比较手背Ⅲ度烧伤创面行切痂后两种不同止血方法对手术效果的影响。

将30例32处手背Ⅲ度烧伤、需手术切痂植皮患者按随机数字表法随机分为两组，每组16手(2人为双手烧伤)。观察组(全程应用止血带)扎电动止血带后行手背创面切痂，无明显活动性出血点后将中厚皮片置于创面，无菌敷料加压包扎，松止血带。对照组(短程应用止血带)扎电动止血带后行手背创面切痂，电刀止血后松止血带，再次电刀止血，无明显活动性出血点后将中厚皮片置于创面，无菌敷料加压包扎。记录和比较两组患者术后血常规结果变化及手术失血量、手术时间、皮片成活率和皮片下血肿形成情况。

术后观察组和对照组红细胞计数分别为(4.16 ± 0.53)×10¹²/L和(4.00 ± 0.50)×10¹²/L，血红蛋白浓度分别为(124.14 ± 8.63)g/L和(120.29 ± 7.53)g/L，红细胞压积分别为(40.64 ± 5.47)%和(40.79 ± 4.59)%，手术失血量分别为(6.73 ± 1.58)mL和(7.02 ± 1.17)mL，皮片下血肿面积分别为(2.63 ± 2.60)cm²和(3.45 ± 2.15)cm²，两组比较差异均无统计学意义(P值均大于0.05)；在总体手术时间方面，观察组和对照组分别为(39.14 ± 6.67)min和(59.14 ± 4.79)min，两组比较差异有统计学意义(t＝－0.90，P＝0.000)；此外，观察组的皮片成活率(96.25 ± 3.37)%高于对照组(95.51 ± 2.25)%)，差异有统计学意义(t＝0.729，P＝0.015)。

全程应用止血带较短程应用止血带术式的手术总体时间缩短，皮片成活率提高，二者在术后血常规改变及皮片下血肿形成方面差异无统计学意义。

To compare the outcomes of two different blood loss prevention modalities during escharectomy and skin transplantation in full-thickness hand burn patients.

Thirty patients with 32 full-thickness hand burns (two patients were injured with both hands) who need escharectomy and skin transplantation were divided randomly into two groups, i. e. test group with tourniquet applied during the escharectomy and skin transplantation period, and control group with temporary application of tourniquet during the escharectomy procedure, each group consisted of 16 hands. Operation time, postoperative blood routine results and amount of blood loss, take rate of skin graft and area of hematoma of grafted skin of two groups were documented and analyzed.

No statistical significance was found between two groups on results of red blood cell count [(4.16 ± 0.53)×10¹²/L versus (4.00 ± 0.50)×10¹²/L) for test group and control group, respectively], hemoglobin [(124.14 ± 8.63)g/L versus (120.29 ± 7.53) g/L) for test group and control group, respectively], blood loss [(6.73 ± 1.58)mL versus (7.02 ± 1.17) mL for test group and control group, respectively] and area of hematoma of grafted skin [(2.63 ± 2.60) cm² versus (3.45 ± 2.15) cm² for test group and control group, respectively]. The operation time cost in test group was significantly shorter than that in control group [(39.14 ± 6.67) min versus (59.14 ± 4.79) min, respectively, t=-0.90, P=0.000]. Moreover, the take rate of grafted skin in test group was significantly higher than that in control group [(96.25 ± 3.37)% versus (95.51 ± 2.25)%, t=0.729, P=0.015].

Continuous application of tourniquet during escharectomy and skin transplantation in full-thickness hand burn patients could shorten the operation time and increase the take rate of grafted skin. However, no statistical significance was noted on the changes of blood routine test and formation of hematoma after operation.