| 徐松涛.负压伤口疗法联合十四味连黄烧伤软膏用于烧伤植皮术前创面床的临床效果[J].浙江中西医结合杂志,2020,30(8): |
| 负压伤口疗法联合十四味连黄烧伤软膏用于烧伤植皮术前创面床的临床效果 |
| Clinical effects of negative pressure wound therapy combined with fourteen flavours lian huang burn ointment on wound bed before burn skin grafting surgery |
| 投稿时间：2020-01-05 修订日期：2020-06-11 |
| DOI： |
| 中文关键词: 烧伤 负压伤口疗法 皮肤移植 伤口愈合 创面床 |
| 英文关键词:Burns Negative-pressure wound therapy Skin transplantation Wound healing Wound bed |
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| 中文摘要: |
| [ 摘要 ] 目的 观察负压伤口疗法（NPWT）联合十四味连黄烧伤软膏在烧伤植皮创面床术前准备中的临床疗效。 方法 2016年3月—2019年8月，笔者单位收治符合入选标准的深度烧伤创面的患者107例，根据不同的治疗方式和患者意愿分为十四味连黄烧伤软膏治疗组36例、单纯NPWT治疗组36例、联合治疗组35例。入院后患者创面均常规清洁消毒，尽量去除创面坏死组织及渗出物。十四味连黄烧伤软膏治疗组患者创面外敷十四味连黄烧伤软膏涂布单层纱布行半暴露治疗，每日或隔日换药1次，直至肉芽组织基本覆盖创面床。单纯NPWT治疗组患者采用持续式负压吸引模式，负压值为-16.6kPa，持续负压治疗13～15天。联合治疗组患者创面外敷十四味连黄烧伤软膏涂布单层纱布后联合持续式负压吸引，治疗9～10天。单纯NPWT治疗组及联合治疗组患者在治疗过程中出现负压引流堵塞情况则及时更换负压材料。于清创前和治疗后分别进行创面分泌物细菌学培养，统计细菌清除情况；记录3组患者植皮创面床术前准备时间、更换负压材料次数或者换药次数。之后3组患者均行植皮手术，记录3组患者创面移植皮片成活率及创面完全愈合时间。对数据行χ2检验、方差分析。 结果 联合治疗组患者植皮创面床术前准备时间、创面完全愈合时间分别为(9.7±1.2)、（23.1±1.8）d，均明显短于单纯NPWT组的（13.9±1.1）、（27.8±2.0）d和十四味连黄烧伤软膏组的（21.3±2.4）、（37.1±3.7）d，P值均小于0.01。联合治疗组患者更换负压材料次数明显少于十四味连黄烧伤软膏组患者换药次数及单纯NPWT组患者更换负压材料次数（P值均小于0.01）。联合治疗组患者移植皮片成活率为（90.0±2.9）%，明显高于十四味连黄烧伤软膏组的（84.2±4.2）%，P <0.01，与单纯NPWT组（90.9±2.8）%比较，差异无统计学意义（P >0.05）。清创前，十四味连黄烧伤软膏组、单纯NPWT组、联合治疗组患者分别有36、36、35处创面检出细菌；治疗后，十四味连黄烧伤软膏组、单纯NPWT组、联合治疗组患者分别有18、5、5处创面检出细菌。单纯NPWT组、联合治疗组患者创面细菌清除效果明显优于十四味连黄烧伤软膏组（P值均小于0.01），联合治疗组患者创面细菌清除效果与单纯NPWT组相近（P >0.05）。 结论 NPWT联合十四味连黄烧伤软膏可快速清除深度烧伤创面坏死组织和细菌，负压引流堵塞发生率低，缩短植皮创面床术前准备时间及创面完全愈合时间，临床疗效优于单纯NPWT或十四味连黄烧伤软膏治疗，是一种较佳的准备植皮创面床的方法。 |
| 英文摘要: |
| [ Abstract ] Objective To observe the clinical effect of negative pressure wound therapy (NPWT) combined with fourteen flavours lian huang burn ointment in preoperative preparation of burn skin grafts wound bed. Methods From March 2016 to August 2019, 107 patients with deep burn wounds who met the inclusion criteria were treated in our burn units. According to different treatment methods and patients' wishes, 107 patients were divided into 36 cases of fourteen flavours lian huang burn ointment treatment group, 36 cases of negative pressure wound treatment (NPWT) group and 35 cases of combined treatment group. After admission, the wounds of these patients were routinely cleaned and disinfected, and necrotic tissue and exudate of wounds were removed as much as possible.In treatment group of fourteen flavours lian huang burn ointment, patients were applicated externally with fourteen flavours lian huang burn ointment, coated with a single layer of gauze for semi-exposure treatment, and changed once a day or every other day until granulation tissue basically covered the whole wound bed. Patients in NPWT group were treated with continuous negative pressure suction mode for 13 to 15 days with negative pressure value was -16.6 kPa. Patients in combined treatment group were applicated externally with fourteen flavours lian huang burn ointment, and combined with continuous negative pressure suction therapy after coating with a single layer of gauze for 9 to 10 days. If negative pressure drainage blockage occurred in patients in NPWT treatment group and combined treatment group, negative pressure materials should be replaced in time. Bacteriological culture of wound secretion was conducted before debridement and after treatment, and bacterial removal was counted. Preoperative preparation time before skin grafting wound bed and frequency of replacing negative pressure materials or dressing were recorded in 3 groups. After that, skin grafting surgery were performed in all the 3 groups, and survival rate of wound grafts and time of wound healing were recorded. Chi-square test and variance analysis were conducted. Results The preoperative preparation time and complete wound healing time of skin grafts bed in the combined treatment group were (9.7±1.2) and (23.1±1.8) d, which were significantly shorter than those of NPWT group (13.9±1.1), (27.8±2.0) and fourteen flavours lian huang burn ointment group (21.3±2.4), (37.1±3.7)d, respectively, with P values less than 0.01. The frequency of replacing negative pressure materials in combined treatment group was significantly less than that in NPWT group and fourteen flavours lian huang burn ointment group (P <0.01). The survival rate of skin grafts in combined treatment group was (90.0±2.9)%, which was significantly higher than (84.2±4.2) % in fourteen flavours lian huang burn ointment group (P <0.01), but there was no statistically significant difference (P >0.05) compared with that in the NPWT group (90.9±2.8) %. Before debridement, bacteria were detected in 36, 36 and 35 wounds in fourteen flavours lian huang burn ointment group, NPWT group and combined treatment group, respectively. After treatment, bacteria were detected in 18, 5 and 5 wounds in fourteen flavours lian huang burn ointment group, NPWT group and combined treatment group, respectively. Bacterial scavenging effect of wounds in NPWT group and combined treatment group was significantly better than that in fourteen flavours lian huang burn ointment group (P <0.01), and scavenging effect in combined treatment group was similar to that in NPWT group (P >0.05). Conclusion NPWT combined with fourteen flavours lian huang burn ointment could quickly remove necrotic tissue and bacteria from deep burn wounds, and the incidence of negative pressure drainage was low. The preoperative preparation time and wound healing time of skin graft bed also could be shortened. The clinical efficacy of combined therapy was better than that of NPWT or fourteen flavours lian huang burn ointment treatment, which was a better method to prepare skin graft wound bed and suitable for patients who were unwilling to undergo surgical debridement or had contraindications to anesthesia. |
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