目录

Choice of Resuscitation Fluid at the Shock Stage of Burns

(Abstract)

Zhang Xiangqing

(Burn Centre of the Jinan Munary Region and Burn Dept, of No.91 Hospital)

Reviewing the clinical practice of the past centurV in retrospect. we recognize that intravenous fluid infusion therapy has helped a great number of patients with large area burn to tide over the critical shock stage smoothly. On the basis of their own clinical experience. different authors have suggested different resuscitation formulas which provide good reference for the resuscitation of burn shock. Because of the variation and limitation of research measures and observation angles, different authors, though had a common principle of treatment---- maintenance of the circulating blood volume, had unavoidably been one sided in considering complicated situations Such as burns. Therefore, clinicians are often difficult to make up their mind in the choice of the resuscitation fluid when they are facing a severe, complicated case.

In this paper. the author presents a detailed discussion on three problems, 1. loss of body fluid and the aim of resuscitation. 2. infusion formulas and clinical evaluation and 3. resuscitation flu ids and how to make choice. The author's dominant idea is that we should not consider burn shock as a single symptom but take stock of all the signs and symptoms of the patients. Shock resuscitation does not merely aim at the tiding over of the clinical shock stage, it also aims at a maximal recovery o f the physiological status and a minimal latent threat of the incidence of complications.

Bacteria Count in Burn Wounds

(Abstract)

Chen Xiaowu, et al.

(1st Affitiated Hospital , Hunan Medical University)

Infections are life--threatening for burn patients. The seventy of the infection and microorganism invasion depend upon the resistance of the host, the toxicity and the amount of the microorganism. This paper presents a review on the methods for determination of the count of bacteria in burn wounds.

A historical review including different methods for bacteria' counting is presented. 1. Wet swab method. .2, direct contact method, 3, gauze method. 4, biopsy method which in' eludes tissue culture and tissue smearing and 5, paper sheet method. Uses of bacteria counting; 1, Predicting the viabiIity of the grafts on the won nd, 2. guid lug the proper management of the wound and 3, monitoring and d iagnosing pyemia.

Wet swab method, direct contact method and gauze method are useful only for determination of the count of bacteria around the wound surface. The connt often fluctuates u nder the infl unce of external factors and therefore the results are often unable to reflect proportionally the degree of infection in the deep tissue. The application of these methods have been limited lately. Biopsy method is widely applied. But this technique is rather complicated and has low reproducibifity.

The recent trend is to develop new methods easy to operate,giving no damage to the wounds, good reproducibility and exactly reflecting the amount of bacteria in the wounds.

Studies on Blood Coagulation Function at the Early Stage of Burns i. Changes in Aggregation Function and Count of Blood Platelets

(Abstract)

Zhang Xiangqing, et al.

(Dept. of Burn Research, No. 91 Hospital)

Determination of the aggregation function and count of blood platelets in peripheral veins of 33 burn patients at the early stage had been carried out, with healthy volunteers as the control. The results revealed that at the early stage of severe burn, the count of blood platelets dropped markedly, 181 .5+ 53.2 x 109/L for the healthy control and 1 20.41 56.7 x 109 / L for the burn patients. Changes in the aggregation function of the platelets also took place. The results from two groups of patients with different seventy of burns revealed that the aggregation function of patients with burn index smaller than 40 tended to be enhanced and the aggregation function of those with burn index greater than 40 tended to decline.

The authors analyzed the causes of the above mentioned changes and suggested that consumptive coagulopathV is very common in severe burn patients. Patients with burn index greater than 40 had an increased amount of fibrin degradation product which may be an important factor responsible for the declination of the aggregation function.

The Experimental Morphological Study on the Microcirculatory Vascular Tree of Skin (III)

(Abstract)

Bat Shuling, et al.

Using the method of comparative observation, we studied the distributive characteristics of three dimensional architecture of the microcirculatory vessels of skin. We discovered that all the cutaneous arteries are distributed in arborescent type. The theory of microcirculatory vascular tree of skin was advanced. The general regularity of the arborescent distribution of the microcircu latory vascu far tree of skin was revealed the clinical and theoretical significance of the microcirculatory vascular tree was suggesfed according to the morphological characteristics of three dimensional arch itectu re of microcircu latory vascu far tree of skin.

Perioperative Period Management of Burns

(Abstract)

Qi Skunzhen, et al.

(Dept. of Burns, International Peace Hospital Named After Dr. Norman Bctkune)

Severe burn patients often need to be operated on for many times to ensure good recovery of their features. functions and to live a happy life. In this paper, some important problems concerning perioperative period management are discussed for the purpose of improving the results of the operatious.

A. Basic concept of perioperative period

It includes preoperative. operative and postoperative periods.

B. Preoperative management

1. Preoperation preparation a.General physical examination. b. psychological preparation. c, physiological preparation. d. wound Surface preparatl on.

2. immediate preparation before operation a. Psychological preparation.

b. organization of operating personnel. c, phVsiological preparation, d. donor site and won nd preparation.

C. Management du rihg operation :

1, Monitoring of anaesthesia

a. Monitoring of blood pressure. pulse. respiration, etc.

b. adjustment of fluid infusion. anaesthesia and other management, according to the condition of the patient.

c. estimate accurately the loss of blood and fluid,

d. ensure unobstructed respiration and adequate oxygen supply.

2. Other management during operation

a, Timely management for those with malfunctioning of blood coagulation.b. apply antibiotics for those severely infected or having a prolonged duration of operation, c. control the scope of operatio n. D. Postoperative management f 1. General management a, Continuous electrocard iograph ic and central venous pressure monitoring and biochemical and blood gas examinations for critical and severe cases. b, application of analgesics and antibiotics. c. examinations including blood routine. blood chemistry. blood gas and blood culture on the very day and 1 and 2 days after operation for those received major operations.

2, Wound management

a. Donor site.b. recipient site.

3. Postoperation nursing

a. Care should be taken for those not waking up timely after major operations until they wake up.,b. keep staying in bed,c. care should be taken to the tightness of the dressing.d. monitoring of urine volume. e, nursing of special parts of burn wounds, f. posture. g, postoperation donor site nursing, h. dietary regimen.

Clinical Analysis of 1567 Cases of Burn Treated with Moist Exposed Therapy

(Abstract)

Yang Kefei, et al.

(Chinese Science and Technology Centre of Burns , Wounds and Surface Ulcer)

1567 cases of burn were treated with moist exposed therapy, during the period from August 1988 to August 1989, in 16 medical units in North--east China. 1499 cases healed. 68 cases died(death rate: 4.34% ). Among the 108 cases with burn area exceeding 50%TBSA, 69 cases were healed (healing rate: 63.89%). Sex ratio f male/female = 18/1. Age range: 2 months to 87 years. The highest incidence was within in the age range of 20 to 40 years. 438 cases fell into this age range. 27.95% of the total. Burn area f 192 cases with severe burn. burn area 31--49% TBSA. 108 cases with exceptionally severe burn, among which 11 cases with total burn area exceeding 80%TBSA. Complications:32 cases complicated by pulmonary edema. 30 cases by auriculochondritis and 25 cases by other injuries. All the patients cured without any sequelae. 1423 out of the 1 567 cases were thermally injured (90.81 %).

Comparison had been made between the clinical results of the moist and the dry therapies. firevealed that the moist therapy had its advantages of lower incidence of shock. systemic infection and other complications. lower disablement and death rate and higher curative rate.

118 Cases of Burn Treated with MEBO

(Abstract)

Yang Jianqui, et al.

(Dent. of Burns. Jiansoiao Hospital. Hanszhou City)

118 cases of burn had been treated witr MEBO. Average burn area :11.79%TBSA, larges burn area l88%TBSA. 78 cases with deep 2nd degree burns. largest area 45%TBSA. 28 cases with 3rd degree burns. largest area 23%TBSA.

Escharotomy was done at the early stage an followed by grafting with skin of large or mediun thickness. For patch 3rd degree wound. staml skin graft was done postescharotomy. The result were very satisfactory. 2 patients died (1 .69%) one left the hospital for unkown reason. All thl rest (115 cases )healed (97.46%).

This paper describes in details. the methods and points for attention in the management of the wounds, promotion of wound healing, lessening of scar formation, prevention of folliculitis around the wound and debridement of shock patients. The authors conclude that MEBO has many advantages over the conventional remedy. It is very efficacious and has analgesic effect. It keeps adequate drainage. improves local microcirculation, prevents progressive necrosis of the stasis zone tissue and inhibits fibroplastic prol iferation.

Experience in Treating 82 Cases of Burn with Moist Exposed Therapy

(Abstract)

Tao Yexing, et al.

(Dent. of Burn Plastic Sursery. Peoule's Hospital. Xinjiang Uygur Autonomous Region)

82 cases of burn had been treated with moist exposed therapy. All the patients healed. The authors suggested that this therapy helps to find a way out to the settlement of difficult problems such as pains in the wounds. infections. formation of scar for second degree burn wounds. prevention of progressive necrosis of stasis zone tissue at the early stage. etc. It also has the advantage of easy inspection of the wound. It is simple to apply and easy to be popularized.

Experience in APPncation of Moist Exposed Therapy for Treating Burns

(Abstract)

Li Fengxiang, at al.

(Cang County Hospital, Hebei Province)

This paper reports the clinical experience in treating 30 cases of burn with moist exposed therapy in the past 4 months. Under a circumstance short of'facilities and instruments. we managed to treat medium and large area burns. Our practice proved that moist exposed therapy is very efficacious for preventing and controlling infections. It alleviates pains, promotes tissue growth and won nd healing and lessens the formation of scar. It is an ideal technique simple and easy to be. applied. it has reliable efficacy and is acceptable to the patients.

Clinical Experience on the Treatment of the Moist, Exposed Therapy in Burn

(Abstract)

Zhang Honshu et al.

(No. I Branch Hospital of Qilu Petrochemical industry Corporation's Central Hospital)

This paper describes our experience of healing 24 burn patients with Moist. Exposed Burn Therapy (MEBT) from June to December in 1989. Our clinical observations showed that the result was positive. The clinical practice shows that MEBT has advantages such as f 1. Stopping pain obviously. 2. Obvious anti--infection effect. 3. Short course of the therapy for the healing of wound: 4. Being easy to use, simplicity for working. needing neither special medical devices nor special working conditions, and being convenient for the small--middle sized hespitals to use widely. 5. Without scarring for deep 11 degree burn. However, the therapy has its disadvantage of taking rather long time to heal deep ill degree burn. thus lengthening the wound course. The paper gives three steps of treating deep ill degree burn. The first is to dissolve scars with the Moist Burn Ointment (MEBO). The second is to take skin grafts after flesh has grown up. The third is to use MEBT once more after the grafted skins come to live (3--7 days); This way not only helps grafted skins to grow and enfarge. but also to prevent wounds from scarring. thus the course of treatment is shortened.

Experience with MEBO in Treating 29 Cases of Acid and Alkali Burns

(Abstract)

Eong Jin, et al.

(Dept. of Burns, 3rd Municipal Hospital, Xuzkou City)

29 cases of acid and alkali burns were treated with MEBO in 1989 to May. 1990. Average aged 25.4.average area: 9.2%TBSA. Most of them had deep 2nd degree burn in lower extremities.

The authors analyzed the efficacy of MEBO and concluded that deep 2nd degree burn can be healed without formation of scar. Small area 3rd degree burn and residual wounds can be healed satisfactorily.

The therapy enables easy inspection of the wound. It has marked analgesic effect. It promotes decrustation. neutralizes the acid and the alkali, prevents infection and promotes healing of the wounds.

200 Cases of Cervical Erosion Treated with MEBO

(Abstract)

Zhang Chengkui, et al.

(Hospital for Staff and Workers, Orgaaic Chemical Plant, Jingmen City, Hubei Province)

In 1990. the authors treated 200 cases of cervical erosion using MEBO and scored very satisfactory results. Patients had course of the disease ranging from 4 months to 14 years and the treatment involved application of the ointment 6 times to 16 times. 180 cases cured. 16 patients who did not abide by the instruction of the doctor strictly. did not pay attention to their menstrual hygiene and did not apply the ointment in a proper way. had their symptoms improved. 4 cases with cervical cancer did not respond to the ointment.

The authors suggested that the treatment should be carried out in a sterilized way. The ointment should be applied 1 to 2 times every day or every other day. During menstrual period and 4 days before and 4 days after the period the application of the ointment should be stopped. When the ointment is applied. hip bath and sexual intercourse should be forbidden.

The Appncation of Moist Exposed Therapy in Aesthetic surgery

(Abstract)

Qu Zkenchang

(Andong Chinese Medicine Hospital, Mudanjiang City, Heilongjiang Province)

17 patients after face planing were treated with moist exposed therapy and 5 treated with conventional dressing therapy. The author points out that moist exposed therapy has the advantages of alleviation of pains and swellings. reduction of exudates, antinfection, promotion of recovery, eastness in nursing and lower cost, as corn. pared with the conventional dressing therapy.

The Application of Moist Exposed Therapy in Skin Planing

(A Report of 2 Cases)

(Abstract)

Shang Jiangji

(People's Hospital, Jingaing She Autonomous County, Zhejiang Province)

2 patients wounded during skin planing in the Aesthetic Surgery Dept. of our Hospital, were treated with MEBO. invented by prof. XuRongxiong. All the patients healed without formation of any scar. MEBO has been proved to have reliable analgesic and antiinfective effects. It promotes proliferation of the epithelial tissue, improves the blood circulation of the wound area, alleviates spasm and inhibits fibroplastic proliferation. It gives good healing without dysfunction or scar formation. MEBO is worthy to be popularized for use in sesthetic surgery.

Rapid Heanng of infected war wounds

(Abstract)

Liu Qigul, et al.

(General Hospital. Chengdu Military Region)

Since 1986. the authors treated 20 cases with a total of 100surface war wounds. using aqueous hydrogen peroxide in the debridement and covering the wounds with aqueous hydrogen peroxide soaked gauze-- moist and semi--exposed therapy. The hydrogen peroxide soaked gauze was applied at regular intervals. The wounds healed in 6 to & days. This therapy did not use saline in the debridement and needed no dressing. The wounds healed rapidly and the results were satisfactory.

MEBO for Treating A Case of Senile Dementia compncated by Multiple Decubital ulcers

(Abstract)

Zhang Changqing

(Shaowu City Hospital, Fujian Province)

A senile dementia patient. male, 68, emaciated and exhausted, was admitted to our hospital on March 16, 1990 for pneumonia in the left lung.. The patient had three decubital ulcers. One 80 mm in diameter. in sacrococcygeal area. another 40 mm. in left femur area and the third 80 mm, in right femur area. Ulceration and necrosis reached the periost. Diagnosis, 3rd to 4th degree decubital ulcers. Debridement was made on admission and various antibiotics were applied for 70 days. Yet ulcers did not heal. Then. MEBO was used instead. The ulcers in the sacrococcygeal and left femur area were healed in 45 to 48 days. The ulcer in the right femur area was infected and did not heal.

Repair of Shank Soft Tissue Defect Using Pedicle Flap and Musculocutaneous Flap

(Abstract)

Fan Wenfu

(Dept. of Orthopaedics, People's Hospital, Xinye County, Henan Province)

Repair of shank soft tissue defect is a task of ,wide attention in surgery. In recent years, the application of pedicle flap and musculocutaneous flap has been popularized and has given very satisfactory results. In this paper. the author gives a concise review on the advantages and disadvantages and general aspects of their of in ical appl ications.