Singer Adam J, McClain Steve A
Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
Acad Emerg Med. 2002 Oct;9(10):977-82. doi: 10.1111/j.1553-2712.2002.tb02128.x.
Burns are dynamic injuries that tend to progress over the course of several days. Steroids inhibit the formation of vasoconstrictive prostanoids that may contribute to this progression of injury. The authors hypothesized that adding topical steroids to a standard antimicrobial agent would reduce the progression of burns and accelerate reepithelialization without increasing infection rates.
This was a prospective, blinded, controlled, experimental trial. Forty-eight standardized second-degree burns were created by applying an aluminum bar preheated to 80 degrees C to the flanks of isoflurane-anesthetized young pigs for 20 seconds. Three equal sets of 16 burns were randomly treated with silver sulfadiazine cream (SSD), clobetasol propionate 0.05% (CP), or both (SSD+CP). Daily dressing changes were performed for 14 days. Full-thickness biopsies were taken after injury and at one, two, seven, ten, and 14 days for blinded histopathological evaluation using hematoxylin and eosin (H&E) staining. The primary outcome was the % reepithelialization (REP) calculated by dividing the length of the neoepidermis by the section's total length (interobserver correlation = 0.99). Depth of injury was measured for each dermal element (collagen; epithelial, mesenchymal, and vascular cells; and vessel thrombosis). Comparisons across groups were performed using one-way analysis of variance (ANOVA). A repeated-measures ANOVA was used to compare injury depths over time. This study had 80% power to detect a 33-percentage point difference in REP across groups (two-tailed alpha = 0.05).
Pretreatment burn depths were similar across groups. While burn depth changed over time, there was no difference between the groups in burn injury progression. There was no difference across the groups in REP or infection rates at all times.
Addition of a potent topical steroid to standard antimicrobial topical agents does not reduce burn depth or accelerate reepithelialization after burns.
烧伤是动态损伤，往往会在数天内进展。类固醇可抑制血管收缩性前列腺素的形成，而血管收缩性前列腺素可能促使损伤进展。作者推测，在标准抗菌剂中添加外用类固醇会减少烧伤进展并加速再上皮化，且不会增加感染率。
这是一项前瞻性、双盲、对照实验性试验。通过将预热至80摄氏度的铝棒施加于异氟烷麻醉的幼猪胁腹20秒，造成48处标准化二度烧伤。16处烧伤的三组被随机分别用磺胺嘧啶银乳膏（SSD）、0.05%丙酸氯倍他索（CP）或两者联用（SSD + CP）治疗。每天换药，持续14天。受伤后以及第1、2、7、10和14天进行全层活检，采用苏木精和伊红（H&E）染色进行双盲组织病理学评估。主要结局是再上皮化百分比（REP），通过将新表皮长度除以切片总长度计算得出（观察者间相关性 = 0.99）。测量每个真皮成分（胶原蛋白；上皮、间充质和血管细胞；以及血管血栓形成）的损伤深度。采用单因素方差分析（ANOVA）进行组间比较。采用重复测量方差分析比较不同时间的损伤深度。本研究有80%的把握检测出各组间REP有33个百分点的差异（双侧α = 0.05）。
各组治疗前烧伤深度相似。虽然烧伤深度随时间变化，但各组间烧伤损伤进展无差异。各组在任何时间的REP或感染率均无差异。
在标准外用抗菌剂中添加强效外用类固醇并不能减少烧伤深度或加速烧伤后的再上皮化。
