削痂时机对深Ⅱ度烧伤局部IL-8释放及创面炎性反应的影响分析

Effect of Eschar Cutting Time on Local IL-8 Release and Inflammatory Reaction in Deep Second Degree Burns

目的:探讨削痂时机对深Ⅱ度烧伤局部IL-8释放及创面炎性反应的影响。方法:选取笔者医院2015年10月-2017年10月收治的深Ⅱ度烧伤患者92例,根据患者的清创时间将其分成A组(n=48)与B组(n=44)。两组患者均行削痂清创术,其中A组在伤后24h内清创,B组在烧伤24h后清创。比较两组围术期指标,包括手术时间、术中出血量、创面愈合时间、细菌定植量、住院时间。分别在手术前后不同时段取烧伤局部的创面分泌物,检测两组白介素-8(IL-8)的释放量,并测定创面白介素-1(IL-1)、白介素6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平,用于观察创面炎症反应的变化,并分析两组手术并发症发生率。结果:A组创面愈合时间、住院时间少于B组,且术后1周的细菌定植量低于B组,差异有统计学意义(P<0.05)。两组术后3d、术后1周的创面IL-8释放量较术前、术后1d显著下降,且A组低于B组,差异有统计学意义(P<0.05)。两组术后1周创面IL-1、IL-6、TNF-α水平低于术前,IL-10水平高于术前,且A组创面IL-6、TNF-α水平低于B组,IL-10水平高于B组,差异有统计学意义(P<0.05)。A组并发症发生率为4.17%,B组为9.09%,组间比较差异无统计学意义(P>0.05)。结论:削痂能下调深Ⅱ度烧伤患者局部IL-8释放量,并减轻创面炎症反应,与烧伤24h后清创相比,在伤后24h内行削痂清创术的效果更好。

Objective To investigate the effect of eschar cutting time on local IL-8 release and inflammatory reaction in deep partial thickness burn.Methods 92 patients with deep second degree burn admitted to our hospital from October 2015 to October 2017 were selected and divided into group A(n=48)and group B according to their debridement time(n=44).Scab removal was performed in both groups.Group A underwent debridement within 24 hours after injury.Group B underwent debridement 24 hours after burn.The indicators of perioperative period were compared between the two groups,including operation time,intraoperative blood loss,wound healing time,bacterial colonization amount and hospitalization time.The two groups of interleukin-8(IL-8)release were measured and the levels of interleukin-1(IL-1),interleukin-6(IL-6),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)were measured in the two groups,respectively,to observe the changes of inflammatory reaction in the wound.The incidence of complications in the two groups was analyzed.Results The wound healing time and hospitalization time in group A were shorter than those in group B,and the bacterial colonization at 1 week after operation was lower than that in group B,the differences were statistically significant(P<0.05).The amount of IL-8 released from the two groups after 3d and 1 week after operation was significantly lower than that of 1d before and after operation,and the A group was lower than that of the B group(P<0.05).The levels of IL-1,IL-6 and TNF-αin the two groups were lower than those before operation,and the level of IL-10 was higher than that before operation.Moreover,the levels of IL-6 and TNF-αin group A were lower than those in group B,and IL-10 level was higher than that in B group.The differences were statistically significant(P<0.05).The incidence of complications in group A was 4.17%,and group B was 9.09%,there was no significant difference between the two groups(P>0.05).Conclusion Eschar ablation can reduce local IL-8 release and reduce inflammatory reaction in patients with deep second degree burn.Compared with debridement after 24h,the effect of debridement and debridement is better in 24h after injury.