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  • Title: [A cross-sectional investigation and analysis of early treatment of partial-thickness burn wounds by professional burn medical staff in China].
    Author: Huang J, Li SY, Wang XX, Li LH, Ye XF, Ji SZ.
    Journal: Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi; 2022 Jun 20; 38(6):538-548. PubMed ID: 35764579.
    Abstract:
    Objective: To assess the current situation of early treatment of partial-thickness burn wounds by professional burn medical staff in China, and to further promote the standardized early clinical treatment of partial-thickness burn wounds. Methods: A cross-sectional investigation was conducted. From November 2020 to February 2021, the self-designed questionnaire for the early treatment of partial-thickness burn wounds was published through the "questionnaire star" website and shared through WeChat to conduct a convenient sampling survey of domestic medical staff engaged in burn specialty who met the inclusion criteria. The number, region, and grade of the affiliated hospital, the age, gender, occupation, and seniority of the respondents were recorded. The respondents were divided into physician group and nurse group, senior group and junior group, eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group. Then the seniority, grade of the affiliated hospital, region of the affiliated hospital of the respondents in physician group and nurse group, conventional treatment of partial-thickness burn blisters, reasons for retaining vesicular skin, reasons for removing vesicular skin, and the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage of respondents in each of all the groups were recorded. Data were statistically analyzed with chi-square test. Results: The survey covered 31 provinces, municipalities, and autonomous regions in China (except for Hong Kong, Macau, and Taiwan regions). A total of 979 questionnaires were recovered, which were all valid. The 979 respondents came from 449 hospitals across the country, including 203 hospitals in the eastern region, 116 hospitals in the western region, 99 hospitals in the central region, and 31 hospitals in the northeast region, 348 tertiary hospitals, 79 secondary hospitals, and 22 primary hospitals. The age of the respondents was (39±10) years. There were 543 males and 436 females, 656 physicians and 323 nurses, 473 juniors and 506 seniors, 460 in the eastern regions and 519 in the non-eastern regions, 818 in tertiary hospitals and 161 in primary and secondary hospitals. There were statistically significant differences in the composition of different seniority in the respondents between physician group and nurse group (χ2=44.32, P<0.01), while there were no statistically significant differences in grade or region of the affiliated hospital of the respondents between physician group and nurse group (P>0.05). There were no statistically significant differences in the conventional treatment of partial-thickness burn blisters among respondents between different occupational groups, seniority groups, and region of the affiliated hospital groups (P>0.05).The respondents in different grade of the affiliated hospital groups differed significantly in the conventional treatment of partial-thickness burn blisters (χ2=6.24, P<0.05). Compared with respondents in nurse group, larger percentage of respondents in physician group chose to retain vesicular skin for protecting the wounds and providing a moist environment, and alleviating the pain of dressing change (with χ2 values of 21.22 and 19.96, respectively, P values below 0.01), and smaller percentage of respondents in physician group chose to retain vesicular skin for prevention of wound infection (χ2=23.55, P<0.01). The reasons for retaining vesicular skin of respondents between physician group and nurse group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to retain vesicular skin for protecting the wounds and providing a moist environment and alleviating the pain of dressing change (with χ2 values of 10.36 and 4.60, respectively, P<0.05 or P<0.01), and smaller percentage of respondents in senior group chose to retain vesicular skin for prevention of wound infection (χ2=8.20, P<0.01). The reasons for retaining vesicular skin of respondents in senior group and junior group were similar in accelerating wound healing, alleviating pigmentation and scar hyperplasia post wound healing (P>0.05). The 5 reasons for the respondents between eastern region group and non-eastern region group, primary and secondary hospital group and tertiary hospital group chose to retain vesicular skin were all similar (P>0.05). Compared with those in physician group, significantly higher percentage of respondents in nurse group were in favor of the following 6 reasons for removing the vesicular skin, including convenience for using more ideal dressings to protect the wounds, prevention of wound infection, facilitating the effect of topical drugs on the wounds, the likely rupture of blisters and wound contamination, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ2 values of 4.35, 25.59, 11.83, 16.76, 46.31, and 17.54, respectively, P<0.05 or P<0.01). Compared with respondents in senior group, larger percentage of respondents in junior group chose to remove vesicular skin for the reasons such as the likely blister rupture and wound contamination, preventing wound infection, accelerating wound healing, and alleviating pigmentation and scar hyperplasia post wound healing (with χ2 values of 17.25, 18.63, 14.83, and 10.23, respectively, P values below 0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to remove vesicular skin for preventing wound infection and the likely rupture of blisters and wound contamination (with χ2 values of 9.30 and 8.65, respectively, P values below 0.01). The 6 reasons for the respondents between tertiary hospital group and primary and secondary hospital group choose to remove vesicular skin were similar (P>0.05). Compared with respondents in physician group, larger percentage of respondents in nurse group chose to use moisturizing materials for partial-thickness burn wounds in the early stage (χ2=6.18, P<0.05), and smaller percentage of respondents in nurse group chose other topical drugs or dressings (χ2=5.20, P<0.05). Compared with respondents in junior group, larger percentage of respondents in senior group chose to use moisturizing materials and other topical drugs or dressings for partial-thickness burn wounds in the early stage (with χ2 values of 4.97 and 21.80, respectively, P<0.05 or P<0.01). Compared with respondents in non-eastern region group, larger percentage of respondents in eastern region group chose to use topical antimicrobial drugs for partial-thickness burn wounds in the early stage (χ2=4.09, P<0.05), and smaller percentage of respondents in eastern region group chose to use other topical drugs or dressings for the partial-thickness burn wounds in the early stage (χ2=5.63, P<0.05). Compared with respondents in primary and secondary hospital group, larger percentage of respondents in tertiary hospital group chose to use biological dressings for partial-thickness burn wounds in the early stage (χ2=9.38, P<0.01). The optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage varied significantly among the respondents between different occupational groups and seniority groups (with χ2 values of 39.58 and 19.93, respectively, P values below 0.01). There were no statistically significant differences between eastern and non-eastern region groups, tertiary hospital group and primary and secondary hospital groups in optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage (P>0.05). Conclusions: The conventional treatment measures of partial-thickness burn blisters and reasons for preserving blister skin by professional burn medical staff in China are relatively consistent, but there are great differences in the selection of reasons for removing blister skin, the conventional selection and optimal solution recommendation of topical drugs or dressings for partial-thickness burn wounds in the early stage. Therefore, it is urgent to establish a clinical treatment standard for partial-thickness burn wounds. 目的： 了解我国烧伤专业医护人员对Ⅱ度烧伤创面的早期处理现状，促进Ⅱ度烧伤创面早期临床规范化治疗。 方法： 采用横断面调查方法。2020年11月—2021年2月，将自制的Ⅱ度烧伤创面早期处理问卷通过“问卷星”网站发布后经微信分享，对符合入选标准的我国从事烧伤专业的医护人员进行便利抽样调查。统计被调查者所属医院的数量、所在地区、等级，被调查者年龄、性别、职业和年资。将被调查者分为医师组、护士组，高年资组、低年资组，东部地区组和非东部地区组，一二级医院组、三级医院组，统计医师组与护士组被调查者的年资、所属医院等级、所属医院所在地区；所有分组中各组被调查者的Ⅱ度烧伤水疱常规处理、保留水疱皮的原因、去除水疱皮的原因，Ⅱ度烧伤创面早期外用药物或敷料的常规选择、最优方案推荐。对数据行χ2检验。 结果： 该次调查覆盖我国31个省市自治区（除香港、澳门和台湾地区），共回收979份问卷，均为有效问卷。979名被调查者来自全国449家医院，其中东部地区医院203家、西部地区医院116家、中部地区医院99家及东北地区医院31家，三级医院348家、二级医院79家、一级医院22家。被调查者年龄为（39±10）岁，男性543名、女性436名，医师656名、护士323名，低年资人员473名、高年资人员506名，东部地区人员460名、非东部地区人员519名，三级医院人员818名、一二级医院人员161名。医师组和护士组中不同年资被调查者构成，差异明显（χ2=44.32，P<0.01）；但医师组和护士组被调查者的所属医院等级、所属医院所在地区分布，差异均无统计学意义（P>0.05）。不同职业组、年资组以及所属医院所在地区组的被调查者在对Ⅱ度烧伤水疱的常规处理上，差异均无统计学意义（P>0.05）。不同所属医院等级组的被调查者在对Ⅱ度烧伤水疱的常规处理上，差异明显（χ2=6.24，P<0.05）。相较于护士组，更大比例医师组被调查者选择保留水疱皮的原因是保护创面并提供湿润环境、减轻换药疼痛（χ2值分别为21.22、19.96，P值均<0.01），更小比例医师组被调查者选择保留水疱皮的原因是预防创面感染（χ2=23.55，P<0.01）；医师组和护士组被调查者选择保留水疱皮的原因是加速创面愈合、减轻创面愈后色素沉着和瘢痕增生的情况均相近（P>0.05）。相较于低年资组，更大比例高年资组被调查者选择保留水疱皮的原因是保护创面并提供湿润环境、减轻换药疼痛（χ2值分别为10.36、4.60，P<0.05或P<0.01），更小比例高年资组被调查者选择保留水疱皮的原因是预防创面感染（χ2=8.20，P<0.01）；高年资组和低年资组被调查者选择保留水疱皮的原因是加速创面愈合、减轻创面愈后色素沉着和瘢痕增生的情况均相近（P>0.05）。东部地区组与非东部地区组相比、三级医院组与一二级医院组相比，被调查者选择保留水疱皮的5种原因情况均相近（P>0.05）。护士组被调查者选择去除水疱皮的6种原因便于采用更理想敷料保护创面、预防创面感染、利于创面外用药物发挥作用、水疱容易破裂污染创面、加速创面愈合、减轻创面愈后色素沉着和瘢痕增生的比例均分别明显大于医师组（χ2值分别为4.35、25.59、11.83、16.76、46.31、17.54，P<0.05或P<0.01）。相较于高年资组，更大比例低年资组被调查者选择去除水疱皮的原因是水疱容易破裂污染创面、预防创面感染、加速创面愈合以及减轻创面愈后色素沉着和瘢痕增生（χ2值分别为17.25、18.63、14.83、10.23，P值均<0.01）。相较于非东部地区组，更大比例东部地区组被调查者选择去除水疱皮的原因是预防创面感染、水疱容易破裂污染创面（χ2值分别为9.30、8.65，P值均<0.01）。三级医院组和一二级医院组被调查者选择去除水疱皮的6种原因情况均相近（P>0.05）。相较于医师组，更大比例护士组被调查者选择对Ⅱ度烧伤创面早期使用保湿材料（χ2=6.18，P<0.05），更小比例护士组被调查者选择其他外用药物或敷料（χ2=5.20，P<0.05）。相较于低年资组，更大比例高年资组被调查者选择对Ⅱ度烧伤创面早期使用保湿材料、其他外用药物或敷料（χ2值分别为4.97、21.80，P<0.05或P<0.01）。相较于非东部地区组，更大比例东部地区组被调查者选择对Ⅱ度烧伤创面早期使用外用抗菌药物（χ2=4.09，P<0.05），更小比例东部地区组被调查者选择对Ⅱ度烧伤创面早期使用其他外用药物或敷料（χ2=5.63，P<0.05）。相较于一二级医院组，更大比例三级医院组被调查者选择对Ⅱ度烧伤创面早期使用生物敷料（χ2=9.38，P<0.01）。不同职业组、年资组的被调查者对Ⅱ度烧伤创面早期外用药物或敷料的最优方案推荐均差异明显（χ2值分别为39.58、19.93，P值均<0.01）。东部地区组和非东部地区组、三级医院组和一二级医院组的被调查者对Ⅱ度烧伤创面早期外用药物或敷料最优方案推荐，差异均无统计学意义（P>0.05）。 结论： 我国烧伤专业医护人员在对Ⅱ度烧伤水疱的常规处理措施和保留水疱皮的原因上较为一致，但在去除水疱皮的原因、Ⅱ度烧伤创面外用药物或敷料的常规应用及最优方案推荐方面差异较大，亟须建立Ⅱ度烧伤创面早期临床治疗规范。.
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