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[综合孵育措施对接受焦痂切除和皮肤移植的大面积烧伤患者围手术期治疗的影响]

[Influence of comprehensive incubational measures on the perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting].

作者信息

Gu L, Wang L, Miao W, Cheng S S, Dai J J

机构信息

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2020 Nov 20;36(11):1060-1064. doi: 10.3760/cma.j.cn501120-20191218-00461.

DOI:10.3760/cma.j.cn501120-20191218-00461
PMID:33238689
Abstract

To explore the influence of standardized and comprehensive incubational measures on perioperative treatment of extensively burned patients who underwent escharectomy and skin grafting. From January 2017 to November 2018, 50 patients with extensive burn who underwent escharectomy and skin grafting in the First Affiliated Hospital of Air Force Medical University and met the inclusion criteria of this study, were recruited in this retrospective cohort study. According to the incubational measures at that time, 20 patients (14 males and 6 females, aged (33.5±5.2) years) who received routine incubation during the perioperative period from January to October 2017 were set as routine incubation group, and 30 patients (23 males and 7 females, aged (35.8±1.4) years) who received standardized comprehensive incubational measures during the perioperative period from November 2017 to November 2018 were set as comprehensive incubation group. Their body temperature was controlled mainly in 4 stages: preoperative preparation and transfer from intensive care unit (ICU) to operating room, preoperative preparation in operating room, intraoperative operating room management, as well as postoperative transfer from operating room to ICU. The initial body temperature in operating room and intraoperative hypothermia duration, intraoperative blood loss, postoperative recovery time, postoperative chill, blister, and ulcer, and wound healing rate on post operation day (POD) 10 were recorded and calculated. Data were statistically analyzed with two independent samples test and chi-square test. (1) The initial body temperature in operating room of patients in comprehensive incubation group was (36.3±0.4) ℃, which was significantly higher than (35.6±0.4)℃ in routine incubation group, =6.658, <0.01; the intraoperative duration of hypothermia was (205±38) min, which was significantly shorter than (234±42) min in routine incubation group, =2.564, <0.05. (2) The intraoperative blood loss of patients in comprehensive incubation group was (323±114) mL, which was significantly less than (490±162) mL in routine incubation group, =4.272, <0.01; the postoperative recovery time was (36±8) min, which was significantly shorter than (49±17) min in routine incubation group, =3.229, <0.01. (3) The incidence of postoperative chill of patients in comprehensive incubation group was significantly lower than that in routine incubation group ((2)=28.626, <0.01). The incidences of postoperative blister and ulcer of patients between the 2 groups were close. (4) On POD 10, the wound healing rate of patients in comprehensive incubation group was (78.08±0.06)%, which was significantly higher than (71.03±0.08)% in routine incubation group, =3.694, <0.01. The standardized and comprehensive incubational measures can effectively improve the initial body temperature of patients entering the operating room, shorten the intraoperative duration of hypothermia, reduce the amount of blood loss and postoperative complications, as well as shorten the postoperative recovery time, thus improve the wound healing rate.

摘要

探讨标准化综合保温措施对大面积烧伤患者切痂植皮围手术期治疗的影响。选取2017年1月至2018年11月在空军军医大学第一附属医院行切痂植皮术且符合本研究纳入标准的50例大面积烧伤患者,进行回顾性队列研究。根据当时的保温措施,将2017年1月至10月围手术期接受常规保温的20例患者(男14例,女6例,年龄(33.5±5.2)岁)设为常规保温组,将2017年11月至2018年11月围手术期接受标准化综合保温措施的30例患者(男23例,女7例,年龄(35.8±1.4)岁)设为综合保温组。主要在4个阶段控制体温:术前准备及从重症监护病房(ICU)转运至手术室、手术室术前准备、术中手术室管理以及术后从手术室转运至ICU。记录并计算手术室初始体温、术中体温过低持续时间、术中失血量、术后恢复时间、术后寒战、水疱及溃疡情况,以及术后第10天的伤口愈合率。采用两独立样本t检验和卡方检验进行统计学分析。(1)综合保温组患者手术室初始体温为(36.3±0.4)℃,显著高于常规保温组的(35.6±0.4)℃,t=6.658,P<0.01;术中体温过低持续时间为(205±38)分钟,显著短于常规保温组的(234±42)分钟,t=z.564,P<0.05。(2)综合保温组患者术中失血量为(323±114)毫升,显著少于常规保温组的(490±162)毫升,t=4.272,P<0.01;术后恢复时间为(36±8)分钟,显著短于常规保温组的(49±17)分钟,t=3.229,P<0.01。(3)综合保温组患者术后寒战发生率显著低于常规保温组(χ²=28.626,P<0.01)。两组患者术后水疱及溃疡发生率相近。(4)术后第10天,综合保温组患者伤口愈合率为(78.0±0.06)%,显著高于常规保温组的(71.03±0.08)%,t=3.694,P<0.01。标准化综合保温措施可有效提高进入手术室患者的初始体温,缩短术中体温过低持续时间,减少失血量及术后并发症,缩短术后恢复时间,从而提高伤口愈合率。

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