复合用药改善耳科Thiersch皮片移植供区术后疼痛与渗出的随机对照研究

Composite medication improves postoperative pain and exudation in the donor area of Thiersch skin grafts in ear surgery: A randomized controlled study

摘要:

目的 评估复合用药方案(红霉素软膏联合利多卡因凝胶)在耳科大腿薄层(Thiersch)皮片移植供区管理中的临床效果。方法 前瞻性纳入90例患者(男54例，女36例)，术前诊断为先天性外耳道狭窄/闭锁、胆脂瘤等，均行外耳道成形术或开放式乳突根治术。采用Thiersch法取皮后，随机分为传统组(生长因子凝胶联合蛋白海绵，n=45)与新型组(传统组基础上加用红霉素软膏联合利多卡因凝胶，n=45)。通过视觉模拟量表(VAS)评估术后72 h疼痛强度，并通过临床观察评估创面渗出控制和上皮化进程。结果 新型组术后24、48、72 h VAS评分均显著低于传统组(P<0.05)，疼痛缓解效果明显。尽管新型组在术后第21天的完全上皮化率略高于传统组(93.3% vs 84.4%)，但差异无统计学意义(P>0.05)。新型组创面干燥时间更早，蛋白海绵脱落更为顺利，提示其可能有助于改善创面微环境。然而，渗出控制方面，新型组与传统组之间差异无统计学意义(P=0.362)。安全性评价显示，新型组未报告任何局部刺激或过敏反应。结论 在传统应用生长因子基础上，红霉素软膏联合利多卡因凝胶复合方案在耳科Thiersch皮片移植供区管理中表现出良好的镇痛效果与可控的愈合表现，且操作简便、安全性好。该方案为需高效镇痛与感染控制的特定人群提供了一种安全有效的选择。

Abstract:

Objective To evaluate the clinical efficacy of a composite medication regimen (erythromycin ointment combined with lidocaine gel) in managing donor sites after Thiersch skin grafts in ear surgery.Methods A prospective study enrolled 90 patients (54 males, 36 females) who were diagnosed preoperatively with congenital external auditory canal stenosis/atresia, cholesteatoma, etc, and underwent either external auditory canal reconstruction or open mastoidectomy. After harvesting the skin graft using the Thiersch technique, they were randomly assigned to either the conventional group (growth factor gel + protein sponge, n=45) or the novel group (combined erythromycin + lidocaine, n=45). Postoperative pain intensity was assessed using the visual analog scale at 24, 48, and 72 hours, while wound exudation control and epithelialization process were evaluated through clinical observation.Results The visual analog scale scores in the novel group were significantly lower than those in the conventional group at all time points (P<0.05), indicating superior analgesic efficacy. Although the complete epithelialization rate of the novel group on the 21st day after surgery was slightly higher than that of the conventional group (93.3% vs 84.4%), the difference was statistically insignificant (P>0.05). The novel group showed earlier wound drying and more complete detachment of the protein sponge, suggesting a potential improvement in the wound microenvironment. However, no significant difference was observed in exudation control between the two groups (P=0.362). No local irritation or allergic reactions were reported in the novel group, demonstrating good safety and tolerability.Conclusions The adjunctive use of topical erythromycin and lidocaine with standard growth factor therapy demonstrates effective postoperative analgesia and favorable wound healing outcomes in donor site management following Thiersch skin grafts in ear surgery. With its simplified application and favorable safety profile, this regimen offers an ideal option for specific populations requiring efficient analgesia and infection control.