ,TT ,INR ,FBg ,PLT ,and ALB , AST ,ALT ,TP ,NO ,ESR ,blood CO2 ,UA ,HDL-C ,CHOL ,RBC ,HGB and HCT blood index were measured ;and 92 cases of mild and moderate burn patients were selected as control group ,the similar indexes of two groups were compared .Results The heart rate ,respiratory rate ,diastolic blood pressure and systolic blood pressure in the severe burn group were significantly higher than those in the control group(P< 0 .05) .The levels of APTT ,PT ,TT ,INR ,FBg and PLT in severe burn group were significantly higher than those in control group(P<0 .05) .The levels of AST ,ALT and NO in severe burn group were significantly higher than those in the control group (P<0 .05);the levels of ALB ,TP ,CO2 ,UA ,HDL-C ,CHOL ,HGB ,RBC and HCT were significantly lower than those of the control group(P<0 .05) .Conclusion Through the detection of severe burn patients with some blood inde-xes ,according to changes in coagulation indexes and biochemical indicators to determine the characteristics of the patient′s injury ,assist doctors in the diagnosis and treatment of patients ,could be timely rehydration ,nutritional support ,improve coagulation status ,improve pa-tient immunity .
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Objective To compare the traditional Chinese medicine enema and routine enema in the period of gastrointestinal dysfunction in patients with severe burn infection the clinical effect of treatment. Methods The control group weakened symptoms on gastrointestinal peristalsis began to appear fasting, gastrointestinal decompression, anal exhaust, saline enema, parenteral nutrition, antibiotic treatment. On the basis of routine treatment in the treatment group the enema for Chinese medicine prescription. Results The curative effect in the treatment group after enema 83.3%(30/36) compared with the control group 41.70% (15/36) had significant difference (P<0.05). At the time of borborygmus, abdominal distension disappeared time, anus Exhaust time, the treatment group were (7.0±0.8)d, (3.4±0.9)d, (7.3±0.8)d, the control group were (12.6±1.8)d, (7.1±1.2)d, (13.4±1.9)d, two sets of data were compared with statistical difference (P<0.05). Conclusion The traditional Chinese medicine enema for large surface gastrointestinal dysfunction during infection deposition burn patients is rapid, safe and reliable, convenient administration, significant curative effect on gastrointestinal functions in patients with motility.
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Objective To investigate the changes of blood biochemical indexes in patients with severe burn ,so as to improve the reference of clinical treatment plan .Methods Totally 152 patients with severe burn treated in the hospital from February 2012 to October 2016 were selected as the observation group ,the blood coagulation indexes of APTA ,PT ,TT ,INR ,FBg ,PLT ,and ALB , AST ,ALT ,TP ,NO ,ESR ,blood CO2 ,UA ,HDL-C ,CHOL ,RBC ,HGB and HCT blood index were measured ;and 92 cases of mild and moderate burn patients were selected as control group ,the similar indexes of two groups were compared .Results The heart rate ,respiratory rate ,diastolic blood pressure and systolic blood pressure in the severe burn group were significantly higher than those in the control group(P< 0 .05) .The levels of APTT ,PT ,TT ,INR ,FBg and PLT in severe burn group were significantly higher than those in control group(P<0 .05) .The levels of AST ,ALT and NO in severe burn group were significantly higher than those in the control group (P<0 .05);the levels of ALB ,TP ,CO2 ,UA ,HDL-C ,CHOL ,HGB ,RBC and HCT were significantly lower than those of the control group(P<0 .05) .Conclusion Through the detection of severe burn patients with some blood inde-xes ,according to changes in coagulation indexes and biochemical indicators to determine the characteristics of the patient′s injury ,assist doctors in the diagnosis and treatment of patients ,could be timely rehydration ,nutritional support ,improve coagulation status ,improve pa-tient immunity .
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OBJECTIVE:To discuss the effect of recombinant human growth hormone(HGH)on serum sndotoxin,inflamma-tory cytokines,wound healing time,hospitalization time and prognosis of elderly patients with severe burn. METHODS:96 elder-ly patients with severe burn in our hospital were randomly divided into treatment group (48 cases) and control group (48 cases). All patients received wound surface care,nutritional support,maintaining water and electrolyte and acid-base balance. Control group received 1 ml 0.9% Sodium chloride solution,sc,qd. Treatment group received 0.3 IU/kg. Recombinant HGH for injection, sc,qd. All patients were treated for 21 d. Serum endotoxin content in 2 groups before and 14,21 d after treatment was compared, inflammatory cytokines (TNF-α,IL-6, IL-8) before and after treatment,wound healing time,hospitalization time and the inci-dence of multiple organ disorder syndrome(MODS),death and systemic infection were observed. RESULTS:There was no signifi-cant difference in serum endotoxin content before and 14 d after treatment(P>0.05);after 21 d,serum endotoxin contents in 2 group obviously decreased,and treatment group was significantly lower than control group,with statistical significance(P<0.05). After treatment,IL-8 level in treatment group was significantly higher than control group,TNF-α and IL-6 were significantly lower than control group,with statistical significances (P<0.05). Wound healing time and hospitalization time in treatment group were significantly shorten than control group,with statistical significances(P<0.05). The incidence of MODS,death and systemic infec-tion in treatment group were significantly lower than control group,with statistical significances(P<0.05). CONCLUSIONS:The application of recombinant HGH in elderly patients with severe burn can reduce toxins absorption of patients and decrease inflamma-tory cytokines to promote wound healing and improve prognosis.
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OBJECTIVE: To explore the keypoints and methods of pharmaceutical care provided by clinical pharmacists in nutritional support for patients with severe burn. METHODS: Through summarizing the pharmaceutical care process in nutrition support therapy in large area burn patients, the contents of pharmaceutical care including the requirements for thermal energy and nutrients, choice of drugs, nutrition support pathway, complication prevention, application of other special nutrients and so on were described. RESULTS: Through pharmaceutical care, the nutritional support regimen was adjusted, which improved the safety and effectiveness of drug treatment and laid the foundation for related treatments for patients with severe burn. CONCLUSION: Nutritional support is one of the important measures in the treatment of severe burn patients. Pharmaceutical care can improve the standardization and effectiveness of nutritional support treatment. At the same time, the value of clinical pharmacists can be reflected through collaborative service with doctors and nurses.
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@#Objective To observe the effect of comprehensive rehabilitation on the recovery of knee joint function in old patients severe burned in lower extremity. Methods 49 patients severe burned in lower extremity were randomly divided into observation group (n=25) and control group (n=24). The control group accepted routine rehabilitation, while the observation group accepted comprehensive rehabilitation. They were assessed with the range of motion (ROM) of knee flexion/extension, 45 m-walking, stair activity, Functional Independence Measure (FIM) and muscle strength 3 months after rehabilitation. Results The active and passive ROM of knee, stair activity, FIM score and muscle strength improved more in the observation group than in the control group (P<0.05). Conclusion Comprehensive rehabilitation promotes the recovery of knee function of old patients with severe burn in lower extremity.
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Objective To explore nursing points on the enteral nutrition support to batched patients with severe burn caused by explosion. Method An enteral nutrition support was carried out for 15 patients with severe burns admitted in our department and pertinent nursing was performed. Results Five patients died because of lack of autologous skin sources and complications of sepsis in 45~87 d after burn. Ten patients got a good recovery after enteral nutrition support, anti-infection treatment and nursing. They lived through the infection period, went into the recovery period. The hospital stay of these patients in ICU was 54~115 d with an average of (90.63 ± 30.37)d. Conclusion Early enteral nutrition support and nursing to the patients with severe burn can improve the nutritional status of patients effectively and promote the rehabilitation of patients.
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Objective To investigate the effect of different doses of ketamine on inflammatory cytokines in rabbits with severe burn at early stage and preliminarily approach its regulatory action on early stage of inflammatory reaction due to stress of trauma.Methods Forty healthy male New Zealand rabbits were randomly divided into four groups in accord with the random number table method: normal control group, scald model group, ketamine analgesia group and ketamine anesthesia group. Before scald, pentobarbital sodium was used for anesthesia, afterwards catheters were inserted into internal jugular vein and internal carotid artery respectively ready for use, and 24 hours later, Ⅲ degree scald at the animal back and buttocks occupying 30% total body surface area (TBSA) was performed as the scald model for all the rabbits except those in normal control group. In ketamine analgesia group, after scald for 0.5 hour, 0.5 mg/kg ketamine intravenous injection was given to the rabbits as the loading dosage and then persistent intravenous pump infusion of 9μg·kg-1·min-1 ketamine was applied for all together 24 hours. In ketamine anesthesia group, after scald for 0.5 hour, 1.5 mg/kg ketamine intravenous injection was given to the rabbits, and then persistent intravenous pump infusion of 45μg·kg-1·min-1 ketamine was applied for 4 hours to maintain systemic anesthesia. In normal control and scald model groups, only intravenous infusion of equal amount of normal saline was given to the rabbits. The amount of intravenous transfusion in each group and the total dosages of ketamine used in ketamine analgesia group and ketamine anesthesia group were recorded. Before scald and 0.5, 6, 12, 24 hours after scald, arterial blood gas analyses were made, and the levels of serum interleukins (IL-1, IL-6) and tumor necrosis factor-α (TNF-α) were determined.Results Although the indexes of blood gas analysis were changed in the four groups, they were all in the normal range, showing that the respiratory function was in the normal range and indirectly reflecting that the circulatory function was also in the normal range, thus the effects on cytokines by factors of respiratory and circulatory functions were ruled out. The levels of IL-1, IL-6 and TNF-α before scald showed no statistically significant differencesamong the four groups (allP > 0.05). From 0.5 hour after scald, the levels of IL-1, IL-6 and TNF-α were markedly higher in model group than those of normal control group [IL-1 (ng/L): 30.27±0.93 vs. 13.79±1.11, IL-6 (ng/L): 47.22±1.49 vs. 46.31±4.12, TNF-α (ng/L): 243.39±20.85 vs. 190.95±14.97, allP < 0.05], and the situation continued until 24 hours after scald; the levels of IL-1, IL-6 and TNF-α from 6 hours after scald were significantly decreased in ketamine analgesia and ketamine anesthesia groups compared with those in the model group, and from 12 hours after scald, the degrees of descent in levels of the above indexes in ketamine analgesia group were more obvious than those in ketamine anesthesia group [IL-1 (ng/L): 19.28±2.51 vs. 40.12±10.31, IL-6 (ng/L): 52.10±4.23 vs. 72.20±10.11, TNF-α (ng/L): 246.03±20.74 vs. 313.71±27.34, allP < 0.05].Conclusion The low-dose ketamine analgesia and ketamine anesthesia have certain degree of inhibitory effect on the expression and release of inflammatory cytokines at the early stage in rabbits with severe burn, the effect of long-term low-dose ketamine analgesia being more significant.