自体微粒皮移植术在大面积深度烧伤并发症防治中的作用

目的 探讨自体微粒皮移植术在大面积深度烧伤并发症防治中的作用。方法 比较性研究我院1993-2002收治的大面积深度烧伤患者64例,根据早期创面处理方法的不同分为切痂自体微粒皮移植术组和切痂邮票状植皮术组,两组患者的一般情况具有可比性。自体微粒皮移植术组行一次性大面积切痂自体微粒皮和大张异体皮联合移植术,切痂邮票状植皮术组分次行部分Ⅲ度创面切痂自体邮票状皮片移植术。观察自体微粒皮移植术后的临床过程,并比较两组患者脓毒症和MODS的发生率。结果①5-7 d,异体皮表皮层出现疱状变性;2周左右,异体真皮出现黑色斑点;4-6周,形成痂皮脱落,其下为新生表皮覆盖。②自体微粒皮移植术组脓毒症和MODS的发生率分别为34.4％和18.8％,明显低于切痂邮票状植皮术组的62.5％和43.8％,差异有显著性(P<0.05)。结论 自体微粒皮移植术治疗大面积深度烧伤切实可行、疗效确切,能有效降低MODS的发生率。

Clinical effect of micro- skin autograft on complication in extensively deep burns

Objective To explore clinical effect of skin - grafting method on complication in extensively deep burned patients.Methods 64 patients with extensively deep burns were retrospectively analyzed in our department from 1993 to 2002. Patients were divided into two groups:one group treated with micro-skin autogfaft after extensive eschar excision in one operation and another group treated with stamp - skin - autograft after routine repeated escharectomy. The clinical course after micro - skin autograft were observed. The incidence of sepsis and MODS were compared between two groups. Results (1)5 - 7 days, there were vesicular degeneration of allo - epidermis.From 14 days , there were black spot of allo - dermis.4 - 6 weeks, the sloughed allo - dermis as a crust was separated from the healed new epidermis. (2) The incidence of sepsis and MODS was 34.4% and 18.8% respectively in group with micro - skin autograft after extensive eschar excision in one operationl.It was evidently lower than another group.Difference was significant between two groups (P < 0.05).Conclusion Micro - skin autograft after extensive eschar excision in one operation for treatment of extensively deep burns is not only feasible but also useful to reduce the incidence of MODS.