水动力清创结合点状皮片移植治疗大面积烧伤残余创面疗效研究

Observation of the effect of hydrodynamic debridement combined with punctate skin graft in the residual wounds of large area burns

目的:研究水动力清创结合点状皮片移植在治疗大面积烧伤残余创面中的疗效。方法:选择进行烧伤残余创面修复治疗的患者59例为研究对象,根据患者自行选择的治疗方式将其均分为两组。对照组采用传统清创方式,观察组则采用水动力清创法,完成清创后均以自体刃厚皮制成点状片皮进行移植修复。比较两组患者每1%TBSA(体表总面积)创面清创时间、治疗前及治疗后第3天创面分泌物细菌培养阳性率,治疗后7d植皮存活率、治疗后7d红肿评分、两组患者二次清创率;以及创面清创时间、创面平均愈合时间等指标。结果:观察组临床显效15例,有效10例,总有效25例,总有效率92.60%;对照组显效9例,有效14例,总有效23例,总有效率80.00%,观察组临床疗效明显优于对照组(P<0.05),两组患者经治疗后,观察组治疗后3d创面分泌物细菌阳性率14.81%,明显低于对照组40.63%;观察组再次清创率7.40%,明显低于对照组28.13%,差异有统计学意义(P<0.05)。观察组患者治疗后创面清创时间和残余创面愈合时间明显短于对照组,差异有统计学意义(P<0.05)。结论:水动力清创结合点状皮片移植可提高大面积烧伤残余创面植皮存活率,降低创面感染率,促进创面愈合。

Objective:To study the effect of hydrodynamic debridement combined with spot skin graft in the residual wounds of large area burns.Methods:Carried out burn residual wound repair in our hospital,and met the inclusion criteria of this study.59 patients were divided into two groups according to their own treatment.The control group was treated by traditional debridement,and the observation group was treated by hydrodynamic debridement.After debridement,skin graft was made from autologous thick skin.Comparison of two groups of patients per 1%TBSA wound debridement time,before treatment and after third D germiculture positive rate,7 d after treatment,the survival rate of skin graft,7 d after treatment,two groups of patients with swelling score two times debridement rate;and debridement time,the average wound healing time index.Results:To observe the clinical effect of 15 cases,10 cases were effective,the total effective number of 25 cases,the total efficiency of 92.60%;control group 9 cases,14 cases were effective,the total effective number of 23 cases,the total efficiency of 80%,the clinical curative effect of observation group was significantly better than the control group(P<0.05),two groups of patients after treatment,observation after treatment,3D positive rate of bacterial wound 14.81%,significantly lower than the control group 40.63%;observation group debridement rate was 7.40%,significantly lower than the control group 28.13%,the difference was statistically significant(P<0.05).The wound debridement time and the residual wound healing time in the observation group were significantly shorter than those in the control group,and the difference was statistically significant(P<0.05).Conclusion:Hydrodynamic debridement combined with punctate skin graft can improve the survival rate of the skin graft in the residual wounds of large area,reduce the infection rate of the wound and promote the healing of the wound.