CAJ | 학술논문

目的观察手术早期不上止血带削痂对修复深Ⅱ度烧伤创面的临床效果.方法 32例大面积深Ⅱ度烧伤患者,均在伤后24h内手术.对各项休克复苏指标稳定的患者,术中不上止血带直接进行创面的薄层削痂,以见到均匀点状出血为度.用肾上腺素等渗生理盐水纱布覆盖止血,覆盖异种脱细胞真皮.统计并记录患者每1％TBSA创面削痂的术中出血量、手术时间以及手术前后的体温变化、创面愈合时间、创面愈合质量及瘢痕挛缩程度,并与术中上止血带的相关文献资料进行对比分析.结果 32例患者中31例完成全部观察过程.患者每1％ TBSA创面削痂手术的平均出血量为(8.8±0.9)ml,手术时间为(0.52±0.06) min；伤后5d体温为(37.7±0.7)℃,明显低于伤后24h的(38.6±0.6)℃(t =0.42,P＜0.05)；创面愈合时间为(25.2±2.2)d；手术时间、伤后5d体温、创面愈合时间与术中上止血带的相关文献资料相比差异均有统计学意义(均P＜0.05).伤后3个月的创面愈合质量评价100％为佳；伤后6个月创面有瘢痕增生、轻度挛缩,但关节活动自如无功能障碍.结论深Ⅱ度烧伤创面手术不上止血带薄层削痂出血少、手术时间短、操作简单,术后修复效果良好.
목적 관찰수술조기불상지혈대삭가대수복심Ⅱ도소상창면적림상효과.방법 32례대면적심Ⅱ도소상환자,균재상후24h내수술.대각항휴극복소지표은정적환자,술중불상지혈대직접진행창면적박층삭가,이견도균균점상출혈위도.용신상선소등삼생리염수사포복개지혈,복개이충탈세포진피.통계병기록환자매1％TBSA창면삭가적술중출혈량、수술시간이급수술전후적체온변화、창면유합시간、창면유합질량급반흔련축정도,병여술중상지혈대적상관문헌자료진행대비분석.결과 32례환자중31례완성전부관찰과정.환자매1％ TBSA창면삭가수술적평균출혈량위(8.8±0.9)ml,수술시간위(0.52±0.06) min；상후5d체온위(37.7±0.7)℃,명현저우상후24h적(38.6±0.6)℃(t =0.42,P＜0.05)；창면유합시간위(25.2±2.2)d；수술시간、상후5d체온、창면유합시간여술중상지혈대적상관문헌자료상비차이균유통계학의의(균P＜0.05).상후3개월적창면유합질량평개100％위가；상후6개월창면유반흔증생、경도련축,단관절활동자여무공능장애.결론 심Ⅱ도소상창면수술불상지혈대박층삭가출혈소、수술시간단、조작간단,술후수복효과량호.
Objective To explore the clinical efficacy of tangential excision of deep partial thickness burn wound without tourniquet during an early stage.Methods A total of 32 patients with a large area of deep partial thickness burn wounds were operated within 24 h post-burn.The lamellar tangential excision was on the basis of stable index of resuscitation from shock without tourniquet. And the depth of tangential excision was achieved to the extent of uniform punctate hemorrhage on burn wounds.Xenogenic acellular dermal matrix was applied after hemostasis with diluted adrenaline.The intraoperative blood loss volumes,operative durations,pre- & post-operative temperatures,length of wound healing,the quality of wound healing and the contracture extent of scars of 1％ TBSA ( total body surface area) wound were recorded and compared with the published data.Results Thirty-one patients completed the whole clinical observation.The intraoperative blood loss volume of 1％ TBSA wound was ( 8.8 ± 0.9) ml,the operative duration of 1％ TBSA wound was ( 0.52 ± 0.06 ) min,the temperature at Day 5 was ( 37.7 ± 0.7 ) ℃ and it was significantly lower than that at 24 h [ (38.6 ± 0.6) ℃ ] ( t =0.42,P ＜ 0.05),the length of wound healing was (25.2 ± 2.2) d.There were significantly statistical differences in terms of the operative durations,the temperature at Day 5 and the length of wound healing with the corresponding literature reports with intraoperative uses of tourniquets (all P＜0.05).The percentage of the quality of wound healing was 100％ at Month 3.The development of scar proliferation were observed in varying degrees.Mild contracture of wounds appeared after 6 month post-burn. But all joints could move with ease and had no obvious dysfunction.Conclusion Lamellate tangential excision of deep partial thickness burn wound during an early stage without tourniquet have advantages of smaller volumes of intraoperative blood loss,shorter operation duration and simpler procedures.Also the depth of tangential excision is easier to control so as to enhance the quality of wound healing.