目的 探討胰島素注射液聯(lián)合納米銀抗菌凝膠和濕潤燒傷膏治療中度燒傷創(chuàng)面感染的臨床療效。方法 選取2013年1月—2015年1月黃石市第五醫(yī)院收治的中度燒傷創(chuàng)面感染患者66例（75個創(chuàng)面）作為研究對象，隨機(jī)分為對照組（33例39個創(chuàng)面）和治療組（33例36個創(chuàng)面）。對照組將納米銀抗菌凝膠和濕潤燒傷膏按照1∶1比例混合，均勻涂抹于燒傷創(chuàng)面，厚度1 mm，無菌紗布加壓包扎。治療組在對照組基礎(chǔ)上燒傷創(chuàng)面皮下浸潤注射胰島素注射液1 U/mL，無菌紗布加壓包扎。記錄兩組患者創(chuàng)面愈合時間、創(chuàng)面細(xì)菌培養(yǎng)轉(zhuǎn)陰換藥次數(shù)，計(jì)算兩組創(chuàng)面愈合率。治療前、治療第7、14、21天發(fā)放視覺模擬評分（VAS）評估患者換藥疼痛程度。治療前和治療7 d測定白介素-6（IL-6）、白介素8（IL-8）、腫瘤壞死因子α（TNF-α）水平。結(jié)果 治療組創(chuàng)面淺Ⅱ度和深Ⅱ度創(chuàng)面愈合時間短于對照組，創(chuàng)面細(xì)菌培養(yǎng)轉(zhuǎn)陰換藥次數(shù)少于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療組淺Ⅱ度第7、14天創(chuàng)面愈合率高于對照組，深Ⅱ度第14、21天創(chuàng)面愈合率高于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療第7、14、21天VAS評分均下降，同組治療前后差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療組治療第7、14、21天VAS評分明顯低于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治治療7 d后，兩組TNF-α、IL-6、IL-8水平均顯著升高，同組治療前后差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組治療7 d后這些觀察指標(biāo)的升高程度明顯低于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 局部注射胰島素注射液聯(lián)合納米銀抗菌凝膠和濕潤燒傷膏治療中度燒傷創(chuàng)面感染，能減輕創(chuàng)面炎性水平，縮短創(chuàng)面感染病程，提高創(chuàng)面愈合率，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the effect of Insulin Injection combined with Nano-silver Antibacterial Gel and Shirun Shaoshang Ointment in treatment of moderate burn and wound infection. Methods Patients (66 cases, 75 wounds) with moderate burn and wound infection in Huangshi No. 5 Hospital from January 2013 to January 2015 were randomly divided into control group (33 cases with 39 wounds) and treatment group (33 cases with 36 wounds). The patients in the control group were treated with external application of Nano-silver Antibacterial Gel and Shirun Shaoshang Ointment mixed in accordance with the ratio of 1:1, evenly applied to the burned wounds, with the thickness of 1 mm, and the sterile gauze were used by pressurized dressing. The patients in treatment group were sc adminnistered with local injection of Insulin Injection on the basis of the control group. The wound healing time and frequency of wound bacterial culture negative conversion and dressing change were recorded, and the wound healing rates in two groups were calculated. The visual analogue scale (VAS) scores before treatment, and treated on days 7, 14, and 21 were recorded to evaluate the pain degree of dressing change. The levels of interleukin-6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor alpha (TNF-α) were determined. Results The healing time of shallow Ⅱ degree and deep Ⅱ degree wound in the treatment group was shorter than that in the control group, and the frequency of wound bacterial culture negative conversion and dressing change was less than that in the control group, and there was difference between two groups (P<0.05). On days 7 and 14, the healing rates of shallow Ⅱ degree wound in the treatment group were higher than those in the control group, and the healing rates of deep Ⅱ degree wound were higher than those in the control group on days 14 and 21, and there was difference between two groups (P<0.05). On days 7, 14, and 21 of treatment, the VAS scores of the treatment group were significantly lower than those of the control group, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment for 7 d, the levels of TNF-α, IL-6, and IL-8 in the two groups were significantly increased, and the differences were statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Insulin Injection combined with Nano-silver Antibacterial Gel and Shirun Shaoshang Ointment has clinical curative effect in the treatment of moderate burn, can reduce the inflammatory level, alleviate dressing change pain, and improve the rate of wound healing, which is of great clinical application value.