分段止血联合高频电刀在上肢烧伤病人切削痂术中的止血疗效观察  

Observation of hemostatic effect of segmented hemostasis combined with high-frequency electrosurgical unit in upper limb burn patients during escharectomy

作　　者：林陆添 刘小飞 凌云浩 巫国庆 LIN Lutian;LIU Xiaofei;LING Yunhao(Department of Burnsand Plastic Surgery,909th Hospital of Joint Logistics Support Force,Fujian,Zhangzhou 363000,China)

机构地区：[1]联勤保障部队第909医院烧伤整形科,福建漳州363000

出　　处：《临床外科杂志》2021年第12期1188-1191,共4页Journal of Clinical Surgery

摘　　要：目的观察分段止血联合高频电刀在上肢烧伤病人切削痂术中的止血效果。方法2017年5月~2020年5月收治的拟行切削痂术的上肢烧伤病人108例,随机分为两组。对照组采用传统止血联合高频电刀,在上臂上1/3处扎橡皮止血带,观察组采用分段止血联合高频电刀,先后在上臂中上1/3处和前臂中段扎橡皮止血带。对照组和观察组均分为削痂术和切痂术,对比两组病人手术时间、出血量、创面愈合时间、植皮成活率、植皮外观优良率、临床疗效、平均动脉压和心率及并发症发生率。结果观察组出血量[切痂术(21.65±3.43)ml,削痂术(23.02±3.57)ml]低于对照组[切痂术(28.37±3.56)ml,削痂术(29.96±3.72)ml](P<0.05),观察组创面愈合时间[切痂术(16.57±2.68)天,削痂术(15.85±2.36)天]短于对照组[切痂术(19.84±2.78)天,削痂术(18.33±2.41)天](P<0.05);两组病人扎橡皮带后5分钟(T2)平均动脉压[切痂术:观察组T1(87.11±13.91),T2(93.33±12.39),T3(86.41±13.52);对照组T1(86.71±13.54),T2(97.81±16.52),T3(84.69±15.24);削痂术:观察组T1(86.94±13.74),T2(86.30±13.48),T3(86.30±13.48);对照组T1(86.62±13.65),T2(97.93±16.61),T3(84.77±15.34)mmHg]和心率[切痂术:观察组T1(79.11±13.12),T2(83.90±10.29),T3(76.81±11.68);对照组T1(78.63±13.02),T2(88.82±13.76),T3(73.83±12.63);削痂术:观察组T1(79.19±13.18),T2(84.52±10.47),T3(76.59±11.56);对照组T1(78.84±13.16),T2(88.99±13.90),T3(73.81±12.67)次/min]均高于术前10分钟(T1)(P<0.05),手术结束(T3)均低于T2时刻(P<0.05),且观察组T2时刻、T3时刻均低于对照组(P<0.05)。结论分段止血联合高频电刀在上肢烧伤病人切削痂术中能够减少出血量,促进创面愈合,同时对平均动脉压和心率影响较小。Objective To explore the hemostatic effect of segmental hemostasis combined with high-frequency electrosurgical unit in upper extremity burn patients with escharectomy.Methods 108 patients with upper limb burns who were scheduled to undergo escharectomy from May 2017 to May 2020 were selected and randomly divided into two groups.The control group used traditional hemostasis combined with high-frequency electrocautery,and the rubber tourniquet was placed on the upper 1/3 of the upper arm,and the observation group used segmented hemostasis combined with high-frequency electrocautery,and the rubber was placed on the upper 1/3 of the upper arm and then the middle of the forearm band.The operation time,blood loss,wound healing time,skin graft survival rate,excellent and good rate of skin graft appearance,clinical efficacy,average arterial pressure,heart rate and complication rate of the two groups were compared.Results The bleeding volume of the observation group[crustectomy(21.65±3.43)ml,escharectomy(23.02±3.57)ml]was lower than that of the control group[crustectomy(28.37±3.56)ml,escharectomy(29.96±3.72)ml](P<0.05),and the wound healing time of the observation group[crustectomy(16.57±2.68)d,escharectomy(15.85±2.36)d]was shorter than that of the control group[crustectomy(19.84±2.78)d,escharectomy(18.33±2.41)d](P<0.05).The average arterial pressure[crustectomy:observation group T1(87.11±13.91),T2(93.33±12.39),T3(86.41±13.52);control group T1(86.71±13.54),T2(97.81±16.52),T3(84.69±15.24);Scab removal:observation group T1(86.94±13.74),T2(86.30±13.48),T3(86.30±13.48);control group T1(86.62±13.65),T2(97.93±16.61),T3(84.77±15.34)mmHg]and heart rate[crustectomy:observation group T1(79.11±13.12),T2(83.90±10.29),T3(76.81±11.68);control group T1(78.63±13.02),T2(88.82±13.76),T3(73.83±12.63);Scab removal:observation group T1(79.19±13.18),T2(84.52±10.47),T3(76.59±11.56);control group T1(78.84±13.16),T2(88.99±13.90),T3(73.81±12.67)Times/min]at T2 of the two groups were higher than those at T1(P<0.05),

关 键 词：分段止血 高频电刀 上肢烧伤 切削痂术 

分 类 号：R644[医药卫生—外科学]