重组人粒细胞/巨噬细胞集落刺激因子联合水凝胶敷料治疗深Ⅱ度烧伤创面临床观察

Recombinant human granulocyte/macrophage colony stimulating factor combined with hydrogel dressing for treatment of deep second degree burn wounds:a clinical observation

目的:观察外用重组人粒细胞/巨噬细胞集落刺激因子(rhGM-CSF)联合水凝胶敷料治疗深Ⅱ度烧伤创面的临床效果。方法:选择四肢部位有深Ⅱ度烧伤创面的住院患者24例,48处研究创面,每例患者2个创面,分别位于不同肢体。研究分为4组。随机选取12例患者,每例患者随机选取一个创面作为rhGM-CSF联合外用水凝胶敷料治疗组(联合治疗组,创面清创后外涂外用重组人粒细胞巨噬细胞刺激因子凝胶,覆盖医用水凝胶敷料),另一个创面作为rhGM-CSF联合外用凡士林油纱治疗组(rhGM-CSF对照组,创面清创后外涂外用重组人粒细胞巨噬细胞刺激因子凝胶,覆盖凡士林油纱);余12例患者每例随机选择一处创面作为水凝胶敷料治疗组(水凝胶对照组,创面直接覆盖医用水凝胶敷料);另一处创面作为凡士林油纱对照组(凡士林对照组,创面直接覆盖凡士林油纱)。每组12处创面。观察各组创面愈合时间及创面感染情况,创面分泌物行细菌培养,比较创面细菌感染阳性率。结果:联合治疗组创面愈合时间较其他3组明显缩短(P<0.05);rhGM-CSF对照组和水凝胶对照组创面愈合时间较凡士林对照组缩短(P<0.05)。rhGM-CSF联合外用水凝胶敷料治疗组创面洁净,细菌检出率低(16.7%);rhGM-CSF治疗组感染状况也较轻,细菌检出率较低(25.0%),凡士林对照组感染状况重,细菌检出率最高(83.3%,P<0.01)。结论:深Ⅱ度烧伤创面外用rhGM-CSF联合水凝胶敷料治疗,可以明显减少创面细菌感染概率,缩短创面愈合时间。

Objective To observe the clinical effects of recombinant human granulocyte/macrophage colony stimulating factor （rhGM- CSF） combined with hydrogel dressing for treatment of deep second degree burn wounds. Methods： Twenty-four patients of deep second degree burn wounds with 48 wound surfaces, 2 wound surfaces in each patient distributed on different limps, were involved in present study. Four treatment groups were established： 12 patients were randomly selected, one of their wound surface was smeared with 5 g rhGM-CSF after debridement, and then covered with topical hydrogel dressing （combination group）; the other wound surface of the 12 patients was smeared with 5 g rhGM-CSF and then covered with vaseline gauze instead of topical hydrogel dressing （rhGM-CSF control group）. The remained 12 patients were divided into two groups with the same method, in which vaseline gauze （vaseline gauze group） or hydrogel dressing （hydrogel dressing group） was used to cover the wound surface after debridement without rhGM-CSF. The healing time and infection of the wound surfaces were observed during the treatment. The positive rate of bacterial infection was compared among the 4 groups. Results： The wound healing time was significantly shorter in combination group than in the other three groups （P〈0.01）, while it was markedly shorter in rhGM-CSF control and hydrogel dressing group when compared to that of vaseline gauze group （P〈0.05）. The wound surfaces were clean in the combination group and the bacterial detection rate was lower （16.7%）, and the infection of the wound surfaces was mild in rhGM-CSF control group with 25.0% of bacterial detection rate. The bacterial detection rate from the wound surfaces was the highest （83.3%） in vaseline gauze group （P〈0.01）. Conclusions： rhGM-CSF combined with hydrogel dressing used in treating deep second degree burn wound can reduce the infection rate of the wounds and significantly shorten the wound healing time.