自体微粒皮移植术修复深度烧伤创面的临床分析  

Efficacy of autologous microskin grafting in repairing extensive deep partial and full thickness burn wounds: report of 214 cases

作　　者：张宜澜[1] 彭代智[1] 段小冬[1] 何斌[1] 周灵[1] 李睿夫[1] 黄亚兰[1] 刘洋[1] 甘雨[1] 

机构地区：[1]第三军医大学西南医院全军烧伤研究所、创伤、烧伤与复合伤国家重点实验室,重庆400038

出　　处：《第三军医大学学报》2015年第9期916-920,共5页Journal of Third Military Medical University

基　　金：卫生行业科研专项(201202002)~~

摘　　要：目的总结自体微粒皮移植术修复深度烧伤创面的临床救治经验。方法收集2002年11月至2013年8月入我院采用自体微粒皮移植术治疗深度烧伤的214例患者的临床资料,分析治疗过程中各因素对患者预后、创面愈合情况以及近、远期愈合质量的影响。结果 1伤后1周内与1周后行切痂微粒皮移植的病死率为分别为16.1%、32.1%（P〈0.05）。2对377个部位的创面愈合率进行分析,B组（扩展比5∶1~10∶1）愈合率最高,达（77.23±19.91）%,比A组（扩展比小于5∶1）具有明显优势（P〈0.05）;在相同愈合率下,B组愈合速度为（1.84±0.76）%/d明显快于C组（扩展比大于10∶1）的（1.53±0.51）%/d（P〈0.05）。3分析创面近期愈后质量显示,174个部位的表皮少量反复破溃,占所有307个部位中的56.68%。4189个部位的创面远期愈后质量显示,其瘢痕增生程度与创面一期愈合率关系密切（χ2=11.697,P〈0.05）。结论对深度烧伤患者早期行切痂微粒皮移植能明显降低患者的病死率;适当的扩展比（5∶1~10∶1）具有良好的创面愈合效果;提高创面一期愈后率能有效改善患者的远期愈合质量。Objective To summarize our experiences of autologous microskin grafting in treatment of extensive deep partial and full thickness burn wounds. Mothod8 Autologous microskin grafting was performed in 214 patients with severe burns during the period of November 2002 to August 2013 in our hospital. Their clinical data, including demographic information, clinical outcomes, wound healing indexes as well as the degree of scar hyperplasia, were all collected and categorized. The factors affecting the prognosis, wound healing and short- and long-term healing were analyzed. Rosults The mortality of the patients underwent aggressive eschar excision and autologous microskin grafting was 16.1% and 32.1% respectively within and after 7 d postburn （ P 〈 0.05 ）. In terms of expansion ratio between recipient-site to donor-site surface area for a total of 377 skin grafting sites, the ratio ranging from 5：1 to 10：1 had a higher primary wound healing rate [ （77.23 ± 19.91 ） % ] than the ratio of less than 5： 1, and a better wound healing speed than that of more than 10：1 [（1.84±0.76）%/d vs （1.53 ±0.51）%/d, P〈0.05]. Among 307 skin grafting regions, repeated ulceration of newly formed epidermis accounted for 56.68% （174/307） of all the grafted positions after short term. The higher primary wound healing rates was closely related to less scar hyperplasia in 189 skin grafting regions （ Chi square = 11. 697, P 〈 0.05 ）. Conclusion The aggressive eschar excision and autologous microskin grafting within 7 d postburn significantly reduces the mortality of patients with extensive deep burns wounds. The ratio ranging from 5：1 to 10：1 has a good wound healing efficacy. The improvement of primary wound healing rate promotes the long-term prognosis of the patients.

关 键 词：深度烧伤 微粒皮 扩展比 创面愈合 瘢痕增生 

分 类 号：R181.3[医药卫生—流行病学] R622.1[医药卫生—公共卫生与预防医学]