刘虎 柯家祥 边曦

[摘要]目的：探讨切削痂植皮术联合纳米银敷料在面部深度烧伤患者中的应用效果。方法：选取2017年1月-2018年1月笔者医院烧伤外科收治的面部深Ⅱ度、Ⅲ度烧伤患者84例，随机分为2组，每组42例。实验组切削痂植皮术后应用纳米银敷料覆盖创面，对照组应用传统无菌凡士林敷料覆盖。比较两组患者治疗效果、创面愈合时间、发热持续时间、术后VAS疼痛评分及第7、14天创面病原菌感染情况。结果：实验组治疗总有效率为97.62%高于对照组的80.95%，差异有统计学意义（P<0.05）。实验组创面愈合时间、发热持续时间及VAS评分均低于对照组，差异有统计学意义（P<0.05）。术后第7、14天实验组感染例数均少于对照组，差异有统计学意义（P<0.05）。结论：切削痂植皮术后联合应用纳米银敷料治疗面部深度烧伤创面，可提高治疗有效率，降低感染率，效果较好。

[关键词]纳米银敷料；深度烧伤；切削痂植皮术；治疗效果；安全性

[中图分类号]R622 [文献标志码]A [文章编号]1008-6455（2018）06-0001-03

Abstract： Objective To explore the clinical effects of scab cutting and skin grafting combined with nano silver dressing in the treatment of severe burns in face. Methods 84 patients with facial deep second degree and third degree burn admitted to our hospital from January 2017 to January 2018 were randomly divided into 2 groups， 42 cases in each group. In the experimental group， the wound was covered with nano silver dressing after scab cutting and skin grafting. The control group were covered with traditional sterile vaseline dressing. The treatment effect， wound healing time， duration of fever， postoperative VAS pain score and pathogen infection on the 7 and 14 days were compared between the two groups. Results The total effective rate of the experimental group was 97.62%， which was higher than that of the control group（80.95%）， the difference was statistically significant（P<0.05）. The wound healing time， duration of fever and VAS score in the experimental group were lower than those in the control group（P<0.05）. On the 7d and 14d after operation， the number of infection cases in the experimental group was less than that in the control group（P<0.05）. Conclusion The application of scab cutting and skin grafting combined with nano silver dressing in the treatment of deep facial burns can improve the effective rate and reduce the infection rate， has a good clinical effect.

Key words： nano-silver dressing； deep burn； scab cutting and skin grafting； efficacy； safety

烧伤主要是指热液、热气、火焰以及炽热的金属等引起的皮肤和黏膜甚至更深层组织的损害[1]。面部作为人体经常裸露部位受到烧伤损害的几率更大，面部烧伤在临床中更多见。由于该部位重要器官、血管及神经走形较多，若产生瘢痕增生不仅会影响患者的外貌以及心理健康，还会因为瘢痕畸形而影响器官的正常功能，因此提高面部深度烧伤的治疗效果将大大改善患者术后生活质量[2]。目前笔者医院对深度面部烧伤患者，主要应用早期切削痂植皮术治疗，该术式能在保障自身植皮存活率的同时降低创面出血、感染、瘢痕增生畸形等术后并发症的发生。纳米银敷料可以有效抑制各类病原菌繁殖，降低感染风险，促进创面愈合，已逐渐应用于临床[3-4]。本研究将面部深度烧伤患者随机分为2组，实验组行切削痂植皮术联合纳米银敷料治疗，对照组切削痂植皮术后应用传统无菌凡士林敷料，对比两组患者术后恢复情况，报道如下。……