早期磨痂联合自粘性软聚硅酮银离子泡沫敷料治疗儿童深Ⅱ度烧伤创面效果的随机对照试验  

A randomized controlled trial on the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing in the treatment of deep partial-thickness burn wounds in children

作　　者：沈阳 贺钧 刘竣彰 张险峰 谭杰 唐文军 杨豪 陈旭 罗兴旺 Shen Yang;He Jun;Liu Junzhang;Zhang Xianfeng;Tan Jie;Tang Wenjun;Yang Hao;Chen Xu;Luo Xingwang(Department of Wound Repair,Guiyang Steel Plant Employees Hospital,Guiyang 550005,China;Department of Burns,Guiyang Steel Plant Employees Hospital,Guiyang 550005,China)

机构地区：[1]贵阳钢厂职工医院创面修复科,贵阳550005 [2]贵阳钢厂职工医院烧伤科,贵阳550005

出　　处：《中华烧伤与创面修复杂志》2024年第4期342-347,共6页Chinese Journal of Burns And Wounds

摘　　要：目的探讨早期磨痂联合自粘性软聚硅酮银离子泡沫敷料(以下称为泡沫敷料)治疗儿童深Ⅱ度烧伤创面的效果。方法该研究为随机对照试验。2021年6月—2022年12月,贵阳钢厂职工医院烧伤科收治78例符合入选标准的深Ⅱ度烧伤患儿。按照随机数字表法将患儿分为2组,剔除1例随访脱落患儿后,联合治疗组纳入38例患儿[男20例、女18例,年龄26.00(16.75,39.75)个月],泡沫敷料组纳入39例患儿[男21例、女18例,年龄19.00(14.00,31.00)个月]。对联合治疗组患儿在伤后48 h内行创面磨痂术,术后用泡沫敷料覆盖创面,7 d更换1次敷料;对泡沫敷料组患儿在伤后48 h内行创面消毒后用泡沫敷料覆盖创面,2~3 d更换1次敷料。2组患儿创面愈合后均常规涂抹硅酮凝胶,每天涂抹2次,连续应用3周后佩戴弹力套,每天佩戴18 h以上,连续佩戴6个月以上。采用儿童疼痛行为量表FLACC评估患儿换药时疼痛程度;观察并记录治疗期间的不良反应、换药次数及创面愈合时间;创面愈合后6个月,采用温哥华瘢痕量表(VSS)评估创面瘢痕情况。结果换药时,联合治疗组患儿疼痛的FLACC评分为3.5(2.0,5.0)分,明显低于泡沫敷料组的6.0(5.0,8.0)分(Z=-5.40,P<0.05)。2组患儿治疗期间均未发生创面水肿、积液或周边皮肤皮疹过敏等不良反应。联合治疗组患儿的换药次数为3(3,4)次,明显少于泡沫敷料组的8(7,10)次(Z=-7.58,P<0.05)。联合治疗组患儿的创面愈合时间为(19±5)d,明显短于泡沫敷料组的(25±6)d(t=-4.48,P<0.05)。创面愈合后6个月,联合治疗组患儿瘢痕的VSS评分为5(2,8)分,明显低于泡沫敷料组的7(5,10)分(Z=-3.05,P<0.05)。结论与单纯使用泡沫敷料相比,早期磨痂联合泡沫敷料治疗深Ⅱ度烧伤患儿可减少换药次数、减轻换药痛苦、缩短创面愈合时间,结合后期抗瘢痕治疗能够有效减轻瘢痕增生。Objective To explore the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing(hereinafter referred to as foam dressing)in treating the deep partial-thickness burn wounds in children.Methods This study was a randomized controlled trial.From June 2021 to December 2022,78 pediatric patients with deep partial-thickness burns who met the inclusion criteria were admitted to the Department of Burns in Guiyang Steel Plant Employees Hospital.According to the random number table,the pediatric patients were divided into two groups,with 38 cases left in combined treatment group(with 20 males and 18 females,aged 26.00(16.75,39.75)months)and 39 cases in foam dressing group(with 21 males and 18 females,aged 19.00(14.00,31.00)months)after the exclusion of one dropped-out child in follow-up.The pediatric patients in combined treatment group underwent eschar dermabrasion of the wound within 48 hours after injury,the wound was covered with foam dressing after operation,and the dressing was replaced once every 7 days;for the pediatric patients in foam dressing group,the wound was sterilized within 48 hours after injury and covered with foam dressing,and the dressing was replaced once every 2 to 3 days.After the wound healing,the children in both groups were routinely applied with silicone gel twice a day for 3 weeks before started wearing elastic sleeves for more than 18 hours a day,and continuously for over than 6 months.The degree of pain during dressing change was evaluated using the children's pain behavior inventory FLACC.The adverse reactions during the treatment period,number of dressing changes,and wound healing time were observed and recorded.Six months after wound healing,the Vancouver scar scale(VSS)was used to evaluate the condition of the wound scar.Results When changing dressing,the FLACC score for pain of pediatric patients in combined treatment group was 3.5(2.0,5.0),which was significantly lower than 6.0(5.0,8.0)in foam dressing group(Z=-5.40,P<0.05).During the treatment period

关 键 词：烧伤 儿童 瘢痕 磨痂术 创面修复 自粘性软聚硅酮银离子泡沫敷料 

分 类 号：R726.2[医药卫生—儿科]