液体石蜡辅助治疗重度烧伤患者残余创面的效果观察

Observation on the effect of liquid paraffin as adjuvant therapy in treating residual wounds of patients with severe burns

目的观察液体石蜡辅助治疗重度烧伤患者残余创面的效果。方法2016年1月—2017年10月,北京积水潭医院收治的58例重度烧伤后期残余创面患者符合本研究入选标准,对其进行回顾性队列研究。患者均采用隔日消毒、更换油纱及银离子抗菌敷料的方法进行残余创面的治疗,直至创面愈合。2016年1—11月收治的29例患者更换敷料前使用碘伏和生理盐水清洗消毒创面,设为生理盐水组,其中男22例、女7例,年龄(38±12)岁;2016年12月—2017年10月收治的29例患者更换敷料前使用碘伏及液体石蜡清洗消毒创面,设为液体石蜡组,其中男20例、女9例,年龄(37±12)岁。比较2组患者首次治疗后7、14、21 d创面治疗有效率、创面感染控制率、创面细菌阳性比,创面完全愈合时间。对数据行两独立样本t检验、Wilcoxon秩和检验、χ^2检验及Bonferroni校正后的Pearsonχ^2检验、连续性校正χ^2检验及Fisher确切概率法检验。结果(1)首次治疗后7、14、21 d,液体石蜡组患者创面治疗有效率分别为34%(10/29)、59%(17/29)、79%(23/29),明显高于生理盐水组的10%(3/29)、24%(7/29)、38%(11/29),χ^2=5.857、7.108、10.235,P<0.05或P<0.01。(2)液体石蜡组患者首次治疗后7、14 d创面感染控制率分别为79%(23/29)、90%(26/29),明显高于生理盐水组的31%(9/29)、52%(15/29),χ^2=13.663、8.321,P<0.01;首次治疗后21 d创面感染控制率为100%(29/29),明显高于生理盐水组的69%(20/29),P<0.01。(3)液体石蜡组患者首次治疗后7、14 d创面细菌阳性比与生理盐水组相近(χ^2=2.097、2.583,P>0.05);首次治疗后21 d创面细菌阳性比为8%(3/39),明显低于生理盐水组的49%(17/35),χ^2=13.625,P<0.01。(4)液体石蜡组患者创面完全愈合时间为15.0(11.0,20.0)d,明显短于生理盐水组的22.0(15.0,27.5)d,Z=2.256,P<0.05。结论采用液体石蜡辅助治疗严重烧伤患者残余创面,可以有效提高创面治疗有效率及感染控制率,降低创面细菌阳性比,缩短创面愈合时间。

Objective To observe the effect of liquid paraffin as adjuvant therapy in treating residual wounds of patients with severe burns.Methods From January 2016 to October 2017,58 patients with residual wounds in the later stage of severe burns were admitted to Beijing Jishuitan Hospital.Those patients met the inclusion criteria of this study and were enrolled in this retrospective cohort study.All the patients received wound disinfection,petrolatum gauze dressing change and silver ion-bearing antimicrobial dressing every other day to treat the residual wound until wound healing.From January to November 2016,29 patients who were treated with iodophor and normal saline to clean and disinfect the wound before dressing change were enrolled in normal saline group,including 22 males and 7 females,aged(38±12)years.From December 2016 to October 2017,29 patients who were treated with iodophor and liquid paraffin to clean and disinfect the wound before dressing change were enrolled in liquid paraffin group,including 20 males and 9 females,aged(37±12)years.The effective rate of treatment,infection control rate,and bacterial positive ratio of wound on post first treatment day(PFTD)7,14,and 21 and the complete wound healing time of patients were compared between the two groups.Data were statistically analyzed with independent sample t test,Wilcoxon rank-sum test,chi-square test,and Pearson chi-square test,continuity correction chi-square test,and Fisher′s exact probability test after Bonferroni correction.Results(1)On PFTD 7,14,and 21,the effective rates of wound treatment in patients of liquid paraffin group were 34%(10/29),59%(17/29),and 79%(23/29),respectively,which were significantly higher than 10%(3/29),24%(7/29),and 38%(11/29)of normal saline group(χ^2=5.857,7.108,10.235,P<0.05 or P<0.01).(2)The wound infection control rates in patients of liquid paraffin group on PFTD 7 and 14 were 79%(23/29)and 90%(26/29),respectively,which were significantly higher than 31%(9/29)and 52%(15/29)of normal saline group(χ^2=13.663,8.321,P<0.01).The wound infection control rate in patients of liquid paraffin group on PFTD 21 was 100%(29/29),which was significantly higher than 69%(20/29)of normal saline group(P<0.01).(3)The bacterial positive ratios in the wounds of liquid paraffin group were similar to those of normal saline group on PFTD 7 and 14(χ^2=2.097,2.583,P>0.05).On PFTD 21,the wound bacterial positive ratio of liquid paraffin group was 8%(3/39),which was significantly lower than 49%(17/35)of normal saline group(χ^2=13.625,P<0.01).(4)The complete wound healing time of patients in liquid paraffin group was 15.0(11.0,20.0)d,which was significantly shorter than 22.0(15.0,27.5)d of normal saline group(Z=2.256,P<0.05).Conclusions In the treatment of residual wounds of severe burn patients,liquid paraffin as adjuvant therapy can effectively improve the treatment effective rate and the infection control rate of wounds,decrease the bacterial positive ratio,and shorten the wound healing time.