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众所周知,深Ⅱ度烧伤可对皮肤真皮层造成损伤,易引发全身感染,增加创面脓毒症几率,且创面恢复后易留瘢痕,除了外观影响外,还可能影响肢体功能,给病人身心带来伤害,甚至致残或自杀[1]。为此,采取何种方式修复创面一直为烧伤干预重点。目前创面修复不仅要治愈创面,而且要求减少瘢痕形成,改善创面外观。近年来表皮生长因子凝胶制剂等外源性细胞因子在烧伤创面修复中应用较多,可促上皮细胞再生、增殖,加速创面愈合[2-3]。但深Ⅱ度烧伤创面溶痂为细菌繁殖创造条件,易感染,而外源性细胞因子抗感染能力不足。为此,对深Ⅱ度烧伤创面建议联合抗感染药物干预[4]。纳米银具有广谱抗菌作用,抗菌作用强,将其作为敷料用于烧伤创面治疗能快速释放纳米银离子,快速杀灭创面细菌、真菌等,控制感染的同时能止痛,且能增强外源性表皮生长因子的作用,减少创面愈合时间。本研究对深Ⅱ度烧伤病人创面行纳米银敷料联合表皮生长因子凝胶制剂治疗,效果较为理想。现作报道。
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观察组治疗4 d创面痂皮慢慢变软,和基底相接的纤维条索变少;治疗6 d大多数痂壳慢慢脱落;治疗8 d病人创面痂皮基本溶解,基底鲜红色,深层肉芽组织快速增多,创缘附近上皮化明显。典型病例图片见图 1、2。对照组治疗4 d创面和基底坏死组织形成干痂;治疗6 d病人创面比较干燥,部分黄白色坏死组织变成黄黑色,坏死组织尚未脱落;治疗8 d病人创面干痂慢慢软化;治疗10 d可见基底肉芽组织生长,干痂慢慢脱落。典型病例图片见图 3、4。
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治疗前,2组病人VAS评分差异无统计学意义(P>0.05);治疗后2组VAS评分明显低于治疗前(P < 0.01),且观察组明显低于对照组(P < 0.01)(见表 1)。
分组 n 治疗前 治疗后 t P 观察组 78 7.55±1.24 2.15±0.60 51.84 < 0.01 对照组 78 7.49±1.31 4.03±0.75 29.67 < 0.01 t — 0.29 17.29 — — P — >0.05 < 0.01 — — 表 1 2组病人治疗前后VAS评分比较($\overline x \pm s$;分)
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观察组治疗1周、2周创面溶痂率均明显高于对照组(P < 0.01)(见表 2);2组病人治疗3周、4周创面溶痂率均100%。
分组 n 治疗1周 治疗2周 观察组 78 76.45±7.12 96.72±3.05 对照组 78 60.00±8.13 87.35±6.24 t — 13.44 11.92 P — < 0.01 < 0.01 表 2 2组病人创面溶痂率比较($\overline x \pm s$;%)
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观察组完全溶痂时间、创面愈合时间均明显短于对照组(P < 0.01)(见表 3)。
分组 n 完全溶痂时间 创面愈合时间 观察组 78 8.00±2.93 19.35±3.08 对照组 78 12.56±3.60 23.84±4.76 t — 8.68 7.00 P — < 0.01 < 0.01 表 3 2组病人完全溶痂时间、创面愈合时间比较($\overline x \pm s$;d)
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观察组创面细菌阳性率为11.54%,低于对照组的24.36%(χ2=4.35,P < 0.05)。共28例病人创面细菌阳性,主要为铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌(见表 4)。
菌株 菌株数/株 构成比/% 铜绿假单胞菌 10 30.30 金黄色葡萄球菌 8 24.24 大肠埃希菌 6 18.18 鲍曼不动杆菌 5 15.15 其他 4 12.12 合计 33 100.00 表 4 28例细菌阳性病人菌株分布情况
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治疗前2组病人创面MMP-1、MMP-2表达水平比较差异无统计学意义(P>0.05);与治疗前比较,治疗2周2组病人MMP-1、MMP-2表达水平均明显下降,且观察组均明显低于对照组(P < 0.01)(见表 5)。
分组 n MMP-1 MMP-2 治疗前 观察组 78 4 493.50±251.00 2 760.10±213.45 对照组 78 4 500.00±264.72 2 752.50±256.34 t — 0.16 0.20 P — >0.05 >0.05 治疗2周 观察组 78 1 650.00±168.30** 1 500.00±150.25** 对照组 78 3 012.50±203.34** 1 998.47±168.98** t — 45.59 19.47 P — < 0.01 < 0.01 组内配对t检验:**P < 0.01 表 5 2组病人治疗前后创面MMP-1、MMP-2光密度值比较($\overline x \pm s$)
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对照组病人主观感觉到烧灼感1例,30 min后自行缓解,2组病人均无过敏反应出现。2组病人血常规检查未发现与药物相关的不良反应。
纳米银敷料联合表皮生长因子凝胶制剂对深Ⅱ度烧伤创面溶痂及愈合的影响
Effect of nanometer silver dressing combined with epidermal growth factor gel on the wound dissolved scab and healing of deep Ⅱ degree burn
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摘要:
目的 分析纳米银敷料联合表皮生长因子凝胶制剂在深Ⅱ度烧伤创面治疗中的应用效果。 方法 按随机数字表法将156例深Ⅱ度烧伤病人分为观察组与对照组,各78例。观察组病人清创后给予纳米银敷料联合表皮生长因子凝胶制剂治疗,对照组病人清创后给予表皮生长因子凝胶制剂治疗。换药时观察创面情况。比较2组病人治疗前、治疗后1周创面视觉模拟评分(VAS)、治疗1周、2周、3周、4周创面溶痂率、细菌培养阳性率及完全溶痂时间、创面愈合时间,治疗前、治疗2周通过免疫组织化学法测定基质金属蛋白酶(MMP)-1、MMP-2表达,并记录治疗前后相关不良反应发生情况。 结果 观察组治疗4 d创面痂皮变软,6 d大部分痂壳脱落,8 d创面痂皮基本溶解;对照组治疗4 d创面干痂形成,6 d创面干燥,部分坏死组织呈黄黑色,但尚未脱落,8 d干痂逐渐软化,10 d干痂逐渐脱落,基底肉芽组织生长。治疗后2组VAS评分明显低于治疗前(P < 0.01),且观察组明显低于对照组(P < 0.01)。观察组治疗1周、2周创面溶痂率均明显高于对照组(P < 0.01)。观察组完全溶痂时间、创面愈合时间均明显短于对照组(P < 0.01)。观察组创面细菌阳性率为11.54%,低于对照组的24.36%(P < 0.05)。与治疗前比较,治疗2周2组病人MMP-1、MMP-2表达水平均明显下降,且观察组均明显低于对照组(P < 0.01)。 结论 纳米银敷料联合表皮生长因子凝胶制剂治疗深Ⅱ度烧伤创面溶痂率高,创面愈合时间较短,其机制可能与抑制创面MMP-1、MMP-2表达相关。 -
关键词:
- 烧伤 /
- 纳米银敷料 /
- 表皮生长因子凝胶制剂 /
- 溶痂
Abstract:Objective To analyze the effects of nanometer silver dressing combined with epidermal growth factor gel on the wound treatment of deep Ⅱ degree burn. Methods One hundred and fifty-six patients with deep Ⅱ degree burn were randomly divided into the observation group and control group by digital table method (78 cases in each group).After the debridement, the observation group was treated with nanometer silver dressing combined with epidermal growth factor gel, and the control group was treated with epidermal growth factor gel.The wound surface condition was observed at changing the dressing.The visual analogue scale (VAS) of wound before and after 1 week of treatment, scab solubility of wound surface after 1, 2, 3 and 4 weeks of treatment, positive rate of bacterial culture, time of completing dissolution and healing time of wound were compared between two groups.The expression levels of matrix metalloproteinase-1 and 2 (MMP-1 and MMP-2) in two groups before and after 2 weeks of treatment were detected using immunohistochemistry.The incidence rates of adverse reactions before and after treatment were recorded. Results In the observation group, the wound scab skin became soft on the 4th day, most of the scab shell fell off on the 6th day, and the wound scab skin basically dissolved on the 8th day.In the control group, the dry scab wound formed on the 4th day, the wound became dry on the 6th day, some necrotic tissues were yellowish black, but not yet shed, the dry scab gradually softened on the 8th day, and the dry scab gradually fell off and basal granulation tissue grew on the 10th day.After treatment, the VAS scores in two groups were significantly lower than that before treatment (P < 0.01), and which in observation group was significantly lower than that in control group (P < 0.01).The wound dissolving rates in observation group at 1 and 2 weeks after treatment were significantly higher than that in control group (P < 0.01).The dissolution time and wound healing time in observation group were significantly shorter than those in control group (P < 0.01).The positive rate of bacteria in observation group (11.54%) was significantly lower than that in control group (24.36%) (P < 0.05).Compared with before treatment, the expression levels of MMP-1 and MMP-2 in two groups significantly decreased, and which in observation group were significantly lower than those in control group (P < 0.01). Conclusion The nanometer silver dressing combined with epidermal growth factor gel in the treatment of the wound of deep Ⅱ degree burn has high dissolving rate of scab and short wound healing time, the mechanism of which may be related to the expression inhibition of MMP-1 and MMP-2 in wounds. -
Key words:
- burn /
- nanometer silver dressing /
- epidermal growth factor gel /
- dissolved scab
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表 1 2组病人治疗前后VAS评分比较(
;分)$\overline x \pm s$ 分组 n 治疗前 治疗后 t P 观察组 78 7.55±1.24 2.15±0.60 51.84 < 0.01 对照组 78 7.49±1.31 4.03±0.75 29.67 < 0.01 t — 0.29 17.29 — — P — >0.05 < 0.01 — — 表 2 2组病人创面溶痂率比较(
;%)$\overline x \pm s$ 分组 n 治疗1周 治疗2周 观察组 78 76.45±7.12 96.72±3.05 对照组 78 60.00±8.13 87.35±6.24 t — 13.44 11.92 P — < 0.01 < 0.01 表 3 2组病人完全溶痂时间、创面愈合时间比较(
;d)$\overline x \pm s$ 分组 n 完全溶痂时间 创面愈合时间 观察组 78 8.00±2.93 19.35±3.08 对照组 78 12.56±3.60 23.84±4.76 t — 8.68 7.00 P — < 0.01 < 0.01 表 4 28例细菌阳性病人菌株分布情况
菌株 菌株数/株 构成比/% 铜绿假单胞菌 10 30.30 金黄色葡萄球菌 8 24.24 大肠埃希菌 6 18.18 鲍曼不动杆菌 5 15.15 其他 4 12.12 合计 33 100.00 表 5 2组病人治疗前后创面MMP-1、MMP-2光密度值比较(
)$\overline x \pm s$ 分组 n MMP-1 MMP-2 治疗前 观察组 78 4 493.50±251.00 2 760.10±213.45 对照组 78 4 500.00±264.72 2 752.50±256.34 t — 0.16 0.20 P — >0.05 >0.05 治疗2周 观察组 78 1 650.00±168.30** 1 500.00±150.25** 对照组 78 3 012.50±203.34** 1 998.47±168.98** t — 45.59 19.47 P — < 0.01 < 0.01 组内配对t检验:**P < 0.01 -
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