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[高频超声在深Ⅱ度烧伤患者皮肤磨削术中的应用]

[Application of high-frequency ultrasound in dermabrasion of patients with deep partial-thickness burns].

作者信息

Zang C Y, Cao Y Q, Xue W J, Zhao R, Zhang M, Zhang Y H, Feng Z, Wang Y B

机构信息

Department of Burns and Plastic Surgery, Provincial Hospital Affiliated to Shandong University, Ji'nan 250021, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2017 Feb 20;33(2):97-102. doi: 10.3760/cma.j.issn.1009-2587.2017.02.010.

Abstract

To investigate the application of high-frequency ultrasound in dermabrasion of patients with deep partial-thickness burns. Twenty-six patients with deep partial-thickness burns conforming to the study criteria were hospitalized in our unit from March 2015 to March 2016. Patients were all performed with dermabrasion. The structure of skin tissue and blood flow signals of uninjured side and wounds before dermabrasion, and those of wounds immediately post dermabrasion and on post dermabrasion day (PDD) 1, 3, 5, 7, 10, 14, and 21 were detected with high-frequency ultrasound, and the percentage of blood flow signals was calculated. According to the results of comparison between percentage of blood flow signals of wounds and that of normal skin before dermabrasion, patients were divided into no significant decrease group (NSD, =19) and significant decrease group (SD, =7). Wound healing time of patients in two groups was recorded. Data were processed with analysis of variance of repeated measurement, LSD test, test and Chi-square test. The correlation between the percentage of blood flow signals of wounds before dermabrasion and wound healing time of 26 patients were analyzed by Spearman correlation analysis. (1) Epidermis of normal skin of patients in two groups before dermabrasion showed continuous smooth linear hyperecho, which was stronger than that of dermis, and boundary of dermis and subcutaneous tissue showed stronger discontinuous linear echo than that of dermis, which gradually transited to subcutaneous tissue. In group NSD, epidermis of wound of patients before dermabrasion showed intermittent rough linear echo, which was weaker than that of normal skin epidermis, and there was no obvious abnormity of boundary between dermis and subcutaneous tissue. Immediately post dermabrasion and on PDD 1, no linear hyperecho of epidermis was observed, showing complete attrition of epidermis, and the echo of dermis and subcutaneous tissue had no obvious change as compared with that before dermabrasion, with flat surface of dermis and partly abraded superficial-dermis but relatively well preserved dermal tissue in whole. The epidermis showed discontinuous linear hyperecho, and epidermis was discontinuously regenerated on PDD 3 and 5. Partial continuous linear hyperecho was detected in the epidermis, showing partial continuous regeneration of epidermis on PDD 7 and 10. The regenerated epidermis was thicker than normal skin epidermis and showed rough linear hyperecho with non-uniform thickness on PDD 14. The regenerated epidermis was thicker than normal skin epidermis and showed rather smooth linear hyperecho with uniform thickness on PDD 21. In group SD, the structure of epidermis and dermis of wound of patients before dermabrasion, immediately post dermabrasion, and on PDD 1 was similar to that in group NSD, but the echo of boundary of dermis and subcutaneous tissue was weakened in different degrees. There was no linear hyperecho of epidermis, showing no epidermis was regenerated on PDD 3 and 5. Intermittent regeneration of epidermis appeared on PDD 7 and 10 with intermittent linear hyperecho. Partial continuous linear hyperecho was detected in the epidermis, showing partial continuous regeneration of epidermis on PDD 14 and 21. (2) The percentages of blood flow signals of wounds of patients in group NSD before dermabrasion, immediately post dermabrasion, and on PDD 1 were (3.1±1.3)%, (6.5±2.0)%, and (5.3±1.9)% respectively, higher than those in group SD [(0.9±1.1)%, (3.5±1.3)%, and (3.6±0.9)% respectively, <0.05 or <0.01]. The percentages of blood flow signals of wounds of patients in two groups were similar at the other time points (with values above 0.05). Compared with the percentage of normal skin in the same group [(3.2±0.7)%], the percentages of blood flow signals of wounds of patients in group NSD were significantly increased immediately post dermabrasion and on PDD 1 (with values below 0.01) but had no significant change at the other time points (with values above 0.05). The percentage of blood flow signals of wounds of patients before dermabrasion in group SD was significantly lower than that of normal skin in the same group [(2.8±0.6)%, <0.01]. The percentage of blood flow signals of wounds of patients in group SD was close to that of normal skin in the same group at each time point post dermabrasion (with values above 0.05). (3) The wound healing time of patients in group NSD was (16.2±2.5) d, lower than that in group SD [(30.9±2.9) d, =12.67, <0.01]. There was obvious negative correlation between the percentage of blood flow signals of wounds before dermabrasion and wound healing time of 26 patients (=-0.77, <0.01). High-frequency ultrasound is a good way to observe the imaging features of wounds in patients with deep partial-thickness burns before and after dermabrasion, and it can provide objective imaging evidence for the performance of dermabrasion in patients with deep partial-thickness burns.

摘要

探讨高频超声在深Ⅱ度烧伤患者磨痂术中的应用。2015年3月至2016年3月,我科收治符合研究标准的深Ⅱ度烧伤患者26例。所有患者均行磨痂术。采用高频超声检测磨痂术前未受伤侧及创面、磨痂术后即刻及术后第1、3、5、7、10、14、21天创面的皮肤组织结构及血流信号,计算血流信号百分比。根据创面血流信号百分比与磨痂术前正常皮肤血流信号百分比的比较结果,将患者分为无明显降低组(NSD组,n = 19)和明显降低组(SD组,n = 7)。记录两组患者创面愈合时间。数据采用重复测量方差分析、LSD检验、t检验和卡方检验进行处理。采用Spearman相关分析对26例患者磨痂术前创面血流信号百分比与创面愈合时间的相关性进行分析。(1)两组患者磨痂术前正常皮肤表皮呈连续光滑的线状高回声,高于真皮回声,真皮与皮下组织边界呈比真皮更强的间断线状回声,逐渐过渡到皮下组织。NSD组患者磨痂术前创面表皮呈间断粗糙线状回声,低于正常皮肤表皮回声,真皮与皮下组织边界无明显异常。磨痂术后即刻及术后第l天,未观察到表皮线状高回声,提示表皮完全磨除,真皮及皮下组织回声与磨痂术前相比无明显变化.真皮表面平整,浅表层部分磨除,但整体真皮组织保存相对完好。术后第3、5天,表皮呈间断线状高回声,提示表皮间断再生。术后第7、10天,表皮检测到部分连续线状高回声,提示表皮部分连续再生。术后第14天,再生表皮较正常皮肤表皮厚,呈粗糙线状高回声,厚度不均。术后第2l天,再生表皮较正常皮肤表皮厚,呈较光滑线状高回声,厚度均匀。SD组患者磨痂术前、磨痂术后即刻及术后第l天创面表皮和真皮结构与NSD组相似,但真皮与皮下组织边界回声不同程度减弱。术后第3、5天,无表皮线状高回声,提示无表皮再生。术后第7、10天,表皮出现间断再生,呈间断线状高回声。术后第14、21天,表皮检测到部分连续线状高回声,提示表皮部分连续再生。(2)NSD组患者磨痂术前、磨痂术后即刻及术后第l天创面血流信号百分比分别为(3.1±1.3)%、(6.5±2.0)%、(5.3±1.9)%,均高于SD组[分别为(0.9±1.1)%、(3.5±1.3)%、(3.6±0.9)%,P<0.05或P<0.01]。两组患者创面血流信号百分比在其他时间点相近(P>0.05)。与同组正常皮肤血流信号百分比[(3.2±0.7)%]相比,NSD组患者磨痂术后即刻及术后第l天创面血流信号百分比明显升高(P<0.01),其他时间点无明显变化(P>0.05)。SD组患者磨痂术前创面血流信号百分比明显低于同组正常皮肤[(2.8±o.6)%,P<0.01]。SD组患者磨痂术后各时间点创面血流信号百分比与同组正常皮肤相近(P>0.05)。(3)NSD组患者创面愈合时间为(16.2±2.5)d,低于SD组[(30.9±2.9)d,t = 12.67,P<0.01]。26例患者磨痂术前创面血流信号百分比与创面愈合时间呈明显负相关(r=-0.77,P<0.01)。高频超声是观察深Ⅱ度烧伤患者磨痂术前、后创面影像学特征的良好方法,可为深Ⅱ度烧伤患者磨痂术的实施提供客观影像学依据。

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