烧伤Ⅱ度创面半暴露干—湿疗法的临床应用观察

Clinical Observation on the Therapy of Partial-wrapping and Dry-moist on Partial-thickness Burn Wounds

目的：观察分阶段综合处理烧伤Ⅱ度创面的半暴露干-湿疗法的临床价值和合理性。方法：前瞻性地观察从2005年8月至2008年8月我院收治的560例非手术治疗的Ⅱ度烧伤患者采用该疗法的疗效。创面早期采用10％磺胺嘧啶银纱布半暴露包扎，d2～d4后改用八湿膏纱布。全部病例在伤后12h内、d3及d7分别观察白细胞数、纤维蛋白原、血小板粘附率及红细胞聚集指数的变化；观察d2、d5创面分泌物细菌培养阳性率；观察创面治疗过程情况及临床效果。观察用药安全性。结果：在伤后12h内、d3Y2．d7白细胞数、纤维蛋白原、血小板粘附率及红细胞聚集指数检测结果逐渐转化接近正常值，各项指标比较差异有显著性意义（P〈0．05）。犬部分浅Ⅱ度烧伤创面可保留底层敷料一期愈合，平均愈合时间为8．5±2．2d；深Ⅱ度烧伤创面部分表层形成半透膜状浅褐色痂皮，达到痂下愈合效果，创面愈合后无疤痕形成，色素沉着很轻微，平均愈合时间为1．1．2±2．5d，部分深11度烧伤创面表层痂皮溶脱，创面细胞活性佳，基底皮肤附件保存良好，创面愈合后有轻度色素沉着或脱失，部分有浅疤痕形成（发生率26．3％），平均愈合时间为16．4±3．5d。结论：分阶段综合处理烧伤11度创面的半暴露干-湿疗法是一种有效、简便、安全的较为“细化”的创面处理方法。

Objective：To observe the therapeutic effect and rationality ol the therapy ot paruai- wrapping and dry - moist on treatment with patient who suffer partial - thickness burn wounds. Method ： Prospective study the curative effect of 560 patients with partial - thickness burn wounds who treat without operation from August 2005 to August 2008. The raw surface were bandaged with 10% AgSD gauze in early period and changed dressings per 1 - 2 days, after 2- 4 days alter dressing to Ba - shi Ointment gauze and change dressings per 2-4days; in the 12th hours, the third day and the 7th day after wounded of all the case, to observe the variation of WBC population, fibrinogen, rate of platelet adhesion reaction and index of RBC aggregation; to observe the masculine rate of bacterial culture from raw surface＇ s secrete in the third day and 7th day; to observe the treatment procedure and the therapeutic effect and the safe of medication. Result： To compare with the results of WBC population, fibrinogen, rate of platelet adhesion reaction and index of RBC aggregation by the 12th hours, the third day and the 7th day after wounded, which become normal step by step, and the results shows significant difference （ P 〈 0.05 ）. Most of the superficial - partial - thickness burn wounds were well adhere with bottom dressing and keeping clean and without purulent secretion, which could be remaining the bottom dressing till primary intention healing. The average healing time was 8.5 ±2. 2 days. Some translucent beige crusts were formed on the surface of most of the deep - partial - thickness burn wounds, which achieve infra - crust - healing and without scarring and light hyper pigmentation. The average healing time was 11.2 ±2.5 days. Some echelon crust of the deep - partial - thickness burn wounds dissolved the crust and keep well hypoactive of raw surface and well appendages of the skin, which got light scarring （ the incidence rate is 26.3% ） and light hyper pigmentation. The average healing time was 16.4 ±3.5 days. Conclusion： The therapy of partial - wrapping and dry - moist is practical and convenient and safe for treatment with partial - thickness burn wounds.