水动力清创系统在严重烧伤患者大面积残余创面清创中的应用效果  

Efficacy of a hydrosurgery system applied in the debridement of extensive residual wounds of patients with severe burn

作　　者：刘功成[1] 阚朝辉 盛嘉隽 李海航[1] 李磊[1] 孙瑜[1] 纪世召[1] 朱世辉[1] 

机构地区：[1]第二军医大学长海医院烧伤外科,全军烧伤研究所,上海200433 [2]皖北卫生职业学院附属医院烧伤科

出　　处：《中华烧伤杂志》2016年第9期549-554,共6页Chinese Journal of Burns

基　　金：国家自然科学基金（81120108015、81501665）

摘　　要：目的 前瞻性探讨水动力清创系统（简称水刀）在严重烧伤患者大面积残余创面清创中的应用效果。方法 2012年5月—2015年11月，第二军医大学附属长海医院烧伤外科收治76例严重烧伤经治疗后遗留大面积残余创面患者。按随机数字表法将患者分为水刀清创组34例和传统清创组42例，分别采用水刀和常规手术器械对残余创面进行清创，2组患者残余创面清创后均取自体刃厚皮制成邮票皮进行移植修复，如有必要同前行二次清创植皮。比较2组患者首次手术中每1%TBSA创面清创时间、首次手术后3 d创面分泌物细菌培养阳性率、首次手术后7 d植皮成活率、二次清创百分比、创面愈合时间。对数据行两独立样本t检验、χ^2检验。结果 水刀清创组患者首次手术中每1%TBSA创面清创时间为（1.2±0.3）min，显著短于传统清创组的（1.9±0.4）min（t＝－9.098，P〈0.001）。首次手术后3 d，水刀清创组患者创面分泌物细菌培养阳性率为11.76%（4/34），较传统清创组的38.10%（16/42）显著降低（χ^2＝6.718，P＝0.010）。首次手术后7 d，水刀清创组患者植皮成活率为（90±8）%，显著高于传统清创组的（83±15）%（t＝2.334，P＝0.022）。水刀清创组患者二次清创百分比为5.88%（2/34），较传统清创组的23.81%（10/42）显著降低（χ^2＝4.542，P＝0.033）。水刀清创组患者创面愈合时间为（10.6±1.5）d，较传统清创组的（13.3±2.5）d显著缩短（t＝－5.442，P〈0.001）。结论 水刀用于严重烧伤患者大面积残余创面清创，高效、彻底，有利于提高植皮成活率，加快创面愈合。Objective To explore the efficacy of a hydrosurgery system applied in the debridement of extensive residual wounds of patients with severe burn prospectively.Methods Seventy-six severely burned patients with extensive residual wounds after treatment were admitted into Department of Burn Surgery of Changhai Hospital of the Second Military Medical University from May 2012 to November 2015. The patients were divided into hydrosurgery system debridement group （HD, n=34） and traditional debridement group （TD, n=42） according to the random number table, and their residual wounds were debrided by a hydrosurgery system and conventional surgical instruments respectively. The wounds of patients in two groups were repaired with stamp-like grafts made from split-thickness autoskin after debridement. Second time of debridement and skin grafting as above was performed if necessary. The time used in debriding 1% TBSA wound in the first surgery, positive rate of bacterial culture of wound exudate on post first surgery day （PFSD） 3, survival rate of skin grafts on PFSD 7, second debridement rate, and wound healing time of patients in two groups were compared. Data were processed with two independent-sample t test and chi-square test.Results The time used in debriding 1% TBSA wound of patients in the first surgery in group HD was （1.2±0.3） min, which was significantly shorter than that in group TD[（1.9±0.4） min, t=-9.098, P〈0.001]. On PFSD 3, positive rate of bacterial culture of wound exudate of patients in group HD was 11.76% （4/34）, which was significantly lower than that in group TD[38.10% （16/42）, χ^2=6.718, P=0.010]. On PFSD 7, the survival rate of skin grafts of patients in group HD was （90±8）%, which was significantly higher than that in group TD[（83±15）%, t=2.334, P=0.022]. The second debridement rate of patients in group HD was 5.88% （2/34）, which was significantly lower than that in group TD[23.81% （10/42）, χ^2=4.542, P=0.033]. The wound healing time of patients in gro

关 键 词：烧伤 清创术 水动力清创系统 残余创面 

分 类 号：R644[医药卫生—外科学]