Gray D T, Pine R W, Harnar T J, Marvin J A, Engrav L H, Heimbach D M
Am J Surg. 1982 Jul;144(1):76-80. doi: 10.1016/0002-9610(82)90605-5.
Using the records of 72 patients treated at the University of Washington Burn Center, this study compared the results of early surgical excision (by 14 days postburn) and autografting to those of autografting after spontaneous separation and bedside debridement of burn eschar. Excised patients had shorter hospitalizations and lower rates of burn wound sepsis and serious burn wound contamination, and less use of potentially toxic antibiotics (p less than 0.05) than did the prognostically equivalent group treated before the introduction of early excision. Excised patients required more blood transfusions (p less than 0.05), but did not differ significantly from controls in rates of mortality or other inpatient complications, in the number of operations performed, or in the adjusted hospital costs. Evaluation of patients treated over the entire study period for more shallow burns indicated no concurrent change in other aspects of burn care which might account for the observed results. We conclude that early excision and grafting in young, otherwise healthy patients with 20 to 40 percent total body surface area burns that are likely to heal within 3 weeks is more effective than the more traditional management of slow wound separation and debridement.
本研究利用华盛顿大学烧伤中心72例患者的记录，比较了早期手术切除（烧伤后14天内）并自体植皮与烧伤焦痂自然分离及床边清创后自体植皮的效果。与早期切除引入前预后相当的治疗组相比，接受切除治疗的患者住院时间更短，烧伤创面脓毒症和严重烧伤创面污染发生率更低，潜在毒性抗生素的使用也更少（p<0.05）。接受切除治疗的患者需要更多输血（p<0.05），但在死亡率、其他住院并发症发生率、手术次数或调整后的住院费用方面与对照组无显著差异。对整个研究期间接受治疗的较浅烧伤患者的评估表明，烧伤护理的其他方面没有同时发生变化，这可能解释了观察到的结果。我们得出结论，对于年轻、身体健康、烧伤总面积为20%至40%且可能在3周内愈合的患者，早期切除并植皮比更传统的缓慢创面分离和清创管理更有效。
