早期清创保守去痂后外覆脱细胞真皮基质治疗小儿深度烧伤的效果  

Effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix in the treatment of children with deep burns

作　　者：梁艳 石文[2] 邵阳[2] 刘新庄[2] 宫红敏 曹国辉 高聪[2] 辛乃军[2] 宋国栋 Liang Yan;Shi Wen;Shao Yang;Liu Xinzhuang;Gong Hongmin;Cao Guohui;Gao Cong;Xin Naijun;Song Guodong(Cheeloo College of Medicine,Shandong University,Jinan 250012,China;Department of Burns and Plastic Surgery,Central Hospital Affiliated to Shandong First Medical University(Jinan Central Hospital),Jinan 250013,China)

机构地区：[1]山东大学齐鲁医学院,济南250012 [2]山东第一医科大学附属中心医院(济南市中心医院)烧伤整复外科,济南250013

出　　处：《中华烧伤与创面修复杂志》2024年第4期348-357,共10页Chinese Journal of Burns And Wounds

基　　金：烧伤科国家临床重点专科;王正国创伤医学发展基金会“生长因子复兴计划”(SZYZ-TR-15);济南市烧创伤与慢性创面临床医学研究中心(201912010);济南市医疗卫生科技创新计划(201907080);山东省医药卫生科技发展计划(202004030738)。

摘　　要：目的探讨早期清创保守去痂后外覆脱细胞真皮基质(ADM)即早期手术治疗小儿深度烧伤的效果。方法该研究为回顾性队列研究。2017年1月—2022年12月,山东第一医科大学附属中心医院收治符合入选标准的1~7岁住院深度烧伤患儿278例。根据治疗过程不同,将行早期手术+常规换药治疗的134例患儿纳入去痂+换药组[男77例、女57例,年龄1(1,2)岁],将仅行常规换药治疗的144例患儿纳入单纯换药组[男90例、女54例,年龄1(1,2)岁]。将去痂+换药组中无Ⅲ度烧伤的51例患儿纳入去痂+换药1组[男26例、女25例,年龄1(1,2)岁],将该组存在Ⅲ度烧伤的83例患儿中未在早期手术的同期行自体皮移植(称为早期植皮)的57例患儿纳入去痂+换药2组[男37例、女20例,年龄1(1,2)岁]。将单纯换药组中无Ⅲ度烧伤的76例患儿纳入单纯换药1组[男51例、女25例,年龄1(1,3)岁],将该组存在Ⅲ度烧伤的68例患儿纳入单纯换药2组[男39例、女29例,年龄1(1,2)岁]。针对去痂+换药组深Ⅱ度和较小面积Ⅲ度烧伤创面,以保留薄层变性真皮从而保全创基健康组织为基准进行去痂,去痂后创面均外敷ADM;针对该组较大面积Ⅲ度烧伤创面,尤其是位于关节功能部位的创面,则去痂至有生机组织平面并行早期植皮。当患儿较浅创面已愈合或趋于愈合后评估残余创面情况,若其难以在14 d内治愈则行择期自体皮移植。统计去痂+换药组、单纯换药组以及去痂+换药1组、单纯换药1组患儿深Ⅱ度烧伤创面的愈合时间、干预愈合时间、手术/换药次数、干预手术/换药次数。末次随访(随访期设为7~12个月)时,统计去痂+换药组54例、单纯换药组48例患儿深Ⅱ度烧伤愈合创面瘢痕增生最严重区域的改良温哥华瘢痕量表(mVSS)评分。统计去痂+换药组、单纯换药组患儿全部烧伤创面愈合时间及手术/换药次数,以及去痂+换药2组、单纯换药2组患儿Ⅲ度烧伤Objective To explore the effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix(ADM),i.e.,early surgery,in the treatment of children with deep burns.Methods This study was a retrospective cohort study.From January 2017 to December 2022,278 deep burned hospitalized children aged 1-7 years who met the inclusion criteria were admitted to Central Hospital Affiliated to Shandong First Medical University.According to the differences in treatment processes,134 children who underwent early surgery+routine dressing change were enrolled in eschar removal+dressing change group(77 males and 57 females,aged 1(1,2)years),and 144 children who underwent only routine dressing change were enrolled in dressing change alone group(90 males and 54 females,aged 1(1,2)years).Fifty-one children without full-thickness burns in eschar removal+dressing change group were enrolled in eschar removal+dressing change group 1(26 males and 25 females,aged 1(1,2)years),and 57 cases of the 83 children with full-thickness burns who did not undergo autologous skin grafting at the same time of early surgery(namely early skin grafting)in eschar removal+dressing change group were included in eschar removal+dressing change group 2(37 males and 20 females,aged 1(1,2)years).Seventy-six children without full-thickness burns in dressing change alone group were included in dressing change alone group 1(51 males and 25 females,aged 1(1,3)years),and 68 children with full-thickness burns in dressing change alone group were included in dressing change alone group 2(39 males and 29 females,aged 1(1,2)years).For deep partial-thickness burn wounds and small full-thickness burn wounds in eschar removal+dressing change group,the eschar removal was performed on the basis of retaining a thin layer of denatured dermis so as to preserve the healthy tissue of the wound base,and ADM was applied to all wounds externally after eschar removal.For larger full-thickness burn wounds in this group,especially those locate

关 键 词：烧伤 儿童 清创术 深Ⅱ度烧伤 Ⅲ度烧伤 去痂术 脱细胞真皮基质 

分 类 号：R726.2[医药卫生—儿科]