制冷喷雾联合高分子水凝胶对急性烧伤创面的影响

doi:10.3969/j.issn.1674-8115.2022.05.002

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (5): 562-569.doi: 10.3969/j.issn.1674-8115.2022.05.002

制冷喷雾联合高分子水凝胶对急性烧伤创面的影响

董叫云(), 宋菲(), 陆树良, 刘琰(), 田鸣()

上海交通大学医学院附属瑞金医院烧伤科，上海 200025

收稿日期:2022-01-24 接受日期:2022-05-06 出版日期:2022-05-28 发布日期:2022-05-28
通讯作者: 刘琰,田鸣 E-mail:dongjiaoyun@hotmail.com;fayex3@126.com。;ly10515@rjh.com.cn;tianming198@163.com
作者简介:董叫云（1976—），女，主管技师，学士；电子信箱：dongjiaoyun@hotmail.com
宋菲女，主管技师；电子信箱：fayex3@126.com。第一联系人：（董叫云、宋菲并列第一作者）
基金资助:
国家自然科学基金(81671916);上海市临床重点专科项目(shslczdzk02302)

Effects of cryogen spray combined with polymeric hydrogel on acute burn wounds

DONG Jiaoyun(), SONG Fei(), LU Shuliang, LIU Yan(), TIAN Ming()

Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China

Received:2022-01-24 Accepted:2022-05-06 Online:2022-05-28 Published:2022-05-28
Contact: LIU Yan,TIAN Ming E-mail:dongjiaoyun@hotmail.com;fayex3@126.com。;ly10515@rjh.com.cn;tianming198@163.com
Supported by:
National Natural Science Foundation of China(81671916);Shanghai Municipal Key Clinical Specialty(shslczdzk02302)

摘要/Abstract

摘要：

目的·开发用于烧伤急救的、可快速降低皮肤温度并且对皮肤组织无刺激性的医疗用品——制冷喷雾剂和聚合物水凝胶。验证联合应用两者是否可快速阻断热源对皮肤组织的持续伤害，是否有利于创面的早期修复及降低烧伤创面的面积及深度。方法·将制冷液灌入高压罐中，评估制冷喷雾剂的制冷效果；制备水凝胶敷料，评估敷料的制冷时长；评估在大鼠背部皮肤连续使用制冷喷雾剂和水凝胶72 h后，对皮肤组织的刺激作用；建立大鼠烫伤模型，随机分为2组，每组6只，采用背部皮肤组织互相对比的方法，在烫伤区域使用制冷喷雾剂和水凝胶联合处理创面，分别与无处理组和自来水处理组做比较，24 h后评估烫伤部位的面积和创面炎症反应情况。结果·与普通自来水相比，15 %浓度的制冷喷雾剂的制冷效果最好，在3 min内，降温速度明显高于自来水对照组（P<0.05）；水凝胶的冷却效果可维持8 h，可以在2 h内将70 ℃水的温度降至室温（22±2）℃，且水温全程低于对照组；2种材料对皮肤组织均无刺激性作用，未导致皮肤组织红斑、水肿等过敏反应。经制冷喷雾剂和水凝胶联合处理的烧伤创面，其焦痂面积显著减少，与无处理组及自来水处理组相比，均有统计学差异（P<0.05）；H-E染色显示，与无处理组及自来水组相比较，联合应用制冷喷雾剂和水凝胶组的创面中，炎症细胞浸润的数量显著减少（P<0.05）。结论·制冷喷雾剂与聚合物水凝胶联合应用显示出良好的冷却效率，可减少焦痂面积、防止创面的不断加深及炎症细胞的聚集，有利于后期创面尽快愈合，且不会造成皮肤组织的过敏反应，可以作为烧伤患者急救管理的一种有效和方便的工具。

关键词: 烧伤, 急救, 制冷剂喷雾, 水凝胶

Abstract:

Objective·To develope a medical device for first aid of burns, a new formulation of cryogen spray and polymeric hydrogel, which can quickly reduce skin temperature and has no irritation, and investigate the effect of cryogen spray combined with polymeric hydrogel on quickly blocking the continuous injury of heat source to the skin tissue, and on the early repair of wound and reduction of the area and depth of burn wound.

Methods·The cryogen spray was filled into the high-pressure tank and its cooling performance was evaluated. Polymeric hydrogel dressing was prepared and the cooling time was evaluated. The irritating effect on rat' back skin tissue was evaluated after exploring on cryogen spray combined with polymeric hydrogel continuouly for 72 h. A burn rat model was created, the rats were randomly divided into two groups with 6 in each group. The burn area and inflammatory reaction of cryogen spray combined with polymeric hydrogel treated for 24 h was compared with that of the untreated group or the tap water treatment group.

Results·Compared with tap water, the cooling effect of 15% concentration cryogen spray was the best. Within 3 minutes, the cooling rate was significantly higher than that of the tap water control group (P<0.05). The cooling effect of polymeric hydrogel can be maintained for 8 h, the temperature of 70 ℃ water can be reduced to room temperature (22 ± 2) ℃ within 2 h, and the water temperature was lower than that of the control group throughout the whole process. Both materials had no irritating effect on skin tissue, and did not cause allergic reactions such as erythema and edema of skin tissue. Compared with the untreated group and the tap water group, the eschar area of the burn wound treated with cryogen spray combined with polymeric hydrogel decreased significantly (P<0.05). H-E staining showed that compared with the untreated group and the tap water group, the number of inflammatory cells in the wound of the combined application of cryogen spray and polymeric hydrogel group decreased significantly (P<0.05).

Conclusion·The combination of cryogen spray and polymeric hydrogel shows good cooling efficiency. The combined application can reduce the eschar area, and prevent the progressive deepening of the wound and the accumulation of inflammatory cells, which is conducive to the wound healing as soon as possible in the later stage. It will not cause allergic reaction of skin tissue. It may be exploited as an effective and convenient tool for the first aid management of burn patients..

Key words: burns, first aid, cryogen spray, hydrogel

中图分类号:

R644

董叫云, 宋菲, 陆树良, 刘琰, 田鸣. 制冷喷雾联合高分子水凝胶对急性烧伤创面的影响[J]. 上海交通大学学报（医学版）, 2022, 42(5): 562-569.

DONG Jiaoyun, SONG Fei, LU Shuliang, LIU Yan, TIAN Ming. Effects of cryogen spray combined with polymeric hydrogel on acute burn wounds[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 562-569.

图/表 10

表1 皮肤刺激试验的分级值

Tab 1 Grading values for the skin irritation test

Test	Skin response	Score
Erythema and eschar formation	No erythema	0
	Very slight erythema （barely perceptible）	1
	Well-defined erythema	2
	Moderate to severe erythema	3
	Severe erythema （beet-redness） to slight eschar formation （injuries in depth）	4
Edema formation	No edema	0
	Very slight edema （barely perceptible）	1
	Slight edema （edges of area well-defined by definite raising）	2
	Moderate edema （raised approximately 1.0 mm）	3
	Severe edema （raised more than 1.0 mm and extending beyond exposure area）	4
Total possible score for irritation		8

表2 皮肤刺激强度分级值

Tab 2 Grading values for the skin irritation intensity

Mean skin irritation intensity score	Intensity grading value
0‒<0.5	No irritation
0.5‒<2.0	Sight irritation
2.0‒<6.0	Moderate irritation
6.0‒<8.0	Severe irritation

图1 伤后各组大鼠创面干预示意

Fig 1 Schematic diagram of wound treatment of rats in each group after injury

图2 高压制冷喷雾剂Note：A. Cryogen spray tank. B. The state in which a pressure tank is sprayed.

Fig 2 The high-pressure cryogen spray tank

表3 不同浓度制冷喷雾剂和普通自来水干预后的冷却速度

Tab 3 The cooling rate of cryogen spray with different concentrations and ordinary tap water

Formula	Cooling time/s
Formula	Repeat 1	Repeat 2	Repeat 3	Average
Ordinary tap water	49.57	43.83	45.65	46.35
10% cryogen spray	35.68	40.87	40.00	38.85
15% cryogen spray	31.72	34.60	33.50	33.27
20% cryogen spray	34.50	31.15	34.80	33.48

图3 附着于无纺布的水凝胶

Fig 3 The hydrogel attached to a non-woven fabric

图4 水凝胶的冷却效果Note： A. The cooling effect of hydrogel after 3 min. B. The cooling effect of hydrogel within 9 h.

Fig 4 Cooling effect of hydrogel

图5 使用制冷喷雾剂和水凝胶干预不同时间后皮肤的刺激反应

Fig 5 Effects of cryogen spray and hydrogel on skin irritation responses after different times of treatment

图6 制冷喷雾剂与水凝胶联合干预对受伤皮肤伤口面积和焦痂区域（红色箭头所示）的影响Note：①P=0.028;②P=0.029.

Fig 6 Effects of cryogen spray combined with hydrogel on the wound and eschar areas in the wounded skin

图7 制冷喷雾剂与水凝胶联合使用后受伤皮肤组织学表现（H-E染色，×20）Note：①P=0.003;②P=0.036.

Fig 7 Histological observation of the wounded skin treated by cryogen spray combined with hydrogel (H-E staining, ×20)

参考文献 30

1	WORLD HEALTH ORGANIZATION. Fact sheet burns[EB/OL]. 2018[2019-04-23]. https://www.who.int/news-room/fact-sheets/detail/burns.
2	SPRONK I, EDGAR D W, VAN B M E, et al. Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands[J]. BMC Public Health, 2020, 20(1):121.
3	ABDEL HAMID A A M,SOLIMAN M F M. Effect of topical aloe vera on the process of healing of full-thickness skin burn: a histological and immunohistochemical study[J]. J Histol Histopathol, 2015, 2(1): 3.
4	CHENG W,WANG S,SHEN C, et al. Epidemiology of hospitalized burn patients in china: a systematic review[J]. Burns Open, 2018, 2(1): 8-16.
5	FINNERTY C C, JESCHKE M G, BRANSKI L K, et al. Hypertrophic scarring: the greatest unmet challenge after burn injury[J]. Lancet, 2016, 388(10052):1427-1436.
6	MCCULLOH C, NORDIN A, TALBOT L J, et al. Accuracy of prehospital care providers in determining total body surface area burned in severe pediatric thermal injury[J]. J Burn Care Res, 2018, 39(4):491-496.
7	CHAN L C, LEE M S, OU Y N, et al. Energy requirements for ICU burn patients in whom the total body surface area affected exceeds 50 percent: a practical equation[J]. Asia Pac J Clin Nutr, 2018, 27(6):1182-1189.
8	SHECKTER C C, LI A, PRIDGEN B, et al. The impact of skin allograft on inpatient outcomes in the treatment of major burns 20-50% total body surface area: a propensity score matched analysis using the nationwide inpatient sample[J]. Burns, 2019, 45(1):146-156.
9	KADDOURA I, ABU-SITTAH G, IBRAHIM A, et al. Burn injury: review of pathophysiology and therapeutic modalities in major burns[J]. Ann Burns Fire Disasters, 2017, 30(2):95-102.
10	CUTTLE L, KIMBLE R M. First aid treatment of burn injuries[J]. Wound Practice & Research, 2010, 18(1): 6-13.
11	GRIFFIN B R, FREAR C C, BABL F, et al. Cool running water first aid decreases skin grafting requirements in pediatric burns: a cohort study of two thousand four hundred ninety-five children[J]. Ann Emerg Med, 2020, 75(1):75-85.
12	MOFAZZAL J M A, SAHANDI Z P, MOOSAVI B S M, et al. Nanomedicine and advanced technologies for burns: preventing infection and facilitating wound healing[J]. Adv Drug Deliv Rev, 2018, 123:33-64.
13	STOICA A E, CHIRCOV C, GRUMEZESCU A M. Hydrogel dressings for the treatment of burn wounds: an up-to-date overview[J]. Materials (Basel), 2020, 13(12).
14	YAO Y, ZHANG A, YUAN C, et al. Recent trends on burn wound care: hydrogel dressings and scaffolds[J]. Biomater Sci, 2021, 9(13):4523-4540.
15	JANDERA V, HUDSON D A, DE W P M, et al. Cooling the burn wound: evaluation of different modalites[J]. Burns, 2000, 26(3):265-270.
16	GOODWIN N S, SPINKS A, WASIAK J. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature[J]. Int Wound J, 2016, 13(4):519-525.
17	CHO Y S, CHOI Y H. Comparison of three cooling methods for burn patients: a randomized clinical trial[J]. Burns, 2017, 43(3):502-508.
18	RAHMAN M S, ISLAM R, RANA M M, et al. Characterization of burn wound healing gel prepared from human amniotic membrane and Aloe vera extract[J]. BMC Complement Altern Med, 2019, 19(1):115.
19	KATTAN A E, ALSHOMER F, ALHUJAYRI A K, et al. Current knowledge of burn injury first aid practices and applied traditional remedies: a nationwide survey[J]. Burns Trauma, 2016, 4:37.
20	WALLACE H J, O'NEILL T B, WOOD F M, et al. Determinants of burn first aid knowledge: cross-sectional study[J]. Burns, 2013, 39(6):1162-1169.
21	CUTTLE L, PEARN J, MCMILLAN J R, et al. A review of first aid treatments for burn injuries[J]. Burns, 2009, 35(6):768-775.
22	FADEYIBI I O, IBRAHIM N A, MUSTAFA I A, et al. Practice of first aid in burn related injuries in a developing country[J]. Burns, 2015, 41(6):1322-1332.
23	HYLAND E J, HARVEY J G, HOLLAND A J. First aid for burns: too little, too late and often wrong[J]. Med J Aust, 2014, 200(2):85.
24	王德怀, 谭子明, 康滔, 等. 冷疗应用于烧伤现场急救处理现状Meta分析[J]. 临床军医杂志, 2019, 47(6): 582-585.
	WANG D H, TAN Z M, KANG T, et al. Meta analysis on the current situation of cold therapy applied in emergency treatment of burns[J]. Clin J Med Off, 2019, 47(6): 582-585.
25	WANG X S,CHEN B,ZHOU Z F. Atomization and surface heat transfer characteristics of cryogen spray cooling with expansion-chambered nozzles[J]. Int J Heat Mass Transf, 2018, 121(6): 15-27.
26	CHENG W,XIE B,HAN F, et al. An experimental investigation of heat transfer enhancement by addition of high-alcohol surfactant (HAS) and dissolving salt additive (DSA) in spray cooling[J]. Exp Therm Fluid Sci, 2013, 45(2): 198-202.
27	LIU H,CAI C,JIA M, et al. Experimental investigation on spray cooling with low-alcohol additives[J]. Appl Therm Eng, 2019, 146(1): 921-930.
28	GUPTA A,KOWALCZUK M,HEASELGRAVE W, et al. The production and application of hydrogels for wound management: a review[J]. Eur Polym J, 2019, 111(2): 134-151.
29	DHALIWAL K, LOPEZ N. Hydrogel dressings and their application in burn wound care[J]. Br J Community Nurs, 2018, 23(Sup9):S24-SS27.
30	ZHANG L, YIN H, LEI X, et al. A systematic review and meta-analysis of clinical effectiveness and safety of hydrogel dressings in the management of skin wounds[J]. Front Bioeng Biotechnol, 2019, 7:342.

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制冷喷雾联合高分子水凝胶对急性烧伤创面的影响

Effects of cryogen spray combined with polymeric hydrogel on acute burn wounds

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