纳米银用于烧伤患者创面后银代谢的变化

目的　观察烧伤创面外用纳米银敷料后银离子在人体内的代谢变化。　方法　正常对照组 :健康志愿者 30例。治疗组 :选择烧伤面积为 6 %～ 12 %TBSA的患者 2 6例 ,均为深、浅不等的Ⅱ度烧伤。采用纳米银敷料外敷创面 ,覆盖面积规定为 5 %TBSA,连续使用 5d。用原子吸收光谱法测定正常对照组及治疗组使用敷料前后不同时相点血清银、2 4h尿银离子的水平 ,检测肝、肾功能。另取纳米银敷料覆盖 14d的创面和创缘组织标本 ,用石墨炉 原子吸收光谱法测定组织中银含量 ,并用透射电镜观察有无银沉积现象。　结果　与正常对照组比较 ,应用纳米银敷料后第 3天和第 5天 ,治疗组患者的血清银及尿银水平均有所升高 ,但第 14天下降至正常 ;其中 7例患者使用纳米银敷料后第 7天出现轻度的肝功能异常 ,但肾功能均正常 ;创面和创缘组织标本中银的质量分数为 (0 .7±0 .1)× 10 -6,透射电镜未见银沉积现象。　结论　纳米银敷料用于中、小面积Ⅱ度烧伤创面 ,银代谢在安全范围。患者肝功能异常的原因是应用纳米银敷料所致还是与烧伤本身有关 ,有待进一步观察。

Change in sliver metabolism after the application of nanometer silver on burn wound

OBJECTIVE: To investigate the change in silver metabolism after the application of nanometer silver on burn wound. METHODS: Twenty-six burn patients with partial thickness burn covering 6-12% TBSA were enrolled in the study as treatment group (T), and 30 healthy adult volunteers as control group (C). Burn wound covering 5% TBSA was covered with nanometer silver dressing for 5 days. The silver contents in the serum and urine in C group of people and in T group of patients at different time points before and after the application of nanometer silver were measured by atomic absorption spectrum method. The hepatic and renal function was also monitored on the 7th and 14th post treatment days (PTD) after silver application. Tissue samples from the wound and wound edge 14 days after silver application were harvested for the determination of silver content by plumbago stove and atomic absorption spectrum. The silver deposition was also detected by transmission electronic microscope. RESULTS: Compared to those in C group, the silver contents in serum and urine in T group increased on 3rd and 5th PTD, but decreased to the normal level on 14th PTD. Mild hepatic dysfunction occurred in 7 cases on 7 PTD, whereas the renal function remained normal. The tissue mass percentage of silver in burn wound and wound edge was (0.7 +/- 0.1) x 10(-6), but no silver deposition in tissue was observed by transmission electron microscope. CONCLUSION: It was proved to be safe to have the nanometer silver dressing applied on partial thickness burn wound of middle and small areas.