Huang J, Li S Y, Wang X X, Li L H, Ye X F, Ji S Z
Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University, Burn Institute of PLA, Shanghai 200433, China.
Department of General Surgery, Naval 929th Hospital, Shanghai 200433, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2022 Jun 20;38(6):538-548. doi: 10.3760/cma.j.cn501225-20220317-00065.
To assess the current situation of early treatment of partial-thickness burn wounds by professional burn medical staff in China, and to further promote the standardized early clinical treatment of partial-thickness burn wounds. A cross-sectional investigation was conducted. From November 2020 to February 2021, the self-designed questionnaire for the early treatment of partial-thickness burn wounds was published through the "questionnaire star" website and shared through WeChat to conduct a convenient sampling survey of domestic medical staff engaged in burn specialty who met the inclusion criteria. The number, region, and grade of the affiliated hospital, the age, gender, occupation, and seniority of the respondents were recorded. The respondents were divided into physician group and nurse group, senior group and junior group, eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group. Then the seniority, grade of the affiliated hospital, region of the affiliated hospital of the respondents in physician group and nurse group, conventional treatment of partial-thickness burn blisters, reasons for retaining vesicular skin, reasons for removing vesicular skin, and the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage of respondents in each of all the groups were recorded. Data were statistically analyzed with chi-square test. The survey covered 31 provinces, municipalities, and autonomous regions in China (except for Hong Kong, Macau, and Taiwan regions). A total of 979 questionnaires were recovered, which were all valid. The 979 respondents came from 449 hospitals across the country, including 203 hospitals in the eastern region, 116 hospitals in the western region, 99 hospitals in the central region, and 31 hospitals in the northeast region, 348 tertiary hospitals, 79 secondary hospitals, and 22 primary hospitals. The age of the respondents was (39±10) years. There were 543 males and 436 females, 656 physicians and 323 nurses, 473 juniors and 506 seniors, 460 in the eastern regions and 519 in the non-eastern regions, 818 in tertiary hospitals and 161 in primary and secondary hospitals. There were statistically significant differences in the composition of different seniority in the respondents between physician group and nurse group (=44.32, <0.01), while there were no statistically significant differences in grade or region of the affiliated hospital of the respondents between physician group and nurse group (>0.05). There were no statistically significant differences in the conventional treatment of partial-thickness burn blisters among respondents between different occupational groups, seniority groups, and region of the affiliated hospital groups (>0.05).The respondents in different grade of the affiliated hospital groups differed significantly in the conventional treatment of partial-thickness burn blisters (=6.24, <0.05). Compared with respondents in nurse group, larger percentage of respondents in physician group chose to retain vesicular skin for protecting the wounds and providing a moist environment, and alleviating the pain of dressing change (with values of 21.22 and 19.96, respectively, values below 0.01), and smaller percentage of respondents in physician group chose to retain vesicular skin for prevention of wound infection (=23.55, <0.01). The reasons for retaining vesicular skin of respondents between physician group and nurse group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (>0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to retain vesicular skin for protecting the wounds and providing a moist environment and alleviating the pain of dressing change (with values of 10.36 and 4.60, respectively, <0.05 or <0.01), and smaller percentage of respondents in senior group chose to retain vesicular skin for prevention of wound infection (=8.20, <0.01). The reasons for retaining vesicular skin of respondents in senior group and junior group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (>0.05). The 5 reasons for the respondents between eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group chose to retain vesicular skin were all similar (>0.05). Compared with those in physician group, significantly higher percentage of respondents in nurse group were in favor of the following 6 reasons for removing the vesicular skin, including convenience for using more ideal dressings to protect the wounds, prevention of wound infection, facilitating the effect of topical drugs on the wounds, the likely rupture of blisters and wound contamination, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with values of 4.35, 25.59, 11.83, 16.76, 46.31, and 17.54, respectively, <0.05 or <0.01). Compared with respondents in senior group, larger percentage of respondents in junior group chose to remove vesicular skin for the reasons such as the likely blister rupture and wound contamination, preventing wound infection, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with values of 17.25, 18.63, 14.83, and 10.23, respectively, values below 0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to remove vesicular skin for preventing wound infection and the likely rupture of blisters and wound contamination (with values of 9.30 and 8.65, respectively, values below 0.01). The 6 reasons for the respondents between tertiary hospital group and primary and secondary hospital group choose to remove vesicular skin were similar (>0.05). Compared with respondents in physician group, larger percentage of respondents in nurse group chose to use moisturizing materials for partial-thickness burn wounds in the early stage (=6.18, <0.05), and smaller percentage of respondents in nurse group chose other topical drugs or dressings (=5.20, <0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to use moisturizing materials and other topical drugs or dressings for partial-thickness burn wounds in the early stage (with values of 4.97 and 21.80, respectively, <0.05 or <0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to use topical antimicrobial drugs for partial-thickness burn wounds in the early stage (=4.09, <0.05), and smaller percentage of respondents in eastern region group chose to use other topical drugs or dressings for the partial-thickness burn wounds in the early stage (=5.63, <0.05). Compared with respondents in primary and secondary hospital group, larger percentage of respondents in tertiary hospital group chose to use biological dressings for partial-thickness burn wounds in the early stage (=9.38, <0.01). The optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage varied significantly among the respondents between different occupational groups and seniority groups (with values of 39.58 and 19.93, respectively, values below 0.01). There were no statistically significant differences between eastern and non-eastern region groups, tertiary hospital group and primary and secondary hospital groups in optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage (>0.05). The conventional treatment measures of partial-thickness burn blisters and reasons for preserving blister skin by professional burn medical staff in China are relatively consistent, but there are great differences in the selection of reasons for removing blister skin, the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage. Therefore, it is urgent to establish a clinical treatment standard for partial-thickness burn wounds.
为评估我国烧伤专业医护人员对浅Ⅱ度烧伤创面早期治疗的现状，进一步推动浅Ⅱ度烧伤创面早期临床治疗的规范化。开展了一项横断面调查。2020年11月至2021年2月，通过“问卷星”网站发布自行设计的浅Ⅱ度烧伤创面早期治疗调查问卷，并通过微信分享，对符合纳入标准的国内从事烧伤专业的医护人员进行方便抽样调查。记录其所在附属医院的数量、地区及等级，受访者的年龄、性别、职业及工作年限。将受访者分为医生组和护士组、高年资组和低年资组、东部地区组和非东部地区组、基层及二级医院组和三级医院组。然后记录医生组和护士组受访者的工作年限、所在附属医院等级、地区，浅Ⅱ度烧伤水疱的常规处理、保留疱皮的原因、去除疱皮的原因，以及各分组中受访者对浅Ⅱ度烧伤创面早期局部用药或敷料的常规选择及最佳方案推荐。采用卡方检验进行统计学分析。调查覆盖我国31个省、直辖市、自治区（除香港、澳门、台湾地区）。共回收有效问卷979份。979名受访者来自全国449家医院，其中东部地区203家，西部地区116家，中部地区99家，东北地区31家；三级医院348家，二级医院79家，一级医院22家。受访者年龄为（39±10）岁。男性543名，女性436名；医生656名，护士323名；低年资473名，高年资506名；东部地区460名，非东部地区519名；三级医院818名，基层及二级医院161名。医生组和护士组受访者不同工作年限构成差异有统计学意义（=44.32，<0.01），而医生组和护士组受访者所在附属医院等级及地区差异无统计学意义（>0.05）。不同职业组、工作年限组及所在附属医院地区组受访者对浅Ⅱ度烧伤水疱的常规处理差异无统计学意义（>0.05）。不同附属医院等级组受访者对浅Ⅱ度烧伤水疱的常规处理差异有统计学意义（=6.24，<0.05）。与护士组相比，医生组中选择保留疱皮以保护创面、提供湿润环境及减轻换药疼痛的受访者比例更高（值分别为21.22和19.96，值均<0.01），而医生组中选择保留疱皮以预防创面感染的受访者比例更低（=23.55，<0.01）。医生组和护士组受访者保留疱皮在促进创面愈合、减轻创面愈合后色素沉着及瘢痕增生方面的原因相似（>0.05）。与低年资组相比，高年资组中选择保留疱皮以保护创面、提供湿润环境及减轻换药疼痛的受访者比例更高（值分别为10.36和4.60，<0.05或<0.01），而高年资组中选择保留疱皮以预防创面感染的受访者比例更低（=8.20，<0.01）。高年资组和低年资组受访者保留疱皮在促进创面愈合、减轻创面愈合后色素沉着及瘢痕增生方面的原因相似（>0.05）。东部地区组和非东部地区组、基层及二级医院组和三级医院组受访者选择保留疱皮的5个原因均相似（>0.05）。与医生组相比，护士组中支持去除疱皮的以下6个原因的受访者比例显著更高，包括便于使用更理想的敷料保护创面、预防创面感染、促进局部用药对创面的作用、水疱可能破裂及创面污染、促进创面愈合、减轻创面愈合后色素沉着及瘢痕增生（值分别为4.35、25.59、11.83、16.76、46.31和17.54，<0.05或<0.01）。与高年资组相比，低年资组中因水疱可能破裂及创面污染、预防创面感染、促进创面愈合、减轻创面愈合后色素沉着及瘢痕增生等原因选择去除疱皮的受访者比例更高（值分别为17.25、18.63、14.83和10.23，值均<0.01）。与非东部地区组相比，东部地区组中因预防创面感染及水疱可能破裂及创面污染选择去除疱皮的受访者比例更高（值分别为9.30和8.65，值均<0.01）。三级医院组和基层及二级医院组受访者选择去除疱皮的6个原因相似（>0.05）。与医生组相比，护士组中选择早期使用保湿材料处理浅Ⅱ度烧伤创面的受访者比例更高（=6.18，<0.05），而护士组中选择其他局部用药或敷料的受访者比例更低（=5.20，<0.05）。与低年资组相比，高年资组中选择早期使用保湿材料及其他局部用药或敷料处理浅Ⅱ度烧伤创面的受访者比例更高（值分别为4.97和21.80，<0.05或<0.01）。与非东部地区组相比，东部地区组中选择早期使用局部抗菌药物处理浅Ⅱ度烧伤创面的受访者比例更高（=4.09，<0.05），而东部地区组中选择早期使用其他局部用药或敷料处理浅Ⅱ度烧伤创面的受访者比例更低（=5.63，<0.05）。与基层及二级医院组相比，三级医院组中选择早期使用生物敷料处理浅Ⅱ度烧伤创面的受访者比例更高（=9.38，<0.01）。不同职业组和工作年限组受访者对浅Ⅱ度烧伤创面早期局部用药或敷料的最佳方案推荐差异有统计学意义（值分别为39.58和19.93，值均<0.01）。东部和非东部地区组、三级医院组和基层及二级医院组在浅Ⅱ度烧伤创面早期局部用药或敷料的最佳方案推荐方面差异无统计学意义（>0.05）。我国烧伤专业医护人员对浅Ⅱ度烧伤水疱的常规处理措施及保留疱皮的原因相对一致，但在去除疱皮原因的选择、浅Ⅱ度烧伤创面早期局部用药或敷料的常规选择及最佳方案推荐方面存在较大差异。因此，迫切需要建立浅Ⅱ度烧伤创面的临床治疗规范。
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