目的 系统比较酶学清创后四种不同类型敷料对深二度烧伤创面远期瘢痕质量的影响。方法 回顾性纳入2019-01至2024-12于空军特色医学中心烧伤科住院的深二度烧伤患者125例,根据酶学清创后敷料类型分为四组:Suprathel组(A组32例)、Mepilex Ag组(B组28例)、Mepitel组(C组35例)和Jelonet组(D组30例)。主要结局指标为12个月时瘢痕弹性R2,次要指标包括经皮水分丢失(TEWL)、黑色素指数、瘢痕厚度、创面愈合时间、疼痛评分、温哥华瘢痕量表(VSS)、患者与观察者瘢痕评估量表(POSAS)及SF-36生活质量评分。结果 12个月时,A组瘢痕弹性R2为(0.79±0.09),优于D组的(0.69±0.11),差异有统计学意义(P=0.009)。A组TEWL[(10.8±2.8)g/(m2·h)]、黑色素指数(165.2±24.5)及瘢痕厚度[(1.35±0.28)mm]均低于D组的(14.2±3.5)g/(m2·h)、(185.6±29.1)、(1.72±0.36)mm,差异有统计学意义(P＜0.05)。创面愈合时间[(13.2±3.1)d]、敷料更换次数[(2.5±1.0)次]及疼痛评分[(3.0±1.0)分],均优于D组的(15.8±3.9)d、(11.5±2.6)次、(4.8±1.5)分,差异有统计学意义(P＜0.05)。12个月时,A组VSS总分为2.0(1.0,4.0)分,POSAS患者总分为12.0(9.0,15.0)分,SF-36躯体健康总评为(78.5±8.2)分,均优于D组的4.0(3.0,6.0)分、18.0(14.0,21.0)分、(71.5±9.6)分,差异有统计学意义(P＜0.05)。B、C组优于D组,但差异无统计学意义。结论 酶学清创后深二度烧伤创面应用合成膜类敷料Suprathel,在改善远期瘢痕质量方面可能优于其他类型敷料。
Abstract
Objective To systematically compare the effects of four types of dressings on long-term scar quality of deep second-degree burn wounds after enzymatic debridement. Methods A total of 125 patients with deep second-degree burns who were hospitalized in the Burn Department of Characteristics Medical Center of PLA Air Force from January 2019 to December 2024 were retrospectively included and divided into four groups according to the dressing type used after enzymatic debridement: Suprathel group (group A, 32 cases), MepilexAg group (group B, 28 cases), Mepitel group (group C, 35 cases), and Jelonet group (group D, 30 cases). The primary outcome measure was scar elasticity (R2) at 12 months, and secondary indicators included transepidermal water loss (TEWL), melanin index, scar thickness, wound healing time, pain score, Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and SF-36 quality of life score. Results At 12 months, the scar elasticity R2 in group A (0.79±0.09) was significantly superior to that in group D (0.69±0.11) , and the difference was statistically significant (P=0.009). The TEWL [(10.8±2.8) g/(m2·h)], melanin index (165.2±24.5) and scar thickness (1.35±0.28) mm in group A were lower than those in group D (14.2±3.5)g/(m2·h), (185.6±29.1), (1.72±0.36) mm, and the differences were statistically significant (P＜0.05).The wound healing time [(13.2±3.1)d], number of dressing changes [(2.5±1.0)times] and pain score [(3.0±1.0)points] were also superior to those in group D (15.8±3.9 days, 11.5±2.6 times, 4.8±1.5 points), and the differences were statistically significant (P＜0.05). At 12 months, group A showed significantly better VSS total score 2.0 (1.0, 4.0), POSAS patient total score 12.0 (9.0, 15.0) and SF-36 PCS (78.5±8.2) compared with the group D 4.0 (3.0, 6.0), 18.0 (14.0, 21.0), (71.5±9.6), and the differences were statistically significant (P＜0.05). Groups B and C were better than Group D, but the differences were not statistically significant. Conclusions After enzymatic debridement, the application of synthetic membrane dressings Suprathel in deep second-degree burn wounds may be superior to other types of dressings in improving long-term scar quality.
关键词
酶学清创 /
深二度烧伤 /
敷料 /
瘢痕质量 /
Suprathel
Key words
enzymatic debridement /
deep second-degree burn /
dressings /
scar quality /
Suprathel
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Bordeanu-Diaconescu E M,Grama S,Grosu-Bularda A,et al.Bromelain in burn care: advancements in enzymatic debridement and patient outcomes[J].Eur Burn J,2024,5(4):438-453.
[2] Kahn S A,Raghava N,Gaweda G,et al.“Minimally invasive” skin grafting with enzymatic debridement and autologous skin cell spray: a retrospective case series[J].Ann Burns Fire Disasters,2023,36(4):355-360.
[3] Hirche C,Citterio A,Hoeksema H,et al.Eschar removal by bromelain based enzymatic debridement (Nexobrid®) in burns: a European consensus[J].Burns,2017,43(8):1640-1653.
[4] De Freitas L R,Udoma-Udofa O C,Reginato P H,et al.Bromelain-based enzymatic debridement versus standard of care in deep burn injuries: a systematic review and meta-analysis[J].J Burn Care Res,2025,46(1):123-131.
[5] 胡大海,刘 毅,张玉红.烧伤创面敷料的研究进展与应用选择[J].中华烧伤与创面修复杂志,2024,40(2): 101-107.
[6] Bird C L,Saucedo Y,Reynolds J,et al.Our initial experience with rapid enzymatic debriding agent for burn eschar: case series from an ABA verified burn center[J].Burns Open,2025,10:100403.
[7] 程 佳,张 钒,秦宏波,等.早期生物敷料覆盖对面部深Ⅱ度烧伤患者创面愈合的疗效观察[J].交通医学, 2025,39(6):619-621.
[8] Heitzmann W,Schulz A,Fuchs P C,et al.Long-term skin quality and scar formation after enzymatic debridement of deep-dermal burn wounds: a follow-up comparative study of Suprathel® and Jelonet®[J].Burns,2026,52(1): 107803.
[9] Trotsyuk A A,Chen K,Hyung S,et al.Inhibiting fibroblast mechanotransduction modulates severity of idiopathic pulmonary fibrosis[J].Adv Wound Care,2022,11(10):511-523.
[10] Monstrey S,Middelkoop E,Vranckx J J,et al.Updated scar management practical guidelines: non-invasive and invasive measures[J].J Plast Reconstr Aesthet Surg,2014,67(8):1017-1025.
[11] Schulz A,Fuchs P C,Rothermundt I,et al.Enzymatic debridement of deeply burned faces: healing and early scarring based on tissue preservation compared to traditional surgical debridement[J].Burns,2017,43(6):1233-1241.
[12] Hasegawa M,Matsushita T,Horikawa M,et al.A novel inhibitor of Smad3 attenuates dermal fibrosis and hyperpigmentation in a mouse model of scleroderma[J].J Invest Dermatol,2019,139(5):1056-1065.
[13] Mataro I,Delli Santi G,Palombo P,et al.Spontaneous healing and scar control following enzymatic debridement of deep second-degree burns[J].Ann Burns Fire Disasters,2017,30(4):313-316.
[14] Mertens T C,van Veer W M,van Zuijlen P P,et al.The effect of silicone sheeting on the biomechanical properties of hypertrophic scars: a randomized controlled trial[J].Wound Repair Regen,2019,27(4):386-393.
[15] Finnerty C C,Jeschke M G,Branski L K,et al.Hypertrophic scarring: the greatest unmet challenge after burn injury[J].Lancet,2016,388(10052):1427-1436.
[16] Lichtman M K,Otero-Vinas M,Falanga V.Transforming growth factor beta (TGF-β) isoforms in wound healing and fibrosis[J].Wound Repair Regen,2016,24(2):215-222.
[17] Shang R Y,Yang J C,Hu W G,et al.Artesunate attenuates skin hypertrophic scar formation by inhibiting fibroblast activation and EndMT of vascular endothelial cells[J].Phytomedicine,2025,140:156498.
[18] Zhao W Y,Zhang L Y,Wang Z C,et al.The compound losartan cream inhibits scar formation via TGF-β/Smad pathway[J].Sci Rep,2022,12(1):14327.
[19] Heitzmann W,Schulz A,Fuchs P C,et al.Assessing the effect of enzymatic debridement on the scar quality in partial-thickness burns to deep dermal burns of the hand: a long-term evaluation[J].Medicina (Kaunas),2024, 60(3):481.
[20] Liang Y,Shi W,Shao Y,et al.Effects of early debridement and conservative eschar removal followed by wound coverage with acellular dermal matrix in the treatment of children with deep burns[J].Chin J Burns Wounds,2024, 40(4):348-357.
[21] 官 浩,张栋梁.烧伤与创面修复外科诊疗中的多学科融合:现状与挑战及未来[J].中华烧伤与创面修复杂志,2025,41(11):1050-1056.
[22] 黄跃生,刘 琰,张丕红.烧伤创面修复与瘢痕防治的现状与展望[J].中华烧伤杂志,2021,37(1):1-7.
[23] 车 蕾,秦子清,台南阳,等.渗出液管理敷料的研究进展[J].武警医学,2025,36(8):723-726.
PDF(1050 KB)
