湿润烧伤膏在点阵激光治疗瘢痕术后创面愈合中的疗效观周阳;熊静【摘要】目的 观察点阵激光治疗瘢痕术后创面应用湿润烧伤膏换药治疗的临床疗 效.方法 对2014年5月-2017年1月南华大学附属浏阳市人民医院整形美容科收 治的284 例瘢痕增生患者,于点阵激光磨削术后,创面左上及右下区域予以湿润烧伤 膏换药治疗(设为治疗组),左下及右上区域予以碘伏换药治疗(设为对照组),对比观察 两种治疗方法的临床疗效•结果湿润烧伤膏治疗组创面愈合时间为(11.0±3.0)d、温 度恢复时间为(2.75±0.25)h、疼痛恢复时间为(3.25±1.25)h、细菌转阴时间为 (5.0±1.0)d、愈后VSS评分为(7.80±0.70)分，对照组创面愈合时间为(18.0±3.0)d、 温度恢复时间为(6.00±1.00)h、疼痛恢复时间为(42.00±30.00)h、细菌转阴时间 为(14.0±2.0)d、愈后VSS评分为(8.70±1.00)分，两组对比,P均v 0.01,差异具有统 计学意义.结论 湿润烧伤膏可有效促进点阵激光治疗瘢痕术后创面的愈合,防治创面 感染,缓解创面疼痛,疗效显著,值得临床推广应用.期刊名称】《中国烧伤创疡杂志》年(卷),期】2017(029)005【总页数】6页(P370-375) 【关键词】 湿润烧伤膏;点阵激光;瘢痕;创面;疗效【作 者】 周阳;熊静【作者单位】 410300 湖南浏阳,南华大学附属浏阳市人民医院整形美容科;410300湖南浏阳,南华大学附属浏阳市人民医院整形美容科正文语种】中 文 瘢痕是人体真皮组织损伤后异常修复而导致的皮肤组织纤维化改变，是人体创伤修 复过程中的主要产物。
瘢痕的形成不仅影响患者的外观形态，还会导致机体的局部 功能障碍［1］研究显示，点阵激光是目前治疗瘢痕的有效疗法之一，既可有效去 除瘢痕，又可避免手术切除、加压包扎、硅酮膜外敷等传统疗法所导致的色素沉着 或色素脱失等弊端［2］，然而，点阵激光术后如何有效促进激光烧灼创面愈合又成 为了临床所面临的新问题笔者为寻求一种较为理想的治疗瘢痕点阵激光术后创面 的方法，自2014年5月一2017年1月对284例瘢痕增生患者于CO2点阵激光 术后，予以湿润烧伤膏治疗局部烧灼创面，取得了满意的疗效，现报告如下本组患者共284例，其中男性154例，女性130例，年龄5~68岁，平均36.6 岁，VSS评分为(9.80±1.40)分，均为2014年5月一2017年1月收治的增生性 瘢痕患者，其瘢痕主要继发于烧烫伤、外伤、手术等创面，分布于全身各处本研 究经伦理委员会批准，且所有患者均签署了知情同意书怀孕或哺乳期妇女；近半年使用过糖皮质激素类药物者；治疗区域或邻近区域有感 染病灶者；曾感染过单纯疱疹病毒或人乳头瘤病毒者；对疗效的期望值超过现实者 患者入院后，对患者的瘢痕组织进行温度测定、VSS评分及疼痛评分(采用数字疼 痛评分法予以评分［3］)，并用消毒棉拭子采集瘢痕表面物质进行细菌培养。
激光磨削术后，立即对创面进行温度测定及疼痛评分，并每30 min进行1次，直 至温度及疼痛恢复至正常水平；同时，每2 d进行1次创面分泌物细菌培养Scar results from fibrosis of normal skin tissue caused by abnormal repair of dermis tissue after it is damaged and is the main product of wound healing process. Scar can disfigure patients, or even cause local dysfunction to them[1]. Studies show that fractional laser is one of the effective treatments of scar. It can remove scar while causing no hyperpigmentation or depigmentation as is caused by some traditional treatments, like surgical excision, pressure dressing, and silicone membrane application[2]. However, promoting wound healing of laser burn after fractional laser treatment poses a new challenge to clinical study. In order to find an ideal solution to treat wound after scar treatment with fractional laser, the author conducted an experiment on 284 patients with scar hypertrophy from May 2014 to January 2017. After carrying out fractional CO2 laser operation, the author applied MEBO on local burned wounds and got a satisfactory clinical efficacy. The report is as follows:1. Clinical data1.1. General dataIn this study, there are 284 patients—154 males and 130 females. Their age ranges from 5 to 68 with an average age of 36.6. Their VSS score is (9.80±1.40). They were all patients with scar hyperplasia admitted to our hospital from May 2014 to January 2017. Their scars were secondary to burns, wounds and surgical incision and distributed throughout their bodies. This study was approved by Ethics Committee and all patients signed informed consent.1.2. Exclusion criteriaPregnant or lactating women; Patients taking glucocorticoid drugs in the last half year; Patients with focus of infection in the treatment area or adjacent areas; Patients infected with herpes simplex virus or human papilloma virus; Patients with unrealistic expectations of clinical efficacy.2. Methods2.1.Preoperative preparationAfter the patient was admitted, temperature measurement, VSS assessment and pain assessment (NRS was adopted[3]) were conducted on their scar tissues. The surface of scar was scrubbed with aseptic swabs to collect substance there for bacterial culture.2.2. Postoperative managementAfter laser abrasion, temperature measurement and pain assessment were performed on the wound surface at 30 min intervals. Measuring 温度及疼痛程度测定后，将创面分为左上、左下、右上及右下四个区域，其中左上 及右下区域均匀涂抹湿润烧伤膏，厚2~3 mm,待深棕色药物变为白色时换药(会 阴等特殊部位涂药后覆盖湿润烧伤膏药纱)，并将其设定为治疗组；左下及右上区 域予以碘伏换药治疗，每天1次，并将其设定为对照组。
分别于药物作用一段时 间后对两组创面分泌物进行生化分析应用湿润烧伤膏治疗过程中需遵循“三不、四及时”原则，“三不”即换药过程中 创面不疼痛、不出血、不损伤正常组织；“四及时”即及时清理液化物、及时清理 渗出物、及时清理坏死组织、及时更换湿润烧伤膏采用SPSS 19.0统计软件对所得数据进行统计学分析，计量资料采用u检验，以() 表示，计数资料采用卡方检验，均以PvO.O5为差异具有统计学意义两组创面均完全愈合，其中治疗组创面于治疗3~4 d后停止渗出,8-14 d后上 皮化愈合，愈合时间为(11.0±3.0)d;对照组创面于治疗6-10 d后结痂，15 ~ 21 d后脱痂，愈合时间为(18.0±3.0)d,治疗过程中有12处创面出现溃疡，均予 以碘伏换药治疗后愈合两组创面愈合时间对比采用u检验，u=27.805 , Pv0.01 ，差异具有统计学意义(表1) ，即湿润烧伤膏可明显促进点阵激光治疗瘢痕 术后创面的愈合激光术前瘢痕温度为36.7~36.9°C;激光术后即刻创面温度为37.1~37.5°C;术 后30 min，治疗组创面温度为36.8~37.2°C[(37.0±0.2)°C],对照组创面温度为 37.0~37.4°C[(37.2±0.2)°C],两组对比采用 u 检验，u = 11.916 , PvO.OI,差异 具有统计学意义；治疗组创面温度于治疗2.5~3.0 h[(2.75±0.25)h]后恢复至术前 水平，对照组创面温度于治疗5.0~7.0 h[(6.00±1.00)h]后恢复至术前水平，两组 对比采用u检验，u = 53.135 , P<0.01 ,差异具有统计学意义(表1)，即湿润烧伤 膏可有效降低点阵激光治疗瘢痕术后创面的温度。
should be maintained until temperature and pain returned to normal level. At the same time, the bacteria culture of wound secretion was performed every two days.After the temperature and pain degree were measured, the wound were divided into four areas: upper right, upper left, lower right and lower left. Then, MEBO of 2-3 mm thickness was applied on upper left and lower right areas (set as treatment group) and dressing change was carried out when scarlet cream turned t。