Ⅱ度烧伤创面治疗专家共识（2024版）Ⅱ：手术治疗和感染防治

中华医学会烧伤外科学分会; 海峡两岸医药卫生交流协会暨烧创伤组织修复专委会

doi:10.3760/cma.j.cn501225-20240112-00015

Ⅱ度烧伤创面治疗专家共识（2024版）Ⅱ：手术治疗和感染防治
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doi: 10.3760/cma.j.cn501225-20240112-00015

基金项目:

中国医学科学院医学与健康科技创新工程项目 2019-I2M-5-076

上海市重中之重研究中心项目 2023ZZ02013

国家自然科学基金重点项目 81930057

国家自然科学基金面上项目 81971836

上海市优秀学术带头人项目 23XD1425000

详细信息

通信作者：夏照帆，海军军医大学第一附属医院烧伤外科，全军烧伤研究所，中国医学科学院烧伤暨烧创复合伤救治关键技术创新单元，上海 200433，Email： xiazhaofan@163.com

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出版历程
- 收稿日期: 2024-01-12
- 网络出版日期: 2024-02-26

Expert consensus on the treatment of second-degree burn wounds (2024 edition) Ⅱ: surgical treatment and infection prevention and treatment

Funds:

Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences 2019-I2M-5-076

Shanghai Top Priority Research Center Project 2023ZZ02013

Key Program of National Natural Science Foundation of China 81930057

General Program of National Natural Science Foundation of China 81971836

Program of Shanghai Academic Research Leader 23XD1425000

摘要

摘要:
Ⅱ度烧伤是临床中最为常见但处理十分棘手的烧伤类型，其治疗不仅需要考虑换药或手术处置方式本身可能产生的不同影响，还需评估烧伤部位、患者年龄及烧伤面积等多方面的因素。目前对于Ⅱ度烧伤创面治疗的手术方式以及感染诊断、分级等尚未形成统一的标准和规范，严重影响临床治疗方案的制订。本共识编写组以循证医学证据为基础，结合专家意见，制订《Ⅱ度烧伤创面治疗专家共识（2024版）Ⅱ：手术治疗和感染防治》。本共识从Ⅱ度烧伤创面的手术治疗及感染防治2个方面提出29条具体推荐意见，旨在形成规范化的Ⅱ度烧伤临床治疗方案。
- 烧伤 /
- 外科手术 /
- 清创术 /
- 感染
Abstract:
Second-degree burns are the most common type of burns in clinical practice and hard to manage. The treatment needs not only to consider the possible different effects of dressing change or surgical treatment itself, but also requires the evaluation of many factors such as burn site, ages of patients, and burn area. At present, there are no unified standards or specifications for the surgical procedures of wound treatment, as well as infection diagnosis and grading of second-degree burn wounds, which seriously affects the formulation of clinical treatment plans. The consensus writing group developed the Expert consensus on the treatment of second-degree burn wounds ( 2024 edition) Ⅱ: surgical treatment and infection prevention and treatment based on evidence-based medical evidence and combined with expert opinion. This expert consensus put forward 29 specific recommendations from two aspects: surgical treatment and infection prevention and treatment of second-degree burn wounds, aiming to form a standardized clinical treatment plan for second-degree burns.
- Burns /
- Surgical procedures, operative /
- Debridement /
- Infection
所有编写组成员均声明不存在利益冲突，无商业组织向本共识编写组支付费用。本共识制订过程中需要的资金均来自本文著录的基金项目，且推荐意见未受资助影响

（文献第1~158条见本刊2024年第1期第13~18页）

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1 Ⅱ度烧伤创面处理流程

注：烧伤后48~72 h进行第1次创面深度评估，之后进行第2次创面深度评估；TBSA为体表总面积《Ⅱ度烧伤创面治疗专家共识（2024版）》编写组见本刊2024年第1期第13页

下载: 全尺寸图片幻灯片

表3 Ⅱ度烧伤创面感染程度的分级诊断标准

表3. Grading diagnostic standard for the infection degree of second-degree burn wounds

感染程度	局部创面表现	全身症状	微生物侵袭组织的层次
未感染	无红肿热痛等感染症状	无明显体征	微生物仅污染或定植于创面表面或坏死组织，未累及正常真皮组织
轻度感染	创面或创周出现局部发红、肿胀、皮温升高和疼痛，分泌物增多或出现脓性分泌物（黏稠、浑浊不透明分泌物）或血性分泌物等，同时需排除导致皮肤炎症反应的其他原因（如创周皮肤过敏、远端肢体骨折、静脉淤血、血栓形成等）	无明显体征	微生物侵袭创面残存的正常真皮浅层
中度感染	创面脓性分泌物明显增多且气味恶臭，创周炎症加重，红肿范围明显扩大，疼痛加剧，周围组织明显肿胀	可能有发热、体温升高等全身感染症状	微生物侵袭创面残存的正常真皮深层或真皮全层
重度感染	创面组织活力差，色泽晦暗，基底干枯，中心渐发黑、坏死，血供进行性变差，渗出增多，伴有异味，创面进行性加深或坏死范围向创周正常组织扩展，甚至发展到全层皮肤坏死	有明显的全身感染症状，如寒战、高热等，严重者可出现脓毒症或脓毒症休克表现	微生物侵袭真皮全层并可能累及创周的正常组织