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1.
Pol Merkur Lekarski ; 48(287): 331-334, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33130793

RESUMO

Among the high-tech methods of wound therapy, the leading place belongs to the technology of manufacture and use of cryolyophilized tissues and bioorganic drugs. Crushed xenoderm's powder stimulates the regenerative processes of the skin and improves the healing process of wounds, as it is enriched with macro- and microelements, amino acids and other cellular elements necessary for skin regeneration. AIM: The aim of this work was to study the wound-healing effectiveness of the developed gel "Xeliogel" on the animal model of aseptic superficial burns. MATERIALS AND METHODS: Evaluation of the degree of catabolism and membrane-destructive processes was performed by determining the marker enzymes of cytolysis - aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in serum, total protein and middle molecular mass in animals with experimental thermal burns. The developed gel "Xeliogel" was applied to the animals for therapeutic purposes. "Xeliogel" is based on aqueous extraction of xenoderm and with lidocaine hydrochloride. In the second group for comparison the Solcoseryl was applied in the form of a gel (Switzerland). This medicine belongs to the group containing active pharmaceutical ingredients of natural origin, namely protein-free dialysate from the blood of calves, and is intended for the treatment of burns of I-II degrees. RESULTS: When using the developed gel "Xeliogel" in experimental thermal burns, normalization of total protein was observed on 14-th days, which is on 7 days faster than under burn conditions, decrease the levels of ALT and AST in the serum with a return to a normal on a 7 day, relative to the control pathology group. In the groups of animals, on whose burn wounds "Xeliogel" gel was applied, already on the 14-th day endogenous intoxication was significantly reduced by 29 % compared with the control group of animals. During the experiment to reduce the area of the wound surface, it was determined that the developed gel "Xeliogel" showed a pharmacological effect similar to the comparison drug "Solkoseryl" gel. CONCLUSIONS: On the model of aseptic burn injury in rats, was determined that the developed gel provides a significant reduction in necrotic processes, the level of endogenous intoxication against the background of restoring the level of total protein in the circulating blood. The results of the research confirm the effectiveness of using the developed gel "Xeliogel" for local treatment of burns of I-II degrees, as the duration of treatment of burns reduced by 4 days compared to the control group and the developed gel is similar to the comparison drug.


Assuntos
Queimaduras , Animais , Queimaduras/tratamento farmacológico , Bovinos , Humanos , Ratos , Pele , Cicatrização
2.
Lima; Perú. Ministerio de Salud; 20201000. 21 p. Ilus.
Monografia em Espanhol | LILACS, MINSAPERU | ID: biblio-1123549

RESUMO

El documento contiene los criterios técnicos para el manejo inicial de niños que han sufrido una quemadura, independientemente de la causa y la extensión.


Assuntos
Queimaduras , Criança , Guias como Assunto , Assistência Integral à Saúde
3.
Lima; Perú. Ministerio de Salud; 20201000. 27 p. tab, graf.
Monografia em Espanhol | LILACS, MINSAPERU | ID: biblio-1123547

RESUMO

El documento contiene los lineamientos que orienten el desarrollo de estrategias, acciones e intervenciones en el sector salud, para la prevención y el control de las lesiones por quemaduras.


Assuntos
Ferimentos e Lesões , Queimaduras , Estratégias , Assistência Integral à Saúde , Controle , Pessoas
4.
Curr Opin Anaesthesiol ; 33(6): 774-780, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33060384

RESUMO

PURPOSE OF REVIEW: Airway management, mechanical ventilation, and treatment of systemic poisoning in burn patients with inhalation injury remains challenging. This review summarizes new concepts as well as open questions. RECENT FINDINGS: Several life-threatening complications, such as airway patency impairment and respiratory insufficiency, can arise in burn patients and require adequate and timely airway management. However, unnecessary endotracheal intubation should be avoided. Direct visual inspection via nasolaryngoscopy can guide appropriate airway management decisions. In cases of lower airway injury, bronchoscopy is recommended to remove casts and estimate the extent of the injury in intubated patients. Several mechanical ventilation strategies have been studied. An interesting modality might be high-frequency percussive ventilation. However, to date, there is no sound evidence that patients with inhalation injury should be ventilated with modes other than those applied to non-burn patients. In all burn patients exposed to enclosed fire, carbon monoxide as well as cyanide poisoning should be suspected. Carbon monoxide poisoning should be treated with an inspiratory oxygen fraction of 100%, whereas cyanide poisoning should be treated with hydroxocobalamin. SUMMARY: Burn patients need specialized care that requires specific knowledge about airway management, mechanical ventilation, and carbon monoxide and cyanide poisoning.


Assuntos
Manuseio das Vias Aéreas/tendências , Queimaduras por Inalação/terapia , Respiração Artificial/tendências , Lesão por Inalação de Fumaça/terapia , Manuseio das Vias Aéreas/métodos , Queimaduras/terapia , Intoxicação por Monóxido de Carbono/terapia , Fogo , Humanos , Respiração Artificial/métodos , Terapia Respiratória , Lesão por Inalação de Fumaça/complicações
7.
Chirurgia (Bucur) ; 115(4): 486-492, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876022

RESUMO

Background: Burns are common reasons for emergency department presentations. While extensive or special burns require treatment in a specialized center, the majority are amenable to ambulatory treatment or hospitalization in a surgical ward. Romania has a national data collecting mechanism regarding all hospitalized patients, but there are no available statistics concerning non-hospitalized burn cases. This study aims to explore the amplitude of burn trauma by analyzing data from an Emergency Department at a major Romanian regional trauma center. Methods: This is a retrospective single-center 1-year study of all burn-related emergency department presentations at the trauma referral center for Romania's North-East region, in 2015. Included in the study were all cases of burns, indiscriminate of their etiology. Results: A total of 355 burn cases were analyzed. The average monthly number of cases was 29.58, with a maximum of 54 and a minimum of 18. There were 206 males and 149 females and 57.7% urban residents. Only 134 cases have been hospitalized during this period. Conclusions: Almost two-thirds of cases have not been hospitalized, thus missing from national statistics. Precise epidemiological data is paramount for a successful national burn management strategy. Creation of a national burn registry is suggested.


Assuntos
Queimaduras/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Unidades de Queimados/estatística & dados numéricos , Queimaduras/terapia , Feminino , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Romênia/epidemiologia , Resultado do Tratamento
8.
Cochrane Database Syst Rev ; 9: CD012826, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32882071

RESUMO

BACKGROUND: Burn injuries are the fourth most common traumatic injury, causing an estimated 180,000 deaths annually worldwide. Superficial burns can be managed with dressings alone, but deeper burns or those that fail to heal promptly are usually treated surgically. Acute burns surgery aims to debride burnt skin until healthy tissue is reached, at which point skin grafts or temporising dressings are applied. Conventional debridement is performed with an angled blade, tangentially shaving burned tissue until healthy tissue is encountered. Hydrosurgery, an alternative to conventional blade debridement, simultaneously debrides, irrigates, and removes tissue with the aim of minimising damage to uninjured tissue. Despite the increasing use of hydrosurgery, its efficacy and the risk of adverse events following surgery for burns is unclear. OBJECTIVES: To assess the effects of hydrosurgical debridement and skin grafting versus conventional surgical debridement and skin grafting for the treatment of acute partial-thickness burns. SEARCH METHODS: In December 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that enrolled people of any age with acute partial-thickness burn injury and assessed the use of hydrosurgery. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, data extraction, 'Risk of bias' assessment, and GRADE assessment of the certainty of the evidence. MAIN RESULTS: One RCT met the inclusion criteria of this review. The study sample size was 61 paediatric participants with acute partial-thickness burns of 3% to 4% total burn surface area. Participants were randomised to hydrosurgery or conventional debridement. There may be little or no difference in mean time to complete healing (mean difference (MD) 0.00 days, 95% confidence interval (CI) -6.25 to 6.25) or postoperative infection risk (risk ratio 1.33, 95% CI 0.57 to 3.11). These results are based on very low-certainty evidence, which was downgraded twice for risk of bias, once for indirectness, and once for imprecision. There may be little or no difference in operative time between hydrosurgery and conventional debridement (MD 0.2 minutes, 95% CI -12.2 to 12.6); again, the certainty of the evidence is very low, downgraded once for risk of bias, once for indirectness, and once for imprecision. There may be little or no difference in scar outcomes at six months. Health-related quality of life, resource use, and other adverse outcomes were not reported. AUTHORS' CONCLUSIONS: This review contains one randomised trial of hydrosurgery versus conventional debridement in a paediatric population with low percentage of total body surface area burn injuries. Based on the available trial data, there may be little or no difference between hydrosurgery and conventional debridement in terms of time to complete healing, postoperative infection, operative time, and scar outcomes at six months. These results are based on very low-certainty evidence. Further research evaluating these outcomes as well as health-related quality of life, resource use, and other adverse event outcomes is required.


Assuntos
Queimaduras/cirurgia , Desbridamento/métodos , Hidroterapia/métodos , Viés , Queimaduras/patologia , Criança , Humanos , Duração da Cirurgia , Transplante de Pele , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Irrigação Terapêutica/métodos , Fatores de Tempo , Cicatrização
10.
Int J Biometeorol ; 64(12): 2195-2203, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32875343

RESUMO

Spa therapy is an integral part of the treatment of burn scars. The objective of this systematic review is to provide an overview of the spa therapy used in the treatment of burn scars and analyze its effects reported in clinical studies. We used the PRISMA checklist and queried 8 scientific databases from August 2019 to July 2020 for articles referenced with the specific key words: (burn) AND ((spa) OR (crenotherap*) OR (sulfur bath) OR (balneo*) OR (hydrotherap*) OR (mineral water) OR (thermal water) OR (spring water) OR (health resort medicine)). We used the EPHPP-QAT to assess the quality of the studies. Out of 10,050 publications identified in our database searches, 3 studies were selected: 2 clinical trials and 1 descriptive multicenter study that polled surgeons for their opinion on spa therapy for burn patients. All of the articles concluded that spa therapy is positive in burn scar recovery. No strong study on the effectiveness of spa therapy for burn scars care according to the EPHPP-QAT was identified. Spa therapy in the Saint Gervais spa center appears to be the only spa technique to have been evaluated for burn scar care. This review underscores the need to perform clinical studies to evaluate the effects and benefits of spa therapy for burn scars on patient's quality of life, and improve our understanding of the mechanisms of action of physiotherapy. Care programs should be harmonized in order to conduct multicenter studies.


Assuntos
Queimaduras , Cicatriz , Queimaduras/terapia , Cicatriz/terapia , Estâncias para Tratamento de Saúde , Humanos , Qualidade de Vida
11.
Acta Chir Plast ; 62(1-2): 18-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32911938

RESUMO

The progress in critical and intensive care burn management in the 21st century has significantly reduced mortality in patients with critical burn injuries. This progress has moved the focus of burns care from simple survival to the quality of life after the burn trauma, in particular to healing of defects caused by full-thickness burns, subsequent maturation, characteristics and appearance of the scars. The benefits of the application of skin substitutes include elimination of excessive scarring, hypertrophic and keloid scar formation and subsequent contracture development. The authors of this article present the strategy of use, application and development of dermal scaffolds as well as the current trends in the use of dermal scaffolds in the treatment of full-thickness burns.


Assuntos
Pele Artificial , Queimaduras/cirurgia , Cicatriz/patologia , Humanos , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Cicatrização
12.
PLoS One ; 15(9): e0239556, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966317

RESUMO

INTRODUCTION: Inhalation injuries carry significant acute care burden including prolonged ventilator days and length of stay. However, few studies have examined post-acute outcomes of inhalation injury survivors. This study compares the long-term outcomes of burn survivors with and without inhalation injury. METHODS: Data collected by the Burn Model System National Database from 1993 to 2019 were analyzed. Demographic and clinical characteristics for adult burn survivors with and without inhalation injury were examined. Outcomes included employment status, Short Form-12/Veterans Rand-12 Physical Composite Score (SF-12/VR-12 PCS), Short Form-12/Veterans Rand-12 Mental Composite Score (SF-12/VR-12 MCS), and Satisfaction With Life Scale (SWLS) at 24 months post-injury. Regression models were used to assess the impacts of sociodemographic and clinical covariates on long-term outcome measures. All models controlled for demographic and clinical characteristics. RESULTS: Data from 1,871 individuals were analyzed (208 with inhalation injury; 1,663 without inhalation injury). The inhalation injury population had a median age of 40.1 years, 68.8% were male, and 69% were White, non-Hispanic. Individuals that sustained an inhalation injury had larger burn size, more operations, and longer lengths of hospital stay (p<0.001). Individuals with inhalation injury were less likely to be employed at 24 months post-injury compared to survivors without inhalation injury (OR = 0.63, p = 0.028). There were no significant differences in PCS, MCS, or SWLS scores between groups in adjusted regression analyses. CONCLUSIONS: Burn survivors with inhalation injury were significantly less likely to be employed at 24 months post-injury compared to survivors without inhalation injury. However, other health-related quality of life outcomes were similar between groups. This study suggests distinct long-term outcomes in adult burn survivors with inhalation injury which may inform future resource allocation and treatment paradigms.


Assuntos
Queimaduras por Inalação/economia , Emprego , Adulto , Idoso , Queimaduras/economia , Queimaduras/fisiopatologia , Queimaduras/terapia , Queimaduras por Inalação/fisiopatologia , Queimaduras por Inalação/terapia , Estudos Transversais , Bases de Dados Factuais , Feminino , Nível de Saúde , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Análise de Regressão , Estudos Retrospectivos , Estados Unidos
13.
Khirurgiia (Mosk) ; (8): 17-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869610

RESUMO

OBJECTIVE: To evaluate the effectiveness of surgical treatment of post-burn defects of face and cranial vault. MATERIAL AND METHODS: There were 65 patients with post-burn defects of face and cranial vault. Mean age of patients was 38.5 years (min 17 years, max 67 years). Soft tissue reconstruction was performed by using of local tissues, combined plasty, balloon dermotension aand free flaps on microvascular anastomoses. Osteoectomy and sequestrectomy were carried out if it was necessary. Implants were used to eliminate through skull defects. RESULTS: Balloon dermotension with expanders and plasty with local tissues ensure skull reconstruction in the vast majority of patients. Through bone defects required reconstruction of the cranial vault with various implants. CONCLUSION: The proposed surgical approach ensures correction of severe functional and cosmetic disorders caused by post-burn skull defects, elimination of bone damage, restoration of normal skin of the face and cranial vault.


Assuntos
Queimaduras/cirurgia , Traumatismos Craniocerebrais/cirurgia , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Adolescente , Adulto , Idoso , Queimaduras/complicações , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Humanos , Microcirurgia , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Crânio/lesões , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Expansão de Tecido , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
14.
J Spec Oper Med ; 20(3): 122-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969017

RESUMO

BACKGROUND: US Air Force (USAF) pararescuemen (PJs) perform long-range ocean rescue missions for ill or injured civilians when advanced care and transport are not available. The purpose of this case series is to examine the details of these missions, review patient treatments and outcomes, and describe common tactics, techniques, and procedures for these missions. METHODS: Cases in which the USAF PJs preformed long-range ocean rescue for critically ill or injured civilians between 2011 and 2018 were identified. Case information was obtained, including patient demographics, location, infiltration/exfiltration methods, diagnoses, treatments, duration of patient care, patient outcome, and lessons learned. RESULTS: A total of 14 pararescue missions involving 22 civilians were identified for analysis. Of the 22 patients, 10 (45%) suffered burns, six (27%) had abdominal issues, four (18%) had musculoskeletal injuries, one had a traumatic brain injury, and one had a necrotizing soft-tissue infection. Medical care of these patients included intravenous fluid and blood product resuscitation, antibiotics, analgesics, airway management, and escharotomy. The median duration of patient care was 51 hours. CONCLUSION: This case series illustrates the complex transportation requirements, patient and gear logistical challenges, austere medicine, and prolonged field care (PFC) unique to USAF PJ open-water response.


Assuntos
Resgate Aéreo , Militares , Lesões Encefálicas Traumáticas , Queimaduras , Humanos , Oceanos e Mares , Ressuscitação
15.
J Spec Oper Med ; 20(3): 135-140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969019

RESUMO

Best practices and training for prolonged field care (PFC) are evolving. The New York Pararescue Team has used part task training, cadaver labs, clinical rotations, and a complicated sim lab to prepare for PFC missions including critical care. This report details an Atlantic Ocean nighttime parachute insertion to provide advanced burn care to two sailors with 50% and 60% body surface area burns. Medical mission planning included pack-out of ventilators, video laryngoscopes, medications, and 50 L of lactated Ringer's (LR). Over the course of 37 hours, the patients required high-volume resuscitation, analgesia, wound care, escharotomies, advanced airway and ventilator management, continuous sedation, telemedicine consultation, and complicated patient movement during evacuation. A debrief survey was obtained from the Operators highlighting recommendation for more clinical rotations and labs, missionspecific pack-outs, and tactical adjustments. This historic mission represents the most sophisticated PFC ever performed by PJs and serves to validate and share our approach to PFC.


Assuntos
Queimaduras , Queimaduras/terapia , Hidratação , Humanos , Soluções Isotônicas , New York , Oceanos e Mares , Ressuscitação , Lactato de Ringer
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(7): 824-827, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32788017

RESUMO

OBJECTIVE: To investigate the protective effect of insulin on burn serum-challenged cardiomyocytes in vitro. METHODS: Primary culture of cardiomyocytes from Sprague-Dawley (SD) 2-day-old neonate rats were divided into sham group, burn group, insulin group, and insulin activation inhibitor LY294002 pretreatment group (LY group). The model of cardiomyocytes injury induced by burn serum of 3-month-old SD rats [the serum of abdominal aortic was collected at 6 hours after modelling 30% total surface area (TBSA) III degree scald rat] was reproduced. In the insulin group, 10% burn serum and insulin (10 U/L) were added into cell culture medium, and in the LY group, LY294002 (50 µmol/L) was pretreated for 30 minutes before the addition of burn serum and insulin. Sham group was only given 10% serum of sham injured rats (sham rats were only placed in 37 centigrade warm water). After the cells were cultured for 12 hours, the release of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and creatine kinase (CK) were determined by enzyme-linked immunosorbent assay (ELISA). The cardiac troponin T (cTnT) protein expression was examined by Western Blot. Apoptosis of cardiomyocytes was observed after Hoechst 33258 staining. RESULTS: Compared with the sham group, the cardiomyocytes were damaged and released inflammatory cytokines after burn serum-challenged. The levels of TNF-α, IL-6 and CK increased [TNF-α (ng/L): 273±48 vs. 21±6, IL-6 (ng/L): 416±83 vs. 44±11, CK (U/L): 1.44±0.24 vs. 0.14±0.08, all P < 0.01], while the expression of cTnT protein decreased (cTnT/ß-actin: 0.12±0.04 vs. 0.86±0.34, P < 0.01), and the cardiomyocyte apoptosis increased [(19.1±5.6)% vs. (5.2±1.3)%, P < 0.01]. Insulin could significantly reduce the damage of cardiomyocytes, decrease the release of TNF-α, IL-6 and CK induced by burn serum [TNF-α (ng/L): 105±37 vs. 273±48, IL-6 (ng/L): 176±77 vs. 416±83, CK (U/L): 0.82±0.26 vs. 1.44±0.24, all P < 0.05], the expression of cTnT protein significantly increased (cTnT/ß-actin: 0.41±0.16 vs. 0.12±0.04, P < 0.05), and the cells apoptosis rate significantly decreased [(10.7±3.2)% vs. (19.1±5.6)%, P < 0.05]. Further blocking experiments showed that LY294002 could mitigate the protective effects of insulin. CONCLUSIONS: For cardiomyocytes challenged by burn serum, insulin may decrease inflammation, apoptosis and then protect the cardiomyocytes.


Assuntos
Queimaduras , Insulina , Miócitos Cardíacos , Animais , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa
17.
Zhonghua Shao Shang Za Zhi ; 36(7): 553-559, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842402

RESUMO

Objective: To explore the effects of early exogenous L-carnitine supplementation on renal function in severely scalded rats. Methods: According to the random number table, sixty-six adult female Sprague-Dawly rats were divided into healthy control group (n=6), scald alone group (n=30), and scald+ carnitine group (n=30). In the latter two groups, the rats were inflicted with full-thickness scald of 30% total body surface area on the back, and the lactated Ringer's solution was injected through the tail vein for resuscitation immediately after scald. At post injury hour (PIH) 1, rats in scald+ carnitine group were intraperitoneally injected with 100 mg/mL L-carnitine solution 400 mg/kg, while rats in scald alone group were intraperitoneally injected with the same volume of normal saline. Rats in these two groups were injected once every 24 hours thereafter. Six rats were taken from each of scald alone group and scald+ carnitine group to collect the renal tissue and abdominal aorta blood at PIH 6, 12, 24, 48, and 72, respectively. The serum content of total protein, albumin, urea nitrogen, creatinine, and cystatin C were determined by the automatic biochemical analyzer. Renal tissue was stained with hematoxylin-eosin to observe histopathological changes. Rats in healthy control group did not undergo any treatment, and their renal tissue and blood sample were extracted and analyzed in the same way as those of severely scalded rats. Data were statistically analyzed with one-way analysis of variance and Bonferroni method. Results: (1) The serum content of total protein and albumin of rats in scald alone group at each time point after injury was significantly lower than that in healthy control group (P<0.05). The serum content of total protein of rats in scald+ carnitine group was significantly higher than that in scald alone group at PIH 12 and 24 (P<0.05), and the serum content of albumin of rats in scald+ carnitine group was significantly higher than that in scald alone group at PIH 12 (P<0.05). The serum content of total protein and albumin of rats in scald alone group and scald+ carnitine group showed a trend of decrease followed by an increase, with the lowest value at PIH 24. (2) The serum content of urea nitrogen and creatinine of rats in scald alone group at each time point after injury was significantly higher than that of healthy control group (P<0.05). The serum content of urea nitrogen of rats in scald+ carnitine group was significantly lower than that in scald alone group at PIH 6, 48, and 72 (P<0.05). The serum content of creatinine of rats in scald+ carnitine group was significantly lower than that in scald alone group at PIH 12, 24, 48, and 72 (P<0.05). The serum content of urea nitrogen and creatinine of rats in scald alone group and scald+ carnitine group showed a trend of increase followed by a decrease, with the peak value at PIH 12. (3) The serum content of cystatin C of rats in scald alone group at PIH 6, 12, 24, 48, and 72 was (0.250±0.030), (0.330±0.070), (0.300±0.060), (0.240±0.060), and (0.190±0.030) mg/L, and the content at the first 4 time points were significantly higher than (0.170±0.020) mg/L of healthy control group (P<0.05). At PIH 24, the serum content of cystatin C of rats in scald+ carnitine group was (0.210±0.040) mg/L, which was significantly lower than that of scald alone group (P<0.05). The serum content of cystatin C of rats in scald alone group and scald+ carnitine group showed a trend of increase followed by a decrease, with the peak value at PIH 12. (4) The renal tissue of rats in healthy control group was almost normal, and the degree of renal tissue injury of rats in scald+ carnitine group was lighter than that in scald alone group at each time point after injury. At PIH 24, the renal tissue of rats in scald alone group showed extensive swelling of the renal tubular epithelial cells, vacuolar degeneration and necrosis, loss of brush borders, and nuclear shrinkage; more than 2/3 of the renal tubular cell nuclei disappeared, the tubular lumen was narrowed, necrotic exfoliated cells could be seen in the lumen, and edema and inflammatory cell infiltration could be seen in the renal interstitial. Compared with those of scald alone group, significantly reduced severity of edema and necrosis of renal tubular epithelial cells, as well as less inflammatory cell infiltration were observed in the renal tissue of rats in scald+ carnitine group. Conclusions: Early supplement of L-carnitine in severely scalded rats can reduce the damage of renal cells, accelerate the restoration of the content of total protein, albumin, urea nitrogen, creatinine, and cystatin C, thereby maintaining the stability of renal function metabolism level.


Assuntos
Queimaduras , Lesões dos Tecidos Moles , Animais , Carnitina , Suplementos Nutricionais , Ensaio de Imunoadsorção Enzimática , Ratos , Ratos Sprague-Dawley
18.
Zhonghua Shao Shang Za Zhi ; 36(7): 560-567, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842403

RESUMO

Objective: To systematically evaluate the clinical effects of microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds using meta-analysis. Methods: Foreign language databases including PubMed and Cochrane Library were searched with the terms of " Meek micrografting, burn" , and Chinese databases including Chinese Journal Full-Text Database, Chinese Biomedical Database, VIP database, and Wanfang Data were searched with the terms in Chinese version of ", Meek," to retrieve the publicly published randomized controlled trials on the microskin grafting and Meek microskin grafting in repairing extensively deep burn wounds from the establishment of each database to March 20, 2019. The outcome indexes included the survival rate of skin graft, primary healing rate, operation time, and surgical treatment cost after the first operation, as well as the wound healing time and length of hospital stay. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies. Results: A total of 821 patients with extensively deep burns were included in 15 studies, including 410 patients in microskin group who received microskin grafting and 411 patients in Meek microskin group who received Meek microskin grafting. The bias risks of the 15 studies included were uncertain. Compared with those of microskin group, the survival rate of skin graft and primary healing rate of patients in Meek microskin group were significantly increased, with relative risks of 0.76 and 0.66 (95% confidence interval=0.66-0.88, 0.50-0.88, P<0.01), the surgical treatment cost was significantly reduced, with a standardized mean difference of 3.19 (95% confidence interval=1.36-5.01, P<0.01), and the operation time, wound healing time, and length of hospital stay were significantly shortened, with standardized mean differences of 6.05, 2.39, and 2.35 (95% confidence interval=3.66-8.44, 1.43-3.35, 2.03-2.68, P<0.01). Subgroup analysis showed that microskin grafting combined with allogenic skin graft might be a heterogeneous source of operation time. Sensitivity analysis showed that the combined effect size was stable in the operation time, surgical treatment cost, and wound healing time. There was no publication bias in the survival rate of skin graft, operation time, wound healing time, and length of hospital stay (P>0.05), while the primary healing rate and surgical treatment cost had publication bias (P<0.01). Conclusions: Compared with microskin grafting, Meek microskin grafting improves the rates of skin graft survival and primary healing, shortens operation time, wound healing time, and length of hospital stay, and reduces the treatment cost in treating extensively deep burn wounds.


Assuntos
Queimaduras , Queimaduras/cirurgia , Sobrevivência de Enxerto , Humanos , Pele , Transplante de Pele , Cicatrização
19.
Zhonghua Shao Shang Za Zhi ; 36(7): 582-586, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842404

RESUMO

Objective: To retrieve, evaluate, and summarize the best evidence for postoperative hypothermia rewarming in adults with severe burns. Methods: Foreign language databases including Cochrane Library, Joanna Briggs Institute Evidence-Based Health Care Center Database, PubMed, Ovid-Medline, BMJ Best Practice, and Web of Science were retrieved with the search terms of " severe burn/major burn/severe degree burn" , " hypothermia/warming intervention/hypothermia/temperature/body temperature change" , and " postoperative /perioperative/peri-operative/post-operative" and Chinese databases including Chinese Journal Full-Text Database, Wanfang Database, and VIP Database were retrieved with the search terms of "//" , "/" , and "" to obtain all the publicly published evidence for postoperative hypothermia rewarming in adults with severe burns from the establishment of each database to April 2018, including systematic evaluations, guidelines, expert consensus, evidence summary, and original research closely related to the evidence. The literatures were screened and evaluated for their quality, the evidences were extracted from them, evaluated, classified in order to summarize the best evidences. Results: A total of 8 literatures were included, including one systematic evaluation, three guidelines, one expert consensus, and three evidence summaries. Finally, the best evidences in 8 aspects including the body temperature monitoring site, body temperature monitoring frequency, surface heating, in vivo heating, rewarming start, multi-strategy rewarming, equipment, and personnel training were summarized. Conclusions: Based in the evidence-based nursing method, this study retrieves and evaluates the literature, summarizes the evidence analysis and evaluation, and obtains the best evidences of postoperative hypothermia rewarming in adult patients with severe burns, which provides a strong reference for the clinical implementation of rewarming.


Assuntos
Queimaduras , Hipotermia , Adulto , Temperatura Corporal , Queimaduras/terapia , Humanos , Reaquecimento
20.
Zhonghua Shao Shang Za Zhi ; 36(7): 547-552, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32842401

RESUMO

Objective: To explore the efficacy of hierarchical medical mode path management on the continuous treatment for chronic wound patients. Methods: From June 2017 to September 2018, the clinical data of 101 patients with chronic wounds who were just discharged from Department of Wound Repair of the Affiliated Hospital of Jiangnan University (hereafter referred to as the author's affiliation) and still needed continuous treatment, meeting the inclusion criteria, were analyzed with the method of retrospective cohort study. Based on the management method of continuous treatment after discharge, the patients were divided into path management group (52 patients, 27 males and 25 females, aged (44±6) years, 57 wounds) and conventional management group (49 patients, 26 males and 23 females, aged (45±6) years, 53 wounds). The patients in path management group were carried out with full-path management under hierarchical medical mode, and the patients in conventional management group were carried out with conventional continuous treatment management. The discharge time from the author's affiliation was the time before continuous treatment management (hereafter referred to as before management), and 12 weeks post discharge was the time after continuous treatment management (hereafter referred to as after management). The depression and anxiety of patients in two groups were assessed by Hamilton Depression Scale 24 item version (HAMD-24) and Self-rating Anxiety Scale (SAS), and the positive ratios of depression and anxiety were calculated. The effective rates of wound treatment, times of debridement and dressing change, and treatment cost during the continuous treatment management period were counted. Data were statistically analyzed with two independent sample t test, chi-square test, Fisher's exact probability test, and Wilcoxon rank-sum test. Results: (1) Before management, the HAMD-24 and SAS scores of patients in two groups were similar. After management, the HAMD-24 and SAS scores of patients in path management group were significantly lower than those of conventional management group (t=4.341, 3.840, P<0.01). Before and after management, the positive rates of depression and anxiety of patients in two groups were similar. (2) After management, the effective rate of wound treatment of patients in path management group was 98.25% (56/57), which was significantly higher than 86.79% (46/53) of conventional management group (χ(2)=5.341, P<0.05). (3) During the management, the times of debridement and dressing change in patients of path management group was 20±4, which was significantly less than 27±7 of conventional management group (t=5.833, P<0.01). (4) During the management, the treatment cost of patients in path management group was (2 479±213) yuan, which was significantly less than (5 215±326) yuan of conventional management group (t=50.185, P<0.01). Conclusions: In the continuous treatment of chronic wound patients, the full-path management under hierarchical medical mode can improve the effective rate of wound treatment, reduce the times of debridement and dressing change and treatment cost, and improve their psychological state.


Assuntos
Assistência ao Convalescente , Queimaduras , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização
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