Pathophysiological analysis of third degree burn and efficacy of total escharectomy in super early phase of burn injury

研究超早期全切痂和调节介质对存活率和氧自由基产物的影响。1.超早期全切痂对患者生存率的影响：非切痂组存活率为43%(3/7)，单纯切痂组为25%(1/4)，切痂加同种异体切痂组为50%(1/2)，切痂加直接缝合组为100%(2/2)。除非切痂创面处理不当，否则超早期切痂不能延长30%三度烧伤大鼠的寿命。2.超早期全切痂对创面后2小时血浆丙二醛(MDA)水平无明显影响。烧伤后立即腹腔注射阿司匹林(50、100、200 mg/kg)可降低各剂量阿司匹林给药组大鼠血浆丙二醛水平。3.FEFEC…更多的超早期全切痂和介体调节二十烷基类化合物超早期全切痂降低血浆血栓素B2和6酮前列腺素F1α水平，阿司匹林降低TxB2水平依赖于阿司匹林剂量。阿司匹林50 mg/kg组TXB2/6ketoPGF1α比值最低，0、100、200 mg/kg阿司匹林组全切痂组TxB2/6ketoPGF1α比值低于非切痂组。结论：1.30度烧伤超早期全切痂可降低血管收缩和血小板聚集介质TXA2的生成，50 mg/kg阿司匹林可降低TXA2/PGI2比值。前列腺素I2具有扩张血管和抑制血小板聚集的作用。因此，超早期全切痂和阿司匹林50 mg/kg的介质调节是维持深烧伤动物微循环的有效方法。2.超早期切痂组预后较好，对切痂创面进行适当的创面护理是必然的。较少

The efficacies of super early phase total escharectomy and mediator modulation on survival rate and oxygen radical product, which was considered to associate with organ dysfunction, were studied. 1.Effect of super early phase total escharectomy on survival rate Survival rates were as followed ; 43% (3/7) in non-escharectomy, 25% (1/4) in escharectomy alone, 50% (1/2) in escharectomy and allograft and 100% (2/2) in escharectomy and direct suture closure. Super early phase escharectomy did not expand the life span of 30% third degree burn rats, unless the excisioned wound was not properly managed. 2.Effect of super early phase total escharectomy and mediator modulation oxygen radical product Plasma malondialdehyde (MDA) level at two hours after burn was not changed by super early phase total escharectomy. Mediator modulation by aspirin (50,100,200 mg/kg) intra peritoneal administration immediately after burn lowered the plasma MDA levels in any dose aspirin administration groups. 3.Effec … More t of super early phase total escharectomy and mediator modulation on eicosanoidsSuper early phase total escharectomy lowered plasma levels of thromboxane (Tx) B2 and 6keto prostaglandin (PG) F1 alpha, and aspirin lowered TxB2 levels in dependence on administered aspirin dose. TxB2/6ketoPGF1 alpha ratio was lowest in 50 mg/kg aspirin administered group, and this ratio was lower in total escharectomy subgroup compared with that in non-eschaectomy subgroup in 0,100,200 mg/kg aspirin administered groups.Conclusion ; 1.Super early phase total escharectomy in 30% third degree burn reduced vasoconstrictive and platelet aggregative mediator TxA2 production, and 50 mg/kg intra peritoneal administration of aspirin lowered TxA2/PGI2 ratio. PGI2 serves for vasodilatation and inhibits platelet aggregation. So super early phase total escharectomy and mediator modulation by 50 mg/kg administration of aspirin were considered useful to maintain the microcirculation in animal with deep degree burn. 2.For the better prognosis in super early phase escharectomy group, proper wound care for excised burned wound was considered inevitable. Less