Venakatachalapathy T S, Mohan Kumar S, Saliba M J
Indira Gandhi Government General Hospital and Postgraduate Institute, Bursn Unit, Pondicherry, India.
Ann Burns Fire Disasters. 2007 Dec 31;20(4):189-98.
Following reports of heparin use in burn treatment, an ethics-committee-approved prospective randomized study with controls compared results obtained using traditional usual burn treatment without heparin with results in similar patients similarly treated with heparin added topically. The subjects were 100 consecutive burn patients (age, 15-35 yr) with second-degree superficial and deep burns of 5-45% TBSA size. Two largely similar cohort groups, i.e. a control group (C) and a heparin group (H) with 50 subjects per group, were randomly treated, the main difference between the groups being that 13 C patients had burns of 35-45% extent vs. only one such patient in H (p < 0.01). The 50 C patients received traditional routine treatment, including topical antimicrobial cream, debridement, and, when needed, skin grafts in the early post-burn period. The 50 H patients, without topical cream, were additionally treated, starting on day 1 post-burn, with 200 IU/ml sodium aqueous heparin solution USP (heparin) dripped on the burn surfaces and inserted into the blisters 2-4 times a day for 1-2 days, and then only on burn surfaces for a total of 5-7 days, prior to skin grafting, when needed. Thereafter, C and H treatment was similar. It was found that the H patients complained of less pain and received less pain medicine than the C patients. H needed fewer dressings and oral antibiotics than C. Significantly less intravenous fluid was infused in H: 33.5 litres in 39 H patients vs. 65 litres in 41 C patients, i.e. nearly 50% less (p < 0.04). The 50 H patients had four skin graftings (8%), while the 50 C patients had 10 (20%). Five 5 C patients died (mortality, 10%). No H patients died. The number of days in hospital for H vs. C was significantly less (overall, p < 0.0001): 58% of H were discharged within 10 days vs. 6% of C; 82% of H were out in 20 days vs. 14% of C; 98% of H vs. 44% of C were out in 30 days; and while 100% of H were discharged by day 40, 56% of C required up to another 10 days. The burns in H patients healed on average in 15 days (maximum period 37 days) vs. an average of 25 days (maximum > 48 days) in C (p < 0.0006). Procedures and costs in H were much reduced compared with C. Photographs of the differences between H and C are presented for the sake of comparison. It is concluded that heparin applied topically for 5-7 days improved burn treatment: it reduced pain, pain medicine, dressings, and use of antibiotics; it significantly reduced IV fluids (p < 0.04), days in hospital (p < 0.0001), and healing time (p < 0.0006); and it reduced skin grafts, mortality, and costs.
在有关于肝素用于烧伤治疗的报道之后，一项经伦理委员会批准的前瞻性随机对照研究，比较了使用不含肝素的传统常规烧伤治疗方法所取得的结果与在类似患者中局部添加肝素进行类似治疗的结果。研究对象为100例连续的烧伤患者（年龄15 - 35岁），烧伤面积为5% - 45%体表总面积（TBSA）的二度浅度和深度烧伤。将患者随机分为两个大致相似的队列组，即对照组（C组）和肝素组（H组），每组50例。两组之间的主要差异在于，C组有13例患者烧伤面积为35% - 45%，而H组仅有1例（p < 0.01）。50例C组患者接受传统常规治疗，包括局部涂抹抗菌乳膏、清创，以及在烧伤后早期必要时进行皮肤移植。50例H组患者不使用局部乳膏，从烧伤后第1天开始，额外接受200 IU/ml美国药典级肝素钠水溶液（肝素）治疗，每天2 - 4次滴注于烧伤创面并注入水疱内，持续1 - 2天，之后仅滴注于烧伤创面，共持续5 - 7天，必要时在皮肤移植前进行。此后，C组和H组的治疗方法相似。结果发现，H组患者抱怨的疼痛比C组少，且使用的止痛药物也更少。H组所需的敷料和口服抗生素比C组少。H组输注的静脉液体显著减少：39例H组患者输注33.5升，而41例C组患者输注65升，即减少了近50%（p < 0.04）。50例H组患者进行了4次皮肤移植（8%），而50例C组患者进行了10次（20%）。50例C组患者中有5例死亡（死亡率10%）。H组无患者死亡。H组患者的住院天数比C组显著减少（总体，p < 0.0001）：58%的H组患者在10天内出院，而C组为6%；82%的H组患者在20天内出院，而C组为14%；98%的H组患者在30天内出院，而C组为44%；虽然100%的H组患者在第40天前出院，但56%的C组患者还需要另外10天。H组患者的烧伤平均在15天内愈合（最长37天），而C组平均为25天（最长> 48天）（p < 0.0006）。与C组相比，H组的操作和费用大幅降低。为便于比较给出了H组和C组差异的照片。结论是，局部应用肝素5 - 7天可改善烧伤治疗：减轻疼痛、减少止痛药物、敷料和抗生素的使用；显著减少静脉液体输注量（p < 0.04）、住院天数（p < 0.0001）和愈合时间（p < 0.0006）；减少皮肤移植、死亡率和费用。
