Copyright © 2018 Changzhou Institute of Materia Medica Co., Ltd
Sodium hyaluronate and burns
Regarding burns, I found a lot of clinical application reports of sodium hyaluronate, so the finishing part is for reference only, not for commercial use!
First, the definition of burns
Burning and scalding is an accidental pain that often occurs in life. Generally refers to heat, including hydrothermal (water, soup, oil, etc.), steam, high temperature gas, flame, hot metal liquid or solid (such as molten steel, steel ingots) and other tissue damage, mainly refers to the skin and / or mucous membrane, serious It can also injure subcutaneous or/and submucosal tissues such as muscles, bones, joints and even internal organs.
Burns are tissue damage caused by hydrothermal fluid, steam, etc., and are a type of thermal burn. Therefore, we are generally referred to as burns and scald diseases. In many hospital emergency departments and communities, burns and burns are high-risk diseases, and they are also the main factors leading to scarring and even disability in life. However, at present, no matter which level of medical institutions, the current treatment of burns and scalds are more consistent, local dressing, sputum, anti-infection, rehydration symptomatic treatment, surgical debridement, skin grafting and other ancillary treatment, although in recent years There are many treatments for scald drugs, silver sulfadiazine (SD-Ag), silver sulfadiazine suspension, silver zinc cream, moist burn cream, compound paulownia burn oil, compound sylvestris oil, hot sore oil, purple burn paste, Skin disease is scattered (furnace silver), but it is rare to have clear clinical evidence.
Second, the burn hazard
1. Red blood cells are largely dissolved, impairing kidney function
2. Produce endotoxin, metabolic disorders, microcirculatory disorders
3. Increased permeability of blood vessel wall, a large number of dehydration
4. Immune function is severely impaired, high probability of infection
5. Acid-base balance destruction, lack of energy metabolism, severe pain
Third, the incidence of burns and burns is high
Summer is the peak period for children to have burns and burns. Although the reasons are varied, many of them are caused by negligent care. For example, the child is given a bath to put hot water first, causing the child to fall into the basin to be injured; the tablecloth is pulled down by the child to turn over the hot pot; the dangerous objects such as the lighter placed by the adults Was injured by the child. In addition, if the appliance is not properly managed, it will also call for burns. According to another data, the average hospital stay for children with burns is 15 days. The cost of treatment and postoperative recovery is the highest among other injuries. Scars can affect a lifetime.
Fourth, the classification of burns
The method of dividing burns and burns is based on the nine-point method: It is proposed by the Third Military Medical University of the Chinese People's Liberation Army to divide the adult body surface area into 11 equal parts, including 9% of the head and neck and 2 9% of the upper limbs. 13% each) and perineum (1%) are 3 9%, and both lower extremities including the buttocks are 5 9% + 1% (46%)
According to the symptoms, we can be divided into I° burns called erythema burns, only a part of the epidermis, but the germinal layer is healthy, so the proliferation and regeneration ability is active, often healed within 3 to 5 days without scars; shallow II° burns, wounds And the entire epidermis and part of the nipple layer. Due to the partial damage of the germinal layer, the regeneration of the epithelium depends on the residual germinal layer and skin attachments, such as epithelial proliferation of sweat glands and hair follicles. If there is no secondary infection, it usually heals in about 1~2 weeks, and there is no scar left. Deep II° burns deeper than the dermal papilla layer, but some dermis and skin attachments remain. The healing depends on the epithelium of the skin attachment, especially the hair follicle. Proliferation of epidermal progenitor cells within the bulge. If there is no infection, it usually takes 3 to 4 weeks to heal itself, often with scars. The clinical variation is more, the shallow is close to the shallow II degree, and the deep is the critical III degree. III° burns are also called burns. Generally refers to the burn of the whole skin, the epidermis, dermis and skin attachments are all destroyed, and the wound repair depends on the surgical skin graft or flap repair. IV° burns, deep burns and muscles, bones and even internal organs. Wound repair depends on surgical skin grafting or flap repair. In severe cases, amputation is required.
5. What can sodium hyaluronate do in burns?
The pathological process of burns is divided into inflammation, proliferation, and tissue repair processes. This process usually lasts for several weeks. Fibroblasts are the cornerstone for reconstructing the dermis and blood vessels. The proliferation of bacteria is the cause of delayed healing and pain in the patient's wounds.
The root cause is that hyaluronic acid is a transparent gelatinous substance with viscous properties. It is a polysaccharide macromolecule, a basic biopolymer with various physiological functions. The HA in the skin is mainly synthesized by fibroblasts, distributed in the granule layer and the sinus layer of the dermis and epidermis, and is the main component of the extracellular and intercellular matrix, involved in the supply of nutrients and the excretion of waste in the process of cell metabolism, and It can cause a series of physiological and biochemical reactions by binding to receptors on the cell membrane, such as attracting inflammatory cells into the wound surface, promoting the movement and proliferation of epithelial cells and fibroblasts, inhibiting the differentiation of fibroblasts, and affecting the production of collagen; HA also inhibits the levels of prostaglandin E2 and the production of oxygen free radicals, relieves pain; promotes neovascularization and epithelial proliferation. Depending on its characteristics, it can be used in a variety of clinical applications other than anti-adhesion.
Sodium hyaluronate promotes the healing mechanism of burns: 1. Sodium hyaluronate can provide a moist environment. Hyaluronic acid is the most known water-retaining functional molecule. It is highly biocompatible and is a repair of burn wounds. Regeneration provides a warm and humid environment close to normal physiology, improving microcirculation and tissue ischemia, hypoxia, and eliminating and reducing free radicals. Second, repair metabolic and signaling molecular pathways to provide optimal microenvironment for wound healing; this viscoelastic matrix protects new granulation, promotes granulation and epithelial formation, thereby reducing scar formation and helping to restore healthy skin. Third, to prevent microbial entry, anti-inflammatory and relieve vascular smoothing and relieve pain.
Sodium hyaluronate gel can form an alternate network structure on the surface of burnt skin tissue, which acts as a biological barrier moisturizing effect. As a case of burns and scalds, exogenous supplementation of sodium hyaluronate is an excellent treatment route. Sodium hyaluronate itself exists in the human body, so it has no toxic side effects, good biocompatibility and high safety; and the degradation product produced by high molecular weight hyaluronic acid has the function of increasing cell migration ability.
6. Report on the application of sodium hyaluronate in practice
First, in a clinical observation of the effects of hyaluronic acid conjugation on anti-TNF-a inhibition of inflammation in burns, the use of HA in the treatment of burn patients showed that granulation grew better than the control group using saline.
Evaluation of nanohydrogel composite based on gel at in/HA/CS suffused with Asiatic acid/ ZnO and CuO nanoparticles for second degree burns. An experimental observation was made in the laboratory for the second degree burn of rats. Combined with treatment, 28 days of treatment comparison, re-epithelialization of collagen fibers, collagen fiber arrangement and angiogenesis were significantly advanced, and the repair of burn sites in rats in the treatment group and the significance of the expression of THF-α and MMP-3 decreased. And has a certain bacteriostatic effect.
In the review of The use of hyaluronic acid based dressings to treat burns: A review, it is explained that during the repair of tissue, HA often has a high concentration of reactions, which is conducive to the migration of fibrin and the proliferation of endothelial cells. This promotes the colonization process of the relevant repair cells. This clinical observation clearly confirms the role of sodium hyaluronate mentioned above in regulating fibrin and promoting endothelial cell proliferation.
Fourth, in the Role of Hyaluronic Acid Treatment in the Prevention of Keloid Scarring and TREATMENT OF PARTIAL THICKNESS BURNS WITH ZN-HYALURONAN: LESSONS OF A CLINICAL PILOT STUDY, a problem is involved in the application of sodium hyaluronate in burns. It may be possible to change the overexpression of fibroblast genes in scar hyperplasia and reduce scar formation.