胰岛素联合纳米银和湿润烧伤膏治疗中度烧伤创面感染的临床研究

Clinical study on insulin combined with nano-silver and Shirun Shaoshang Ointment in treatment of moderate burn and wound infection

目的探讨胰岛素注射液联合纳米银抗菌凝胶和湿润烧伤膏治疗中度烧伤创面感染的临床疗效。方法选取2013年1月—2015年1月黄石市第五医院收治的中度烧伤创面感染患者66例(75个创面)作为研究对象,随机分为对照组(33例39个创面)和治疗组(33例36个创面)。对照组将纳米银抗菌凝胶和湿润烧伤膏按照1∶1比例混合,均匀涂抹于烧伤创面,厚度1 mm,无菌纱布加压包扎。治疗组在对照组基础上烧伤创面皮下浸润注射胰岛素注射液1 U/m L,无菌纱布加压包扎。记录两组患者创面愈合时间、创面细菌培养转阴换药次数,计算两组创面愈合率。治疗前、治疗第7、14、21天发放视觉模拟评分(VAS)评估患者换药疼痛程度。治疗前和治疗7 d测定白介素-6(IL-6)、白介素8(IL-8)、肿瘤坏死因子α(TNF-α)水平。结果治疗组创面浅Ⅱ度和深Ⅱ度创面愈合时间短于对照组,创面细菌培养转阴换药次数少于对照组,两组比较差异具有统计学意义(P<0.05)。治疗组浅Ⅱ度第7、14天创面愈合率高于对照组,深Ⅱ度第14、21天创面愈合率高于对照组,两组比较差异具有统计学意义(P<0.05)。两组治疗第7、14、21天VAS评分均下降,同组治疗前后差异具有统计学意义(P<0.05);治疗组治疗第7、14、21天VAS评分明显低于对照组,两组比较差异具有统计学意义(P<0.05)。治治疗7 d后,两组TNF-α、IL-6、IL-8水平均显著升高,同组治疗前后差异有统计学意义(P<0.05);且治疗组治疗7 d后这些观察指标的升高程度明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论局部注射胰岛素注射液联合纳米银抗菌凝胶和湿润烧伤膏治疗中度烧伤创面感染,能减轻创面炎性水平,缩短创面感染病程,提高创面愈合率,具有一定的临床推广应用价值。

Objective To investigate the effect of Insulin Injection combined with Nano-silver Antibacterial Gel and Shirun Shaoshang Ointment in treatment of moderate burn and wound infection. Methods Patients（66 cases, 75 wounds） with moderate burn and wound infection in Huangshi No. 5 Hospital from January 2013 to January 2015 were randomly divided into control group（33 cases with 39 wounds） and treatment group（33 cases with 36 wounds）. The patients in the control group were treated with external application of Nano-silver Antibacterial Gel and Shirun Shaoshang Ointment mixed in accordance with the ratio of 1∶1, evenly applied to the burned wounds, with the thickness of 1 mm, and the sterile gauze were used by pressurized dressing. The patients in treatment group were sc adminnistered with local injection of Insulin Injection on the basis of the control group. The wound healing time and frequency of wound bacterial culture negative conversion and dressing change were recorded, and the wound healing rates in two groups were calculated. The visual analogue scale（VAS） scores before treatment, and treated on days 7, 14, and 21 were recorded to evaluate the pain degree of dressing change. The levels of interleukin-6（IL-6）, interleukin 8（IL-8）, and tumor necrosis factor alpha（TNF-α） were determined. Results The healing time of shallow II degree and deep II degree wound in the treatment group was shorter than that in the control group, and the frequency of wound bacterial culture negative conversion and dressing change was less than that in the control group, and there was difference between two groups（P〈0.05）. On days 7 and 14, the healing rates of shallow II degree wound in the treatment group were higher than those in the control group, and the healing rates of deep II degree wound were higher than those in the control group on days 14 and 21, and there was difference between two groups（P〈0.05）. On days 7, 14, and 21 of treatment, the VAS scores of the treatment group were significantly lower than those of the control group, and the difference was statistically significant in the same group（P〈0.05）. And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups（P〈0.05）. After treatment for 7 d, the levels of TNF-α, IL-6, and IL-8 in the two groups were significantly increased, and the differences were statistically significant in the same group（P〈0.05）. And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups（P〈0.05）. Conclusion Insulin Injection combined with Nano-silver Antibacterial Gel and Shirun Shaoshang Ointment has clinical curative effect in the treatment of moderate burn, can reduce the inflammatory level, alleviate dressing change pain, and improve the rate of wound healing, which is of great clinical application value.