| Background:Partial thickness burns are the injury that reaches the dermis and can be divided into superficial partial thickness burns and deep partial thickness burns according to the different dermis layers.Studies have shown that the early development of burn wounds is a dynamic process,the progressive deepening of burn wounds can occur 3 hours after the injury,visible to the naked eye at 6 hours,peak at 24 hours,and last to 48-72 hours.According to Jackson burn wounds of theory of"three zones"after injury,intermediate between stasis zone for ecological organization,it can occur due to the difference of wound treatment of different outcomes,namely the outcome is two-fold,if early wound mishandled,between ecological organization may outcome of necrotic tissue,which show the burn wounds progressive deepening,However,early and reasonable treatment may reverse the occurrence of tissue necrosis.Therefore,how to improve the outcome of ecological tissues in the stagnation zone has become a research hotspot in recent years,and reasonable and standardized treatment for early wounds plays an important role in preventing or reducing the dynamic progression of wounds.Early post burn wound treatment including cold emergency treatment and the application of topical medications or dressing,at present the mainstream view within 3 hours after injury immediately with cold water flush the wound up to 20～30 minutes continuously,not only can effectively reduce the local temperature,reduce the residual heat transfer function down,and can effectively relieve the pain and prevent the progressive deepening of the wound,At present,it has become an important way of early first-aid treatment of burn wound,and has become a universally recognized consensus.However after cold treatment of burn wounds early cognitive processing has not yet formed a unified specification,including blister skin treatment,topical products,dressings,etc.,especially in recent years,along with a variety of rapid progress in the study of topical products,dressings,etc,make partial thickness burns increasingly complex degree burn wound treatment,also has not yet formed at present partial thickness burns wound treatment in clinical diagnosis and treatment norms and consensus.For these reasons,this topic first carried out a questionnaire survey to understand the current situation of the early treatment and understanding of partial thickness burns by domestic medical staff,that is,the cross-sectional survey of the early treatment of partial thickness burns by national burn professional medical staff.This topic further designed and carried out a multi-center prospective observational study based on the real clinical environment to further explore and verify the possibility of early treatment of partial thickness burns for the prevention of wound progression,and to explore the effect of early,timely,reasonable and standardized treatment on the deepening outcome and healing time of partial thickness burns wounds.Methods:1.A Cross-sectional Investigation of Early Treatment of Partial Thickness Burns of National Burn Professional Medical PersonnelThis research group investigates through reading the relevant literature,combine the common treatment measures for the early treatment of partial thickness burns at home and abroad,and design and improve the questionnaire according to the feedback of experts.During the period from November 2020 to February 2021,the questionnaire was released through the"Questionnaire Star"website platform,and burn professionals across the country were invited to fill in anonymously online.In the questionnaire,the treated burn patients were limited to partial thickness burns burn patients with boiling water burns within 24 hours,and their burn sites were limited to common common parts such as trunk and limbs,mainly focusing on the early treatment of partial thickness burns:including the treatment of blisters,the reasons for retaining the vesicle skin,the reasons for removing the vesicle skin,the conventional choice of topical drugs or dressings for the wound in the early stage after the partial thickness burns burn,and the recommendation of the optimal treatment of topical drugs or dressings for the wound after the partial thickness burns burn.To avoid duplicate submissions,the questionnaire is set to submit only once per person.The statistical method uses SPSS 22.0 to descriptively analyze the general data of the respondents and the problems related to the early treatment of partial thickness burns,and the counting data are described as examples and composition ratios,andχ~2is used for analysis.2.A Real-world Study of Early Conservative Dressing Treatment of Partial Thickness BurnsSeptember to september 2021 During March 2022,this real-world study was conducted simultaneously at burn centers in eight hospitals.Patients with small and medium-sized partial thickness burns within 24 hours of thermal burns were recruited and were selected by the first physician to be included in the cohort based on inclusion/exclusion.Each participant’s wound treatment was clinically treated in the hospital,and the researchers did not interfere with the choice of treatment plan.Prospective observation and recording of follow-up point data of all enrolled patients,screening period records patient demographic data and clinical baseline characteristics,including age,sex,burn causes,test site,burn area,burn area,burn total area,etc.During the treatment period,patient observation indicators were recorded,including the time of complete wound healing,wound deepening,dressing change pain score,wound inflammation score,etc.The statistical method used SPSS 22.0 to descriptively analyze the baseline data of the included patients,and the efficacy observation index data were analyzed by t test andχ~2test.Results:1.A Cross-sectional Investigation of Early Treatment of Partial Thickness Burns Of National Burn Professional Medical PersonnelThe survey was received There were 979 questionnaires from 31 provinces across the country,and the questionnaire was 100%efficient.The respondents included 656 doctors and 323 nurses,with an average age of 38.95±9.9 years,of which 83.6%were from tertiary hospitals.The majority of respondents(87.1%)advocated that the vesicular skin and drainage blister fluid should be retained in the early treatment of partial thickness burns,and highly agreed that the vesicular skin protected the wound and provided a moist microenvironment to promote wound healing(92.7%).The routine choice of early treatment of wounds in the respondents was not uniform,mainly external moisturizing and absorbent dressings or moisturizing materials(68.7%),topical antibacterial drugs(67.2%)and topical wound healing drugs(67.1%).In terms of optimal regimen recommendations,the majority of medical staff(45.5%)gave priority to recommending topical moisturizing and absorbent dressings or moisturizing materials,followed by topical wound healing drugs(20.1%),topical biological dressings(16.3%)and topical antibacterial drugs(14.1%),and only a small number of people chose other treatment regimens such as oil creams(4%).2.A Real-world Study of Early Conservative Dressing Treatment of Partial Thickness BurnsIn this study,80 patients with partial thickness burns and 10 patients with loss during the treatment period were recruited.A total of 70 subjects were included in the statistical analysis,including 53 patients(75.71%)with superficial partial thickness burns and 17 patients(24.29%)with deep partial thickness burns,mainly males and adults older than 12 years.Grouped according to the characteristics of the first use of dressings or drug treatment:39 patients(55.71%)were biological/foam dressing group,22 patients(31.43%)were silver-containing antibacterial gauze group,and 9 patients(12.86%)were moisturizing topical drugs/oil yarn groups,of which partial thickness burns patients and deep partial thickness burns patients were the most used foam dressings,respectively,31 cases(44.29%)and 4 cases(5.71%).The silver-containing antibacterial gauze treatment group significantly increased the mean healing time of the superficial partial thickness burns(β=0.302,P<0.05).The silver-containing antibacterial gauze treatment group significantly worsened the pain of superficial partial thickness burns dressing change(β=0.710,P<0.001).The bio/foam dressing treatment group significantly reduced the pain of dressing change(β=-0.648,P<0.01).The degree of inflammatory response to deep partial thickness burns wounds was more pronounced in the moisturizing topical drug/yarn treatment group(β=0.633,P<0.01).The silver-containing antibacterial dressing group had a lower overall wound healing rate of 21 days of deep partial thickness burns(50.0%vs 100.0%,100.0%,P<0.05),while the wound deepening rate within 3 days of superficial partial thickness burns was higher(12.5%vs 2.7%,0.0%,P=0.866).Conclusions:There are great differences in the recommendation of early topical dressings or drugs for burn wounds and the optimal plan by burn medical professionals in China,which is not consistent with the international mainstream view.For early partial thickness burns wound treatment options,give priority to provide dressing wounds moist environment of external use,including biological dressings,foam dressings,compared with silver ions in the preparation of dressing or antibiotic ointment,and its potential in promoting wound healing,reduce the bandage wound pain,reduce inflammation reactions have a certain advantage. |
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