大面积烧伤的治疗(附63例报告)

TREATMENT OF LARGE AREA BURNS (A REPORT OF 63 CASES)

本文重点讨论了63例大面积烧伤病人的综合治疗。本组中烧伤面积最小的42％,最大为98％。治愈51例,死亡10例,自动出院2例。深Ⅱ度创面可自行愈合。少数疤痕经继续应用MEBO后可变软消失。作者认为:1.积极防治休克的发生或发展是治疗大面积烧伤成败的关键;伤后1～2天适量输全血、血浆及白蛋白是有益的,同时应用复方丹参、低分子右旋糖酐,654-2等药物,以改善微循环,对休克的治疗起积极作用。2.合理使用抗生素,并采用中医辨证的方法,给予清热解毒、活血化瘀、扶正祛邪,去腐生肌的中药,有利于全身感染的防治。3.尽快清除坏死组织,促进肉芽组织形成,为深度创面创造植皮条件,争取早日消灭创面。4.植皮后的创面应用MEBO包扎,可促进皮的成活,有利于加快创面愈合。5.严重感染创面清创后可直接涂药,2一3天全身症状明显好转。

This paper reports the comprehensive treat-ment of 63 cases of large area burn. The smallest burn area was 42%BSA and the largest 98%BSA. 51 cases healed and 10 cases died. 2 cases left the hospital on their own will. The results proved that deep second degree burns can be healed spontaneously. If scar formed. MEBO should be applied continuously until the scar softened and vanished. The authors concluded: 1. The key to the success in the treatment of large area burns is to prevent shock. First 2 days post burn, adequate transfusion of whole blood, plasm and albumin is necessary. At the same time, administration of Fufang Dand Shen. low molecu-lar weight dextran, 654-2. etc. is recommended to improve microcirculation. These drugs may play positive role in the prevention and treatment of shock. 2, Pay attention to the rational use of antibiot-ics and adhere to the principle of Chinese Tradi- tional Medicine that diagnosis and treatment should base on overall analysis of the symptoms and signs. Chinese drugs with heat clearing, detoxifying, blood stasis removing, body resist-ance strengthening, pathogenic factor eliminating, necrotic tissue removing and granulation pro-moting effects can be used for the prevention and the treatment of systemic infections. 3, Timely removal of necrotic tissue is rec-ommended to promote granulation and to create favorable conditions for skin grafting and early ob-literation of the wounds. 4, After skin grafting, the wounds are ban-daged with MEBO to promote survival of the skin graft and to accelerate the healing of the wounds. 5, MEBO is directly applied onto severely in-fected wounds after debriedement. 2 to 3 days later, the systemic symptoms of the patients will significantly turn for the better.