自黏性軟聚硅酮泡沫敷料包扎聯合優質護理對燒傷后皮膚移植患者供區創面愈合的影響

顧凌燕 陶峰 李永娟

[摘要]目的：探討自黏性軟聚硅酮泡沫敷料（美皮康）包扎聯合優質護理對燒傷后皮膚移植供皮區愈合的療效。方法：將筆者醫院普外科2015年12月-2017年4月進行燒傷后皮膚移植的72例患者隨機分成兩組，每組36例。兩組患者均采取相同的皮膚移植手術方法，術后均采用美皮康敷料包扎創面。對照組采用常規護理，觀察組采用優質護理。觀察并比較兩組患者術后的視覺模擬疼痛（Visual analogue scales，VAS）評分、溫哥華瘢痕評價（Vancouver scar scale，VSS）評分、創面愈合時間及異常情況發生率。結果：術后1d、7d，觀察組患者的VAS評分顯著低于對照組，差異有統計學意義（P<0.01）。術后3個月、12個月，觀察組患者的VSS評分均顯著低于對照組（P<0.01）。觀察組患者的傷口愈合時間及異常情況發生率顯著低于對照組，差異具有統計學意義（P<0.01）。結論：美皮康敷料包扎供區聯合優質護理能顯著緩解燒傷后皮膚移植患者的疼痛，減少瘢痕形成及創面異常情況的發生，有利于創面的自然愈合。

[關鍵詞]優質護理;燒傷;皮膚移植;供皮區;自黏性軟聚硅酮泡沫敷料（美皮康）

[中圖分類號]R473.6 ? ?[文獻標志碼]B ? ?[文章編號]1008-6455（2019）12-0153-03

Effect of Self-adhesive Silicone Foam Dressing Combined with High Quality Nursing Care on Wound Healing of Donor Site after Skin Grafting in Burned Patients

GU Ling-yan1，TAO Feng1，LI Yong-juan2

（1.Wound Ostomy Clinic;2.Department of ENT，Maxillofacial Surgery，Qinghai Red Cross Hospital，Xining 810000，Qinghai，China）

Abstract： Objective ?To explore the effect of self-adhesive silicone foam dressing （Mepilex） ?combined with high quality nursing on skin graft donor site after burn. Methods ?72 patients with skin transplantation after burn admitted into the the department of general surgery in our hospital from December 2015 to April 2017 were randomly divided into two groups. Both groups were treated with the same skin transplantation method and wrapped with self-adhesive silicone foam （Mepilex） dressing. The control group was given conventional nursing， while the observation group was given quality nursing after surgery. The scores of VAS and VSS， wound healing time and the incidence of abnormal conditions were observed and compared between the two groups. Results ?On the 1d and 7d after surgery， the VAS score of the observation group was significantly lower than that of the control group， the differences were statistically significant（P<0.01）. At the 3 months and 12 months after operation， the VSS scores of the patients in the observation group were significantly lower than those in the control group（P<0.01）. The time of wound healing and the incidence of abnormal conditions in the observation group were significantly lower than those in the control group（P<0.01）. Conclusion ?Mepilex dressing combined with quality nursing can significantly relieve the pain status， reduce the incidence of scar formation and abnormal conditions， and it is conducive to the natural healing of wound surface in patients with skin transplantation after burn.

Key words： high quality care; burns; skin transplantation; donor site; self-adhesive silicone foam dressing （Mepilex）

皮膚移植是治療創傷、燒傷及其他因素所致皮膚缺損的常用方法，移植的皮膚與植皮區組織是否建立了有效的血液循環，是皮膚移植能否成功的關鍵。術后的護理手段關系到創面感染、皮片的固定及患者的心理狀態等。而這些因素是移植皮片或皮瓣成活的關鍵。皮膚移植術后常用敷料進行包扎，起到減少感染、固定皮片的作用。既往多采用無菌凡士林紗布油紗條進行術后切口的引流、堵漏、創面覆蓋、切口換藥等，而自黏性軟聚硅酮泡沫敷料（美皮康）常于用壓瘡、皮炎和糖尿病病足中，其用于燒傷后皮膚移植護理的報道較少。優質護理是近年來較為推崇的護理方式，其護理效果顯著。筆者醫院對燒傷后皮膚移植患者采用美皮康聯合優質護理，療效較好，現報道如下。……