异种脱细胞真皮基质联合丝素蛋白辅料对幼儿Ⅱ度烫伤的临床疗效研究

Clinical study on the treatment of second degree scald in infants with porcine acellular dermal matrix combined with silk fibroin excipients

目的分析异种脱细胞真皮基质联合丝素蛋白辅料对幼儿Ⅱ度烫伤的治疗效果。方法随机选择湖北医药学院附属襄阳市第一人民医院104例Ⅱ度烫伤患儿,采用随机数字表法分为对照组(丝蛋白敷料覆盖)和试验组(异种脱细胞真皮基质联合丝蛋白敷料覆盖),每组52例。实验结果中计量资料用x±s表示,组间比较采用两样本t检验,治疗前后比较采用配对t检验;计量资料采用百分比表示,比较采用χ^2检验,疼痛程度采用Z检验。结果试验组患儿换药次数(2.87±0.98)次、完全溶痂时间(8.26±3.18)d、温哥华评分(4.25±0.87)分,对照组分别为(5.64±1.02)次、(12.38±3.02)d、(8.12±1.04)分,差异均有统计学意义(t=14.121,6.775,20.582,P均<0.001)。试验组患儿浅Ⅱ度创面感染率0.00﹪、愈合时间(8.53±1.49)d,对照组患儿分别为17.31﹪、(10.61±2.05)d,差异均有统计学意义(χ^2=9.853,P=0.002,t=5.918,P<0.001)。试验组患儿深Ⅱ度创面感染率5.77﹪、愈合时间(12.90±1.64)d,对照组患儿分别为34.62﹪、(15.45±1.49)d,差异均有统计学意义(χ^2=13.425,P<0.001,t=8.299,P<0.001)。治疗后比较,试验组患儿创面周围炎症评分(1.91±0.48)分、创面渗出物评分(2.86±0.45)分,对照组患儿分别为(1.33±0.37)分、(2.09±0.53)分,差异有统计学意义(t=6.901,7.986,P均<0.001)。试验组患儿疼痛程度与对照组比较,差异有统计学意义(Z=41.657,P<0.001)。结论采用异种脱细胞真皮基质联合丝蛋白敷料覆盖治疗Ⅱ度烫伤患儿,可减少术后感染,缩短痊愈时间,降低疼痛程度,疗效优势明显。

objective To evaluate the effect of porcine acellular dermal matrix combined with silk fibroin in treating second degree scald in children.Methods 104 patients withⅡdegree burn were randomly divided into the control group(silk dressing)and the experimental group(porcine decellularized dermal matrix plus silk dressing),by random number table,with 52 patients in each group.The statistical differences in the frequency of dressing change,time of complete scab dissolution,vancouver score,wound infection,healing time,inflammation around the wound,wound exudate score and pain were compared between the two groups.Continuous variables were expressed as x±s,the difference between two groups were compared by two-samples t-test,the difference between before and after treatment were compared by pared-samples t-test;categorical variables were expressed as percentage and compared by chi-square test.The difference of pain score was tested by Z-test.Result The number of dressing changes(2.87±0.98),time of complete scab dissolution(8.26±3.18)d and vancouver score(4.25±0.87)of the experimental group were significantly lower than those of the control group(5.64±1.02),(12.38±3.02)d and(8.12±1.04)(t=14.121,6.775,20.582,P<0.001).The wound infection rate(0.00﹪),the healing time(8.53+1.49)d of patients with shallowⅡdegree were significantly lower in the experimental group than those in the control group(17.31﹪),(10.61±2.05)(c2=9.853,P=0.002,t=5.918,P<0.001).DeepⅡdegree wound infection rate(5.77﹪)and the healing time(12.90±1.64)were significantly lower in the experimental group than in the control group(34.62﹪),(15.45±1.49)(c2=13.425,P=0.000,t=8.299,P<0.001).After treatment,the inflammation score(1.91±0.48)and wound exudate score(2.86±0.45)of the experimental group were significantly higher than those of the control group(1.33±0.37)and(2.09±0.53)(t=6.901,7.986,P<0.001).The pain score of the experimental group was lower than that of the control group(Z=41.657,P<0.001).Conclusions The effect of xenogeneic acellular dermal matrix combined with silk protein dressing in the treatment of children with second degree scald was remarkable.It could reduce the infection and recovery time after operation,promote recover,reduce pain,and have obvious therapeutic advantages.