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目的对生物胶原纤维刘氏烧伤敷料(LBD)进行临床疗效观察并探讨其应用前景。方法临床应用生物胶原纤维刘氏烧伤敷料治疗287例烧伤患者。对于新鲜浅二度或深二度烧伤创面红白相间,以红为主,特别是表皮撕脱创面,入院后,立即在清创室或床头覆盖LBD(不需麻醉),此组共125例;深二度烧伤创面以苍白为主或呈现表皮坏死型者,早期削磨痂不植皮应用LBD覆盖43例,三度烧伤早期切痂植皮(自体微粒或皮片)56例,肉芽植皮创面41例和供皮区22例。结果临床应用LBD早期覆盖新鲜烧伤创面后患者疼痛立即减轻,直观创面血浆渗出停止,休克期度过平稳,无一例因休克和脓毒症死亡。33例削痂创面中有8例削痂过深和10例削痂过浅,部分创面需通过换药或再补植皮治愈,其他15例在2周后上皮化,3～4周治愈,平均(21.0±1.2)d治愈。10例磨痂创面平均(20.1±21.0)d愈合。切痂创面3例微粒植皮,术后因未能按时去除外敷料,LBD发生溶解,创面通过换药治愈,5例部分创面形成肉芽(为原烧伤面积5%以下),经补植皮治愈,创面平均愈合时间(28.5±1.1)d。肉芽植皮创面愈合时间10～20d,10例需再补植皮,15例需换药治愈,创面平均愈合时间(14.2±1.3)d。供皮区创面愈合在7～11d,创面平均愈合时间(8.1±2.1)d。287例烧伤患者最大一次覆盖面积达90%,一次切痂和削磨痂最大面积分别为40%和85%。治愈出院280例,自动出院6例,死于败血症1例。结论生物胶原纤维刘氏烧伤敷料可广泛应用在各种烧伤创面,早期直接覆盖新鲜烧伤创面有保护创面、减少水分及血浆蛋白丢失的作用,对于预防休克和感染有较好疗效;对深二度削磨痂创面覆盖不需植皮,对三度切痂植皮创面可代替尸体皮,是理想的烧伤创面真皮替代覆盖物,可常规应用于烧伤创面。
Objective To observe the clinical effect of LBD wound on collagen fibers and to explore its application prospects. Methods Clinical application of biofibrous collagen Liu burn wound dressing treatment of 287 cases of burn patients. For fresh superficial second or deep second degree burn wounds, red and white, mainly red, especially the skin avulsion wounds, immediately after admission, cover the LBD (without anesthesia) in the debridement room or bedside, a total of 125 Cases of deep second-degree burn wounds mainly pale or epidermal necrosis type, the early shaving crust non-skin graft application LBD cover 43 cases, the third degree burns early excision skin graft (autologous particles or skin flap) in 56 cases of granulation skin grafting wounds 41 cases and donor area in 22 cases. Results The clinical application of LBD immediately after the cover of fresh burn wounds patients with immediate relief of pain, visual wound plasma exudate stopped, the shock period was smooth, no case of death due to shock and sepsis. Among the 33 patients who underwent incision scars, 8 had excessively cut off the scab and 10 had excessively cut off the scab. Some of the wounds were cured by dressing change or replantation. The other 15 patients were epithelialized after 2 weeks and were cured in 3 to 4 weeks. The average (21.0 ± 1.2) d cure. In 10 cases, the average wound healing time was (20.1 ± 21.0) days. 5 cases of wounds formed granulation (less than 5% of the original burn area). After the skin graft was cured, the wounds were cured by dressing change. The average wound healing time (28.5 ± 1.1) d. Granulation skin grafting wound healing time 10 ~ 20d, 10 cases of skin graft, 15 cases need to be cured, the average wound healing time (14.2 ± 1.3) d. Donor area wound healing in 7 ~ 11d, wound healing time (8.1 ± 2.1) d. The maximum area covered by 90% of the 287 burn patients was 40% and the maximum size of the 40% and 85% of the cutters and sharpening scars respectively. 280 cases were cured, 6 cases were discharged automatically and 1 case died of sepsis. Conclusions The biomaterial collagen Liu Liu burn dressing can be widely used in a variety of burn wounds, early direct coverage of fresh burn wounds to protect the wound, reduce water and plasma protein loss, for the prevention of shock and infection have a good effect; deep second degree Scratch crust wound coverage without skin grafting, skin grafting on the three degrees escharectomy can replace the body skin, is the ideal burn wound dermis alternative covering, can be routinely applied to burn wounds.