医用胶在急诊外科处理额面部皮肤裂伤中的应用

Application of tissue adhesive in treatment of the amount facial skin lacerations in emergency surgical practice

目的探讨急诊外科额面部皮肤裂伤特点与治疗经验,总结医用胶在处理额面部皮肤裂伤中的临床应用价值,为更好提高急诊外科额面部皮肤裂伤治疗效果提供理论依据。方法选择2012年3月-2013年12月南昌大学第二附属医院急诊外科救治的额面部皮肤裂伤患者268例。将其随机分为粘合组与缝合组,其中粘合组134例,男84例,女50例,年龄2-84岁,平均(31.5±2.3)岁,均采用医用胶清创粘合伤口;缝合组134例,男87例,女47例,年龄1-86岁,平均(33.4±1.9)岁,均采用常规清创缝合伤口。比较两组患者手术时间、疼痛指数、1周后患者伤口并发症发生率以及伤口愈合外观满意度指标。结果粘合组手术时间(12.50±2.73)min与疼痛指数(3.57±1.61)明显小于缝合组[(18.74±4.85)min、(7.32±0.82)min],比较差异具有统计学意义(P<0.05);粘合组1周后总并发症(12.7%)明显低于缝合组(23.1%)粘合组;术后伤口外观满意度:优良69.4%,满意25.4%,不满意5.2%,满意度为94.5%;缝合组术后伤口满意度:优良26.1%,满意46.3%,不满意27.6%,满意度为72.4%。患者对使用医用胶粘合后的伤口愈合满意度明显高于缝合组,比较差异具有统计学意义(P<0.05)。结论相对于缝合组采用医用胶粘合额面部皮肤裂伤具有手术时间短、并发症少、疼痛感低、伤口对合严密、瘢痕小、外观美观和无需拆线等优点,且无因缝合产生的反应红斑、硬结及瘢痕增生,其无痛与美观的特点深受儿童与妇女欢迎,值得推广。

Objective To investigate the characteristics and experience of the treatment of skin facial laceration in emergency surgery and summarize the clinical value of tissue adhesive in the treatment of facial skin laceration. To provide a theoretical foundation for better enhancing therapeutic effect of facial skin laceration in emergency surgery. Methods 268 cases of facial skin laceration collected from the Second Affiliated Hospital of Nanchang University in between March 2012 to December 2013 were randomly divided into two groups：tissue adhesive（TA） group and routine suturing（RS） group,tissue adhesive group consist of 134 patients,male 84 cases,female 50 cases,aged 2 to 84 years,mean 31.5±2.3 years,all treated with tissue adhesive,suturing group consisits of 134 patients,male 87 cases,female 47 cases,aged 1 to 86 years,mean 33.4±1.9 years,all treated with routine suture.To compare the operative time,pain index and wound healing appearance satisfaction between two groups. Results Operation time and pain index of tissue adhesive group are significantly shorter and smaller than suturing group,the difference was statistically significant（P〈0.05）. After one week,the TA group vs routine suturing（RS） group,the complications are significant less. Wound healing appearance satisfaction of TA group and RS group are as follows：excellent 69.4% /26.1%,satisfaction 25.4% /46.3%,not satisfaction 5.2%/27.6%,degree of satisfaction 94.5%/72.4%,respectively. wound healing satisfaction of TA group are significantly higher than RS group,the difference was statistically significant（P〈0.05）. Conclusion Compared with RS group,TA group equiped with advantages of shorter operation time,less complications,lower pain feeling,closer wound anastomosis,smaller scar,better outlook and without having to remove the stitches,second,which failed to bring about erythema,induration and scarring induced by suturing,finally,its characteristics of Painless and better outlook are welcomed by children and women and worthing popularizing.