探讨水动力清创系统(简称水刀)在大面积深Ⅱ度烧伤中的清创效果。

选取2019年10月至2022年10月安徽医科大学第一附属医院烧伤科收治的41例大面积深Ⅱ度烧伤患者进行回顾性队列研究，按照是否使用水刀清创分为水刀清创组(20例)和传统清创组(21例)，均联合自体Meek皮片封闭创面。术后采取常规抗感染、定期换药等治疗。观察两组患者术后7 d植皮存活率、手术区愈合时间，记录并计算术后降钙素原(PCT)及C反应蛋白(CRP)降低率。数据比较采用t检验、χ²检验、Mann-Whitney U检验。

水刀清创组的手术区植皮存活率为95.9%(87.7%，96.7%)，高于传统清创组的83.3%(80.0%，87.7%)，差异有统计学意义(Z＝-3.748，P<0.001)。水刀清创组术后PCT降低率[(59.5±21.5)%]高于传统清创组[(26.1±32.7)%]，差异有统计学意义(t ＝3.839，P<0.001)。水刀清创组术后CRP降低率为55.8%(32.3%，66.8%)，高于传统清创组[32.3%(15.4%，37.3%)]，差异有统计学意义(Z ＝-3.170，P＝0.002)。水刀清创组手术区愈合时间为(37.1±17.3)d，短于传统清创组[(48.9±4.2)d]，差异有统计学意义(t ＝-2.058，P＝0.046)。

与传统清创术比较，水动力清创系统联合Meek皮片移植治疗大面积深Ⅱ度烧伤能更精准地清除坏死组织，减轻全身炎症反应，创造有利的植皮环境，提高植皮存活率，加快创面愈合。

To explore the effect of the hydrosurgery system in the debridement of patients with extensive and deep second-degree burns.

Forty-one patients with extensive and deep second-degree burns admitted to the Department of Burns, the First Affiliated Hospital of Anhui Medical University from October 2019 to October 2022 were selected for a retrospective cohort study, and were divided into a hydrosurgery system debridement group (20 cases) and a traditional debridement group (21 cases) according to whether or not hydrosurgery system was used, combined with autologous Meek micrograft technique to heal the wounds. Post-operative care included routine anti-infection and regular dressing changes. The survival rate of the implant at 7 days after surgery and the healing time of the surgical area were observed in both groups, and the postoperative procalcitonin (PCT) and C-reactive protein (CRP) reduction rates were recorded and calculated. Data were analysed using t-test, chi-square test and Mann-Whitney U test.

The implant survival rate of the hydrosurgery system debridement group was 95.9%(87.7%, 96.7%), which was significantly higher than that of the traditional debridement group [83.3%(80.0%, 87.7%)], and the difference was statistically significant (Z=-3.748, P<0.001). The post-operative PCT reduction rate of the hydrosurgery system debridement group was (59.5±21.5)%, which was significantly higher than that of the traditional debridement group [(26.1±32.7)%], and the difference was statistically significant (t=3.839, P<0.001). The post-operative CRP reduction rate of the hydrosurgery system debridement group was 55.8%(32.3%, 66.8%), which was significantly higher than that of the traditional debridement group [32.3%(15.4%, 37.3%)], with a statistically significant difference (Z=-3.170, P=0.002). The healing time of the surgical area in the hydrosurgery system debridement group was (37.1±17.3) days, which was significantly shorter than that of the traditional debridement group (48.9±4.2) days, with a statistically significant difference (t=-2.058, P=0.046).

Compared with traditional debridement, hydrosurgery system debridement combined with Meek micrograft technique can more precisely remove necrotic tissue, reduce systemic inflammation, create a favourable environment for skin grafting, improve skin grafting survival rate, accelerate wound healing for patients with extensive and deep second-degree burns.