CAJ | 학술논문

目的：研究早期大面积深Ⅱ度烧伤磨痂与烧伤感染的关系。方法对35例烧伤面积＞30％且创面以深Ⅱ度烧伤为主的烧伤患者，进行前瞻性研究。按对创面处理的方式不同，将其分为早期磨痂组和保痂组。保痂组17例，用苯扎溴铵简单清创，创面用磺胺嘧啶银乳膏包扎处理，并上悬浮床或翻身床，换药治疗。早期磨痂组18例，休克纠正后，48 h内在全麻下行磨痂术，用钢丝球磨除创面的坏死组织，刚好有小出血点为止，创面冲洗后，再用术尔泰纱布湿敷，最后将生物敷料（脱细胞猪皮）覆盖创面，外层用纳米银纱布加压包扎。比较两组患者全身炎症反应综合征及脓毒症发生率，以及内毒素（LPS）、TNF-α、IL-6、IL-8的动态变化。结果早期磨痂组，磨痂时间在伤后48 h以内，磨痂面积30％～60％，平均愈合时间为14．1 d，保痂组平均愈合间为19．8 d；磨痂组全身炎症反应综合征及脓毒发生率为31％，低于保痂组的85％。 LPS、IL-6、IL-8同时低于保痂组。结论大面积深Ⅱ度烧伤早期全麻下磨痂，不仅能缩短创面愈合时间，而且降低创面感染及全身感染。
목적：연구조기대면적심Ⅱ도소상마가여소상감염적관계。방법대35례소상면적＞30％차창면이심Ⅱ도소상위주적소상환자，진행전첨성연구。안대창면처리적방식불동，장기분위조기마가조화보가조。보가조17례，용분찰추안간단청창，창면용광알밀정은유고포찰처리，병상현부상혹번신상，환약치료。조기마가조18례，휴극규정후，48 h내재전마하행마가술，용강사구마제창면적배사조직，강호유소출혈점위지，창면충세후，재용술이태사포습부，최후장생물부료（탈세포저피）복개창면，외층용납미은사포가압포찰。비교량조환자전신염증반응종합정급농독증발생솔，이급내독소（LPS）、TNF-α、IL-6、IL-8적동태변화。결과조기마가조，마가시간재상후48 h이내，마가면적30％～60％，평균유합시간위14．1 d，보가조평균유합간위19．8 d；마가조전신염증반응종합정급농독발생솔위31％，저우보가조적85％。 LPS、IL-6、IL-8동시저우보가조。결론대면적심Ⅱ도소상조기전마하마가，불부능축단창면유합시간，이차강저창면감염급전신감염。
Objective To investigate the relationship between early eschar grinding and infection in the patients with large area of deep partial thickness burns. Methods Prospective studies were conducted in 35 patients with more than 30% TBSA of deep partial thickness burns. The patients were divided into eschar grinding group (EG group) and conservative care group (CC group) according to the different treatments regimes. The burn wounds of 17 patients in CC group were treated with 0.2% bromogeramine solution and 1% sulfadiazine silver cream,and changed dressings everyday. The 18 patients in EG group were treated with dermabrasion under general anesthesia within 48 hours after admission. The occurrence of systemic inflammatory response syndrome (SIRS) and sepsis,development of serum lipopolysaccharide (LPS),TNF-α,IL-6,and IL-8 were compared between the two groups. Results The patients in EG group were healed averagely within 14.1 days,while those in CC group within 19.8 days. The incidence rate of SIRS and sepsis in EG group was 31%,lower than that of CC group(85%). The serum levels of LPS, IL-6 and IL-8 of EG group were also lower than CC group. Conclusion Early eschar grinding of large area deep partial thickness burns under general anesthesia not only can shortenwound healing time but avoid burn wound and systemic infection.