两种敷料结合自体细胞喷雾技术对手部深Ⅱ度烧伤的疗效观察

Curative effects of two dressings combined with autologous cell spray technique for patients with deep second-degree burn on their hands

目的探讨两种敷料结合自体细胞喷雾技术对手部深Ⅱ度烧伤的疗效。方法选取2020年6月至2023年12月延安大学附属医院烧伤整形手外科收治的68例手部深Ⅱ度烧伤患者进行随机对照试验,采用随机数字表法将其分为对照组和观察组,各34例。对照组男22例、女12例,年龄(35.18±11.34)岁,烧伤面积为(17.41±3.52)cm^(2);接受湿润烧伤膏联合自体细胞喷雾技术治疗;观察组男20例、女14例,年龄(36.84±10.75)岁,烧伤面积为(18.28±3.39)cm^(2);给予水凝胶敷料联合自体细胞喷雾技术治疗。两组均治疗14 d。比较两组患者治疗后血清炎症因子、免疫功能、血清致痛因子,以及治疗结束3个月后手功能评分、手部瘢痕评分、总有效率。统计学方法采用t检验、χ^(2)检验。结果治疗后,观察组创面愈合时间短于对照组[(12.48±2.95)d比(14.31±3.26)d],差异有统计学意义(t=2.43,P<0.05);治疗14 d后,观察组肿瘤坏死因子-α(TNF-ɑ)、白细胞介素(IL)-6、IL-8、超敏C反应蛋白(hs-CRP)水平、CD8^(+)均低于对照组,CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均高于对照组,差异均有统计学意义(均P<0.05);观察组致痛因子前列腺素E2(PGE2)、神经肽Y(NPY)、5-羟色胺(5-HT)水平均低于对照组[(155.88±28.10)ng/L比(172.30±29.97)ng/L、(140.61±19.89)μg/L比(154.58±25.79)μg/L、(118.92±16.75)ng/L比(129.57±16.61)ng/L],差异均有统计学意义(t=2.33、2.50、2.63,均P<0.05)。治疗结束3个月后,观察组手功能评分的触觉、痛觉、运动均高于对照组[(79.25±8.01)分比(74.79±7.15)分、(84.71±9.06)分比(80.58±7.68)分、(68.40±7.88)分比(63.73±7.17)分],差异均有统计学意义(t=2.42、2.03、2.56,均P<0.05);观察组手部瘢痕各项评分均低于对照组,差异均有统计学意义(均P<0.05);观察组总有效率高于对照组(χ^(2)=5.40,P<0.05)。结论水凝胶敷料联合自体细胞喷雾技术对加快手部深Ⅱ度烧伤患者创面愈合效果更好,可减轻炎症、缓解疼痛,促进手功能恢复,改善瘢痕质量,并提高总体疗效。

Objective To explore the efficacies of two different dressings combined with autologous cell spray technique in the treatment of patients with deep second-degree burns on their hands.Methods Sixty-eight patients with deep second-degree burns on their hands who were treated at Department of Burn,Plastic,and Hand Surgery,Hospital Affiliated to Yan'an University from June 2020 to December 2023 were selected for the randomized controlled trial,and were divided into a control group and an observation group by the random number table method,with 34 cases in each group.There were 22 males and 12 females in the control group;they were(35.18±11.34)years old;their burn area was(17.41±3.52)cm^(2).There were 20 males and 14 females in the observation group;they were(36.84±10.75)years old;their burn area was(18.28±3.39)cm^(2).The control group were treated with moist exposed burn ointment(MEBO)and autologous cell spray technique,and the observation group with hydrogel dressing and autologous cell spray technique.Both groups were treated for 14 days.The serum levels of inflammatory factors,immune function,and serum levels of pain-inducing factors after 14 days'treatment,scores of hand function and scar 3 months after the treatment,and total efficacies were compared between the two groups using t test andχ^(2)test.Results After the treatment,the wound healing time in the observation group was shorter than that in the control group[(12.48±2.95)d vs.(14.31±3.26)d],with a statistical difference(t=2.43;P<0.05).After 14 days'treatment,the levels of tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-8,high-sensitivity C-reactive protein(hs-CRP),and CD8^(+)in the observation group were lower than those in the control group;the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group;there were statistical differences(all P<0.05).The serum levels of pain-inducing factors,prostaglandin E2(PGE2),neuropeptide Y(NPY),and 5-hydroxytryptamine(5-HT),in the observation group were lower than those in the control group[(155.88±28.10)ng/L vs.(172.30±29.97)ng/L,(140.61±19.89)μg/L vs.(154.58±25.79)μg/L,and(118.92±16.75)ng/L vs.(129.57±16.61)ng/L],with statistical differences(t=2.33,2.50,and 2.63;all P<0.05).Three months after the treatment,the scores of tactile,pain,and motor function of the hands in the observation group were higher than those in the control group[(79.25±8.01)vs.(74.79±7.15),(84.71±9.06)vs.(80.58±7.68),and(68.40±7.88)vs.(63.73±7.17)],with statistical differences(t=2.42,2.03,and 2.56;all P<0.05).The scores of vascular distribution,color,thickness,and softness of the scars in the observation group were lower than those in the control group,with statistical differences(all P<0.05).The overall efficacy in the observation group was higher than that in the control group(χ^(2)=5.40;P<0.05).Conclusion Hydrogel dressing combined with autologous cell spray technique for patients with deep second-degree burn on their hands can accelerate wound healing,reduce inflammation,alleviate pain,promote hand function recovery,and improve scar quality and overall efficacy.