OXYGEN IN THE CLINICAL MANAGEMENT OF WOUNDS

该项目的中心目标是开发临床方法，确保慢性和急性伤口的无感染和无并发症愈合。我们在实现这一目标方面取得了重大进展。无论是在理论上还是在临床实践中，灌注和氧合都是修复的最重要要求。我们之前已经证明：1）感染与伤口组织氧成反比，胶原与伤口组织氧成正比，2）伤口缺氧在急性和慢性伤口中都是常见的，以及3）伤口缺氧可以通过许多简单的手段来预防或纠正，包括加温、容量置换和交感神经阻滞。我们现在提出改进和开发确定伤口灌注和氧合的简单的、临床上有用的手段，这将允许我们：1）描绘伤口愈合的理想条件以及如何实现它们; 2）证明可以设计不良愈合的预后指标，其识别潜在有用的干预以改善伤口血流和氧合;和3）测量和满足个体患者对伤口灌注和氧合的需要以确保愈合。在过去，我们主要关注克服或防止伤口缺氧的需要，即创建含氧量正常的伤口。因为我们已经学会了在许多情况下克服伤口缺氧，我们现在可以开发进一步的证据，关于高氧在控制细菌注射和伤口血管生成中的有益作用。此外，我们可以评估循环高氧（其中高压氧是一个子集）作为刺激血管生成。本项目中的提案主要依赖于项目1、2和3。在这方面，项目4的目的是将该计划的基础科学项目的建议和以前的研究结果从实验室转化为临床。

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.