摘要
目的研究大面积深Ⅱ度烧伤创面不同的处理方法及与创面愈合的关系。方法对52烧伤面积>30%且创面以深Ⅱ度烧伤为主的烧伤患者,进行前瞻性研究。按对创面处理的方式不同,将其分为早期磨痂组(A组)、削痂组(B组)、保痂组(C组)。A组18例,休克纠正后,48 h内在全麻下行磨痂术,用钢丝球磨除创面的坏死组织,刚好有致密的小出血点为止,创面冲洗后,再用术尔泰纱布湿敷,最后将生物敷料(脱细胞猪真皮基质)覆盖创面,外层用纳米银纱布加压包扎。B组17例,用滚轴刀削除创面坏死组织,其他处理同磨痂组。C组17例,用苯扎溴铵简单冲洗,创面用磺胺嘧啶银乳膏包扎处理,并上悬浮床或翻身床,换药治疗。观察创面愈合时间,愈合创面色素沉着深浅,瘢痕严重程度。同时比较全身炎症反应综合征及脓毒症发生率,以及内毒素、IL-6、IL-8的动态变化。结果A组平均愈合时间为14.1 d,B组平均愈合时间17.2 d,C组平均愈合间为19.8 d;A组愈合质量优于B、C组。A组全身炎症反应综合征及脓毒症发生率较C组低,LPS、IL-6、IL-8同时低于C组。A组与B组相比,SIRS及SEPSIS无显著性差异,LPS、IL-6、IL-8相比差异无统计学意义。结论大面积深Ⅱ度烧伤早期全麻下磨痂,能缩短创面愈合时间,愈合质量好,瘢痕轻,而且降低创面感染及炎症介质的释放。
Objective To investigate the relationship between early eschar grinding and wound healing in the patients with large area of deep partial thickness burns. Methods Prospective studies were conducted in 52 patients with more than 30% TBSA of deep partial thickness bums. The patients were divided into eschar grinding group （A group）,eschar shaving group （B group）,and conservative care group （C group） according to the different treatments. The 18 patients in A group were treated with dermabrasion under general anesthesia within 48 hours after admission,while 17 patients in B group with eschar shaving. The burn wounds of 17 patients in C group were treated with 0.2% bromogeramine solution and 1% sulfadiazine silver cream,and changed dressings everyday. The wound healing time,scar hyperplasia,occurrence of systemic inflammatory response syndrome（SIRS） and sepsis,development of serum lipopolysaccharide （LPS）,IL-6,and IL-8 of the three groups were compared. Results The patients were healed averagely within 14.1 days,17.2 days,and 19.8 days respectively in A,B,and C group. Less car hyperplasia were examined in A group compared with B or C group. The incidence rate of SIRS and sepsis in A group was lower than that of C group. The serum levels of LPS,IL-6,and IL-8 in A group were also lower than C group. However,these data were not statistically significant between A and B group. Conclusion Early eschar grinding of large area deep partial thickness burns under general anesthesia could shorten wound healing time ,improve healing quality,and may avoid burn wound and systemic infection.
出处
《实用医药杂志》
2014年第12期1066-1068,1071,共4页
Practical Journal of Medicine & Pharmacy
关键词
烧伤
磨痂
削痂
创面修复
Burn
Eschar grinding
Eschar shaving：Wound healing
