气管内滴入成纤维细胞生长因子治疗呼吸道烧伤的效果
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摘要
目的分析气管内滴入外用重组人碱性成纤维细胞生长因子(rh-bFGF)治疗呼吸道烧伤的效果。方法选取2016年3月至2018年4月呼吸道烧伤患者35例为研究对象,将其随机分为对照组与观察组。对照组患者15例,给予补液、气管切开及纤维支气管镜吸痰等常规治疗,同时将生理氯化钠溶液滴入气道内,12 h/次;观察组患者20例,在常规治疗基础上采用5 ml生理氯化钠溶液溶解rh-bFGF 3.5万IU,应用注射器经气管切开处缓慢滴入气道内,12 h/次,记录两组气管黏膜愈合情况、气管黏膜充血水肿恢复情况、血氧饱和度(SpO_2)变化及并发症发生率。结果实验组伤后7 d、10 d、14 d、24 d创面愈合率高于对照组(P<0.05),观察组气管黏膜愈合时间短于对照组(P<0.05);观察组伤后10 d、14 d、24 d气管黏膜充血水肿恢复率高于对照组(P<0.05);观察组伤后7 d、10 d、14 d、24 d动脉血氧分压(PaO_2)高于对照组(P<0.05);对照组PaO_2有所上升,但波动不明显(P>0.05);观察组伤后1个月并发症发生率略低于对照组,差异未见统计学意义(P>0.05)。结论气管内滴入rh-bFGF可较好促进呼吸道烧伤患者气管黏膜愈合,黏膜充血水肿恢复,改善PaO_2,值得临床推广应用。
Objective To analyze the effect of intratracheal instillation of recombinant human basic fibroblast growth factor(rh-bFGF) in patients with respiratory tract burns. Methods From March 2016 to April 2018, 35 patients with respiratory tract burns admitted were selected as the study subjects. They were randomly divided into control group and observation group.There were 15 patients in the control group,routine treatments such as fluid replacement, tracheotomy and sputum aspiration by fiberoptic bronchoscope were given.At the same time, the physiological sodium chloride solution was dripped into the airway,12 h/time.There were 20 patients in the observation group.On the basis of routine treatment,Dissolution of rh-bFGF 35,000 IU in 5 ml physiological sodium chloride solution was given.Use syringe to drip slowly into airway through tracheotomy,12 h/time.The healing of tracheal mucosa, the recovery of congestion and edema of tracheal mucosa, the change of arterial partial oxygen pressure(PaO_2)and the incidence of complications were recorded.Results The wound healing rate of the observation group was higher than that of the control group at the 7 th, 10 th, 14 th and 24 th days after injury(P<0.05).The healing time of tracheal mucosa in observation group was shorter than that in control group(P<0.05).The recovery rate of tracheal mucosal congestion and edema in the observation group was higher than that in the control group at the 10 th, 14 th and 24 th days after injury(P<0.05).The arterial partial pressure of oxygen(PaO_2) in the observation group was higher than that in the control group at the 7 th, 10 th, 14 th and 24 th days after injury(P<0.05).In the control group, PaO_2 increased, but the fluctuation was not significant(P>0.05).The incidence of complications in the observation group was slightly lower than that in the control group at 1 month after injury,but there was no significant difference(P>0.05). Conclusions Intratheteral drip of rh-bFGF can promote the healing of tracheal mucosa in patients with respiratory tract burn.The recovery of mucosal congestion and edema and the improvement of PaO_2 are worthy of clinical application.
Objective To analyze the effect of intratracheal instillation of recombinant human basic fibroblast growth factor(rh-bFGF) in patients with respiratory tract burns. Methods From March 2016 to April 2018, 35 patients with respiratory tract burns admitted were selected as the study subjects. They were randomly divided into control group and observation group.There were 15 patients in the control group,routine treatments such as fluid replacement, tracheotomy and sputum aspiration by fiberoptic bronchoscope were given.At the same time, the physiological sodium chloride solution was dripped into the airway,12 h/time.There were 20 patients in the observation group.On the basis of routine treatment,Dissolution of rh-bFGF 35,000 IU in 5 ml physiological sodium chloride solution was given.Use syringe to drip slowly into airway through tracheotomy,12 h/time.The healing of tracheal mucosa, the recovery of congestion and edema of tracheal mucosa, the change of arterial partial oxygen pressure(PaO_2)and the incidence of complications were recorded.Results The wound healing rate of the observation group was higher than that of the control group at the 7 th, 10 th, 14 th and 24 th days after injury(P<0.05).The healing time of tracheal mucosa in observation group was shorter than that in control group(P<0.05).The recovery rate of tracheal mucosal congestion and edema in the observation group was higher than that in the control group at the 10 th, 14 th and 24 th days after injury(P<0.05).The arterial partial pressure of oxygen(PaO_2) in the observation group was higher than that in the control group at the 7 th, 10 th, 14 th and 24 th days after injury(P<0.05).In the control group, PaO_2 increased, but the fluctuation was not significant(P>0.05).The incidence of complications in the observation group was slightly lower than that in the control group at 1 month after injury,but there was no significant difference(P>0.05). Conclusions Intratheteral drip of rh-bFGF can promote the healing of tracheal mucosa in patients with respiratory tract burn.The recovery of mucosal congestion and edema and the improvement of PaO_2 are worthy of clinical application.
引文
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[13] 刘洋,张宜澜,黄亚兰,等.人工真皮联合碱性成纤维细胞生长因子在瘢痕和皮肤深度创面整复中的临床应用[J].中华烧伤杂志,2016,32(4):198-203.DOI:10.3760/cma.j.issn.1009-2587.2016.04.003.
[14] 吴红梅,白翠翠,李芳芹,等.早期输注高氧液对重症烧伤患者脂质过氧化反应的影响及注意事项[J].西部医学,2016,28(12):1676-1679.DOI:10.3969/j.issn.1672-3511.2016.12.011.
[15] 杨晓津,方涛,高秀清.复方多黏菌素B软膏联合碱性成纤维细胞生长因子治疗儿童深Ⅱ度烧伤创面临床疗效分析[J].天津医药,2016,44(9):1147-1149.DOI:10.11958/20160717.
[16] Bae IH,Park JW,Kim DY. Enhanced regenerative healing efficacy of ahighly skin permeable growth factor nanocomplex in a full-thickness excisional mouse wound model[J]. Int J Nanomedicine,2014,9:4551-4567. DOI:10. 2147/IJN. S68399.
[2] 苗桂萍.大面积烧伤合并吸入性损伤76例的护理[J].中华劳动卫生职业病杂志,2014,32(10):780.DOI:10.3760/cma.j.issn.1001-9391.2014.10.019.
[3] 张文浩,吴起,马军,等.负压封闭引流联合肝素溶液治疗四肢深Ⅱ度烧伤创面的临床效果[J].中华烧伤杂志,2017,33(8):497-500.DOI:10.3760/cma.j.issn.1009-2587.2017.08.008.
[4] Simon M,Metschke M,Braune SA,et al.Death after percutaneous dilatational tracheostomy:a systematic review and analysis of risk factors[J].Crit Care,2013,17(5):R258.DOI:10.1186/cc13085.
[5] 马启海.血必净注射液联合重组牛碱性成纤维细胞生长因子凝胶治疗深度烧伤残余创面的临床研究[J].现代药物与临床,2017,32(12):2469-2472.DOI:10.7501/j.issn.1674-5515.2017.12.040.
[6] 高立平,易博,廖殿晓,等.烧伤科连续5年医院感染回顾性调查[J].中国感染控制杂志,2018,17(1):77-79.DOI:10.3969/j.issn.1671-9638.2018.01.018.
[7] 吕芳.集束化护理对呼吸道烧伤气管切开患者救治效果的影响[J].河北医药,2016,38(12):1909-1911.DOI:10.3969/j.issn.1002-7386.2016.12.045.
[8] Maier IL,Karch A,Mikolajczyk R,et al.Effect of beta-blocker therapy on the risk of infections and death after acute stroke-a historical cohort study[J].PloS One,2015,10(2):e0116836.DOI:10.1371/journal.pone.0116836.
[9] 刘晓彤,沈若武,卞明心.大鼠创伤皮肤组织VEGF、PDGF和bFGF表达及意义 [J].青岛大学医学院学报,2016,52(2):209-214.
[10] Honnegowda TM,Kumar P,Udupa EGP,et al.Role of angiogenesis and angiogenic factors in acute and chronie wound healing[J].Plast Aesthet Res,2015,2(5):243-249.DOI:10.4103/2347-9264.165438.
[11] 王慧慧,赵玉梅.成纤维细胞生长因子的研究进展及口腔应用前景[J].口腔医学,2017,37(7):651-655.
[12] 蔡景宁,李斌,谢晓繁,等.重组人酸性成纤维细胞生长因子治疗深Ⅱ度烧伤的疗效观察[J].中国临床医生杂志,2016,44(2):69-71.DOI:10.3969/j.issn.2095-8552.2016.02.023.
[13] 刘洋,张宜澜,黄亚兰,等.人工真皮联合碱性成纤维细胞生长因子在瘢痕和皮肤深度创面整复中的临床应用[J].中华烧伤杂志,2016,32(4):198-203.DOI:10.3760/cma.j.issn.1009-2587.2016.04.003.
[14] 吴红梅,白翠翠,李芳芹,等.早期输注高氧液对重症烧伤患者脂质过氧化反应的影响及注意事项[J].西部医学,2016,28(12):1676-1679.DOI:10.3969/j.issn.1672-3511.2016.12.011.
[15] 杨晓津,方涛,高秀清.复方多黏菌素B软膏联合碱性成纤维细胞生长因子治疗儿童深Ⅱ度烧伤创面临床疗效分析[J].天津医药,2016,44(9):1147-1149.DOI:10.11958/20160717.
[16] Bae IH,Park JW,Kim DY. Enhanced regenerative healing efficacy of ahighly skin permeable growth factor nanocomplex in a full-thickness excisional mouse wound model[J]. Int J Nanomedicine,2014,9:4551-4567. DOI:10. 2147/IJN. S68399.