大面积深度烧伤创面三种治疗方法疗效的回顾性分析_临床医学论文.docVIP

大面积深度烧伤创面三种治疗方法疗效的回顾性分析_临床医学论文 大面积深度烧伤创面三种治疗方法疗效的回顾性分析_临床医学论文 作者：王浩，李小毅，黄书润，林玉丹，刘江涛 【摘要】 目的 探讨大面积深度烧伤创面三种治疗方法的特点和疗效。方法 选取我科1993年1月—2004年12月应用保痂后期肉芽创面植皮术（保痂组）、切削痂异体皮打洞自体皮嵌入术（嵌入组）和切削痂微粒皮移植术（微粒组）等三种方法治疗的107例大面积深度烧伤患者，对治疗结果进行回顾性分析。结果 创面平均愈合时间：保痂组（62.1±8.9）d，嵌入组（51.3±7.6）d，微粒组（52.6±8.2）d。保痂组病程长，并发症多，死亡率高，嵌入组、微粒组创面上皮化快，并发症少，愈合外观较满意，其中微粒组更节省皮源，方法简单，易于掌握。结论 伤后及时清除创面坏死组织，并寻求积极有效地覆盖物封闭创面，对减少创面侵袭性感染、减少并发症，加快创面愈合，缩短病程，提高大面积深度烧伤治愈率至关重要。 【关键词】 烧伤；保痂；混和移植法；微粒皮移植 　　Abstract： Objective To study the features and the outcomes of three therapeutic approaches to large deep burn wounds.Methods A total of 107 patients with large deep burn, who were treated respectively with three different approaches between Jan 1993 and Dec 2004, were studied retrospectviely. The approaches included eschar reserving plus late skin grafting (escharreserved group), eschar shaving plus allograft holing and autograft inlaying (inlaid group), and eschar shaving plus microskin grafting (microskin group). Results The mean wound healing time was 62.1±8.9 days for the eschar-reserved group, 51.3±7.6 days for the inlaid group, and 52.6±8.2 days for the microskin group. Longer wound lasting time, more complications and higher death rate were found in the escharreserved group, whereas in the other two groups the wounds healed up with faster epithelization, fewer complications and more satisfactory appearances. Furthermore, microskin group had the virtue of saving on skin source and easy procedure. Conclusion It is important to clear the necrotic tissues of the wounds in time and then to cover them with appropriate materials in order to reduce invasive infection, lower complication, accelerate healing, shorten course and increase healing rate. 　　Key words： burn; eschar reservation; mixed grafting; microskin 　　大面积深度烧伤患者，由于自体皮源少，烧伤创面的修复是其治疗的重点和难点。尽早尽多地去除创面坏死组织，寻找有效方法覆盖切削痂创面是救治大面积深度烧伤的重要手段。我科1993年1月—2004年12月，先后采用了保痂后期肉芽创面植皮术、切削痂异体皮打洞自体皮嵌入术和切削痂微粒皮移植术等3种治疗方法治疗了107例大面积深度烧伤患者（不包括因某些原因中途放弃治疗自动出院者），现将治疗结果报告如下。 　　1 临床资料 　　1