浸浴对大面积烧伤残余创面感染及愈合的影响分析

雷德会 杨丽英

[摘要]目的：探討浸浴在全身大面积深度烧伤后残余创面预防感染、促进创面愈合的价值。方法：选取笔者医院2016年3月-2019年2月收治的90例大面积深度烧伤残余创面患者，随机分组为试验组和对照组，各45例，对照组给予常规治疗，试验组采用浸浴结合换药治疗，对比两组患者残余创面的愈合时间、换药次数、单次换药时间、不同时间的创面愈合率及不同时间点两组患者创面肉芽组织中表皮细胞生长因子（Epidermal growth factor，EGF）、肿瘤坏死因子-α（Tumor necrosis factorα，TNF-α）表达情况。结果：试验组治疗7d、14d、21d的创面愈合率均显著高于对照组，差异有统计学意义（P<0.05）。试验组的残余创面愈合时间、单次换药时间、换药次数低于对照组，差异具有统计学意义（P<0.05）。治疗7d、14d、21d，试验组的创面肉芽组织中EGF高于对照组，TNF-α低于对照组，差异具有统计学意义（P<0.05）。治疗21d，试验组的创面分泌物细菌培养阳性率显著低于对照组，差异具有统计学意义（P<0.05）。结论：浸浴能够预防全身大面积深度烧伤后残余创面感染、促进创面愈合，具有较好的临床效果。

[关键词]浸浴;大面积深度烧伤;残余创面;感染;表皮生长因子;肿瘤坏死因子-α

[中图分类号]R644    [文献标志码]A    [文章编号]1008-6455（2021）03-0073-03

Effect of Bathing on Infection and Healing of Large Area Burn Residual Wounds

LEI De-hui1，YANG LI-ying2

（1.Department of Ankle Shoulder and Elbow Surgery，Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine，Panzhihua 617000，Sichuan，China;2.Department of Burn and Plastic Surgery，Ziyang First People's Hospital，Ziyang 641300，Sichuan，China）

Abstract： Objective  To explore the value of bathing to prevent residual wound infection and promote wound healing after extensive deep burn in the whole body. Methods  90 patients with large-area deep burns admitted to our hospital from March 2016 to February 2019 were randomly divided into the experimental group and the control group. The experimental group was treated with whole body bathing combined with routine nursing and treatment. The control group received only routine nursing and treatment. The healing time of the residual wounds， the number of dressing changes， the time of single dressing change， the wound healing rate at different times， the expression of epidermal growth factor（EGF） and tumor necrosis factor-α（TNF-α） in granulation tissue of the two groups were compared. Results  The wound healing rate of the experimental group on the 7th， 14th， and 21th day was significantly higher than those of the control group， the differences were statistically significant（P<0.05）. Compared with the control group， the residual wound healing time， single dressing change time and dressing change times in the experimental group were statistically significant（P<0.05）. On the  7th， 14th， and 21th day of treatment， the EGF in the wound epidermis of the experimental group was higher than that of the control group（P<0.05）. The TNF-α in the wound epidermis of the experimental group was lower than that of the control group（P<0.05）. At 21th day of treatment， the positive rate of bacterial culture on the wound surface of the experimental group was significantly lower than that of the control group（P<0.05）. Conclusion  Bathing has a positive effect on preventing residual wound infection and promoting wound healing after extensive deep burn in the body.

Key words： bathing; large area deep burn; residual wound; infection; epidermal growth factor（EGF）; tumor necrosis factor–α（TNF-α）

燒伤是常见的软组织损伤类型，包括火烧伤、电烧伤及烫伤等引起的皮肤软组织热损伤[1]。对于大面积的深度烧伤，往往伴有体液的大量丢失，免疫力的降低，患者需要经历休克期、感染期等，病程进展较为复杂。而在患者进入康复期后，促进创面的愈合是首要的治疗目标。在大面积烧伤治疗后，往往存在部分残余创面难以愈合，甚至需要植皮治疗，并且发生创面感染的风险较高，导致肉芽组织或表皮生长困难，对后续的治疗产生影响[2]。浸浴能够改善全身的血液循环，改善皮肤及软组织的微循环，在烧伤感染期及康复期对创面愈合具有较好的效果，为进一步研究浸浴疗法对烧伤残余创面感染及愈合的影响，本研究观察了浸浴在全身大面积深度烧伤后残余创面的治疗效果。……