空气流动床在我国西部高原地区大面积烧伤治疗中的应用观察

摘要

Objective:To investigate the clinical effects of air-fluidized bed in treatment of large area of burns in plateau areas of western China.Methods:Seventy-seven patients with burn area ＞ 47％ TBSA and full-thickness burn area ＞ 30％ TBSA involved in present study were divided into two groups according to the time (May 2013) when the air-fluidized beds were adopted in the Fourth Hospital of PLA.Of them 35 patients admitted from Apr.30,2010 to Apr.30,2013 received turn-over beds treatment,and their wounds were treated with eschar excision and skin grafting;another 42 patients admitted from May 3 l,2013 to May 31,2016 received air-fluidized beds treatment,and their wounds were treated with eschar reservation and skin grafting.All the patients received anti shock treatment by fluid infusion,anti-infection,irradiation with a far infrared burn therapy instrument.The wound scabbing and healing time,infection rate,patients received operation,fluid volume and blood transfusion during shock phase,levels of serum sodium,length of hospital stay and cost of hospitalization of the two groups were observed and compared.Results:Compared with the patients in turn-over beds group,the wound scabbing and healing time and the length of hospital stay were obviously shortened (P＜0.01);the number of patients received operation,the amount of blood products and the cost of hospitalization decreased significantly (P＜0.01),and the wound infection rate declined markedly (P＜0.05) in those of air-fluidized beds group.Compared with the patients in turn-over beds,the volume of fluid resuscitation increased (P＜0.01) and the serum sodium level also increased significantly (P＜0.05) in patients of air-fluidized beds group.Conclusions:The air-fluidized bed may act in protecting the wound surface,reducing wound infection and accelerating wound healing in treatment of extensive burns.However,it will cause the increased loss of fluid and hypertonic dehydration,so the fluid amount should be increased properly.In general,treatment with air-fluidized bed can reduce the number of operations,decrease the consumption of blood products,shorten the length of hospital stay,especially save the treatment costs,so is worthy of promotion in underdeveloped areas of western China.%目的:观察在我国西部高原地区使用空气流动床治疗大面积烧伤的临床效果.方法:我院于2013年5月引进使用空气流动床,以此时间为分组标准,2010年4月30日-2013年4月30日收治的使用烧伤翻身床治疗的35例患者为翻身床组,创面予切削痂手术及植皮处理.2013年5月31日-2016年5月31日收治的使用空气流动床治疗的42例患者为空气流动床组,创面行保痂治疗及植皮处理.全部患者的烧伤面积＞47％TBSA,Ⅲ度烧伤面积＞30％TBSA.两组患者均行补液抗休克、抗感染、远红外烧伤治疗仪照射等治疗.观察两组患者创面干痂时间、创面感染情况、创面愈合时间、手术例数、休克期补液量、血制品用量、血钠值、住院时间及住院费用的差异.结果:空气流动床组创面干痂时间、创面愈合时间、住院时间均较翻身床组明显缩短(P＜0.01),手术例数、血制品用量、住院费用均明显减少(P＜0.01),创面感染率也明显下降(P＜0.05),休克期补液量则增加(P＜0.01),血钠值明显增加(P＜0.05).结论:空气流动床在大面积烧伤治疗中具有保护创面、减少创面感染和加速创面愈合的作用;但是会引起液体丢失增多、高渗性脱水,因此应当适当增加补液量.空气流动床总体上能减少手术次数、降低血制品消耗、缩短住院时间,尤其明显节省治疗费用,值得推广.