导入透明质酸的脱细胞羊皮联合自体微粒皮复合移植治疗大面积烧伤  

A retrospective analysis of 5 cases of major burns treated by goat acellular dermal matrix combined with hyaluronic acid

作　　者：赵筱卓[1] 宁方刚[1] 杜伟力[1] 张国安[1] 

机构地区：[1]北京积水潭医院烧伤科,100035

出　　处：《中华外科杂志》2014年第4期285-288,共4页Chinese Journal of Surgery

基　　金：首都临床特色应用研究资助项目（Z111107058811098）

摘　　要：目的 评估导入透明质酸的反复冻融结合超声振荡法制备的脱细胞羊皮应用于大面积烧伤治疗的临床疗效.方法 回顾性分析2011年6月至2013年9月行自体微粒皮联合异种皮移植术的5例患者的临床资料,患者均为男性,年龄33 ～ 50岁,平均烧伤面积83％±11％,其中Ⅲ度创面60％ ～ 90％.患者入院后按照大面积烧伤常规治疗中流程进行液体复苏、气道管理、创面处理、控制感染等治疗,待休克期度过后,血流动力学稳定时行微粒皮联合脱细胞羊皮复合移植手术.对异种脱细胞真皮在大面积烧伤治疗中的可行性及手术操作技术进行总结.结果 5例患者全部存活,休克期度过平稳,未发生严重的肺部感染、肾衰竭、创面脓毒症、败血症等严重合并症,共行9次微粒皮手术,覆盖17个肢体.平均脱细胞真皮脱落时间（17.7±2.7）d,接受手术次数（7.4±1.1）次,残余创面＜5％时间为（72±6）d,总住院时间（115 ±27）d.结论 导入透明质酸的脱细胞羊皮可替代异体皮联合自体微粒皮复合移植应用于大面积烧伤的治疗.Objective To evaluate the clinical efficacy of the goat acellular dermal matrix combined with hyaluronic acid （h-GADM） in the treatment of major burns.Methods A retrospective analysis of 5 patients with major burns undergoing combines microskin and h-GADM grafting.All patients were male,aged 33 to 50 years,and mean burn area were 83％ ± 11％,which Ⅲ degree wounds 60％ to 90％.After extensive burns patients admitted to hospital in accordance with conventional treatment processes included fluid resuscitation,airway management,wound management,infection control and other treatment.The patients received the surgery after the shock of spending and hemodynamically stable.Summarized the feasibility and operative techniques of the new method,and elaborated on details by a typical case as an example.Results All the 5 patients were survival,go through the shock period smoothly,not haven any serious complications as lung infection,wound sepsis,septicemia and kidney failure occurred.A total of nine mircoskin graft operations were undergoing and covered 17 limbs.The average time of the h-GADM desquamtion was （17.7 ± 2.7） days after operation,the hospitalization time was （115 ± 27） days.After （72 ±6） days,the residual wound was less than 5％ total body surface area.Conclusion The h-GAMD can be a good alternative to cadaver skin in the treatment of major bums.

关 键 词：烧伤 皮肤移植 生物敷料 

分 类 号：R644[医药卫生—外科学]