磺胺嘧啶银治疗的烧伤创面转换湿润暴露疗法的临床观察

Clinical Study on Changing Therapy of Burn Wounds from Using SD-Ag into MEBT

目的:探讨由磺胺嘧啶银(SD-Ag)治疗创面转换为湿润暴露疗法(MEBT)的可行性。方法:对2006年2月～2007年2月收治的14例院外使用磺胺嘧啶银处理的烧伤创面,分别采用立即、分区及延迟转换为湿润暴露疗法治疗,对伤后48h的创面,清洗磺胺嘧啶银后立即完成治疗方法的转换,对已成痂、溶痂的创面根据创面大小、炎症程度、创面深度分为立即转换、分区转换及延迟转换处理。结果:立即转换者11例,9例在伤后48h内入院,2例伤后1周入院,清洗磺胺嘧啶银后立即转为MEBT处理创面,浅Ⅱ度在7d～10d愈合,深Ⅱ度在14d～21d愈合,Ⅲ度创面28d～35d愈合,愈合后无明显瘢痕增生,色素沉着轻;分区转换者1例,在伤后1周入院,创面溶痂、创周炎症明显,浅Ⅱ度、深Ⅱ度立即转换,Ⅲ度创面延迟转换,深度创面经耕耘、薄化处理后21d～35d愈合;延迟转换者2例,在一周内完全过度到MEBT治疗,深Ⅱ度耕耘、薄化处理后皮岛稀疏,1个月自愈,Ⅲ度创面耕耘、薄化处理后无明显皮岛,1个月后植皮封闭创面,愈合后瘢痕增生明显。结论:湿润暴露疗法对经磺胺嘧啶银治疗的烧伤创面仍能发挥其有效的治疗作用,浅度创面能以MEBT治疗方式愈合,深度创面宜早期实施耕耘、薄化技术处理,以利于创面愈合。

Objective： To study the feasibility of changing therapy of burns wounds from using SD - Ag into MEBT. Method： During a period of 02/2006 -02/2007, 14 patients having treated with SD -Ag were admitted and treated with MEBT instead at the time points of immediate admission, or part by part, or delayed some time As for burn wounds within 48 hours after injury, therapy was changed immediately after SD - Ag cleaned; as for bums wounds with eschar or eschar dissolved, immediate, part by part or delayed some time therapy change were conducted dependent on wound size, inflammation degree, depth of burns wounds. Results： There were 11 patients conducted immediate therapy, of whom 9 were admitted within 48 hours after injury, while other 2 patients were admitted at the day of 1 week after injured; all the 11 patients were applied with MEBO immediate after SD - Ag cleaned. Patients with superficial second - degree burns got healed in 7 to 10 days, deep second - degree in 14 to 21 days, third - degree in 28 to 35 days. No apparent scar hyperplasia and pigmentation observed. One patient was part by part case. The case was admitted 1 week after injured when the eschar dissolved, obvious inflammation at wound site. For the part of superficial and deep Ⅱ degree wounds immediate therapy changing were conducted, while for the Ⅲ wounds therapy changing was conducted delay some time. The wounds needed to plough and to be thinned, then healed in 21 - 35 days ; 2 patients were the cases to change therapy delay some time. The 2 cases were completely changed to applying MEBO in 1 week. For the part of deep Ⅱ degree only sparse skin islands were observed and wounds were healed in 1 month after plough and thinning technique used, while for the Ⅲ degree part no skin islands were observed after plough and thinning technique used and wounds were closed by means of skingrafting one month later. Healed wounds were with apparent scar hyperplasia. Conclusion： MEBT can play its therapeutic role for burns wounds that had already been treated by SD - Ag. Superficial burns wounds could get healed by MEBT. Early application of ploughing and thinning technique is profitable for heahng deep burns wounds.