全身烧伤伴吸入性损伤患者1例个性化护理

摘 要：烧伤不仅给人体造成巨大的生理创伤，还造成严重的心理创伤，再加上面对家庭的破坏，在这种状态下，患者会出现一些极端的应激反应，早期采取有效的康复护理干预便显得尤为重要。笔者所在的科室于2019年7月收治1例全身烧伤伴吸入性损伤的患者，该患者烧伤面积高达92%，在烧伤治疗和护理上存在极大的难度。最终通过科室医务人员的不懈努力，成功将患者救治。现将该患者于烧伤重症期间护理体会介绍如下， 总结归纳护理经验，以供同行参考。

关键词：烧伤 休克 护理 吸入性损伤

手外伤伤口感染的相关因素分析与护理教育

摘 要:目的 探讨手外伤伤口感染的相关因素以及护理教育。方法 以某三甲医院为例,调查了手外伤伤口感染患者的相关资料。通过对未接受过伤口护理教育的手外伤患者与接受过伤口护理教育的手外伤患者情况进行调查。结果 发现手外伤患者的伤口感染程度主要与患者的文化程度、就诊时间、清创不彻底以及机体免疫力等有关。发现接受过伤口护理教育的手外伤患者比未接受过伤口护理教育的手外伤患者的伤口感染率明显下降。结论 指导患者采取正确的处理方法保护创面,对促进康复具有重要意义。

关键词:手外伤 伤口感染 相关因素 护理教育

一种可调节温湿度的防压疮吸氧面罩

摘 要：文章介绍一种可调节温湿度的防压疮吸氧面罩的改良与应用。此吸氧面罩包括防压疮气囊、可调节固定带、可调节温湿度装置、单向阀排气孔、干燥盒。防压疮气囊包括内环空腔层、透气减压层（纱布外层内为记忆海绵）、充气孔与挤压气囊。可调节温湿度装置包括蓄电池组件、温度调节器（内含加热管）与湿度调节器，且后端与缓冲座相连接。此吸氧面罩能有效防止患者长时间使用而引起面部皮肤损伤甚至溃疡，预防压疮的发生，也能改变氧气的温湿度，使患者吸入适宜的氧气，避免气道黏膜干燥，增加舒适感。同时，可固定调节带采用输液管材质，并使用魔术贴，方便使用，性价比高，易被患者所接受。

关键词：吸氧面罩；防压疮；可调节温湿度

Custom-Molded Offloading Footwear Effectively Prevents Recurrence and Amputation, and Lowers Mortality Rates in High-Risk Diabetic Foot Patients: A Multicenter, Prospective Observational Study

Background: Recurrence of high-risk diabetic feet, after wound, healing is a common challenge among diabetic patients. Continuous use of an offloading device significantly prevents recurrence of high-risk diabetic feet, although patient adherence is imperative to ensuring this therapy’s clinical efficacy. In this study, we explored clinical outcomes of patients with a high-risk diabetic foot who had been prescribed with custom-molded offloading footwear under different adherence conditions.

Methods: A total of 48 patients (17 females and 31 males) with high-risk diabetic feet, who had been with prescribed offloading footwear in 13 medical centers across 4 cities, were enrolled in the current study. The patients were assigned into either continuous offloading therapy (COT, n = 31) or interrupted offloading therapy (IOT, n = 17) groups, according to their adherence to the therapy. All patients were followed up monthly, and differences in recurrence, amputation, and deaths between the groups were analyzed at 4 months after therapy.

Results: Forty-eight patients met our inclusion criteria and were therefore included in the final analysis. Among them, 31 were stratified into the COT group and adhered to offloading therapy throughout the study period, whereas 17 were grouped as IOT and exhibited interrupted adherence to offloading therapy. We found statistically significant differences in recurrence rates (0 vs 38.46%, p < 0.01), amputation (0 vs 11.76%, p < 0.01), and deaths (0% vs 5.88%, p < 0.01) between the groups during follow-up.

Conclusion: Patients’ adherence is imperative to efficacy of custom-molded offloading footwear during treatment of high-risk diabetic foot. Further studies are needed to elucidate the role of improved design of the offloading device and the need for enhanced patient education for improved adherence.

Keywords: custom-molded offloading footwear, high-risk diabetic foot, patient adherence

Milk exosomes-mediated miR-31-5p delivery accelerates diabetic wound healing through promoting angiogenesis

Abstract:The refractory diabetic wound has remained a worldwide challenge as one of the major health problems. The impaired angiogenesis phase during diabetic wound healing partly contributes to the pathological process. MicroRNA (miRNA) is an essential regulator of gene expression in crucial biological processes and is a promising nucleic acid drug in therapeutic fields of the diabetic wound. However, miRNA therapies have limitations due to lacking an effective delivery system. In the present study, we found a significant reduction of miR-31-5p expression in the full-thickness wounds of diabetic mice compared to normal mice. Further, miR-31-5p has been proven to promote the proliferation, migration, and angiogenesis of endothelial cells. Thus, we conceived the idea of exogenously supplementing miR-31-5p mimics to treat the diabetic wound. We used milk-derived exosomes as a novel system for miR-31-5p delivery and successfully encapsulated miR-31-5p mimics into milk exosomes through electroporation. Then, we proved that the miR-31-5p loaded in exosomes achieved higher cell uptake and was able to resist degradation. Moreover, our miRNA-exosomal formulation demonstrated dramatically improved endothelial cell functions in vitro, together with the promotion of angiogenesis and enhanced diabetic wound healing in vivo. Collectively, our data showed the feasibility of milk exosomes as a scalable, biocompatible, and cost-effective delivery system to enhance the bioavailability and efficacy of miRNAs.