بررسي كارائي غشاء آمنيون به عنوان پانسمان بيولوژيكي در بهبود محل برداشت پيوند در بيماران سوختگي

Evaluation of Amniotic Membrane Efficacy as Biologic Dressing for the Improvement of Donor Site in Burnt Patients

زﻣﯿﻨﻪ و ﻫﺪف: ﺷﯿﻮه ﻫﺎي ﻣﺨﺘﻠﻔﯽ ﺑﺮاي ﭘﺎﻧﺴﻤﺎن ﻣﺤﻞ ﺑﺮداﺷﺖ ﭘﯿﻮﻧﺪ ﭘﻮﺳﺖ در ﺑﯿﻤﺎران ﺳﻮﺧﺘﮕﯽ ﺑﻪ ﮐﺎر ﻣﯽ رود ﮐﻪ ﺗﺸﺎﺑﻪ آﻧﻬﺎ در وﺟﻮد درد، ﻣﺤﺪودﯾﺖ ﺣﺮﮐﺖ اﻧﺪام و اﺣﺘﻤﺎل ﻋﻮارض ﻣﻮﺿﻌﯽ ﻣﺎﻧﻨﺪ اﺳﮑﺎر و ﻋﻔﻮﻧﺖ ﻣﯽ ﺑﺎﺷﺪ. از ﻏﺸﺎء آﻣﻨﯿﻮن ﺑﺮاي ﺑﻬﺒﻮدي و ﺗﺮﻣﯿﻢ زﺧﻢ ﻫﺎي ﻣﺨﺘﻠﻒ اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ. ﺑﺮ اﯾﻦ اﺳﺎس ﮐﺎرآﯾﯽ ﻏﺸﺎ آﻣﻨﯿﻮن ﺑﻪ ﻋﻨﻮان ﭘﺎﻧﺴﻤﺎن ﺑﯿﻮﻟﻮژﯾﮑﯽ در ﻣﺤﻞ ﺑﺮداﺷﺖ ﭘﯿﻮﻧﺪ ﭘﻮﺳﺖ از ﻧﻈﺮ ﮐﯿﻔﯿﺖ درد، ﺗﺤﺮك اﻧﺪام، ﻣﯿﺰان ﻋﻔﻮﻧﺖ و زﻣﺎن ﺟﺪا ﺷﺪن ﭘﺎﻧﺴﻤﺎن ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺖ. ﻣﻮاد و روش ﻫﺎ: ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺻﻮرت ﯾﮏ ﮐﺎر آزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ ﺑﺮ روي 32 ﺑﯿﻤﺎر ﺑﺴﺘﺮي در ﺑﺨﺶ ﺳﻮﺧﺘﮕﯽ ﺑﯿﻤﺎرﺳﺘﺎن اﻧﺠﺎم ﺷﺪ. ﻫﺮ ﯾﮏ ﺑﯿﻤﺎر ﺑﻪ ﻋﻨﻮان ﻧﻤﻮﻧﻪ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ و ﮐﻨﺘﺮل در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﻏﺸﺎء آﻣﻨﯿﻮن در ﺳﺰارﯾﻦ ﻫﺎي اﻟﮑﺘﯿﻮ ﭘﺲ از رد ﺷﺪن ﻋﻔﻮﻧﺖ ﻫﺎي ﻗﺎﺑﻞ اﻧﺘﻘﺎل از ﻃﺮﯾﻖ ﺟﻔﺖ ﺗﻬﯿﻪ و در ﻣﺤﻞ ﺑﺮداﺷﺖ ﭘﯿﻮﻧﺪ ﭘﻮﺳﺖ اﺳﺘﻔﺎده ﻣﯽ ﺷﺪ، اﯾﻦ ﻧﺎﺣﯿﻪ ﺑﺎ ﻃﺮف دﯾﮕﺮ ﮐﻪ ﺑﻪ روش ﻣﻌﻤﻮﻟﯽ ﭘﺎﻧﺴﻤﺎن ﻣﯽ ﺷﺪ، ﻣﻘﺎﯾﺴﻪ و ﻃﺒﻖ ﭘﺮوﺗﮑﻞ ﻃﺮح از ﻧﻈﺮ ﺷﺪت درد، ﻣﯿﺰان ﺗﺤﺮك اﻧﺪام، ﻋﻔﻮﻧﺖ و زﻣﺎن ﺟﺪا ﺷﺪن ﭘﺎﻧﺴﻤﺎن ﻫﺎ ﺑﺮرﺳﯽ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: 14 ﺑﯿﻤﺎر زن و 18 ﻣﻮرد ﻣﺮد ﺑﻮدﻧﺪ. ﻣﯿﺎﻧﮕﯿﻦ ﺷﺪت درد در ﻧﺎﺣﯿﻪ ﻣﻄﺎﻟﻌﻪ ﺗﺎ روز ﭘﻨﺠﻢ ﭘﺲ از ﺟﺮاﺣﯽ ﮐﻤﺘﺮ از ﻧﺎﺣﯿﻪ ﮐﻨﺘﺮل ﺑﻮد، وﺿﻌﯿﺖ ﺗﺤﺮك اﻧﺪام در ﻧﺎﺣﯿﻪ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ ﺑﻬﺘﺮ از ﻧﺎﺣﯿﻪ ﮐﻨﺘﺮل ﺑﻮد، ﺷﺪت درد و ﺗﺤﺮك در دو ﻧﺎﺣﯿﻪ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ و ﮐﻨﺘﺮل ﺑﻪ ﺗﺮﺗﯿﺐ از روز ﺷﺸﻢ ﺗﺎ روز ﭼﻬﺎردﻫﻢ ﺗﻔﺎوت ﻧﺪاﺷﺖ، ﻣﯿﺰان ﻋﻔﻮﻧﺖ و زﻣﺎن ﺟﺪا ﺷﺪن ﭘﺎﻧﺴﻤﺎن در ﻧﻮاﺣﯽ ﻣﻮرد ﻣﻄﺎﻟﻌﻪ و ﮐﻨﺘﺮل ﺗﻔﺎوت ﻧﺪاﺷﺖ. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺑﻪ ﻧﻈﺮ ﻣﯽ رﺳﺪ اﺳﺘﻔﺎده از ﻏﺸﺎء آﻣﻨﯿﻮن در ﻣﺤﻞ ﺑﺮداﺷﺖ ﭘﯿﻮﻧﺪ ﭘﻮﺳﺖ اﺣﺘﻤﺎﻻ ًﺑﻪ دﻟﯿﻞ ﺗﺴﺮﯾﻊ در اﭘﯽ ﺗﻠﯿﺎﻟﯿﺰاﺳﯿﻮن و ﺗﺮﻣﯿﻢ ﺳﺮﯾﻌﺘﺮ زﺧﻢ ﺑﺎﻋﺚ ﮐﺎﻫﺶ ﺷﺪت درد و ﺗﺴﻬﯿﻞ ﺗﺤﺮك اﻧﺪام در ﻣﺤﻞ ﺑﺮداﺷﺖ ﭘﯿﻮﻧﺪ در روزﻫﺎي اول ﭘﺲ از ﺟﺮاﺣﯽ ﻣﯽ ﮔﺮدد. ﺑﻨﺎﺑﺮاﯾﻦ ﮐﺎﻫﺶ اﺣﺘﻤﺎل ﻧﯿﺎز ﺑﻪ ﺗﺠﻮﯾﺰ ﻣﺴﮑﻦ و اﺣﺘﻤﺎل ﻋﻮارض ﮐﻢ ﺗﺤﺮﮐﯽ ﺑﯿﻤﺎران ﺳﻮﺧﺘﮕﯽ ﭘﺲ از ﭘﯿﻮﻧﺪ ﭘﻮﺳﺖ , ﺗﺮﺧﯿﺺ ﺳﺮﯾﻊ ﺗﺮ ﺑﯿﻤﺎران ﻣﻮرد اﻧﺘﻈﺎر اﺳﺖ.

Introduction & Objective: Different methods for dressing of donor site in burnt patients who have similarl pain, limitation of mobility of donor site and local complications such as infection and scar. Amniotic membrane has been used for the improvement of healing in some wounds. Accordingly in this study amnion was used as biologic dressing for the donor site to evaluate it’s efficacy in the improvement of pain, movement score and the risk of local infection. Materials & Methods: This study was done as a clinical trial over 32 admitted patients in the burn department of the hospital. Amnion was prepared in the elective caesarean section after ruling out any placental site with routine dressing. Then the two sites were compared about the severity of the pain, movement score, infection and time of dressing sloughing. Results: Fourteen patients were women and 18 men. The mean score of pain and movement up to the sixth post operative day respectively was less than the control site. No difference was seen in the infection and dressing slough in the two sites. Conclusions: It seems that the use of amnion for the dressing of donor site probably causes more rapid epithelialization and wound healing and can improve pain and movement score in early post operative days. Accordingly it is expected to need less analgesia and low rate of immobilization associated with the complication of burnt patients after graft and their early discharge.