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Clinical Research about Treating Wound Infections of Severe Burns with MEBO
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Add Timeㄩ2014/1/16 14:59:04
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Clinical Research about Treating Wound Infections of Severe Burns with MEBO
Zheng Yuhong, Wang Zhiying and Hou Pengfei
Burns are common in our daily life. Therefore, we design a research method featuring control groups that are clinically selected in an effort to prevent burns wounds infections. The burns treatment techniques adopted in traditional clinical practice and MEBT/MEBO are all selected for the treatment of patients with extensive burns. Through comparisons and analysis, the two methods are importantly different in such areas as preventing and controlling infections, the wound healing time and skin grafting rate. The clinical treatment results are quite satisfactory. Now, I would like to detail the research process as following:
 
Clinical Information
Enrollment Standards 每 Patients and their family members shall agree to be selected as target of clinical research and sign the Letter of Consent. They shall also agree to accept in-situ skin regenerative medical treatment and surgical burns treatment. The patients are from 1 to 80 years old, suffering from extensive burns (30%TBAS to 49%TBSA with regard to total burns area, 11%TBSA to 19%TBSA with regard to full-thickness burns or 6%TBSA to 9%TBSA with regard to full-thickness burns deep type).
Case Information 每 Altogether, there are 60 patients selected, who are all suffering from extensive burns. These patients are divided into two groups, the experiment group and control group, with 30 patients respectively. Experiment Group: 21 males and 9 females; the oldest one is 74 and the smallest is 15 months, averaging 36.01 ㊣ 22.5 years; 21 suffering from hot liquid burns, 5 flame burns, 2 steam burns and 2 electric arc burns; the largest area of burns is 49%TBSA, the smallest one is 30%TBSA, averaging 39.15%TBSA ㊣ 15.7%TBSA. Control Group: 20 males and 10 females, the oldest one is 72 years old and the smallest is 19 months old, averaging 23.8 ㊣ 21.4 years old; 19 suffering from hot liquid burns, 3 flame burns, 2 sulfuric acid burns, 1 hot cinder burns, 1 electric arc burns, 2 steam burns, 1 thermokalite and 1 molten iron; the largest burn area is 49%TBSA, the smallest one is 32%TBSA, averaging 38.36%TBSA ㊣ 15.9%TBSA. No obvious differences can be observed when comparing with the two Groups (pˇ0.05).
Treatment Methods
General Treatment 每 Patients in two groups shall be treated based on rehabilitation plan for routine burn treatment for effective liquid rehabilitation treatment in shock phase. At the same time, antibiotics shall be used to prevent infections and nutrition support and other systemic treatment measures shall be taken for support treatment.
 
Wound Treatment 每 Experiment Group: After being admitted into hospital, patients shall use MEBO as early as possible. Tongue depressors or sterilized gloves shall be used to smear MEBO onto wounds with a thickness of about 1mm, and the wound shall always be maintained with medicine and under moist environment in order to prevent dryness and immersion. The dressings shall be changed once every 4 hours, and the sterilized gauze or toilet paper shall be used during dressing change to remove the secretions and liquefactions. Also, the principle of no further pains, bleeding, dryness and damages to normal tissues shall be followed. And, the partial-thickness wounds shall be treated according to above means, without any special measures. As for partial-thickness and full-thickness burns wounds, ploughing knife or surgical knife can be used for relieving. And, for extensive wounds, the necrotic eschar can be thinned with humby knife in order to relieve local tension, improve and restore local blood circulation and smooth drainage and promote absorption of medicine. For full-thickness wounds, auto microskin plantation technique shall be adopted if no new skin islands can be observed on wounds after 4 to 6 weeks of treatment, and the wounds shall be closed as soon as possible. Control Group: debridement and sterilization of wounds shall be done followed by smearing flamazine suspension and drying the wounds which shall be smeared three times a day. Sulfadiazine silver paste shall be smeared every day before being bandaged with dressings, and the comprehensive burns treatment device shall be adopted, and the dressing change shall be done once every day. The wounds that are clinically diagnosed as partial-thickness and full-thickness ones shall be incised for skin grafting in different batches.
Evaluation Index for Treatment Results
Rate of Invasive Infections on Wounds; Average Time of Antibiotics Adopted; Rate of Secondary Antibiotics; Average Healing Time of Wounds; Skin Grafting Rate.
 
Treatment Results
 
Through treatment, wounds of patients of two groups can be closed and healed. The average healing time is 34.9 ㊣ 8.6 days for Experiment Group and 39.4 ㊣ 9.1 days for Control Group. Average time for antibiotics: 7.6 days for Experiment Group and 15.9 days for Control Group. Usage of secondary antibiotics: 4 cases (13.3%) for Experiment Group, 9 cases (30.0%) for Control Group. Invasive infection on wounds: 4 cases (13.3%) for Experiment Group and 20 cases (66.7%) for Control Group. Skin grafting surgery: 3 cases (10.0%) for Experiment Group and 20 cases (66.7%) for Control Group. Through u inspections, the average healing time of wounds is obviously different (Pˉ0.05). The utilization rate of secondary antibiotics, rate of invasive infections and skin grafting rate are obviously different (Pˉ0.01).
 
Typical Cases
 
Mr. Zhang, 60, was admitted into hospital one hour before flame injury on many parts of the body. In physical examination on admission, he was painful, suffering from a body temperature of 36.8 degrees, heart rate of 90/min and blood pressure of 100mmHg/60mmHg. The check-up over his cardiopulmonary functions was normal, the wounds can be found on both upper and lower limbs, and the wounds on two upper limbs and thighs presented dark red and brown, some pale, smooth and tough. The patient sensed no pains on them. And, the wounds on two shanks were yellow, hard, leather-like and shrinking. The patient sensed no pains, and suffered from cold distal limbs and poor circulations.
 
Diagnosis on Admission 每 The patient suffered from extensive burns with an area of 49%TBSA, among which 20%TBSA were partial-thickness burns deep type, 15%TBSA were full-thickness burns superficial type and 14%TBSA were full-thickness burns deep type.
 
Treatment Methods 每 In-situ skin regeneration techniques shall be adopted on patients after admission. The wounds shall be smeared with MEBO and dressings shall be changed promptly in order to maintain moist wounds. The necrotic eschars on full thickness burns shall be treated with ploughing techniques and thinning techniques in order to gradually remove necrotic tissues on wounds and maintain vigorous tissues. Injections of Beta lactam and aminoglycoside antibiotics shall be done for 7 days, no infections were found. Twenty one days later, most necrotic skin fall off, and partial and full-thickness burns on two upper limbs and thighs healed within 28 to 35 days. The granulations on full-thickness wounds on two shanks shall be treated with micro skin plantation techniques. The wounds will heal two weeks later, and the skin was elastic. Half a year later, patients presented satisfactory functions, elastic skin and could live by themselves.
 
Clinical Discussions
 
Through clinical research and practice, we believe in that the mechanisms for in-situ skin regeneration medical techniques in the treatment and prevention of severe burns wounds include:
 
The infections can be kept under control through maintaining smooth drainage on wounds, e.g. adopting MEBO to realize automatic drainage. Dressings shall be changed once every 4 to 6 hours, and the liquefied necrotic tissues on full-thickness wounds shall be promptly cleansed and removed. For full-thickness wounds, the ploughing therapy and thinning techniques shall be adopted to rapidly remove necrotic tissues on wounds and protect those normal tissues in an effort to reduce volume of necrotic substances and the level of toxins absorbed and the risks of sepsis on wounds. This is one of the major measures to control burn infections through in-situ skin regeneration techniques.
 
The technique of controlling bacteria and poisons through biological means can be adopted to prevent and curb wound infections. Through experiments and clinical practice, bacteria can vary morphologically in the micro environment formed by MEBO. The metabolism will slow down, the reproduction will also slow down and the volume of bacteria will decrease. This helps reduce virulence of bacteria and effectively prevents intrusion of other pathogenic bacterium. Such technique featuring reducing tissues containing bacteria and normal tissue through controlling bacteria is also an important mechanism of in-situ skin regeneration medical technique to curb and prevent burn infection.
 
MEBO contains large amount of lipid which can facilitate skin regeneration and serve as source of materials and energy for the composition of cell membranes. The lipid can save those endangering cells and can provide materials and energy necessary for the reproduction of skin stem cells and the activities of local immune cells after being absorbed into blood, thus effectively enhancing immunity to prevent infections, resuscitating endangering cells and screening new cells, resisting attack of microorganism and devouring necrotic substances and bacteria.
 
The 汕-sitosterol in MEBO can fight against inflammation like glucocorticoid after being absorbed into blood, thus reducing risks of systemic inflammatory reactions, enhancing nonspecific immunity and preventing burns infections.
With regard to application of antibiotics for systemic treatment, the partial-thickness burns of less than 30%TBSA usually do not require systematic infection-prevention treatment. And, routine treatment shall only be carried out for those burns of over 30%TBSA. The principle of using antibiotics shall be effective, low in toxins levels and short in treatment course. The administration for the first time shall not exceed 7 days, thus effectively reducing the side effects of antibiotics and reduce the formation of drug-resistant bacteria.
 

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