Ⅱ度烧伤创面治疗专家共识（2024版）Ⅰ：院前急救和非手术治疗

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/cmaj.cn501225-20231019-00120

Ⅱ度烧伤创面治疗专家共识（2024版）Ⅰ：院前急救和非手术治疗
点击查看共识英文版(PDF) 共识英文版(HTML)

doi: 10.3760/cmaj.cn501225-20231019-00120

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: 2023-10-19

Expert consensus on the treatment of second-degree burn wounds (2024 edition)Ⅰ: pre-hospital first aid and non-surgical 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。目前关于Ⅱ度烧伤创面的急救、诊断、分类、保守换药的方式、外用敷料或药物的选择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及临床研究开展的一致性。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）Ⅰ：院前急救和非手术治疗》。本共识从Ⅱ度烧伤创面的早期急救和非手术治疗2个方面提出29条具体推荐意见，旨在形成规范的Ⅱ度烧伤创面临床治疗方案。
- 烧伤 /
- 急救 /
- 创面处理 /
- 专家共识
Abstract:
Second-degree burn is the most common type of burns in clinical practice and hard to manage. At present, there is no unified standard or specification for the first aid, diagnosis, classification, manner of conservative dressing change, and choice of external dressings or medications for second-degree burn wounds, which significantly affects the formulation of clinical treatment plans and the consistency of clinical studies. The consensus writing group developed the Expert consensus on the treatment of second-degree burn wounds (2024 edition) Ⅰ : pre-hospital first aid and non-surgical treatment based on evidence-based medicine evidence and expert opinion. This expert consensus put forward 29 specific recommendations from 2 aspects: pre-hospital first aid and non-surgical treatment for second-degree burn wounds, aiming to form a standardized clinical treatment plan for second-degree burn wounds.
- Burns /
- First aid /
- Wound management /
- Expert consensus
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

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参考文献(158)

[1]	NortonR, KobusingyeO. Injuries[J]. N Engl J Med, 2013,368(18):1723-1730. DOI: 10.1056/NEJMra1109343.
[2]	JiSZ,LuoPF,KongZD,et al.Pre-hospital emergency burn management in Shanghai: analysis of 1868 burn patients[J].Burns,2012,38(8):1174-1180.DOI: 10.1016/j.burns.2012.03.010.
[3]	GuyattGH, OxmanAD, VistGE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ, 2008,336(7650):924-926. DOI: 10.1136/bmj.39489.470347.
[4]	WillyCSD. Literature analysis (2005-2012) on the topic antiseptics for the treatment of acute soft tissue and bone wounds following the guidelines of evidence-based medicine[M/OL]. Berlin: Lindqvist Book Publishing, 2013 [2023-10-19]. https://www.researchgate.net/publication/332258419. https://www.researchgate.net/publication/332258419
[5]	ISBI Practice Guidelines Committee,SubcommitteeAdvisory,SubcommitteeSteering.ISBI practice guidelines for burn care, part 2[J].Burns,2018,44(7):1617-1706.DOI: 10.1016/j.burns.2018.09.012.
[6]	ShrivastavaP,GoelA.Pre-hospital care in burn injury[J].Indian J Plast Surg,2010,43(Suppl):S15-22.DOI: 10.4103/0970-0358.70720.
[7]	AllisonK, PorterK. Consensus on the prehospital approach to burns patient management[J]. Emerg Med J, 2004,21(1):112-114. DOI: 10.1136/emj.2003.008789.
[8]	HudspithJ, RayattS. First aid and treatment of minor burns[J]. BMJ, 2004,328(7454):1487-1489.DOI: 10.1136/bmj.328.7454.1487.
[9]	GrunwaldTB, GarnerWL. Acute burns[J]. Plast Reconstr Surg, 2008,121(5):311e-319e.DOI: 10.1097/PRS.0b013e318172ae1f.
[10]	JacksonDM. The diagnosis of the depth of burning[J]. Br J Surg, 1953,40(164):588-596. DOI: 10.1002/bjs.18004016413.
[11]	NisanciM,EskiM,SahinI,et al.Saving the zone of stasis in burns with activated protein C: an experimental study in rats[J].Burns,2010,36(3):397-402.DOI: 10.1016/j.burns.2009.06.208.
[12]	JakobssonOP,ArtursonG.The effect of prompt local cooling on oedema formation in scalded rat paws[J].Burns Incl Therm Inj,1985,12(1):8-15.DOI: 10.1016/0305-4179(85)90177-9.
[13]	AltintasB,AltintasAA,KraemerR,et al.Acute effects of local cold therapy in superficial burns on pain, in vivo microcirculation, edema formation and histomorphology[J].Burns,2014,40(5):915-921.DOI: 10.1016/j.burns.2013.11.023.
[14]	CuttleL, PearnJ, McMillanJR, et al. A review of first aid treatments for burn injuries[J]. Burns, 2009,35(6):768-775.DOI: 10.1016/j.burns.2008.10.011.
[15]	FrearCC, GriffinB, KimbleR. Adequacy of cool running water first aid by healthcare professionals in the treatment of paediatric burns: a cross-sectional study of 4537 children[J].Emerg Med Australas, 2021,33(4):615-622.DOI: 10.1111/1742-6723.13686.
[16]	GriffinBR, FrearCC, BablF, et al.Cool running water first aid decreases skin grafting requirements in pediatric burns: a cohort study of two thousand four hundred ninety-five children[J]. Ann Emerg Med, 2020,75(1):75-85.DOI: 10.1016/j.annemergmed.2019.06.028.
[17]	WoodFM,PhillipsM,JovicT,et al.Water first aid is beneficial in humans post-burn: evidence from a bi-national cohort study[J].PLoS One,2016,11(1):e0147259.DOI: 10.1371/journal.pone.0147259.
[18]	HarishV,TiwariN,FisherOM,et al.First aid improves clinical outcomes in burn injuries: evidence from a cohort study of 4918 patients[J].Burns,2019,45(2):433-439.DOI: 10.1016/j.burns.2018.09.024.
[19]	GriffinB,CabilanCJ,AyoubB,et al.The effect of 20 minutes of cool running water first aid within three hours of thermal burn injury on patient outcomes: a systematic review and meta-analysis[J].Australas Emerg Care,2022,25(4):367-376.DOI: 10.1016/j.auec.2022.05.004.
[20]	DjärvT, DoumaM, PalmieriT, et al. Duration of cooling with water for thermal burns as a first aid intervention: a systematic review[J]. Burns, 2022,48(2):251-262. DOI: 10.1016/j.burns.2021.10.007.
[21]	CuttleL,KempfM,KravchukO,et al.The optimal temperature of first aid treatment for partial thickness burn injuries[J].Wound Repair Regen,2008,16(5):626-634.DOI: 10.1111/j.1524-475X.2008.00413.x.
[22]	ChoYS,ChoiYH.Comparison of three cooling methods for burn patients: a randomized clinical trial[J].Burns,2017,43(3):502-508.DOI: 10.1016/j.burns.2016.09.010.
[23]	YuanJ, WuC, HollandAJ, et al. Assessment of cooling on an acute scald burn injury in a porcine model[J]. J Burn Care Res, 2007,28(3):514-520. DOI: 10.1097/BCR.0B013E318053DB13.
[24]	WrightEH,TylerM,VojnovicB,et al.Human model of burn injury that quantifies the benefit of cooling as a first aid measure[J].Br J Surg,2019,106(11):1472-1479.DOI: 10.1002/bjs.11263.
[25]	VenterTH,KarpelowskyJS,RodeH.Cooling of the burn wound: the ideal temperature of the coolant[J].Burns,2007,33(7):917-922.DOI: 10.1016/j.burns.2006.10.408.
[26]	The Australian and New Zealand Burn Association. Emergency management of severe burns manual[M]. 7th ed. Sydney: The Education Committee of the Australian and New Zealand Burns Association, Ltd., 2002.
[27]	SchnellHM,ZaspelJG.Cooling extensive burns: sprayed coolants can improve initial cooling management - a thermography-based study[J].Burns,2008,34(4):505-508.DOI: 10.1016/j.burns.2007.06.012.
[28]	WalkerA,BaumberR,RobsonB.Pre-hospital management of burns by the UK fire service[J].Emerg Med J,2005,22(3):205-208.DOI: 10.1136/emj.2004.015784.
[29]	CuttleL,KravchukO,WallisB,et al.An audit of first-aid treatment of pediatric burns patients and their clinical outcome[J].J Burn Care Res,2009,30(6):1028-1034.DOI: 10.1097/BCR.0b013e3181bfb7d1.
[30]	AllisonK.The UK pre-hospital management of burn patients: current practice and the need for a standard approach[J].Burns,2002,28(2):135-142.DOI: 10.1016/s0305-4179(01)00083-3.
[31]	HolbertMD,KimbleRM,ChatfieldM,et al.Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries: a prospective randomised controlled trial[J].BMJ Open,2021,11(1):e039981.DOI: 10.1136/bmjopen-2020-039981.
[32]	DurrantCAT, SimpsonAR, WilliamsG.Thermal injury – the first 24 h[J].Current Anaesthesia & Critical Care, 2008, 19(5/6):256-263.DOI: 10.1016/j.cacc.2008.09.014.
[33]	HarishV,LiZ,MaitzP.First aid is associated with improved outcomes in large body surface area burns[J].Burns,2019,45(8):1743-1748.DOI: 10.1016/j.burns.2019.05.006.
[34]	CoxSG,MartinezR,GlickA,et al.A review of community management of paediatric burns[J].Burns,2015,41(8):1805-1810.DOI: 10.1016/j.burns.2015.05.024.
[35]	BaartmansMG,de JongAE,van BaarME,et al.Early management in children with burns: cooling, wound care and pain management[J].Burns,2016,42(4):777-782.DOI: 10.1016/j.burns.2016.03.003.
[36]	SteeleJE, AtkinsJL, VizcaychipiMP. Factors at scene and in transfer related to the development of hypothermia in major burns[J]. Ann Burns Fire Disasters, 2016,29(2):103-107.
[37]	LönneckerS,SchoderV.Hypothermia in patients with burn injuries: influence of prehospital treatment[J].Chirurg,2001,72(2):164-167.DOI: 10.1007/s001040051286.
[38]	SingerAJ,TairaBR,ThodeHC,et al.The association between hypothermia, prehospital cooling, and mortality in burn victims[J].Acad Emerg Med,2010,17(4):456-459.DOI: 10.1111/j.1553-2712.2010.00702.x.
[39]	LegrandM,BarraudD,ConstantI,et al.Management of severe thermal burns in the acute phase in adults and children[J].Anaesth Crit Care Pain Med,2020,39(2):253-267.DOI: 10.1016/j.accpm.2020.03.006.
[40]	ZidemanDA,De BuckED,SingletaryEM,et al.European Resuscitation Council guidelines for resuscitation 2015 section 9. First aid[J].Resuscitation,2015,95:278-287.DOI: 10.1016/j.resuscitation.2015.07.031.
[41]	McLureM,MacneilF,WoodFM,et al.A rapid review of burns first aid guidelines: is there consistency across international guidelines?[J].Cureus,2021,13(6):e15779.DOI: 10.7759/cureus.15779.
[42]	KarpelowskyJS,WallisL,MadareeA,et al.South African Burn Society burn stabilisation protocol[J].S Afr Med J,2007,97(8):574-577.
[43]	duKampA.Deroofing minor burn blisters--what is the evidence?[J].Accid Emerg Nurs,2001,9(4):217-221.DOI: 10.1054/aaen.2001.0282.
[44]	WilsonA,LeemingA.Cervical cytology screening: a comparison of two call systems[J].Br Med J (Clin Res Ed),1987,295(6591):181-182.DOI: 10.1136/bmj.295.6591.181-a.
[45]	SargentRL.Management of blisters in the partial-thickness burn: an integrative research review[J].J Burn Care Res,2006,27(1):66-81.DOI: 10.1097/01.bcr.0000191961.95907.b1.
[46]	PanSC,WuLW,ChenCL,et al.Deep partial thickness burn blister fluid promotes neovascularization in the early stage of burn wound healing[J].Wound Repair Regen,2010,18(3):311-318.DOI: 10.1111/j.1524-475X.2010.00586.x.
[47]	RoHS, ShinJY, SabbaghMD, et al. Effectiveness of aspiration or deroofing for blister management in patients with burns: a prospective randomized controlled trial[J]. Medicine (Baltimore), 2018,97(17):e0563.
[48]	GimbelNS,KapetanskyDI,WeissmanF,et al.A study of epithelization in blistered burns[J].AMA Arch Surg,1957,74(5):800-803.DOI: 10.1001/archsurg.1957.01280110142019.
[49]	YaoY,ZhangA,YuanC,et al.Recent trends on burn wound care: hydrogel dressings and scaffolds[J].Biomater Sci,2021,9(13):4523-4540.DOI: 10.1039/d1bm00411e.
[50]	GnaneswaranN,PereraE,PereraM,et al.Cutaneous chemical burns: assessment and early management[J].Aust Fam Physician,2015,44(3):135-139.
[51]	BrombergBE, SongIC, WaldenRH. Hydrotherapy of chemical burns[J]. Plast Reconstr Surg, 1965,35:85-95. DOI: 10.1097/00006534-196501000-00010.
[52]	LeonardLG,ScheulenJJ,MunsterAM.Chemical burns: effect of prompt first aid[J].J Trauma,1982,22(5):420-423.DOI: 10.1097/00005373-198205000-00013.
[53]	SingerA,SagiA,Ben MeirP,et al.Chemical burns: our 10-year experience[J].Burns,1992,18(3):250-252.DOI: 10.1016/0305-4179(92)90081-5.
[54]	TanT,WongDS.Chemical burns revisited: what is the most appropriate method of decontamination?[J].Burns,2015,41(4):761-763.DOI: 10.1016/j.burns.2014.10.004.
[55]	ChaiH, ChaudhariN, KornhaberR, et al. Chemical burn to the skin: a systematic review of first aid impacts on clinical outcomes[J]. Burns, 2022,48(7):1527-1543. DOI: 10.1016/j.burns.2022.05.006.
[56]	PalaoR, MongeI, RuizM, et al. Chemical burns: pathophysiology and treatment[J]. Burns, 2010,36(3):295-304. DOI: 10.1016/j.burns.2009.07.009.
[57]	LynnDD,ZukinLM,DellavalleR.The safety and efficacy of Diphoterine for ocular and cutaneous burns in humans[J].Cutan Ocul Toxicol,2017,36(2):185-192.DOI: 10.1080/15569527.2016.1217423.
[58]	DonoghueAM. Diphoterine for alkali chemical splashes to the skin at alumina refineries[J]. Int J Dermatol, 2010,49(8):894-900. DOI: 10.1111/j.1365-4632.2009.04397.x.
[59]	AlexanderKS,WasiakJ,ClelandH.Chemical burns: Diphoterine untangled[J].Burns,2018,44(4):752-766.DOI: 10.1016/j.burns.2017.09.017.
[60]	HorchR,SpilkerG,StarkGB.Phenol burns and intoxications[J].Burns,1994,20(1):45-50.DOI: 10.1016/0305-4179(94)90105-8.
[61]	BarqouniL,Abu ShaabanN,ElessiK.Interventions for treating phosphorus burns[J].Cochrane Database Syst Rev,2014,2014(6):CD008805.DOI: 10.1002/14651858.CD008805.pub3.
[62]	SummerlinWT,WalderAI,MoncriefJA.White phosphorus burns and massive hemolysis[J].J Trauma,1967,7(3):476-484.DOI: 10.1097/00005373-196705000-00012.
[63]	CurreriPW,AschMJ,PruittBA.The treatment of chemical burns: specialized diagnostic, therapeutic, and prognostic considerations[J].J Trauma,1970,10(8):634-642.
[64]	FlammigerA,MaibachH.Sulfuric acid burns (corrosion and acute irritation): evidence-based overview to management[J].Cutan Ocul Toxicol,2006,25(1):55-61.DOI: 10.1080/15569520500536634.
[65]	Dinis-OliveiraRJ,CarvalhoF,MoreiraR,et al.Clinical and forensic signs related to chemical burns: a mechanistic approach[J].Burns,2015,41(4):658-679.DOI: 10.1016/j.burns.2014.09.002.
[66]	YuY, SunR, GuJ, et al. Management of a man with hydrofluoric acid burns: a case report and review[J]. J Burn Care Res, 2020,41(1):200-210. DOI: 10.1093/jbcr/irz136.
[67]	WilliamsFN, LeeJO. Chemical burns[M/OL]//Herdon DN. Total burn care. 5th ed. New York: Elsevier Health Sciences, 2018 [2023-10-19]. https://bibleandbookcenter.com/read/total-burn-care/. https://bibleandbookcenter.com/read/total-burn-care/
[68]	LeeRC,AstumianRD.The physicochemical basis for thermal and non-thermal 'burn' injuries[J].Burns,1996,22(7):509-519.DOI: 10.1016/0305-4179(96)00051-4.
[69]	KoumbourlisAC. Electrical injuries[J]. Crit Care Med, 2002,30(11 Suppl):S424-430.DOI: 10.1097/00003246-200211001-00007.
[70]	LeeDH,DesaiMJ,GaugerEM.Electrical injuries of the hand and upper extremity[J].J Am Acad Orthop Surg,2019,27(1):e1-e8.DOI: 10.5435/JAAOS-D-17-00833.
[71]	Vanden HoekTL,MorrisonLJ,ShusterM,et al.Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J].Circulation,2010,122(18 Suppl 3):S829-861.DOI: 10.1161/CIRCULATIONAHA.110.971069.
[72]	BernalE. Electrical injuries[M/OL] //Herdon DN. Total burn care. 5th ed. New York: Elsevier Health Sciences, 2018 [2023-10-19]. http://www.onacademic.com/detail/journal_1000040810073710_9857.html. http://www.onacademic.com/detail/journal_1000040810073710_9857.html
[73]	International Wounds International best practice guidelines: effective skin and wound management of non-complex burns 2023-10-19 https://www.woundsinternational.com/uploads/resources/5ebace6c70d4ea53a5d3e28ca65f1b74.pdf InternationalWounds. International best practice guidelines: effective skin and wound management of non-complex burns[EB/OL]. 2014 [2023-10-19]. https://www.woundsinternational.com/uploads/resources/5ebace6c70d4ea53a5d3e28ca65f1b74.pdf.
[74]	HeimbachD,EngravL,GrubeB,et al.Burn depth: a review[J].World J Surg,1992,16(1):10-15.DOI: 10.1007/BF02067108.
[75]	DevganL,BhatS,AylwardS,et al.Modalities for the assessment of burn wound depth[J].J Burns Wounds,2006,5:e2.
[76]	SchulzT,MarotzJ,SeiderS,et al.Burn depth assessment using hyperspectral imaging in a prospective single center study[J].Burns,2022,48(5):1112-1119.DOI: 10.1016/j.burns.2021.09.010.
[77]	StillJM,LawEJ,KlavuhnKG,et al.Diagnosis of burn depth using laser-induced indocyanine green fluorescence: a preliminary clinical trial[J].Burns,2001,27(4):364-371.DOI: 10.1016/s0305-4179(00)00140-6.
[78]	HeimbachDM, AfromowitzMA, EngravLH, et al.Burn depth estimation--man or machine[J].J Trauma, 1984, 24(5):373-378.
[79]	RiordanCL,McDonoughM,DavidsonJM,et al.Noncontact laser Doppler imaging in burn depth analysis of the extremities[J].J Burn Care Rehabil,2003,24(4):177-186.DOI: 10.1097/01.BCR.0000075966.50533.B0.
[80]	Burke-SmithA,CollierJ,JonesI.A comparison of non-invasive imaging modalities: infrared thermography, spectrophotometric intracutaneous analysis and laser Doppler imaging for the assessment of adult burns[J].Burns,2015,41(8):1695-1707.DOI: 10.1016/j.burns.2015.06.023.
[81]	SenCK,GhatakS,GnyawaliSC,et al.Cutaneous imaging technologies in acute burn and chronic wound care[J].Plast Reconstr Surg,2016,138(3 Suppl):S119-128.DOI: 10.1097/PRS.0000000000002654.
[82]	GanapathyP,TamminediT,QinY,et al.Dual-imaging system for burn depth diagnosis[J].Burns,2014,40(1):67-81.DOI: 10.1016/j.burns.2013.05.004.
[83]	BurmeisterDM,CernaC,BecerraSC,et al.Noninvasive techniques for the determination of burn severity in real time[J].J Burn Care Res,2017,38(1):e180-e191.DOI: 10.1097/BCR.0000000000000338.
[84]	PapeSA,BakerRD,WilsonD,et al.Burn wound healing time assessed by laser Doppler imaging (LDI). Part 1: derivation of a dedicated colour code for image interpretation[J].Burns,2012,38(2):187-194.DOI: 10.1016/j.burns.2010.11.009.
[85]	HollandAJ,MartinHC,CassDT.Laser Doppler imaging prediction of burn wound outcome in children[J].Burns,2002,28(1):11-17.DOI: 10.1016/s0305-4179(01)00064-x.
[86]	DeitchEA,WheelahanTM,RoseMP,et al.Hypertrophic burn scars: analysis of variables[J].J Trauma,1983,23(10):895-898.
[87]	GangemiEN,GregoriD,BerchiallaP,et al.Epidemiology and risk factors for pathologic scarring after burn wounds[J].Arch Facial Plast Surg,2008,10(2):93-102.DOI: 10.1001/archfaci.10.2.93.
[88]	WachtelTL,BerryCC,WachtelEE,et al.The inter-rater reliability of estimating the size of burns from various burn area chart drawings[J].Burns,2000,26(2):156-170.DOI: 10.1016/s0305-4179(99)00047-9.
[89]	LivingstonEH,LeeS.Percentage of burned body surface area determination in obese and nonobese patients[J].J Surg Res,2000,91(2):106-110.DOI: 10.1006/jsre.2000.5909.
[90]	WilliamsRY, WohlgemuthSD. Does the "rule of nines" apply to morbidly obese burn victims?[J]. J Burn Care Res, 2013,34(4):447-452. DOI: 10.1097/BCR.0b013e31827217bd.
[91]	MillerSF,FinleyRK,WaltmanM,et al.Burn size estimate reliability: a study[J].J Burn Care Rehabil,1991,12(6):546-559.DOI: 10.1097/00004630-199111000-00010.
[92]	PerryRJ,MooreCA,MorganBD,et al.Determining the approximate area of a burn: an inconsistency investigated and re-evaluated[J].BMJ,1996,312(7042):1338.DOI: 10.1136/bmj.312.7042.1338.
[93]	MertensDM, JenkinsME, WardenGD. Outpatient burn management[J]. Nurs Clin North Am, 1997,32(2):343-364.
[94]	BenjaminNC, LeeJO, NorburyWB, et al. Accuracy of currently used paper burn diagram vs a three-dimensional computerized model[J]. J Burn Care Res, 2017,38(1):e254-e260. DOI: 10.1097/BCR.0000000000000363.
[95]	RetrouveyH,ChanJ,ShahrokhiS.Comparison of two-dimensional methods versus three-dimensional scanning systems in the assessment of total body surface area estimation in burn patients[J].Burns,2018,44(1):195-200.DOI: 10.1016/j.burns.2017.07.003.
[96]	SwainAH,AzadianBS,WakeleyCJ,et al.Management of blisters in minor burns[J].Br Med J (Clin Res Ed),1987,295(6591):181.DOI: 10.1136/bmj.295.6591.181.
[97]	ShawJ, DibbleC. Best evidence topic report. Management of burns blisters[J]. Emerg Med J, 2006,23(8):648-649. DOI: 10.1136/emj.2006.039115.
[98]	AprilMD,KoyfmanA,LongB.Select burn blisters should not be left intact[J].Ann Emerg Med,2020,76(6):771-773.DOI: 10.1016/j.annemergmed.2020.04.017.
[99]	DunnKW.The management of burn wound blisters[J].J Wound Care,2001,10(7):250; author reply 250.DOI: 10.12968/jowc.2001.10.7.26352.
[100]	ChenXJ, YanDX, GaoGZ, et al. Analysis of clinical data of 16 595 pediatric burn patients during fifteen years[J]. Zhonghua Shao Shang Za Zhi, 2013,29(1):6-10.
[101]	AtiyehBS,DiboSA,HayekSN.Wound cleansing, topical antiseptics and wound healing[J].Int Wound J,2009,6(6):420-430.DOI: 10.1111/j.1742-481X.2009.00639.x.
[102]	BalinAK,PrattL.Dilute povidone-iodine solutions inhibit human skin fibroblast growth[J].Dermatol Surg,2002,28(3):210-214.DOI: 10.1046/j.1524-4725.2002.01161.x.
[103]	OuléMK,AzinwiR,BernierAM,et al.Polyhexamethylene guanidine hydrochloride-based disinfectant: a novel tool to fight meticillin-resistant Staphylococcus aureus and nosocomial infections[J].J Med Microbiol,2008,57(Pt 12):1523-1528.DOI: 10.1099/jmm.0.2008/003350-0.
[104]	ShipskiĭAV,Afanas'evVV,PolikarpovNA,et al. Comparative analysis of antimicrobial action of polyhexametylenguanide hydrochloride (Biopag) and chlorhexidine bigluconate upon potential infectious agent of suppurative-inflammatory diseases of maxillo-facial region and neck[J].Stomatologiia (Mosk),2007,86(3):46-50.
[105]	WarnerPM, CoffeeTL,YowlerCJ. Outpatient burn management[J]. Surg Clin North Am, 2014,94(4):879-892.DOI: 10.1016/j.suc.2014.05.009.
[106]	WaitzmanAA, NeliganPC. How to manage burns in primary care[J]. Can Fam Physician, 1993, 39: 2394-2400.
[107]	GenuinoGA,Baluyut-AngelesKV,EspirituAP,et al.Topical petrolatum gel alone versus topical silver sulfadiazine with standard gauze dressings for the treatment of superficial partial thickness burns in adults: a randomized controlled trial[J].Burns,2014,40(7):1267-1273.DOI: 10.1016/j.burns.2014.07.024.
[108]	WasiakJ,ClelandH.Burns: dressings[J].BMJ Clin Evid,2015,2015:1903.
[109]	HosseiniSN,MousavinasabSN,FallahnezhatM.Xenoderm dressing in the treatment of second degree burns[J].Burns,2007,33(6):776-781.DOI: 10.1016/j.burns.2006.10.396.
[110]	HosseiniSN,KarimianA,MousavinasabSN,et al.Xenoderm versus 1% silver sulfadiazine in partial-thickness burns[J].Asian J Surg,2009,32(4):234-239.DOI: 10.1016/S1015-9584(09)60400-0.
[111]	AdlyOA,MoghazyAM,AbbasAH,et al.Assessment of amniotic and polyurethane membrane dressings in the treatment of burns[J].Burns,2010,36(5):703-710.DOI: 10.1016/j.burns.2009.09.003.
[112]	MostaqueAK,RahmanKB.Comparisons of the effects of biological membrane (amnion) and silver sulfadiazine in the management of burn wounds in children[J].J Burn Care Res,2011,32(2):200-209.DOI: 10.1097/BCR.0b013e31820aad94.
[113]	TroyJ, KarlnoskiR, DownesK,et al. The use of EZ Derm ^® in partial-thickness burns: an institutional review of 157 patients[J]. Eplasty, 2013,13:e14.
[114]	VloemansAF,HermansMH,van der WalMB,et al.Optimal treatment of partial thickness burns in children: a systematic review[J].Burns,2014,40(2):177-190.DOI: 10.1016/j.burns.2013.09.016.
[115]	HermansMH.Porcine xenografts vs. (cryopreserved) allografts in the management of partial thickness burns: is there a clinical difference?[J].Burns,2014,40(3):408-415.DOI: 10.1016/j.burns.2013.08.020.
[116]	BarretJP,DziewulskiP,RamzyPI,et al.Biobrane versus 1% silver sulfadiazine in second-degree pediatric burns[J].Plast Reconstr Surg,2000,105(1):62-65.DOI: 10.1097/00006534-200001000-00010.
[117]	GerdingRL,ImbemboAL,FratianneRB.Biosynthetic skin substitute vs. 1% silver sulfadiazine for treatment of inpatient partial-thickness thermal burns[J].J Trauma,1988,28(8):1265-1269.DOI: 10.1097/00005373-198808000-00022.
[118]	GerdingRL,EmermanCL,EffronD,et al.Outpatient management of partial-thickness burns: Biobrane versus 1% silver sulfadiazine[J].Ann Emerg Med,1990,19(2):121-124.DOI: 10.1016/s0196-0644(05)81793-7.
[119]	KumarRJ,KimbleRM,BootsR,et al.Treatment of partial-thickness burns: a prospective, randomized trial using Transcyte[J].ANZ J Surg,2004,74(8):622-626.DOI: 10.1111/j.1445-1433.2004.03106.x.
[120]	SchwarzeH,KüntscherM,UhligC,et al.Suprathel, a new skin substitute, in the management of partial-thickness burn wounds: results of a clinical study[J].Ann Plast Surg,2008,60(2):181-185.DOI: 10.1097/SAP.0b013e318056bbf6.
[121]	LenselinkE,AndriessenA.A cohort study on the efficacy of a polyhexanide-containing biocellulose dressing in the treatment of biofilms in wounds[J].J Wound Care,2011,20(11):534, 536-539.DOI: 10.12968/jowc.2011.20.11.534.
[122]	RahimiF,RezayatmandR.Use of a biosynthetic wound dressing to treat burns: a systematic review[J].J Wound Care,2020,29(Suppl 12):S16-22.DOI: 10.12968/jowc.2020.29.Sup12.S16.
[123]	SchieferJL,AretzGF,FuchsPC,et al.Comparison of wound healing and patient comfort in partial-thickness burn wounds treated with SUPRATHEL and epictehydro wound dressings[J].Int Wound J,2022,19(4):782-790.DOI: 10.1111/iwj.13674.
[124]	HundeshagenG,CollinsVN,WurzerP,et al.A prospective, randomized, controlled trial comparing the outpatient treatment of pediatric and adult partial-thickness burns with Suprathel or Mepilex Ag[J].J Burn Care Res,2018,39(2):261-267.DOI: 10.1097/BCR.0000000000000584.
[125]	TanPW,HoWC,SongC.The use of Urgotul in the treatment of partial thickness burns and split-thickness skin graft donor sites: a prospective control study[J].Int Wound J,2009,6(4):295-300.DOI: 10.1111/j.1742-481X.2009.00611.x.
[126]	HeynemanA,HoeksemaH,VandekerckhoveD,et al.The role of silver sulphadiazine in the conservative treatment of partial thickness burn wounds: a systematic review[J].Burns,2016,42(7):1377-1386.DOI: 10.1016/j.burns.2016.03.029.
[127]	AbediniF,AhmadiA,YavariA,et al.Comparison of silver nylon wound dressing and silver sulfadiazine in partial burn wound therapy[J].Int Wound J,2013,10(5):573-578.DOI: 10.1111/j.1742-481X.2012.01024.x.
[128]	StairTO,D'OrtaJ,AltieriMF,et al.Polyurethane and silver sulfadiazene dressings in treatment of partial-thickness burns and abrasions[J].Am J Emerg Med,1986,4(3):214-217.DOI: 10.1016/0735-6757(86)90068-9.
[129]	AfilaloM,DankoffJ,GuttmanA,et al.DuoDERM hydroactive dressing versus silver sulphadiazine/Bactigras in the emergency treatment of partial skin thickness burns[J].Burns,1992,18(4):313-316.DOI: 10.1016/0305-4179(92)90153-l.
[130]	AboelnagaA,ElmasryM,AdlyOA,et al.Microbial cellulose dressing compared with silver sulphadiazine for the treatment of partial thickness burns: a prospective, randomised, clinical trial[J].Burns,2018,44(8):1982-1988.DOI: 10.1016/j.burns.2018.06.007.
[131]	BroussardKC,PowersJG.Wound dressings: selecting the most appropriate type[J].Am J Clin Dermatol,2013,14(6):449-459.DOI: 10.1007/s40257-013-0046-4.
[132]	ShiC,WangC,LiuH,et al.Selection of appropriate wound dressing for various wounds[J].Front Bioeng Biotechnol,2020,8:182.DOI: 10.3389/fbioe.2020.00182.
[133]	StoicaAE,ChircovC,GrumezescuAM.Nanomaterials for wound dressings: an up-to-date overview[J].Molecules,2020,25(11):2699.DOI: 10.3390/molecules25112699.
[134]	OpasanonS,MuangmanP,NamviriyachoteN.Clinical effectiveness of alginate silver dressing in outpatient management of partial-thickness burns[J].Int Wound J,2010,7(6):467-471.DOI: 10.1111/j.1742-481X.2010.00718.x.
[135]	WasiakJ, ClelandH, CampbellF,et al.Dressings for superficial and partial thickness burns[J].Cochrane Database Syst Rev, 2013(3):CD002106. DOI: 10.1002/14651858.CD002106.pub4.
[136]	VlachouE,ChippE,ShaleE,et al.The safety of nanocrystalline silver dressings on burns: a study of systemic silver absorption[J].Burns,2007,33(8):979-985.DOI: 10.1016/j.burns.2007.07.014.
[137]	SternHS.Silver sulphadiazine and the healing of partial thickness burns: a prospective clinical trial[J].Br J Plast Surg,1989,42(5):581-585.DOI: 10.1016/0007-1226(89)90050-7.
[138]	LansdownAB,WilliamsA.How safe is silver in wound care?[J].J Wound Care,2004,13(4):131-136.DOI: 10.12968/jowc.2004.13.4.26596.
[139]	LuS,XiangJ,QingC,et al.Effect of necrotic tissue on progressive injury in deep partial thickness burn wounds[J].Chin Med J (Engl),2002,115(3):323-325.
[140]	SalibianAA,RosarioA,SeveroL,et al.Current concepts on burn wound conversion-a review of recent advances in understanding the secondary progressions of burns[J].Burns,2016,42(5):1025-1035.DOI: 10.1016/j.burns.2015.11.007.
[141]	BarrettS.Mepilex Ag: an antimicrobial, absorbent foam dressing with Safetac technology[J].Br J Nurs, 2009, 18(20):S28, S30-36.DOI: 10.12968/bjon.2009.18.Sup7.45133.
[142]	ChoiYM,CampbellK,LevekC,et al.Antibiotic ointment versus a silver-based dressing for children with extremity burns: a randomized controlled study[J].J Pediatr Surg,2019,54(7):1391-1396.DOI: 10.1016/j.jpedsurg.2018.06.011.
[143]	SinghA,BhatnagarA.Management of superficial partial thickness burn with collagen sheet dressing compared with paraffin gauze and silver sulfadiazine[J].Ann Burns Fire Disasters,2020,33(3):233-238.
[144]	ChagantiP,GordonI,ChaoJH,et al.A systematic review of foam dressings for partial thickness burns[J].Am J Emerg Med,2019,37(6):1184-1190.DOI: 10.1016/j.ajem.2019.04.014.
[145]	YangC,XiongAB,HeXC,et al.Efficacy and feasibility of amniotic membrane for the treatment of burn wounds: a meta-analysis[J].J Trauma Acute Care Surg,2021,90(4):744-755.DOI: 10.1097/TA.0000000000003050.
[146]	KriegerY,RubinG,SchulzA,et al.Bromelain-based enzymatic debridement and minimal invasive modality (mim) care of deeply burned hands[J].Ann Burns Fire Disasters,2017,30(3):198-204.
[147]	RosenbergL,KriegerY,Bogdanov-BerezovskiA,et al.A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT[J].Burns,2014,40(3):466-474.DOI: 10.1016/j.burns.2013.08.013.
[148]	HircheC,Kreken AlmelandS,DheansaB,et al.Eschar removal by bromelain based enzymatic debridement (Nexobrid ^®) in burns: European consensus guidelines update[J].Burns,2020,46(4):782-796.DOI: 10.1016/j.burns.2020.03.002.
[149]	StoicaAE,ChircovC,GrumezescuAM.Hydrogel dressings for the treatment of burn wounds: an up-to-date overview[J].Materials (Basel),2020,13(12):2853.DOI: 10.3390/ma13122853.
[150]	RosenbergL,LapidO,Bogdanov-BerezovskyA,et al.Safety and efficacy of a proteolytic enzyme for enzymatic burn debridement: a preliminary report[J].Burns,2004,30(8):843-850.DOI: 10.1016/j.burns.2004.04.010.
[151]	OzcanC,ErgünO,CelikA,et al.Enzymatic debridement of burn wound with collagenase in children with partial-thickness burns[J].Burns,2002,28(8):791-794.DOI: 10.1016/s0305-4179(02)00191-2.
[152]	RamundoJ,GrayM.Enzymatic wound debridement[J].J Wound Ostomy Continence Nurs,2008,35(3):273-280.DOI: 10.1097/01.WON.0000319125.21854.78.
[153]	SchulzA, ShohamY, RosenbergL, et al. Enzymatic versus traditional surgical debridement of severely burned hands: a comparison of selectivity, efficacy, healing time, and three-month scar quality[J]. J Burn Care Res, 2017,38(4):e745-e755.DOI: 10.1097/BCR.0000000000000478.
[154]	BoykinJV,ErikssonE,PittmanRN.In vivo microcirculation of a scald burn and the progression of postburn dermal ischemia[J].Plast Reconstr Surg,1980,66(2):191-198.DOI: 10.1097/00006534-198008000-00002.
[155]	NanneyLB,WenczakBA,LynchJB.Progressive burn injury documented with vimentin immunostaining[J].J Burn Care Rehabil,1996,17(3):191-198.DOI: 10.1097/00004630-199605000-00003.
[156]	HanCM,ChengB,WuP,et al.Clinical guideline on topical growth factors for skin wounds[J/OL].Burns Trauma,2020,8:tkaa035[2023-10-19].https://pubmed.ncbi.nlm.nih.gov/33015207/.DOI: 10.1093/burnst/tkaa035.
[157]	ZhangY,WangT,HeJ,et al.Growth factor therapy in patients with partial-thickness burns: a systematic review and meta-analysis[J].Int Wound J,2016,13(3):354-366.DOI: 10.1111/iwj.12313.
[158]	GragnaniA,TonarelliE,ChomiskiV,et al.Fibroblast growth factor in the treatment of burns: a systematic review[J].Burns,2022,48(1):104-110.DOI: 10.1016/j.burns.2021.04.006.

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表1 基于GRADE系统的证据质量等级及描述

表1. Evidence quality level and description based on GRADE system

证据质量等级	描述
高	非常确信效应估计值接近真实效应值
中	对效应估计值有中等程度的信心，效应估计值可能接近真实效应值，但仍存在二者大不相同的可能性
低	对效应估计值的确信程度有限，效应估计值可能与真实效应值大不相同
注：GRADE为推荐意见分级的评估、制订和评价；证据质量等级可因存在偏倚风险、研究结果不一致或发表偏倚而降低，可因疗效显著或存在明显剂量-效应关系而升高

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表2 Ⅱ度烧伤创面的分类及特点

表2. Classification and characteristics of second-degree burn wounds

深度	损伤组织层次	外观表现	触觉特征	愈合时间	愈合后瘢痕增生情况
浅Ⅱ度	表皮及真皮浅层	有红斑、水疱，创基有渗出	疼痛明显，按压创基发白	<2周	一般无瘢痕
偏浅深Ⅱ度	表皮及真皮中层	深粉色，有水疱，创基湿润或干燥	疼痛或痛觉消失，按压创基不发白	2~3周	瘢痕发生率约为30%
偏深深Ⅱ度	表皮及真皮深层	红白相间，可有水疱，创基湿润或干燥	疼痛或痛觉消失，按压创基不发白	>3周	瘢痕发生率为70%~80%