负压封闭引流治疗创伤性脑损伤术后创腔感染的作用  

Role of vacuum sealing drainage in treatment of wound infection after surgical operation of traumatic brain injury

作　　者：郭昱[1] 李生辉[1] 刘春祥[1] 

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《中华创伤杂志》2013年第9期827-831,共5页Chinese Journal of Trauma

摘　　要：目的 比较清创结合负压封闭引流（vacuum sealing drainage,VSD）和清创结合常规换药治疗创伤性脑损伤（traumatic brain injury,TBI）术后头皮下感染患者的疗效,探讨VSD治疗TBI术后创腔感染的效果. 方法 回顾性分析2005年8月-2012年1月收治的60例TBI去骨瓣减压术后创腔感染患者的临床资料.根据患者入院后所选择的治疗方式,分为清创结合VSD治疗组（A组）和清创结合常规换药组（B组）,每组30例.比较两组患者伤口愈合情况、感染复发率和住院时间等. 结果 60例患者均获随访12 ～36个月,平均21.6个月.A组30例患者术后创腔感染均未复发,伤口如期拆线.B组30例患者中7例（23％）拔除伤口引流管后创腔感染复发,再次行清创引流术并延迟伤口拆线后伤口愈合.A组与B组术后伤口愈合时间（分别为13 d、22 d）、换药次数（分别为3次、8次）、住院天数（分别为17 d、26 d）、抗生素使用时间（分别为7d、14 d）、术后体温降至正常时间（分别为2d、4d）差异均有统计学意义（P＜0.05）. 结论 VSD有利于感染创腔的快速愈合,在TBI去骨瓣减压术后感染创腔的治疗中效果显著,值得临床推广.Objective To compare the application of debridement combined with vacuum sealing drainage （VSD） versus debridement combined with conventional dressing change in patients with subscalp infection following surgical treatment of traumatic brain injury （TBI） and investigate the effect of VSD in treatment of wound infection associated with surgery for TBI.Methods A retrospective review was conducted on clinical data of 60 TBI patients with combined wound infection after decompressive craniotomy between August 2005 and January 2012.According to the treatment modalities after admission,the patients were divided into debridement combined with VSD group （Group A） and debridement combined with conventional dressing change group （Group B）,with 30 patients per group.Then wound healing,infection relapse rate and length of hospital stay were compared between the two groups.Results All 60 patients were followed up for 12-36 months （mean 21.6 months）.The wound infection did not recur after surgery in Group A and sutures were removed in time.Seven patients （23%） in Group B presented with recurrent wound infection after the removal of wound drainage tube,which was healed after an additional debridement and drainage as well as the delay of suture removal.Wound healing time （13 d vs 22 d）,dressing change frequency （3 times vs 8 times）,length of hospital stay （17 d vs 26 d）,antibiotic use duration （7 d vs 14 d）,and time to drop the body temperature to normal after operation （2 d vs 4 d） in Group A and B respectively showed significant difference （P 〈 0.05）.Conclusion In treatment of wound infection associated with decompressive craniotomy for TBI,VSD is beneficial for rapid healing of the infected wound and is worthy of wide clinical use.

关 键 词：脑损伤 感染 引流术 

分 类 号：R651.15[医药卫生—外科学]