Wright E H, Harris A L, Furniss D
Department of Plastic Surgery, Stoke Mandeville Hospital, and the Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom.
Medical Oncology, Department of Oncology, University of Oxford, Green Templeton College, 43 Woodstock Road, Oxford OX2 6HG, United Kingdom.
Burns. 2015 Aug;41(5):882-9. doi: 10.1016/j.burns.2015.01.004. Epub 2015 Mar 26.
The role of cooling in the acute management of burns is widely accepted in clinical practice, and is a cornerstone of basic first aid in burns. This has been underlined in a number of animal models. The mechanism by which it delivers its benefit is poorly understood, but there is a reduction in burns progression over the first 48 h, reduced healing time, and some subjective improvements in scarring when cooling is administered after burning. Intradermal temperature normalises within a matter of seconds to a few minutes, yet the benefits of even delayed cooling persist, implying it is not simply the removal of thermal energy from the damaged tissues. Animal models have used oedema formation, preservation of dermal perfusion, healing time and hair retention as indicators of burns severity, and have shown cooling to improve these indices, but pharmacological or immunological blockade of humoural and cellular mediators of inflammation did not reproduce the benefit of cooling. More recently, some studies of tissue from human and animal burns have shown consistent, reproducible, temporal changes in gene expression in burned tissues. Here, we review the experimental evidence of the role and mechanism of cooling in burns management, and suggest future research directions that may eventually lead to improved treatment outcomes.
在临床实践中，冷却在烧伤急性处理中的作用已得到广泛认可，并且是烧伤基本急救的基石。这在许多动物模型中都得到了强调。其发挥作用的机制尚不清楚，但在烧伤后的最初48小时内，烧伤进展会减缓，愈合时间缩短，并且在烧伤后进行冷却处理时，疤痕会有一些主观上的改善。皮内温度在几秒钟到几分钟内恢复正常，但即使延迟冷却也仍有效果，这意味着冷却的益处不仅仅是从受损组织中移除热能。动物模型已将水肿形成、真皮灌注的维持、愈合时间和毛发保留作为烧伤严重程度的指标，并表明冷却可改善这些指标，但对炎症的体液和细胞介质进行药理学或免疫性阻断并不能重现冷却的益处。最近，一些对人类和动物烧伤组织的研究显示，烧伤组织中的基因表达存在一致的、可重复的、随时间变化的情况。在此，我们综述冷却在烧伤处理中的作用和机制的实验证据，并提出未来可能最终改善治疗效果的研究方向。
