水凝胶敷料在深Ⅱ度烧伤创面磨削痂术后应用效果的前瞻性随机对照研究

尚念胜; 崔炳环; 王成; 高华; 徐滨; 赵冉; 霍然

doi:10.3760/cma.j.cn501120-20210419-00133

水凝胶敷料在深Ⅱ度烧伤创面磨削痂术后应用效果的前瞻性随机对照研究

doi: 10.3760/cma.j.cn501120-20210419-00133

1.
淄博市第六人民医院烧伤整形科　　255012
2.
山东省立医院烧伤整形美容外科，济南　　250021

基金项目:

淄博市重点研发计划 2019ZC010216

详细信息

通讯作者:
霍然，Email：huoran@medmail.com.cn

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出版历程
- 收稿日期: 2021-04-19

A prospective randomized controlled study of the application effect of hydrogel dressings on deep partial-thickness burn wounds after dermabrasion and tangential excision

1.
Department of Burns and Plastic Surgery, Zibo Sixth People's Hospital, Zibo 255012, China
2.
Department of Burns, Plastic and Cosmetic Surgery, Shandong Provincial Hospital, Jinan 250021, China

Funds:

Zibo Key Research and Development Plan 2019ZC010216

More Information

Corresponding author: Huo Ran, Email: huoran@medmail.com.cn

摘要

摘要: 目的探讨水凝胶敷料在深Ⅱ度烧伤创面磨削痂术后应用的临床效果。方法采用前瞻性随机对照研究方法。2015年11月—2019年8月，淄博市第六人民医院收治的168例深Ⅱ度烧伤患者符合入选标准，将其按随机数字表法分为磨削痂术后进行相应治疗的水凝胶敷料+凡士林油纱组（84例，男67例、女17例）和单纯凡士林油纱组（84例，男65例、女19例），其年龄分别为（31±16）、（35±17）岁。每3~5天换药1次，对于创面超过21 d未愈合者或未超过21 d但创面位于关节部位后期可能影响功能活动者，取自体躯干或大腿刃厚或中厚皮片行植皮术。术后持续动态观察创面大体情况直至创面愈合；术后前4次换药时评估敷料粘连程度并采用数字分级评分法（NRS）评估疼痛程度，计算术后3、6、15 d换药时的创面愈合率，计算入院时及术后3、6、15 d换药时创面分泌物/清洗液细菌培养阳性比例，记录换药次数，计算手术植皮率，记录创面完全愈合时间，随访6个月时采用温哥华瘢痕量表（VSS）评估瘢痕增生情况。对数据行重复测量方差分析、独立样本t检验、Mann-Whitney U检验、χ²检验或Fisher确切概率法检验、Bonferroni校正。结果术后观察期间，水凝胶敷料+凡士林油纱组患者内层敷料较容易去除、疼痛轻微，创面湿润且分泌物较少，创面愈合较快；单纯凡士林油纱组患者内层敷料去除时粘连较明显、疼痛感较强、有渗血，创面分泌物多于水凝胶敷料+凡士林油纱组，创面愈合较慢。与单纯凡士林油纱组比较，水凝胶敷料+凡士林油纱组患者术后前4次换药时敷料粘连程度与疼痛NRS评分均明显降低（χ²=52.625，Z=-10.854，P<0.01）；术后3、6、15 d换药时的创面愈合率均明显升高（t=10.347、41.150、167.627，P<0.01）；创面分泌物/清洗液细菌培养阳性比例在入院时及术后3 d换药时无明显变化（P>0.05），于术后6、15 d换药时明显降低（χ²=15.616、15.226，P<0.01）；换药次数明显减少（t=-11.986，P<0.01）；手术植皮率明显降低（χ²=35.850，P<0.01）。水凝胶敷料+凡士林油纱组患者创面完全愈合时间为（17.6±2.8）d，明显短于单纯凡士林油纱组的（27.1±3.0）d（t=-21.288，P<0.01）。随访6个月，水凝胶敷料+凡士林油纱组患者瘢痕增生的VSS评分明显低于单纯凡士林油纱组（Z=-11.287，P<0.01）。结论与单纯使用凡士林油纱比较，深Ⅱ度烧伤创面磨削痂术后应用涂覆水凝胶敷料的凡士林油纱覆盖保湿作用明显，可明显减轻换药时敷料粘连程度和患者疼痛，提高创面愈合率，降低创面感染率和手术植皮率，减少换药次数，缩短创面完全愈合时间，有效减轻瘢痕增生。
- 烧伤 /
- 水凝胶 /
- 伤口愈合 /
- 敷料 /
- 磨削痂术
Abstract: Objective To investigate the clinical effect of applying hydrogel dressings in deep partial-thickness burn wounds after dermabrasion and tangential excision. Methods A prospective randomized controlled study was conducted. From November 2015 to August 2019, 168 patients with deep partial-thickness burns hospitalized in Zibo Sixth People's Hospital met the inclusion criteria. According to the random number table, the patients were divided into hydrogel dressing+vaseline gauze group (84 cases, 67 males and 17 females) and vaseline gauze only group (84 cases, 65 males and 19 females) who were aged (31±16) and (35±17) years, respectively, and were given corresponding treatment after dermabrasion and tangential excision. The dressings were changed every 3-5 days. Autologous skin grafting was performed with split-thickness or medium-thickness skin grafts taken from trunk or thigh if the wounds failed to heal over 21 days or the wounds were less than 21 days but located in the joints, which might affect the functional activities at later stage. After operation, the general condition of the wounds was observed continuously and dynamically till the wounds were healed. The degree of dressing adhesion was evaluated during the first 4 dressing changes after operation, and the degree of pain was evaluated using Numerical Rating Scale (NRS). The wound healing rate on post operation day (POD) 3, 6, and 15 was calculated. The positive proportion of bacterial culture of wound exudates/cleanout fluid on admission and at dressing change on POD 3, 6, and 15 was calculated. The number of dressing changes were recorded, the rate of skin grafting operation was calculated, and the time of complete wound healing was recorded. Vancouver Scar Scale (VSS) was used in 6 months of follow-up to evaluate the hyperplasia of scar. Data were statistically analyzed with analysis of variance for repeated measurement, independent sample t test, Mann-Whitney U test, chi-square test or Fisher's exact probability test, and Bonferroni correction. Results During the observation period after operation, the wound was moist with less exudates and the wound healed much faster in patients of hydrogel dressing+vaseline gauze group, with the inner dressing being easier to remove with mild pain, while the wounds showed more exudates and slower healing in patients of vaseline gauze only group with the obvious adhesions of inner dressing, stronger pain, and bleeding in the wounds. Compared with those in vaseline gauze only group, the degree of dressing adhesion and pain NRS score of patients in hydrogel dressing+vaseline gauze group decreased significantly during the first 4 dressing changes after operation (χ²=52.625, Z=-10.854, P<0.01), the wound healing rate increased significantly at dressing change on POD 3, 6, and 15 (t=10.347, 41.150, 167.627, P<0.01), the positive proportion of wound exudates/cleanout fluid bacterial culture did not change significantly on admission or at dressing change on POD 3 (P>0.05) but decreased significantly at dressing change on POD 6 and 15 (χ²=15.616, 15.226, P<0.01), the dressing change times was significantly reduced (t=-11.986, P<0.01), and the rate of skin grafting operation was significantly decreased (χ²=35.850, P<0.01). The complete wound healing time of patients in hydrogel dressing+vaseline gauze group was (17.6±2.8) d, significantly shorter than (27.1±3.0) d in vaseline gauze only group (t=-21.288, P<0.01). During the follow-up of 6 months, the VSS score of scar hyperplasia of patients in hydrogel dressing+vaseline gauze group was significantly lower than that in vaseline gauze only group (Z=-11.287, P<0.01). Conclusions Compared with the use of vaseline gauze only, the application of vaseline gauze coated with hydrogel dressing in deep partial-thickness burn wounds after dermabrasion and tangential excision is more effective in moisturizing, significantly reducing the degree of dressing adhesion and patients' pain during dressing change, increasing wound healing rate, decreasing wound infection rate and the rate of skin grafting operation, and reducing the number of dressing changes. It shortens the time for complete wound healing, and effectively relieves scar hyperplasia.
- Burns /
- Hydrogel /
- Wound healing /
- Dressing /
- Dermabrasion and tangential excision
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HTML全文

1 水凝胶敷料+凡士林油纱组足部深Ⅱ度火焰烧伤患者磨削痂术后应用涂覆水凝胶敷料的凡士林油纱治疗。1A.治疗前创面基底红白相间；1B.入院后第3天，行磨削痂术至见创面较致密渗血点；1C.伤后18 d，创面愈合

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表1 2组深Ⅱ度烧伤患者一般资料比较

组别	例数	性别（例）		年龄（岁，x¯±s）	深Ⅱ度烧伤面积（%TBSA，x¯±s）
组别	例数	男	女	年龄（岁，x¯±s）	深Ⅱ度烧伤面积（%TBSA，x¯±s）
水凝胶敷料+凡士林油纱组	84	67	17	31±16	10.2±0.4
单纯凡士林油纱组	84	65	19	35±17	10.2±0.6
统计量值		χ²=0.035		t=-1.446	t=0.238
P值		0.85		0.15	0.81
注：TBSA为体表总面积

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表2 2组深Ⅱ度烧伤患者术后各时间点创面愈合率比较（%,x¯±s)

组别	例数	3 d	6 d	15 d
水凝胶敷料+凡士林油纱组	84	5.1±2.0	20.5±2.4	81.2±2.0
单纯凡士林油纱组	84	2.5±1.1	5.6±2.3	27.5±2.1
t值		10.347	41.150	167.627
P值		<0.01	<0.01	<0.01
注：处理因素主效应，F=14 039.892，P<0.01；时间因素主效应，F=37 049.815， P<0.01；两者交互作用，F=8 117.988，P<0.01

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表3 2组深Ⅱ度烧伤患者各时间点创面分泌物细菌培养阳性情况比较（例）

组别	例数	入院时	术后3 d	术后6 d	术后15 d
水凝胶敷料+凡士林油纱组	84	3	6	9	3
单纯凡士林油纱组	84	2	8	32	22
χ²值		—	0.078	15.616	15.226
P值		>0.99	0.78	<0.01	<0.01
注：“—”表示无此统计量值

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参考文献(18)

[1]	赵冉,曹永倩,臧成瑜,等.烧伤创面磨痂术研究进展[J].中华烧伤杂志,2018,34(3):187-189.DOI: 10.3760/cma.j.issn.1009-2587.2018.03.016.
[2]	KwaKAA,GoeiH,BreederveldRS,et al.A systematic review on surgical and nonsurgical debridement techniques of burn wounds[J].J Plast Reconstr Aesthet Surg,2019,72(11):1752-1762.DOI: 10.1016/j.bjps.2019.07.006.
[3]	邬业强,熊秉刚,黎明华,等.早期磨削痂联合负压封闭引流治疗Ⅱ度烧伤合并糖尿病患者的临床疗效观察[J].现代诊断与治疗,2019,30(17):2996-2998.
[4]	王德昌,赵冉.重视磨痂术在早期深Ⅱ度烧伤创面的应用[J].中华烧伤杂志,2020,36(6):506-509.DOI: 10.3760/cma.j.cn501120-20190115-00007.
[5]	夏卫东,叶媛媛,杨锐金,等.早期磨削痂后负压封闭引流治疗糖尿病合并烧伤患者深Ⅱ度创面的疗效[J].中华烧伤杂志,2017,33(7):442-444.DOI: 10.3760/cma.j.issn.1009-2587.2017.07.011.
[6]	李波,张承德,徐向荣.磨痂术联合DR脱细胞异种皮移植术治疗四肢深Ⅱ度烧伤的临床效果及安全性分析[J].医学理论与实践,2020,33(12):1989-1990.DOI: 10.19381/j.issn.1001-7585.2020.12.050.
[7]	周忠志,黄新灵.重组人表皮生长因子凝胶联合纳米银敷料对深Ⅱ度烧伤患者创面总体细菌培养阳性率及愈合时间的影响[J].中国地方病防治杂志,2017,32(12):1400.
[8]	梁康,赵利敏,农玮,等.水凝胶敷料联合VSD技术治疗四肢开放性骨折术后难愈创面的临床效果[J].微创医学,2021,16(1):90-92.DOI: 10.11864/j.issn.1673.2021.01.24.
[9]	黄锐娜,黄锐佳,牛彩丽,等.五种常用敷料治疗压疮疗效的网状Meta分析[J].中国组织工程研究,2020,24(16):2614-2619.DOI: 10.3969/j.issn.2095-4344.2293.
[10]	蔡伟杰,韩培.水凝胶敷料治疗慢性创面研究进展[J].国际骨科学杂志,2020,41(4):195-198.DOI: 10.3969/j.issn.1673-7083.2020.04.001.
[11]	李文甜,涂计,高飞,等.凝胶敷料用于骨外露创面的修复:创新与发展[J].中国组织工程研究,2017,21(10):1617-1622.DOI: 10.3969/j.issn.2095-4344.2017.10.023.
[12]	朱朝军,张朝晖,马静,等.干性与湿性愈合疗法在糖尿病足坏疽治疗中的应用[J/CD].中华损伤与修复杂志:电子版,2014,9(2):186-188.DOI: 10.3877/cma.j.issn.1673-9450.2014.02.017.
[13]	SajidMT,MustafaQu,ShaheenN,et al. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers[J].J Coll Physicians Surg Pak,2015,25(11):789-793.
[14]	中华医学会烧伤外科学分会.磨痂术在烧伤创面中的临床应用全国专家共识(2021版)[J].中华烧伤杂志,2021,37(6):501-507.DOI: 10.3760/cma.j.cn501120-20210110-00013.
[15]	陈雄林,曹小明,江和,等.临床敷料在皮肤创伤中的应用[J].实用临床医学,2017,18(10):98-102.DOI: 10.13764/j.cnki.lcsy.2017.10.039.
[16]	RutterL.Obtaining the optimum moist wound healing environment[J].Br J Community Nurs,2017,22(Suppl 12):S36-40.DOI: 10.12968/bjcn.2017.22.Sup12.S36.
[17]	谭谦,徐晔.慢性创面治疗的理论和策略[J].中华烧伤杂志,2020,36(9):798-802.DOI: 10.3760/cma.j.cn501120-20200728-00361.
[18]	廖昭会,付强,王达利,等.无定形水凝胶敷料对大鼠皮肤烫伤及创伤模型的疗效分析[J]. 解剖学杂志,2017,40(4):444-448.DOI: 10.3969/j.issn.1001-1633.2017.04.019.