【关键词】MEBO；病因；烫伤防治
Causes of accidental scald in hospital and its prevention and treatment ZUO Si-qin, XU Gang, ZHOU Rong-fang, Dept. of Plastic Surgery and Burns, North Jiangsu People's Hospital, Yangzhou, Jiangsu Province 225009，China
【Abstract】Objective: To review and analyze the causes of scald happened in hospital and the way of its prevention and treatment. Method: From Jan. 1997 to Mar. 2005, we treated 33 cases of scald happened in hospital. Among them, 18 cases were scalded when they warmed themselves with steam heat (accounted for 545%) and 15 cases were scalded when they received treatment (accounted for 455%). Result: 19 cases were treated with MEBO until the wounds completely healed. No scar formed and no dysfunction happened. 14 cases received surgical operation in association with MEBO treatment. The wounds were healed in 1st intention, accept for one case healed with cicatricial contraction in both feet and the function was not good. This patient received a secondary surgical operation and the function finally recovered. Conclusion: It is important to publicize the knowledge of preventing accidental scald and burn, so that the patients can protect themselves. Medical workers should adhere strictly to the regulations of technical operations. Cooperation of medical workers and patients is an effective approach to the prevention of accidental scald in hospital.
【Key words】MEBO; cause; scald; prevention and treatment
医院内患者意外烫伤偶有发生。秋冬季节发生率较高，多为腹壁与下肢小面积深度烫伤。我科自1997年1月至2005年3月间，先后治疗33例医院内意外烫伤病人，由于烫伤范围较小，均以门诊非手术治疗为主，早期应用MEBO局部治疗，并根据烫伤部位与深度选择不同的修复方法治疗，使创面得到及时修复。本组病例由于发现及时，治疗及护理得当，疗效满意，未造成严重的负面影响。现报告如下：
一、临床资料
全组病例共33例，其中男15例，女18例，年龄1岁～68岁，其中新生儿2例。致伤原因：住院期间单纯使用热水袋取暖烫伤9例(占27.3%)；偏瘫肢体热水袋烫伤4例(占12.1%)；麻醉术后热水袋烫伤3例(占9.1%)；中医拔火罐艾条炙、理疗致烫伤8例(占24.2%)；红外线烤灯致烫伤2例(占6.1%)，高频电刀铅板接触肢体皮肤意外放电烫伤4例(占121%)；高频电刀开关失灵致皮肤烫伤1例(占3.0%)；新生儿洗澡烫伤2例(占6.1%)。烫伤面积与深度：浅Ⅱ度～深Ⅱ度面积0.5%～1.0% TBSA 21例（其中深Ⅱ度16例），深Ⅱ度～Ⅲ度面积1.5%～3.0% TBSA 4例；浅Ⅱ度～深Ⅱ度面积4.0%～6.0% TBSA 5例；浅Ⅱ度～深Ⅱ度面积7.0%～10.0% TBSA 3例；其中深Ⅱ度1例。本组病例均来自于各级基层医院，其中家属擅自给患者取暖烫伤18例(占54.5%)，治疗过程中意外烫伤15例(占45.5%)。
二、治疗方法
本组病例由于烫伤范围小，以门诊治疗为主。门诊治疗24例，其中有5例晚期创面直径＜2cm，在门诊行自体皮移植手术治疗。本组中有9例住院治疗，行切/削痂自体皮移植手术，其中2例行邻近筋膜皮瓣修复辅以自体皮移植术；其余病人均早期使用MEBO局部治疗。用药前使用生理盐水清洗创面，局部应用MEBO外涂，药层厚度约1.0mm～1.5mm，创面覆盖无菌纱布2～3层并包扎以减少药层的污染。在每次换药时去除创面上液化物和残留药膏，每日换药一次，2周后可行刺激性小的蚕食脱痂方法去除浮离的焦痂组织，进一步促进创面引流与“祛腐生肌”，辅助MEBO充分发挥药物的效应，促进残留毛囊上皮和创缘上皮组织自行匐行愈合，但在换药时应进行医患沟通，积极做好患者的心理指导，及时消除患者对创面治疗的紧张恐惧心理，及时与患者沟通说明采用MEBO治疗，具有止痛、清热解毒、祛腐生肌，促进再生上皮修复等作用［1、2］，让患者乐于接受MEBO药物的治疗。在清除创面液化物或蚕食脱痂时［3］应做好创面护理［4］，动作要轻柔，防止造成组织过度损伤，或损伤间生态组织，最大限度地保护创面残留上皮组织。
三、 治疗结果
本组医院内小面积意外烫伤33例中，19例局部应用MEBO反复换药创面完全愈合，无瘢痕及功能障碍；14例行手术自体皮移植，其中5例晚期创面直径＜2cm,在门诊行自体皮移植治疗均得到一期愈合，仅有一例双足背轻度瘢痕挛缩畸形，经二期手术修复后，完全恢复正常功能和良好的外形
