小面积深Ⅱ°与Ⅲ°酸烧伤切削痂延期植皮术的临床研究

Clinical study of delayed skin transplantation after eschar excision for small area deep Ⅱ°and Ⅲ° acid burn wound

目的研究小面积深Ⅱ°与Ⅲ°酸烧伤临床切削痂后进行延期植皮手术的效果。方法2000年1月～2010年1月收住院的经手术植皮的小面积深Ⅱ°与Ⅲ°酸烧伤患者98例，随机分为2组，切削痂后直接植皮为对照组44例，延期植皮术处理为干预组54例。经治疗后对两组手术时间、皮下血肿率、创面细菌量、植皮成活率、创面愈合时间等进行比较分析。结果手术时间比较2组差异无统计学意义（P〉0．05）；干预组皮下血肿率低于对照组（P〈0．05）；干预组创面细菌量与对照组比较无明显增加（P〉0．05）；干预组植皮成活率高于对照组（P〈0．05）；干预组创面愈合时间短于对照组（P〈0．01）。结论小面积深Ⅱ°与Ⅲ°酸烧伤削痂后延期植皮术具有皮下血肿少，植皮成活率高，感染率低，愈合时间短等优点，是一种比较好的手术选择，综合效果优于立即植皮。

Objective To study the therapeutic effects of delayed skin transplantation after eschar excision for small area deep Ⅱ°and Ⅲ° acid burn wound. Methods In the 98 cases of small area deep Ⅱ°and Ⅲ° acid burn wound admitted between January 2000 and January 2010, 44 of them were treated with eschar excision and instantly skin grafting （control group）, and the rest of 54 were treated with delayed skin transplantation after eschar excision （intervention group）. An analysis was conducted on the following aspects, operation time, incidences of subcutaneous hematoma, bacteria counts, skin graft survival rate and wound healing time between the two groups. Results The operation time and bacteria counts reflected no statistical difference between the two groups （P〉0.05）; the incidences of subcutaneous hematoma of intervention group were significantly lower than that of control group （P〈0.05）; skin graft survival rate of intervention group were significantly higher than that of control group （P〈0.05）; and in intervention group wound healing time was significantly shorter （P〈0.01）. Conclusion Delayed skin transplantation after eschar excision for small area deep Ⅱ°and Ⅲ° acid burn wound has advantages of few subcutaneous hematoma, high skin graft survival rate, low infection rate and rapid healing. So delayed skin transplantation is considered a better choice of the operation for the small area deep Ⅱ°and Ⅲ° acid burn wound than the instant skin grafting.