OXYGEN IN THE CLINICAL MANAGEMENT OF WOUNDS

该项目的中心目标是发展临床手段，以确保慢性和急性伤口的无感染和无并发症愈合。我们已经朝着这一目标取得了实质性进展。无论是理论还是临床实践，灌注和氧合都是修复最重要的要求。我们之前的研究表明：1)感染与伤口组织氧成反比，胶原蛋白与伤口组织氧成正比；2)伤口缺氧在急性和慢性伤口中都很常见；3)伤口缺氧可以通过一些简单的方法预防或纠正，包括加热、容量置换和交感神经阻滞。我们现在建议改进和开发简单的，临床上有用的方法来确定伤口灌注和氧合，这将使我们：1)描绘伤口愈合的理想条件以及如何实现它们；2)证明愈合不良的预后指标可以被设计出来，以确定潜在有用的干预措施，以改善伤口血流和氧合；3)测量和满足个体患者对伤口灌注和氧合的需求，以确保愈合。在过去，我们主要关注克服或预防伤口缺氧的需要，即创造常氧伤口。因为我们已经学会了在许多情况下克服伤口缺氧，我们现在可以进一步证明高氧在控制细菌注射和伤口血管生成方面的有益作用。此外，我们可以评估循环高氧（高压氧是其中的一个子集）作为血管生成的刺激物。这个项目中的建议主要依赖于项目1、2和3。在这方面，项目4的目标是将本计划基础科学项目的建议和先前的发现从实验室转化为床边。

The central aim of this project is to develop clinical means of assuring infection- and complication-free healing of both chronic and acute wounds. We have made substantial progress toward that goal. As a matter of both theory and clinical practice, perfusion and oxygenation are the most important requirements for repair. We have previously shown that: 1) infection is inversely proportional and collagen is directly proportional to wound tissue oxygen, 2) wound hypoxia is common in both acute and chronic wounds, and 3) wound hypoxia can be prevented or corrected by a number of simple means, including warming, volume replacement, and sympathetic blockade. We now propose to refine and exploit simple, clinically useful means of determining wound perfusion and oxygenation that will allow us: 1) to delineate the ideal conditions for wound healing and how to achieve them; 2) to demonstrate that prognostic indicators of poor healing can be devised that identify potentially useful interventions to improve wound blood flow and oxygenation; and 3) to measure and meet the individual patient's need for wound perfusion and oxygenation to assure healing. In the past we have focused largely on the need to overcome or prevent wound hypoxia, i.e. to create normoxic wounds. Because we have learned to overcome wound hypoxia in many cases we can now develop further evidence regarding the beneficial effects of hyperoxia in control of bacterial injection and in angiogenesis in wounds. Furthermore, we can evaluate cycled hyperoxia (of which hyperbaric oxygen is a subset) as a stimulant to angiogenesis. The proposals in this project rest heavily on Projects 1, 2, and 3. In this regard, the aim of Project 4 is to translate the proposals and previous findings of the basic science projects of this Program from the bench to the bedside.