保留焦痂湿润皮簇内植治疗深Ⅲ度烧伤的临床研究

Clinical research on MEBT/MEBO combining with skin cells implantation under scab in treating deepⅢdegree burns

目的:验证保留焦痂湿润皮簇内植培养技术对深Ⅲ度烧伤创面愈合与功能康复的有效性、安全性。方法:本研究选取有深Ⅲ度烧伤创面的患者120例,以深Ⅲ度烧伤创面作为研究样本,随机分为对照组与治疗组,对照组56例,91个创面,深Ⅲ度烧伤面积为(10.3±6.2)%TBSA,应用烧伤湿性医疗技术(MEBT/ MEBO)常规治疗;实验组64例,127个创面,深Ⅲ度烧伤(11.5±8.2)%TBSA,用保留焦痂湿润皮簇内植术(自体皮簇+MEBT/MEBO)治疗;观察指标为治疗前、后的临床症状、体征,局部红肿范围、疼痛程度、焦痂溶脱、发热、血白细胞及中性粒细胞、创面pH变化,每3天观察并记录一次,6天为1疗程,每疗程结束后进行初评;两个疗程后,每6天观察记录一次,7个疗程后积分评定疗效。结果:实验组平均疗程为36.85±2.81天,对照组41.95±3.19天,经t检验(P<0.005),两组治疗前后症状积分,经t检验P<0.005,组间均有非常显著性差异,提示湿润皮簇内植术疗效明显优于单纯MEBT/MEBO的疗效;实验组127个深Ⅲ度创面皮簇内植术后创面甲级愈合119个(93.7%),乙级愈合8个(6.3%);无丙级与丁级愈合创面;两组病人均未发生不良反应。结论:湿润皮簇内植术治疗深Ⅲ度烧伤创面愈合时间缩短、瘢痕形成较轻、功能康复良好,是一种安全、有效的治疗方法。

Objective：To testify the efficacy and safety of MEBT/MEBO combining with skin cells implantation under scab in treating deepⅢdegree burns and functional rehabilitation.Methods：120 patients with deepⅢdegree burn wounds were entered into the research and were divided randomly into control group and test group.There were 56 cases with 91 wounds in control group and area of wounds was（10.3±6.2）% TBSA,treating with MEBT/MEBO as routine. And there were 64 cases with 127 wounds in testing group and area of wounds was（11.5±8.2）% TBSA,treating with MEBT/MEBO combining with skin cells implantation under scab.Observation was focused on clinical symptoms and physical signs before and after treatment,area of red swelling of the skin,pain extend,scab exfoliation,temperature,number of white blood cells and neutrophilic leukocyte and pH value of wounds.All above observations were made and recorded every three days and every six days were a course of treatment.A primary assessment was made after each course.After two courses,observation was made recorded every six days and final assessment of the effect was made after 7 courses treatment on the basis of scores accumulated in each assessment.Results：The total average period of course of test group was 36.85±2.81 days and control group was 41.95±3.19 days.The testing was P〈0.005.Comparing the symptom scores of two group before and after treatment, there is very significant difference between two groups（P〈0.005）,which indicates the effect of MEBT/MEBO combining with skin grafting under scab is superior to that of MEBT/MEBO treatment alone.In 127 wounds of test group,119 wounds （93.7%）healed in first grade and 8 wounds（6.3%）healed in second grade.No adverse effects were observed in both groups.Conclusion：MEBT/MEBO combining with dot skin implantation under scab treating deepⅢdegree burns could shorten healing time,prevent scar formation and benefit functional rehabilitation.It is a safety and effective treatment method.