观察3种创面敷料对薄中厚皮片供皮区创面愈合的影响。

选取蚌埠医学院第一附属医院整形烧伤科2020年1月至12月收治的38例自体皮片移植术患者。在同一患者供皮区分别取相同面积的类矩形薄中厚皮片3处，每处均间隔1 cm，每例所取皮片总面积基本相同，将同一患者的3处供皮区分为凡士林敷料组、银离子藻酸盐敷料组和丝素蛋白膜状敷料组3组，取皮后分别贴敷凡士林敷料、银离子藻酸盐敷料和丝素蛋白膜状敷料。对比3组供皮区创面积血率、初次换药时患者的疼痛程度[数字评定量表(NRS)]、创面感染率、创面上皮化愈合时间、创面后期愈合效果。对数据行单因素方差分析、t检验和χ²检验。

(1)创面积血率：丝素蛋白膜状敷料组创面积血率(23.68%)分别高于分别高于凡士林敷料组(2.63%)和银离子藻酸盐敷料组(5.26%)，差异均有统计学意义(χ²＝ 7.370、5.208, P<0.05)，凡士林敷料组与银离子藻酸盐敷料组积血率比较，差异无统计学意义(χ²＝0.347, P>0.05)；(2)初次换药时疼痛程度评价：丝素蛋白膜状敷料组的NRS评分为(2.97±1.48)分，分别低于银离子藻酸盐敷料组[(3.97±1.84)分]和凡士林敷料组[(6.03±1.37)分]，差异均有统计学意义(t＝ 4.854、0.873, P<0.05)；银离子藻酸盐敷料组疼痛评分低于凡士林敷料组，差异有统计学意义(t＝1.467, P<0.05)；(3)创面感染率：银离子藻酸盐敷料组创面感染率(5.26%)分别与丝素蛋白膜状敷料组(0)和凡士林敷料组(10.53%)比较，差异均无统计学意义(χ²＝ 2.054、0.724, P>0.05)；丝素蛋白膜状敷料组与凡士林敷料组比较，感染率低，差异有统计学意义(χ²＝ 4.222, P<0.05)；(4)创面上皮化愈合时间：丝素蛋白膜状敷料组创面上皮化愈合时间为(8.95±1.34) d，与银离子藻酸盐敷料组[(13.69±1.64) d]以及凡士林敷料组[(11.78±1.43) d]比较，愈合时间均较短，差异均有统计学意义(t＝0.953、1.204, P<0.05)。与银离子藻酸盐敷料组比较，凡士林敷料组愈合时间短，差异有统计学意义(t＝2.147, P<0.05)；(5)创面后期愈合效果：3组在瘢痕增生和色素沉着2方面均无明显差异。

丝素蛋白膜状敷料应用于薄中厚皮片供皮区，具有相对无痛、抗感染能力强、上皮化愈合时间短等优势，但在防止创面积血方面效果欠佳。

To observe the effects about the healing of thin medium-thickness skin grafts with three wound dressings.

Thirty-eight autologous skin graft patients in Department of Plastic and Burns, First Affiliated Hospital of Bengbu Medical College from January to December 2020 were selected. Three equal areas identical rectangular thin medium-thickness skins were taken on the same patient′s, which were 1 cm apart and the total area of skin slices taken from each patient was basically the same. The skin of the same patient was divided into three groups: paraffin gauze dressing group, alginate Ag dressing group and silk fibroin wound dressing group. After the skin graft was removed, it was applied separately paraffin gauze dressing, alginate Ag dressing and silk fibroin wound dressing. Wound hemorrhage, pain degree of the patient during the first dressing change[number rating scale (NRS)], wound infection, wound healing time, wound healing effect of the three groups were compared. Data were statistically analyzed with one-way analysis of variance, t test and chi-square test.

(1)Wound hematocele rate: compared with paraffin gauze dressing group(2.63%), alginate Ag dressing group(5.26%), silk fibroin wound dressing group had a higher blood accumulation rate(23.68%), and the differences were statistically significant(χ²=7.370, 5.208; P<0.05), and compared with the blood accumulation rate of paraffin gauze dressing group and alginate Ag dressing group, the difference was not statistically significant (χ²=0.347, P>0.05). (2) Pain degree of the patient during the first dressing change: the NRS score of the silk fibroin wound dressing group was (2.97±1.48)points, which was lower than alginate Ag dressing group[(3.97±1.84) points] and paraffin gauze dressing group[(6.03±1.37)points], the differences were statistically significant(t=4.854, 0.873; P<0.05); the pain score of the alginate Ag dressing group was lower than paraffin gauze dressing group, the difference was statistically significant(t=1.467, P<0.05). (3)Wound infection rate: the infection rate of balginate Ag dressing group was 5.26%, compared with silk fibroin wound dressing group (0) paraffin gauze dressing group(10.53%), the differences were not statistically significant(χ²= 2.054, 0.724; P>0.05); the infection rate of silk fibroin wound dressing group was lower than paraffin gauze dressing group, the difference was statistically significant(χ²=4.222, P<0.05). (4)Wound epithelialization healing time: the would epithelialization healing time of alginate Ag dressing group was (13.69±1.64) d which was shorter than the paraffin gauze dressing group[(11.78±1.43) d] and the silk fibroin wound dressing group[(8.95±1.34) d], and the differences were statistically significant (t=0.953, 1.204; P<0.05). Compared with alginate Ag dressing group, the wound epithelialization healing time of paraffin gauze dressing group was shorter, and the difference was statistically significant (t=2.147, P<0.05). (5)Wound healing effect: there were no differences among three groups in scars and pigmentation.

The silk fibroin wound dressing has defect in wound hemorrhage. However, it has obvious advantages in pain score, wound infection, and wound healing time.