负压封闭引流术结合生肌膏外敷治疗褥疮的病例对照研究  

Myogenic elephant skin cream combined with Vacuum sealing drainage(VSD) for the treatment of bedsores

作　　者：高益斌[1] 童松林[1] 潘方[1] 虞建浩[1] 

机构地区：[1]慈溪市人民医院骨一科,浙江慈溪315300

出　　处：《中国骨伤》2015年第2期150-154,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨负压封闭引流术（VSD）结合生肌膏外敷治疗重度褥疮的疗效。方法：自2009年6月至2013年6月治疗Ⅲ、Ⅳ度褥疮29例,采用VSD技术结合生肌膏外敷治疗15例（VSD组）,男7例,女8例;年龄17-96岁,平均（69.0±5.3）岁。常规换药治疗14例（对照组）,男6例,女8例;年龄40-86岁,平均（71.0±4.2）岁。分别于治疗后7、14、21、28 d,分别取两组创面标本,采用SABC法进行免疫组化CD34检测,高倍镜下观察镜野内血管交叉的数目,作为毛细血管密度值,用来评定创面组织肉芽增生情况。以毛细血管密度值和肉眼观察创面为指标,进行临床疗效评价。结果：29例中7、14、21、28 d创面标本资料完整的17例,其中VSD组9例,对照组8例,镜野内VSD组毛细血管密度值比对照组高,表明应用VSD技术肉芽组织增生比常规换药快得多。VSD组治愈13例（15处）,好转2例（3处）;对照组治愈3例（3处）,好转7例（9处）,未愈4例（5处）。结论：采用VSD技术持续高负压吸引彻底清除创面及腔隙内的渗液,可有效控制感染,促进肉芽组织生长,再外敷生肌膏,改善局部血供的同时,使新生肉芽及上皮细胞生长迅速。治疗过程风险小,疗程短,为临床治疗褥疮提供了一种安全、有效的新方法。Objective：To discuss the efficacy of the myogenic elephant skin cream combining with VSD for treating severe bedsores. Methods：Twenty nine cases of Ⅲ and Ⅳ degree bedsores were treated from June 2009 to June 2013. Among them,15 cases were treated by myogenic elephant skin cream combined with VSD（VSD group） including 7 males and 8 females with an average age of（69.0±5.3） years old ranging from 17 to 96 years;other 14 cases were treated by the treatment of conventional dressing change（control group） including 6 males and 8 females with an average age of（71.0±4.2） years old ranging from 40 to 86 years. At 7,14,21,28 d after treatments,specimens of wound two groups were respectively taken to examine immunohistochemical CD34 adopted SABC,the number of wild vascular cross were observed as capillary density value under high magnification microscope. It was used to assess the hyperplasia of granulation tissue of wound. The capillary density value and the visual wound observation were indicators for evaluation of clinical efficacy. Results：Seventeen of 19 cases got complete data of specimens of wound at 7,14,21,28 d,included 9 cases of VSD group,8 of control group. In the microscope view,the capillary density of VSD group was higher than that of control group significantly（P〈0.05）,it showed the application of VSD technology improved hyperplasia of granulation tissue much faster than conventional dressing change. In VSD group,13 cases with 15 wounds healed,2 cases with 3 wounds improved;in control group,3 cases with 3 wounds healed,7 cases with 9wounds improved,4 cases with 5 wounds were unhealed. Conclusion：Using the VSD technology with continuous high pressure suction to clean the drainage of wound and lacuna thoroughly can effectively control infection,promote the growth of granulation tissue,and then applying myogenic elephant skin cream to improve partial blood supply while prompting rapid growth of new granulation tissue and epithelial cell. The risk of this treatment is low,and th

关 键 词：封闭负压引流 生肌象皮膏 褥疮 

分 类 号：R615[医药卫生—外科学]