銀纖維敷料聯合負壓傷口療法治療深Ⅱ度燒傷創面

曾勇 李小英 蔣秋萍

[摘要]目的：探討銀纖維敷料聯合負壓傷口療法治療深Ⅱ度燒傷創面的臨床療效。方法：選擇筆者醫院2016年6月-2018年7月住院治療的68例深Ⅱ度燒傷創面患者作為研究對象，采用隨機數字表法分為觀察組和對照組，各34例。觀察組應用銀纖維敷料聯合負壓傷口療法治療，對照組應用磺胺嘧啶鋅軟膏外涂。記錄各時點創面疼痛程度評分、創面滲液量、創面愈合率、創面完全愈合時間和細菌陽性率，觀察不良反應發生情況，比較兩組治療21d的總顯效率。結果：兩組在治療前及治療后15min的創面疼痛程度評分上差異均無統計學意義（P>0.05）;觀察組治療后即刻的創面疼痛程度評分明顯低于對照組，差異有統計學意義（P<0.05）。觀察組治療7d、14d、21d后的創面滲液量均明顯少于對照組，創面愈合率均明顯高于對照組，創面完全愈合時間明顯短于對照組，差異均有統計學意義（P<0.05）。治療前兩組創面分泌物細菌培養陽性率比較差異無統計學意義（P>0.05）;治療7d、14d后觀察組創面分泌物細菌培養陽性率均明顯低于對照組，差異均有統計學意義（P<0.05）。兩組均順利完成治療，顯著控制創面分泌物及腫脹，其中觀察組治療21d的臨床總顯效率為97.06%，明顯高于對照組的82.35%，差異有統計學意義（P<0.05）;兩組治療期間的血常規和心、肝、腎功能均無明顯異常，未見過敏反應及與治療相關的嚴重不良反應。結論：銀纖維敷料聯合負壓傷口療法治療深Ⅱ度燒傷創面的臨床療效顯著，在減輕換藥疼痛程度、清除細菌、減少滲液和促進愈合上具有優勢，且安全可靠，值得臨床推廣應用。

[關鍵詞]燒傷創面;深Ⅱ度;銀纖維敷料;負壓傷口療法;磺胺嘧啶鋅軟膏;感染;愈合

[中圖分類號]R622 ? ?[文獻標志碼]A ? ?[文章編號]1008-6455（2019）11-0007-04

Abstract： Objective ?To investigate the clinical efficacy of silver fiber dressing combined with negative pressure wound therapy in the treatment of deep second degree burn wounds. Methods ?68 cases of deep second degree burn wounds treated in our hospital from June 2016 to July 2018 were selected as the study subjects， the patients were divided into the observation group and the control group by random number table， 34 cases in each group. The observation group was treated with silver fiber dressing combined with negative pressure wound therapy， the control group was treated with sulfadiazine zinc ointment. The score of wound pain at each time point， the amount of wound seepage， the wound healing rate， the wound complete healing time and Bacterial positive rate were recorded， observed occurrence of adverse reactions，the total efficacy of the two groups for 21d was compared. Results ?There was no significant difference in the score of wound pain degree between the two groups before and 15min after treatment（P>0.05）. The score of wound pain in the observation group were significantly lower than that in the control group immediately after treatment， the difference was statistically significant（P<0.05）. The amount of wound seepage in the observation group at 7d， 14d and 21d are significantly less than that in the control group， the wound healing rate was significantly higher than that in the control group， and the wound healing time was significantly shorter than that in the control group， the difference were statistically significant（P<0.05）. There was no significant difference in the positive rate of bacterial culture of wound secretions between the two groups before treatment（P>0.05）. After treatment for 7 and 14 days， the positive rate of bacterial culture of wound secretions in the observation group are significantly lower than that in the control group（P<0.05）. The total effective rate of the observation group was 97.06% after 21 days of treatment， which was significantly higher than that of the control group （82.35%， ?P<0.05）. Blood routine and cardiac， hepatic and renal functions of the two groups are not significantly abnormal during the treatment， and no allergic reactions or serious adverse reactions related to the treatment are observed. Conclusion ?Silver fiber dressings joint negative pressure wound therapy for deep Ⅱ degree burn wounds clinical curative effect is distinct， it has advantages in reducing the pain of dressing change， removing bacteria， reducing seepage and promoting healing， and the security is reliable， it is worthy of clinical application.

Key words： burn wounds; deep Ⅱ degrees; silver fiber dressing; negative pressure wound therapy; sulfadiazine zinc ointment; infection; healing

深Ⅱ度燒傷創面在臨床救治中多見，此類創面由于血液循環障礙、滲液物聚集及壞死組織占位，易導致創面加深、擴大，增加治療難度，延長創面愈合時間[1]。自1993年Fleischmann等[2]提出負壓傷口療法治療各種感染創面以來，國內外研究相繼證實了該療法在促進創面血管和神經生成的優勢。近年來，國外學者嘗試采用負壓傷口療法治療深Ⅱ度燒傷創面，在清除創面壞死組織上顯示出明顯療效，能否明顯提高臨床療效仍不十分明確[3]。盡管有學者觀察到……