A randomized controlled trial on the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing in the treatment of deep partial-thickness burn wounds in children
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摘要:
目的 探讨早期磨痂联合自粘性软聚硅酮银离子泡沫敷料（以下称为泡沫敷料）治疗儿童深Ⅱ度烧伤创面的效果。 方法 该研究为随机对照试验。2021年6月—2022年12月，贵阳钢厂职工医院烧伤科收治78例符合入选标准的深Ⅱ度烧伤患儿。按照随机数字表法将患儿分为2组，剔除1例随访脱落患儿后，联合治疗组纳入38例患儿［男20例、女18例，年龄26.00（16.75，39.75）个月］，泡沫敷料组纳入39例患儿［男21例、女18例，年龄19.00（14.00，31.00）个月］。对联合治疗组患儿在伤后48 h内行创面磨痂术，术后用泡沫敷料覆盖创面，7 d更换1次敷料；对泡沫敷料组患儿在伤后48 h内行创面消毒后用泡沫敷料覆盖创面，2~3 d更换1次敷料。2组患儿创面愈合后均常规涂抹硅酮凝胶，每天涂抹2次，连续应用3周后佩戴弹力套，每天佩戴18 h以上，连续佩戴6个月以上。采用儿童疼痛行为量表FLACC评估患儿换药时疼痛程度；观察并记录治疗期间的不良反应、换药次数及创面愈合时间；创面愈合后6个月，采用温哥华瘢痕量表（VSS）评估创面瘢痕情况。 结果 换药时，联合治疗组患儿疼痛的FLACC评分为3.5（2.0，5.0）分，明显低于泡沫敷料组的6.0（5.0，8.0）分（ Z=-5.40， P<0.05）。2组患儿治疗期间均未发生创面水肿、积液或周边皮肤皮疹过敏等不良反应。联合治疗组患儿的换药次数为3（3，4）次，明显少于泡沫敷料组的8（7，10）次（ Z=-7.58， P<0.05）。联合治疗组患儿的创面愈合时间为（19±5）d，明显短于泡沫敷料组的（25±6）d（ t=-4.48， P<0.05）。创面愈合后6个月，联合治疗组患儿瘢痕的VSS评分为5（2，8）分，明显低于泡沫敷料组的7（5，10）分（ Z=-3.05， P<0.05）。 结论 与单纯使用泡沫敷料相比，早期磨痂联合泡沫敷料治疗深Ⅱ度烧伤患儿可减少换药次数、减轻换药痛苦、缩短创面愈合时间，结合后期抗瘢痕治疗能够有效减轻瘢痕增生。 Abstract:Objective To explore the effect of early eschar dermabrasion combined with antimicrobial soft silicone foam dressing (hereinafter referred to as foam dressing) in treating the deep partial-thickness burn wounds in children. Methods This study was a randomized controlled trial. From June 2021 to December 2022, 78 pediatric patients with deep partial-thickness burns who met the inclusion criteria were admitted to the Department of Burns in Guiyang Steel Plant Employees Hospital. According to the random number table, the pediatric patients were divided into two groups, with 38 cases left in combined treatment group (with 20 males and 18 females, aged 26.00 (16.75, 39.75) months) and 39 cases in foam dressing group (with 21 males and 18 females, aged 19.00 (14.00, 31.00) months) after the exclusion of one dropped-out child in follow-up. The pediatric patients in combined treatment group underwent eschar dermabrasion of the wound within 48 hours after injury, the wound was covered with foam dressing after operation, and the dressing was replaced once every 7 days; for the pediatric patients in foam dressing group, the wound was sterilized within 48 hours after injury and covered with foam dressing, and the dressing was replaced once every 2 to 3 days. After the wound healing, the children in both groups were routinely applied with silicone gel twice a day for 3 weeks before started wearing elastic sleeves for more than 18 hours a day, and continuously for over than 6 months. The degree of pain during dressing change was evaluated using the children's pain behavior inventory FLACC. The adverse reactions during the treatment period, number of dressing changes, and wound healing time were observed and recorded. Six months after wound healing, the Vancouver scar scale (VSS) was used to evaluate the condition of the wound scar. Results When changing dressing, the FLACC score for pain of pediatric patients in combined treatment group was 3.5 (2.0, 5.0), which was significantly lower than 6.0 (5.0, 8.0) in foam dressing group ( Z=-5.40, P<0.05). During the treatment period, no adverse reactions such as wound edema, fluid accumulation, or peripheral skin rash allergies occurred in any pediatric patient in both groups. The number of dressing changes of pediatric patients in combined treatment group was 3 (3, 4) times, which was significantly less than 8 (7, 10) times in foam dressing group ( Z=-7.58, P<0.05). The wound healing time of pediatric patients in combined treatment group was (19±5) days, which was significantly shorter than (25±6) days in foam dressing group ( t=-4.48, P<0.05). Six months after wound healing, the VSS score for scar of pediatric patients in combined treatment group was 5 (2, 8), which was significantly lower than 7 (5, 10) in foam dressing group ( Z=-3.05, P<0.05). Conclusions Compared with using foam dressings alone, early eschar dermabrasion combined with foam dressings can reduce the number of dressing changes, alleviate the pain during dressing changes, and shorten the wound healing time in treating children with deep partial-thickness burns, and effectively alleviate scar hyperplasia by combining with anti-scar treatment post burns. -
Key words:
- Burns /
- Child /
- Cicatrix /
- Eschar dermabrasion /
- Wound repair /
- Antimicrobial soft silicone foam dressing
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参考文献
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1 早期磨痂联合自粘性软聚硅酮银离子泡沫敷料治疗儿童深Ⅱ度烧伤创面的效果。1A.入院时创面情况，深Ⅱ度创面创基以红白相间为主；1B.磨痂术后即刻情况；1C.磨痂术后外敷自粘性软聚硅酮银离子泡沫敷料中；1D.术后17 d揭开敷料后可见，创面基本愈合；1E.创面愈合后6个月随访，创面处未见明显瘢痕增生，但存在色素减退
表1 2组深Ⅱ度烧伤患儿一般资料比较
表1. Comparison of general data of pediatric patients with deep partial-thickness burns between two groups
组别 例数 性别（例） 年龄［月， M（ Q 1， Q 3）］ 体重［kg， M（ Q 1， Q 3）］ 深Ⅱ度烧伤创面面积［%TBSA， M（ Q 1， Q 3）］ 居住地区（例） 男 女 城市 农村 联合治疗组 38 20 18 26.00（16.75，39.75） 12.50（11.00，15.25） 12（10，16） 24 14 泡沫敷料组 39 21 18 19.00（14.00，31.00） 12.00（10.00，14.00） 12（8，15） 22 17 统计量值 χ 2=0.01 Z=-1.33 Z=-1.26 Z=-0.62 χ 2=0.36 P值 0.915 0.183 0.208 0.531 0.546 注：对联合治疗组患儿创面行磨痂+自粘性软聚硅酮银离子泡沫敷料外敷治疗，对泡沫敷料组患儿创面仅行自粘性软聚硅酮银离子泡沫敷料外敷治疗；TBSA为体表总面积 
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