Ozcan Coşkun, Ergün Orkan, Celik Ahmet, Cördük Nergül, Ozok Geylani
Ege University Faculty of Medicine, Department of Pediatric Surgery, Pediatric Burns Unit, 35100 Bornova, Izmir, Turkey.
Burns. 2002 Dec;28(8):791-4. doi: 10.1016/s0305-4179(02)00191-2.
Seventy-eight pediatric burn patients treated by enzymatic debridement with collagenase clostridiopeptidase A (CCA), were compared to 41 patients those burn wounds were excised surgically. Patients whose burn wounds were initially assessed as partial-thickness at admission were enrolled in the study. Total removal of eschar was achieved in 49 of 78 (62.8%) patients by CCA only (group D). In 29 patients (37.2%), therapy with CCA was ceased because of the development of burn wound infection or a manifest need for grafting of the wound, therefore, these patients underwent tangential wound excision (group DS). The records of 41 patients, treated by early tangential excision, having similar burn wounds by extent and depth with groups D and DS were used as controls (group S). There was no significant difference between the time to achieve a clean wound bed in groups D, DS and S (mean 7.8, 8, and 7 days, respectively, P>0.05). In group D, none of the patients required blood transfusion, except one. Patients in group DS were found to have fewer excisions (mean 1.1) when compared to those in group S (mean 1.5, P<0.05). The shortest hospital stay was found in group D (12.5 days, P<0.01). In conclusion, the use of CCA, provided a short hospital stay, reduced the overall need for surgery and blood transfusions in patients with partial-thickness burns. Thus, CCA should be considered as an initial treatment of choice for removal of eschar in children, having a partial-thickness burn wound without infection.
将78例采用胶原酶梭菌肽酶A（CCA）进行酶清创治疗的小儿烧伤患者与41例接受手术切除烧伤创面的患者进行比较。纳入研究的患者为入院时烧伤创面初步评估为浅Ⅱ度的患者。仅通过CCA治疗，78例患者中的49例（62.8%）实现了焦痂的完全清除（D组）。在29例患者（37.2%）中，由于烧伤创面感染的发生或明显需要进行创面植皮，停止了CCA治疗，因此，这些患者接受了削痂手术（DS组）。将41例通过早期削痂治疗、烧伤创面的范围和深度与D组和DS组相似的患者记录用作对照（S组）。D组、DS组和S组达到清洁创面床的时间之间无显著差异（分别为平均7.8天、8天和7天，P>0.05）。在D组中，除1例患者外，无其他患者需要输血。与S组患者（平均1.5次，P<0.05）相比，DS组患者的手术切除次数较少（平均1.1次）。D组的住院时间最短（12.5天，P<0.01）。总之，使用CCA可缩短住院时间，减少浅Ⅱ度烧伤患者的总体手术需求和输血需求。因此，对于无感染的浅Ⅱ度烧伤创面的儿童，CCA应被视为去除焦痂的首选初始治疗方法。
