水胶体敷料在大面积烧伤患者中的应用效果及促进创面愈合机制探讨

高栋梁 张雷

[摘要]目的：分析水膠体敷料在大面积烧伤患者中的应用效果及其促进创面愈合机制。方法：选择笔者医院2018年1月-2019年6月收治的200例大面积烧伤患者，以随机数表法分为采取纱布加压包扎的对照组以及采取水胶体敷料包扎的观察组，各100例，两组均接受Meek植皮术治疗，对两组创面愈合时间、创面细菌定量、炎性细胞因子（C反应蛋白、白介素6、转化生长因子-β1）、血管新生指标（血管内皮生长因子、碱性成纤维细胞生长因子）进行比较。结果：观察组创面愈合时间（19.85±1.15）d，短于对照组（25.50±1.50）d，创面细菌定量（420.25±15.20）cfu/g小于对照组（877.50±15.35）cfu/g，差异有统计学意义（t=29.893、211.667，P均=0.000）。治疗后观察组C反应蛋白（9.25±1.05）mg/L、白介素6（71.10±12.10）ng/L、转化生长因子-β1（9.33±1.17）μg/L，低于对照组（12.11±1.08）mg/L、（84.88±12.82）ng/L、（12.14±1.12）μg/L，差异有统计学意义（t=18.987、77.245、17.349，P均=0.000）。观察组血管内皮生长因子（140.29±1.61）ng/L、碱性成纤维细胞生长因子（88.92±1.18）ng/L，高于对照组（124.38±1.52）ng/L、（79.86±1.24）ng/L，差异有统计学意义（t=71.856、52.929，P均=0.000）。结论：在大面积烧伤患者治疗中水胶体敷料能够通过抑制炎症反应、促进血管新生来促进创面愈合，值得在今后临床治疗工作中推广使用。

[关键词]大面积烧伤;水胶体敷料;创面愈合机制;炎性细胞因子;血管内皮生长因子;碱性成纤维细胞生长因子

Abstract： Objective  To analyze the application effect of hydrocolloid dressing in large area burn patients and its mechanism of promoting wound healing. Methods  A total of 200 patients with extensive burns admitted to our hospital from January 2018 to June 2019 were enrolled. The randomized number grouping method was divided into the control group with gauze pressure bandage and the observation group with hydrocolloid dressing. Both groups were treated with Meek skin grafting， wound healing time， bacterial count of wounds， inflammatory cytokines （C-reactive protein， interleukin 6， transforming growth factor-β1）， angiogenesis index （vascular endothelial growth factor， basic fibroblast growth factor） was compared. Results  The wound healing time of the observation group was （19.85±1.15）d， which was shorter than that of the control group （25.50±1.50）d， and the bacterial count of the wound was （420.25±15.20）cfu/g， which was smaller than that of the control group （877.50±15.35）cfu/g， the differences were statistically significant （t=29.893， 211.667， P=0.000）. After treatment， C-reactive protein （9.25±1.05）mg/L， interleukin-6 （71.10±12.10）ng/L， transforming growth factor-β1 （9.33±1.17）μg/L， lower than the control group （12.11±1.08）mg/L， （84.88±12.82）ng/L， （12.14±1.12）μg/L， the differences were statistically significant （t=18.987， 77.245， 17.349， P=0.000）. The vascular endothelial growth factor （140.29±1.61）ng/L and basic fibroblast growth factor （88.92±1.18）ng/L were higher than the control group （124.38±1.52）ng/L， （79.86±1.24）ng/L， the differences were statistically significant （t=71.856， 52.929， P = 0.000）. Conclusion  Hydrocolloid dressing can promote wound healing by inhibiting inflammatory reaction and promoting angiogenesis in the treatment of large-area burn patients. It is worthy of popularization in clinical treatment work in the future.

Key words： large area burns; hydrocolloid dressings; wound healing mechanism; inflammatory cytokines; vascular endothelial growth factor; basic fibroblast growth factor

烧伤是目前临床中较为常见的病症类型，绝大多数患者为热力导致的皮肤损伤，除此之外化学烧伤、电烧伤亦属于烧伤范畴[1]。大面积烧伤为烧伤的严重类型，烧伤面积大于50%或烧伤面积小于50%但分度为Ⅲ度[2]。由于大面积烧伤患者烧伤面积大，创面处理贯穿了整个治疗环节，相较于小面积烧伤，此类患者治疗面临的困难性更大、创面感染风险以及由此所致的死亡率更高，所以促进创面愈合成为困扰临床的棘手问题[3]。……