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围手术期科学P50研究中心:美国国立综合医学科学研究所对团队科学的投资如何降低烧伤后死亡率。

The P50 Research Center in Perioperative Sciences: How the investment by the National Institute of General Medical Sciences in team science has reduced postburn mortality.

作者信息

Finnerty Celeste C, Capek Karel D, Voigt Charles, Hundeshagen Gabriel, Cambiaso-Daniel Janos, Porter Craig, Sousse Linda E, El Ayadi Amina, Zapata-Sirvent Ramon, Guillory Ashley N, Suman Oscar E, Herndon David N

机构信息

From the Department of Surgery (C.C.F., K.D.C., C.V., G.H., J.C.-D., C.P., L.E.S., A.E.A., R.Z.-S., A.N.G., O.E.S., D.N.H.) and Institute for Translational Sciences (C.C.F., C.V., A.N.G., D.N.H.), University of Texas Medical Branch, Galveston, Texas; and Shriners Hospitals for Children (C.C.F., K.D.C., C.V., G.H., J.C.-D., C.P., L.E.S., A.E.A., R.Z.-S., A.N.G., O.E.S., D.N.H.), Galveston, Texas.

出版信息

J Trauma Acute Care Surg. 2017 Sep;83(3):532-542. doi: 10.1097/TA.0000000000001644.

Abstract

Since the inception of the P50 Research Center in Injury and Peri-operative Sciences (RCIPS) funding mechanism, the National Institute of General Medical Sciences has supported a team approach to science. Many advances in critical care, particularly burns, have been driven by RCIPS teams. In fact, burns that were fatal in the early 1970s, prior to the inception of the P50 RCIPS program, are now routinely survived as a result of the P50-funded research. The advances in clinical care that led to the reduction in postburn death were made by optimizing resuscitation, incorporating early excision and grafting, bolstering acute care including support for inhalation injury, modulating the hypermetabolic response, augmenting the immune response, incorporating aerobic exercise, and developing antiscarring strategies. The work of the Burn RCIPS programs advanced our understanding of the pathophysiologic response to burn injury. As a result, the effects of a large burn on all organ systems have been studied, leading to the discovery of persistent dysfunction, elucidation of the underlying molecular mechanisms, and identification of potential therapeutic targets. Survival and subsequent patient satisfaction with quality of life have increased. In this review article, we describe the contributions of the Galveston P50 RCIPS that have changed postburn care and have considerably reduced postburn mortality.

摘要

自损伤与围手术期科学P50研究中心(RCIPS)资助机制设立以来,美国国立综合医学科学研究所一直支持团队科研方式。重症监护领域的许多进展,尤其是烧伤方面,都是由RCIPS团队推动的。事实上,在P50 RCIPS项目设立之前,20世纪70年代初致命的烧伤,如今由于P50资助的研究,患者已能常规存活。通过优化复苏、采用早期切除和植皮、加强包括吸入性损伤支持在内的急性护理、调节高代谢反应、增强免疫反应、纳入有氧运动以及制定抗瘢痕策略,临床护理取得进展,烧伤后死亡率得以降低。烧伤RCIPS项目的工作加深了我们对烧伤损伤病理生理反应的理解。因此,对大面积烧伤对所有器官系统的影响进行了研究,从而发现了持续性功能障碍,阐明了潜在的分子机制,并确定了潜在的治疗靶点。患者生存率以及随后对生活质量的满意度都有所提高。在这篇综述文章中,我们描述了加尔维斯顿P50 RCIPS所做的贡献,这些贡献改变了烧伤后护理方式,并大幅降低了烧伤后死亡率。

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