早期削痂對深Ⅱ度燒傷創(chuàng)面愈合的臨床研究

【摘要】 目的 探討深Ⅱ度燒傷創(chuàng)面?zhèn)?4 h內(nèi)削痂的臨床療效。 方法將30例有削痂手術(shù)指征并在傷后24 h內(nèi)行削痂術(shù)的深Ⅱ度燒傷患者設(shè)為實(shí)驗(yàn)組，并另選30例削痂條件相似而且按常規(guī)在傷后4~6d行削痂手術(shù)設(shè)為對照組。比較兩組在休克期補(bǔ)液量、并發(fā)癥發(fā)生率、尿量及創(chuàng)面愈合時(shí)間。結(jié)果 兩組患者在休克期的補(bǔ)液量比較差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），實(shí)驗(yàn)組在休克期的尿量顯著多于對照組(P＜0.05或0.01)，并發(fā)癥發(fā)生率顯著低于對照組(P＜0.05)，同時(shí)創(chuàng)面愈合時(shí)間較對照組明顯縮短(P＜0.01)。結(jié)論深Ⅱ度燒傷創(chuàng)面于傷后24 h內(nèi)削痂是安全的，并能縮短創(chuàng)面愈合時(shí)間，減輕患者的經(jīng)濟(jì)負(fù)擔(dān)。

【關(guān)鍵詞】 深Ⅱ度燒傷；削痂術(shù)；創(chuàng)面愈合

文章編號：1003-1383(2010)06-0671-02 中圖分類號：R 664文獻(xiàn)標(biāo)識碼：A

doi:10.3969/j.issn.1003-1383.2010.06.008

Clinical study of early tangential excision for deep Ⅱ burn wound healing

HUANG Zhiqun，LU Gang，GU Shixing，TANG Qiang

（Department of Burns Plastic Surgery，the Affiliated Hospital of Youjiang Medical

College for Nationalities，Guangxi，Baise 533000，China）

【Abstract】 Objective To study the clinical effect of tangential excision for wound healing within 24h after deep Ⅱ burn.

Methods 30 patients with surgical indications and under going tangential excision with 24h after deep Ⅱ degree burn were chosen as the treatment group.30 cases of similar conditions for tangential excision and under going operation during 4 to 6 days after injury were chosen as the control group.Their fluid volume in shock stage，incidence rate of complication，urine volume and wound healing time was compared.

Results There was no significant difference of the fluid volume in shock stage between two groups(P＞0.05); the urine volume of treatment group was larger than control group in shock stage，while the complication rate was significantly lower， and the wound healing time was shorter comparing with control group(P＜0.01).

Conclusion The tangential excision for wound healing within 24h after deep Ⅱ burn wounds is safe and can shorten healing time and reducing the economic burden of patients.

【Key words】 the deep Ⅱ degree burn injury；tangential excision;wound healing

深度燒傷創(chuàng)面壞死組織的存在是導(dǎo)致創(chuàng)面進(jìn)行性加深及體內(nèi)一系列病理生理性改變的根源，應(yīng)用手術(shù)方法去除深度燒傷創(chuàng)面壞死組織，并有效覆蓋創(chuàng)面是救治深度燒傷的主要手段［1］。臨床實(shí)施削痂手術(shù)一般在傷后4~6 d，此時(shí)會出現(xiàn)創(chuàng)面加深的現(xiàn)象，因此通過調(diào)整削痂的手術(shù)時(shí)間、方法達(dá)到改善或防止深Ⅱ度燒傷創(chuàng)面進(jìn)行性加深，是當(dāng)前燒傷外科界急需解決的難點(diǎn)和熱點(diǎn)［2］。筆者通過對深Ⅱ度燒傷患者的創(chuàng)面于傷后24 h內(nèi)行削痂術(shù)，觀察其安全性及創(chuàng)面愈合的療效，探討早期削痂的可行性。

資料與方法

1.一般資料 選擇2007年1月至2010年2月在我科住院的深Ⅱ度燒傷患者60例，患者傷后創(chuàng)面未作特別處理，均為傷后24 h內(nèi)入院，且有削痂手術(shù)指征。隨機(jī)分為兩組，實(shí)驗(yàn)組30例，男24例，女6例，平均年齡為（30±6）歲，平均燒傷面積占全身體表面積的（54.2±17.3）%，平均削痂面積為（49.2±10.3）%。……