改良的负压吸引技术结合生长因子冲洗在小儿上肢深Ⅱ度烧伤创面的应用

Application of Improved Negative Pressure Suction Technique Combined with Growth Factor Flushing in Deep Ⅱ Degree Burn Wounds of Upper Limbs in Children

目的 :探讨早期使用改良的持续封闭负压吸引技术结合生长因子持续冲洗小儿上肢深Ⅱ度烧伤创面的临床疗效。方法:选取2014年1月—2018年1月我院收治的40例小儿上肢深Ⅱ度烧伤创面患儿,应用医用海绵(聚乙烯醇泡沫敷料)覆盖创面,无菌贴膜粘贴密封,在此基础上改良,包括无菌纱布片代替针线缝合,持续使用重组人表皮生长因子(rhEGF)加入0.9%氯化钠注射液冲洗技术,观察操作治疗中,患儿疼痛、漏气漏水、医用海绵板结、创面愈合时间、愈合后瘢痕情况。结果 :医用海绵无板结现象,无缝线牵扯痛,无正常皮肤损伤、贴膜下无漏气漏水现象,1例使用7天发现绿脓杆菌感染即提前拆除医用海绵,延迟到伤后30天愈合,其它16例12~15天愈合,23例16~24天愈合,后期出现软平瘢痕15例,不影响功能、增生性瘢痕5例,关节活动轻度受限。结论 :改良的持续负压封闭吸引技术能明显减轻患儿痛苦,节省麻醉和材料费用,消除患儿家长对麻醉担忧,医用海绵无板结现象,一次性密封无需反复粘贴,减轻医务工作者负担,可有效防止烧伤创面感染,促进创面愈合,减轻瘢痕,对烧伤部位外观和功能影响相对较轻。

Objectives:To explore the clinical efficacy of early use of improved continuous closed negative pressure suction technique combined with continuous growth factor flushing the treatment of deepⅡdegree burn wounds of upper limbs in children.Method:40 children with deepⅡdegree burn wounds of upper limbs admitted to our hospital from January 2014 to January 2018 were selected.The wounds were covered with medical sponge(polyvinyl alcohol foam dressing),and pasted and sealed with sterile films.On this basis,improvement was made,including using aseptic gauze pieces to replace suture with needles and threads,continuously using recombinant human epidermal growth factor(rh EGF)saline flushing technique,observing pains,air leakage and water leakage,medical sponge hardening,wound healing time and scar after healing during the operation and treatment.Results:The medical sponge had no hardening phenomenon,no suture distraction pain,no normal skin damage,no air leakage and water leakage under the films.One case was found to be infected with Pseudomonas Aeruginosa after 7 days of use,and the medical sponge was removed in advance.The healing was delayed until 30 days after injury.The wounds in other 16 cases were healed between 12 days and15 days,and the wounds in 23 cases were healed between 16 days and 24 days.15 cases had soft flat scars in the later stage,and 5 cases had hypertrophic scars which didn’t affect functions,but slightly restricted joint activities.Conclusion:The improved continuous negative pressure suction technique can significantly relieve the suffering of the children,save the cost of anesthesia and materials,eliminate the parents’anxiety about anesthesia,reduce burden of medical workers because the medical sponge had no hardening phenomenon and there was no need of repeatedly pasting due to disposable seal,effectively prevent burn wound infection,promote wound healing and reduce scarring,and has relatively little effect on the appearance and functions of burn sites.