几种深Ⅱ度烧伤创面处理方法的回顾及改善创面微循环的初步实验研究

Preliminary study on the improvement of wound microcirculation and retrospection on several methods of the management of deep partial thickness burn wound

目的回顾性分析几种深Ⅱ度烧伤创面的修复方法,探讨改善创面微循环对创面愈合的意义。方法(1)对于笔者单位烧伤患者的深Ⅱ度创面,应用削痂疗法治疗614例、磨痂疗法治疗32例、清创后异体皮覆盖86例、外用磺胺嘧啶银后创面暴露1836例、外用中药京万红烫伤膏包扎治疗408例。统计、分析各种疗法的治疗效果。(2)制作大鼠深Ⅱ度烫伤模型。伤后5min内分别由其尾静脉注入等渗盐水(对照组,10只)、巴曲酶(治疗组,10只),创面均外用磺胺嘧啶银。测定两组大鼠伤前及伤后0.5—72.0h的创面皮肤血流灌注单位,计算其伤后14、18d的创面愈合率、收缩率及创面愈合时间。用组织学方法观察两组大鼠创面愈合后的皮肤毛囊数。结果(1)削痂疗法术后2—3周创面愈合,其中烧伤总面积50%～79%TBSA的患者治愈率94.8%,总面积80%～98%TBSA者治愈率93.4%。磨痂疗法磨痂+异体皮覆盖术后(13.8±2.1)d创面愈合,无瘢痕形成。清创后异体皮覆盖其中82例患者术后(18.0±2.3)d创面愈合。外用磺胺嘧啶银后暴露其中1658例患者用药后(26.0±3.2)d痂下愈合。外用京万红烫伤膏后包扎患者多有细菌感染,其中下肢创面愈合时间为(26.0±2.8)d。(2)治疗组大鼠伤后2.0—72.0h创面局部血流灌注单位均明显高于对照组(P<0.01)。伤后14、18d,治疗组创面愈合率明显?

Objective To analyze several methods of wound repair for deep partial thickness burn wounds retrospectively, so as to evaluate the significance of improvement of wound microcirculation on wound healing. Methods (1) 2,976 burn patients admitted to our department were enrolled in the study, among them 614 undertook tangential excision, 32,eschar abrasion, 86 allo-skin coverage after debridement, 1836 tropical application of silver sulfadiazine and 408 with traditional Chinese medicine (Jing Wan Hong ointment) with gauze bandage. The results of the management with different methods were compared. (2) Rat model with deep partial thickness burn was reproduced and topical application of silver sulfadiazine was given. The rats were randomly divided into control (n=10, with normal saline injected via caudal vein within 5 minutes postburn), and treatment (n=10, with batroxobin injected via caudal vein within 5 minutes postburn) groups. The blood flow perfusion unit in the wound skin was measured before burn and at 0.5 to 72 postburn hours by Laser Doppler. The wound healing rate, contraction rate and wound healing time in each group were calculated on 14 and 18 postburn days (PBDs). The number of hair follicles after wound healing was observed by histological method. Results (1) The burn wound treated by tangential excision healed within 2 to 3 post operation weeks (POWs), with the healing rate of 94.8% in patients with burn covering 50%-70% TBSA and 93.4% in those with burn of 80%～98% TBSA. The healing time of patients with allo-grafts coverage after eschar abrasion was 13.8±2.1 days without scar formation. The wound healing time was 18.0±2.3 day in 82 patients with allo-graft coverage after debridement, and it was 26.0±3.2 days with subeschar healing in 1658 patients with topical application of silver sulfadiazine. Infection in burn wound was encountered in most patients undergoing traditional Chinese medicine bandage treatment with wound healing time of 26.0±2.8 days in the lower extremities. (2) The blood flow perfusion unit of the rats in the treatment group was significantly higher than that in the control group (P<0.01). The wound healing rate in treatment group on 14 and 18 PBD was obviously higher than that in the control group (P<0.01). But the wound contraction rate in the two groups was similar (P>0.05). The wound healing time in treatment group was much shorter than that in control group (P<0.01). A few hair follicles remained in the dermis of the rats in the control group on 30 PBD, and the number was evidently smaller than that in the treatment group (P<0.01). Conclusion Early tangential excision and eschar abrasion remained better methods in the management of deep partial thickness burn wounds, as they could ameliorate burn wound infection, shorten treatment period, raise wound healing rate and quality. Application of batroxobin could accelerate wound healing rate by improving wound microcirculation in deep partial thickness burn wound.