肿胀麻醉技术在Ⅲ°烧伤切痂手术中的临床观察

The Observation of the Application of Tumescent Technique in Escharectomy for Deep Burned Patients

目的探讨肿胀麻醉技术在Ⅲ°烧伤切痂手术中的止血疗效。方法选取2014年2月至2015年8月在我科住院的烧伤患者46例,按照随机数字表法随机分为2组：治疗组23例,在烧伤切痂手术中采用肿胀技术;对照组23例,在烧伤切痂手术中采用止血带止血。观察两组患者的出血量、输血量、移植皮片存活率及血肿形成率等临床结果。结果两组患者均顺利完成手术,治疗组患者的每1%切痂面积失血量明显少于对照组,为（13.5±8.9）ml vs.（40.6±12.4）ml,t=2.648,P=0.011;治疗组无输血患者,对照组输血（402.3±80.6）ml,治疗组明显优于对照组,P=0.01。治疗组和对照组的皮片存活率分别为91.2%±8.4%vs.90.1%±7.6%,两组比较无统计学差异,t=1.532,P=0.321;治疗组和对照组的皮片存活率分别为4.3%（1/23）vs.8.7%（2/23）,两组比较无统计学差异,χ~2=0.357,P=0.380。结论在Ⅲ°烧伤切痂手术中采用肿胀麻醉技术能有效地控制术中出血,安全可靠。

Objective To observe the hemostatic effect of tumescent technique in escharectomy for deep burned patients. Methods 46 deep burned patients were randomly divided into observation group and control group. In the observation group,there were 23 patients used tumescent technique before escharectomy. And in the control group,there were 23 patients used tourniquet hemostasis before escharectomy. The clinical outcomes of the two groups such as intra-operative blood loss,blood transfusion amount,transplantation flap survival rate and hematoma formation rate were observed. Results The blood loss of each 1% escharectomy area of the observation group was less than the control group,which was（ 13. 5 ± 8. 9） ml vs.（ 40. 6 ± 12. 4） ml,with t =2. 648 and P = 0. 011. The blood transfusion amount of the observation group was less than the control group,which was 0 vs.（ 402. 3 ± 80. 6） ml,with P = 0. 01. The flap survival rate of the observation group and control group was 91. 2% ± 8. 4% vs. 90. 1% ± 7. 6% with no statistical difference（ t = 1. 532,P = 0. 321）. The hematoma formation rate of the observation group and control group was 4. 3%（ 1 /23） vs. 8. 7%（ 2 /23） respectively,with no statistical difference（ χ~2= 0. 357,P = 0. 380）. Conclusion The application of tumescent technique can effectively reduce the bleeding of escharectomy and is safe and reliable.