休克早期微创性磨擦治疗大面积深Ⅱ度烧伤创面

Management of extensive deep partial thickness burn wounds by dermabrsion during early postburn shock stage

目的 探讨治疗大面积深Ⅱ度烧伤创面的新手术方法。 方法 将 5 5例大面积深Ⅱ度烧伤患者随机分成两组 ,A组为微创性磨擦组 (30例 ) ,B组为削痂组 (2 5例 )。A组首次手术时间为伤后 (12 .3± 10 .7)h ,B组为 (4 7.2± 11.5 )h。以患者的尿量、心率和动脉血氧饱和度 (SaO2 )作为主要监测指标。结果 A组患者一次性磨擦面积为 (6 5 .5± 19.4 ) %TBSA ,B组一次性削痂面积为(6 4 .8± 18.7) %TBSA。术中、术后各项监测指标均较平稳 ,与条件相似的B组比较 ,A组创面愈合时间平均为 2 0d ,较B组缩短 10d左右 ;内脏并发症及菌血症发生率低 (A组 2 6 .7% ,B组 72 0 % ) ;平均住院费用下降 ,愈合后创面瘢痕明显减轻。 结论 休克早期 ,采用微创性磨擦的方法治疗大面积深Ⅱ度烧伤创面 ,具有操作简便、损伤轻、感染率低、并发症少、创面愈合快等特点 ,是一种较好的早期处理创面的方法。

Objective To explore new methods for the management of extensive deep partial thickness burn wounds. Methods Fifty burn patients with extensive deep partial thickness burn wounds were randomly divided into two groups: A and B groups. The patients in A group(n=30) were treated with dermarasion while those in B(n=25) with conventional tangential excision. The first operation time in A and B groups was 12.3±10.7 hours and 47.2±11.5 hours, respectively.The patients' urine output, heart rate and arterial oxygen saturation(SaO2) were monitored. Results The mean one setting operation area in A and B groups were (65.5±19.4)% and (64.8±18.7)%, respectively. All the indices remained stable in both groups during and after the operation. Nevertheless, the burn wound healing time (20 days averagely ) in A group was 10 days shorter than that in B group. The incidences of internal organ injury and bacteremia in A group were much lower than those in B group. Furthermore, the hospitalization cost in A group was decreased compared with that in B group. And the scar after wound healing was much less obvious in A group than that in B group. Conclusion Dermabrasion during early postburn shock stage for the management of deep partial thickness burn wound had many advantages such as: easy manipulation, less injury to patients, lower infection rate, less complications and quicker burn wound healing. [