徐建军 李林辉 张鹏 林才

[摘要] 目的 通過将薄层削痂及井网划痕术与封闭式负压引流技术创新性结合应用于早期中小面积深Ⅱ度创面的治疗，观察其对中小面积深Ⅱ度烧伤患者的临床疗效。 方法 采用病例对照研究，回顾性分析我科2015年2月～2017年6月期间收治的32例中小面积深Ⅱ度烧伤患者的临床资料，其中新型手术方案为实验组，传统手术方案为对照组，每组16例，观察比较两组患者术后创面完全愈合时间、创面细菌培养阳性率、术后创口疼痛程度、住院时间及创面愈合质量等指标并进行分析。 结果 实验组患者术后创面完全愈合时间为（14.68±0.88）d；创面细菌培养阳性率术后14 d为（3.25±0.45）%，术后21 d为（0.31±0.48）%；创口疼痛评分术后14 d为（2.44±0.51）分，术后21 d为（0.31±0.46）分；住院时间为（20.66±0.86）d；Sawada瘢痕评分为（3.94±0.77）分。对照组创面完全愈合时间为（20.48±0.96）d；创面细菌培养阳性率术后14 d为（5.44±0.81）%，术后21 d为（2.19±0.78）%；创口疼痛评分术后14 d为（4.06±0.77）分，术后21 d为（1.75±0.46）分；住院时间为（28.18±1.38）d；Sawada瘢痕评分（6.94±0.78）分，组间比较差异有统计学意义（P<0.01）。 结论 新型手术方案应用于早期中小面积深Ⅱ度烧伤创面的治疗，临床上具有较多优点，是中小面积深Ⅱ度创面治疗较好的选择。

[关键词] 薄层削痂；井网划痕术；VSD术；中小面积深Ⅱ度烧伤；创面愈合

[中图分类号] R644 [文献标识码] A [文章编号] 1673-9701（2018）08-0007-05

The clinical effectiveness of treatment combining thinning tangential excision of eschar and gridding scratch operation and vacuum scaling drainage in patients with deep Ⅱdegree burn of medium and small area

XU Jianjun LI Linhui ZHANG Peng LIN Cai

Burn-Wound Center，the First Affiliated Hospital of Wenzhou Medical University，Wenzhou 325000，China

[Abstract] Objective To investigate the clinical effectiveness of the innovative early treatment combining thinning tangential excision of eschar and gridding scratch operation and vacuum scaling drainage（VSD）in patients with deep second-degree burn of medium and small area. Methods This was a case-control study. The clinical records of 32 patients with deep Ⅱdegree burn of medium and small area in our department from February 2015 to June 2017 were reviewed and analyzed. The patients who had been through the innovative surgery treatment were taken as case group and patients through the conventional surgery treatment as control group， with 16 patients in each group. The time of wound complete healing， positive rate of wound bacterial cultivation， degree of wound pain after surgery， the time of hospital stay and the quality of wound healing were compared and analyzed. Results In the case group， the time of wound complete healing was（14.68±0.88）days. The positive rate of wound bacterial cultivation 14 days after surgery was（3.25±0.45）% and it was（0.31±0.48）% 21 days after surgery. The wound pain score was（2.44±0.51）points 14 days after surgery and（0.31±0.46）points 21 days after surgery. The time of hospital stay was（20.66±0.86）days as well as the Sawada scar score （3.94±0.77）. In the control group， the time of wound complete healing was （20.48±0.96） days. The positive rate of wound bacterial cultivation 14 days after surgery was（5.44±0.81）% and it was （2.19±0.78）% 21 days after surgery. The wound pain score was（4.06±0.77）points 14 days after surgery and（1.75±0.46）points 21 days after surgery. The time of hospital stay was （28.18±1.38）days and the Sawada scar score（6.94±0.78）points. There was significant difference between two groups（P<0.01）. Conclusion There were many clinical advantages in applying the new surgery treatment of deep second-degree burn wound of medium and small area. It would be a good choice for patients with deep second-degree burn of medium and small area.

[Key words] Thinning tangential excision of eschar；Gridding scratch operation；VSD；Deep second-degree burn of medium and small area；Wound healing

烧伤治疗包括液体复苏、防治感染、创面修复、后期功能康复四个阶段，而烧伤创面的外科治疗始终贯穿于烧伤治疗的整个阶段，不同深度烧伤创面的治疗各有其临床特点。深Ⅱ度烧伤治疗一直是烧伤治疗的重点及难点，其处理方法不同于Ⅰ度、浅Ⅱ度或Ⅲ度烧伤，因为深Ⅱ度烧伤创面有其独特的病理学特征[1]，其间生态组织理论上具有很强的可塑性，存在向浅Ⅱ度烧伤创面转化的潜能，最后自行修复。……