廖米荣 王慧利 郭正祥

[摘要] 目的 探討纳米银敷料联合重组牛碱性成纤维细胞生长因子对深Ⅱ度烧伤创面炎性因子及EGF、VEGF表达的影响。 方法 纳入本院烧伤科2013年1月～2017年12月收治的96例深Ⅱ度烧伤患者的临床资料为研究对象，将所纳入的对象按照随机数表法分为对照组和观察组，每组48例。比较两组患者创面愈合时间、创面愈合率、血清IL-1β及TNF-α水平。 结果 ①观察组创面愈合时间明显低于对照组（P<0.05）；观察组治疗后创面细菌培养阳性率明显低于对照组（P<0.05）；②两组患者治疗后创面愈合率随时间的延长而明显升高（P<0.05）；观察组在各时间点创面愈合率明显高于对照组（P<0.05）；③治疗后两组IL-1β以及TNF-α水平均明显下降，观察组明显低于对照组（P<0.05）；④两组患者EGF、VEGF表达水平在治疗后第1、7、14天呈上升趋势，在第14天达到峰值，在第14天之后开始呈下降趋势；在上升过程中观察组各时间点EGF、VEGF表达水平明显高于对照组（P<0.05），下降过程中观察组各时间点EGF、VEGF表达水平明显低于对照组（P<0.05）。结论 纳米银敷料联合重组牛碱性成纤维细胞生长因子对深Ⅱ度烧伤患者进行创面治疗，其对创面修复速度明显更快，创面愈合率更高，且可更大程度地预防感染，安全性更高。

[关键词] 深Ⅱ度烧伤；纳米银敷料；重组牛碱性纤维细胞生长因子；炎性因子

[中图分类号] R644 [文献标识码] B [文章编号] 1673-9701（2018）30-0089-04

[Abstract] Objective To investigate the effects of nano-silver dressing combined with recombinant bovine basic fibroblast growth factor on the expression of inflammatory factors， EGF and VEGF in deep second degree burn wounds. Methods The clinical data of 96 patients with deep second degree burns who were admitted to the department of burns in our hospital from January 2013 to December 2017 were included as the study subjects. The included subjects were divided into the control group and the observation group according to the random number table method， with 48 cases in each group. The wound healing time， the wound healing rate， the levels of IL-β and TNF-α were compared between two groups. Results ①The wound healing time in the observation group was significantly lower than that in the control group（P<0.05）； the positive rate of wound bacterial culture in the observation group was significantly lower than that in the control group（P<0.05）； ②The wound healing rate of the two groups of patients after treatment was increased significantly with the prolongation of time（P<0.05）； the wound healing rate in the observation group was significantly higher than that in the control group at each time point（P<0.05）； ③After treatment， the levels of IL-1β and TNF-α were significantly decreased in the two groups， and the observation group was significantly lower than the control group （P<0.05）； ④ the expression levels of EGF and VEGF in the two groups showed an increasing trend on the 1 d， 7 d and 14 d after treatment， and peaked on the 14 d. After 14d， it began to show a decreasing trend； the expression levels of EGF and VEGF in the observation group were significantly higher than those in the control group during the increasing process at each time point（P<0.05）. The expression levels of EGF and VEGF in the observation group were significantly lower than those in the control group during the decreasing process at each time point （P<0.05）. Conclusion Nano-silver dressing combined with recombinant bovine basic fibroblast growth factor is used for wound healing in the patients with deep second degree burns， and the repair speed of the wound is obviously faster， the wound healing rate is higher， the infection can be prevented to a greater extent， and the safety is higher.

[Key words] Deep second degree burn；Nano-silver dressing；Recombinant bovine basic fibroblast growth factor；Inflammatory factors

深Ⅱ度烧伤由于皮肤附件仍有部分残余，若无感染等并发症的出现一般可在4周内痊愈[1]。但由于烧伤创面自我修复的复杂性，在其恢复过程过程中往往会出现诸多不利因素，如感染等，严重影响皮肤的修复[2]。因此，对于深Ⅱ度烧伤患者，其创面是否能够快速愈合是影响患者治疗的效果的重要因素之一[3]。故而，如何选择创面外用药以加速其创面愈合、预防创面感染、提高临床效果是治疗的关键。纳米银敷料是临床运用较早的烧伤创面修复用药，具有修复创面、抗炎等作用，临床效果确切[4]。但调查显示，仅使用纳米银敷料对部分患者的创面愈合时间以及杀菌效果均不太理想[5]。因此，找寻更好的烧伤创面用药方案，对深Ⅱ度烧伤患者的治疗具有重要的意义。重组牛碱性成纤维细胞生长因子是一种多功能细胞生长因子，是近年来运用于烧伤创面修复的一种外用药物。……