银离子敷料联合水凝胶局部治疗犬咬伤Ⅲ级创面:随机分组对照  

Efficacy of ionic silver dressing and gel in local treatment of dog bite Ⅲ wounds: A randomized control study

作　　者：王金文[1] 滕永军[1] 

机构地区：[1]兰州大学第一医院急诊科,甘肃省兰州市730000

出　　处：《中国组织工程研究与临床康复》2008年第14期2659-2662,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：甘肃省科学事业费研究项目资助(QS061-C33-12)课题名称:活化血小板启动慢性伤口愈合网络调控机制的研究~~

摘　　要：背景:银离子敷料联合水凝胶在其他创面治疗中目前已取得较多临床证据,但在犬咬伤创面的作用研究较少。目的:评价银离子敷料联合水凝胶治疗严重犬咬伤创面的效果。设计、时间及地点:随机对照实验,2005-01/2007-02兰州大学第一医院急诊科收治的犬咬伤患者40例。对象:犬咬伤Ⅲ级创面患者40例,按随机数字表法分为干预组(n=20)和对照组(n=20)。银离子敷料(AQUACEL○RAg,ConvaTec,LOT:6A20132)及水凝胶(DuoDerm○RHydroactive○RGEL,ConvaTec,LOT:6G09153)为中国施贵宝康复宝医疗有限公司产品。方法:治疗前3d,两组均按照常规处理创面并进行免疫治疗和抗生素治疗。治疗第4天,干预组序贯应用银离子敷料(>10d)、水凝胶治疗,对照组采用生理盐水纱条治疗。动态观察创面愈合情况。主要观察指标:于治疗后3,10,17d记录创面愈合情况。结果:干预组犬咬伤创面的平均痊愈时间明显短于对照组,差异有显著性意义(P<0.05)。同时,治疗10,17d干预组创面范围差值高于对照组,差异有显著性意义(P<0.05)。干预组在使用银离子敷料阶段部分创面肉芽表面色泽略暗,使用水凝胶阶段部分伤口肉芽有过度生长,患者身体及创面均无不适表现,去除敷料无疼痛,肉芽无损伤;对照组去除敷料疼痛,且肉芽组织有不同程度损伤,未发现其他副作用。术后9个月随访患者9例,干预组5例,对照组4例,随访患者均未发生伤口复发与狂犬病症状,仅于患部皮肤出现局部色素沉着、皮肤瘢痕。结论:银离子敷料联合水凝胶治疗犬咬伤创面的临床效果较好,且无明显副作用。BACKGROUND： Ionic silver dressing and gel have been proved to be available in clinical treatment of various wounds at present, however, little is understood concerning their efficacy in dog bite wounds. OBJECTIVE： To evaluate the efficacy of ionic silver dressing and gel on the critical dog bite wounds. DESIGN, TIME AND SETTING： A randomized control study was carried out among 40 patients with the dog bite wound, who were admitted in Emergency Department of the First Hospital Affiliated to Lanzhou University between January 2005 and February 2007. PARTICIPANTS： Forty cases with dog bite Ⅲ wounds were divided into two groups randomly, treatment group （n=20） and control group （n=20）. Ionic silver dressing （AQUACELAg, ConvaTec, LOT： 6A20132） and gel （DuoDerm Hydroactive GEL, ConvaTec, LOT： 6G09153） were both adopted. METHODS： Before treatment, patients in both groups were pretreated with sharp debridement, immunotherapy and antibiotics therapy for the first three days in routine. From the fourth days, the wounds were treated with ionic silver dressing （〉 10 days） and gel in the treatment group, while the wounds in the control group were treated with normal saline gauze. Wound healing was observe dynamically. MAIN OUTCOME MEASURES： Wound healing was recorded at day 3, 10 and 17 after treatment. RESULTS： The average wound healing period in the treatment group was significantly shorter than that in the control group （P 〈 0.05）. Furthermore, the difference value of healing area in the treatment group was significantly higher than that in the control group （P 〈 0.05） at days 10 and 17. Wound granulation was colored darkly when ionic silver dressing was applied, and extensively grew when gel was applied in the treatment group, no complaints of the patients or pain on the dressing removal was found, without granulation injury. In the control group, the pain on the dressing removal was observed, the granulation tissue was injured at different degrees, without any side ef

关 键 词：银离子敷料 水凝胶 创面 犬咬伤 

分 类 号：R318[医药卫生—生物医学工程]