聚乙烯醇泡沫材料对Ⅲ度烧伤患者的创面修复效果研究

Effect of PVA foam on wound healing in patients with third degree burn

目的研究聚乙烯醇泡沫材料对Ⅲ度烧伤患者的创面修复效果。方法选择2018年5月至2020年5月安康市中心医院烧伤整形外科收治的80例Ⅲ度烧伤患者作为研究对象,按照随机数表法将患者分为观察组和对照组各40例,对照组患者采用聚氨酯泡沫材料行负压治疗,观察组患者采用聚乙烯醇泡沫材料行负压治疗。负压治疗一周后,比较两组患者的材料安装时间、材料与创面黏连度、创面出血量、肉芽组织增生厚度、微血管管控数量、血小板-内皮细胞黏附分子(CD31)蛋白表达量、所用材料对创面渗透的引流量、从创面移去的泡沫材料的回弹系数(RI)与原始回弹系数(RO)比值(RI/RO)、创面细菌菌落数、异物颗粒残留量和皮缘湿疹率等指标。结果治疗一周后,观察组患者的材料安装时间为(18.46±3.67)min,明显长于对照组的(13.34±2.55)min,黏连度及创面出血量分别为(6.35±0.53)N、(21.67±3.77)mL,明显低/少于对照组的(15.86±1.21)N、(58.64±4.65)mL,差异均具有统计学意义(P<0.05);观察组患者的肉芽组织增生厚度、微血管管控数量、CD31蛋白表达量分别为(1.53±0.43)mm、(34.64±3.53)条、0.74±0.02,明显低(少)于对照组的(2.41±0.71)mm、(42.52±4.12)条、1.05±0.05,差异均有统计学意义(P<0.05);观察组患者的回弹系数RI/RO比值、引流量分别为0.35±0.11、(1242.00±254.00)mL,明显低于对照组的0.57±0.17、(1597.00±364.00)mL,差异均有统计学意义(P<0.05);观察组和对照组患者的创面细菌菌落数分别为(9.63±1.32)×10^(5)CFU,(10.13±1.41)×10^(5)CFU,差异无统计学意义(P>0.05);观察组患者的异物颗粒残留量为(3.64±0.12)个,明显少于对照组的(13.75±0.45)个,差异有统计学意义(P<0.05);观察组和对照组患者的皮缘湿疹率分别为35.00%和37.50%,差异无统计学意义(P>0.05)。结论聚乙烯醇泡沫材料对Ⅲ度烧伤患者的创面修复效果良好,能明显减少创面黏连的发生,有效减少创面出血量和异物残留量,具有较高的临床应用价值。

Objective To study the effect of PVA foam on wound healing of patients with third degree burn,and to provide clinical guidance for the recovery of patients.Methods Eighty patients with third degree burn admitted to the Department of Burn and Plastic Surgery,Ankang Central Hospital from May 2018 to May 2020 were selected as the research objects.According to the random number table method,the patients were divided into the observation group and the control group,with 40 patients in each group.The control group was treated with negative pressure with polyurethane foam,while the observation group was treated with PVA foam.One week after negative pressure treatment,the time of material installation,adhesion between material and wound,wound bleeding volume,thickness of granulation tissue proliferation,number of microvessels,expression of platelet endothelial cell adhesion molecule(CD31)protein,drainage volume of material used for wound penetration,and the number of microvessels,the rebound coefficient(RI),and the original rebound coefficient(RO)ratio(RI/RO),the number of bacterial colonies on the wound surface,the residue of foreign particles and the rate of eczema on the skin margin were removed from the wound were detected and recorded.Results The material installation time of the observation group was(18.46±3.67)min,which was significantly longer than(13.34±2.55)min of the control group;the degree of adhesion and the amount of bleeding on the wound surface were(6.35±0.53)N and(21.67±3.77)m L,which were significantly less than(15.86±1.21)N and(58.64±4.65)mL of the control group(P<0.05);the granulation tissue proliferation thickness,number of microvascular control,and CD31 protein expression in observation group were(1.53±0.43)mm,34.64±3.53,and(0.74±0.02)strips,which were significantly lower than(2.41±0.71)mm,(42.52±4.12)strips,and 1.05±0.05 in the control group(P<0.05);the ratio of rebound coefficient RI/RO and drainage volume in the observation group were 0.35±0.14 and(1242.00±254.00)mL,which were significantly lower than 0.57±0.17 and(1597.00±364.00)m L in control group(P<0.05);the number of bacterial colonies on the wound in the observation group and the control group were(9.63±1.32)×10^(5) CFU and(10.13±1.41)×10^(5) CFU,and there was no statistically significant difference(P>0.05);the residual amount of foreign body particles in observation group was 3.64±0.12,which was significantly lower than 13.75±0.45 in control group(P<0.05);the rates of marginal eczema in observation group and control group were 35.00%and 37.50%,and there was no statistically significant difference(P>0.05).Conclusion Polyvinyl alcohol foam has good effect on wound healing of patients with third degree burn,which can significantly reduce the incidence of wound adhesion,effectively reduce wound bleeding and foreign body residues,and has high clinical application value.