OXYGEN IN THE CLINICAL MANAGEMENT OF WOUNDS

该项目的中心目标是开发确保慢性和急性伤口无感染和无并发症愈合的临床方法。我们在实现这一目标方面取得了实质性进展。无论在理论上还是临床实践中，灌注和氧合都是修复的最重要要求。我们以前已经证明：1)感染成反比，而胶原与伤口组织氧成正比，2)伤口缺氧在急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来预防或纠正，包括加温、容量替代和交感神经阻断。我们现在建议改进和开发简单的、临床上有用的确定伤口血流和氧合的方法，使我们能够：1)描绘伤口愈合的理想条件和如何实现这些条件；2)证明可以设计出愈合不良的预后指标，以确定潜在的有用干预措施，以改善伤口的血流和氧合；以及3)测量和满足个体患者对伤口血流和氧合的需求，以确保愈合。在过去，我们主要关注克服或防止伤口缺氧的需要，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剂。本项目中的建议主要依赖于项目1、2和3。在这方面，项目4的目的是将本计划的基础科学项目的建议和以前的发现从工作台上翻译到床边。

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.