超声清创法在烧伤残余创面中的应用及其临床疗效

何泽亮; 李锦; 随振阳; 张聚磊; 安亮恩; 刘玲玲; 张程亮; 姚媛媛; 仇树林; 李晓东

doi:10.3760/cma.j.cn501120-20211123-00396

超声清创法在烧伤残余创面中的应用及其临床疗效

doi: 10.3760/cma.j.cn501120-20211123-00396

解放军联勤保障部队第980医院烧伤整形科，石家庄　　050091

基金项目:

河北省医学科学研究课题计划 20211620

详细信息

通讯作者:
李晓东，Email：13933168616@163.com

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出版历程
- 收稿日期: 2021-11-23

Application and clinical efficacy of ultrasound debridement method in residual burn wounds

Department of Burn and Plastic Surgery, the 980th Hospital of the Joint Logistic Support Force of PLA, Shijiazhuang 050091, China

Funds:

Medical Science Research Project of Hebei Province of China 20211620

More Information

Corresponding author: Li Xiaodong, Email: 13933168616@163.com

摘要

摘要: 目的探讨超声清创法在烧伤残余创面中的应用及其临床疗效。方法采用回顾性队列研究方法。2017年8月—2021年8月解放军联勤保障部队第980医院收治64例符合入选标准的烧伤残余创面患者，根据对残余创面采用的清创方法，将患者分为超声清创组［34例，男22例、女12例，年龄（31±13）岁］和传统清创组［30例，男19例、女11例、年龄（32±13）岁］。对2组患者创面行相应的清创后，根据患者创面所在部位及皮源情况选择邮票皮片或大张皮片进行移植治疗。对于Ⅰ期手术后未愈合创面，则行二次清创+植皮术，2组创面的清创方式均分别同其Ⅰ期。术后3 d，采用药物敏感试验检测创面中细菌情况并计算细菌阳性率。术后7 d，计算创面中皮片成活率及皮下血肿发生率。出院时，统计患者创面愈合时长及清创次数并计算二次清创率。对数据行独立样本t检验或χ²检验。结果术后3 d，超声清创组创面感染金黄色葡萄球菌者2例、铜绿假单胞菌者2例，传统清创组创面感染金黄色葡萄球菌者5例、铜绿假单胞菌者3例、鲍曼不动杆菌者1例、肺炎克雷伯菌者1例、阴沟肠杆菌者1例；超声清创组创面细菌阳性率明显低于传统清创组（χ²=5.51，P<0.05）。术后7 d，超声清创组创面的移植皮片成活率为（92±5）%，明显高于传统清创组的（84±10）%（χ²=6.78，P<0.01）；超声清创组创面皮下血肿发生率为17.6%（6/34），明显低于传统清创组的40.0%（12/30），χ²=3.94，P<0.05。出院时，超声清创组创面愈合时长为（11.0±2.0）d，明显短于传统清创组的（13.0±3.1）d，（t=3.81，P<0.01）；超声清创组创面二次清创率为2.9%（1/34），明显低于传统清创组的20.0%（6/30），χ²=4.76，P<0.05。结论超声清创法可显著减轻烧伤残余创面细菌负荷，减少术后血肿形成，促进移植皮片成活，从而缩短患者病程。
- 烧伤 /
- 感染 /
- 清创术 /
- 皮肤移植 /
- 残余创面
Abstract: Objective To investigate the application and clinical efficacy of ultrasound debridement method in residual burn wounds. Methods A retrospective cohort study was conducted. From August 2017 to August 2021, 64 patients with residual burn wounds who met the inclusion criteria were admitted to the 980^th Hospital of the Joint Logistic Support Force of PLA. According to the debridement method adopted for the residual wounds, the patients were divided into ultrasound debridement group (34 cases, 22 males and 12 females, aged (31±13) years) and traditional debridement group (30 cases, 19 males and 11 females, aged (32±13) years). After the corresponding debridement, the wounds of patients in the two groups were selected for stamp skin grafting or large skin grafting according to the wound site and skin donor status. For unhealed wounds after stage Ⅰ surgery, secondary debridement and skin grafting were be performed, with the wound debridement methods in the 2 groups being the same as those of stage Ⅰ, respectively. On postoperative day 3, drug-sensitive test was used to detect the bacteria in the wound and the positive rate of bacteria was calculate. On postoperative day 7, the survival rate of skin slices in wound and the incidence of subcutaneous hematoma were calculated. At discharge, wound healing time and debridement times of patients were counted, and the secondary debridement rate was calculated. Data were statistically analyzed with independent sample t test or chi-square test. Results On postoperative day 3, the wounds in ultrasound debridement group were infected with Staphylococcus aureus in 2 cases and Pseudomonas aeruginosa in 2 cases, and the wounds in traditional debridement group were infected with Staphylococcus aureus in 5 cases, Pseudomonas aeruginosa in 3 cases, Acinetobacter baumannii in 1 cases, Klebsiella pneumoniae in 1 cases, and Enterobacter cloacae in 1 cases. The positive rate of bacteria of wound in ultrasound debridement group was significantly lower than that in traditional debridement group (χ²=5.51, P<0.05). On postoperative day 7, the survival rate of skin grafts in ultrasound debridement group was (92±5) %, which was significantly higher than (84±10) % in traditional debridement group (χ²=6.78, P<0.01); the incidence of subcutaneous hematoma in ultrasound debridement group was 17.6% (6/34), which was significantly lower than 40.0%( 12/30) in traditional debridement group, χ²=3.94, P<0.05. At discharge, the wound healing time in ultrasound debridement group was (11.0±2.0) d, which was significantly shorter than (13.0±3.1) d in traditional debridement group (t=3.81, P<0.01); the secondary debridement rate of wounds in ultrasound debridement group was 2.9% (1/34), which was significantly lower than 20.0% (6/30) in traditional debridement group (χ²=4.76, P<0.05). Conclusions Ultrasound debridement method can significantly reduce the bacterial load of residual burn wounds, reduce postoperative hematoma formation, and promote the survival of skin grafts to shorten the course of disease of patients.
- Burns /
- Infection /
- Debridement /
- Skin transplantation /
- Residual burn wounds
何泽亮：酝酿和设计研究方案、实施手术、采集并分析数据、撰写论文；李锦、随振阳：采集并分析数据；张聚磊、安亮恩、刘玲玲：实施手术、采集数据、修改文章；张程亮、姚媛媛：实施手术、设计研究、分析数据、修改文章；仇树林、李晓东：设计研究方案、课题指导与获取经费

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1 超声清创法+邮票皮移植治疗背部烧伤患者残余创面的疗效。1A.伤后25 d入院时，创面中较少肉芽组织增生；1B.伤后32 d背部创面清创术前，见肉芽组织增生明显，突出皮面；1C.清创术中；1D.术后12 d，邮票皮片存活良好

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表1 2组烧伤残余创面患者一般资料及其烧伤创面情况比较

组别	例数	性别（例）		年龄（岁，x¯±s）	致伤原因（例）			烧伤部位（例）			烧伤总面积（%TBSA，x¯±s）	残余创面面积（%TBSA，x¯±s）	伤后清创时间（d，x¯±s）
组别	例数	男	女	年龄（岁，x¯±s）	火焰烧伤	热液烫伤	电烧伤	头面颈部	前后躯干	四肢	烧伤总面积（%TBSA，x¯±s）	残余创面面积（%TBSA，x¯±s）	伤后清创时间（d，x¯±s）
超声清创组	34	22	12	31±13	19	12	3	4	20	10	51±14	10.9±4.0	32±6
传统清创组	30	19	11	32±13	17	11	2	3	19	8	50±12	10.1±2.9	33±5
统计量值		χ²=0.01		t=0.30	χ²=0.10			χ²=0.14			t=0.29	t=0.89	t=0.71
P值		0.909		0.972	0.949			0.932			0.707	0.907	0.169
注：TBSA为体表总面积