目录

【摘要】　目的：观察湿性半暴露疗法与传统的凡士林纱布治疗供皮区创面的疗效。方法：对我院4年内122例患者200处(整形或烧伤)手术的供皮区创面，采用同个体、同部位或同一个体的对称部位、年龄相似的病例，应用半暴露湿性疗法与半暴露干燥疗法治疗，观察其疼痛、愈合时间、感染、瘢痕增生情况。结果：湿性较干燥疗法愈合时间缩短4天～7天，创面疼痛轻微，尤其是换药时不疼痛，纱布下不积脓，不影响术后睡眠。愈后1年复诊：湿性组韧厚皮区色泽与周围皮肤无差异、薄中厚区色素沉着或脱失、中厚皮区扁平质软瘢痕，而干燥组病人剧痛需应用镇痛药、愈合时间较长、部分创面出现增生性瘢痕。结论：湿性半暴露疗法能缩短供皮区创面愈合时间，有良好的止痛和预防感染之作用，且能减少瘢痕增生，半暴露湿性疗法是供皮区创面的良好适应症。
【关键词】　湿性疗法；干燥疗法；供皮区创面；疗效
【标识符】　doi：10．3969/j．issn．1001-0726．2009．04．010

Comparison of Therapeutic Effect Between Moist Therapy and Drying Therapy in Treating Donor Site Wound. MENG Jin-song, LI Chang-ming, WANG Jian，et al. Dept. of Burn and Plastic, Burn Hospital of Zhoukou City, Henan Province, 466000, China．
【Abstract】 Objective: To observe the different of clinical effect between moist semi-exposed therapy and conventional  Vaseline gauze treatment in treating donor site wound. Method: 122 hospitalized patients (200 wounds) with donor site wound were enrolled in the program last 4 years. Comparison of Semi-exposed moist therapy and semi-exposed drying therapy in the similar age patients were carried out either in the same part of the same individual, or in symmetric parts of the same individual. Indexes observed were pain degree, wound healing time, infection and scar formation. Result: The wound healing time of moist therapy was shorter than that of drying therapy. Minor wound pain, no pain when dressing changed, no empyema under gauze and good sleep of post-operation were observed  in the 4~7 days. After one year of follow-up in moist group, there was no difference between colors of blade-thick skin and surrounding skin; pigmentation and depigmentation in thin medium split-thickness zone and flat soft scar in intermediate split-thickness zone were observed. But in drying group, the patients needed analgesics due to pain, had longer wound healing time and appeared hypertropic scar in some wound. Conclusion: Moist semi-exposed therapy is a good for indications to treat donor site wound due to shortening wound healing time, stopping pain well, preventing wound from infection and reducing scar formation.
【Key words】 Moist therapy; Drying therapy; Donor site wound; Effect

为观察湿性与干燥疗法治疗供皮区创面的情况，我院于2003年10月～2007年10月，对122例200处手术供皮区创面，分别采用湿性与干燥技术治疗，结果湿润组供皮创面的愈合时间、皮肤外观等方面均比干燥组满意。
1．资料与方法
1．1．一般资料：共122例200处供皮区创面，设计湿性与干燥组各100处供皮区创面（简称创面）作自身对照。湿性组：男性，45例62处供皮创面；女性，23例38处供皮区创面；年龄≤14岁者15例26处创面，14岁～49岁者32例48处创面，≥50岁者21例26处创面；干燥组：男性，32例58处创面，女性，22例42处创面；年龄≤14岁者17例30处创面，14岁～49岁者27例52处创面，≥50岁者10例18处创面 。
1．2．治疗方法：在手术室常规消毒后，应用s型电动取皮机分别在小腿取韧厚皮、大腿或腹部取薄中厚皮、背部取中厚皮，创面行药物治疗。湿性组：将湿润烧伤膏（MEBO）涂于取皮区,厚约1mm~2mm，再覆盖一层MEBO药纱，而后多层无菌敷料包扎。术后24小时拆除外层敷料，留1层纱布作半暴露，每日继续外涂MEBO,6小时～12小时重复涂药一次，保持湿润；第3天～4天创面处于液化高峰期，每日更换MEBO药纱1次～2次；第5天～8天液化物明显减少，继续更换MEBO药纱或直接在纱布上涂药，直至愈合。治疗时在用药部位的下方垫一层油布，上方应用弓形架，架上再盖被褥。干燥组：用传统的凡士林油纱覆盖创面，无菌敷料加压包扎，1天～2天后去除外层敷料，留2层～3层纱布，保持干燥，避免创面受压，见渗出液用红外线治疗灯或白炽灯烘干，直至愈合。