刘礼平 邓涛 朱鹏

【摘要】 目的：比较中面积深Ⅱ度烧伤患者应用削痂清创与水刀清创治疗的临床效果。方法：选取2021年1月—2023年3月吉安市中心人民医院收治的中面积深Ⅱ度烧伤患者，共82例，按照随机数字表法分成水刀清创组（41例）与削痂清创组（41例）。水刀清创组采用水刀清创治疗，削痂清创组采用削痂清创治疗。比较两组临床指标、预后情况、创面愈合质量、炎症因子及疼痛介质。结果：水刀清创组每1%面积清创时间、创面愈合时间、住院时间均较削痂清创组短，创面细菌菌落数更少，差异均有统计学意义（P<0.05）。相较削痂清创组，水刀清创组二次清创率更低，差异有统计学意义（P<0.05）。相较削痂清创组，水刀清创组改良温哥华瘢痕评估量表（mVSS）评分均更低，差异均有统计学意义（P<0.05）。治疗后，两组降钙素原（PCT）、C反应蛋白（CRP）水平均较治疗前下降，相较削痂清创组，水刀清创组均更低，差异均有统计学意义（P<0.05）。治疗后，两组5-羟色胺（5-HT）、神经肽Y（NPY）水平均较治疗前下降，相较削痂清创组，水刀清创组均更低，差异均有统计学意义（P<0.05）。结论：与削痂清创比较，中面积深Ⅱ度烧伤患者应用水刀治疗的效果更好，能够改善临床指标及预后情况，促进创面良好愈合，调节炎症因子、疼痛介质水平。

【关键词】 中面积深Ⅱ度烧伤创面 削痂清创 水刀

Comparison of Clinical Effects between Scab Removal and Debridement and Water Knife Debridement Treatment for Moderate Area Deep Ⅱ Degree Burn Wounds/LIU Liping， DENG Tao， ZHU Peng. //Medical Innovation of China， 2024， 21（15）： -135

[Abstract] Objective： To compare the clinical effects of scab removal debridement and water knife debridement treatment on patients with medium area deep Ⅱ degree burns. Method： A total of 82 patients with moderate area deep Ⅱ degree burns who were admitted in Jian Central Hospital from January 2021 to March 2023 were selected and divided into the water knife debridement group （41 cases） and the scab removal debridement group （41 cases） by random number table method. The water knife debridement group was treated with water knife debridement， while the scab removal debridement group was treated with scab removal debridement. Clinical indicators， prognosis， wound healing quality， inflammatory factors and pain mediators were compared in both groups. Result： In comparision of the scab removal debridement group， debridement time per 1% area， wound healing time， and hospital stay time in the water knife debridement group were shorter， bacterial colonies on the wound surface was fewer， the differences were statistically significant （P<0.05）. In comparision of the scab removal debridement group， the secondary debridement rate of the water knife debridement group was lower， the difference was statistically significant （P<0.05）. In comparision of the scab removal debridement group， the modifier vancouver scar scale （mVSS） scores in the water knife debridement group were lower， the differences were statistically significant （P<0.05）. After treatment， the procalcitonin （PCT） and C reactive protein （CRP） levels in both groups were decreased compared to those before treatment， and in comparision of the scab removal debridement group， those in the water knife debridement group were lower， the differences were statistically significant （P<0.05）. After treatment， the 5-hydroxy tryptamine （5-HT） and neuropeptide Y （NPY） levels in both groups were decreased compared to those before treatment， and in comparision of the scab removal debridement group， those in the water knife debridement group were lower， the differences were statistically significant （P<0.05）. Conclusion： Compared with scab removal and debridement， the use of water knife therapy for patients with medium area deep Ⅱ degree burns has a better effect， which can improve clinical indicators and prognosis， promote good wound healing， and regulate the levels of inflammatory factors and pain mediators.

[Key words] Medium area deep Ⅱ degree burn wound Scab removal and debridement Water knife

First-author's address： Department of Burn and Plastic Surgery， Jian Central Hospital， Jian 343000， China

doi：10.3969/j.issn.1674-4985.2024.15.031

烧伤主要由火焰、热液、高温气体等引起，患者皮肤及黏膜组织受到损害，严重时可伤及皮下组织，需要通过植皮手术来修复组织缺损、矫正外部畸形[1]。削痂清创治疗可利用手术刀、削痂刀等锐性手术器械清理创面，为植皮手术的顺利进行创造良好条件，但清创过程费时费力，效率较低，且难以准确控制清创深度，容易出现清创过深或过浅的问题[2]。水刀治疗主要利用高压、高速水流分离组织，能够对感染坏死的组织进行切除、冲洗和回吸收，但受到烧伤创面复杂性的影响，水刀治疗对不同部位及深度创面的清创效果存在差异[3]。中面积深Ⅱ度烧伤创面存在坏死组织与健康组织界限不清的情况，清创难度相对较大，深入探析削痂清创与水刀治疗的疗效差异，有助于临床上合理选择清创方式[4]。本研究对82例中面积深Ⅱ度烧伤患者进行分析，旨在比较削痂清创与水刀治疗的临床效果，详情如下。……