Á¦¸ñ:
È»ó -- Àü¹®°¡¿ë
Ãʱâ È»óÄ¡·áÀÇ Á߿伺 ¹× ÃÖ¼ÒÀÇ È»óÈäÅ͸¦ °¡Á®¿À´Â È»ó â»óÀÇ ÃÖ±ÙÀÇ Ä¡·á[ Early
Burn Wound Management] : Revised July 1st 2007
Dong-Chul, Kim M.D., Ph.D
È»óÀ» ÀÔÀºÈÄ È»óÈäÅ͸¦ ³²±âÁö ¾Êµµ·Ï ÇϱâÀ§Çؼ´Â Ãʱâ È»óÀÇ Ä¡·á°¡ ¸Å¿ì Áß¿äÇÑ°ÍÀÌ °Á¶µÇ°í ÀÖÀ¸¸ç, °¡´ÉÇÑ »¡¸® ÃʱâÈ»óâ»óÀ»
Ä¡À¯ ½ÃÅ°°Å³ª È»óºÎÀ§¸¦ ÁÙÀÌ´Â °ÍÀÌ °áÁ¤ÀûÀÌ´Ù.
Ãʱâ È»ó ȯºÎ µå·¹½Ì¿¡¼ °¨¿° ¹× ¿°ÁõÀÇ Á¶Àý, ½ÀÀ± ȯ°æÀÇ À¯Áö, ÇǺΠÀç»ýÀ» µ½´Â ¼ºÀåÀÎÀÚ,
»çÀÌÅäÄ«ÀÎÀÇ Åõ¿©, ±¹¼ÒÀû Heparin Ä¡·áÀÇ ½ÃÀÛµîÀÌ °Á¶µÇ°í ÀÖ´Ù.
ÀÌ·¯ÇÑ Ä¡·áÀÇ Modality¸¦ À§Çؼ ÃÖ±Ù °¨¿°Á¶ÀýÀ» À§Çؼ ¿À¿°µÇ°í ¿°Áõ ¹ÝÀÀÀÌ Àִ ȯºÎ¿¡¼
with ActicoatÀÇ »ç¿ë, 2µµ È»óµîÀÇ ½ÉºÎÈ»óÀ¸·ÎÀÇ Àüȯ[conversion]À» ¹æÁöÇÏ´Â ±¹¼ÒÀûl heparinÀÇ
»ç¿ë, - antithrombotic and antiinflammatory effects , effects of increased
extracellular glycosaminoglycans which enhance collagen synthesis and
epithelializationµîÀÌ ÀÖÀ½], ÀÌ¿Ü¿¡ ÇǺÎÀÇ ºü¸¥ Àç»ý¿¡ ¿µÇâÀ»¹ÌÄ¡´Â ¼ºÀåÀÎÀÚ µéÀÇ »ç¿ë[EGF, PDF,placental
extracts(Laennec¨Þ)µîÀ» È»ó Àü¹®°¡ÀÇ ¾ö°ÝÇÑ Ã¢»ó°ü¸®ÇÏ¿¡ »ç¿ëÇÒ¼ö ÀÖ´Ù.
ÃÖ±ÙÀÇ ÀÌ·¯ÇÑ °³³äÀÇ ÀÓ»ó ¼º°ø »ç·Ê°¡ º¸°íµÇ°í ÀÖÀ¸¸ç, ÀÌ´Â °í½ÄÀû Ä¡·á¿¡ ºñÇÏ¿© ºÎºÐÃþ È»óȯÀÚÀÇ
â»óÄ¡À¯ ±âÀÏÀÌ 1-3ÀÏ Á¤µµ ÁÙ¾îµå´Â °á°ú¸¦ º¸ÀÌ°í ÀÖ¾î µû¶ó¼ ¹ß»ýµÇ´Â È»óÈäÅ͸¦ÃÖ¼ÒÈ ÇÒ ¼ö ÀÖ´Ù´Â Á¡À» ÁöÀûÇÒ¼ö ÀÖ´Ù.Ç
Indication: »ç¿ëÀÇ ÀûÀÀÁ¶°Ç
1) contaminated or infected burn wound over mid second
degree to thisr degree burn, the ActicoatTM was used from the acute stage.
2) In the cases which usually burn wound showed excoriation
of bullae and relatively non infected wound, the topical heparin or placental
extracts therapy were started. For using topical heparin therapy, the
heparin solution, 100-200U/ml was prepared, and it moisten the the hydrophilic
moist wound healing products such as AquaCel¨Þ or Mediform¨ÞTM ]. After
these dressing materials soaked in the heparin solution were applied on
the denuded burn wound, and it overdressed with transparent film dressing
such as Tegaderm¨Þ or Op site¨Þ dressing for keeping the moist wound environment.
3) Also In the cases which usually burn wound showed
excoriation of bullae and relatively non infected wound, one of growth
promoting agent of epithelialization, placental extract [Laennec¨Þ ]
Fo rits use, after 2 ml of Laennec¨Þ was diluted in 20
ml saline, it can be made 10% Laennec¨Þ solution. It moisten the hydrophilic
moist wound healing products for containing of placental extracts. The
soaked moist wound products were applied over the burn wound, and it also
covered with transparnet film dressing for keeping the moist wound environment.
°¢·Ð =
¿ ¼Õ»ó (THERMAL INJURIES)
¿Âµµ¿¡
ÀÇÇÑ ÇǺÎÀÇ Æı«´Â ½É°¢ÇÑ ±¹¼ÒÀû ±×¸®°í Àü½ÅÀû º¯È¸¦ ÃÊ·¡ÇÑ´Ù. ÀÌ·¯ÇÑ ÇǺÎÁ¶Á÷ Æı«´Â ¿, ÈÇÐ ¹ÝÀÀ, Àü±â, ȤÀº ÇÑ·©¿¡
ÀÇÇØ ÀϾÙ. ½ÉÇÑ ¿ ¼Õ»óÀ» ÀÔÀº ȯÀÚÀÇ Ã³Ä¡¿¡´Â ±¹¼ÒÀû ÇǺμջóÀÇ º´Å»ý¸®ÇÐ, Áø´Ü, óġ»Ó ¾Æ´Ï¶ó ¿¼Õ»óÀ¸·Î ÀÎÇÑ Àü½ÅÀûÀÎ
Ç÷¾× ¿ªÇÐÀû(hemodynamic), ´ë»çÀû(metabolic), ¿µ¾çÇÐÀû(nutritional), ¸é¿ªÇÐÀû(immunologic),
±×¸®°í Á¤½ÅÀû Ç×»ó¼º(psychological homeostasis) ±âÀüµîÀÇ ºÒ±ÕÇü¿¡ ´ëÇÑ ÀÌÇØ°¡ ÇÊ¿äÇÏ´Ù.
±¹³»
È»óȯÀÚÀÇ ¹ß»ýÀº ¸Å³â ¾à 13000¸í ÀÌ»óÀÌ ÀÔ¿ø °¡·áÇÏ°í ÀÖÀ¸¸ç, ¾à 23¸¸¸íÀÌ ¿Ü·¡È¯ÀÚ·Î º´ÀÇ¿ø¿¡¼ Ä¡·áµÇ°í ÀÖ´Ù. ±¹³»
ÀÔ¿øÇÑ È»óÀÇ °¡Àå ¸¹Àº ¿øÀÎÀ¸·Î´Â È¿°È»óÀ̸ç, ¿ÅÁÈ»ó, Á¢ÃËÈ»ó, Àü±âÈ»ó, ÈÇÐÈ»ó ±âŸÀÇ ¼øÀÌ´Ù. ¼Ò¾ÆÈ»óȯÀÚ´Â ÀüüȻóȯÀÚÀÇ
¾à 1/3À» Â÷ÁöÇÏ°í ÀÖ´Ù. ÃÖ±Ù 6°³¿ù¿¡¼ 2³â »çÀÌÀÇ ¿¬·ÉÀÇ ¼Ò¾Æ¿¡¼ Àü±â ¶Ç´Â ¾Ð·Â ¼ÜÀÇ Áõ±â¿¡ ÀÇÇØ ¼öºÎ¿¡ È»óÀ» Áõ±âÈ»óÀÇ
¿¹°¡ ±¹³»¿¡ ¸¹ÀÌ ¹ß»ýµÇ°í ÀÖ¾î ºÎ¸ðÀÇ °¢º°ÇÑ ÁÖÀÇ°¡ ¿ä±¸µÈ´Ù. ¶ÇÇÑ 2 - 6¼¼ÀÇ ¾î¸°¾ÆÀÌ¿¡¼ ³Ã¿Â¼ö±â¿¡ ÀÇÇÑ È»ó ¶ÇÇÑ ºó¹øÇÏ°Ô
ÀϾ°í ÀÖ´Ù.
ÈçÈ÷
È»óȯÀÚÀÇ ÀÔ¿ø±â°£Àº Àü½Åüǥ¸éÀû(total body surface area: TBSA)¿¡ ´ëÇÑ È»óºÎÀ§ÀÇ %¿¡ 1-1.5ÀÏÀ»
°öÇÑ ±â°£ÀÌ ¿äÇÑ´Ù.
¡¡
I. È»ó(BURNS)
¡¡
1)
ÇǺÎÀÇ ±â´É ¹× ±¸Á¶(function and structures)
(1)±â´É
¹æ¾î(protection):
ÁÖº¯ ȯ°æÀÇ ¿Âµµ, ÈÇй°Áú, ¼¼±Õ, ¿Ü»ó µî¿¡ ´ëÇÑ º¸È£º®
¸é¿ªÇÐÀû(immunologic):
°¢ÁúÃþ(keratin layer)Àº ¼¼±Õ¿¡ ´ëÇÑ ¹æ¾î ÀÛ¿ëÀ» ÇÑ´Ù.
¼ö¾×
±ÕÇü(fluid balance): ¼öºÐ ¼Ò½Ç(water loss)À» ¹æÁö
ü¿ÂÁ¶Àý(thermoregulation):
°úµµÇÑ ¿ ¼Ò½Ç°ú ¿ ȹµæÀ» ¹æÁö
½Å°æ°¨°¢(neurosensory);
ÅëÁõ,ü¿Â, °¨°¢ÀÇ ¼ö¿ë±â(receptors)
»çȸÀûÀÎ
»óÈ£ÀÛ¿ë(social-interaction): ¿Ü¸ð
(2)±¸Á¶
a)µÎ²²:
¾à 1-2 mm À̸ç, ¹Ì¹ß´ÞµÈ À¯¾Æ, À§ÃàÀÌ ÀÖ´Â ³ëÀο¡¼ ¾ã¾ÆÁø´Ù.
b)»óÇÇ:
¹Ù±ùÂÊ ¾ãÀº ÃþÀ¸·Î ÁÖ·Î »óÇǼ¼Æ÷·Î ±¸¼ºµÇ¾î ÀÖÀ¸¸ç, Á¦ÀÏ
¹Ù±ùÂÊ¿¡
Äɶóƾ(keratin)À» Æ÷ÇÔÇÑ ¼¼Æ÷¸¦ °¢È¼¼Æ÷(keratinocyte)¶ó ºÎ¸¥´Ù.
±âÀú »óÇǼ¼Æ÷´Â ÆÄÀ̺긮³ë³Øƾ(fibronectin)À̶ó ºÒ¸®´Â ºÎÂø ºÐÀÚ(adhesion molecule)¿¡ ÀÇÇØ
±âÀú¸·(basement membrane)¿¡ ºÎÂøµÇ¾î ÀÖ´Ù. ÀÌ ¹Ì¼º¼÷ ¼¼Æ÷´Â °è¼Ó ºÐ¿ÇÏ¿© À̵¿(migration)
µÇ¾î ¹Ù±ùÂÊÀ¸·Î Å»°¢µÈ Ç¥¸éÀÇ ¼¼Æ÷¸¦ º¹À§ÇÑ´Ù. ¿Ü»óÈÄ »óÇǼ¼Æ÷ÀÇ º¹À§(replacement)´Â ÀÌ·¯ÇÑ Àç»ý°úÁ¤(regenerative
process)¿¡ ÀÇÇϸç, ÀÌ·¯ÇÑ Àç»ýÀº ÃÖÀûÀÇ Á¶Á÷ Ä¡À¯ ȯ°æ(optimal tissue healing enviroment)¿¡
ÀÇÇØÁö¸ç, ¼ºÀåÀÎÀÚ(growth factor)¶ó°í ºÒ¸®¿ì´Â ÈÇÐÀû ÀÚ±Ø(chemical stimuli)Àº ¹°·Ð ¼¼Æ÷
º¹Á¦(replication), À̵¿(migration)ÀÇ °úÁ¤À¸·Î ÀÌ·ç¾îÁø´Ù. ¸¹Àº ±× ½ÅÈ£(cues)´Â ÁøÇÇ ¿ä¼Ò(dermal
elements)¿¡¼ ¿À¸ç ƯÈ÷ ÁøÇÇÀÇ ±âÁú ´Ü¹éÁú(matrix protein)ÀÎ ÆÄÀ̺긮³ë³Øƾ(fibronectin),
±âÁú ÈÇÕ¹°(matrix compound)ÀÎ hyaluronic acid·ÎºÎÅÍ ¿Â´Ù.
(c)ÁøÇÇ:
À¯µÎ ÁøÇÇ(papillary dermis) -- epidermal rete pegÀ» Æ÷ÇÔ
¸Á»ó ÁøÇÇ(reticular dermis)
±âº» ¼¼Æ÷ Çü(primary cell type)Àº ¼¶À¯¾Æ¼¼Æ÷(fibroblast)À̸ç, ¿©±â¿¡¼ Áß¿äÇÑ ¼¼Æ÷¿Ü ±âÁú
´Ü¹éÁú(extracellular matrix protein)ÀÎ ±³¿øÁú(collagen), ź·Â¼Ò(elastin),
±âÁú(matrix,ground substance)µîÀ» »ý¼ºÇÑ´Ù. ¶ÇÇÑ ÀÌ ¼¼Æ÷´Â »óÇǼ¼Æ÷¸¦ ±âÀú¼¼Æ÷¸·¿¡ ºÎÂø½ÃÅ°´Â
ºÎÂø´Ü¹éÁú(adhesion protein)À» »ý»êÇÑ´Ù. ÀÌ ºÎÂø ´Ü¹éÁú(adhesion protein)Àº »óÇÇÀ̵¿(epidermal
migration)°ú º¹Á¦(replication)¿¡ ÀÛ¿ëÇϱ⵵ ÇÑ´Ù. ±âÁú(matrix)Àº glycosaminoglycans(GAG
component) ¶ó°í ºÒ¸®´Â complex polysaccharide-protein complex, hyaluronic
acidµîÀ¸·Î ÀÌ·ç¾îÁ® ÀÖ´Ù. ÀÌ ±âÁú(matrix)Àº ¼¼Æ÷(cell)¿Í °áüÁ¶Á÷ ¹æÇ⼺( connective tissue
orientation) ¼¼Æ÷¿¡ ¿µ¾çºÐ È®»ê(nutrient diffusion)À» ÇÏ°ÔÇÏ´Â ¹ÝÀ¯µ¿¼º(semifluid)À»
Á¦°øÇÏ°í, ¼¼Æ÷ À̵¿(cell migration)ÀÇ ºñ°è(scaffold)·Î ¿ªÇÒÀ» ÇÑ´Ù. ¼¶À¯¾Æ¼¼Æ÷¿¡¼ »ý»êÇÏ´Â
¹°Áú(Fibroblast products)·Î´Â ¨ç ±³¿øÁú(collagen, ÁÖ·Î ÇǺο¡¼´Â Type one) ¨è ±âÁú
´Ü¹éÁú(matrix protein)·Î´Â ÆÄÀ̺ê·Î³Øƾ(fibronectin), tenascin µî ¨éproteoglycans,
glycosaminoglycan, hyaluronic acid, ±âŸÀÇ ´Ù¸¥ ±âÁú ±¸¼º¼ººÐµé(matrix components),
¨ê»çÀÌÅäÄ«ÀÎ(cytokynes), ´Ù¸¥ ¼ºÀå ÃËÁø¹°Áú( other growth stimulants)µîÀÌ ÀÖ´Ù.
¡¡
Fig.1. ÇǺÎÀÇ ±¸Á¶
¡¡
2)
È»óÈÄ »ý¸®ÇÐÀû º¯È
a)¼øȯ±â º¯È(circulatory derangement)
¸ð¼¼Ç÷°ü Åõ°ú¼º(capillary permeabilty)ÀÌ Áõ°¡Çϸç, ´Ü¹éÁú(protein)°ú ÀüÇØÁú(ƯÈ÷ Na+)
ÀÌ ¸¹Àº ü¾× ¼Õ½ÇÀÌ ¹ß»ýµÇ¸ç Ç÷¾×·®°¨¼Ò(hypovolemia), ½ÅÇ÷·ù·®(renal blood flow) °¨¼Ò,
GFR °¨¼Ò, ºó´¢(oliguria), venous return , ½É¹ÚÃâ·®(cardiac output) °¨¼Ò,
Ç÷¾×·® °¨¼Ò¿¡ ÀÇÇÑ ¼ï(hypovolemic shock)µîÀ¸·Î ÁøÀüµÈ´Ù.
b)ºóÇ÷(anemia)
Æò±Õ ÀûÇ÷±¸ ¼Ò½ÇÀÌ ÀüüÀÇ 15%
(Àüü ÀûÇ÷±¸ÀÇ 4-40%)¿¡ ÇØ´çµÇ¸ç,
ÀÌÀÇ ±âÀüÀ¸·Î´Â È»óºÎÀÇ ÀûÇ÷±¸
°¨¼Ò(destruction of RBC in burned area), ¸ð¼¼Ç÷°ü¿¡¼ÀÇ Æ÷Âø(trapping in
capillary),ÀûÇ÷±¸ Æı«¼ºÀÇ Áõ°¡(increased fragility of RBC),¿ëÇ÷( hemolysis),
ÀûÇ÷±¸ »ýÁ¸±â°£ÀÇ °¨¼Ò(shortening of RBC survival time) µîÀ¸·Î ¼³¸íµÉ¼ö ÀÖ´Ù.
c) ´ë»çÀû ¹ÝÀÀ(metabolic response)
¿ »ý»ê Áõ°¡(increased heat production),üÁß°¨¼Ò(weight loss), negative
nitrogen balance, negative potassium & phosphorous balance,
ź¼öȹ° ¹× Áö¹æ´ë»ç ÀÌ»óÀÌ ¿Â´Ù.
d)¼¼Æ÷ ¼Õ»óÀÇ È¿°ú(effect of cellular injury)
±¹¼ÒÀûÀ¸·Î´Â Ç÷°üÈ°¼º ¿ä¼Ò(vasoactive elements)ÀÇ À¯¸®, ¼¼Æ÷°£ »ïÅõ¾Ð ³óµµ(interstitial
osmorality )°¡
Áõ°¡µÇ¸ç, Àü½ÅÀûÀ¸·Î´Â È£¸£¸ó(hormone)ÀÇ ºÐºñ, ¸é¿ªÇÐÀû(immunologic) È¿°ú°¡ ¹ß»ýµÈ´Ù.
¿©·¯ ¼ºÀåÀÎÀÚ(growth factors)µé°ú »ýÀÇÇÐÀûÀÎ Á¶Á¤±â( biomedical mediators) µéÀÎ
ÇÁ·Î½ºÅ¸±×¶õµò(prostaglandin), Å°´Ñ(kinins),¼¼·ÎÅä´Ñ(serotonin),È÷½ºÅ¸¹Î(histamin),
oxygen radicals,lipid peroxidaseµîÀÇ À¯¸®,
¾Ë·ÁÁø ÇǺΠ¼ºÀåÃËÁøÀÎÀÚ(growth factors and growth enhancing agents)ÀÇ Á¾·ù´Â
Æú¸®ÆéƼµå ¼ºÀåÀÎÀÚ(polypeptide growth factors), ÈÇÐÀû
Àü´Þü(chemical messenger)µîÀ» µé¼öÀÖ´Ù. »ý¼ºÀå¼Ò´Â ÁÖ·Î ´ÜÇÙ±¸(monocytes), ´ë½Ä¼¼Æ÷(macrophages)
¹× ±âŸ ¸ðµç ÇǺμ¼Æ÷¿¡¼ ¸¸µé¾îÁö´Â °ÍÀ¸·Î ¾Ë·ÁÁ®ÀÖ´Ù. È»óÈÄ¿¡µµ â»óÄ¡À¯¿Í °ü·ÃµÈ ¿©·¯Á¾·ù ¼ºÀåÀÎÀÚµéÀÌ
ºÐºñµÇ°Ô µÈ´Ù.
¡¡
Table
1. â»óÄ¡À¯¿¡ °ü·ÃµÈ ÁÖ¿ä growth factors
Molecules
/ source
/Action
Basic
fibrogrowth factor /keratinocyte,fibroblast /stimulate epidermal
cell growth
Epidermal
growth factor /Salivary gland Stimulate /epidermal cell proliferation
Keratinocyte
growth factor /Hypothalamus
/Stimulate epidermal cell growth
Interleukin-1
/Macrophages, epidermal cells /Stimulate epidermal growth and motility
Plaelet-Drived
Growth Factor /Platelet endothelium /Stimulate epidermal hyperplasia in
combination with EGF
Transforming
growth factor-B /Fibroblast, Platelet /All forms inhibit epidermal
cell proliferation but stimulate motility
¡¡
3) °í¿Â¿¡ ÀÇÇÑ ÇǺÎÁ¶Á÷ÀÇ º´Å»ý¸®
¡¡
(1)°í¿ÂÀº ºü¸¥ ´Ü¹éÁú º¯¼º°ú ¼¼Æ÷¼Õ»óÀ» ÀÏÀ¸Å²´Ù. Á¶Á÷ Æı«ÀÇ ½ÉÇÑ Á¤µµ´Â ¿Âµµ¿Í ³ëÃâµÈ ½Ã°£¿¡ ºñ·ÊÇϸç(Fig.
9-1),
¶ÇÇÑ ¿Àü´ÞÀÇ ¸Å°³Ã¼¿¡ ÀÇÇØ °áÁ¤µÈ´Ù. ¶ß°Å¿î ¹°Àº dry heat(ºÒ) º¸´Ù ´õ »¡¸® Á¶Á÷À¸·Î ¿À» Àü´ÞÇÑ´Ù. ´ëºÎºÐÀÇ
È»óÀº ¸Å¿ì °í¿Â¿¡¼¸¸ ÀϾ´Â °ÍÀº ¾Æ´Ï¸ç, Á߽ɿµµ(Core temperature) 370C ¿¡¼ 6µµ¸¸
³ô¾Æµµ È»óÀ» ÀÔÀ» ¼ö ÀÖÀ¸¸ç, Ç¥¸é ü¿Â ¼·¾¾ 60µµ À̻󿡼 Áï½Ã ¼¼Æ÷°¡ Á×°í Ç÷ÀüÀÌ ¹ß»ýµÈ´Ù. ¶ÇÇÑ ¾ãÀº µÎ²²ÀÇ
ÇǺο¡¼ ´õ ±íÀº È»óÀ» À԰ԵȴÙ.
¡¡
Fig. 2. ¿Âµµ¿Í ³ëÃâ½Ã°£¿¡ µû¸¥ Á¶Á÷Æı«
¡¡
Table
2. ¶ß°Å¿î ¹°¼Ó¿¡¼ ÀüÃþÈ»óÀ» ÀÏÀ¸Å³¼ö ÀÖ´Â ¿Âµµ
Time
|
Temperature ( ¡É )
|
1 second
|
70
|
2 seconds
|
65.6
|
10 seconds
|
60
|
30 seconds
|
54.5
|
1 minute
|
52.7
|
10 minute
|
48.9
|
(2) ¿°Áõ¹ÝÀÀ¿¡ ÀÇÇØ ÃÊ·¡µÇ´Â ¼Õ»ó(Inflammation mediated injury)
( ¼ö»óÈÄ 1-3ÀÏ)
È»óÀ¸·Î È°¼ºÈµÈ ¿°Áõ¹ÝÀÀÀÇ µ¶¼º Á¶Á¤±â(toxic mediators)¿¡ ÀÇÇØ ´õ ¸¹Àº Á¶Á÷¼Õ»óÀÌ ¹ß»ýµÈ´Ù. ¹°·Ð â»óÄ¡À¯ÀÇ
°úÁ¤¿¡ ¿°Áõ¹ÝÀÀ(inlammatory response)´Â ÇÊ¿äÇÏÁö¸¸ °úµµÈ÷ »ý¼ºµÈ »êÈÁ¦(oxidants), ´Ü¹éÁúºÐÇØÈ¿¼Ò(protease)
µîÀº ¸ð¼¼Ç÷°üÀÇ ³»ÇÇ(endothelium)ÀÇ ¼Õ»ó, ÇǺΠ¼¼Æ÷ ¼Õ»óµîÀ» ´õ¿í ½ÉÇÏ°Ô ÇÑ´Ù. ´Ü¹éÁúºÐÇØÈ¿¼Ò(protease)´Â
Ä¡À¯µÇ´Â Á¶Á÷(healing tissue)¸¦ ¼Õ»ó½ÃÅ°¸ç, ¼ºÀåÀÎÀÚ(growth factor)¸¦ ¹«·ÂÈÇϸç, »êÈÁ¦(oxidants)´Â
¼¼Æ÷¸¦ Á×À̸ç, ´Ü¹éÁúÀ» º¯¼º, ¿°ÁõÀ» ´õ¿í È°¼ºÈÇÏ´Â ÀÛ¿ëÀ» ÇÑ´Ù.
µû¶ó¼ ÀÌ·¯ÇÑ Á¶Á¤±â(mediators)ÀÇ ÀÛ¿ëÀ» Á¶±â¿¡ ¹æÁöÇÒ ÇÊ¿ä°¡ ÀÖ´Ù.
(3) ÇãÇ÷¿¡ ÀÇÇØ À¯µµµÇ´Â ¼¼Æ÷ ¼Õ»ó( Ischemia induced cell injury )
¼Õ»ó¹ÞÀº ¸ð¼¼Ç÷°üÀº °è¼Ó Ç÷ÀüÀÌ ÁøÇàµÇ¸ç ´õ ½ÉÇÑ ÇãÇ÷(ischemia)¿Í Á¶Á÷±«»ç¸¦ À¯µµÇÑ´Ù. Àü½ÅÀûÀÎ Ç÷¾Ð°ÇÏ¿Í ±¹¼ÒÀûÀÎ
Ç÷¾×¼øȯ ÀåÇØ ¿ª½Ã ºñ½ÁÇÑ È¿°ú¸¦ ÃÊ·¡ÇÑ´Ù.
(4)Delayed injury
Ãʱâ È»ó ¹× mediatorsÀÇ ¼Õ»óÈÄ¿¡µµ Áö¼ÓµÇ´Â Á¶Á÷ÀÇ ¼Õ»óÀÌ ¿Ã¼ö ÀÖ´Ù.
È»óºÎÀÇ °¡ÇÇ, ¼¼±ÕÁý¶ôÇü¼º(bacterial colonization), ±â°èÀû ¿Ü»ó(mechanical trauma),
½ÉÁö¾î´Â µµÆ÷ÇÑ ¿Ü¿ëÇ×±ÕÁ¦(topical antibacterial agent)µî¿¡ ÀÇÇؼµµ ¹ß»ýµÈ´Ù.¶ÇÇÑ »óóºÎÀ§ÀÇ °úµµÇÑ
È£Áß±¸(neutrophil) ¹× ±Ø½ÉÇÑ ´Ü¹éÁú ºÐÇØÈ°¼º( proteolytic activity)µµ â»óÄ¡À¯¸¦ Áö¿¬½ÃŲ´Ù.
(5)È»ó¼Õ»óÀÇ 3 Áö¿ª(Three Zone of Injury)
a.ÀÀ°í´ë(zone of coagulation or zone of tissue necrosis) ºñ°¡¿ªÀû ¼¼Æ÷¼Õ»ó ºÎÀ§
b.Á¤Ã¼´ë(zone of stasis or Zone of tissue injury) 24~48½Ã°£ ³»¿¡ Ưº°ÇÑ Ã³Ä¡ ¾øÀÌ´Â
¼¼Æ÷ ±«»ç°¡ ÁøÇàµÇ´Â Áö¿ª. Áö¼ÓÀûÀÎ ÇǺ기 ħÂø( fibrin deposition),Ç÷°ü¼öÃà(vasoconstriction),
Ç÷Àü(thrombosis)µîÀ¸·Î ÇãÇ÷(ischemia)À» ÃÊ·¡ÇÏ¿© ¼¼Æ÷¸¦ Á×°ÔÇÏ´Â ºÎÀ§.
c.¿ïÇ÷´ë(zone of hyperemia) ÀûÀº ¼¼Æ÷¼Õ»óÀÌ ¹ß»ýµÈ ºÎÀ§·Î °¨¿°(invasive infection )
¶Ç´Â ½ÉÇÑ ¿°ÁõÀÌ ¾øÀ¸¸é ¼öÀÏ ÈÄ È¸º¹ÀÌ °¡´ÉÇÑ Áö¿ª
â»óÀüȯ(wound conversion);ÁÖ·Î Áß°£ ¹× ½ÉºÎ 2µµ È»ó(mid-to deep dermal burns)¿¡¼
ȯºÎÀÇ Ç÷·ù°¨¼Ò, â»óÄ¡À¯±â°£ÀÇ Áö¿¬,
°úµµÇÑ ¿°Áõ ¹× ½ÉÇÑ °¨¿°ÀÌ ÀÖ´Â °æ¿ì¿¡ ¹ß»ýµÈ´Ù.Áï »ó±â Á¤Ã¼´ë(zone of stasis) °¡ ÀÀ°í´ë(zone
of coagulation)·Î º¯È¯µÇ´Â °ÍÀÌ´Ù.
Fig.3.È»ó¼Õ»óÀÇ 3 Áö¿ª(Three Zone of Injury)
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