纳米银－猪脱细胞真皮基质敷料治疗浅Ⅱ度烧伤创面的临床观察

目的观察纳米银－猪脱细胞真皮基质敷料在临床上治疗浅Ⅱ度烧伤创面的临床疗效。 方法2014年1月到2015年12月，选取北京军区总医院烧伤整形科收治的浅Ⅱ度烧伤患者90例，按入院顺序依次编码，采用随机排列数字表法将90例患者分为纳米银敷料组、猪脱细胞真皮基质敷料组及纳米银－猪脱细胞真皮基质敷料组，每组30例。患者入院当天，拍照计算创面面积，并用咽拭子取创面分泌物作细菌培养，行创面清创术，分别在创面上敷以纳米银敷料、猪脱细胞真皮基质敷料以及纳米银－猪脱细胞真皮基质敷料。于治疗后第5天，用咽拭子取创面分泌物作细菌培养；采用痛觉评分标准，通过询问与观察患者换药时的痛觉情况，评估患者换药时痛觉评分。于治疗后第7天，拍照计算创面面积，计算创面愈合率。记录创面最终愈合时间。数据比较采用单因素方差分析、χ²检验及SNK－q检验。 结果纳米银敷料组、猪脱细胞真皮基质敷料组及纳米银－猪脱细胞真皮基质敷料组在治疗后第5天创面细菌培养阳性数结果分别为2例(6.6%)、9例(30.0%)、1例(3.3%)，3组结果比较，差异有统计学意义(χ²＝10.962，P＝0.004)；纳米银－猪脱细胞真皮基质敷料组的细菌培养阳性数结果显著优于猪脱细胞真皮基质敷料组，差异有统计学意义(χ²＝7.680，P＝0.006)。纳米银敷料组、猪脱细胞真皮基质敷料组及纳米银－猪脱细胞真皮基质敷料组治疗后第5天的痛觉评分[(8.6±0.5)、(6.6±0.8)、(0.6±1.3)分]，治疗后第7天的创面愈合率[(61.67±18.22)%、(86.77±15.32)%、(99.80±0.56)%]，创面愈合时间[(11.5±1.3)、(10.3±0.7)、(7.3±0.7)d]，组间差异均有统计学意义差异(F＝201.7、19.9、55.7，P值均小于0.05)；纳米银－猪脱细胞真皮基质敷料组治疗后第5天的痛觉评分显著低于其余两组，差异均有统计学意义(P值均小于0.05)；治疗后第7天的创面愈合率明显优于其余两组，差异均有统计学意义(P值均小于0.05)；创面愈合时间显著短于其余两组，比较差异均有统计学意义(P值均小于0.05)。 结论纳米银－猪脱细胞真皮基质敷料具有抗感染、促进创面愈合及减轻换药痛觉的作用。

Clinical study of nanosilver/porcine acellular dermal matrix dressing in the treatment of superficial second degree burn wounds

ObjectiveTo observe the clinical effect of nanosilver/porcine acellular dermal matrix dressing on superficial second degree burn wounds. MethodsFrom January 2014 to December 2015, 90 patients with superficial second degree burn were treated and observed in the Department of Burns and Plastics Surgery, General Hospital of Beijing Military Region. According to the order of admission and random number table, the patients were randomly divided into 3 groups, nanosilver dressing group, porcine acellular dermal matrix dressing group and nanosilver/porcine acellular dermal matrix dressing group, each group of 30 patients. On the day of admission, the wounds areas were calculated by taking pictures and the wound secretion was taken for bacterial culture by using the throat swab, burn wounds were treated with debridement, then apply nanosilver dressing, porcine acellular dermal matrix dressing and nanosilver/porcine acellular dermal matrix dressing on the wounds. On the 5th day after treatment , the wound secretion was taken for bacterial culture by using the throat swab again. Pain score was assessed by asking and observing the changes of pain in patients after dressing change. On the 7th day after treatment, the wounds areas were calculated by taking pictures. The wound healing rate was calculated. Wound healing time was recorded. The data were compared by using one-way ANOVA test, SNK-q test and Chi-square test. ResultsOn the 5th day after treatment, the wound bacterial culture results of nanosilver dressing group, porcine acellular dermal matrix dressing group and nanosilver/porcine acellular dermal matrix dressing group were 2(6.6%), 9(30.0%), 1(3.3%), there were significant differences among the three groups(χ²=10.962, P=0.004). The wound bacterial culture result of the nanosilver/porcine acellular dermal matrix dressing group was better than the porcine acellular dermal matrix dressing group, there was significant difference between the two groups(χ²=7.680, P=0.006). The pain scores of nanosilver dressing group, porcine acellular dermal matrix dressing group and nanosilver/porcine acellular dermal matrix dressing group on the 5th day after treatment were [(8.6±0.5)points, (6.6±0.8)points, (0.6±1.3)points], the wound healing rates of the three groups on the 7th day after treatment were [(61.67±18.22)%, (86.77±15.32)%, (99.80±0.56)%], the wound healing time of the three groups were [(11.5±1.3)days, (10.3±0.7)days, (7.3±0.7)days], there were significant differences among the three groups(F=201.7, 19.9, 55.7, P values were all less than 0.05). The pain score of the nanosilver/porcine acellular dermal matrix dressing group on the 5th day after treatment was lower than the other two groups(P values were all less than 0.05), the wound healing rate of the nano-silver/porcine acellular dermal matrix dressing group on the 7th day after treatment was better than the other two groups(P values were all less than 0.05), the wound healing time of the nanosilver/porcine acellular dermal matrix dressing group was shorter than the other two groups(P values were all less than 0.05). ConclusionThe nanosilver/porcine acellular dermal matrix dressing has the effects of anti-infection, promoting wound healing and reducing the pain when dressing changing.