聚乙烯醇和聚氨酯负压材料在Ⅲ度烧伤切痂创面应用的前瞻性随机对照试验  

Randomized controlled trial on application of negative pressure materials of polyvinyl alcohol and polyurethane in full-thickness burn wounds after escharotomy

作　　者：黄振 王朋 潘珍乙 董亮 苏建 徐能武 Huang Zhen;Wang Peng;Pan Zhenyi;Dong Liang;Su Jian;Xu Nengwu(Department of Plastic Surgery and Burns,Xuzhou Renci Hospital,Xuzhou 221004,China)

机构地区：[1]徐州仁慈医院整形烧伤科,221004

出　　处：《中华烧伤杂志》2020年第9期813-820,共8页Chinese Journal of Burns

摘　　要：目的对比聚乙烯醇和聚氨酯负压材料用于治疗Ⅲ度烧伤切痂创面的效果与特性差异。方法选择2018年1月—2019年12月徐州仁慈医院收治的符合入选标准的60例Ⅲ度烧伤患者,进行前瞻性随机对照试验。按照随机数字表法分为聚乙烯醇组(男13例、女17例)和聚氨酯组(男14例、女16例)各30例,年龄分别为(34±7)、(35±6)岁,烧伤总面积分别为4.20%(2.23%,4.90%)、3.89%(2.18%,4.76%)体表总面积(TBSA)、切痂面积分别为2.70%(1.97%,3.42%)、2.87%(2.12%,3.34%)TBSA。患者入院后立即对Ⅲ度烧伤创面行清创术,每日碘伏换药1次。伤后第3天行切痂术,彻底止血并用生理盐水冲洗创面后,2组患者分别选取相应的泡沫材料及配套设备行负压治疗,负压值设置为-19.9 kPa,持续负压治疗1周。记录负压材料安装时间。负压治疗1周,记录去除泡沫材料的最大拉力,评估泡沫材料与创面的粘连度;记录去除泡沫材料过程中创面出血量;苏木精-伊红(HE)染色观察创面肉芽组织增生情况,免疫组织化学染色及蛋白质印迹法检测CD31表达反映血管化情况。检测泡沫材料负压治疗1周与使用前的回弹系数R1/R0比值,记录负压治疗1周内创面渗液引流量,以此表示泡沫材料对创面渗液的引流能力。负压治疗1周,记录创面细菌定植情况、异物残留情况、皮缘湿疹率。对数据行χ2检验、独立样本t检验、Mann-Whitney U检验。结果(1)聚氨酯组患者的负压材料安装时间为(14±3)min,明显短于聚乙烯醇组的(18±3)min(t=2.788,P<0.01)。(2)负压治疗1周,聚乙烯醇组患者去除泡沫材料的最大拉力为(6.4±0.4)N,明显低于聚氨酯组的(16.7±0.8)N(t=12.010,P<0.01)。(3)负压治疗1周,去除泡沫材料过程中,聚乙烯醇组患者的创面出血量为(20±3)mL,明显少于聚氨酯组的(59±3)mL(t=50.200,P<0.01)。(4)负压治疗1周,HE染色显示,聚氨酯组患者创面肉芽组织增生厚度为(2.3±0.6)mm,明显高于聚乙�Objective To compare the effects and characteristic difference of negative pressure materials of polyvinyl alcohol and polyurethane in the treatment of full-thickness burn wounds after escharotomy.Methods From January 2018 to December 2019,60 patients with full-thickness burns who met the inclusion criteria and hospitalized in Xuzhou Renci Hospital were recruited in this prospective randomized controlled trial.According to the random number table,60 cases were divided into polyvinyl alcohol group(n=30,13 males and 17 females)and polyurethane group(n=30,14 males and 16 females),aged(34±7)and(35±6)years respectively,with burn area of 4.20%(2.23%,4.90%)total body surface area(TBSA)and 3.89%(2.18%,4.76%)TBSA and escharectomy area of 2.70%(1.97%,3.42%)TBSA and 2.87%(2.12%,3.34%)TBSA,respectively.After patient′s admission,debridement was immediately performed on the full-thickness burn wound,and the dressing was changed with iodophor once a day.Escharectomy was performed on post injury day 3.After thorough hemostasis and washing the wounds with normal saline,patients of the two groups chose corresponding foam materials and supporting facilities for continuous negative-pressure treatment for 1 week,with the negative pressure value setting at-19.9 kPa.Installation time of negative-pressure material was recorded.After a week of negative-pressure treatment,the maximum pulling force of removing foam material was recorded to evaluate the adhesional degree between foam materials and wounds.The amount of bleeding in the process of removing foam materials was recorded,hyperplasiaof granulation tissue was observed with hematoxylin eosin(HE)staining,and the expression of CD31 was detected by immunohistochemical staining and Western blotting to denote vascularization.The ratio of R1 to R0 of coefficient of restitution of foam material before and one week after negative-pressure treatment and drainage volume of wound exudate within a week of negative-pressure treatment were recorded to denote the drainage ability of foam materi

关 键 词：烧伤 负压伤口疗法 伤口愈合 聚乙烯醇 聚氨酯 

分 类 号：R616.2[医药卫生—外科学] R64[医药卫生—临床医学]