3种皮肤移植供皮区止血方法对比研究

Comparison of three different processes for hemostasis in skin donor site

目的探索烧伤供皮区止血方法,以减少供区失血及感染发生率。方法行中厚皮移植(供皮区均在四肢)病例134例(烧伤77例、整形57例),随机分为盐酸肾上腺素生理盐水皮下注射组(简称副肾盐水组)47例、止血带下取皮组(止血带组)42例及外敷蛇毒血凝酶注射液组(简称血凝酶组)45例。通过收集渗血的敷料后测定其中的血红蛋白含量,以患者血红蛋白浓度换算成失血量(体积)。以单位供皮面积标准化数据,同时记录供皮区愈合时间及感染发生情况。结果副肾盐水组的渗血最少[(0.41±0.22)ml/cm^2],其次为止血带组,组间差异有显著性(P<0.01);各组供皮区愈合时间无统计学差异(P>0.05),副肾盐水组的感染发生率较其他两组高(P<0.05)。结论副肾盐水处理供皮区可明显减少失血,但感染发生率较高;止血带法可有效减少渗出量,与血凝酶法合用可能有协同作用。

Objective To reduce of blood loss and infection rate in skin donor site by different hemostasis during operation. Methods The 134 adult burn （77 persons） and plastic （57 persons） patients admitted in author＇s department who underwent free moderate thickness skin grafting were involved in this study. All the patients were divided randomly into 3 groups：Epinephrine group （47 cases,in which 1：500000 diluted adrenaline hydrochloride were subcutaneous injected in donor sites）,Tourniquet group （42 cases,in which gas-filled tourniquets were applied to the involved extremities when harvested skin graft）,Hemocoagulase group （45 cases,in which 1：50ml diluted Slounase were wet compressed in donor site after harvested skin graft）. The blood loss was assessed by quantitating hemoglobin which eluted from ensanguined dress. Healing period and infection rate of donor site were all involved. All the data above-mentioned were dealed with SPSS software（version 12.0）. Results The least total volume of blood loss（0.41＋0.22 ml/cm2） was observed in Epinephrine group,and ourniquet group followed. The P value was less than 0.01. Three groups were no significant difference in healing periods（P〉O.05）, meanwhile the infection rate in Epinephrine group was higher than others （P〈0.05）. Conclusion The blood loss in donor site could be reduced obviously by diluted adrenaline hydrochloride which subcutaneous injected,but not in the infection rate. Application of tourniquets or/and hemocoagulase might lead synergistic effect.