Expert consensus on the treatment of second-degree burn wounds (2024 edition) Ⅱ: surgical treatment and infection prevention and treatment
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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。
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.
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Key words:
- Burns /
- Surgical procedures, operative /
- Debridement /
- Infection
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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
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 
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