摘要：目的:探讨皮肤原位再生医疗技术(Moist exposed burn therapy/moist exposed burn ointment,MEBT/MEBO)对四肢创伤创面皮肤屏障功能及血管生成的影响。方法:选取2017年9月-2019年9月笔者医院110例四肢创伤患者,随机数字表法分组,各55例。对照组施行负压封闭引流技术(Vacuum sealing drainage,VSD),实验组施行MEBT/MEBO。观察两组治疗效果、创面愈合时间、疼痛程度、住院时间及并发症情况,对比治疗前、治疗后两周血管生成指标[微血管密度(Microvessel density,MVD)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、S100钙结合蛋白A9(Serum calcium-binding protein A9,S100A9)]、皮肤屏障功能[经皮水份丢失量(Transepider-malwaterloss,TEWL)、皮肤表面pH值],并于治疗后24周随访瘢痕程度(Vancouver scar scale,VSS)。结果:实验组治疗总有效率90.91%高于对照组的74.55%,差异有统计学意义(P<0.05)。实验组创面愈合时间、住院时间短于对照组,VAS评分低于对照组,差异有统计学意义(P<0.05)。治疗后两周实验组肉芽组织中MVD、VEGF、S100A9水平高于对照组,差异有统计学意义(P<0.05)。治疗后两周两组TEWL低于治疗前,皮肤表面pH值高于治疗前,但组间比较差异无统计学意义(P>0.05)。实验组并发症发生率5.45%低于对照组的18.18%,差异有统计学意义(P<0.05)。治疗后24周实验组VSS评分低于对照组,差异有统计学意义(P<0.05)。结论:MEBT/MEBO应用于四肢创伤创面,有助于促进血管生成,减轻疼痛,缩短创面愈合时间,降低并发症,提高治疗效果。

摘要：Ethnopharmacological relevance The diabetic wound is one of the common chronic complications of diabetes, which seriously affects patients’ quality of life and even causes disability and death. Traditional Chinese medicine (TCM) is a unique and precious resource in China, which has a good curative effect and safety. At present, it has been found that Chinese herbal compounds and effective active ingredients can effectively promote diabetic wound healing, and its mechanism needs to be further studied. Signaling pathways are involved in the pathogenesis and progression of diabetic wounds, which is one of the main targets for the pathologic mechanism of diabetic wounds and the pharmacological research of therapeutic drugs. Aim of the review This study has been carried out to reveal the classical signaling pathways and potential targets by the action of TCM on diabetic wound healing and provides evidence for its clinical efficacy. Materials and methods “diabetic wound”, “diabetic foot ulcer”, “traditional Chinese medicine”, “natural plant” and “medicinal plant”, were selected as the main keywords, and various online search engines, such as PubMed, Web of Science, CNKI and other publication resources, were used for searching literature. Results The results showed that TCM could regulate the signaling pathways to promote diabetic wound healing, such as Wnt, Nrf2/ARE, MAPK, PI3K/Akt, NF-κB, Notch, TGF-β/Smad, HIF-1α/VEGF, which maintaining inflammatory interaction balance, inhibiting oxidative stress and regulating abnormal glucose metabolism. Conclusion The effect of TCM on diabetic wound healing was reflected in multiple levels and multiple pathways. It is envisaged to carry out further research from precision-targeted therapy, provide ideas for screening the core target of TCM in treating diabetic wounds and create modern innovative drugs based on this target.

摘要：目的研究重组人表皮细胞生长因子(rhEGF)对氯乙酸化学灼伤患者瘢痕指数(SI)与血清生长因子水平的影响。方法选取吉林市化工医院2018年1月至2020年11月收治的42例氯乙酸化学灼伤患者,分组方式按照随机数字表法划分,对照组(21例)患者行常规治疗并涂抹湿润烧伤膏,观察组(21例)患者在对照组的基础上采用rhEGF外用溶液治疗,两组患者均治疗14 d。比较两组患者治疗14 d后临床疗效;比较两组患者治疗期间不良反应发生情况;比较两组患者SI指数与愈合时间;比较两组患者治疗前、治疗14 d后血清碱性成纤维细胞生长因子(bFGF)、表皮生长因子(EGF)、血管内皮生长因子(VEGF)水平。结果观察组患者治疗14 d后临床总有效率显著高于对照组;观察组患者SI指数显著低于对照组,愈合时间显著短于对照组;与治疗前比,血清bFGF、 EGF、 VEGF水平治疗后两组患者均显著升高,且观察组较对照组显著升高(均P <0.05);在治疗过程中,两组患者不良反应总发生率观察组较高,但差异无统计学意义(P>0.05)。结论 rhEGF用于治疗氯乙酸化学灼伤患者,可促进其创面愈合,提高治疗效果,减少瘢痕产生,提升生长因子水平,且不会增加不良反应。

摘要：目的 探讨重组人酸性成纤维细胞生长因子(rh-aFGF)结合纳米银敷料与美宝湿润烧伤膏在烧伤创面削痂术后的作用。方法 选取2019年9月—2021年7月南阳南石医院深Ⅱ度烧伤患者70例，随机分为观察组与对照组，每组各35例患者，所有患者均在伤后48 h内进行削痂手术，术后对照组给予纳米银敷料与美宝湿润烧伤膏，观察组给予rh-aFGF结合纳米银敷料与美宝湿润烧伤膏，比较两组创面愈合情况、创面细菌阳性率、创面肉芽与上皮生长情况、瘢痕情况[温哥华瘢痕量表(VSS)评分]、血清炎性因子[白细胞介素-2/-6/-10(IL-2/6/10)、肿瘤坏死因子-α(TNF-α)]以及创面组织指标[血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)]表达水平。结果 观察组术后1周、2周、3周时创面愈合率高于对照组(P<0.05);术后1周，观察组创面细菌阳性率14.29%低于对照组37.14%(P<0.05);观察组术后1周、2周、3周时创面肉芽与上皮生长情况优于对照组(P<0.05);观察组术后3个月瘢痕VSS评分中血管分布、颜色、厚度、柔软度维度评分均低于对照组(P<0.05);两组术后1周血清IL-6、TNF-α、IL-2、IL-10水平比较(P>0.05);观察组术后1周创面组织VEGF mRNA、TGF-β1 mRNA表达水平高于对照组(P<0.05)。结论 rh-aFGF结合纳米银敷料与美宝湿润烧伤膏有利于加快烧伤创面削痂术后创面愈合进程，促进创面肉芽与上皮生长，减少瘢痕形成，提高细菌清除率，调节创面VEGF、TGF-β1表达，促进组织修复。