Pediatric Surgery, Children's Hospital Colorado.
Department of Pediatrics, University of Colorado School of Medicine.
J Pediatr Surg. 2019 Jul;54(7):1391-1396. doi: 10.1016/j.jpedsurg.2018.06.011. Epub 2018 Jun 18.
Antibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds.
Children with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant.
Ninety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40-0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag (4% versus 27%; p = 0.004).
Our study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag for pediatric extremity burn injuries.
Treatment study; Level 1.
抗生素或含银的敷料广泛用于烧伤创面护理。我们治疗儿童四肢烧伤创面的标准方法是使用抗生素软膏或制霉菌素软膏浸渍的非粘性纱布（第一层），然后是卷纱布、软石膏垫、石膏和软绷带（3M™ Scotchcast™，圣保罗，明尼苏达州）。本研究的目的是比较我们的标准软膏基第一层与 Mepitel Ag（Mölnlycke Health Care，哥德堡，瑞典）在治疗儿童上下肢烧伤创面的效果。
新发生的上下肢烧伤患儿在烧伤科就诊时符合入组条件。符合条件的患儿被纳入并随机分组，根据烧伤深度分为软膏组或 Mepitel Ag®组。随机分组后，研究人员和患儿对治疗分组不知情。每周大约更换一次或两次敷料，直到烧伤创面愈合或植皮。主要结局是创面愈合时间，p 值<0.05 认为有统计学意义。
96 例儿童 113 处上下肢烧伤纳入分析。Mepitel Ag®（风险比[HR]0.57（95%置信区间（CI）0.40-0.82）；p = 0.002）显著降低了创面愈合率，调整了烧伤深度和真菌感染的影响。两组真菌感染和植皮的发生率相似。与 Mepitel Ag 组相比，随机接受标准软膏敷料的患儿需要到烧伤科就诊 4 次或以上的可能性显著降低（4%比 27%；p = 0.004）。
我们的研究表明，与 Mepitel Ag 相比，我们的标准软膏敷料显著提高了儿童四肢烧伤创面的愈合率。
治疗研究；等级 1。
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