目的:比较不同敷料对局部小面积烧伤创面的治疗效果。方法:按照纳入标准收集2017年12月~2020年1月期间在我院治疗的100例烧伤病人分为5组每组20例,采用传统磺胺嘧啶银纱布、银离子泡沫敷料、银离子海藻酸钙敷料、锌离子海藻酸钙敷料以及海藻酸钙敷料这五种不同的敷料对创面进行护理治疗,过程中观察记录创面愈合情况、创面感染情况、创缘炎症反应以及换药疼痛程度等与护理效果相关的各项指标,多重比较分析不同敷料各项指标的组间差异。结果:使用传统磺胺嘧啶银纱布和泡沫敷料的患者伤口愈合时间比三种海藻酸钙敷料长(P < 0.05);换药次数最多的是传统磺胺嘧啶银纱布组,其次是三种海藻酸钙敷料组,银离子泡沫敷料组的换药次数最少,这三组之间有显著的组间差异(P < 0.05);另外,这五种不同的敷料均未发生创面感染,并且只有传统磺胺嘧啶银纱布组发生了显著高于其他组的创缘炎症反应(P < 0.05);在换药疼痛程度的评价方面,其他四组的疼痛程度均小于传统磺胺嘧啶银纱布组(P < 0.05)。结论:泡沫敷料和海藻酸钙敷料均可替代传统的磺胺嘧啶银纱布敷料,海藻酸钙敷料能加速伤口愈合,而泡沫敷料由于换药次数少可以减少护理人力成本,另外,在一定条件下抗菌药物的使用可能是非必须的,因此可综合考虑具体情况使用不同功效不同材质的敷料。 Objective: To compare the therapeutic effect of different dressings on local small area burn wound. Methods: 100 cases of burn patients in our hospital from December 2017 to January 2020 were collected in accordance with the inclusion criteria. They were divided into 5 groups, 20 cases in each group. The traditional silver sulfadiazine (SSD), silver-containing foam dressing, silver-containing calcium alginate, zinc-containing calcium alginate and calcium alginate dressings of five different dressings on wound care and treatment, observe and record all indexes related to nursing effect, such as wound healing, wound infection, wound edge inflammation and dressing change pain, and the differences of various indexes of different dressings between groups were analyzed by multiple comparisons. Results: Patients using traditional SSD and foam dressings had longer wound healing times than those using three calcium alginate dressings (P < 0.05). The traditional SSD group had the most dressing changes, followed by the three calcium alginate dressing groups, and the silver-containing foam dressing group had the least dressing changes, indicating a significant difference between the three groups (P < 0.05). In addition, none of the five different dressings had wound infection, and only the traditional SSD group had significantly higher marginal inflammatory response than the other groups (P < 0.05). In the evaluation of the pain degree of dressing change, the pain degree of the other four groups was lower than that of the traditional SSD group (P < 0.05). Conclusion: Foam dressings and calcium alginate dressings can replace traditional SSD dressings, calcium alginate dressings can accelerate wound healing, and foam dressing due to low replacement frequency can reduce the nursing manpower cost; in addition, under certain conditions, the use of antimicrobial agents may be unnecessary. Therefore, dressings of different efficacy and different materials can be used comprehensively considering the specific situation.
目的:比较不同敷料对局部小面积烧伤创面的治疗效果。方法:按照纳入标准收集2017年12月~2020年1月期间在我院治疗的100例烧伤病人分为5组每组20例,采用传统磺胺嘧啶银纱布、银离子泡沫敷料、银离子海藻酸钙敷料、锌离子海藻酸钙敷料以及海藻酸钙敷料这五种不同的敷料对创面进行护理治疗,过程中观察记录创面愈合情况、创面感染情况、创缘炎症反应以及换药疼痛程度等与护理效果相关的各项指标,多重比较分析不同敷料各项指标的组间差异。结果:使用传统磺胺嘧啶银纱布和泡沫敷料的患者伤口愈合时间比三种海藻酸钙敷料长(P < 0.05);换药次数最多的是传统磺胺嘧啶银纱布组,其次是三种海藻酸钙敷料组,银离子泡沫敷料组的换药次数最少,这三组之间有显著的组间差异(P < 0.05);另外,这五种不同的敷料均未发生创面感染,并且只有传统磺胺嘧啶银纱布组发生了显著高于其他组的创缘炎症反应(P < 0.05);在换药疼痛程度的评价方面,其他四组的疼痛程度均小于传统磺胺嘧啶银纱布组(P < 0.05)。结论:泡沫敷料和海藻酸钙敷料均可替代传统的磺胺嘧啶银纱布敷料,海藻酸钙敷料能加速伤口愈合,而泡沫敷料由于换药次数少可以减少护理人力成本,另外,在一定条件下抗菌药物的使用可能是非必须的,因此可综合考虑具体情况使用不同功效不同材质的敷料。
泡沫敷料,海藻酸钙敷料,磺胺嘧啶银纱布,局部小面积烧伤,烧伤创面护理
Juan Li*, Dongmei He, Ying Liu, Dongye Yuan, Liangnan He, Chao Cai, Xuejuan Zhang, Yajing Wei, Ying Wang, Min An#
Department of Burn, Mianyang Central Hospital, Mianyang Sichuan
Received: Mar. 17th, 2022; accepted: Apr. 19th, 2022; published: Apr. 26th, 2022
Objective: To compare the therapeutic effect of different dressings on local small area burn wound. Methods: 100 cases of burn patients in our hospital from December 2017 to January 2020 were collected in accordance with the inclusion criteria. They were divided into 5 groups, 20 cases in each group. The traditional silver sulfadiazine (SSD), silver-containing foam dressing, silver-containing calcium alginate, zinc-containing calcium alginate and calcium alginate dressings of five different dressings on wound care and treatment, observe and record all indexes related to nursing effect, such as wound healing, wound infection, wound edge inflammation and dressing change pain, and the differences of various indexes of different dressings between groups were analyzed by multiple comparisons. Results: Patients using traditional SSD and foam dressings had longer wound healing times than those using three calcium alginate dressings (P < 0.05). The traditional SSD group had the most dressing changes, followed by the three calcium alginate dressing groups, and the silver-containing foam dressing group had the least dressing changes, indicating a significant difference between the three groups (P < 0.05). In addition, none of the five different dressings had wound infection, and only the traditional SSD group had significantly higher marginal inflammatory response than the other groups (P < 0.05). In the evaluation of the pain degree of dressing change, the pain degree of the other four groups was lower than that of the traditional SSD group (P < 0.05). Conclusion: Foam dressings and calcium alginate dressings can replace traditional SSD dressings, calcium alginate dressings can accelerate wound healing, and foam dressing due to low replacement frequency can reduce the nursing manpower cost; in addition, under certain conditions, the use of antimicrobial agents may be unnecessary. Therefore, dressings of different efficacy and different materials can be used comprehensively considering the specific situation.
Keywords:Foam Dressing, Calcium Alginate Dressing, SSD, Burns to a Small Area, Burn Wound Care
Copyright © 2022 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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局部小面积烧伤在急诊室相当常见,近半个世纪以来,使用1%磺胺嘧啶银(silver sulfadiazine, SSD)外敷后用纱布进行包扎并且每天更换的方法被认为是保守治疗烧伤创面的标准疗法 [
2017年12月~2020年1月在我院收治的100例烧伤病人,征得病人知情同意。纳入标准:1) 年龄18周岁以上;2) 浅II度创面或者较浅的深II创面,并且根据Lund-Browder分类 [
分组 | 年龄(岁) | 烫伤面积(%) |
---|---|---|
Group 1 | 37.71 ± 12.93 | 7.62 ± 1.72 |
Group 2 | 35.29 ± 11.37 | 7.89 ± 1.98 |
Group 3 | 39.67 ± 14.83 | 7.59 ± 1.08 |
Group 4 | 39.42 ± 12.84 | 7.56 ± 1.46 |
Group 5 | 38.09 ± 14.37 | 7.85 ± 1.67 |
表1. 烧伤患者一般资料比较( x ¯ ± s )
Group 1:使用1% SSD外敷后用纱布进行包扎,每日更换敷料;Group 2:使用银离子泡沫敷料,每7天更换1次敷料;Group 3:使用银离子海藻酸钙敷料,每4天更换1次敷料;Group 4:使用锌离子海藻酸钙敷料,每4天更换1次敷料;Group 5:使用海藻酸钙敷料,每4天更换1次敷料。
所有组别每次更换敷料时,观察记录以下指标:1) 创面愈合情况,以创面完全上皮化为判断依据记录创面完全愈合的最后天数;2) 创面感染情况,进行创面渗液细菌学培养检测,观察是否有细菌感染;3) 创缘炎症反应,换药时观察创面周边正常皮肤是否出现红肿;4) 换药疼痛程度,以视觉模拟评分法(visual analogue scale, VAS)让患者标出自己的疼痛程度,0代表无痛,10代表无法承受的最大疼痛。除Group 1每4天更换敷料时进行评价外,其余组别均是每次更换敷料时进行评价。5) 对其他如换药次数以及治疗过程中是否产生任何不适进行记录。
采用SPSS v.22软件进行统计学分析。计量资料以平均值 ± 标准差( x ¯ ± s )表示,多组间的疗效比较采用单因素方差分析中的LSD多重比较分析,P < 0.05表明有显著性差异。
比较5组不同敷料的治疗情况发现,在创面愈合时间方面,Group 1和Group 2之间没有显著差异,Group 3、Group 4和Group 5之间没有显著差异,Group 3、Group 4和Group 5三组的创面愈合时间显著低于Group 1和Group 2 (P < 0.05)。总体换药次数方面,Group 1换药次数最多,显著高于其他4组(P < 0.05),Group 2换药次数最少,显著低于其他4组(P < 0.05),Group 3、Group 4和Group 5三组之间没有显著差异,这三组的换药次数显著低于Group 1 (P < 0.05)并且显著高于Group 2 (P < 0.05) (见表2)。
另外,这5组均未发现创面感染情况。除Group 2和Group 4未观察到创缘炎症发生外,Group 1的创缘炎症发生例(率)为9/20(45%),Group 3的创缘炎症发生例(率)为1/20 (5%),Group 5的创缘炎症发生例(率)为2/20 (10%),Group 1的创缘炎症发生率显著高于其他4组(P < 0.05)。
分组 | 愈合时间(天) | 换药次数(次) |
---|---|---|
Group 1 | 13.53 ± 4.63a | 12.66 ± 3.64a |
Group 2 | 12.95 ± 5.88a | 1.98 ± 0.37b |
Group 3 | 8.63 ± 4.32b | 2.94 ± 1.26c |
Group 4 | 8.17 ± 5.31b | 2.68 ± 0.98c |
Group 5 | 8.39 ± 4.54b | 2.81 ± 0.90c |
表2. 不同敷料治疗情况的比较( x ¯ ± s )
注:LSD多重比较分析结果用不用的字母表示,字母标示相同的组间无显著差异(P > 0.05),字母标示不同的组间有显著差异(P < 0.05)。
比较5组敷药换药时的疼痛程度发现,Group 1患者的疼痛程度在第一次和第二次的VAS评分中均显著高于其他4组(P < 0.05),其他4组间没有显著差异。在进行第三次患者VAS评分时,Group 2只剩5例患者并且不到7天的换药周期已经痊愈,因此纳入评价的是最后一次揭下敷料的患者疼痛程度,Group 1、Group 3、Group 4和Group 5分别有16、4、7和6例患者纳入评价,Group 1患者的疼痛程度显著高于其他4组(P < 0.05),其他4组间没有显著差异(见表3)。
分组 | VAS 第一次评分 | VAS 第二次评分 | VAS 第三次评分 |
---|---|---|---|
Group 1 | 6.94 ± 2.09a | 6.29 ± 1.93a | 2.15 ± 0.55a |
Group 2 | 1.39 ± 0.45b | 1.25 ± 0.29b | 0.16 ± 0.07b |
Group 3 | 1.52 ± 0.42b | 1.28 ± 0.18b | 0.28 ± 0.08b |
Group 4 | 1.98 ± 0.58b | 1.56 ± 0.43b | 0.26 ± 0.03b |
Group 5 | 2.09 ± 0.56b | 1.26 ± 0.35b | 0.23 ± 0.05b |
表3. 不同敷料换药疼痛程度比较( x ¯ ± s )
注:LSD多重比较分析结果用不用的字母表示,字母标示相同的组间无显著差异(P > 0.05),字母标示不同的组间有显著差异(P < 0.05)。
局部小面积烧伤如果护理不当可能会导致愈合时间延长、疤痕形成和感染,特别是涉及四肢的烧伤如果护理不当还可能导致行动不便 [
本研究选择了传统SSD敷料、银离子泡沫敷料、银离子海藻酸钙敷料、锌离子海藻酸钙敷料和海藻酸钙敷料进行对比发现,在促进伤口愈合方面,纱布敷料和泡沫敷料的效果明显不及海藻酸钙敷料,有许多研究 [
另外,虽然几个世纪以来都是利用银的抗菌作用防止烧伤和慢性伤口的感染,近几十年来一直采用SSD外敷作为治疗烧伤的标准方法,但是在本研究中,除了含银敷料外,锌离子海藻酸钙敷料和海藻酸钙敷料应用在治疗过程中均未发现细菌感染。锌离子跟银离子一样本身也具有抗菌作用,也同样被用于高级创面敷料中 [
除了利于创面愈合和避免创面感染外,减少患者疼痛、减少换药次数以及防止不良反应等需求对患者的生活质量有巨大改善。本研究发现,除传统的SSD敷料需要每天更换、令患者感到疼痛不适并且还会引发创缘炎症反应外,泡沫敷料和海藻酸钙敷料在减少患者疼痛和创缘炎症反应方面的效果是一致的,泡沫敷料是因为本身材料不具有粘性,因此可以很轻松的移除并且不会对伤口和周围皮肤造成损伤 [
李 娟,何冬梅,刘 英,袁东烨,何靓男,蔡 超,张雪娟,魏雅静,王 英,安 敏. 不同敷料对局部小面积烧伤创面的护理效果 The Nursing Effect of Different Dressings on Local Small Area Burn Wound[J]. 护理学, 2022, 11(02): 279-284. https://doi.org/10.12677/NS.2022.112048