异体脱细胞真皮和异种脱细胞真皮在烧伤创面治疗中的应用效果比较

Application effect comparison on allogenic acellular dermal matrix and xenogenic acellular dermal matrix in the treatment of burn wounds

目的比较异体脱细胞真皮和异种（猪）脱细胞真皮在烧伤创面治疗中的效果，探讨异种脱细胞真皮替代异体脱细胞真皮的可行性。方法选择深圳市宝安人民医院2012年5月～2013年6月有深Ⅱ度偏深和Ⅲ度烧伤创面需削痂切痂植皮治疗，同时自体皮源不足的患者30例，采用随机数字表法分为两组，采用异体皮＋微粒皮治疗的15例患者设为异体组，采用异种（猪）脱细胞真皮＋微粒皮治疗的15例患者设为异种组。比较两组创面愈合时间、近期愈合质量；患者均随访6个月，采用温哥华瘢痕评分量表和患者自我满意度评价表对愈合效果进行评价。结果近期效果：异体组31个创面Ⅰ类愈合16个（51．61％），Ⅱ类愈合15个（48．39％）；异种组30个创面Ⅰ类愈合15个（50．00％），Ⅱ类愈合15个（50．00％），差异无统计学意义（P〉0．05）。两组创面脱水干燥时间、深Ⅱ度创面愈合时间和Ⅲ度创面愈合时间比较差异无统计学意义（P〉0．05）。远期效果：随访6个月，两组色泽、血管分布、厚度和柔软度评分比较差异无统计学意义（P〉0．05）。异体组和异种组优良率分别为51．61％和50．00％，差异无统计学意义（P〉0．05）。结论两种材料疗效相似，基本可互相替代，将其应用于临床可缓解异体皮的皮源不足．同时降低患者的治疗费用，社会和经济效益双赢。

Objective To compare the effect on allogenic acellular dermal matrix and xenogenic （pig） acellular dermal matrix in the treatment of burn wounds, to explore the feasibility of xenogeneic acellular dermal substitute acellular dermal. Methods In Bao＇an People＇s Hospital of Shenzhen City from May 2012 to June 2013 with deep second degree and third degree burn wounds of deep partial tangential excision and skin grafting for treatment of 30 patients of autologous skin at the same time, they were divided into two groups by the random digital table method, allograft ＋ micro skin treatment were used in allograft group of 15 patients, xenogenic （pig） acellular dermal matrix ＋ micro skin treatment were applied in heterogeneous group of 15 patients. The wound healing time, the healing quality between two groups were compared; the patients were followed up for 6 months, the self satisfaction of Vancouver scar scale and patient evaluation table were used to evaluate the healing effect. Results The short-term effect： there were 16 （51.61%） one type of healing and 15 （48.39%） two type of healing in 31 wounds of allograft group, there were 15 （50.00%） one type of healing and 15 （50.00%） two type of healing in 30 wounds of heterogeneous group, with no statistical difference （P 〉 0.05）. Drying time of wound healing, deep second degree bum wound healing time and third degree burn wound healing time between two groups was compared respectively, there was no statistical difference （P 〉 0.05）. The long term effect： after 6 months of follow-up, color, blood vessel distribution, thickness and softness scores between two groups had no statistical difference （P 〉 0.05）. The excellent and good rate of allograft group and heterogeneous group was 51.61% and 50.00% respectively, with no statistical difference （P 〉 0.05）, Conclusion The curative effects of two materials are similar, can replace each other, its clinical application can alleviate allograft skin source, at the same time, reduce treatment cost of patients, social and economic benefits of a win-win situation.