中华烧伤与创面修复杂志

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The emergence and spread of carbapenems–resistant Klebsiella pneumoniae (CRKP) in burn ward is an important threat to burn management. CRKP isolates are resistant to almost all available antibiotics and are susceptible only to polymyxins and tigecycline. The mechanism of the drug resistance of CRKP is associated with the plasmid–encoded carbapenemase Klebsiella pneumoniae carbapenemase (KPC), a carbapenem–hydrolyzing β–lactamase. Antibiotics which can currently be used to treat CRKP infection include polymyxins, tigecycline, and some aminoglycosides. The efficacy of using antibiotics in combination is better than that of single–agent therapy for the treatment of CRKP infection in bloodstream. In order to control CRKP infection in burn patients, strategies for preventing CRKP dissemination in burn ward are strongly advocated.

To further enhance the comprehensive prevention and treatment of burn infection

Xu Qinglian, Fang Linsen

2015, 31(1): 9-10. doi: 10.3760/cma.j.issn.1009-2587.2015.01.003

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Comprehensive prevention and treatment of burn infection should be further enhanced, as monotonous treatment is prone to fail to get satisfying curative effects. In the articles to be published in this issue, causative factors for burn infection are analyzed in depth and discussed from different angles, and they will lay the foundation for the comprehensive prevention and treatment of burn infection.

Role of non–receptor tyrosine kinase Tec in the production of pro–inflammatory cytokines from macrophages induced by endotoxin/lipopolysaccharide

Wang Chao, Wang Fei, Zhou Bo, Qiu Le, Wang Jian, Liu Sheng, Chen Xulin

2015, 31(1): 11-15. doi: 10.3760/cma.j.issn.1009-2587.2015.01.004

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Objective To investigate the role of non–receptor tyrosine kinase Tec in the production of TNF–α and IL–1β from macrophages induced by LPS and its related mechanism. Methods RAW264.7 mononuclear–macrophages cultured in 6–well plates were divided into 4 groups according to the random number table, with 24 wells in each group. Cells in blank group were routinely cultured (cultured with DMEM medium containing 10% FBS) for 2 hours. Cells in LFM–A13 group were pretreated with 75 μmol/L Tec specific inhibitor LFM–A13 for 1 hour and then routinely cultured for 1 hour. Cells in LPS group were routinely cultured for 1 hour and then treated with 0.1 μg/mL LPS for 1 hour. Cells in LPS+ LFM–A13 group were pretreated with 75 μmol/L LFM–A13 for 1 hour and then treated with 0.1 μg/mL LPS for 1 hour. The content of TNF–α and IL–1β in culture supernatant of cells was determined with ELISA. The mRNA expressions of TNF–α and IL–1β in cells were assayed with real–time fluorescent quantitative RT–PCR. The activity of intracellular Tec, p38 MAPK, and transforming growth factor activated kinase 1 (TAK1) was determined with Western blotting. Data were processed with one–way analysis of variance and LSD test. Results The content of TNF–α and IL–1β in culture supernatant of cells in LFM–A13 group was close to that in blank group (with P values above 0.05). The mRNA expressions of TNF–α and IL–1β in the cells of LFM–A13 group were close to those of blank group (with P values above 0.05). The content of TNF–α and IL–1β in culture supernatant of cells in LPS group was respectively (1 213±154) and (636±90) pg/mL, which was higher than that in blank group [(330±44) and (211±31) pg/mL, with P values below 0.01]. The mRNA expressions of TNF–α and IL–1β in the cells of LPS group were respectively 1.57±0.22 and 1.44±0.24, which were significantly higher than those of blank group (1.00±0.18 and 1.00±0.19, with P values below 0.01). The content of TNF–α and IL–1β in culture supernatant of cells in LPS+ LFM–A13 group was respectively (787±109) and (453±64) pg/mL, which was significantly lower than that in LPS group (with P values below 0.05). The mRNA expressions of TNF–α and IL–1β in the cells of LPS+ LFM–A13 group were respectively 1.21±0.15 and 1.21±0.22, and they were significantly lower than those of LPS group (with P values below 0.05). The activity of intracellular Tec, TAK1, and p38 MAPK of cells in LPS+ LFM–A13 group was close to that in blank group (with P values above 0.05). The activity of intracellular Tec, TAK1, and p38 MAPK of cells in LPS group was respectively 2.69±0.41, 3.99±0.65, and 2.07±0.31, which was significantly higher than that in blank group (1.00±0.17, 1.00±0.16, and 1.00±0.18, with P values below 0.01) and LPS+ LFM–A13 group (1.02±0.17, 1.18±0.20, and 1.58±0.28, P<0.05 or P<0.01). Conclusions Tec promotes the production and release of pro–inflammatory cytokines TNF–α and IL–1β from macrophages induced by LPS via TAK1–p38 MAPK signaling pathway.

Effects of docosahexaenoic acid on inflammation–associated cytokines in blood and pulmonary tissue of rats with severe scald injury

Zhang Jie, Xia Zhengguo, Li Xingzhao, Cai Chen, Xu Qinglian

2015, 31(1): 16-20. doi: 10.3760/cma.j.issn.1009-2587.2015.01.005

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Objective To observe the effects of docosahexaenoic acid (DHA) on the expressions of TNF–α, IL–6, and leukotriene B₄ (LTB₄) in serum and expression of NF–κB in pulmonary tissue of rats with severe scald injury. Methods One hundred and sixty SD rats were divided into sham injury (A), sham injury+ DHA (B), scald (C), and scald+ DHA (D) groups according to the random number table, with 40 rats in each group. Rats in groups A and B were sham injured, while rats in groups C and D were inflicted with 30% TBSA full–thickness scald on the back. Rats in groups B and D were injected with 0.5 mg/mL DHA solution with the dosage of 1 mL/kg via tail vein 5 minutes post injury, while rats in groups A and C with normal saline solution 1 mL/kg. At post injury hour (PIH) 3, 6, 12, 24, and 48, pulmonary tissue and abdominal aorta blood were collected from 8 rats in each group. The serum levels of TNF–α, IL–6, and LTB₄ were determined with ELISA, and the protein expression of NF–κB p65 in pulmonary tissue was determined with Western blotting. Data were processed with analysis of variance of factorial design and LSD–t test. Results (1) The serum levels of TNF–α and IL–6 of rats in group A were similar to those of group B at each time point (with t_TNF–α values from 0.223 to 0.947, t_IL–6 values from 0.767 to 2.084, P values above 0.05). Compared with those of group A, the serum levels of TNF–α and IL–6 of rats in groups C and D were significantly higher at each time point (with t_TNF–α values from 11.800 to 40.357, t_IL–6 values from 10.334 to 39.321, P values below 0.01). The serum levels of TNF–α and IL–6 of rats in group D were significantly lower than those of group C at each time point (with t_TNF–α values from –17.643 to –8.331, t_IL–6 values from –21.596 to –6.332, P values below 0.01). The serum levels of TNF–α and IL–6 in groups C and D both showed a trend of increase earlier and decrease later, and they peaked at PIH 12, respectively (360.4±13.2), (306.8±7.2) pg/mL and (265.4±12.3), (230.5±2.2) pg/mL. (2) The serum level of LTB₄ in group A was similar to that of group B at each time point (with t values from 0.787 to 1.096, P values above 0.05). The serum level of LTB₄ was significantly higher in groups C and D than in group A at each time point (with t values from 7.501 to 38.962, P values below 0.01). The serum level of LTB₄ in group D was obviously lower than that of group C at each time point (with t values from –19.244 to –2.532, P values below 0.01). The serum level of LTB₄ in groups C and D both showed a trend of increase earlier and decrease later, and it peaked at PIH 12, (4.59±0.29) and (2.85±0.32) ng/mL respectively. (3) The protein expression of NF–κB p65 in pulmonary tissue in group A was similar to that of group B at each time point (with t values from 0.847 to 1.256, P values above 0.05). The protein expression of NF–κB p65 was significantly higher in groups C and D than in group A at each time point (with t values from 15.167 to 98.074, P values below 0.01). The protein expression of NF–κB p65 in group D was obviously lower than that of group C at each time point (with t values from –37.190 to –14.415, P values below 0.01). The protein expression of NF–κB p65 in groups C and D both showed a trend of increase earlier and decrease later, and it peaked at PIH 12, respectively 4.46±0.12 and 2.94±0.21. Conclusions Parenteral supply of DHA to rats with severe scald injury can reduce the levels of TNF–α, IL–6, and LTB₄ in serum and decrease the expression of NF–κB in pulmonary tissue, thus alleviating the inflammation response.

Drug resistance and status of infection of Acinetobacter baumannii in burn intensive care unit during 3 years

Chen Bin, Li Xiaojian, Zhang Zhi, Zhang Xuhui, Deng Zhongyuan, Zhong Xiaomin, Tang Wenbin, Liu Changling, Cao Wenjuan

2015, 31(1): 21-24. doi: 10.3760/cma.j.issn.1009-2587.2015.01.006

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Objective To analyze the detection, drug resistance, and status of infection of Acinetobacter baumannii (AB) in burn ICU during 3 years. Methods A total of 2 010 specimens of wound secretion, blood, venous catheter attachment, sputum, stool and urine were collected from 505 burn patients hospitalized in our burn ICU from January 2011 to December 2013, and bacterial culture was performed. Pathogens were identified by automatic microorganism identifying and drug sensitivity analyzer. Drug resistance of all the obtained AB to 16 antibiotics commonly used in clinic, including cefoperazone/sulbactam, polymyxin, etc., was tested with K–B paper disk diffusion method. Patients with AB infection were ascertained. The WHONET 5.6 software was used to analyze the distribution of pathogens during 3 years, the isolation of AB with different sources and the status of drug resistance of AB to 16 antibiotics each year, and the status of patients with AB infection, and their outcome. Results A total of 961 strains of pathogens were isolated, among which 185 (19.25%) strains were Gram positive cocci, 728 (75.75%) strains were Gram negative bacilli, and 48 (4.99%) strains were fungi. A total of 172 strains of AB were isolated, ranking the second place among all the detected pathogens, with 67 (38.95%) strains from wound secretion, 11 (6.40%) strains from blood, 23 (13.37%) strains from venous catheter attachment, and 71 (41.28%) strains from sputum, no AB strain was isolated from feces or urine. The AB strains were found sensitive to polymyxin and with relatively low drug resistance rate to minocycline, while the drug resistance rates were over 80.0% to the other 14 antibiotics commonly used in clinic in 2013. AB culture of wound secretion was positive in 27 patients. Among them, 7 patients suffered from wound infection, and the wound infection was caused by AB in 1 out of the 7 patients. AB culture of blood was positive in 7 patients. Among them, 3 patients suffered from bloodstream infection, and the infection was due to AB invasion in 1 out of the 3 patients. AB culture of venous catheter attachment was positive in 20 patients. Among them, 8 patients suffered from bloodstream infection, and the infection was due to AB invasion in 1 out of the 8 patients. AB culture of sputum was positive in 35 patients. Among them, 13 patients suffered from ventilatory associated pneumonia, and 2 out of the 13 patients were diagnosed as AB infection. A total of 69 patients were AB culture positive, among them 64 patients were cured, 2 patients were transferred to other hospitals, and 3 patients died, with the mortality rate of 4.35%. Conclusions AB in our burn ICU has a high detection rate and extensive drug resistance in above–mentioned 3 years. However, AB was mainly colonized in patients with extensive burns with a low mortality rate.

Effects of early oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury

Sun Kedai, Dong Zhiwei, Chen Jing, Liu Pan, Gong Yali, Peng Yizhi

2015, 31(1): 25-29. doi: 10.3760/cma.j.issn.1009-2587.2015.01.007

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Objective To explore the effects of oral administration of mixed enteral nutritional agent on intestinal mucosal barrier of patients with severe burn injury at early stage. Methods Twenty–four patients with severe burn injury admitted to our burn ward from August 2013 to September 2014, conforming to the study criteria, were divided into conventional therapy group (n=12) and early enteral feeding group (n=12) according to the random number table. Patients in conventional therapy group received conventional treatment immediately after admission, while those in early enteral feeding group were orally given 100 mL of a mixture of glutamine, probiotics, and prebiotics once a day besides conventional treatment for 7 days. Serum levels of diamine oxidase (DAO) and procalcitonin (PCT) and plasma level of LPS were determined by ELISA before treatment and on treatment day (TD) 1, 3, 7, 14, and 21. Wound secretion and blood samples were collected for bacterial culture within the 21 TD. The incidence of MODS within the 21 TD was observed. Data were processed with Fisher′s exact test, rank sum test, analysis of variance for repeated measurement, and LSD–t test. Results (1) Serum levels of DAO in patients of early enteral feeding group on TD 7, 14, and 21 were respectively (14.9±3.7), (12.4±3.1), and (9.5±0.7) ng/mL, which were significantly lower than those of conventional therapy group [(17.5±4.0), (16.3±3.3), and (13.0±1.1) ng/mL, with t values from 2.913 to 15.304, P values below 0.01]. Serum levels of DAO at the other time points were close between the two groups (with t values from –0.598 to 0.139, P values above 0.05). (2) Compared with serum levels of PCT in patients of conventional therapy group [(11.7±20.9) and (12.9±23.9) ng/mL], those of early enteral feeding group were significantly lower on TD 7 and 14 [(2.7±8.1) and (2.0±5.6) ng/mL, with Z values respectively –2.919 and –2.139, P<0.05 or P<0.01]. Serum levels of PCT at the other time points were close between the two groups (with Z values from –1.833 to –0.346, P values above 0.05). (3) Plasma level of LPS in patients of early enteral feeding group on TD 7 was (33±56) pg/mL, which was significantly lower than that of conventional therapy group [(102±108) pg/mL, Z=–2.046, P<0.05]. Plasma levels of LPS at the other time points between the two groups showed no significant difference (with Z values from –2.003~–0.526, P values above 0.05). (4) Positive results in bacterial culture of wound secretion were approximately the same between the two groups (P>0.05). Bacterial culture of blood was positive in 7 patients of conventional therapy group and 1 patient of early enteral feeding group, showing significantly statistical difference (P<0.05). MODS was observed in 1 patient of conventional therapy group, showing no significantly statistical difference with that of early enteral feeding group (no patient, P>0.05). Conclusions Early intestinal feeding of mixed enteral nutritional agent in addition to conventional therapy can effectively promote repair of the impairment of intestinal mucosal barrier, protect integrity of intestinal mucosa, reduce damage to intestines, and alleviate inflammatory response in patients suffering from severe burn injury.

Effects of astragalus polysaccharide on intestinal immune function of rats with severe scald injury

Huang Cuilan, Zhan Jianhua, Luo Jinhua

2015, 31(1): 30-36. doi: 10.3760/cma.j.issn.1009-2587.2015.01.008

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Objective To observe the effects of astragalus polysaccharide (AP) on the intestinal mucosal morphology, level of secretory IgA (s–IgA) in intestinal mucus, and distribution of T lymphocyte subsets in Peyer′s patch in rats with severe scald injury. Methods One hundred and thirty SD rats were divided into sham injury group (SI, sham injured, n=10), scald group (S, n=30), low dosage group (LD, n=30), moderate dosage group (MD, n=30), and high dosage group (HD, n=30) according to the random number table. Rats in the latter 4 groups were inflicted with 30% TBSA full–thickness scald on the back. From post injury hour 2, rats in groups LD, MD, and HD were intraperitoneally injected with 0.5 mL AP solution with the dosage of 100, 200, and 300 mg/kg each day respectively, and rats in group S were injected with 0.5 mL normal saline instead. Ten rats from group SI immediately after injury and 10 rats from each of the latter 4 groups on post injury day (PID) 3, 7, 14 were sacrificed, and their intestines were harvested. The morphology of ileal mucosa was examined after HE staining; the level of s–IgA in ileal mucus was determined with double–antibody sandwich ELISA method; the proportions of CD3⁺, CD4⁺, CD8⁺ T lymphocytes in Peyer′s patches of intestine were determined with flow cytometer, and the proportion of CD4⁺ to CD8⁺ was calculated. Data were processed with one–way analysis of variance, analysis of variance of factorial design, and SNK test. Results (1) Villi in normal form and intact villus epithelial cells were observed in rats of group SI immediately after injury, while edema of villi and necrosis and desquamation of an enormous amount of villi were observed in groups with scalded rats on PID 3, with significant infiltration of inflammatory cells. On PID 7, no obvious improvement in intestinal mucosal lesion was observed in groups with scalded rats. On PID 14, the pathology in intestinal mucosa of rats remained nearly the same in group S, and it was alleviated obviously in groups LD and MD, and the morphology of intestinal mucosa of rats in group HD was recovered to that of group SI. (2) On PID 3, 7, and 14, the level of s–IgA in intestinal mucus significantly decreased in groups S, LD, MD, and HD [(43±5), (45±5), (46±5) μg/mL; (47±5), (48±5), (49±6) μg/mL; (50±6), (51±5), (52±5) μg/mL; (53±6), (54±5), (55±5) μg/mL] as compared with that of rats in group SI immediately after injury [(69±4) μg/mL, with P values below 0.05]. The level of s–IgA in intestinal mucus of rats in group MD was significantly higher than that in group S at each time point (with P values below 0.05), and that of group HD was significantly higher than that in groups S and LD at each time point (with P values below 0.05). (3) Compared with those of rats in group SI immediately after injury, the proportions of CD3⁺ T lymphocytes and CD4⁺ T lymphocytes significantly decreased in groups with scalded rats at each time point (with P values below 0.05), except for those in group HD on PID 14. The proportion of CD4⁺ T lymphocytes of rats in group LD was significantly higher than that in group S on PID 3 (P<0.05). The proportions of CD3⁺ T lymphocytes and CD4⁺ T lymphocytes were significantly higher in groups MD and HD than in groups S and LD (except for the proportion of CD4⁺ T lymphocytes in group MD on PID 3 and 14) at each time point (with P values below 0.05). The proportion of CD3⁺ T lymphocytes on PID 7 and 14 and that of CD4⁺ T lymphocytes on PID 3 were significantly higher in group HD than in group MD (with P values below 0.05). Compared with that of rats in group SI immediately after injury, the proportion of CD8⁺ T lymphocytes significantly increased in the other 4 groups at each time point (with P values below 0.05). The proportion of CD8⁺ T lymphocytes was significantly lower in rats of group LD on PID 7 and 14 and groups MD and HD at each time point than in group S (with P values below 0.05). The proportion of CD8⁺ T lymphocytes was significantly lower in rats of group MD on PID 7 and 14 and group HD at each time point than in group LD (with P values below 0.05). The proportion of CD8⁺ T lymphocytes was significantly lower in rats of group HD on PID 7 and 14 than in group MD (with P values below 0.05). On PID 3, 7, and 14, the proportion of CD4⁺ to CD8⁺ was significantly lower in groups S, LD, MD, and HD (0.65±0.11, 0.68±0.13, 0.73±0.22; 0.76±0.15, 0.78±0.14, 0.90±0.10; 0.85±0.21, 0.89±0.18, 1.08±0.19; 0.99±0.20, 1.05±0.21, 1.25±0.23) as compared with that of rats in group SI immediately after injury (1.74±0.20, with P values below 0.05). The proportion of CD4⁺ to CD8⁺ was significantly higher in rats of group HD than in group MD on PID 7 (P<0.05), and the proportion was significantly higher in these two groups than in group S at each time point (with P values below 0.05). The proportion of CD4⁺ to CD8⁺ was significantly higher in rats of group MD on PID 14 and group HD at each time point than in group LD (with P values below 0.05). Compared within each group, the proportions of CD3⁺, CD4⁺, CD8⁺ T lymphocytes and the proportion of CD4⁺ to CD8⁺ of rats in groups LD, MD, and HD showed a trend of gradual elevation along with passage of time. Conclusions AP can improve the injury to intestinal mucosa and modulate the balance of T lymphocyte subsets in Peyer′s patch in a time– and dose–dependent manner, and it can promote s–IgA secretion of intestinal mucosa in a dose–dependent manner.

Influence of hydrogen sulfide on the intestinal biological barrier of rats with severe burn injury

Li Yi, Wang Hongjin, Wu Xiaowei, Wang Laihong

2015, 31(1): 37-41. doi: 10.3760/cma.j.issn.1009-2587.2015.01.009

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Objective To explore the influence of hydrogen sulfide on the intestinal biological barrier, by applying exogenous hydrogen sulfide and hydrogen sulfide synthase inhibitor for the treatment of rats with severe burn injury. Methods One hundred and four SD rats were divided into sham injury (SI, n=8), burn control (BC, n=32), sodium hydrosulfide (SH, n=32), and propargylglycine groups (PPG, n=32) according to the random number table. Rats in group SI were sham injured without fluid resuscitation. Rats in the latter 3 groups were inflicted with 30% TBSA full–thickness scald (referred to as burn below) on the back and intraperitoneally injected with 40 mL/kg balanced salt solution immediately after injury. Rats in groups SH and PPG were respectively intraperitoneally injected with SH (56 μmol/kg) and PPG (45 mg/kg) within 1 hour post injury. From post injury day (PID) 2, SH (56 μmol/kg) and PPG (45 mg/kg) were respectively intraperitoneally injected once a day to rats in groups SH and PPG. Eight rats from groups BC, SH, and PPG were sacrificed on PID 2, 7, 14 and 21, and ceca samples were collected. Ceca samples were added to the appropriate culture medium after being homogenized and diluted, for the culture of Bifidobacterium, Lactobacillus, Enterococcus, Enterobacter, and Candida albicans. The content of bacteria was calculated after the bacteria number was counted. The same procedure was performed for rats in group SI. Data were processed with logarithmic function, one–way analysis of variance, analysis of variance of factorial design, and SNK–q test. Results On each PID, the content of Bifidobacterium and Lactobacillus in the ceca of each group with burned rats was less than that of group SI (with q values from 4.12 to 20.74, P values below 0.05); while the content of Enterococcus, Enterobacter, and Candida albicans was more than that of group SI (with q values from 2.84 to 68.29, P values below 0.05). Compared with that of group BC, the content of Bifidobacterium and Lactobacillus in the ceca of rats in group SH were increased on each PID (with q values from 2.88 to 17.57, P values below 0.05). In group SH, the content of Bifidobacterium peaked as (6.54±0.35) lg (CFU/g) on PID 7, the content of Lactobacillus peaked as (7.25±0.71) lg (CFU/g) on PID 21. Compared with that of group BC, the content of Enterococcus, Enterobacter, and Candida albicans in the ceca of rats in group SH was reduced on each PID (with q values from 2.79 to 29.59, P values below 0.05). Compared with that of group BC, the content of Bifidobacterium and Lactobacillus in the ceca of rats in group PPG was decreased on each PID (with q values from 2.82 to 46.56, P values below 0.05); while the content of Enterococcus, Enterobacter, and Candida albicans was significantly increased on each PID (with q values from 2.93 to 41.42, P values below 0.05). In group PPG, the content of Enterococcus peaked as (9.41±0.22) lg (CFU/g) on PID 21, the content of Enterobacter peaked as (9.96±0.24) lg (CFU/g) on PID 14, and that of Candida albicans peaked as (3.94±0.84) lg (CFU/g) on PID 14. Conclusions Exogenous hydrogen sulfide can subdue the growth of pathogenic bacteria while promote that of probiotics, thus helping maintain the integrity of intestinal biological barrier of rats with burn injury.

Influence of poly–β–1–6–N–acetylglucosamine on biofilm formation and drug resistance of Acinetobacter baumannii

Guo Haina, Xiang Jun

2015, 31(1): 45-47. doi: 10.3760/cma.j.issn.1009-2587.2015.01.011

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Acinetobacter baumannii has emerged as one of the leading bacteria for nosocomial infections, especially in burn wards and ICUs. The bacteria can easily form biofilm and readily attach to abiotic and biotic surfaces, resulting in persistent biofilm–mediated infections. Being surrounded by self–produced extracellular polymeric substance (EPS), the microorganisms in biofilm can acquire protective property against detrimental environment and their tolerance toward antibiotics is increased. Poly–β–1–6–N–acetylglucosamine (PNAG), the common constituent of EPS in Acinetobacter baumannii, acts as the key virulence factor and plays a crucial role in biofilm formation process. This review describes the properties and functions of the PNAG and its influence on biofilm formation and drug resistance of Acinetobacter baumannii.

Application of patient–controlled intravenous analgesia of dezocine combined with sufentanil in burn patients after surgery

Li Shangkun, Min Su, Wu Bin, Tang Wanbi

2015, 31(1): 48-51. doi: 10.3760/cma.j.issn.1009-2587.2015.01.012

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Objective To evaluate the efficacy and safety of patient–controlled intravenous analgesia (PCIA) of dezocine combined with sufentanil in burn patients after escharectomy or tangential excision followed by autologous skin grafting. Methods Sixty burn patients hospitalized in Department of Burns and Plastic Surgery of our hospital from February 2011 to December 2013, conforming to the study criteria and going to have escharectomy or tangential excision followed by autologous skin grafting, were divided into sufentanil group (S, n=30) and dezocine+ sufentanil group (DS, n=30) according to the random number table. Patients in group S were given 150 mL normal saline containing 2.5 μg/kg sufentanil citrate and 6 mg tropisetron after skin grafting for 48 hours. Patients in group DS were given 150 mL normal saline containing 0.25 mg/kg dezocine, 1.5 μg/kg sufentanil citrate, and 6 mg tropisetron for 48 hours. Visual Analog Scale (VAS), Bruggrmann Comfort Scale (BCS), and Ramsay Sedation Scale were used to evaluate the sedative effect or analgesic effect, and their scores were recorded at administration hour (AH) 2, 6, 12, 24, and 48. The times of efficient injection and incidence of adverse effect within the 48 AH were recorded. Data were processed with analysis of variance for repeated measurement, t test, chi–square test, and Fisher′s exact test. Results There were no obvious differences in the scores of VAS and BCS between two groups at each time point (with t values from –0.426 to 0.864, P values above 0.05). The scores of Ramsay Sedation Scale in group S at AH 2, 6, 12, 24, and 48 were respectively (3.2±0.6), (3.2±0.5), (3.3±0.7), (3.2±0.4), and (3.3±0.4) points, which were higher than those in group DS [(2.4±0.6), (2.5±0.5), (2.4±0.6), (2.4±0.4), and (2.4±0.5) points, with t values from 5.302 to 8.391, P values below 0.001]. The times of efficient injection within the 48 AH was 6.8±0.7 in group S and 6.5±0.9 in group DS, showing no significantly statistical difference (t=1.260, P>0.05). Respiratory depression was not observed in both groups; the incidence of pruritus was the same, and that of urine retention was similar between the 2 groups within the 48 AH (with P values above 0.05). Within the 48 AH, the incidence of nausea and vomiting in group S was 26.7% (8/30), which was obviously higher than that in group DS (6.7%, 2/30, P<0.05); the incidence of drowsiness in group S was 20.0% (6/30), which was significantly higher than that in group DS (no patient, P<0.05). Conclusions Dezocine combined with sufentanil can provide effective postoperative analgesia with little adverse effect for PCIA in burn patients after escharectomy or tangential excision followed by autologous skin grafting, therefore it can be widely used.

Advances in the research of clinical features and treatment of ammonia burns

Wu Guosheng, Xiao Shichu, Sun Yu, Ji Shizhao, Xia Zhaofan

2015, 31(1): 76-78. doi: 10.3760/cma.j.issn.1009-2587.2015.01.023

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Ammonia is commonly used in industry and agriculture. It is also one of the most frequently accidentally spilled chemicals. Exposure to ammonia can cause severe cutaneous burn or freezing injury, ocular injury, and inhalation injury, among them inhalation injury is the most lethal one. Although the diagnosis and treatment of ammonia burns have been improved, the long–term prognosis is not satisfactory. In this article, we reviewed the literature concerning ammonia burns, in order to summarize the clinical features and treatment of such injury.

2015 Vol. 31, No. 1

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