荷负电气溶胶治疗Ⅱ度烧伤创面的临床效果及病理学观察

Clinical study and pathological examination on the treatment of deep partial thickness burn wound with negative charge aerosol

目的观察荷负电气溶胶(下称气溶胶)治疗Ⅱ度烧伤创面的效果。方法选择单纯浅Ⅱ、深Ⅱ度烧伤患者,随机分为:(1)气溶胶组:浅Ⅱ度180例、深Ⅱ度100例,伤后6h^2d开始用气溶胶治疗创面,l^2次/d,1.5h/次。(2)对照组:浅Ⅱ、深Ⅱ度患者各30例,常规治疗。(3)自身对照组:浅Ⅱ、深Ⅱ度患者各10例,同上用气溶胶治疗,但同一患者部分创面覆盖无菌金属片屏蔽气溶胶(屏蔽组),部分创面不屏蔽(非屏蔽组)。观察气溶胶治疗过程中患者创面的大体变化,治疗前后进行创面细菌培养,并监测其肝、肾功能及血生化指标有无改变。记录各组患者创面愈合时间。另制作深Ⅱ度烫伤大鼠模型,同前分为气溶胶组和对照组并治疗。取两组大鼠治疗前及治疗后1、2、3周的创面组织标本,作病理学观察。结果气溶胶治疗后患者创面渗出少,治疗前后均无细菌生长。总体来讲,气溶胶治疗前后患者肝、肾功能及血生化指标无明显改变。气溶胶组患者浅Ⅱ度创面伤后(6.3±1.6)d愈合,深Ⅱ度创面(15.1±3.1)d愈合,明显短于对照组相同深度创面[(11.3±1.4)、(21.2±1.4)d,P<0.01]。自身对照组中,相同烧伤深度的非屏蔽组与屏蔽组比较,创面愈合时间也明显缩短(P<0.01)。病理学检查显示,气溶胶组大鼠治疗后第3周皮肤结构已基本恢复正常,而对照组此时恢复较差。结论气溶胶能有效促进Ⅱ度烧伤创面的愈合且使用安全。

Objective To investigate the effect of negative charge aerosol（NCA） on the treatment of burn wound. Methods Patients with superficial or deep partial thickness burn only were enrolled in the study, and they were randomly divided into trial group （T, including 180 cases of superficial thickness burn and 100 cases of deep partial thickness burn） , control group （ C, including 30 cases with superficial thickness burn and 30 with deep partial thickness burn） , and self control group （ SC,including 10 cases with superficial thickness burn and 10 with deep partial thickness burn）. The patients in T and SC groups were treated with NCA for 1.5 hours , 1 - 2 times a day, from 6 postburn hour （PBH） to 2 postburn day （PBD） , while those in C group received conventional treatment. For those in SC group, some of the wounds were covered with sterile scissel, while other wounds without scissel covering. The general changes in the wounds during NCA treatment were observed, and bacterial culture before and after NCA treatment was performed. The healing time was recorded and the blood biochemical parameters were determined. Rat model with deep partial thickness scald was established, and the rats were also divided into T and C groups, and received treatment as in human. Tissue samples were harvested from the wounds of rats in the 2 groups before and 1, 2, 3weeks after treatment for pathological examination. Results There was no infection and little exudation in the patients in T group. No bacteria were found in the wound before and after NCA treatment. The healing time of the wounds of patients with superficial and deep partial thickness burn in T group was 6.3 ：t： 1.6 d and 15.1 ±3.1 d, respectively, which was obviously shorter than those in C group（ 11.3±1.4 d and 21.2 ±1.4 d, P 〈 0.01 ）. In SC group, the healing time of those with sterile scissel coverage was also significantly shorter than those without covering （ P 〈0.01 ）. There was no obvious change in the liver and kidney functions and blood biochemical parameters among the patients. Pathological examination showed that the skin structure was almost recovered in the rats in T group 3 weeks after treatment, while those in C group was not.Conclusion Negative charge aerosol is safe and effective in promoting wound healing of the patients with partial thickness burns.