深Ⅱ度烧伤创面3种治疗方法的比较

目的比较深Ⅱ度烧伤创面3种治疗方法的效果。方法选择对治疗方案知情同意的深Ⅱ度烧伤患者27例,根据患者意向分为封闭式负压引流（VSD）组、磺胺嘧啶银（SD-Ag）组、削痂组,每组9例。VSD组：维持负压20～60 kPa,持续7～10 d。SD-Ag组：每日外用SD-Ag。削痂组：伤后24 h内削痂并覆盖生物敷料。术后进行康复治疗,定期随访,评估疗效。结果创面愈合时间：VSD组（18.64±3.25）d,SD-Ag组（22.35±3.45）d,削痂组（24.67±3.38）d,VSD组明显短于SD-Ag组及削痂组（均P〈0.05）。随访1年瘢痕评估：VSD组＂-＂例数显著多于SD-Ag组和削痂组（均P〈0.01）,＂＋＂～＂＋＋＋＂总例数明显少于SD-Ag组和削痂组（均P〈0.05）。结论 VSD方法可使创面高效引流,清除细菌,进行自溶性清创,操作简单。术后同时进行康复治疗,可最大限度地恢复外形和功能,无明显增生性瘢痕。

The Comparison of Three Treatment Methods in Repair of Deep Second Degree Burn Wounds

Objective To Comparison the effects of three treatment methods in deep second degree burn wound.Methods Twenty seven patients with deep second degree burn were chosen and divided into the VSD group,SD-Ag group and eschar tangential excision group according to patients＇ intention, each group containing 9 cases.As to VSD group,pressure from20 to 60 kPa was applied to the wound for 7～10 days;in the SD-Ag group,SD-Ag topic agent was applied everyday;in the eschar tangential excision group,the wound eschar was excised tangentially and bio-dressing materials were used to cover the wound in 24 hours after injury.Rehabilitation,regular follow-up and evaluation were performed after treatment.Results Wound healing time,（18.64±3.25） d for VSD group,（22.35±3.45） d for SD-Ag group and（24.67±3.38）d for eschar tangential excision group.There was significant diference between SD-Ag,tangential excision groups and VSD group（all P〈0.05）.Scar evaluation after one year follow-up was as follows;the cases with sign of ＂-＂in the VSD group were more than those significantly in the SD-Ag group and in the tangential excision group（P〈0.01 for both）,and the cases with sign of＂＋ ＂or ＂ ＋＋＋ ＂were less than those significantly in the SD-Ag group and the tangential excicion group totally （P〈0.05 for both）.Conclusion The VSD operation procedure is simple for effective drainage and autolysis debridement,rehabilitation at the same time would restore the appearance and function of the wound greatly with no obvious hypertrophic scars.