目录

中国烧伤创疡科技中心（１０００５３） 王洪生

辽宁省大连市第四人民医院（１１６０３１） 侯 健 王 洪 唐殿成

［摘 要］目的：观察ＭＥＢＴ／ＭＥＢＯ在全身应用不同种类抗生素和伤后至接受湿疗不同时间的情况下，对面部不同深度烧伤的临床效果。方法：将采用ＭＥＢＴ／ＭＥＢＯ治愈的８３０例面部不同深度烧伤病人按全身应用不同种类的抗生素和伤后至接受湿疗的时间二种情况分组，并对各自的临床疗效分别进行统计学分析。结果：面部浅Ⅱ度烧伤创面的愈合时间与全身应用抗生素的种类和伤后至接受湿疗的时间（２４小时内）无关；面部深Ⅱ度创面的愈合时间与全身应用抗生素的种类和伤后至接受湿疗的时间有显著统计学差异；面部Ⅲ度创面的愈合时间与全身应用抗生素的种类有显著统计学差异，但与伤后至接受湿疗的时间（２４小时内）无关。结论： 采用ＭＥＢＴ／ＭＥＢＯ治疗面部深度烧伤宜针对性的全身应用广谱、高效抗菌素，并且伤后接受湿疗的时间越早（尤其是深Ⅱ度烧伤）创面愈合越快。

［关键词］面部 烧伤创面 ＭＥＢＴ

Factors Influencing the Efficacy of MEBO in Treating Facial Burn (A Report of 830 Cases) Wang Hongsheng, Hou Jian, Wang Hong, et al., Ch ina Science and Technology Center for Burns, Wounds and Ulcers 100053

［Abstract］Objective: To observe the efficacy of MEBT/MEBO in treatin g face burn of different degree, including those treated with different antibiotics systemic ally and received MEBT treatment at different times post burn. Methods: 830 case s of face burn of different degree were treated with MEBT/MEBO. They were divide d into two groups, according to different antibiotics they received systemically and the time they received MEBT post burn. The results were statistically analy zed. Results: For superficial second degree face burn wounds, the wound healing time was independent of what kind of antibiotics they received systemically and what time post burn they started to receive MEBT (within 24 hr). For deep second degree face burn, the wound healing time varied with different antibiotics they received systemically and the time they received MEBT post burn, the difference was statistically significant. For third degree face burn, the wound healing ti me varied with different antibiotics they received systemically, the difference was statistically significant, but wound healing time was not related to the tim e post burn (within 24 hr) they received MEBT. Conclusion: When MEBT/MEBO was ap plied in treating deep face burn, systemic administration of broad spectrum and high effective antibiotics was needed, the earlier they received MEBT, the earli er the wounds healed.

［Key words］Face Burn wounds MEBT

颜面部位暴露，烧伤十分常见。自１９９０年１月以来，对伤后２４小时内入院的８３０例面部不同深度烧伤，创面采用ＭＥＢＴ／ＭＥＢＯ处理，并根据情况全身应用不同种类的抗生素，取得了满意效果。本文对全身应用不同种类抗生素及伤后至接受湿疗的时间对ＭＥＢ Ｔ／ＭＥＢＯ治疗面部不同深度烧伤创面愈合时间的影响进行了统计学分析，现将结果报告如下。

一、临床资料

自１９９０年１月至２０００年１月，收治伤后２４小时内入院的面部烧伤患者８３０例， 男６６０例，女１７０例，平均年龄３１．００±１５．１０（ｘ－Ｄ５±ｓ）， 其中火焰烧伤４５３例，热液烧伤２０６例，电弧烧伤８９例，高温物体（沥青、热塑料 等）烧伤３１例，酸碱烧伤２８例，蒸汽烧伤２３例。浅Ⅱ度烧伤１６８例，深Ⅱ度烧伤５８０例，Ⅲ度烧伤８２例。

二、治疗方法

１.创面处理：入院后对浅Ⅱ度、深Ⅱ度烧伤创面不清创，直接用无菌压舌板将ＭＥＢＯ涂于创面约１ｍｍ厚，每４～６小时换药一次，每次涂ＭＥＢＯ之前，先用无菌卫生纸将创面上原有的药物、分泌物、液化物等轻柔擦拭干净，然后再涂ＭＥＢＯ于创面上。对浅Ⅱ度、深Ⅱ度创面上的水泡，要用无菌注射将水疱内液吸除，保留水疱皮的完整性，伤后７２小时 将水疱连同创面所有腐皮一并清除。对Ⅲ度创面，入院时创面先用生理盐水、０．１％新洁 尔灭和ＰＶＰ碘分别清毒３次，用耕耘刀对Ⅲ度创面进行耕耘至创面由苍白转为白里透红后，用无菌压舌板涂厚约１ｍｍ的ＭＥＢＯ于烧伤创面上，创面换药次数和方法同浅、深Ⅱ度烧伤。

２．根据患者情况全身应用不同种类的抗生素。

三、结 果

１．全身应用抗生素种类与创面愈合时间的关系见表１、表２、表３。

２．伤后至接受湿疗处理时间与创面愈合时间的关系见表４、表５、表６

四、讨 论

１．ＭＥＢＴ／ＭＥＢＯ在全身应用不同种类抗生素的情况下，与面部浅Ⅱ度、深Ⅱ度、Ⅲ 度烧伤创面愈合时间的关系：表１显示面部浅Ⅱ度创面愈合时间与全身应用抗生素种类无关。表２、表３显示面部深Ⅱ度和Ⅲ度烧伤创面愈合时间与全身应用抗菌素的种类有显著的统计学差异，应用３代头孢菌素，磷霉素和３代喹诺酮类抗菌素三者效果相似，