Aboelnaga Ahmed, Elmasry Moustafa, Adly Osama A, Elbadawy Mohamed A, Abbas Ashraf H, Abdelrahman Islam, Salah Omar, Steinvall Ingrid
Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt; Department of Plastic Surgery, Hand Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Burns. 2018 Dec;44(8):1982-1988. doi: 10.1016/j.burns.2018.06.007. Epub 2018 Jul 10.
BACKGROUND: The current treatment for partial thickness burns at the trial site is silver sulphadiazine, as it minimises bacterial colonisation of wounds. Its deleterious effect on wound healing, together with the need for repeated, often painful, procedures, has brought about the search for a better treatment. Microbial cellulose has shown promising results that avoid these disadvantages. The aim of this study was therefore to compare microbial cellulose with silver sulphadiazine as a dressing for partial thickness burns. METHOD: All patients who presented with partial thickness (superficial and deep dermal) burns from October 2014 to October 2016 were screened for this randomised clinical trial. Twenty patients were included in each group: the cellulose group was treated with microbial cellulose sheets and the control group with silver sulphadiazine cream 10mg/g. The wound was evaluated every third day. Pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale during and after each procedure. Other variables recorded were age, sex, percentage total body surface area burned (TBSA%), clinical signs of infection, time for epithelialisation and hospital stay. Linear multivariable regression was used to analyse the significance of differences between the treatment groups by adjusting for the size and depth of the burn, and the patient's age. RESULTS: Median TBSA% was 9% (IQR 5.5-12.5). The median number of dressing changes was 1 (IQR 1-2) in the cellulose group, which was lower than that in the control group (median 9.5, IQR 6-16) (p<0.001). Multivariable regression analysis showed that the group treated with microbial cellulose spent 6.3 (95% CI 0.2-12.5) fewer days in hospital (p=0.04), had a mean score that was 3.4 (95% CI 2.5-4.3) points lower during wound care (p<0.001), and 2.2 (95% CI 1.6-2.7) afterwards (p<0.001). Epithelialisation was quicker, but not significantly so. CONCLUSION: These results suggest that the microbial cellulose dressing is a better first choice for treatment of partial thickness burns than silver sulphadiazine cream. Fewer dressings of the wound were done and, combined with the low pain scores, this is good for both the patients and the health care system. The differences in randomisation of the area of burns is, however, a concern that needs to be included in the interpretation of the results.
背景：试验地点目前对浅度烧伤的治疗方法是使用磺胺嘧啶银，因为它能使伤口的细菌定植最小化。其对伤口愈合的有害影响，以及需要反复进行且往往很痛苦的操作，促使人们寻找更好的治疗方法。微生物纤维素已显示出有希望避免这些缺点的结果。因此，本研究的目的是比较微生物纤维素与磺胺嘧啶银作为浅度烧伤敷料的效果。 方法：对2014年10月至2016年10月出现浅度（浅度和深度真皮）烧伤的所有患者进行了这项随机临床试验筛选。每组纳入20名患者：纤维素组用微生物纤维素片治疗，对照组用10mg/g的磺胺嘧啶银乳膏治疗。每三天对伤口进行评估。在每次操作期间和之后，使用面部、腿部、活动、哭闹、安慰（FLACC）量表评估疼痛。记录的其他变量包括年龄、性别、烧伤总面积百分比（TBSA%）、感染的临床体征、上皮化时间和住院时间。使用线性多变量回归通过调整烧伤的大小和深度以及患者年龄来分析治疗组之间差异的显著性。 结果：TBSA%的中位数为9%（四分位间距5.5 - 12.5）。纤维素组换药的中位数为1次（四分位间距1 - 2），低于对照组（中位数9.5，四分位间距6 - 16）（p<0.001）。多变量回归分析表明，用微生物纤维素治疗的组住院天数少6.3天（95%置信区间0.2 - 12.5）（p = 0.04），伤口护理期间平均得分低3.4分（95%置信区间2.5 - 4.3）（p<0.001），之后低2.2分（95%置信区间1.6 - 2.7）（p<0.001）。上皮化更快，但差异不显著。 结论：这些结果表明，对于浅度烧伤的治疗，微生物纤维素敷料比磺胺嘧啶银乳膏是更好的首选。伤口换药次数更少，再加上疼痛评分低，这对患者和医疗系统都有好处。然而，烧伤面积随机化的差异是一个需要在结果解释中考虑的问题。
J Med Assoc Thai. 2009-10
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