Expert consensus on the treatment of second-degree burn wounds (2024 edition)Ⅰ: pre-hospital first aid and non-surgical 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。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。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.
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Key words:
- Burns /
- First aid /
- Wound management /
- Expert consensus
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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%
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