标题：Meek植皮术联合纳米银敷料治疗在大面积烧伤创面修复中的应用

      作者：牛雪涛 1，赵举辉 2，李子标 1    汉中市中心医院烧伤与创面修复外科 1、医疗美容整形外科 2，陕西 汉中 723000

      卷次： 2023年34卷5期

      【摘要】 目的 观察Meek植皮术联合纳米银敷料治疗在大面积烧伤创面修复中的应用效果。方法 回顾性分析2014年1月至2021年12月汉中市中心医院烧伤与创面修复外科收治的83例大面积烧伤者的临床资料，按创面处理方式不同分为观察组39例和对照组44例，对照组患者行Meek植皮术，观察组患者采取Meek植皮术联合纳米银敷料治疗。观察两组患者的创面愈合情况，并比较植皮前、植皮后 7 d创面基质金属蛋白酶 [MMP-1、MMP-2]、金属蛋白酶抑制剂-1 (TIMP-1)水平，记录住院期间并发症发生情况；治疗后随访60 d，比较两组患者治疗前后的生存质量[简明烧伤健康量表(BSHS-A)]。结果 观察组患者植皮后7 d的创面MMP-1和MMP-2吸光度(IA)值分别为2 131.81±165.43、1 842.65±159.56，明显低于对照组同时间点的3 612.16±195.38、2 346.64±135.58，而TIMP-1为 837.72±133.83，明显高于对照组同时间点的612.37±121.85，差异均有统计学意义(P<0.05)；观察组患者植皮后7 d的皮片存活率为(87.82±5.29)%，明显高于对照组的(73.35±4.34)%，而皮片融合时间和创面愈合时间分别为(14.62±2.13) d、(41.28±5.46) d，明显短于对照组的(19.47±3.96) d、(52.35±6.41) d，差异均有统计学意义(P<0.05)；住院期间，观察组患者的并发症总发生率为10.26%，明显低于对照组的29.55%，差异有统计学意义(P<0.05)；观察组治疗60 d后，BSHS-A的各项评分及总分明显高于对照组，差异均有统计学意义(P均<0.05)。结论 Meek植皮术联合纳米银敷料用于大面积烧伤创面修复患者治疗，能抑制创面基质金属蛋白酶过度表达，促进创面愈合、降低并发症发生率，有利于改善患者生存质量。
      【关键词】 大面积烧伤；创面修复；Meek植皮术；纳米银敷料；并发症；生存质量
      【中图分类号】 R644 【文献标识码】 A 【文章编号】 1003—6350（2023）05—0646—04

Application of Meek skin grafting combined with Nanometer silver dressing in the repair of extensive burnwounds.
NIU Xue-tao 1, ZHAO Ju-hui 2, LI Zi-biao 1. Department of Burn and Wound Repair Surgery 1, Department ofMedical Cosmetology and Plastic Surgery 2, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi, CHINA
【Abstract】 Objective To observe the application effects of Meek skin grafting combined with Nanometer sil-ver dressing in the repair of extensive burn wounds. Methods The clinical data of 83 patients with extensive burns inDepartment of Burn and Wound Repair Surgery, Hanzhong Central Hospital from January 2014 to December 2021 wereretrospectively analyzed. According to the different treatment methods for wound, the patients were divided into an ob-servation group (39 cases) and a control group (44 cases). The patients in the control group were given Meek skin graft-ing, while the patients in the observation group were treated with Meek skin grafting combined with Nanometer silverdressing. The wound healing of patients in the two groups was observed, and the levels of wound matrix metalloprotein-ases (MMP-1, MMP-2), tissue inhibitor of metalloproteinase-1 (TIMP-1) were compared before skin grafting and at 7 dafter skin grafting. The occurrence of complications during hospitalization were recorded. The patients were followed upfor 60 d after treatment, and the quality of life scores [Abbreviated Burn Specific Health Scale (BSHS-A)] were com-pared between the two groups before and after treatment. Results The integral absorbance (IA) values of woundMMP-1 and MMP-2 were 2 131.81±165.43 and 1 842.65±159.56 in the observation group at 7 d after skin grafting,which were significantly lower than 3 612.16±195.38 and 2 346.64±135.58 in the control group, while that of TIMP-1was 837.72±133.83, significantly higher than 612.37±121.85 in the control group (P<0.05). The flap survival rate was(87.82±5.29)% in the observation group at 7 d after skin grafting, which was significantly higher than (73.35±4.34)% inthe control group (P<0.05); the flap fusion time and wound healing time were (14.62±2.13) d and (41.28±5.46) d, signifi-cantly shorter than (19.47±3.96) d and (52.35±6.41) d in the control group (P<0.05). During hospitalization, the total inci-dence rate of complications in the observation group was significantly lower than that in control group (10.26% vs 29.55%,P<0.05). The scores of items and total score of BSHS-A in the observation group after 60 d of treatment were significantlyhigher than those in the control group (all P<0.05). Conclusion Meek skin grafting combined with Nanometer silverdressing for repair of massive burn wound can inhibit the over-expressions of wound matrix metalloproteinases, promotethe wound healing, reduce the incidence rates of complications, and help improve the quality of life of patients.
      【Key words】 Extensive burn; Wound repair; Meek skin grafting; Nanometer silver dressing; Complications;Quality of life