表皮生长因子联合银离子敷料治疗压力性溃疡创面炎性反应的观察(1)

http://www.100md.com 2018年3月15日 《中国美容医学》 2018年第6期

     [摘要]目的：探讨应用重组人表皮生长因子凝胶联合银离子敷料治疗压力性溃疡的创面炎性反应。方法：选择2014年1月-2018年1月103例Ⅲ、Ⅳ期压力性溃疡患者为研究对象，常规清创消毒，用药物覆盖创面，及时清创换药。按外用药物的不同分为银离子敷料组(n=35)、表皮生长因子凝胶组(n=30)和联合组(n=38)，定期观察各组各时间点创面炎性反应情况。结果：治疗后1周、2周联合组创面渗液细菌培养阳性率低于凝胶组和敷料组，差异有统计学意义(P<0.05)；治疗后2周、4周联合组创面局部中重度炎症发生率明显低于凝胶组和敷料组，差异有统计学意义(P<0.05)。结论：表皮生长因子凝胶联合银离子敷料治疗压力性溃疡，能有效降低创面细菌培养阳性率及创面中重度炎性程度，促进创面愈合，安全有效，值得临床推广。

    [关键词]压力性溃疡；表皮生长因子凝胶；银离子敷料；伤口愈合；创面细菌阳性率；创面炎性反应

    [中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2018)06-0028-03

    Abstract： Objective To explore the application of recombinant human epidermal growth factor gel combined with silver ion dressing in treating the inflammatory reaction of pressure ulcer. Methods 103 patients with stage Ⅲ and Ⅳ pressure ulcers treated in our department from January 2014 to January 2018 were selected as the study subjects. Routine debridement and disinfection were performed. Routine debridement and disinfection， covering wounds with drugs， timely debridement and dressing change. They were divided into the silver ion dressing group(n=35)， the epidermal growth factor gel group(n=30) and the combined group(n=38) according to the difference of topical drugs. Then the inflammatory reaction at each time point was observed regularly. Results After 1 and 2 weeks， the positive rate of bacterial culture in the combined group was lower than that in the gel group and the dressing group， the differences were statistically significant(P<0.05). The incidence of moderate and severe inflammation in the combined group was significantly lower than that in the gel group and the dressing group at 2 and 4 weeks after treatment(P<0.05). Conclusion The combination of epidermal growth factor gel and silver ion dressing to treat pressure ulcer can effectively reduce the positive rate of bacterial culture and the degree of moderate and severe inflammation of the wound， thus promoting the healing of the wound， which is safe and effective， and is worthy of clinical popularization.

    Key words： pressure ulcer； epidermal growth factor gel； silver ion dressing； wound healing； positive rate of wounded bacteria； wound inflammatory response

    壓力性溃疡简称压疮，是由于人体局部组织长期受压，导致组织持续缺血、缺氧、营养不良而致组织溃烂坏死而形成[1-2]，国际上将压疮列为严重伤害患者的五大常见因素之一，并被称为20世纪花费最高的并发症之一[3]，其对患者的身心健康均可产生非常大的不良影响，其中以Ⅲ、Ⅳ期压疮尤为严重[4]。2014年1月-2018年1月笔者科室对Ⅲ、Ⅳ期压疮患者应用银离子敷料联合重组人表皮生长因子凝胶治疗，更早地有效控制创面细菌，减轻创面炎性反应，从而促进创面愈合，安全有效。

    1 资料和方法

    1.1 临床资料：本组患者103例，均为Ⅲ、Ⅳ期压疮患者。其中男56例，女47例；年龄55～65岁20例，66～75岁43例，76岁以上40例，平均年龄73.5岁；压疮部位：髋部12例，足部33例，骶尾48例，肩胛部3例，外踝7例；创面面积约2.5cm×3.5cm～11.5cm×12.5cm。所有患者随机分为3组：银离子敷料组(敷料组)35例，表皮生长因子凝胶组(凝胶组)30例，表皮生长因子凝胶联合银离子敷料组(联合组)38例。三组患者性别、平均年龄、压疮部位、创面面积及基础疾病和文化程度等基础资料比较，差异无统计学意义(P>0.05)，具有可比性。(王强 彭友林)

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