削痂植皮术联合负压封闭引流治疗中度烧伤创面的临床效果观察

目的：探讨削痂植皮术联合负压封闭引流技术(Vacuum sealing drainage,VSD)治疗中度烧伤患者的临床效果及安全性。方法：选取2015年10月-2019年10月笔者医院收治的中度烧伤患者90例,随机数字表法分为观察组和对照组。对照组(n=41)采用削痂植皮术治疗,观察组(n=49)采用削痂植皮术联合VSD技术治疗。比较两组皮片成活时间、皮片成活率、换药次数及住院时间;观察治疗前后两组创面愈合时间与创面愈合质量;采用生活能力量表(Activity of daily living,ADL)、焦虑自评量表(Self-rating anxiety scale,SAS)及长海痛尺评估患者预后质量。结果：观察组皮片成活时间、换药次数、住院时间、并发症发生率与创面愈合时间均小于对照组,差异有统计学意义(P<0.05)。观察组ADL评分高于对照组和治疗前,SDS评分与长海痛尺评分低于对照组和治疗前,差异均有统计学意义(P<0.05)。结论：削痂植皮术联合VSD治疗中度烧伤创面治疗效果显著,可提高创面愈合质量,显著改善患者预后。     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

目的 前瞻性评价早期VSD治疗深Ⅱ度烧伤创面的临床疗效,为其临床应用提供依据.方法 选择笔者单位2009年5月-2010年3月收治的双下肢烧伤后3 h内入院、总面积小于10%且各下肢深Ⅱ度面积大于1%TBSA的患者22例.依照部位对称、深度相同、面积相近等同体对照原则,将每例患者创面分为VSD治疗组(应用VSD治疗)与对照组(应用10 g/L磺胺嘧啶银霜换药).观察2组患者创面的水分蒸发量、肿胀程度、细菌定植情况、疼痛程度、愈合时间及愈合质量并进行比较分析.数据行t检验与秩和检验.结果 21例患者完成试验,均在伤后4 h内完成创面处理.VSD治疗组正常皮肤及覆盖敷料前创面的水分蒸发量与对照组相近(t值分别为1.310、-0.911,P值均大于0.05);创面覆盖敷料2 h后,敷料表面的水分蒸发量[(44.3±3.9)mL·h-1·m-2]明显少于对照组[(66.1±6.4)mL·h-1·m-2,t=-11.39,P<0.01].伤后3、7 d,VSD治疗组大腿周径较伤后5 h分别增加了(3.48±0.35)、(2.51±0.21)cm,明显小于对照组的(8.02±0.41)、(3.99±0.32)cm(t值分别为4.110、3.569,P值均小于0.01).2组创面入院时及伤后10 d细菌培养阳性率组间比较,差异均无统计学意义(Z值分别为-0.894、0.000,P值均大于0.05);2组伤后10 d细菌培养阳性率均较各组入院时显著降低(Z值分别为-3.220、-3.870,P值均小于0.01).VSD治疗组创面伤后10 d的pH值(7.12±0.06)呈现弱酸性,对照组(7.41±0.13)则为中性.VSD治疗组伤后1、3、7 d创面疼痛程度轻于对照组(t值分别为-16.132、-21.230、-16.453,P值均小于0.01).2组创面愈合时间比较,差异无统计学意义(t=1.186,P>0.05).伤后2、3个月VSD治疗组创面愈合质量评价为佳(100.00%、100.00%),明显优于对照组(19.05%、85.71%,Z值分别为-11.638、-3.870,P值均小于0.01).结论 早期VSD治疗不能使深Ⅱ度烧伤创面愈合时间提前,但能显著提高其愈合质量,是处理深Ⅱ度烧伤创面的有效方法之一,值得临床关注与进一步研究.     

早期削痂对深Ⅱ度烧伤创面愈合影响的临床研究

目的:探讨早期削痂(伤后24h内)对深Ⅱ度烧伤治疗的安全性及有效性。方法:选择我院收治的50例深Ⅱ度烧伤患者,根据手术时间将伤后24h内进行削痂手术的22例患者纳入观察组,将伤后4～6天行削痂术的28例患者纳入对照组,观察比较两组患者休克期静脉补液量及尿量、休克征象发生率及并发症情况、创面愈合时间。结果:伤后前3天,两组患者血浆补液量、平衡液补液量以及尿量均无明显差异(P>0.05);观察组创面愈合时间平均为(22.4±4.6)天,对照组创面平均愈合时间(28.6±5.4)天,观察组明显短于对照组,差异具有统计学意义(P<0.01);观察组休克征象发生率为18.18%,对照组发生率为21.43%,两组发生率比较差异无统计学意义(P>0.05)。结论:早期削痂是治疗深Ⅱ度烧伤安全、有效的方法,值得在临床上推广应用。     

深Ⅱ度烧伤创面伤后24小时内削痂的临床观察

目的　探讨深Ⅱ度烧伤患者伤后 2 4h内创面行削痂术的安全性和临床疗效。　方法12例有削痂手术指征并在伤后 2 4h内行削痂术的深Ⅱ度烧伤患者为A组 ;14例削痂条件相似并按常规在伤后 4～ 6d行削痂术的深Ⅱ度烧伤患者为B组。比较两组休克期补液量、休克征象发生率、回吸收期的生命体征、尿量及愈合时间。　结果　两组患者在休克期补液量、休克征象发生率方面差异均无显著性意义 (P >0 .0 5 ) ;A组休克期尿量明显增多 ,回吸收期的体温、心率与B组明显不同(P <0 .0 5～ 0 .0 1) ;A组创面平均愈合时间较B组短 (P <0 .0 1)。　结论　深Ⅱ度烧伤创面于伤后2 4h内削痂是安全的 ,并能缩短创面愈合时间。     

表皮生长因子溶液配合负压封闭引流技术治疗深Ⅱ度烧伤创面的疗效观察

目的：：观察应用表皮生长因子溶液冲洗封闭负压引流装置和创面治疗深Ⅱ度烧伤创面的疗效。方法：四肢深Ⅱ度烧伤患者60例,年龄18~60岁,烧伤创面面积5%~10%,随机分为治疗组和对照组。两组均采用负压封闭引流技术治疗,分别以表皮生长因子溶液(治疗组)或生理盐水(对照组)每日2次冲洗负压装置。伤后第5、10、15天更换负压装置,并观察体温变化、创面愈合率及创面完全愈合时间。结果：①治疗组11例(36.7%)患者出现发热,较对照组(12例,40.0%)差异无统计学意义(χ2=0.071,P =0.791)。②治疗组第10、15天创面愈合率[0.47670±0.02783和0.78070±0.02599]明显高于对照组[0.42570±0.02445比0.73130±0.02945],创面总体愈合时间[(19.27±1.82)d]短于对照组[(23.10±2.07)d],差异均有统计学意义(P 均<0.05)。④治疗前,治疗组和对照组分别有5例和6例患者创面分泌物细菌培养阳性,治疗后两组均有2例未愈创面,其分泌物细菌培养结果均为阴性。结论：表皮生长因子溶液配合密闭式负压吸引作为负压装置冲洗剂,能促进深Ⅱ度烧伤创面愈合,提高负压封闭引流技术在深Ⅱ度烧伤创面的疗效。     

削痂并保留薄层变性组织治疗大面积烧伤深Ⅱ度创面35例

我科20世纪90年代初至今，共收治大面积深度烧伤患35例。其中深Ⅱ度创面大多采用削痂时保留薄层变性组织的作法，术后不予植皮，取得满意疗效，现报告如下。     

早期削痂治疗头皮深Ⅱ度烧伤43例

临床资料 :本组男 36例 ,女 7例 ,年龄 17～ 6 2岁 ,烧伤总面积 1%～ 95 %TBSA ,头皮部烧伤均为深Ⅱ度 ,致伤原因为火焰、热液和化学烧伤。手术方法 :伤后 1～ 5d行头皮部早期削痂术。术前剃净患者头发 ,全身麻醉。取仰卧位 ,头皮下注射等渗盐水 ,内含 1∶2 0 0 0 0 0肾上腺素溶液 ,用量宜多 ,以增加局部组织内压力 ,压迫止血。用滚轴刀沿头皮真皮层削除坏死组织。创面经洗必泰、等渗盐水反复冲洗后 ,用油纱布覆盖 ,贴敷宜紧密 ,并以多层敷料加压包扎。术后 2d揭去外层敷料 ,仅余一层油纱布 ,行半暴露疗法。防止局部长期受压 ,经常变换头…     

高压氧在深Ⅱ度烧伤创面削痂术后的临床应用

1 临床资料2010年5月-2011年7月,选择在笔者单位急诊入院的深Ⅱ度烧伤患者80例,按照随机数字表法分为2组.(1)高压氧组40例,其中男28例、女12例,年龄14 ～ 63岁,平均36岁.烧伤总面积5.0％ ～ 43.0％ TBSA,创面分布于躯干8例、双上肢12例、双下肢20例,平均手术创面面积18.5％ TBSA.(2)对照组40例,其中男24例、女16例,年龄16～ 68岁,平均38岁.烧伤总面积4.0％ ～41.0％ TBSA,创面分布于躯干9例、双上肢11例、双下肢20例,平均手术面积17.2％ TBSA.2组患者年龄相差3岁,体质指数小于或等于3,创面部位基本相同,无基础疾病.     

银离子抗菌敷料联合负压封闭引流术在深Ⅱ度烧伤创面修复中的应用及护理观察

目的:分析银离子抗菌敷料联合负压封闭引流技术(Vacuum sealing drainage, VSD)在深Ⅱ度烧伤创面修复的效果。方法:选取笔者医院2016年1月-2018年1月深Ⅱ度烧伤患者150例,按照随机数字表将患者随机分为A、B、C三组;三组患者采用不同方法对创面进行治疗:A组采用银离子抗菌敷料进行治疗,B组为采用磺胺嘧啶银软膏+VSD治疗,C组采用银离子抗菌敷料+VSD治疗,观察并比较三组患者创面愈合时间、创面愈合率、换药次数、疼痛评分、住院时间、住院费用和并发症发生情况。结果:C组创面愈合时间明显少于A组、B组,创面愈合率高于A组、B组,差异有统计学意义(P0.05);B组与A组比较差异亦有统计学意义(P0.05)。C组并发症发生率低于A组、B组,差异有统计学意义(P0.05),B组与A组比较差异无统计学意义(P0.05)。C组换药次数及住院时间明显低于A组、B组,差异有统计学意义(P0.05);三组间住院费用比较,差异无统计学意义(P0.05)。治疗后C组、B组疼痛程度较A组明显降低,差异有统计学意义(P0.05);B组和C组组间比较,差异无统计学意义(P0.05)。结论:VSD联合银离子抗菌敷料治疗深Ⅱ度烧伤患者创面能缩短创面平均愈合时间、提高创面愈合率、减少换药次数、缩短住院时间、减少疼痛及并发症的发生,且不明显增加患者住院费用,值得在临床推广。     

局部氧疗合并可调节负压创面治疗技术修复深Ⅱ度烧伤创面

目的:探讨局部氧疗合并可调节负压创面治疗技术(Local oxygen therapy combined with regulated negative pressure-assisted wound therapy,RONPT)治疗深Ⅱ度烧伤创面的疗效.方法:以笔者医院2017年9月-2019年12月收治的50例烧伤...     

植皮联合负压封闭引流技术修复深度烧伤创面的应用观察及并发症分析

目的:探讨植皮联合负压封闭引流(Vacuum sealing drainage,VSD)技术修复深度烧伤创面的应用效果。方法:选取2015年10月-2017年10月收治的70例深度烧伤患者进行研究,随机分为观察组及对照组,每组35例。观察组采用创面植皮联合VSD技术进行治疗,对照组进行创面植皮后使用普通敷料加压包扎封闭创面,对两组患者的平均换药次数、平均住院时间、术后两周创面愈合率、创面愈合时间、并发症发生率进行统计分析,评价两种方式效果差别。结果:观察组患者平均换药次数、平均住院时间、术后两周创面愈合率及创面愈合时间均优于对照组,差异均具有统计学意义(P0.05);观察组患者术后并发症发生率为5.7%低于对照组的22.9%,差异有统计学意义(P0.05)。结论:深度烧伤创面采用植皮联合VSD技术修复,术后相关指标改善明显,并发症风险明显降低,操作简便安全且效果更佳,值得临床推广应用。     

负压封闭引流联合牛碱性成纤维细胞生长因子对四肢深Ⅱ度烧伤创面治疗效果研究

目的:研究负压封闭引流(Vacuum sealing drainage,VSD)联合牛碱性成纤维细胞生长因子(Basic fibroblast growth factor,bFGF)对四肢深Ⅱ度烧伤创面的治疗效果。方法:选择2018年4月-2019年3月笔者医院收治的80例四肢深Ⅱ度烧伤患者,分别采用常规治疗(对照组,n=20),负压封闭引流治疗(治疗组A,n=20),牛碱性成纤维细胞生长因子治疗(治疗组B,n=20)和负压封闭引流联合牛碱性成纤维细胞生长因子治疗(治疗组C,n=20)。观察比较四组患者创面大体情况、创面愈合时间、创面愈合率、创面分泌物细菌培养情况和瘢痕增生情况。结果:经不同处理10d和21d后,治疗组A、B和C创面改善情况明显优于对照组,且治疗组C情况改善最好;治疗组A、B和C创面愈合时间均明显低于对照组,治疗组C愈合时间最短,差异均具有统计学意义(P0.05)。10d、14d和21d后,治疗组A、B和C创面愈合率明显高于对照组,且10d、14d后治疗组C创面愈合率最高(P0.05),但21d后治疗组A、B和C创面愈合率无差别(P0.05)。治疗组A、B和C患者愈后1个月、2个月、4个月瘢痕颜色评分明显低于对照组,治疗组A、B和C患者愈后2个月、4个月瘢痕厚度、血管分布及柔软度评分均明显低于对照组,且C组愈后4个月的各指标评分均明显低于治疗组A和B(P0.05)。所有患者治疗后1d均无细菌感染,但治疗10d、14d和21d后,治疗组A、B和C组细菌培养阳性病例数比例均明显低于对照组,治疗组C细菌培养阳性病例数最低(P0.05)。结论:负压封闭引流联合bFGF可有效加快四肢深Ⅱ度烧伤创面的愈合,改善愈后的瘢痕生长,减少创面病原菌感染率,具有临床推广使用价值。     

二次负压封闭引流对小儿大面积深Ⅱ度烧伤创面愈合的疗效研究

目的:探讨二次负压封闭引流(Vacuumsealingdrainage,VSD)对小儿大面积深Ⅱ度烧伤创面的应用疗效。方法:回顾性分析2015年-2017年收治的50例大面积深Ⅱ度烧伤患儿,随机分为观察组及对照组,每组25例。观察组行二次VSD治疗,既在创面削痂和植皮手术后分别应用VSD技术进行治疗,行削痂手术后采用VSD技术治疗至肉芽创面新鲜后行植皮术,植皮后再采用VSD技术进行治疗直至愈合;对照组削痂手术后行植皮术,植皮后敷料加压包扎治疗,定期换药直至愈合。对两组患儿的平均换药次数、平均住院时间、创面愈合时间、并发症发生率进行统计分析,评价治疗效果。结果:观察组平均换药次数、平均住院时间、创面愈合时间及术后并发症发生率均低于对照组[(4.4±0.5)次,(26.0±2.5)d,(23.0±1.8)d,4.0%(1/25)vs(10.5±1.2)次,(38.0±4.5)d,(34.0±3.7)d,20.0%(5/25)],差异有统计学意义(P0.05)。结论:采用二次VSD治疗小儿大面积深Ⅱ度烧伤创面应用效果良好,较传统治疗方式有明显优势,操作简便,安全有效,值得临床推广应用。     

早期磨痂手术在面部深Ⅱ度烧伤创面的应用

1 .一般资料 :本组男 73例 ,女 6例 ,年龄 12～ 48岁 ,烧伤总面积 5 %～ 90 %。其中火焰烧伤 48例 ,浓硫酸烧伤 3例 ,矿井下粉尘燃爆伤 2 3例 ,其他原因烧伤 5例。2 .手术方法 :患者入院后给予清创、抗休克治疗。中小面积烧伤者 ,清创和磨痂手术同时进行 ,大面积烧伤者 ,磨痂手术时间为伤后 2 4～ 48ｈ。手术在全身麻醉下以质量浓度为 2 0 ｇ/Ｌ的碘伏消毒创面 ,铺无菌巾 ,用金属丝球对创面进行有序磨擦至创面出现出血点或泛红为止 ,然后用等渗盐水清洗创面。由于上眼睑皮肤较薄 ,磨痂时应注意防止过深。如果磨痂手术因种种原因在受伤 3ｄ后…     

烧伤后24 h内削痂防治深Ⅱ度创面进行性加深的组织学观察

目的　探讨烧伤后 2 4h内行削痂手术 ,对深Ⅱ度烧伤创面进行性加深的防治作用。方法　选择 12例深Ⅱ度烧伤患者 ,在伤后 2 4h内进行创面削痂手术。分别从手术前、手术后 (伤后 5～7d)和未手术创面 (伤后 5～ 7d)获取标本。采用HE染色、Masson′s染色和免疫组化技术标记Vi mentin抗原阳性细胞的方法 ,对创面组织标本进行组织学观察。　结果　随病程演进 ,未手术创面炎性反应程度明显加重 ,组织坏死范围扩大 ,原来残存的皮肤附件因炎症加重而消失 ;Masson′s染色棕红色范围扩大 ,亮绿色范围缩小 ;Vimentin抗原阳性细胞数量明显减少。伤后 2 4h内削痂创面局部炎症反应较未削痂创面明显减轻 ,可见新鲜肉芽形成和部分上皮修复 ,组织坏死范围未见进一步扩大 ,与未手术区比较差异有显著性意义 (P <0 .0 5 ) ;Masson′s染色亮绿色范围无明显缩小 ;Vimentin抗原阳性细胞数量明显多于未手术区 (P <0 .0 5 )。　结论　烧伤后 2 4h内削痂 ,能适时去除创面坏死组织、阻断组织变质性损害的加剧 ,从而有效改善深Ⅱ度创面的进行性加深现象 ,对创面愈合具有促进作用。