探讨水凝胶联合藻酸盐银敷料在面部深Ⅱ度烧伤治疗中的应用效果。

选取2017年2月至2020年2月新疆维吾尔自治区人民医院烧伤创面修复科收治的82例面部深Ⅱ度烧伤患者，使用随机数字表法将患者分为干预组和对照组，每组各41例。2组患者均于治疗前根据临床操作规范去除创面失活组织，0.9%氯化钠溶液冲洗创面后使用无菌纱布吸干。对照组给予将磺胺嘧啶银乳膏揉搓至无菌凡士林油纱布，制作成"面膜"敷料贴附于患者面部进行治疗，每日更换敷料1次；干预组根据患者创面渗出量选择水凝胶敷料所需剂量，均匀涂抹至创面，并根据患者创面大小裁剪藻酸盐银敷料(大于创面外缘0.5 cm)，使其完全覆盖并贴附于创面，根据外层藻酸盐银敷料湿润度决定更换敷料频次，5～7 d更换1次敷料。观察2组患者治疗期间有无不良反应发生、换药次数、平均视觉模拟评分法(VAS)评分及平均治疗费用，患者出院后6个月进行门诊随访，根据患者创面愈合后瘢痕增生及色素沉着程度对患者治疗有效率进行评价，统计2组患者治疗的总有效率。数据比较采用t检验和秩和检验。

2组患者均通过换药痊愈，治疗过程中未出现局部严重感染及其他全身严重不良反应。干预组患者换药次数、平均VAS评分及平均治疗费用分别为(4.8±0.7)次、(4.5±0.8)分、(2 013.6±190.7)元，与对照组[(23.0±1.2)次、(6.3±0.7)分、(3 523.5±223.4)元]比较，差异均有统计学意义(t＝86.866、11.992、34.868，P<0.05)；患者出院后6个月门诊随访，干预组中优29例(70.7%)、良10例(24.4%)、中1例(2.4%)、差1例(2.4%)，治疗的总有效率为95.1%，对照组中优17例(41.5%)、良16例(39.0%)、中3例(7.3%)、差5例(12.2%)，治疗的总有效率为80.5%，2组患者治疗的总有效率比较，差异有统计学意义(Z＝2.817，P＝0.005)。

水凝胶联合藻酸盐银敷料治疗能够减轻患者疼痛、减少换药频次、降低平均治疗费用、降低创面愈合后瘢痕形成及色素沉着，适用于面部深Ⅱ度烧伤创面的治疗。

To explore the effect of hydrogel combined with silver alginate dressing in the treatment of deep partial thickness burn on the face.

A total of 82 patients with deep partial thickness burn treated in the Department of Burns and Wound Repair, People′s Hospital of Xinjiang Uygur Autonomous Region from February 2017 to February 2020 were selected and randomly divided into intervention group and control group according to the random number table method, with 41 patients in each group. Before treatment, patients in both groups were treated with inactivated wound tissues removed according to clinical operating specifications, and the wounds were rinsed with 0.9% sodium chloride solution and dried with sterile gauze. The control group was given the silver sulfadiazine cream to be rubbed into sterile petrolatum oil gauze, made into a "mask" dressing and attached to the patient′s face for treatment, and the dressing was changed once a day. The intervention group selected the required dosage of the hydrogel dressing according to the amount of exudation from the wound of the patient, and applied it evenly to the wound, and cut the silver alginate dressing (0.5 cm larger than the outer edge of the wound) according to the size of the wound to make it completely covered and attached to the wound, the frequency of dressing change was determined according to the wettability of the outer silver alginate dressing, and the dressing was changed once every 5 to 7 days. Observed whether there were adverse reactions, the number of dressing changes, the average visual analogue scale (VAS) score and the average treatment cost of the two groups of patients during the treatment period. The patients were followed up 6 months after discharge from the hospital, the effective rate of treatment was evaluated according to the degree of scar hyperplasia and pigmentation after wound healing, and the total effective rate of treatment for the two groups of patients was calculated. Data were compared with t test and rank sum test.

Patients in the two groups were cured by dressing change, and there were no serious local infections and other serious systemic adverse reactions during the treatment. The number of dressing changes, the average VAS score, and the average treatment cost of the intervention group were (4.8±0.7) times, (4.5±0.8) minutes, (2 013.6±190.7) yuan, and compared with the control group [(23.0±1.2) times, (6.3±0.7) points and (3 523.5±223.4 yuan), the difference was statistically significant (t=86.866, 11.992, 34.868; P<0.05). Patients were followed up in the outpatient clinic for 6 months after discharge, in the intervention group, 29 cases were excellent (70.7%), 10 cases were good (24.4%), 1 case was moderate(2.4%) and 1 case was poor (2.4%), the total effective rate of treatment was 95.1%; in the control group, 17 cases were excellent (41.5%), 16 cases were good (39.0%), 3 cases were moderate(7.3%) and 5 cases were poor (12.2%), the total effective rate of treatment was 80.5%. The total effective rate of treatment between the two groups was compared, and the difference was statistically significant (Z=2.817, P=0.005).

Hydrogel combined with silver alginate dressing can relieve patients′ pain, reduce the frequency of dressing changes, reduce the average treatment cost, reduce scar formation and pigmentation after wound healing, and is suitable for the treatment of deep partial thickness burn on the face.