大面积烧伤异体皮移植两种手术方法临床效果观察

Allogeneic skin closure of the extensive burned patients:a clinical investigation on two surgical methods

目的观察大面积烧伤四肢切削痂后同期完成异体皮移植术与延期完成异体皮移植术两种手术方法的临床效果。方法大面积烧伤8例做为治疗组,四肢切削痂后异体皮延期移植,手术分两次进行,首次只行四肢切削痂术,创面用生物敷料覆盖,3d后去除生物敷料行异体皮移植术;大面积烧伤10例做为对照组,四肢切削痂术与异体皮移植术同期完成。对比观察2组病例手术时间、手术人员、术中切削痂面积、术中输液总量和输注浓缩红细胞数量、术中创面细菌培养结果、术后并发症发生率及植皮成活率、统计手术费用。结果治疗组单次手术时间少于对照组,组间比较差异有统计学意义(P<0.01);治疗组手术人员数量少于对照组(P<0.01);2组术中切削痂面积比较相近(P>0.05);术中输液总量和输注浓缩红细胞数量对照组多于治疗组单次手术的量(P<0.01);术中创面菌培养均为无菌生长;术后1周内对照组并发症发生率大于治疗组(P<0.05);异体皮移植10d后成活率治疗组大于对照组(P<0.05);治疗组单次手术费用少于对照组(P<0.001),而治疗组2次手术费用之和大于对照组(P<0.001)。结论大面积烧伤四肢切削痂后异体皮延期移植,缩短了单次手术时间,减轻了对患者的二次打击,术后并发症发生率低,提高了异体皮的成活率。

Objective To observe the clinical effect using allogeneic skin closure of the extensive burned patients by period and delayed eschar shaving. Methods Eight extensive burned patients served as treatment group, delayed allogeneic skin grafting was done after four limbs eschar shaving, operated twice, the first surgery being four limbs eschar shaving, covering the wound with biological dressing, removing the biological dressing and transplanting allogeneic skin 3 days later. Ten extensive burned patients served as the control group. Four limbs eschar shaving and allogeneic skin grating were done simutaneously. The operation time, surgical persons, the area of eschar shaving, the fluid and concentration of RBC volume in operation, wound bacterial culture results in operation, the incidence of postoperative complications, graft survival and surgical costs were observed. Results The treatment group was less than the control group in single operation time, the differences being statistically significant （P 〈0.01 ）. The area of eschar shaving in 2 groups was similar（P 〉 0.05 ）. The fluid and concentration of RBC volume in single operation in treatment group were more than the control group. The growth of wound bacteria cultures were sterile in operation. The complication rate of control group was morn than treatment group after 1 week （P 〈 0.05 ）. The treatment group was morn than control group in the survival rate of allogeneic skin transplant after 10 days. Cost of single surg in treatment group was less than the control group （ P 〈 0.001 ）, but the cost of twice surgery in treatment group was more than the control group （ P 〈 0. 001 ）. Conclusion Four limbs eschar shaving before delayed allogeneic skin grasting for extensive burned patients can shorten the time of single operation, reduce the two- hit to patients, lower incidence of postoperative complications, improve the survival rate of allogeneic skin.