回顾性研究糜蛋白酶结合亲水纤维敷料换药对慢性创面愈合的作用。

收集苏州大学附属常熟医院常熟市第一人民医院烧伤整形科自2018年1月至2021年10月住院治疗的98例慢性创面患者病历资料。其中28例采用常规治疗方案换药治疗，纳入对照组；38例采用糜蛋白酶换药治疗，设为糜蛋白酶组；32例应用糜蛋白酶联合亲水纤维敷料换药治疗，设为复合换药组。比较3组患者创面愈合时间、换药次数、平均治疗总费用、创面感染率及疼痛评分。数据比较采用单因素方差分析、t检验与χ²检验。

复合换药组、糜蛋白酶组及对照组3组间平均创面愈合时间、平均换药次数、平均疼痛评分比较，差异均有统计学意义(F＝91.94、69.36、9.063，P<0.05)；3组间平均治疗总费用与创面感染率比较，差异均无统计学意义(F＝1.117、χ²＝4.256，P>0.05)。复合换药组平均创面愈合时间[(17.2±0.4) d]显著低于糜蛋白酶组[(24.1±0.5) d]与对照组[(24.9±0.5) d]，差异均有统计学意义(t＝11.47、13.31，P<0.05)；复合换药组患者平均换药次数[(8.25±0.29)次]显著低于糜蛋白酶组[(12.74 ±0.28)次]与对照组[(12.71±0.49)次]，差异均有统计学意义(t＝11.21、8.27，P<0.05)；复合换药组平均疼痛评分[(1.9±0.2)分]显著低于糜蛋白酶组[(2.6±0.2)分]与对照组[(3.1±0.2)分]，差异均有统计学意义(t＝2.76、4.23，P<0.05)。

糜蛋白酶结合亲水纤维敷料换药可有效促进慢性创面坏死组织清除，促进创面新鲜肉芽组织生长，降低感染率，同时不增加治疗总费用，因此值得进一步研究及临床推广。

To retrospectively study the effect of chymotrypsin combined with hydrophilic fiber dressing on chronic wound healing.

The clinical data of 98 cases with chronic wounds hospitalized in the Department of Burns and Plastic Surgery, Changshu Hospital Affiliated to Soochow University, Changshu No.1 People′s Hospital from January 2018 to October 2021 were collected. Among them, 28 cases were treated with dressing change for routine treatment and were included in the control group; 38 cases were treated with chymotrypsin and were included in the chymotrypsin group; 32 cases were treated with chymotrypsin combined with hydrophilic fiber dressing and were included in the compound dressing change group. The wound healing time, dressing change times, average total treatment cost, incidence of wound infection and pain score were compared among the three groups. Data were processed with one-way analysis of variance, t test and chi-square test.

There were statistically significant differences in average wound healing time, average dressing change times, and average pain score among compound dressing change group, chymotrypsin group and control group (F=91.94, 69.36, 9.063; P<0.05). There were no statistically significant differences in the average total treatment cost and the incidence of infection among the three groups (F=1.117, χ²=4.256; P>0.05). The average wound healing time in the compound dressing group was (17.2±0.4) d, which was significantly lower than that in the control group [(24.9±0.5) d] and chymotrypsin group [(24.1±0.5) d], and the differences were statistically significant(t=11.47, 13.31; P<0.05). The average dressing change times in the compound dressing group was (8.25±0.29) times, which was significantly lower than that in the chymotrypsin group [(12.74±0.28) times] and the control group [(12.71±0.49) times] , and the differences were statistically significant(t=11.21, 8.27; P<0.05). The pain score of patients in the compound dressing change group was (1.9±0.2) points, which was significantly lower than that in the chymotrypsin group [(2.6±0.2) points] and the control group [(3.1±0.2) points] , the differences were statistically significant (t=2.761, 4.228; P<0.05).

Chymotrypsin combined with hydrophilic fiber dressing can effectively promote the clearance of chronic wound necrotic tissue, promote the growth of fresh granulation tissue, reduce the infection rate, and do not increase the total cost of treatment. Therefore, it is worthy of further research and clinical promotion.