Meek植皮术联合纳米银敷料治疗在大面积烧伤创面修复中的应用  

Application of Meek skin grafting combined with Nanometer silver dressing in the repair of extensive burn wounds

作　　者：牛雪涛 赵举辉 李子标 NIU Xue-tao;ZHAO Ju-hui;LI Zi-biao(Department of Burn and Wound Repair Surgery,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,CHINA;Department of Medical Cosmetology and Plastic Surgery,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,CHINA)

机构地区：[1]汉中市中心医院烧伤与创面修复外科,陕西汉中723000 [2]汉中市中心医院医疗美容整形外科,陕西汉中723000

出　　处：《海南医学》2023年第5期646-649,共4页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:2019SF-148)。

摘　　要：目的观察Meek植皮术联合纳米银敷料治疗在大面积烧伤创面修复中的应用效果。方法回顾性分析2014年1月至2021年12月汉中市中心医院烧伤与创面修复外科收治的83例大面积烧伤者的临床资料,按创面处理方式不同分为观察组39例和对照组44例,对照组患者行Meek植皮术,观察组患者采取Meek植皮术联合纳米银敷料治疗。观察两组患者的创面愈合情况,并比较植皮前、植皮后7 d创面基质金属蛋白酶[MMP-1、MMP-2]、金属蛋白酶抑制剂-1(TIMP-1)水平,记录住院期间并发症发生情况;治疗后随访60 d,比较两组患者治疗前后的生存质量[简明烧伤健康量表(BSHS-A)]。结果观察组患者植皮后7 d的创面MMP-1和MMP-2吸光度(IA)值分别为2131.81±165.43、1842.65±159.56,明显低于对照组同时间点的3612.16±195.38、2346.64±135.58,而TIMP-1为837.72±133.83,明显高于对照组同时间点的612.37±121.85,差异均有统计学意义(P<0.05);观察组患者植皮后7 d的皮片存活率为(87.82±5.29)%,明显高于对照组的(73.35±4.34)%,而皮片融合时间和创面愈合时间分别为(14.62±2.13)d、(41.28±5.46)d,明显短于对照组的(19.47±3.96)d、(52.35±6.41)d,差异均有统计学意义(P<0.05);住院期间,观察组患者的并发症总发生率为10.26%,明显低于对照组的29.55%,差异有统计学意义(P<0.05);观察组治疗60 d后,BSHS-A的各项评分及总分明显高于对照组,差异均有统计学意义(P均<0.05)。结论Meek植皮术联合纳米银敷料用于大面积烧伤创面修复患者治疗,能抑制创面基质金属蛋白酶过度表达,促进创面愈合、降低并发症发生率,有利于改善患者生存质量。Objective To observe the application effects of Meek skin grafting combined with Nanometer silver dressing in the repair of extensive burn wounds.Methods The clinical data of 83 patients with extensive burns in Department of Burn and Wound Repair Surgery,Hanzhong Central Hospital from January 2014 to December 2021 were retrospectively analyzed.According to the different treatment methods for wound,the patients were divided into an observation group(39 cases)and a control group(44 cases).The patients in the control group were given Meek skin grafting,while the patients in the observation group were treated with Meek skin grafting combined with Nanometer silver dressing.The wound healing of patients in the two groups was observed,and the levels of wound matrix metalloproteinases(MMP-1,MMP-2),tissue inhibitor of metalloproteinase-1(TIMP-1)were compared before skin grafting and at 7 d after skin grafting.The occurrence of complications during hospitalization were recorded.The patients were followed up for 60 d after treatment,and the quality of life scores[Abbreviated Burn Specific Health Scale(BSHS-A)]were compared between the two groups before and after treatment.Results The integral absorbance(IA)values of wound MMP-1 and MMP-2 were 2131.81±165.43 and 1842.65±159.56 in the observation group at 7 d after skin grafting,which were significantly lower than 3612.16±195.38 and 2346.64±135.58 in the control group,while that of TIMP-1 was 837.72±133.83,significantly higher than 612.37±121.85 in the control group(P<0.05).The flap survival rate was(87.82±5.29)%in the observation group at 7 d after skin grafting,which was significantly higher than(73.35±4.34)%in the control group(P<0.05);the flap fusion time and wound healing time were(14.62±2.13)d and(41.28±5.46)d,significantly shorter than(19.47±3.96)d and(52.35±6.41)d in the control group(P<0.05).During hospitalization,the total incidence rate of complications in the observation group was significantly lower than that in control group(10.26%vs 29.55%,P<0.05).T

关 键 词：大面积烧伤 创面修复 MEEK植皮术 纳米银敷料 并发症 生存质量 

分 类 号：R644[医药卫生—外科学]