改性甲壳素联合重组人碱性成纤维细胞生长因子治疗浅Ⅱ度烧伤创面的临床观察
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摘要
目的观察改性甲壳素联合重组人碱性成纤维细胞生长因子(rh-b FGF)在治疗浅Ⅱ度烧伤创面的治疗效果。方法将石家庄市第一医院烧伤整形科2015年11月至2017年8月收治的80例浅Ⅱ度烧伤患者按随机数字表法分为治疗组和对照组,每组40例。治疗组患者创面先外用rhb FGF喷洒,再用改性甲壳素生物修复膜覆盖,常规预防感染治疗,每天换药1次,直至创面愈合;对照组清理创面后,外用改性甲壳素生物修复膜覆盖创面,每日换药1次。观察两组患者平均创面愈合时间、患者伤后7、10、13 d创面愈合率、创面感染情况、瘢痕情况、患者换药疼痛指数及其他不良反应。患者创面平均愈合时间及不同时间点烧伤创面愈合率、患者换药疼痛指数比较均采用t检验。结果治疗组患者创面平均愈合时间(11.55±2.02)d,较对照组[(12.63±1.96)d]明显缩短,差异均有统计学意义(t=2.41,P=0.02);治疗组伤后7、10、13 d创面愈合率分别为(86.00±4.28)%、(95.53±3.65)%和(99.55±0.68)%,明显高于对照组[(84.23±3.38)%、(93.50±3.21)%和(99.10±1.06)%],差异均有统计学意义(t=2.06、2.63、2.27,P=0.04、0.01、0.03);治疗组患者换药疼痛数字评分法(NRS)评分为(3.46±0.51)分,对照组患者换药疼痛NRS评分为(3.50±0.50)分,两组比较差异无统计学意义(t=0.27,P=0.78)。治疗过程两组均未出现感染患者,随访3个月均未出现瘢痕增生;未发现其他不良反应。结论应用改性甲壳素联合rh-b FGF能明显缩短浅Ⅱ度烧伤患者创面愈合时间,提高创面愈合率,未见其他不良反应。
Objective To observe the therapeutic effect of modified chitin combined recombinant human basic fibrolast grouth factor( rh-b FGF) on superficial partial-thickness burn wounds.Methods Eighty cases of Superficial partial-thickness burns from the department of Burns and Plastic Surgery,First Hospital of Shijiazhuang from November 2015 to August 2017 were divided into the treatment group and the control group according to the random number table method,40 cases in each group. The treatment group patients' wounds were first sprayed with rh-b FGF,then covered with modified chitin,and routinely prevented infection treatment. The dressing was changed once a day until the wounds healed. After cleaned the wounds of control group,externally modified chitin was used to cover the wounds and the dressing was changed once a day. The average wound healing time,wound healing rates of patients on 7,10 and 13 days after injury,wound infection status,scar condition,patient dressing pain index,and other adverse reactions were observed. The t-test was used to compare the average wound healing time,the healing rates of wounds at different time,and the patient's dressing pain index. Results The average healing time in the treatment group was(11. 55 ± 2. 02) d,which was shorter than the [( 12. 63 ± 1. 96) d]of control group,the difference was statistically significant( t = 2. 41,P = 0. 02). The healing rates in the treatment group at 7,10,13 days were(86. 00 ± 4. 28) %,(95. 53 ± 3. 65) % and(99. 55 ± 0. 68) %,those were higher than the control group [( 84. 23 ± 3. 38) %,( 93. 50 ± 3. 21) % and( 99. 10 ± 1. 06) % ],the differences were statistically significant( t = 2. 06,2. 63,2. 27; P = 0. 04,0. 01,0. 03). The numerical rating score( NRS) of patients in the treatment group was(3. 46 ± 0. 51) points,and in the control group was( 3. 50 ± 0. 50) points,there was no statistically significant difference( t = 0. 27,P = 0. 78). No infection occurred in both groups during the treatment,and no scar hyperplasia was observed in the follow-up3 months. No other adverse reactions were found. Conclusion The use of modified chitin combined with rh-b FGF can significantly shorten the wound healing time and increase the wound healing rate in patients with superficial second degree burns,and no other adverse reactions were found.
Objective To observe the therapeutic effect of modified chitin combined recombinant human basic fibrolast grouth factor( rh-b FGF) on superficial partial-thickness burn wounds.Methods Eighty cases of Superficial partial-thickness burns from the department of Burns and Plastic Surgery,First Hospital of Shijiazhuang from November 2015 to August 2017 were divided into the treatment group and the control group according to the random number table method,40 cases in each group. The treatment group patients' wounds were first sprayed with rh-b FGF,then covered with modified chitin,and routinely prevented infection treatment. The dressing was changed once a day until the wounds healed. After cleaned the wounds of control group,externally modified chitin was used to cover the wounds and the dressing was changed once a day. The average wound healing time,wound healing rates of patients on 7,10 and 13 days after injury,wound infection status,scar condition,patient dressing pain index,and other adverse reactions were observed. The t-test was used to compare the average wound healing time,the healing rates of wounds at different time,and the patient's dressing pain index. Results The average healing time in the treatment group was(11. 55 ± 2. 02) d,which was shorter than the [( 12. 63 ± 1. 96) d]of control group,the difference was statistically significant( t = 2. 41,P = 0. 02). The healing rates in the treatment group at 7,10,13 days were(86. 00 ± 4. 28) %,(95. 53 ± 3. 65) % and(99. 55 ± 0. 68) %,those were higher than the control group [( 84. 23 ± 3. 38) %,( 93. 50 ± 3. 21) % and( 99. 10 ± 1. 06) % ],the differences were statistically significant( t = 2. 06,2. 63,2. 27; P = 0. 04,0. 01,0. 03). The numerical rating score( NRS) of patients in the treatment group was(3. 46 ± 0. 51) points,and in the control group was( 3. 50 ± 0. 50) points,there was no statistically significant difference( t = 0. 27,P = 0. 78). No infection occurred in both groups during the treatment,and no scar hyperplasia was observed in the follow-up3 months. No other adverse reactions were found. Conclusion The use of modified chitin combined with rh-b FGF can significantly shorten the wound healing time and increase the wound healing rate in patients with superficial second degree burns,and no other adverse reactions were found.
引文
[1]林洁,代志强.重组牛碱成纤维细胞生长因子外用凝胶治疗局部烧烫伤的疗效观察[J].中国医药导刊,2014,16(6):1016-1017.
[2]蒋宏林,冯岚.改性甲壳素生物敷料用于新鲜创面患者的临床疗效观察[J].护士进修杂志,2014,29(10):953-954.
[3]张瑞娟.甲壳素及其衍生物的药理作用及研究进展[J].内蒙古中医药,2013,32(29):104-105.
[4]储益平,殷书梅.甲壳聚多糖的药理实验研究[J].时珍国医国药,2004,15(4):202.
[5]曾名勇.几种甲壳质衍生物在医药上的应用[J].中国海洋药物,1995(1):49-52.
[6]王中和,陆顺娟,胡海生,等.低分子壳多糖对癌症放疗患者免疫功能的影响[J].首都医科大学学报,1997,18(1):80-82.
[7]陈长春,程海涛,孙康,等.生物可吸收性甲壳素纤维增强聚乳酸复合材料体内体外降解性研究[J].生物医学工程学杂志,2000,17(2):117-121.
[8]林伊凡,梁翠玲.湿润烧伤膏配合微波治疗60例慢性宫颈炎疗效分析[J].中国医学创新,2014,11(3):90-92.
[9]康丽兰.改性甲壳素创面修复凝露联合微波治疗慢性宫颈炎的疗效观察[J].临床合理用药杂志,2015,8(7A):42-43.
[10]徐秀梅,邵丽琴,蒋仲霞.微波联合外用溃疡散保妇康栓治疗慢性宫颈炎的疗效观察[J].中国实用医药,2013,8(5):35-36.
[11]刘力,李佳怡,熊霞,等.改性甲壳素创面修复凝露联合红光照射治疗慢性皮肤溃疡的疗效观察[J].重庆医学,2012,41(33):3517-3518.
[12]李步云,杨一峰,吴忠仕,等.改性甲壳素生物修复膜临床观察试验总结[J].中国医疗前沿,2008,3(6):59-60.
[13]王永满,陈峥.改性甲壳素创面修复凝露联合红光照射治疗慢性皮肤溃疡的效果观察[J/CD].中国医学前沿杂志(电子版),2015,7(11):141-142.
[14]赵铁生,刘道峰.改性甲壳素凝胶在面部裂伤处理中的临床应用[J].滨州医学院学报,2012,35(3):212-213.
[15]汤华林,许海平,李亚屏,等.改性甲壳素凝露覆盖暴露法治疗皮肤挫擦伤的疗效观察[J].现代实用医学,2009,21(12):1351-1353.
[16]胡毕亿.b FGF结合远红外线对促进烧伤创面愈合的临床研究[J].中华全科医学,2013,11(10):1565-1566.
[17]谢越峰,柴家科.b FGF结合远红外线治疗对烧伤创面愈合的影响[J].中国现代医生,2014,52(15):27-30.
[18]晋国营,范友芬,陈粹,等.重组人碱性成纤维细胞生长因子对深二度烧伤创面愈合的效果观察[J].现代实用医学,2014,26(4):480-508.
[19]Ishizaki H,Westermark A,van Setten-Get,et al.Basic fibroblast growth factor(b FGF)in saliva--physiological and clinical implications[J].Acta Otolaryngol Suppl,2000(543):193-195.
[20]郭立云,张洁莹,孙恒,等.碱性成纤维细胞生长因子对碱烧伤兔眼角膜新生血管的影响[J].山东医药,2014,54(45):7-9.
[21]江德生.点阵CO2激光联合超生导入治疗痤疮后凹陷性瘢痕临床观察[J].中国美容医学,2017,26(5):93-95.
[22]翁景宁,张惠蓉.碱性成纤维细胞生长因子诱导牛晶状体上皮细胞增殖细胞核抗原的表达及对晶状体上皮细胞作用的研究[J].中华眼科杂志,2002,38(3):176-179.
[23]樊丁才,王富生,王志远.碱性成纤维细胞生长因子与瘢痕成纤维细胞Ⅰ、Ⅲ型胶原蛋白代谢的研究[J].中国现代医生,2014,52(12):1-3.
[24]肖勇.创面持续负压引流+重组牛碱性成纤维细胞生长因子外用溶液冲管在慢性溃疡创面修复中的应用研究[J].泰山医学院学报,2017,38(4):422-423.
[25]徐风瑞,何明武,杨帆.重组牛碱性成纤维细胞生长因子促进烧伤创面愈合效果观察[J].临床合理用药杂志,2016,9(1):35-38.
[26]潘德标,叶冠雄,吴成军,等.重组人碱性成纤维细胞生长因子与磺胺嘧啶银霜联合应用对慢性难愈性创面愈合过程的修复效应[J].温州医科大学学报,2014,44(4):294-296.
[2]蒋宏林,冯岚.改性甲壳素生物敷料用于新鲜创面患者的临床疗效观察[J].护士进修杂志,2014,29(10):953-954.
[3]张瑞娟.甲壳素及其衍生物的药理作用及研究进展[J].内蒙古中医药,2013,32(29):104-105.
[4]储益平,殷书梅.甲壳聚多糖的药理实验研究[J].时珍国医国药,2004,15(4):202.
[5]曾名勇.几种甲壳质衍生物在医药上的应用[J].中国海洋药物,1995(1):49-52.
[6]王中和,陆顺娟,胡海生,等.低分子壳多糖对癌症放疗患者免疫功能的影响[J].首都医科大学学报,1997,18(1):80-82.
[7]陈长春,程海涛,孙康,等.生物可吸收性甲壳素纤维增强聚乳酸复合材料体内体外降解性研究[J].生物医学工程学杂志,2000,17(2):117-121.
[8]林伊凡,梁翠玲.湿润烧伤膏配合微波治疗60例慢性宫颈炎疗效分析[J].中国医学创新,2014,11(3):90-92.
[9]康丽兰.改性甲壳素创面修复凝露联合微波治疗慢性宫颈炎的疗效观察[J].临床合理用药杂志,2015,8(7A):42-43.
[10]徐秀梅,邵丽琴,蒋仲霞.微波联合外用溃疡散保妇康栓治疗慢性宫颈炎的疗效观察[J].中国实用医药,2013,8(5):35-36.
[11]刘力,李佳怡,熊霞,等.改性甲壳素创面修复凝露联合红光照射治疗慢性皮肤溃疡的疗效观察[J].重庆医学,2012,41(33):3517-3518.
[12]李步云,杨一峰,吴忠仕,等.改性甲壳素生物修复膜临床观察试验总结[J].中国医疗前沿,2008,3(6):59-60.
[13]王永满,陈峥.改性甲壳素创面修复凝露联合红光照射治疗慢性皮肤溃疡的效果观察[J/CD].中国医学前沿杂志(电子版),2015,7(11):141-142.
[14]赵铁生,刘道峰.改性甲壳素凝胶在面部裂伤处理中的临床应用[J].滨州医学院学报,2012,35(3):212-213.
[15]汤华林,许海平,李亚屏,等.改性甲壳素凝露覆盖暴露法治疗皮肤挫擦伤的疗效观察[J].现代实用医学,2009,21(12):1351-1353.
[16]胡毕亿.b FGF结合远红外线对促进烧伤创面愈合的临床研究[J].中华全科医学,2013,11(10):1565-1566.
[17]谢越峰,柴家科.b FGF结合远红外线治疗对烧伤创面愈合的影响[J].中国现代医生,2014,52(15):27-30.
[18]晋国营,范友芬,陈粹,等.重组人碱性成纤维细胞生长因子对深二度烧伤创面愈合的效果观察[J].现代实用医学,2014,26(4):480-508.
[19]Ishizaki H,Westermark A,van Setten-Get,et al.Basic fibroblast growth factor(b FGF)in saliva--physiological and clinical implications[J].Acta Otolaryngol Suppl,2000(543):193-195.
[20]郭立云,张洁莹,孙恒,等.碱性成纤维细胞生长因子对碱烧伤兔眼角膜新生血管的影响[J].山东医药,2014,54(45):7-9.
[21]江德生.点阵CO2激光联合超生导入治疗痤疮后凹陷性瘢痕临床观察[J].中国美容医学,2017,26(5):93-95.
[22]翁景宁,张惠蓉.碱性成纤维细胞生长因子诱导牛晶状体上皮细胞增殖细胞核抗原的表达及对晶状体上皮细胞作用的研究[J].中华眼科杂志,2002,38(3):176-179.
[23]樊丁才,王富生,王志远.碱性成纤维细胞生长因子与瘢痕成纤维细胞Ⅰ、Ⅲ型胶原蛋白代谢的研究[J].中国现代医生,2014,52(12):1-3.
[24]肖勇.创面持续负压引流+重组牛碱性成纤维细胞生长因子外用溶液冲管在慢性溃疡创面修复中的应用研究[J].泰山医学院学报,2017,38(4):422-423.
[25]徐风瑞,何明武,杨帆.重组牛碱性成纤维细胞生长因子促进烧伤创面愈合效果观察[J].临床合理用药杂志,2016,9(1):35-38.
[26]潘德标,叶冠雄,吴成军,等.重组人碱性成纤维细胞生长因子与磺胺嘧啶银霜联合应用对慢性难愈性创面愈合过程的修复效应[J].温州医科大学学报,2014,44(4):294-296.