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[超声清创法在烧伤残余创面中的应用及临床疗效]

[Application and clinical efficacy of ultrasound debridement method in residual burn wounds].

作者信息

He Z L, Li J, Sui Z Y, Zhang J L, An L E, Liu L L, Zhang C L, Yao Y Y, Qiu S L, Li X D

机构信息

Department of Burn and Plastic Surgery, the 980th Hospital of the Joint Logistic Support Force of PLA, Shijiazhuang 050091, China.

出版信息

Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2022 Nov 20;38(11):1034-1039. doi: 10.3760/cma.j.cn501120-20211123-00396.

Abstract

To investigate the application and clinical efficacy of ultrasound debridement method in residual burn wounds. A retrospective cohort study was conducted. From August 2017 to August 2021, 64 patients with residual burn wounds who met the inclusion criteria were admitted to the 980 Hospital of the Joint Logistic Support Force of PLA. According to the debridement method adopted for the residual wounds, the patients were divided into ultrasound debridement group (34 cases, 22 males and 12 females, aged (31±13) years) and traditional debridement group (30 cases, 19 males and 11 females, aged (32±13) years). After the corresponding debridement, the wounds of patients in the two groups were selected for stamp skin grafting or large skin grafting according to the wound site and skin donor status. For unhealed wounds after stage Ⅰ surgery, secondary debridement and skin grafting were be performed, with the wound debridement methods in the 2 groups being the same as those of stage Ⅰ, respectively. On postoperative day 3, drug-sensitive test was used to detect the bacteria in the wound and the positive rate of bacteria was calculate. On postoperative day 7, the survival rate of skin slices in wound and the incidence of subcutaneous hematoma were calculated. At discharge, wound healing time and debridement times of patients were counted, and the secondary debridement rate was calculated. Data were statistically analyzed with independent sample test or chi-square test. On postoperative day 3, the wounds in ultrasound debridement group were infected with in 2 cases and in 2 cases, and the wounds in traditional debridement group were infected with in 5 cases, in 3 cases, in 1 cases, in 1 cases, and in 1 cases. The positive rate of bacteria of wound in ultrasound debridement group was significantly lower than that in traditional debridement group (=5.51, <0.05). On postoperative day 7, the survival rate of skin grafts in ultrasound debridement group was (92±5) %, which was significantly higher than (84±10) % in traditional debridement group (=6.78, <0.01); the incidence of subcutaneous hematoma in ultrasound debridement group was 17.6% (6/34), which was significantly lower than 40.0%( 12/30) in traditional debridement group, =3.94, <0.05. At discharge, the wound healing time in ultrasound debridement group was (11.0±2.0) d, which was significantly shorter than (13.0±3.1) d in traditional debridement group (=3.81, <0.01); the secondary debridement rate of wounds in ultrasound debridement group was 2.9% (1/34), which was significantly lower than 20.0% (6/30) in traditional debridement group (=4.76, <0.05). Ultrasound debridement method can significantly reduce the bacterial load of residual burn wounds, reduce postoperative hematoma formation, and promote the survival of skin grafts to shorten the course of disease of patients.

摘要

探讨超声清创法在烧伤残余创面的应用及临床疗效。进行回顾性队列研究。2017年8月至2021年8月,解放军联勤保障部队第980医院收治符合纳入标准的烧伤残余创面患者64例。根据残余创面采用的清创方法,将患者分为超声清创组(34例,男22例,女12例,年龄(31±13)岁)和传统清创组(30例,男19例,女11例,年龄(32±13)岁)。相应清创后,根据创面部位及皮肤供区情况,对两组患者的创面行邮票植皮或大片植皮。对于Ⅰ期手术后未愈合创面,行二期清创及植皮,两组创面清创方法分别与Ⅰ期相同。术后第3天,采用药敏试验检测创面细菌并计算细菌阳性率。术后第7天,计算创面皮片成活率及皮下血肿发生率。出院时,统计患者创面愈合时间及清创次数,并计算二期清创率。数据采用独立样本t检验或卡方检验进行统计学分析。术后第3天,超声清创组创面感染金黄色葡萄球菌2例、表皮葡萄球菌2例,传统清创组创面感染金黄色葡萄球菌5例、表皮葡萄球菌3例、鲍曼不动杆菌1例、铜绿假单胞菌1例、阴沟肠杆菌1例。超声清创组创面细菌阳性率显著低于传统清创组(χ²=5.51,P<0.05)。术后第7天,超声清创组皮片成活率为(92±5)%,显著高于传统清创组的(84±10)%(t=6.78,P<0.01);超声清创组皮下血肿发生率为17.6%(6/34),显著低于传统清创组的40.0%(12/30),χ²=3.94,P<0.05。出院时,超声清创组创面愈合时间为(11.0±2.0)d,显著短于传统清创组的(13.0±3.1)d(t=3.81,P<0.01);超声清创组创面二期清创率为2.9%(1/34),显著低于传统清创组的20.0%(6/30),χ²=4.76,P<0.05。超声清创法可显著降低烧伤残余创面的细菌载量,减少术后血肿形成,促进皮片成活以缩短患者病程。

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