蒋朔 李云飞 陈莉 雷云 李永忠

[摘要]目的：探討可调节负压创面治疗技术（Regulated negative pressure-assisted wound therapy，RNPT）联合局部应用中药大黄对深Ⅱ度烧烫伤创面的治疗效果及安全性。方法：选择医院2016年1月-2018年12月收治的90例深Ⅱ度烧烫伤患者作为研究对象，按照入院顺序进行编号，采用随机数字表法随机分为观察组和对照组，每组各45例。对照组给予RNPT治疗，观察组给予RNPT联合大黄外敷治疗，比较两组创面完全愈合时间、治疗3周后愈合情况和临床疗效，以及生长因子、炎症因子和脂质过氧化反应指标，并观察其安全性。结果：观察组创面完全愈合时间显著低于对照组，差异有统计学意义（P<0.05）。治疗3周后，观察组治愈率和创面愈合率显著高于对照组，中医证候积分显著低于对照组，差异均有统计学意义（P<0.05）。治疗1周、3周后两组血清肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-1β（IL-1β）均显著降低，且观察组显著低于同期对照组，差异均有统计学意义（P<0.05）。治疗1周、3周后观察组血清碱性成纤维细胞生长因子（bFGF）、血管内皮细胞生长因子（VEGF）显著升高，且高于同期对照组，差异均有统计学意义（P<0.05）。治疗3周后，两组超氧化物歧化酶（SOD）均显著提高，且观察组显著高于对照组，差异均有统计学意义（P<0.05）;两组丙二醛（MDA）显著降低，且观察组低于对照组，差异均有统计学意义（P<0.05）。结论：RNPT联合局部应用中药大黄治疗深Ⅱ度烧烫伤创面能明显缩短创面愈合时间，提供临床治疗效果，安全性高，可能与促进生长因子分泌，抑制炎症反应和脂质过氧化反应有关。

[关键词]烧烫伤创面;可调节负压创面治疗技术;大黄;疗效;安全性

[中图分类号]R644    [文献标志码]A    [文章编号]1008-6455（2021）06-0005-04

Efficacy and Safety of Regulated Negative Pressure-assisted Wound Therapy （RNPT） Combined with Local Application of Rheum Officinale on Deep Second Degree Burn Wounds

JIANG Shuo，LI Yun-fei，CHEN Li，LEI Yun，LI Yong-zhong

（Department of Burn Plastic and Aesthetic Surgery，Deyang People's Hospital，Deyang 618000，Sichuan，China）

Abstract： Objective  To investigate the efficacy and safety of regulated negative pressure-assisted wound therapy （RNPT） combined with rheum officinale in treating deep second degree burn wounds. Methods  90 patients with deep second degree burn and scald admitted to our hospital from January 2016 to December 2018 were selected as the study subjects，randomly divided into the observation group and the control group with 45 cases in each group. The control group was treated with RNPT， while the observation group was treated with RNPT combined with rheum officinale external application. The time of complete wound healing， healing after 3 weeks of treatment， clinical efficacy， growth factor， inflammatory factor and lipid peroxidation were compared between the two groups. Results  The time of complete wound healing in the observation group was significantly lower than that in the control group， the difference was statistically significant （P<0.05）. After 3 weeks of treatment， the healing rate and wound healing rate in the observation group were significantly higher than those in the control group （P<0.05）. And the score of TCM syndromes was significantly lower than that of the control group （P<0.05）. After one week and 3 weeks of treatment， the levels of serum TNF-α， IL-6， IL-1β in the two groups were significantly decreased （P<0.05）， and those in the observation group were significantly lower than those in the control group （P<0.05）. After one week and 3 weeks of treatment， the serum basic fibroblast growth factor （bFGF） and vascular endothelial growth factor （VEGF） in the observation group were significantly higher than those in the control group at the same period （P<0.05）. After 3 weeks of treatment， SOD in the two groups were significantly increased， and the observation group was significantly higher than the control group （P<0.05）. MDA in the two groups were significantly decreased， and the observation group was significantly lower than the control group （P<0.05）. Conclusion  RNPT combined with local application of rheum officinale can significantly shorten the healing time of deep II degree burn wounds. It may be related to promoting the secretion of growth factors， inhibiting inflammation and lipid peroxidation.

Key words： burn and scald wound; regulated negative pressure-assisted wound therapy （RNPT）; rheum officinale; curative effect; safety

烧烫伤是指因热力、电、放射线或化学物质等作用于人体皮肤而引起皮肤损伤，包括表皮、黏膜、皮下组织等多种损伤[1]，是临床常见和多发的复杂外伤疾病。全球每年约有超过20万人死于烧烫伤，我国每年约有超过2 000万人发生不成程度的烧烫伤，造成了严重的经济负担和社会负担。相关研究表明，目前我国人群烧烫伤疾病负担相较于上世纪90年代有所下降，但儿童和老人烧烫伤负担相对提高，且男性烧烫伤负担高于女性[2]。烧烫伤患者皮肤防御功能被破坏，创面存在大量坏死组织和细胞，容易造成感染，及时有效地促进烧烫伤创面修复是治疗的基本原则。抗生素、手术等是治疗烧烫伤的常见方式，近年……