不同负压材料在Ⅲ度烧伤切痂创面修复中的应用效果比较

蔡德南 陈新龙 陈斐 王木盛 梁显南

[摘要]目的：分析不同負压材料在Ⅲ度烧伤切痂创面修复中的应用效果。方法：选取2017年6月-2020年6月笔者医院烧伤整形科收治的Ⅲ度烧伤患者125例，按照随机数字表法分为A组（61例）和B组（64例），两组均应用负压封闭引流技术进行治疗，伤后第3天行切痂术，A组创面覆盖聚乙烯醇负压材料，B组创面覆盖聚氨酯负压材料，比较两种材料在Ⅲ度烧伤切痂创面中的应用效果。结果：A组治疗1周时的最大拉力、创面出血量、肉芽组织增生厚度、CD31阳性新生血管数、植入海绵内巨噬细胞阳性数、肌成纤维细胞α-SMA数、Ki67阳性数、TGF-β1阳性数、负压材料回弹系数R1/RO值、创面异物颗粒残留数量等均明显低于B组，差异有统计学意义（P<0.05）;其创面渗液引流量大于B组（P<0.05）。两组干湿比、治疗1周后炎性水平、创面细菌菌落数、皮缘湿疹率比较差异均无统计学意义（P>0.05）。结论：聚乙烯醇材料和创面的粘连度较小，可减少创面出血以及异物残留，适用于创面由肉芽组织覆盖、渗液较多、窦道较深的情况;聚氨酯安装方便、不易干结皱缩，可促进创面肉芽组织的生长及血管化，适用于需要保护深部组织、培养肉芽组织、创面污染严重者;两种材料在减轻组织水肿、减轻炎性反应的效果相当，在抑制细菌繁殖、皮肤湿疹防治方面均有待改善。

[关键词]烧伤;负压封闭引流;切痂创面;敷料;聚乙烯醇;聚氨酯;伤口愈合

[中图分类号]R644    [文献标志码]A    [文章编号]1008-6455（2021）07-0022-04

Application of Different Vacuum Sealing Materials in Third Degree Burn Wounds after Escharectomy： A Comparative Study

CAI De-nan，CHEN Xin-long，CHEN Fei，WANG Mu-sheng，LIANG Xian-nan

（Department of Burn Plastic Dermatology，Sanya Central Hospital，Sanya 572000，Hainan，China）

Abstract： Objective  To analyze the application of different vacuum sealing materials in third degree burn wounds after escharectomy. Methods  125 patients with third degree burn who were admitted to the department of burn and plastic surgery of the hospital from June 2017 to June 2020 were enrolled. According to random number table method， they were divided into the group A （61 cases） and the group B （64 cases）. Both groups were treated with vacuum sealing drainage and then treated with escharectomy at 3d after burn. The group A was covered with polyvinyl alcohol， while the group B was covered with polyurethane. Application effects of the two kinds of materials in third degree burn wounds after escharectomy were compared. Results  The maximum tension after one week of treatment， wound blood loss， thickness of granulation tissue proliferation， number of CD31-positive new vessels， positive staining of macrophages in the implanted sponge， myofibroblast α-SMA count， Ki67 positive cell count， TGF-β1 positive cell count， resilience coefficient of vacuum sealing material （R1/RO） and amount of residual foreign particles on wounds in the group A were significantly smaller than those in the group B， the differences were statistically significant （P<0.05）. The drainage volume of wound exudate was significantly larger than that in the group B （P<0.05）. There were no significant differences in dry-wet ratio， inflammatory level after one week of treatment， number of bacterial colonies on wound and marginal eczema rate between the two groups （P>0.05）. Conclusion  The adhesion between polyvinyl alcohol and wound is low， which can reduce wound bleeding and foreign body residue. It is suitable for coverage of wound granulation tissue， much exudate and deep sinus tract. Polyurethane is easy to install and not easy to be dry and wrinkle， which can promote the growth and vascularization of wound granulation tissue. It is suitable for protecting deep tissues， cultivating granulation tissue and patients with severe pollution. The effects of the two materials are comparable in alleviating tissue edema and inflammatory reactions. And they needs to be improved in terms of inhibiting bacterial reproduction and preventing skin eczema.

Key words： burn; vacuum sealing drainage; wound after escharectomy; dressing; polyvinyl alcohol; polyurethane; wound healing

Ⅲ度烧伤属于比较重的烧伤，是全层皮肤烧伤坏死，局部表现为创面基底苍白，没有弹性，痛觉不敏感，也可以表现为成皮革状，没有弹性，局部皮肤焦化[1-2]。负压封闭引流技术（Vacuum sealing drainage，VSD）是一种处理各种复杂创面和用于深部引流的全新方法[3]。……