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负压封闭引流联合局部氧疗对创伤性创面愈合的影响
龙锐 陈智 费军
陆军军医大学大坪医院急诊医学科, 重庆 400042
Clinical efficacy of vacuum sealing drainage combined with topical oxygen therapy for traumatic wounds
Long Rui, Chen Zhi, Fei Jun.

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摘要 

目的  探讨负压封闭引流(VSD)技术联合局部氧疗对创伤性创面愈合的影响。方法  采用回顾性病例对照研究分析2016年7月— 2019年6月陆军军医大学大坪医院收治的60例创伤性创面患者的临床资料,其中男34例,女26例;年龄22~72岁[(42.2±12.8)岁]。受伤部位:下肢48例,上肢9例,背部3例。创面面积30~156 cm2[(76.9±25.1)cm2]。20例给予传统换药术(A组),20例给予VSD+生理盐水冲洗(B组),20例给予VSD+局部氧疗(C组)。比较三组细菌清除率、创面肉芽组织覆盖率、创面组织液氧分压,比较B、C组泡沫干瘪率、堵管率,同时比较三组创面愈合时间、换药次数和住院时间。  结果  A组细菌清除率为(58.5±11.1)%,B组为(78.3±7.0)%,C组为(85.3±9.7)%, B组和C组与A组比较、B组与C组比较差异均有统计学意义(P<0.05);A组创面肉芽组织覆盖率为(49.1±14.7)%,B组为(71.5±9.9)%,C组为(86.0±9.2)%,B组和C组与A组比较、B组与C组比较差异均有统计学意义(P<0.05);A组创面组织液氧分压为(49.4±11.2)%,B组为(49.5±10.1)%,C组为(80.9±12.1)%,B组和C组与A组比较、B组与C组比较差异均有统计学意义(P<0.05)。C组泡沫干瘪率[9.5(5.0,13.8)%]、堵管率[0.6(0,1.7)%]与B组泡沫干瘪率[9.0(5.0,10.0)%]、堵管率[0.6(0,1.2)%]比较差异均无统计学意义(P>0.05)。A组创面愈合时间为(36.5±4.8)d ,B组为(25.9±3.9)d、C组为(25.5±4.2)d;A组换药次数为23.0(20.3,27.8)次,B组为8.0(6.0,9.0)次,C组为7.5(5.3,9.0)次;A组住院时间为23.5(19.0,27.8)d,B组为17.0(15.3,19.0)d,C组为17.0(16.0,18.8)d,B组和C组与A组比较差异均有统计学意义(P<0.05),B组与C组比较差异无统计学意义(P>0.05)。  结论  与传统换药方法比较,VSD联合局部氧疗用于创伤性创面能促进创面愈合,减少换药次数;与VSD联合生理盐水冲洗比较,VSD联合局部氧疗能提高创面细菌清除率、促进创面肉芽组织生长。

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关键词 负压伤口疗法冲洗治疗创伤和损伤伤口愈合    
Abstract

Objective  To study the clinical efficacy of vacuum sealing drainage (VSD) plus topical oxygen therapy for traumatic wounds.   Methods  A retrospective casecontrol study was conducted to analyze the clinical data of 60 patients with traumatic wounds admitted to Daping Hospital of Army Medical University from July 2016 to June 2019, including 34 males and 26 females, aged 22-72 years[(42.2±12.8)years]. There were 48 patients with wound sites in lower extremities, 9 in upper extremities, 3 in back. The area of the wounds was 30-156 cm2[(76.9±25.1)cm2]. A total of 20 patients were treated with regular dressing (Group A), 20 patients were treated with VSD plus irrigation of saline (Group B), and 20 patients were treated with vacuum sealing drainage plus irrigation of saline loaded with oxygen (Group C). Bacteria clearance rate, granulation tissue coverage rate and partial pressure of oxygen of the exudate in wounds were compared among the three groups. Foam dry rate and blockage rate of drainage tube were compared between Group B and Group C. Wound healing time, dressing change time and hospitalization day were compared among the three groups.   Results  Bacterial clearance rate of wounds in Group B [(78.3±7.0)%] and Group C [(85.3±9.7)%] was higher than that in Group A [(58.5±11.1)%] (both P<0.05), while Group C was higher than that in Group B (P<0.05). Granulation tissue coverage rate of wounds in Group B [(71.5±9.9)%] and Group C [(86.0±9.2)%] was higher than that in Group A [(49.1±14.7)%] (both P<0.05), while Group C was higher than that in Group B (P<0.05). Partial pressure of oxygen of the exudate in wounds in Group B [(49.5±10.1)%] and Group C [(80.9±12.1)%] was higher than that in Group A[(49.4±11.2) %] (both P<0.05),  while Group C was higher than that in Group B (P<0.05). The foam dry rate [9.5 (5.0, 13.8)%] and drainage tube blockage rate [0.6 (0, 1.7)%] in Group C showed no significant difference with that [9.0 (5.0, 10.0)%, 0.6 (0, 1.2)%] in Group B (P>0.05). Wounds healing time in Groups A, B, C were (36.5±4.8)days,  (25.9±3.9)days,  (25.5±4.2)days, respectively; dressing change times in Groups A, B, C were 23.0 (20.3, 27.8)times, 8.0 (6.0, 9.0)times, 7.5 (5.3, 9.0)times, respectively; hospitalization day in Groups A, B, C were 23.5 (19.0, 27.8)d, 17.0 (15.3, 19.0)d, 17.0 (16.0, 18.8)d, respectively. These outcomes in Group B and Group C showed significant differences compared to Group A (P<0.05), while there were no significant differences between Group B and Group C (P>0.05).   Conclusions  VSD plus topical oxygen therapy can facilitate wound healing and reduce dressing change frequency for traumatic wounds compared to traditional methods. The technique can also improve bacterial clearance rate and granulation tissue coverage rate of wounds compared to VSD plus irrigation of saline, but the difference of wounds healing time is similar.

Key wordsNegative-pressure wound therapy    Oxygen    Therapeutic irrigation    Wounds and injuries    Wound healing   
     出版日期: 2020-05-09
引用本文:   
龙锐 陈智 费军. 负压封闭引流联合局部氧疗对创伤性创面愈合的影响[J]. 中华创伤杂志, 2020, 36(3): 262-268. Long Rui, Chen Zhi, Fei Jun.. Clinical efficacy of vacuum sealing drainage combined with topical oxygen therapy for traumatic wounds. CHINESE JOURNAL OF TRAUMA, 2020, 36(3): 262-268.
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http://manu24.magtech.com.cn/jweb_zgcszz/CN/10.3760/cma.j.issn.1001-8050.2020.03.014     或     http://manu24.magtech.com.cn/jweb_zgcszz/CN/Y2020/V36/I3/262
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