植皮成活率及愈合时间与不同切痂术式的关系

Effects of different escharectomy on the survival rate of skin graft and healing time

目的:观察不同的切痂术式对肢体深度烧伤患者术中出血量、植皮成活率及创面愈合时间的影响,探寻更合适的肢体切痂的手术方式。方法:选择2001-06/2004-05济南市中心医院烧伤科收治的肢体Ⅲ度烧伤患者22例患者38个肢体,按入院先后顺序随机分为2组,逆行切痂组11例20个肢体,常规顺行切痂组11例18个肢体,患者均签署知情同意书且得到医院伦理道德委员会许可。两组患者于休克期平稳度过后分别做逆行切痂术和常规顺行切痂术,除关节功能部位移植大张中厚皮外,其他创面移植邮票皮片。术中收集止血纱布计算出血量,术后观察植皮成活率和创面愈合时间。结果:22例患者全部进入结果分析,无脱落。①逆行切痂组患者的1%体表面积切痂出血量显著低于常规顺行切痂组[(21.30±2.11,30.30±2.67)mL(P<0.01)]。②逆行切痂组患者的植皮成活率显著高于常规顺行切痂组[(83.45±5.57,73.27±5.06)%(P<0.01)]。③逆行切痂组患者的创面愈合时间显著短于常规顺行切痂组[(33.73±4.15,44.64±3.72)d(P<0.01)]。结论:逆行切痂能明显减少肢体深度烧伤患者的术中出血量,增加植皮成活率,缩短创面愈合时间,减少患者痛苦,值得推广应用。

AIM： To investigate the effects of various escharectomy on the bleeding volume, survival rate of skin graft and completely healing time, so as to search the best pattern of escharectomy.METHODS： Thirty-eight limbs of 22 patients with type Ⅲ burn were selected from the Department of Burn, Jinan Central Hospital from June 2001 to May 2004, and randomly divided into 2 groups： the experimental group （n=11, 20 limbs）, which undertaken a new operation of escharectomy beginning from the trunk to fingers （or tiptoes）, and control group （n =11, 18 limbs）, which undertaken traditional operation of escharectomy beginning from fingers （or tiptoes） to the trunk. All patients singed the informed consent and the experiment was permitted by the Hospital Ethics Committee. Meanwhile, the operations were performed after shock stage, and except the joint functional sites were transplanted with large thick skin graft, other wounds were given postal stamp skin grafts. Gauzes for hemostasia were collected during operations to calculate the bleeding volume, and the survival rate of skin planting and completely healing time were observed after operation. RESULTS： Twenty-two patients entered in the result analysis with no loss. ①The bleeding volume during operation of 1% body surface of the experiment group was significantly lower than that of the control group [（21.30±2.11, 30.30±2.67） mL, P 〈 0.01]. ②The survival rate of the experiment group was significantly higher than that of the control group [（83.45±5.57, 73.27±5.06）%, P 〈 0.01]. ③The average healing time of the experiment group was remarkably shorter than that of the control group [（33.73±4.15, 44.64±3.72） days, P 〈 0.01]. CONCLUSION： The escharectomy beginning from the trunk to fingers （or tiptoes） can evidently reduce the bleeding volume during operation, increase the survival rate of skin graft, and shorten the completely healing time. Moreover, it could release the pain of patients, so it is promising to be used widely.