中华烧伤与创面修复杂志

Lay further emphasis on the treatment in critical burn

Guo Guanghua

2016, 32(3): 129-132. doi: 10.3760/cma.j.issn.1009-2587.2016.03.001

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In recent years, growth in number of mass burn casualties accompanied by large number of deaths, has increased, such as dust blast occurred in Kunshan in 2014 and explosion of chemicals occurred in Tianjin in 2015. These disasters made us aware that our knowledge of care of mass burn casualties must be renewed, and therapeutic strategies currently practiced in ICU should be adopted. This paper introduces the concept of critical burn and provides reference on how to carry out fluid resuscitation, early enteral nutrition, mechanical ventilation, continuous renal replacement therapy, wound management, as well as infection control, etc.

Clinical randomized controlled trial on the feasibility and validity of continuous blood purification during the early stage of severe burn

Liu Feng, Huang Zhenggen, Peng Yizhi, Wu Jun, He Weifeng, Yuan Zhiqiang, Zhang Jiaping, Luo Qizhi, Yan Hong, Peng Daizhi, Dang Yongming, Luo Gaoxing

2016, 32(3): 133-139. doi: 10.3760/cma.j.issn.1009-2587.2016.03.002

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Objective To observe and primarily evaluate the feasibility and validity of continuous blood purification (CBP) during the early stage of severe burn. Methods Forty-one patients with severe burn admitted to our ward from January 2013 to July 2015, conforming to the study criteria, were divided into conventional treatment group (CT, n=21) and blood purification group (BP, n=20) according to the random number table and patient's personal consent. Patients in group CT received CT conforming to the traditional resuscitation principle for severe burn, while patients in group BP received CT and blood purification treatment in the mode of continuous venous-venous hemodiafiltration in addition up to post injury hour (PIH) 72. On post injury day (PID) 1, 2, 3, the vital signs, volume of fluid input, and volume of the urine output were observed and recorded; femoral artery blood was drawn to determine lactate, bicarbonate radical, and base excess, and oxygen index was calculated. At PIH 12, 24, 48, 72, femoral vein blood was drawn to determine white cell count, platelet count, neutrophils, creatine kinase-MB, creatine kinase, lactic dehydrogenase, aspartate transaminase (AST), alanine aminotransferase (ALT), creatinine, urea nitrogen, and blood glucose (the ratio of AST to ALT was calculated). The incidence of infection, sepsis, and multiple organ dysfunction syndrome (MODS) and the mortality of patients were recorded during 2 months after injury. Data were processed with chi-square test, analysis of variance for repeated measurement, t test and Wilcoxon test, and the values of P were adjusted by Bonferroni. Results The observation was completed in the 41 patients without exclusion. (1) There were no statistically significant differences in vital signs, volume of fluid input, and volume of the urine output of patients between two groups on PID 1, 2, 3 (with t values from -1.64 to 1.48, P values above 0.05). (2) Compared with that in group CT, the level of lactate of patients in group BP declined significantly on PID 2 and 3 (with Z values respectively -2.37 and -2.46, P values below 0.05). Compared with those in group CT, the levels of bicarbonate radical and base excess of patients in group BP declined significantly on PID 3 (with t values both as -2.51, P values below 0.05). The oxygen index of patients in group BP on PID 3 was (370±98) mmHg (1 mmHg=0.133 kPa), which was significantly higher than that in group CT [(305±81) mmHg, t=2.27, P<0.05]. (3) There were no statistically significant differences in white cell count, platelet count, neutrophils, creatine kinase, lactic dehydrogenase, AST, ALT, and AST to ALT ratio of patients between two groups at PIH 12, 24, 48, 72 (with t values from -1.47 to 1.19, Z values from -1.58 to -0.03, P values above 0.05). At PIH 24, 48, 72, the levels of creatine kinase-MB and blood glucose of patients in group BP were respectively (81±43), (55±34), (58±40) U/L and (7.9±2.0), (6.7±0.9), (6.9±1.8) mmol/L, which were significantly lower than those in group CT [(179±184), (124±71), (103±57) U/L and (10.1±3.8), (9.1±2.4), (8.8±4.1) mmol/L, with Z values from -3.73 to -2.02, P<0.05 or P<0.01]. Compared with those of patients in group CT, creatinine at PIH 48 and urea nitrogen at PIH 24, 48, 72 were obviously lower in group BP (with t values from -4.23 to -2.44, P<0.05 or P<0.01). (4) During the two months after injury, the infection rate of patients in group BP was 60.0% (12/20), which was significantly lower than that in group CT [95.2% (20/21), χ²=5.51, P<0.05]. The incidence of sepsis and MODS and the mortality of patients in group BP were all lower than those in group CT, but there were no statistically significant differences (with χ² values from 0.22 to 2.93, P values above 0.05). Conclusions Conducting CBP in the early stage of severe burn is safe and feasible, which does not obviously affect the vital signs, volumes of fluid input and urine output, or platelet count of patients, additionally, it could help protect the function of vital organs, eliminate stress hyperglycemia, and reduce infection rate. Clinical trial registration Chinese Clinical Trial Registry, ChiCTR-TRC-12002616.

Effect of application of pulse contour cardiac output monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty

Yang Wenxian, Guo Guanghua, Shen Guoliang, Lin Wei, Zhao Xiaoyu, Qi Qiang, Qian Han'gen, Xie Wenzhong, Wang Zhixue

2016, 32(3): 140-146. doi: 10.3760/cma.j.issn.1009-2587.2016.03.003

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Objective To investigate the effect of the application of pulse contour cardiac output (PiCCO) monitoring technology on delayed resuscitation of patients with extensive burn in a mass casualty. Methods The clinical data of 41 patients injured in Kunshan dash explosion hospitalized in the First Affiliated Hospital of Soochow University, the 100th Hospital of the People's Liberation Army, and Suzhou Municipal Hospital were retrospectively analyzed. The patients were divided into traditional monitoring group (T, n=22) and PiCCO monitoring group (P, n=19) according to the monitoring technic during delayed resuscitation. The input volumes of electrolyte, colloids, and water of patients in the two groups within 2 hours after admission, the first, second, and third 8 hours post injury (HPI), and the first 24 HPI were recorded. The fluid infusion coefficients of patients in the two groups within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were calculated. The urine volume, mean arterial pressure (MAP), and central venous pressure (CVP) of patients in the two groups at post injury hour (PIH) 8, 16, 24, 48, 72, and 96 were recorded. The blood lactate, base excess, hematocrit (HCT), and platelet count of patients in the two groups at PIH 24, 48, 72, and 96 were recorded. Complications and death of patients in the two groups were recorded. Data were processed with analysis of variance for repeated measurement, Chi-square test, t test, and Wilcoxon test. The deviations between figure 2 and the fluid infusion coefficients of the first or second 24 HPI, and the deviations between figure 1 and the fluid infusion coefficients of the second, third or fourth 24 HPI were calculated, and the three groups deviations were analyzed by Pearson correlation analysis. Results (1) The input volumes of electrolyte of patients in group P were significantly more than those in group T within the first 8 and 24 HPI (with Z values respectively -3.506 and -2.654, P<0.05 or P<0.01), and the input volumes of electrolyte of patients in the two groups were similar within the other time periods (with Z values from -1.871 to -0.680, P values above 0.05). The input volumes of colloid of patients in group P were significantly less than those in group T within the second, third 8 HPI, and the first 24 HPI (with Z values from -4.720 to -2.643, P<0.05 or P<0.01), and the input volumes of colloid of patients in the two groups were similar within the other time periods (with Z values respectively -2.376 and -2.303, P values above 0.05). The input volumes of water of patients in the two groups were similar within each time period (with Z values from -1.959 to -0.241, P values above 0.05). (2) The fluid infusion coefficients of patients in group T within 2 hours after admission, the first, second, and third 8 HPI, and the first, second, third, and fourth 24 HPI were respectively (0.59±0.18), (0.70±0.23), (0.94±0.24), (0.74±0.14), (2.38±0.44), (1.70±0.56), (1.35±0.67), and (0.92±0.46) mL·kg^-1·%TBSA^-1, and the values in group P were respectively (0.59±0.29), (0.82±0.37), (0.86±0.38), (0.59±0.24), (2.27±0.85), (2.13±0.68), (1.59±3.78), and (1.46±0.56) mL·kg^-1·%TBSA^-1. The fluid infusion coefficients of patients in the two groups were similar within 2 hours after admission, the first, second 8 HPI, and the first, third 24 HPI (with t values from -1.262 to 0.871, P values above 0.05). The fluid infusion coefficient of patients in group P was significantly lower than that in group T within the third 8 HPI (t=2.456, P<0.05), and the fluid infusion coefficient of patients in group P were significantly higher than that in group T within the second and fourth 24 HPI (with t values respectively -2.234 and -3.370, P<0.05 or P<0.01). There was obviously negative correlation between the deviations of figure 2 and the fluid infusion coefficient of the first 24 HPI and that of the second 24 HPI (r=-0.438, P<0.01). There was no obvious correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the third 24 HPI (r=0.091, P>0.05). There was obviously positive correlation between the deviations of figure 1 and the fluid infusion coefficient of the second 24 HPI and that of the fourth 24 HPI (r=0.695, P<0.01). (3) The urine volumes and MAP of patients in the two groups were similar at each time point (with Z values from -1.884 to 0, P values above 0.05). The CVP of patients in group P were significantly higher than that in group T at PIH 16, 24, 48, and 72 (with Z values from -4.341 to -2.213, P<0.05 or P<0.01), and the CVP of patients in the two groups were similar at the other time points (with Z values respectively -0.132 and -1.208, P values above 0.05). The blood lactate of patients in group P was significantly higher than that in group T at PIH 72 (Z= -2.958, P<0.01) , and the blood lactate of patients in the two groups were similar at the other time points (with Z values from -1.742 to -0.433, P values above 0.05). The base excess of patients in group P were significantly lower than that in group T at PIH 24, 48, 72, and 96 (with Z values from -4.970 to -4.734, P values below 0.01). The HCT of patients in the two groups were similar at PIH 24, 48, 72, and 96 (with Z values from -2.239 to -0.196, P values above 0.05). There were significant differences in the platelet count of patients in the two groups at PIH 24, 72, and 96 (with Z values from -4.578 to -2.512, P<0.05 or P<0.01). (4) There were 15 cases in group T accompanied by complications, and 7 cases died, while 13 cases in group P accompanied by complications, and 9 cases died. The occurrence of complications and death of patients in the two groups were similar (with χ² values respectively <0.001 and 1.306, P values above 0.05). Conclusions On the basis of traditional burn shock monitoring index, the effect of fluid resuscitation in patients with severe burn monitored by PiCCO technology is not so good and still needs further clinical research.

Prognostic significance of serum procalcitonin in patients with extremely severe burn and sepsis

Yang Xinjing, Jin Jun, Xu Hua, Zhao Daguo, Sun Xue, Liu Shenglan, Guo Qiang

2016, 32(3): 147-151. doi: 10.3760/cma.j.issn.1009-2587.2016.03.004

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Objective To analyze the changes in serum procalcitonin (PCT) in patients with extremely severe burn and sepsis, and to evaluate its clinical significance in the prognosis of patients. Methods Thirteen patients with extremely severe burn and sepsis injured in the aluminum dust explosion accident, which occurred in Kunshan of Jiangsu province, were admitted to our unit on August 2nd, 2014. They were involved in this retrospective study and divided into death group (n=5) and survival group (n=8) according to the outcome. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and Sequential Organ Failure Assessment (SOFA) score at post admission hour (PAH) 24 were compared among the patients between two groups. Serum level of PCT, serum level of C-reactive protein (CRP), white cell count, neutrophils, platelet count, level of aspartate transaminase (AST), level of prealbumin (PA), level of creatinine, level of urea nitrogen, and level of blood sodium were compared among the patients between two groups in post admission week (PAW) 1, 2, 3, and 4. Data were processed with Fisher's exact test, analysis of variance for repeated measurement, t test, and Mann-Whitney test. Receiver operating characteristic (ROC) curves of serum PCT values were plotted to evaluate the predictive value for death of 13 patients in PAW 3 and 4. Results The differences in APACHE Ⅱ score and SOFA score at PAH 24 and serum level of CRP, white cell count, level of AST, level of creatinine, level of urea nitrogen, and level of blood sodium from PAW 1 to 4 of the patients between two groups were not statistically significant (with t values from -1.164 to 0.587, Z values from -1.872 to -0.442, P values above 0.05). The serum levels of PCT in patients of death group in PAW 3 and 4 were respectively (15.8±14.9) and (13.6±5.6) ng/mL, which were significantly higher than those of survival group [(2.4±1.8) and (4.9±6.1) ng/mL, with Z values respectively -2.635 and -2.208, P<0.05 or P<0.01]. The serum levels of PCT of patients in death group and survival group in PAW 1 and 2 were close (with Z values respectively -0.732 and -1.025, P values above 0.05). Compared with those of survival group, neutrophils in PAW 4 was significantly increased (t=-3.690, P<0.01), the platelet count in PAW 4 was significantly decreased (t=4.858, P<0.01), and the level of PA in PAW 2 was significantly increased in patients of death group (t=-2.320, P<0.05). There were no statistically significant differences in neutrophils, platelet count, and the level of PA at the other time points of patients between death group and survival group (with t values from -1.562 to 1.904, P values above 0.05). The total areas under ROC curves of serum level of PCT for predicting death of 13 patients with extremely severe burn and sepsis in PAW 3 and 4 were respectively 0.938 and 0.906, and 7.45 ng/mL and 8.77 ng/mL were respectively chosen as the optimal threshold values, with sensitivity of 75.0% and 100.0% and specificity of 100.0% and 87.5%. Conclusions Serum level of PCT in PAW 3 and 4 can be used as the vital prognostic indicators for patients with extremely severe burn and sepsis, and it can be considered as a guide for rational treatment in clinic.

Clinical randomized controlled trial on the feasibility and validity of continuous blood purification during the early stage of severe burn

Liu Feng, Huang Zhenggen, Peng Yizhi

2016, 32(3): 152-153. doi: 10.3760/cma.j.issn.1009-2587.2016.03.005

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2016, 32(3): 154-155. doi: 10.3760/cma.j.issn.1009-2587.2016.03.006

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Advances in the research of blast lung injury

Peng Linghua, Guo Guanghua

2016, 32(3): 156-159. doi: 10.3760/cma.j.issn.1009-2587.2016.03.007

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In recent years, a variety of explosive weapons become increasingly common used in regional military conflicts and terrorist bomb attacks. Meanwhile, the incidence of accidental explosion also showed an increase in the industries and daily life. The lung is the most labile organ and it is used to be severely injured organ in blast injury although even no signs of external injury could be observed on chest. Blast injury can present the symptoms such as lung rupture, bleeding, edema and emphysema. Respiratory dysfunction can affect oxygen supply to organs and systemic tissue, resulting in rapid and sustained hypoxemia and high mortality rate. Blast lung injury is characterized by respiratory disturbance and hypoxia. This article summarizes the etiology, pathogenesis, pathophysiological changes, diagnosis, and treatment of blast lung injury, with a hope to provide some useful clinical information.

2016, 32(3): 167-167. doi: 10.3760/cma.j.issn.1009-2587.2016.03.101

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2016, 32(3): 167-167. doi: 10.3760/cma.j.issn.1009-2587.2016.03.102

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2016, 32(3): 175-175. doi: 10.3760/cma.j.issn.1009-2587.2016.03.103

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2016, 32(3): 180-180. doi: 10.3760/cma.j.issn.1009-2587.2016.03.104

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2016, 32(3): 181-183. doi: 10.3760/cma.j.issn.1009-2587.2016.03.011

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2016, 32(3): 183-184. doi: 10.3760/cma.j.issn.1009-2587.2016.03.012

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2016, 32(3): 185-186. doi: 10.3760/cma.j.issn.1009-2587.2016.03.013

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2016, 32(3): 187-188. doi: 10.3760/cma.j.issn.1009-2587.2016.03.014

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2016, 32(3): 189-192. doi: 10.3760/cma.j.issn.1009-2587.2016.03.015

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Expression and significance of tumor necrosis factor alpha, matrix metalloproteinase 2 and collagen in skin tissue of pressure ulcer of rats

Wang Xiaohui, Mao Tingting, Pan Yingying, Xie Haohuang, Zhang Hongyu, Xiao Jian, Jiang Liping

2016, 32(3): 160-167. doi: 10.3760/cma.j.issn.1009-2587.2016.03.008

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Objective To observe the expressions of tumor necrosis factor alpha (TNF-α), matrix metalloproteinase 2 (MMP-2) and collagen in local skin tissue of pressure ulcer of rats, and to explore the possible mechanism of the pathogenesis of pressure ulcer. Methods Forty male SD rats were divided into normal control group, 3 d compression group, 5 d compression group, 7 d compression group, and 9 d compression group according to the random number table, with 8 rats in each group. The rats in normal control group did not receive any treatment, whereas the rats in the latter 4 groups were established the deep tissue injury model (3 d compression group) and pressure ulcer model (the other 3 groups) on the gracilis muscle on both hind limbs using a way of cycle compression of ischemia-reperfusion magnet. The rats in 3 d compression group received only three cycles of compression, while the compressed skin of the rats in 5 d compression group, 7 d compression group, and 9 d compression group were cut through and received pressure to 5, 7 and 9 cycles after three cycles of compression, respectively. The rats in 3 d compression group were sacrificed immediately after receiving compression for 3 d (the rats in normal control group were sacrificed at the same time), and the rats in the other 3 groups were respectively sacrificed after receiving compression for 5, 7, and 9 d, and the skin tissue on the central part of gracilis muscle on both hind limbs were harvested. The morphology of the skin tissue was observed with HE staining. The expression of collagen fiber was observed with Masson staining. The expressions of collagen type Ⅳ and MMP-2 were detected by immunohistochemical method. The expressions of TNF-α and phosphorylated NF kappa B (NF-κB) were determined by Western blotting. Data were processed with one-way analysis of variance and LSD test. Results (1) In normal control group, the skin tissue of rats was stratified squamous epithelium, with the clear skin structure, and there was no obvious infiltration of inflammatory cells. In 3 d compression group, the skin layers of rats were clear, with quite a few fibroblasts, and the inflammatory cells began to infiltrate. In 5 d compression group, 7 d compression group, and 9 d compression group, the epidermis of rats thickened, with the number of fibroblasts reduced, and the infiltration of inflammatory cells enhanced with the compressed time prolonging. (2) In normal control group, the collagen fibers in skin tissue of rats were arranged in order, with rich content. In 3 d compression group, the collagen fibers in skin tissue of rats were arranged orderly, with high expression level, which was similar to that in normal control group (P>0.05). In 5 d compression group and 7 d compression group, the collagen fibers in skin tissue of rats were arranged in disorder, with the expression level gradually reduced, which were significantly lower than that in normal control group (with P values below 0.01). In 9 d compression group, the expression of collagen fiber in skin tissue of rats was a little higher than that in 7 d compression group, but it was still significantly lower than that in normal control group (P<0.01). (3) The expressions of collagen type Ⅳ in skin tissue of rats in normal control group, 3 d compression group, 5 d compression group, 7 d compression group, and 9 d compression group were respectively 11.0±2.8, 9.0±1.7, 8.3±2.8, 5.1±1.8, and 5.4±1.2. The expression of collagen type Ⅳ in skin tissue of rats in 3 d compression group was similar to that in normal control group (P>0.05). The expressions of collagen type Ⅳ in skin tissue of rats in 5 d compression group, 7 d compression group, and 9 d compression group were significantly lower than that in normal control group (P<0.05 or P<0.01). The expression of MMP-2 in skin tissue of rats in 3 d compression group was similar to that in normal control group (P>0.05). The expressions of MMP-2 in skin tissue of rats in 5 d compression group, 7 d compression group, and 9 d compression group were significantly higher than that in normal control group (P<0.05 or P<0.01). (4) The expression of TNF-α in skin tissue of rats in normal control group was 0.48±0.11, and the expressions of TNF-α in skin tissue of rats in 3 d compression group, 5 d compression group, 7 d compression group, and 9 d compression group were respectively 0.84±0.08, 1.13±0.19, 1.34±0.16, and 1.52±0.23, which were all significantly higher than that in normal control group (with P values below 0.01). The expressions of phosphorylated NF-κB in skin tissue of rats in 3 d compression group and 9 d compression group were similar to that in normal control group (with P values above 0.05), and the expressions of phosphorylated NF-κB in skin tissue of rats in 5 d compression group and 7 d compression group were significantly higher than that in normal control group (P<0.05 or P<0.01). Conclusions The high expression of MMP-2 and reduction of collagen induced by inflammatory reaction mediated by the high expression of TNF-α in local skin tissue of pressure ulcer of rats may be one of the important reasons for the formation of pressure ulcer.

Effects of San-huang-sheng-fu oil on peripheral circulatory disorders and foot ulcers in diabetic rats and the mechanisms

Wan Yan, Yang Yanjing, Li Yusang, Li Xiaojun, Zhang Wei, Liu Min, Tang Hebin

2016, 32(3): 168-175. doi: 10.3760/cma.j.issn.1009-2587.2016.03.009

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Objective To observe the effects of San-huang-sheng-fu oil (S) on peripheral circulatory disorders and foot ulcers in diabetic rats and the relevant mechanisms. Methods (1) Twenty-five Wistar rats were divided into non-diabetes (N), diabetes and sham treatment (DS), metformin (M), S, and combined treatment (CT) groups according to the random number table, with 5 rats in each group. Rats in group N were injected with sodium citrate buffer solution, while rats in the other 4 groups were injected with 10 mg/mL streptozotocin to induce diabetes. In post injection week (PIW) 3, feet of rats in all the 5 groups received an ice-cold stimulation to induce peripheral circulatory disorders. From PIW 9 to 12, rats in groups N and DS were gavaged with saline and applied with sesame oil on pelma of both hind limbs; rats in group M were gavaged with diluted M and applied with sesame oil on pelma of both hind limbs; rats in group S were gavaged with saline and applied with S on pelma of both hind limbs; rats in group CT were gavaged with diluted M and applied with S on pelma of both hind limbs. In PIW 9 before treatment (hereinafter referred to as before treatment) and post treatment week (PTW) 1, 2, and 3, plantar temperature and hot pain threshold of rats were detected by infrared thermometer and foot tester respectively. (2) Another 25 rats were divided and induced with diabetes (expect for group N) as above. In PIW 9, rats in the 5 groups were inflicted with foot ulcer in the left pelma of hind limb by steam and received the corresponding treatment. On post treatment day (PTD) 3, 7, 21, and 35, the general condition and area of wounds were observed and measured respectively. All the rats were sacrificed on PTD 35, and wound tissue was collected for histomorphological observation and determination of expressions of cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) using HE staining and immunohistochemical staining respectively. Data were processed with analysis of variance for repeated measurement, one-way analysis of variance, and Bonferroni post hoc test. Results (1) The experiment of peripheral circulatory disorders in diabetes. Compared with the plantar temperature of rats in group N, except for that in group CT in PTW 2 and groups M, S, and CT in PTW 3 (with t values from 0.258 to 2.647, P values above 0.05), the plantar temperature of rats with diabetes in the 4 groups at each time point was lowered significantly (with t values from 2.811 to 6.066, P values below 0.05). Compared with the plantar temperature of rats in group DS, except for that in group CT in PTW 2 and 3 significantly increased (with t values respectively 3.419 and 2.863, P values below 0.05), the plantar temperature of rats in groups M, S, and CT showed no significant difference at each time point (with t values from 0.128 to 1.654, P values above 0.05). The plantar hot pain threshold of rats was significantly decreased in group N than in the other 4 groups before treatment and group S in PTW 1 (with t values from 2.836 to 4.456, P values below 0.05). The plantar hot pain thresholds of rats in groups M, S, and CT were close to the hot pain threshold in group DS (with t values from 0.312 to 1.611, P values above 0.05). (2) The experiment of diabetic foot ulcers. Edema existed in all the wounds of rats on PTD 3. The wound areas of all the rats continued to increase with swelling and scar formation on PTD 7. On PTD 21, the scar of rats in groups N, S, and CT fell off; the wounds of rats in group DS were still swollen; scar of rats did not fall off with dark red in the skin around the wound in group M. On PTD 35, wounds of rats in groups N, S, and CT were nearly healed; while wounds of rats in groups DS and M were still swollen and the scar around the wound failed to fall off. On PTD 3 and 7, the wound areas of rats with diabetes in the 4 groups were close to those in group N (with t values from 0.111 to 1.476, P values above 0.05). On PTD 21, the wound area of rats in group DS was significantly larger than that in group N (t=5.502, P<0.01), while the wound areas of rats with diabetes in the other 3 groups were close to the area in group N (with t values from 0.544 to 1.676, P values above 0.05). On PTD 21, the wound area of rats in group M was close to that in group DS (t=1.895, P>0.05), while the wound areas of rats in groups S and CT were significantly smaller than the area in group DS (with t values respectively 5.809 and 3.426, P<0.05 or P<0.01). On PTD 35, the wound areas of rats in groups DS and M were significantly larger than the area in group N (with t values respectively 8.495 and 4.108, P values below 0.01), while the wound areas of rats in groups S and CT were close to the area in group N (with t values respectively 0.291 and 2.195, P values above 0.05). On PTD 35, the wound area of rats in group M was close to that in group DS (t=0.897, P>0.05); while the wound areas of rats in groups S and CT were significantly smaller than the area in group DS (with t values respectively 6.923 and 6.583, P values below 0.01). On PTD 35, the structures of wound tissue were in better integrity with less inflammatory cells and more regularly arranged collagen fibers around the wounds of rats in groups N, S, and CT than in groups DS and M. On PTD 35, the expression levels of COX-2 and VEGF in the wounds of rats in group DS [respectively (222±89)% and (55±12)%] were close to those in group M [respectively (137±24)% and (94±36)%, with t values respectively 3.046 and 2.653, P values above 0.05]. On PTD 35, the expression level of COX-2 in the wounds of rats in group DS was significantly higher than the expression levels of COX-2 in groups N, S, and CT [respectively (100±35)%, (91±42)%, and (109±17)%, with t values from 4.039 to 4.653, P values below 0.01], while the expression level of VEGF in the wounds of rats in group DS was significantly lower than the expression levels of VEGF in groups N, S, and CT [respectively (100±28)%, (143±12)%, and (120±13)%, with t values from 3.363 to 5.905, P<0.05 or P<0.01]. Conclusions S can improve the plantar temperature decrease and pain dysesthesia of rats caused by diabetic peripheral circulatory disorders. It also can promote wound healing of diabetic foot ulcers in rats with down-regulation of COX-2 and up-regulation of VEGF.

Prevalence of deep venous thrombosis in burn patients and its influencing factors

Gao Fengying, Xi Yaofeng, Zheng Mingxia, Qiao Fen

2016, 32(3): 176-180. doi: 10.3760/cma.j.issn.1009-2587.2016.03.010

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Abstract:
Objective To investigate the prevalence of deep venous thrombosis (DVT) in burn patients, and to explore its influencing factors. Methods Clinical data of 2 506 burn patients admitted to our ward from January 2009 to January 2014, conforming to the study criteria, were retrospectively analyzed. Patients were divided into DVT group (n=26) and non-DVT group (n=2 480) according to whether or not DVT occurred during hospitalization. The incidence of DVT was calculated. The diagnosis time and type of DVT were recorded. The data of gender, age, depth of burn, total burn area, location of injury, cause of injury, infection of wound, venous transfusion of fluid (hypertonic solution and blood), location of intravenous catheterization, skin grafting, timing of first skin grafting after injury, D-dimer, bedridden duration after injury among patients between two groups were compared with chi-square test and Wilcoxon test. Indexes with statistically significant differences between two groups were selected, and they were processed with multivariate logistic stepwise regression analysis to screen the independent risk factors of DVT. Results (1) The incidence of DVT was 1.04% (26/2 506). The diagnosis time of DVT was 16-62(40±12)d, and patients diagnosed as having DVT after the 20th day post injury accounted for 92.3% (24/26). All DVT occurred in lower limbs, with 1 case of central type, 24 cases of peripheral type, and 1 case of mixed type. (2) There were no statistically significant differences in gender, location of injury (upper limbs, trunk, head and face), cause of injury, jugular vein catheterization, skin grafting, and timing of first skin grafting after injury among patients between two groups (with χ² values from 1.853 to 3.742, Z=3.342, P values above 0.05). There were statistically significant differences in age, depth of burn, total burn area, burn in lower limbs, infection of wound, venous transfusion of hypertonic solution and blood, femoral vein and subclavian vein catheterization, D-dimer, and bedridden duration after injury among patients between two groups (with χ² values from 4.569 to 11.324, Z values respectively 7.357 and 7.012, P<0.05 or P<0.01). (3) Age, total burn area, burn in lower limbs, infection of wound, and D-dimer were the independent risk factors of DVT (with odds ratio respectively 2.904, 2.655, 3.574, 2.786, 3.142, 95% confidence interval respectively 1.504-7.652, 1.368-6.594, 1.958-8.511, 1.459-7.001, 1.922-8.062, P values below 0.05). Conclusions The incidence of DVT in burn patients is relatively low; it is diagnosed after the 20th day post injury in most patients, and the overwhelming majority is the peripheral type. Age, total burn area, burn in lower limbs, infection of wound, and D-dimer are the independent risk factors of DVT in burn patients, with which its occurrence could be predicted.

2016 Vol. 32, No. 3

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