藻酸盐敷料联合rhGM-CSF用水胶体封闭治疗肌腱、骨外露的疗效研究

目的探讨藻酸盐敷料联合重组人粒细胞巨噬细胞集落刺激因子(rhGM-CSF)凝胶和莫匹罗星软膏混合物覆盖创面后，用水胶体敷料封闭肌腱、骨外露创面的临床疗效。 方法选取2018年10月至2020年5月在达州市中心医院烧伤整形科住院和伤口治疗中心门诊治疗的肌腱、骨外露面积>0. 5 cm²的50例患者，采用抽签法分为实验组(藻酸盐＋rhGM-CSF＋莫匹罗星软膏＋水胶体封闭)和对照组(凡士林油纱＋rhGM-CSF＋莫匹罗星软膏)，每组各25例。连续观察肉芽组织完全覆盖外露肌腱、骨所需时间、创面愈合时间、前3次换药时疼痛视觉模拟评分(VAS)。数据比较采用t检验和χ²检验。 结果实验组肉芽组织完全覆盖外露肌腱、骨所需时间(20.556±10.214) d少于对照组(28.040±11.929)d，差异有统计学意义(t＝2.436，P＝0.019)；实验组创面愈合时间(30.778±12.762) d少于对照组(40.600±17.231) d]，差异有统计学意义(t＝2.348，P＝0.023)；前3次换药实验组VAS(1.893±0.924)分明显低于对照组(5.067±1.223)分，差异有统计学意义(t＝17.933，P<0.001)。 结论藻酸盐敷料联合rhGM-CSF和莫匹罗星软膏混合物并用水胶体敷料封闭创面可加速创面肉芽组织生长，使其早期覆盖肌腱、骨骼，加快创面愈合，减轻患者换药疼痛，提高换药效率，降低皮瓣手术率，为无皮瓣手术条件及拒绝皮瓣手术患者提供新的治疗方案，可在门诊及基层医院得到推广。

A study about the effect alginate dressing with recombinant human granulocyte macrophage colony stimulating factor have on tendon-bone exposed wounds after block therapy under hydrocolloid dressing

ObjectiveTo explore the clinical efficacy of alginate dressing combined with recombinant human granulocyte macrophage colony stimulating factor(rhGM-CSF) gel and Mupirocin ointment mixture to cover the wound surface, and then hydrocolloid dressing was used to seal the tendon and bone exposed wounds. MethodsFrom October 2018 to May 2020, in the Department of Burns and Plastic and Wound Treatment Center of Dazhou Central Hospital, 50 patients with wounds area larger than 0.5 cm² were divided into the control group and the intervention group by lottery method, with 25 patients in each group. Time for granulation tissue to completely cover exposed tendons and bones, wound healing time and visual analogue scale(VAS) in the first 3 dressing changes were evaluated in both groups. The data was analyzed by t test and chi-square test. ResultsTime for granulation tissue to completely cover exposed tendons and bones in intervention group was (20.556±10.214) d, which was lower than that of the control group(28.040±11.929) d], the difference was statistically significant(t=2.436, P=0.019); wound healing time of the intervention group was (30.778±12.762) d, which was shorter than that of the control group (40.600±17.231) d], the difference was statistically significant (t=2.348, P=0.023); VAS in the first 3 dressing changes in intervention group was (1.893±0.924) points, which was lower than that of the control group(5.067±1.223) points], the difference was statistically significant(t=17.933, P<0.001). ConclusionsAlginate dressing combined with the mixture of rhGM-CSF and Mupiroxine ointment, and then closed wound with hydrocolloid dressing can promote the growth of granulation tissue, cover of tendon and bone and wound healing, reduce pain during dressing change and improve the efficiency of dressing change, as well as reduce the flap surgery, providing a new technique for patients whose wounds do not meet the surgical conditions and who refuse surgeries.Hence, it is worth developing this technique in primary hospitals.