银离子生物敷料封闭网状植皮创面临床观察:前瞻性病例对照研究

Silver-containing biological dressing applied for transplanted meshed autografts: a prospective case-control study

目的通过与传统网眼油纱封闭网状植皮创面法进行比较,分析银离子生物敷料封闭网状植皮创面方法应用于烧伤、创伤等各种开放创面植皮手术的临床效果。方法符合入选标准的18例患者按手术方法分为两组,试验组(6例)为银离子生物敷料覆盖网状植皮创面,对照组(12例)为传统网眼油纱封闭网状植皮创面。记录入选患者的人口统计学特征、创面情况、植皮后创面感染情况、术后第一次更换最内层敷料时间、术后第一次换药疼痛评分、住院时间,并计算植皮成活率、术后植皮创面感染率和住院总费用。结果试验组术后植皮创面感染率低于对照组(0 vs 50.0%,P<0.05);试验组术后第一次更换内层敷料疼痛评分小于对照组(2.50±1.05 vs 5.42±2.02,P<0.01);试验组第一次更换内层敷料时间晚于对照组[(7.50±1.05)d vs(4.08±1.31)d,P<0.01];试验组住院时间短于对照组[(14.33±1.50)d vs(16.42±1.93)d,P<0.05];试验组术后植皮成活率高于对照组[(97.50±1.87)%vs(91.42±4.48)%,P<0.01]。结论银离子生物敷料封闭网状植皮创面的方法可以提高植皮存活率、缩短创面愈合时间、减少患者痛苦,疗效满意。

Objective To investigate the clinical application of silver-containing biological dressing in covering transplanted meshed autografts for treatment of open wounds（burns and trauma） by comparing with traditional petrolatum gauge on meshed autografts.Methods Eighteen patients fulfilling the inclusion criteria were divided into two groups according to the operation methods.The meshed autografts in the experimental group（6 patients） were covered with silver-containing biological dressing and those in the control group（12 patients） were covered with petrolatum gauge.The demographic data,wound condition,wound infection after skin grafting,time of first post-operative inner layer dressing change,pain score during the first inner layer dressing change,and length of hospital stay were all observed.The survival rate of skin graft,wound infection rate and total cost of hospitalization were also calculated.Results The experimental group had significantly lower wound infection rate（0 vs 50.0%,P〈0.05） and pain score at the first inner layer dressing change（2.50 ± 1.05 vs 5.42 ± 2.02,P〈0.01） after skin grafting compared with the control group.The period from skin grafting to the first post-operative change of inner layer dressing was significantly longer in the experimental group compared with that in the control group（[7.50 ± 1.05] d vs [4.08 ± 1.31] d,P〈0.01）.The experimental group had a significantly shorter hospital stay compared with the control group（[14.33 ± 1.50] d vs [16.42 ± 1.93] d,P〈0.05）.Moreover,the survival rate of skin grafting in the experimental group was significantly higher than that in the control group（[97.50 ± 1.87]% vs [91.42 ± 4.48]%,P〈0.01）.Conclusion Wound closing by meshed autografts with silver-containing biological dressing can increase the survival rate of skin graft,shorten wound healing time,reduce local pain,and obtain satisfactory outcome.