磨痂术在深Ⅱ度烧烫伤患者创面早期处理中的效果  

Clinical effeet of eschar dermabrasion in the treatment of deepⅡdegree burn wound

作　　者：庞梦茹 刘思业 袁媛 雷雨 PANG Mengru;LIU Siye;YUAN Yuan;LEI Yu(Department of Burns and Plastic Surgery,the Affiliated Hospital of Guizhou Medical University,Guiyang 550001,Guizhou,China)

机构地区：[1]贵州医科大学附属医院烧伤整形科,贵州贵阳550001

出　　处：《贵州医科大学学报》2024年第11期1672-1677,共6页Journal of Guizhou Medical University

基　　金：国家自然科学基金(82160377);贵州省科技计划项目(黔科合成果-LC[2022]033/01)。

摘　　要：目的 探讨磨痂术对深Ⅱ度烧烫伤创面早期处理的临床效果。方法 31例烧烫伤患者分为磨痂组[磨痂术(钝性清创)+脱细胞异种真皮,n=16]及对照组[削痂术(锐性清创)+换药,n=15],收集2组烧烫伤患者住院期间的一般临床资料(年龄、性别、烧伤面积、换药次数、创面愈合时间、住院时间及住院费用信息),治疗前和早期治疗时(治疗后第7天)的临床体征(体温、疼痛感及疼痛分级)及血液生化指标(血糖、白细胞及血小板计数、红细胞比积、C反应蛋白及总渗透压),采用温哥华量表评分(VSS)评估2组烧烫伤患者治疗后第3及6个月时的瘢痕,采用视觉评估法评估2组烧烫伤患者治疗后第6个月时烧伤区域关节活动度评分和累及关节情况。结果 2组烧烫伤患者的一般临床资料比较,差异均无统计学意义(P>0.05);2组烧烫伤患者治疗后第7天时体温、疼痛感、血糖水平、白细胞及血小板计数、红细胞比积较治疗前均下降(P<0.05),磨痂组烧烫伤患者治疗后第7天时C反应蛋白高于治疗前、但低于对照组(P<0.05);2组患者治疗前后血浆总渗透压比较,差异均无统计学意义(P>0.05);与对照组比较,磨痂组患者同时点的疼痛分级、白细胞计数及C反应蛋白水平均下降(P<0.05),换药次数、创面愈合时间、住院时间及住院费用均减少(P<0.05或P<0.01),治疗后第3及6个月时瘢痕色泽、质地、充血及疼痛、瘙痒VSS评分分值降低(P<0.01);2组烧烫伤患者治疗后6个月时关节活动度评分及累及关节率比较,差异均无统计学意义(P>0.05)。结论 磨痂术的早期运用可帮助烧烫伤患者平稳度过溶痂期,减轻局部及全身炎症、促进早期愈合,治疗效果良好。Objective To investigate the clinical effect of eschar dermabrasion,as a blunt debridement,in the early management of deepⅡdegree burn wounds.Methods Thirty-one patients with burn wounds were divided into the eschar group(with eschar dermabrasion+acellular xenodermis,n=16)and the control group(with surgical debridement+dressing change,n=15).The general clinical data(age,gender,burn area,number of dressing changes,wound healing time,time of hospital stay and hospitalization cost)of the two groups were collected,and the clinical signs(body temperature,pain sensation and pain grade)and blood biochemical indexes(blood glucose,white blood cells and platelet count,hematocrit,C-reactive protein,and total osmolality)were detected.The Vancouver scale score(VSS)was used to evaluate the severity of scars in the 3 rd and 6 th months after treatment,and the range of motion score and cumulative joint condition in the burn area in the 6 th month after treatment were evaluated by visual evaluation method.Results There was no significant difference in the general clinical data of the two groups(P>0.05).On the 7 th day after treatment,the body temperature,pains,blood glucose level,white blood cells and platelet count,and hematocrit of the two groups decreased(P<0.05),and the C-reactive protein of the eschar group was higher before treatment and lower than that in the control group(P<0.05).There was no significant difference in total osmotic pressure between the two groups before and after treatment(P<0.05).Compared with the control group,the pain grade,white blood cell count and C-reactive protein level of the eschar group decreased(P<0.05),and the frequency of dressing changes,wound healing time,hospital stay and hospitalization costs were reduced(P<0.05 or P<0.01).VSS scores of scar color,texture,congestion,pain and itching in the scar grinding group in the 3 rd and 6 th months after treatment were significantly lower than those in the control group(P<0.01).There was no significant difference in the joint degree score and join

关 键 词：烧伤 瘢痕 清创术 磨痂术 创面愈合 钝性清创术 

分 类 号：R644[医药卫生—外科学]