聚酰胺薄纱对烧伤切痂后微型皮片移植创面蒸发量和愈合的影响

目的 探讨深度烧伤切痂后微型皮片移植创面覆盖聚酰胺薄纱对创面蒸发量和愈合的影响.方法 采用同体对照方法 ,对20例深度烧伤后24 h内入院、需要切痂微型皮片移植的患者,每例选择部位相近烧伤区域2处各约1%的创面作为观察区,其中1处创面采用Meek皮片移植技术植皮,创面内层覆盖聚酰胺薄纱(聚酰胺薄纱组);另1处采用邮票植皮技术,创面内层覆盖凡士林油纱(凡士林油纱组).植皮术后5 d,应用EP-Ⅰ型蒸发仪检测内层敷料表面、揭开内层敷料的植皮区创面(裸露创面)及创面临近的正常皮肤表面水分蒸发量;观察皮片成活率、术后10、15、20 d创面愈合率和创面完伞愈合时间;采用视觉模拟评分法进行术后5 d首次换药及术后10 d揭除内层敷料时疼痛程度评估.结果 聚酰胺薄纱组内层敷料表面水分蒸发量(ml·h-1·m-2)明显低于凡士林油纱组(分别为24.8±5.2、35.4±5.0,P<0.01),并明显低于裸露创面(41.3±4.5,P<0.01),而与正常皮肤表面(21.1±5.1)相近;凡士林油纱组内层敷料表面水分蒸发量也明显低于裸露创面(40.7±3.6,P<0.01),但明显高于正常皮肤表面(21.2±3.8,P<0.01).聚酰胺薄纱组皮片成活率(98%±3%)与凡士林油纱组(98%±2%)相近(P>0.05);术后10、15、20 d创面愈合率(分别为80%±20%、96%±7%、100%)均明显高于凡士林油纱组(分别为70%±33%、81%±21%、97%±11%,均P<0.01);创面完全愈合时间(d)明显短于凡十林油纱组(分别为13.6±1.9、16.7±2.6,P<0.01);术后5 d换药及10 d揭除内层敷料时疼痛程度评分(分别为3.2±0.8、4.9±0.4)均明显低于凡士林油纱组(分别为5.1±0.6、8.2±0.5,均P<0.01).结论 聚酰胺薄纱具有较好的保湿性,能促进烧伤切痂后植皮创而的愈合,并能减轻创面换药及揭除内层敷料时的疼痛程度,是一种比较理想的皮片移植支撑载体兼创面内层覆盖物.

Influence of polyester gauze on evaporation capacity and healing of the surface of microskin graft wound after escharectomy

Objective To investigate the influence of polyester gauze on evaporation capacity and its clinical effect after escharectomy of deep burn wound and micro-skin grafting. Methods Twenty patients with deep burn admitted within 24 hours after injury underwent escharectomy and Meek skin grafting. Two surfaces of wound with the area of about 1% as the whole wound surface were used, one covered by Meek skin graft and polyester gauze as inner dressing (polyester gauze group), and the other covered by split-thickness skin sheet 0. 3 mm ×0. 3 mm in size and vaseline oil gauze as inner dressing (vaseline oil gauze group). Five days after skin grafting, the evaporation capacities of the surface of inner dressing, wound surface without dressing( nude wound), and normal skin near the wound were tested by evaporation test equipment. The complete healing time and survival rate of skin sheet in both groups were observed. The degree of pain during dressing change was evaluated with visual analog scale. Results The evaporation capacity of the inner dressing surface of polyester gauze group was ( 24. 8±5.2 ) ml · h-1· m-2 ,significantly lower than those of the vaseline oil gauze group (35.4±5.0) ml·h-1 · m-2, p <0.01 ] and nude wound (41.3±4.5) ml· h-1· m-2, P <0. 01 ], and similar to that of the normal skin near the _wound (21.1±5.1 ) ml· h-1· m-2 ,P >0.05]. The evaporation capacity of the inner dressing surface of vaseline oil gauze group was significantly lower than nude wound (40. 7 ± 3. 6) ml·h-1· m-2 P <0.01 ], but significantly higher than the normal skin near the wound (21.2±3.8) ml· h-1· m-2, p <0.01 ]. The survival rate of skin sheets of the polyester gauze group was 98% ± 3%, not significantly different from that of the vaseline oil gauze group (98%±2% , P >0.05). The wound healing rates on days 10, 15, and 20 of the polyester gauze group were 80%±20%, 96%±7%, and 100% respectively,all significantly higher than those of the vaseline oil gauze group (70%±33%, 81%±21%, and 97% ±11% respectively, all P < 0. 01 ). The complete healing time of the polyester gauze group was ( 13.6± 1.9) days, significantly shorter than that of the vaseline oil gauze group ( 16.7±2.6) days, P <0. 01 ]. The pain scores during dressing change 5 and 10 days after grafting of the polyester gauze group were (3.2± 0.8) and (4.9± 0.4 ) respectively, both significantly lower than those of the vaseline oil gauze group (5.1 ±0.6) and (8.2± 0.5 ) respectively, both P < 0.01 ]. Conclusions Polyester gauze has quite good abilities to retain moisture and can promote the migration and proliferation of epithelial cells, relieves the pain caused by tearing of dressings off the wound, thus raising its acceptability. It is a relatively ideal cartier of skin grafting, as well as a new type of inner cover for the wound.