休克期磨痂对小儿深Ⅱ度烧伤创面愈合及瘢痕形成的影响

Study on dermabrasion in the shock phase of children extensive deep partial thickness burns

目的研究小儿深Ⅱ度烧伤创面休克期磨痂的临床效果。方法选取2010年1月至2015年1月山东大学附属省立医院烧伤科收治的深Ⅱ度烧伤小儿80例,根据治疗方法不同将患儿分为随机磨痂组和对照组,每组40例。磨痂组于伤后48 h内在全身麻醉下实施磨痂手术。对照组创面予磺胺嘧啶银外涂包扎,隔日换药。利用100 MHz高分辨率B型超声观察磨痂后患儿创面血运情况,观察记录两组患儿住院期间的换药次数、创面愈合时间、残余创面植皮率,以温哥华烧伤瘢痕评定量表作为标准评估瘢痕增生情况,相关指标比较采用t检验及χ~2检验。结果与对照组相比,磨痂组创面血流信号显著增强。磨痂组创面愈合时间(15.4±3.5)d短于对照组(21.6±4.7)d,差异具有统计学意义(t=12.735,P<0.05)。两组换药次数比较,磨痂组术后换药次数[(5.6±2.2)次]少于对照组[(10.5±3.8)次],差异有统计学意义(t=14.435,P<0.05)。两组残余创面植皮率比较,磨痂组(15%)低于对照组(35%),差异有统计学意义(χ~2=4.363,P<0.05)。磨痂组温哥华烧伤瘢痕评分[(5.0±1.6)分]低于对照组[(9.7±2.2)分],差异有统计学意义(t=13.235,P<0.05)。结论休克期磨痂能明显改善小儿深Ⅱ度烧伤创面血运,促进创面愈合,显著降低患儿再植皮手术发生率,减少换药次数,减轻瘢痕增生,值得临床推广应用。

Objective To analyze the clinical effect of dermabrasion in the shock phase of children extensive deep partial thickness burns. Methods Eighty cases of deep burn hospitalized children were selected in department of burns and plastic surgery,Shandong Provincial Hospital Affiliated to Shandong University from January 2010 to January 2015. All the burn children were divided into the dermabrasion group and the control group,according to different treatments,40 cases each group. In the dermabrasion group,the patients received eschar grinding operation in 48 hours after injury. In the control group,the patients were treated with silver sulfadiazine. The burn wound blood flow signal of the two groups were observed by 100 MHz B-Ultrasound at shock stage. The wound healing time,the rate of changing wound dressing,the rate of skin grafting operation,scar hyperplasia were assessed by the vancouver of burn scar rating scale. In vancouver of burn scar rating scale for assessment of standard scar hyperplasia and the wound healing quality index were observed. Relevant indicators were analysised by t test and Chi-square. Results Compared with the control group,the burn wound blood flow signal of the dermabrasion group significantly enhanced. The wound healing time was shorter[(15. 4 ± 3. 5) d]than the control group[(21. 6 ± 4. 7) d],the difference was statistically sinificant(t = 12. 735, P < 0. 05). The switching frequency of the dermabrasion group [(5. 6 ± 2. 2) times] was less than the control group [(10. 5 ± 3. 8) times ],the difference was statistically sinificant(t = 14. 435,P < 0. 05). The rate of changing wound dressing of the dermabrasion group(15%) was lower than the control group(35%), the difference was statistically sinificant(χ~2= 4. 363,P < 0. 05). The vancouver score of the dermabrasion group [(5. 0 ± 1. 6) scores]was less than the control group [(9. 7 ± 2. 2) scores],the difference was statistically sinificant(t = 13. 235,P < 0. 05). Conclusion The treatment of dermabrasion at the shock stage has the advantages of shortening wound healing time and light scar.