Jelínková Z, Kaloudová Y, Řihová H, Suchánek I, Brychta P
Acta Chir Plast. 2017 Summer;59(1):5-10.
Chemical necrectomy of deep burns using 40% benzoic acid has been used extensively by the Department of Burns and Reconstructive Surgery at the University Hospital since its establishment in 1982. In spite of definite advantages for the patient and medical staff, hard data concerning benzoic acid absorption through skin necrosis and patient safety was missing.
We examined 22 burn patients in collaboration with the University Hospital Brno, Department of Clinical Biochemistry. The plasmatic levels of benzoic acid, hippuric acids and glycine, which is consumed during the metabolism of benzoic acid, were measured. Urine samples were collected to determine the total amount of hippuric acid that is excreted. We were able to determine the total amount of absorbed and excreted benzoic acid from these values.
We consistently found that there was a rapid and short-term increase of plasmatic levels of benzoic acid (maximum 1.3 mmol/l). This value is about 5 times lower than the minimum toxic level of this acid (6.5 mmol/l). The same course has been observed in hippuric acid. The level of glycine dropped slightly, but was still within the normal range.
Typical and atypical courses of the levels of both acids were discussed as well as the correlation of the dynamics of elimination with the extent of benzoic acid application in relationship with the clinical status of the patient. The effectiveness and safety of this method was evaluated.
After summarizing the observations, it was demonstrated that chemical necrectomy using 40% benzoic acid is a selective method comparable with other types of sharp necrectomy. Chemical necrectomy is inexpensive, easy to perform and also reduces blood loss. Toxicity of absorbed benzoic acid is clinically negligible. Furthermore, benzoic acids antimycotic and antibacterial properties prevent the development of wound infection.
自1982年大学医院烧伤与重建外科成立以来，一直广泛使用40%苯甲酸对深度烧伤进行化学坏死组织切除。尽管对患者和医护人员有明显优势，但缺乏关于苯甲酸通过皮肤坏死吸收情况及患者安全性的确切数据。
我们与布尔诺大学医院临床生物化学部合作，对22例烧伤患者进行了检查。测量了苯甲酸、马尿酸和在苯甲酸代谢过程中消耗的甘氨酸的血浆水平。收集尿液样本以确定排泄的马尿酸总量。通过这些数值，我们能够确定吸收和排泄的苯甲酸总量。
我们始终发现，苯甲酸的血浆水平迅速且短期升高（最高达1.3毫摩尔/升）。该值比该酸的最低中毒水平（6.5毫摩尔/升）低约5倍。马尿酸也观察到相同的情况。甘氨酸水平略有下降，但仍在正常范围内。
讨论了两种酸水平的典型和非典型变化过程，以及消除动力学与苯甲酸应用范围和患者临床状况之间的相关性。评估了该方法的有效性和安全性。
在总结观察结果后，证明使用40%苯甲酸进行化学坏死组织切除是一种与其他类型锐性坏死组织切除相当的选择性方法。化学坏死组织切除成本低、操作简便，还能减少失血。吸收的苯甲酸的毒性在临床上可忽略不计。此外，苯甲酸的抗真菌和抗菌特性可防止伤口感染的发生。
