磺胺嘧啶银乳膏在压疮中的应用

<正>压疮是临床上常见的一种并发症,以皮肤破溃疮口经久不愈为特征,多为久病卧床,局部组织长期受压,血液循环障碍,气血运行失调,肌肤失养,组织活力低下,每日摩擦皮肤,染毒而成[1],我院自2009年以来,采用磺胺嘧啶银乳膏局部外敷的方法治疗压疮,收到一定的疗效,现介绍如下。     

磺胺嘧啶银脂质水胶敷料在经烧伤瘢痕外周静脉置管的应用

目的探讨磺胺嘧啶银脂质水胶敷料(优拓SSD敷料)在大面积烧伤患者经瘢痕外周静脉置管的应用效果。方法将68例大面积烧伤患者按照随机数字表法分为对照组(32例)和观察组(36例),两组按照静脉留置输液技术规范经瘢痕外周静脉置管,置管后对照组采用普通套管贴膜覆盖置管及周围皮肤,观察组先用优拓SSD敷料覆盖,再用普通套管贴膜固定置管。结果观察组皮肤损伤、局部感染发生率、更换贴膜敷料的次数及疼痛评分显著低于对照组(均P<0.01)。结论优拓SSD敷料用于经瘢痕留置套管针,可以防止瘢痕与贴膜粘连,减轻患者疼痛,防止局部感染及瘢痕组织损伤的发生。     

应用磺胺嘧啶银软膏面膜治疗面部烧伤创面

面部为暴露部位,烧伤发生率较高,治疗时多采用暴露疗法,即用磺胺嘧啶银(SD Ag)软膏外涂创面,3次/d,换药时再将残留的药膏清除。此操作较繁琐,药物难以涂抹均匀。为此笔者制作了“SD Ag软膏面膜”用以治疗面部烧伤创面,效果较好。该“面膜”是根据患者面部创面形状用单层大张无菌纱布剪制而成,预留双眼、鼻、口等处的开口,在纱布上均匀涂布SD Ag软膏。它可根据用量一次性制备,存好备用。使用时将其覆盖于面部创面上并用压舌板轻轻按压,使之紧贴于创面,不留空隙。每次换药时只需将“面膜”轻轻揭掉,创面经简单处理后,再覆以新的“面膜”。…     

磺胺嘧啶银治疗烧伤创面102例疗效观察

目的 观察磺胺嘧啶银治疗烧伤创面的效果.方法 采用磺胺嘧啶银治疗大面积深度烧伤及暴露部位烧伤患者102例,男56例,女46例,年龄1～47岁,烧伤面积0.5%～51%,烧伤深度均在浅Ⅱ°和Ⅲ°之间.患者均在烧伤后第1天开始使用磺胺嘧啶银治疗.结果 浅Ⅱ度创面73例均在伤后8～12 d痊愈,无1例发生感染和创面加深,平均...     

硝普钠和磺胺嘧啶银联合应用对大鼠深Ⅱ度烧伤创面愈合的影响

目的：研究硝普钠、磺胺嘧啶银及二者合用对深Ⅱ度烧伤皮肤创面愈合的影响。方法：100只WiStar大鼠背部深Ⅱ度烧伤创面,随机分成0．9％氯化钠注射液组、1％磺胺嘧啶银霜组、lmmol／L硝普钠组和1％磺胺嘧啶银霜＋lmmol／L硝普钠组。每组25只大鼠。动态观察烧伤后不同时间点创面细胞增殖周期、羟脯氨酸含量及创面组织愈合情况,计算创面愈合率。结果：伤后随时间推移磺胺嘧啶银霜＋硝普钠组创面愈合率高于其他三组;伤后第10天,磺胺嘧啶银霜＋硝普钠组创面羟脯氨酸含量、细胞S期百分比达到峰值,明显高于0．9％氯化钠注射液（P〈O．01）,磺胺嘧啶银霜组、硝普钠组之间比较无显著差异（P〉0．05）。结论：磺胺嘧啶银霜和硝普钠合用可有效促进大鼠深Ⅱ度烧伤创面愈合。     

桔梗提取物木犀草素联合磺胺嘧啶银治疗浅Ⅱ度烫伤作用研究

探讨桔梗成分木犀草素与磺胺嘧啶银联合治疗浅Ⅱ度烫伤的协同作用,为优化治疗方案提供新的理论基础。方法 构建SD大鼠浅Ⅱ度烫伤模型,依据给药情况分为五组：A组为模型组,B组为磺胺嘧啶银组,C组为木犀草素组,D组为磺胺嘧啶银和木犀草素联用组,N组为正常对照组。根据给药第4天和第7天的创面愈合率评价不同给药组的疗效。通过测量大鼠烫伤区域伤口直径,采用苏木精-伊红（HE）染色观察创面皮肤组织的病理变化,采用Western blot检测大鼠创面皮肤组织血管内皮生长因子（VEGF）、基质金属蛋白酶2（MMP-2）和Ⅰ型胶原蛋白（Coll-Ⅰ）表达,采用ELISA检测大鼠的肿瘤坏死因子α（TNF-α）、白细胞介素10（IL-10）水平。结果 B组、C组第7天烫伤创面愈合率均高于A组（P＜0.05）;D组第7天烫伤创面愈合率均高于A组、B组、C组（P ＜0.05）。D组皮肤层完整,角质层、表皮和真皮结构正常,皮肤毛囊及附属结构基本完整,恢复程度优于B组和C组。B组、C组VEGF、Coll-Ⅰ水平高于A组,MMP-2水平低于A组（P ＜0.05）;B组和C组VEGF、Coll-Ⅰ、MMP-2水平比较,差异无统计学意义（P ＞0.05）;D组VEGF、Coll-Ⅰ水平均高于A组、B组、C组,MMP-2水平均低于A组、B组、C组（P ＜0.05）。B组、C组TNF-α水平均低于A组（P ＜0.05）;B组、C组TNF-α水平比较,差异无统计学意义（P＞0.05）;A组、B组、C组IL-10水平比较,差异无统计学意义（P＞0.05）;D组TNF-α水平均低于A组、B组、C组,IL-10水平均高于A组、B组、C组（P ＜0.05）。结论 磺胺嘧啶银联合木犀草素治疗浅Ⅱ度烫伤的效果优于单独用药,其潜在机制之一可能是通过下调MMP-2表达,上调VEGF、Coll-Ⅰ和IL-10表达,抑制TNF-α等因子的表达,以减轻组织炎症,改善烫伤创面皮肤组织环境,促进愈合。     

纳米银敷料在修复Ⅱ度烧伤创面的应用研究

目的观察纳米银敷料在Ⅱ度烧伤创面的防治感染作用及对创面愈合时间的影响。方法将Ⅱ度(深、浅)烧伤创面患者随机分为纳米银敷料组(A组,65例),1%磺胺嘧啶银霜组(B组,63例)和凡士林油纱组(C组,63例)。创面敷料或用药每天更换1次,使用前后进行创面细菌培养,观察创面愈合时间并进行统计学比较。结果在防治创面细菌定植方面,治疗后创面细菌培养阳性率A组(0%)与B组(1·6%)相似,均较治疗前下降,而C组治疗后细菌培养阳性率(14·3%)较治疗前(4·8%)明显增加。A组浅Ⅱ度创面愈合时间为(9·6±1·6)d,与B、C两组比较均明显提前(P<0·01);A组深Ⅱ度创面愈合时间为(19·1±2·6)d,与C组比较差异具有统计学意义(P<0·01),与B组比较差异无统计学意义(P>0·05)。结论Ⅱ度烧伤创面应用纳米银敷料,可以降低患者创面感染的风险,缩短创面愈合时间。     

美皮康银离子敷料联合愈邦抗菌医用敷料治疗深Ⅱ度烫伤创面疗效观察

目的：探讨美皮康银离子敷料联合愈邦抗菌医用敷料治疗深Ⅱ度烫伤创面的临床效果。方法：选取2018年5月-2020年10月笔者医院收治的深Ⅱ度烫伤患者68例,随机数字表法分为观察组与对照组,每组34例。对照组给予磺胺嘧啶银乳膏联合愈邦抗菌医用敷料治疗,观察组给予美皮康银离子敷料联合愈邦抗菌医用敷料治疗。比较两组创面愈合率、创面细菌培养结果、创面渗液与肿胀情况、创面疼痛程度、色素沉着及瘢痕情况。结果：两组治疗后1周、4周创面愈合率比较差异无统计学意义（P>0.05）;观察组治疗后2周、3周创面愈合率高于对照组,差异有统计学意义（P<0.05）。观察组创面愈合时间短于对照组,差异有统计学意义（P<0.05）。观察组治疗后1周、2周创面细菌培养阳性率分别为14.71%、2.94%低于对照组的38.24%、20.59%,差异有统计学意义（P<0.05）。观察组治疗后1周、2周、3周创面渗出情况优于对照组,差异有统计学意义（P<0.05）。观察组治疗后1周、2周、3周创面疼痛视觉模拟评分法（Visual analogue scale,VAS）评分低于对照组,差异有统计学...     

磺胺嘧啶银软膏联合京万红软膏治疗溃疡期压疮的临床研究

目的:观察磺胺嘧啶银软膏联合京万红软膏治疗压疮的临床疗效.方法:将65例(81处)压疮病人随机分为观察组34例(42处)及对照组31例(39处).观察组用磺胺嘧啶银软膏联合京万红软膏换药,对照组用京万红软膏换药.结果:观察组较对照组治疗有效率高,差异有统计学意义(X2=11.8,p＜0.05).结论:磺胺嘧啶银软膏联合京万红软膏治疗压疮有良好的效果.     

磺胺嘧啶银联合生肌象皮膏治疗Ⅲ期压疮的效果观察

目的 探讨应用磺胺嘧啶银联合生肌象皮膏治疗Ⅲ期压疮的临床效果.方法 将125例Ⅲ期压疮患者按入院时间分为两组.对照组(59例)采用传统方法治疗,观察组(66例)采用磺胺嘧啶银与生肌象皮膏联合治疗.分别观察两组感染控制时间、肉芽组织形成时间及愈合时间.结果 观察组感染控制时间、肉芽组织形成时间及愈合时间显著短于对照组(均P＜0.01).结论 磺胺嘧啶银联合生肌象皮膏治疗Ⅲ期压疮,可祛腐生肌,有效控制感染创面,促进创面愈合.     

Comparison of silver nylon wound dressing and silver sulfadiazine in partial burn wound therapy

The study aims to perform a comparative assessment of two types of burn wound treatment. To do the assessment, patients with partial thickness burn wounds with total body surface area <40% were simple randomised to treat with nanocrystalline silver nylon wound dressing or silver sulfadiazine cream. Efficacy of treatment, use of analgesics, number of wound dressing change, wound infection and final hospitalisation cost were evaluated. The study showed silver nylon wound dressing significantly reduced length of hospital stay, analgesic use, wound infection and inflammation compared with silver sulfadiazine.     

Foam dressing with epidermal growth factor for severe radiation dermatitis in head and neck cancer patients

This study was conducted to evaluate the effects of foam dressing with human recombinant human epidermal growth factor (rhEGF) on the healing process in head and neck cancer patients who experience radiation‐induced dermatitis (RID). Seven patients, including three with oropharyngeal, two with nasopharyngeal and one each with hypopharyngeal and laryngeal carcinoma, who underwent radiotherapy (RT) for head and neck cancer at the Asan Medical Center from March to December 2008 were prospectively included in this study. Patients who showed severe RID (more than wet desquamation) on the supraclavicular fossa or neck areas were treated by wound cleaning and debridement of granulation tissue, followed by daily rhEGF spray and foam dressing. Median time to stop exudates and reepithelialisation was 4 days. Within 14 days (median 8 days), all patients showed complete healing of RID and no longer required dressings. This new method of treatment with dressing containing rhEGF may have the potential to accelerate the healing process in patients with RID. A case–control study is needed to confirm this finding.     

Effectiveness of four topical treatment methods in a rat model of superficial partial-thickness burn injury: the advantages of combining zinc-hyaluronan gel with silver foam dressing

BackgroundThere are several options available for conservative treatment of partial-thickness burns, however, reliable, affordable, and easily obtainable animal testing models are hard to find for the comparison of the different treatment methods. We aimed at developing a preclinical testing model and at comparing four treatment methods for superficial partial-thickness burns.MethodsBurn injury was induced in 90 adult male Wistar rats by placing the 130°C hot tip of a commercially obtainable soldering device for 30 s on the clipped skin of the interscapular region at a steady pressure. Skin histology was studied on days 5, 10, and 22 after the induction of the burn injury, on which days, respectively, the ratio of the not epithelialized wound (%), the extent of re-epithelialization (score), and the scar thickness (µm) were assessed. We compared 4 groups: silver-sulfadiazine cream, zinc-hyaluronan gel, silver foam dressing, and the combination of zinc-hyaluronan gel with a silver foam dressing.ResultsOn day 5, the induction of superficial partial-thickness burn injury was confirmed histologically in the rats. The zinc-hyaluronan gel and the combination treatment resulted in a markedly smaller ratio of the non-epithelialized area (29 ± 10% and 28 ± 13%, respectively) than silver-sulfadiazine cream (69 ± 4%; p < 0.01). On day 10, the extent of re-epithelialization was the lowest (～0.2) in the silver-sulfadiazine cream group, while the other 3 treatments performed significantly better. The combination treatment lead to the maximal score of 2 in all rats, which was higher than in the other 3 treatment groups. On day 22, the scar thickness was the smallest in the combination treatment group (560 ± 42 µm), which was significantly less than in the silver-sulfadiazine cream group (712 ± 38 µm; p < 0.05).ConclusionsWe designed and histologically confirmed a reproducible method for induction of superficial partial-thickness burns in rats for preclinical testing. In our model, the combination of zinc-hyaluronan gel with silver foam dressing was more effective than either of its components alone or than silver-sulfadiazine cream.     

Application of polycaprolactone,chitosan, and collagen composite as a nanofibrous mat loaded with silver sulfadiazine and growth factors for wound dressing

Fabrication of nanofibrous biomaterials composed of natural and synthetic materials that incorporated with antibiotic and growth factors with controlled release manner is an attractive topic in wound healing. The purpose of this study was to prepare optimal composite of materials as biomimetic nanofibrous mats for application in wound healing. The mat was prepared of polycaprolactone (PCL) in the bottom, chitosan/poly ethylene oxide (Cs/PEO) in the middle, and PCL/collagen (PCL/Coll) in the top layer. A panel of standard characterization tests of nanofibrous mat was performed and its compatibilities in strength and integration were confirmed. Middle layer was loaded with epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF), and silver sulfadiazine (SSD) was incorporated in the bottom layer as an anti‐infection factor. Then, on the dorsum of rats, a 400‐mm² wound was created and surrounded by a silicone ring to control the usual tissue contractions. Nanofibrous mats with or without growth factors were applied as wound dressings and at day 14, the healing process was evaluated. At day 14, the treated group by designed mat showed faster epithelialization and angiogenesis. Silicone ring in the test group was desirable in wound closure compared to the control group. Reformation of skin tissue was manifested in a shorter time. This composite nanofibrous mat could be introduced as a dynamic and effective candidate for wound dressing.     

Randomized controlled single center study comparing a polyhexanide containing bio-cellulose dressing with silver sulfadiazine cream in partial-thickness dermal burns

Objective

A prospective, randomized, controlled single center study was designed to evaluate clinical efficacy of a polyhexanide containing bio-cellulose dressing (group B) compared to a silver-sulfadiazine cream (group A) in sixty partial-thickness burn patients.

Patients and methods

Local ethics committee approval was obtained and patients consented. Parameters were: pain reduction (VAS), healing time and wound bed condition, comparing day 0 (start) versus day 14 (end), as well as, ease of dressing use and treatment costs.

Results

All completed the study (n = 30/n = 30) and were included in the ITT analysis, with a total of 72 burns (group A: n = 38, group B: n = 34). We noted no differences in healing time. Pain reduction was significantly faster and better in group B (p < 0.01). There were fewer dressing changes in group B, compared to group A. Ease of use for the bio-cellulose dressing was rated better compared to group A. In group B, € 95.20 was saved for a 10 day treatment period, compared to group A.

Conclusion

Group B demonstrated a better and faster pain reduction in the treated partial-thickness burns, compared to group A. The results indicate the polyhexanide containing bio-cellulose dressing to be a safe and cost effective treatment for partial-thickness burns.     

Acute leukopenia associated with silver sulfadiazine therapy

A patient with a 30% scald burn was treated with topical silver sulfadiazine (Silvadene). On two occasions, within 48 hours of treatment, the patient developed acute leukopenia. Bone marrow aspiration revealed cell maturation arrest. The possible mechanisms of this leukopenia are discussed. It is recommended that daily leukocyte counts be done in burn patients being treated with silver sulfadiazine.     

A prospective,randomized trial of silver containing hydrofiber dressing versus 1% silver sulfadiazine for the treatment of partial thickness burns

Silver sulfadiazine has been used as a topical burn wound treatment for many years. Pain associated with dressing changes is a common problem in burn wounds. Aquacel Ag, a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity. The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns. This prospective randomized study was conducted in 70 patients who had partial thickness burns less than 15% of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006–February 2008. Patients were divided into two groups: Aquacel Ag‐treated group with dressing changes every 3 days (35 patients) and 1% silver sulfadiazine‐treated group, with daily dressing changes (35 patients). There was no difference in demographic data including age, gender, burn percentage between groups. Time‐to‐wound healing pain score during dressing change and cost of treatment were compared between both groups. Time‐to‐wound closure was significantly shorter in the Aquacel Ag‐treated group (10 ± 3 versus 13.7 ± 4 days, P < 0·02) as well as pain scores at days 1, 3 and 7 (4·1 ± 2·1, 2·1 ± 1·8, 0·9 ± 1·4 versus 6·1 ± 2·3, 5·2 ± 2·1, 3·3 ± 1·9, respectively, P < 0·02). Total cost of treatment was 52 ± 29 US dollars for the Aquacel Ag‐treated group versus 93 ± 36 US dollars for the silver sulfadiazine‐treated group. This study showed that Aquacel Ag increased time to healing, decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost. This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic.