中华烧伤与创面修复杂志

Discipline construction is the theme of the development of burn surgery

Jia Chiyu

2018, 34(3): 129-131. doi: 10.3760/cma.j.issn.1009-2587.2018.03.001

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Discipline construction is the core element of department development, including discipline structure setting, scale, equipment, medical workers structure, clinical feature and advantage, talent training, teaching level, scientific research level, management system, and cultural construction of department. As leader and engine of discipline construction, directors′ ability is an important factor for discipline construction. Clinical characteristic is the basis of discipline construction; innovation actuation is the essence of discipline construction; talents training is the guarantee of discipline construction; scientific research is the wing of discipline construction; cultural construction is the hot spring of discipline construction. Discipline construction is the theme of the development of burn surgery.

Talking about the discipline construction and development of burn from five ideas

Guo Guanghua

2018, 34(3): 132-135. doi: 10.3760/cma.j.issn.1009-2587.2018.03.002

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Discipline construction is an important aspect of hospital modernization management and construction. The level of medical treatment, education, and scientific research could be assured and improved through discipline construction, which could speed up the talent training, promote science and technology innovation, and realize the sustainable development of hospital. At present, most of the hospital management models adopt the two ranks of the hospital and department. The manager of a department must grasp medical treatment, education, scientific research, and discipline construction steadily. The author talks about the discipline construction and development of burn from " five ideas" for the readers.

Practice and thinking about the establishment and management of burn intensive care unit

Li Xiaojian

2018, 34(3): 136-139. doi: 10.3760/cma.j.issn.1009-2587.2018.03.003

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The treatment of critically burned patients has benefited from the development of knowledge and technologies that we got in critical care medicine of our country in the past ten years. The close-ended management model of general intensive care unit (ICU) and the idea of general ICU doctors who treat the monitoring of organ function and alternative therapy of organs as their primary tasks would affect the treatments for special critical patients hospitalized in general ICU, especially for those patients who were severely burned. If the burn wounds of patients are not treated timely, properly or in effective manner, the final treatment outcome would be affected. Therefore, the establishment of burn ICU is necessary. The development and close-ended management of burn specialty ICU has significantly improved the success rates, reduced complications, shortened hospitalization time, and increased the quality of wound healing of severe burn patients in the past more than 10 years in our unit. With the reducing of burn, especially severe burn accidents, the construction of regional burn center and burn specialty ICU locating in burn center is necessary. It can not only reduce the waste of medical resource, but also ensure timely and professional treatments for the patients in sudden fire accidents. At present, there is no consensus on the establishment and management model of burn specialty ICU, and further discussion is needed in practice.

Innovation drive is the original motive force of discipline construction: the developing road of Department of Burns and Plastic Surgery in the 309th Hospital of PLA

Jia Chiyu

2018, 34(3): 140-142. doi: 10.3760/cma.j.issn.1009-2587.2018.03.004

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Discipline construction is a systematic project, covering clinic, teaching, scientific research, management, and humanity. Based on the perspective of innovation drive, from the aspects of discipline structure setting, specialized laboratory construction, sub-specialty formation, clinical characteristic and advantage formation, and management concept update, this article summarizes the growth process of Department of Burns and Plastic Surgery in the 309th Hospital of PLA.

Influence of three-level collaboration network of pediatric burns treatment in Anhui province on treatment effects of burn children

Xia Zhengguo, Zhou Xianliang, Kong Weichang, Li Xingzhao, Song Junhui, Fang Linsen, Hu Delin, Cai Chen, Tang Yizhong, Yu Youxin, Wang Chunhua, Xu Qinglian

2018, 34(3): 143-148. doi: 10.3760/cma.j.issn.1009-2587.2018.03.005

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Objective To explore the influence of three-level collaboration network of pediatric burns in Anhui province on treatment effects of burn children. Methods The data of medical records of pediatric burn children transferred from Lu′an People′s Hospital and Fuyang People′s Hospital to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2015 and January 2016 to September 2017 (before and after establishing three-level collaboration network of pediatric burns treatment) were analyzed: percentage of transferred burn children to hospitalized burn children in corresponding period, gender, age, burn degree, treatment method, treatment result, occurrence and treatment result of shock, and operative and non-operative treatment time and cost. Rehabilitation result of burn children transferred back to local hospitals in 2016 and 2017. Data were processed with t test, chi-square test, Mann-Whitney U test, and Fisher′s exact test. Results (1) Percentage of burn children transferred from January 2014 to December 2015 was 34.3% (291/848) of the total number of hospitalized burn children in the same period of time, which was close to 30.4% (210/691) of burn children transferred from January 2016 to September 2017 (χ²=2.672, P>0.05). (2) Gender, age, burn degree, and treatment method of burn children transferred from the two periods of time were close (χ²=3.382, Z=-1.917, -1.911, χ²=3.133, P>0.05). (3) Cure rates of children with mild, moderate, and severe burns transferred from January 2016 to September 2017 were significantly higher than those of burn children transferred from January 2014 to December 2015 (χ²=11.777, 6.948, 4.310, P<0.05). Cure rates of children with extremely severe burns transferred from the two periods of time were close (χ²=1.181, P>0.05). (4) Children with mild and moderate burns transferred from the two periods of time were with no shock. The incidence of shock of children with severe burns transferred from January 2014 to December 2015 was 6.0% (4/67), and 3 children among them were cured. The incidence of shock of children with severe burns transferred from January 2016 to September 2017 was 3.9% (2/51), and both children were cured. The incidences and cures of shock of children with severe burns transferred from the two periods of time were close (χ²=0.006, P>0.05). Incidence of shock of children with extremely severe burns transferred from January 2014 to December 2015 was 57.1% (32/56), significantly higher than that of burn children transferred from January 2016 to September 2017 [34.5% (10/29), χ²=3.925, P<0.05]. Shock of 25 children with extremely severe burns transferred from January 2014 to December 2015 were cured, and shock of 9 children with extremely severe burns transferred from January 2016 to September 2017 were cured. The cures of shock of children with extremely severe burns transferred from the two periods of time were close ( χ²=0.139, P>0.05). (5) Time of operative treatment of children with moderate, severe, and extremely severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 (t=2.335, 2.065, 2.310, P<0.05). Time of operative treatment of children with mild burns transferred from the two periods of time was close (Z=-0.417, P>0.05). Costs of operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were significantly more than those of burn children transferred from January 2016 to September 2017 (Z=-3.324, t=2.167, P<0.05). Costs of operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close (t=0.627, 0.808, P>0.05). (6)Time of non-operative treatment of children with mild, moderate, and severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 (t=2.335, Z=-2.095, t=2.152, P<0.05). Time of non-operative treatment of children with extremely severe burns transferred from the two periods of time was close (t=0.450, P>0.05). Costs of non-operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were obviously higher than those of burn children transferred from January 2016 to September 2017 (Z=-2.164, t=2.040, P<0.05). Costs of non-operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close (t=0.146, 1.235, P>0.05). (7) Sixty-seven burn children transferred from January 2016 to September 2017 were transferred back to local hospitals for rehabilitation under the guidance of experts of the First Affiliated Hospital of Anhui Medical University, with 25 patients in 2016 and 42 patients in 2017. Effective rehabilitation rates of burn children transferred back to local hospitals for rehabilitation in 2016 and 2017 were both 100%. Conclusions The three-level collaboration network of pediatric burns treatment in Anhui province can effectively increase cure rate of children with mild, moderate, and severe burns, reduce incidence of shock of children with extremely severe burns, shorten time of operative treatment of burn children with moderate, severe, and extremely severe burns, and time of non-operative treatment of children with mild, moderate, and severe burns, reduce treatment costs of children with moderate and severe burns, and improve rehabilitation effectiveness of children transferred from Lu′an People′s Hospital and Fuyang People′s Hospital to the the First Affiliated Hospital of Anhui Medical University.

2018, 34(3): 142-142. doi: 10.3760/cma.j.issn.1009-2587.2018.03.101

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2018, 34(3): 149-152. doi: 10.3760/cma.j.issn.1009-2587.2018.03.006

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2018, 34(3): 151-152. doi: 10.3760/cma.j.issn.1009-2587.2018.03.007

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2018, 34(3): 171-172. doi: 10.3760/cma.j.issn.1009-2587.2018.03.011

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2018, 34(3): 173-175. doi: 10.3760/cma.j.issn.1009-2587.2018.03.012

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2018, 34(3): 175-177. doi: 10.3760/cma.j.issn.1009-2587.2018.03.013

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2018, 34(3): 186-186. doi: 10.3760/cma.j.issn.1009-2587.2018.03.102

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Analysis of distribution and drug resistance of pathogens of burn patients during 9 years

Dou Yi, Zhang Qin

2018, 34(3): 153-159. doi: 10.3760/cma.j.issn.1009-2587.2018.03.008

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Objective To investigate distribution and drug resistance of pathogens of burn patients. Methods A total of 3 357 strains were cultured and isolated from 25 286 specimens of wounds excretion, deep venous catheters, venous blood, stool, mid-stream urine, sputum, puncture fluid, and throat swab of 11 510 burn patients hospitalized in our burn wards from January 2007 to December 2015. After being identified by API bacteria identification panels and automatically bacteria identification equipment, drug-resistances of Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae to 28 common antibiotics were tested by drug sensitivity test with K-B paper disk diffusion method. The WHONET 5.6 software was used to analyze constituent ratio of gram-negative bacteria and gram-positive bacteria in each year, distribution of pathogens in each year, and drug resistance of the above-mentioned 4 pathogens in 9 years to 28 common antibiotics. Data were analyzed by the linear model curve fitting. Results (1) From 2007 to 2015, constituent ratios of gram-negative bacteria were respectively 41.22% (101/245), 41.88% (165/394), 45.92% (169/368), 42.54% (208/489), 52.35% (267/510), 56.89% (194/341), 58.99% (210/356), 56.95% (172/302), and 50.28% (177/352), with significantly increasing trend (R²=0.625, P<0.05); constituent ratios of gram-positive bacteria were respectively 58.78% (144/245), 58.12% (229/394), 54.08% (199/368), 57.46% (281/489), 47.65% (243/510), 43.11% (147/341), 41.01% (146/356), 43.05% (130/302), 49.72% (175/352), with significantly decreasing trend (R²=0.625, P<0.05). In 9 years, constituent ratio of Staphylococcus aureus ranked the first in all bacteria, and constituent ratios of Pseudomonas aeruginosa and Klebsiella pneumoniae were with significantly increasing trend (R²=0.811, 0.778, P<0.01). (2) In 9 years, drug-resistant rates of Staphylococcus aureus to gentamycin and rifampicin were with significantly decreasing trend (R²=0.727, 0.766, P<0.01); drug-resistant rates of Staphylococcus aureus to phosphonomycin were always in lower levels of 4.6% to 19.5%. In 9 years, drug-resistant rates of Pseudomonas aeruginosa to ceftazidime and ciprofloxacin had no significant change in trend (R²=0.023, <0.001, P>0.05), while drug-resistant rates of Pseudomonas aeruginosa to other 10 common antibiotics were with significantly increasing trend (R²=0.764, 0.793, 0.785, 0.768, 0.752, 0.749, 0.789, 0.786, 0.706, 0.629, P<0.01). In 9 years, drug-resistant rate of Acinetobacter baumannii to ampicillin/sulbactam was with significantly decreasing trend (R²=0.652, P<0.01), and drug-resistant rate of Acinetobacter baumannii to amikacin was with significantly increasing trend ( R²=0.531, P<0.05). In 9 years, drug-resistant rates of Klebsiella pneumoniae to piperacillin, ampicillin/sulbactam, cefuroxime, ceftazidime, cefotaxime, cefepime, imipenem, meropenem, amikacin, and gentamicin were with obviously increasing trend (R²=0.481, 0.672, 0.694, 0.532, 0.810, 0.641, 0.809, 0.709, 0.579, 0.810, P<0.05 or P<0.01). Conclusions Constituent ratios of gram-positive bacteria of Pseudomonas aeruginosa and Klebsiella pneumoniae of burn patients hospitalized in our burn wards from 2007 to 2015 were significantly increased, while constituent ratios of Staphylococcus aureus of those children always ranked the first. Drug-resistence of bacteria of those children in our burn wards was serious. Drug-resistant rate of Staphylococcus aureus only to phosphonomycin was always in lower level. Drug-resistant rates of Pseudomonas aeruginosa to 10 common antibiotics except ceftazidime and ciprofloxacin were significantly increased. Drug-resistant rate of Acinetobacter baumannii only to ampicillin/sulbactam was significantly decreased. Drug-resistant rates of Klebsiella pneumoniae to most common antibiotics were significantly increased.

Influence of WeChat platform on the compliance of continuous treatment of scar in adult burn patients

Wang Fei, Zhang Haili

2018, 34(3): 160-164. doi: 10.3760/cma.j.issn.1009-2587.2018.03.009

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Objective To explore influence of the WeChat platform on the compliance of continuous treatment of scar in adult burn patients. Methods A total of 124 adult burn patients, conforming to the study criteria, admitted in the Department of Burns of our hospital from January 2015 to January 2016 were divided into WeChat group (n=63) and control group (n=61) according to the random number table. Patients in control group only received regular discharging rehabilitation guide, while patients in WeChat group received regular discharging rehabilitation guide and joined WeChat platform after being discharged from hospital. Through pushing rehabilitation plan and rehabilitation related knowledge, organizing support discussion of burn patients, answering the patients′ questions, members of WeChat platform intervention group conducted continuous treatment for 6 months on patients of WeChat group. The compliance of functional exercise of patients in two groups in one week before discharge and 3 and 6 months after discharge was evaluated by using the self-made functional exercise compliance log sheet. The compliance of using anti-scar drug and appliance of patients in two groups in 3 and 6 months after discharge was evaluated by using self-made anti-scar drug and appliance usage log sheets. Data were processed with chi-square test, independent sample t test, non-parametric rank sum test of independent sample, and Wilcoxon rank sum test. Results (1) The compliance ratio of functional exercise of patients in WeChat group (95.24%, 60/63) was close to 93.44% (57/61) in control group in one week before discharge (χ²=0.188, P>0.05). The compliance ratios of functional exercise of patients in WeChat group were respectively 93.65% (59/63) and 87.30% (55/63) in 3 and 6 months after discharge, which were higher than 68.85% (42/61) and 65.57% (40/61) in control group (χ²=12.615, 8.166, P<0.01). (2) The compliance of using anti-scar drug of patients in WeChat group was significantly better than that in control group in 3 and 6 months after discharge (Z=-4.150, -4.563, P<0.01). (3) The compliance of using anti-scar appliance of patients in WeChat group in 3 and 6 months after discharge was obviously better than that in control group (Z=-4.242, -4.301, P<0.01). Conclusions By using WeChat platform to provide guide for scar rehabilitation continuous treatment, adult burn patients have better compliance to functional exercise and usage of anti-scar drug and appliance.

Qualitative research on pain experiences of adult burn patients

Li Lin, Pan Qiong, Xu Le, Lin Renqin, Dai Jiaxi, Chen Zhaohong

2018, 34(3): 165-170. doi: 10.3760/cma.j.issn.1009-2587.2018.03.010

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Objective To explore the pain experiences of adult burn patients so as to lay foundation for practical analgesic measures. Methods Using phenomenological method in qualitative research, semi-structured interviews were conducted on 12 adult burn patients hospitalized in our burn units from May to November 2015, aiming at pain experiences from immediately after burns to 3 to 7 months after being discharged from hospital. Then the Colaizzi′s analysis method was applied to analyze, induce, and refine themes of interview data. Results After analysis, pain experiences of adult burn patients were generalized into 6 themes: deep pain experiences, heavy psychological burden, limited daily life, poor assessment and treatment of pain, different attributions of pain, and different ways of coping of pain. Conclusions Burn pain brings harm to the patients′ physiology, mentality, and daily life. Nevertheless, pain processing modes of medical staff and patients themselves are the key factors affecting patients′ pain experiences. Therefore, according to the deficiency of current situation of pain management, the targeted analgesic intervention measures should be carried out from the perspectives of medical staff and patients.

Advances in the research of relationship between brown or beige fat and hypermetabolism after severe burn

Zhang Meng, Liu Yan, Zhang Xiong

2018, 34(3): 178-182. doi: 10.3760/cma.j.issn.1009-2587.2018.03.014

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Hypermetabolism is one of the remarkable characteristics of burn injury. Prolonged hypermetabolism causes insufficient energy supply, which leads to delayed wound healing, immune system dysfunction, increased infection rate, and multi-organ failure. In recent years, it is concerned that the activation of brown or beige adipose tissue may be related to hypermetabolism in severe burn patients. Brown or beige adipose tissue could be regulated by stress hormones and some cytokines which increase and persist in high level for several months after severe burn. This paper reviews the current knowledge of brown or beige adipocytes developmental lineages, molecular regulation mechanism, and regulation of brown or beige adipocytes activation after severe burn.

Advances in the research of antibacterial properties of silver ion and its application in wound treatment

Su Xuerong, Xue Yuying, Li Qiang

2018, 34(3): 183-186. doi: 10.3760/cma.j.issn.1009-2587.2018.03.015

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Nowadays, antibacterial products containing silver ion are widely used in clinical wound treatment. The concentration of silver ion in products, pH value, and other factors may affect the release of silver ion and its antibacterial effects. In the treatment of clinical wound, silver ion product plays a good role in anti-infection, promoting healing and reducing medical expenses. In this paper, the related applications of silver ion products in wound surface are analyzed, and the antibacterial properties of silver ion and its therapeutic effects in wound treatment are summarized.

Advances in the research of dermabrasion in burn wounds

Zhao Ran, Cao Yongqian, Zang Chengyu, Wang Yibing

2018, 34(3): 187-189. doi: 10.3760/cma.j.issn.1009-2587.2018.03.016

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The process of burn wounds healing includes the removal of necrotic tissue, the hyperplasia of granulation tissue and epithelialization. The removal of necrotic tissue is the first step in dealing with burn wounds. Although there are a variety of adjuvant drugs for removing necrotic tissue, surgical debridement is still the main way of debridement of burn wounds. Surgical debridement of burn wounds includes escharectomy, tangential excision and dermabrasion. Escharectomy and tangential excision have been widely used in clinical practice, while dermabrasion has not been known to the majority of burns colleagues. This article summarizes the clinical application and progress of dermabrasion in burn wounds.

Wet cement skin burns

Long Zhongheng, Xie Weiguo

2018, 34(3): 190-192. doi: 10.3760/cma.j.issn.1009-2587.2018.03.017

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Under certain condition, wet cement can cause skin chemical burns, which belongs to alkaline burns. As the symptoms are insidious in onset, the patients may be initially unaware of the injury until several hours later. It often causes full-thickness burns especially in knees, the lower limbs, and ankles. The prevalence of wet cement burns may be hugely underestimated. This article reviews the definition, occurrence, progress of injury and pathogenesis, clinical characteristics and diagnosis, and treatment and prevention of wet cement skin burns, in order to promote its prevention.

2018 Vol. 34, No. 3

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