在烧伤治疗中使用肝素的报道之后,一项伦理委员会批准的前瞻性随机研究与对照进行了比较,比较了使用传统常规烧伤治疗但不使用肝素的结果,以及类似患者局部加用肝素治疗的结果.受试者为100名连续烧伤患者(年龄<15岁),具有5-45%全身表面积大小的二度浅表和深度烧伤。随机治疗两个基本相似的队列组-对照组(C)和肝素组(H),每组50名受试者。对照组50例患者接受传统常规治疗,包括局部抗菌乳膏,清创术,and,当需要时,烧伤后早期的皮肤移植。肝素组患者50例,没有外用乳膏,额外治疗,从第一天开始,用200IU/ml肝素钠水溶液USP(肝素)滴在烧伤表面,并插入水泡中,每天两到四次,持续1-2天,然后只在烧伤表面上总共5-7天,植皮前,当需要的时候。此后,对照组和肝素组治疗效果相似。发现肝素患者抱怨疼痛较少,并且接受的止痛药少于对照组。肝素组比对照组需要更少的敷料和口服抗生素。50例肝素组患者进行了4次皮肤移植(8%),而对照组50例患者有10例(20%)。对照组5例患者死亡(死亡率10%)。无肝素组患者逝世亡。肝素组住院天数明显少于对照组(总体P<0.0001):肝素组患者中有58%在10天内出院,对照组患者中有6%出院;肝素组患者中有82%在20天内出院,对照组患者中有14%出院;肝素组的98%和对照组的44%在30天内出院;肝素组的100%患者在40天出院,对照组的56%需要10天。肝素组患者的烧伤平均愈合15天(最长37天),对照组患者平均愈合25天(最长>48天)(P<0.0006)。与对照组相比,肝素组的程序和费用大大降低。为了比较,给出了肝素组和对照组之间的差异。结论是,肝素局部应用5-7天改善了烧伤治疗:它减轻了疼痛,止痛药,敷料,和抗生素的使用;它显著减少了静脉输液(P<0.04),住院天数(P<0.0001),和愈合时间(P<0.0006);它减少了皮肤移植,死亡率,和成本。
Following reports of heparin use in burn treatment, an ethics-committee-approved prospective randomized
study with controls compared results obtained using traditional usual burn treatment without heparin with results in similar patients similarly treated with heparin added topically. The subjects were 100 consecutive burn patients (age <15 years) with second-degree superficial and deep burns of 5-45 % total body surface area size. Two largely similar cohort groups-a control group (C) and a heparin group (H) with 50 subjects per group-were randomly treated. The 50 control group patients received traditional routine treatment, including topical antimicrobial cream, debridement, and, when needed, skin grafts in the early postburn period. The 50 heparin group patients, without topical cream, were additionally treated, starting on day 1 postburn, with 200 IU/ml sodium aqueous heparin solution USP (heparin) dripped on the burn surfaces and inserted into the blisters two to four times a day for 1-2 days, and then only on burn surfaces for a total of 5-7 days, before skin grafting, when needed. Thereafter, control and heparin group treatment was similar. It was found that the heparin patients complained of less pain and received less pain medicine than the control patients. The heparin group needed fewer dressings and oral antibiotics than the control group. The 50 heparin group patients had 4 skin graftings (8 %), while the 50 control group patients had 10 (20 %). Five control group patients died (mortality 10 %). No heparin group patients died. The number of days in hospital for the heparin group versus control group was significantly less (overall P < 0.0001): 58 % of heparin group patients were discharged within 10 days versus 6 % of control group patients; 82 % of heparin group patients were out in 20 days versus 14 % of control group patients; 98 % of the heparin group versus 44 % of the control group were out in 30 days; and while 100 % of heparin group patients were discharged by day 40, 56 % of the control group required up to another 10 days. Burns in heparin group patients healed on average in 15 days (maximum period 37 days) versus an average of 25 days (maximum >48 days) in control group patients (P < 0.0006). Procedures and costs in the heparin group were much reduced compared with the control group. Differences between the heparin and control groups are presented for the sake of comparison. It was concluded that heparin applied topically for 5-7 days improved burn treatment: it reduced pain, pain medicine, dressings, and use of antibiotics; it significantly reduced IV fluids (P < 0.04), days in hospital (P < 0.0001), and healing time (P < 0.0006); and it reduced skin grafts, mortality, and costs.