湿润暴露疗法治疗烧伤的初步探讨

A PRELIMINARY SURVEY OF THE TREATMENT OF BURNS USING MEBT

本文介绍采用湿润暴露疗法治疗各类烧伤567例,严重烧伤251例,最大烧伤面积95％。发生并发症43例,发生率7.58％。其中感染并发症10例,发生率1.76％。11例死亡,死亡率1.94％。12例未愈自动出院,544例治愈,总治愈率95.9％。和同期178例干燥暴露疗法相比,两者在平均愈合时间、治愈率无统计学差异,在感染性并发症发生率、深Ⅱ度创面植皮率、瘢痕发生率均有统计学差异,P<0.01。作者就湿润暴露疗法的病理治疗学基础,深度创面处理技巧及大面积重度烧伤的治疗进行了探讨,提出“均匀涂药、保持湿润、及时清创、彻底暴露”16字治疗要诀。强调在实行治疗期间,对深度结痂创面应变被动自然溶痂为主动药刀结合法除痂,及时清理创面液化坏死物。大面积深度烧伤应配合积极的全身治疗,使用有效抗生素和积极复盖创面以提高救治成功率。

567 cases of burn were treated with MEBT. The total healing rate was 95. 5%. As compared with the results of dry therapy used in the same period, no significant difference was found between the average healing time and healing rate. But there was statistically very significant difference between the infection rate, complication incidence, frequency of skin grafting for deep 2nd degree wounds and scar formation (P<0. 01). Moist therapy was superior to dry therapy in these aspects. The author suggested a policy of the treatment of large area burns namely, ensuring uniform smearing of the ointment, keeping a moist environment, ensuring timely debriedement and thorough exposure of the wounds. The author emphasized that scabbed deep wounds should be treated with the ointment in conjunction with surgical operation. Timely removal of the scab would promote early healing of the wound. Active systemic treatment and local application of antibiotics to cover the wound would raise the successful rate of the treatment and reduce the disablement rate.