影响Meek植皮术治疗大面积深度烧伤疗效的多因素分析

Multivariate Analysis of the Effect of Meek Micrografting Technique in the Severely Burned Patients

目的探讨大面积深度烧伤患者Meek植皮术的预后影响因素。方法选择2014年1月至2018年1月间于我院诊治的96例大面积深度烧伤患者,根据Meek植皮术后30d愈合情况分为早期愈合组(<30 d,62例)和延迟愈合组(≥30 d,34例)。比较两组患者的临床资料、手术相关指标和术后并发症发生情况。应用多因素Cox回归模型分析影响创面愈合能力的危险因素。结果两组患者的年龄、性别比、吸入性损伤比例、烧伤面积(%TBSA)、真皮深部组织/皮肤全层(deep dermal/full thickness,DD/FT)比例及烧伤原因等临床资料无统计学差异(P> 0. 05),早期愈合组的烧伤面积明显小于延迟愈合组(P <0. 05)。早期愈合组的创面所需的供皮面积、手术时间和住院时间明显少于延迟愈合组,移植皮片成活率明显高于延迟愈合组(P <0. 05)。早期愈合组和延迟愈合组术后30 d内的并发症总发生率分别为11. 29%和35. 29%,早期愈合组术后并发症的总发生率明显低于延迟愈合组(P <0. 05)。多因素Cox回归分析显示,烧伤面积(%TBSA)和移植皮片成活率是影响创面愈合能力的独立影响因素,其中,烧伤总面积/TBSA(HR=0. 282,P=0. 009)是影响创面完全愈合的独立危险因素,移植皮片成活率(HR=2. 279,P=0. 028)是创面完全愈合的保护因素。结论大面积深度烧伤患者Meek植皮后的预后情况与烧伤面积及移植皮片成活率有关;对大面积烧伤病人,提高Meek植皮术后皮片成活值得重视。

Objective To investigate the prognostic factors of Meek micrografting technique in severely burned patients. Methods 96 severely burned patients were divided into the early healing group( < 30 days,62 cases) and the delayed healing group( ≥30 days,34 cases) according to the healing condition after Meek skin micrografting. The clinical data,surgical related indicators and complications were compared between the two groups. Multivariate Cox regression model was used to analyze the risk factors affecting wound healing ability. Results There was no significant difference in the age,sex ratio,proportion of inhalation injury,burn area( % TBSA),proportion of deep dermal/full thickness( DD/FT) and causes of burn between the two groups( P > 0. 05). The burn area in the early healing group was significantly less than that of the delayed healing group( P < 0. 05). The donor area,operation time and hospitalization time in the early healing group were significantly less than that of the delayed healing group,and the survival rate of the graft was significantly higher than that of the delayed healing group( P < 0. 05). The total incidence of complications in the early healing group and the delayed healing group was 11. 29% and 35. 29% respectively( P < 0. 05) within 30 days after operation. Multivariate Cox regression analysis showed that burn area( % TBSA) and skin graft survival rate were independent factors affecting wound healing ability. Total burn area( % TBSA)( HR = 0. 282,P = 0. 009) was an independent risk factor for wound healing,and the skin graft survival rate( HR = 2. 279,P = 0. 028) was a protective factor for wound healing. Conclusion The prognosis of large area deep burn patients after Meek skin grafting is related to the area of burn and the survival rate of skin graft. It is worth paying attention to improve the survival rate of skin graft after Meek skin grafting for severely burned patients.