负压封闭引流术治疗四肢软组织严重挤压伤的效果  

Effect of vacuum sealing drainage on treating severe crush injury of limbs soft tissue

作　　者：杨威[1] 刘杨[2] 赵鸣雁[1] 

机构地区：[1]哈尔滨医科大学附属第一医院ICU,黑龙江哈尔滨150001 [2]哈尔滨医科大学附属第一医院骨科,黑龙江哈尔滨150001

出　　处：《中国医药导报》2015年第22期67-70,共4页China Medical Herald

基　　金：黑龙江省教育厅科技研究项目(12541481)

摘　　要：目的 观察负压封闭引流术（VSD）对四肢软组织严重挤压伤的治疗效果。方法 选择哈尔滨医科大学附属第一医院2012年10月-2014年10月收治的62例GustiloⅢ型软组织挤压伤患者,根据清创术后选择VSD引流或常规换药治疗分为观察组（35例）和对照组（27例）,观察组清创术后安装VSD装置,对照组根据伤口情况每日换药1-2次。术后对患者行积极的全身治疗,并于术后48 h检测患者血浆白细胞（WBC）计数,血清钾离子（K＋）、肌酐（Scr）、尿素氮（BUN）水平以及尿蛋白情况。观察患者出现急性肾损伤（AKI）、全身炎症反应综合征（SIRS）、脓毒症、多器官功能障碍综合征（MODS）并发症的发生率,并统计患者病死率。在患者出院时统计患者伤口闭合时间、血液净化次数、住院时间及截肢率等预后指标。结果 观察组WBC[（13.25±3.16）×109/L]、K＋[（5.04±1.07）mmol/L]、Scr[（163.43±53.27）μmol/L]、BUN[（6.92±2.61）mmol/L]、尿蛋白评分[（2.09±0.83）分]均优于对照组[WBC：（18.63±4.58）×109/L,K＋：（5.93±1.42）mmol/L,Scr：（334.56±109.82）μmol/L,BUN：（10.35±3.48）mmol/L,尿蛋白评分：（2.67±1.12）分],差异有统计学意义（P〈0.05）。观察组出现AKF、SIRS、脓毒症、MODS并发症的发生率依次为42.9%、60.0%、48.6%、11.4%,低于对照组（70.4%、85.2%、77.8%、33.3%）,差异有统计学意义（P〈0.05）。观察组伤口闭合时间[（14.26±4.32）d]、血液净化次数[（6.28±3.69）次]、住院时间[（27.38±6.75）d]均较对照组[伤口闭合时间：（19.73±5.47）d,血液净化次数：（8.74±4.23）次,住院时间：（35.49±10.18）d]降低,差异有统计学意义（P〈0.05）。两组患者病死率及截肢率比较（2.86%、11.1%比5.9%、16.7%）,差异无统计学意义（P〉0.05）。结论 VSD技术能够有效降低软组织损伤后局部有害物质的吸收,减轻全身中毒症状,提高治疗效果�Objective To observe the therapeutic effect of vacuum sealing drainage（VSD） on treating severe crush injury of limbs soft tissue. Methods From October 2012 to October 2014, in the First Affiliated Hospital of Harbin Medical University, 62 Gustilo Ⅲ crush injured patients were chosen and divided into observed group（n = 35） and control group（n = 27）, according to using VSD or dressing change after debridement. After debridement, the observed group was installed VSD, the control group was used dressing change 1-2 times/d. With the positive therapy, all the patients were detected including white blood cell count（WBC）, concentration of serum K＋, levels of serum creatinine（Scr） and urea nitrogen（BUN）, and urine protein quantity. The rates of complication were observed including acute kidney injury（AKI）, systemic inflammatory response syndrome（SIRS）, sepsis and multiple organ dysfunction syndrome（MODS）, and both groups were calculated the mortality. At discharge, wound closure time, times of blood purification, hospital stays and ratio of amputation were measured as prognostic index. Results WBC [（13.25 ±3.16） ×109/L], serum K＋[（5.04 ±1.07）mmol/L], Scr [（163.43±53.27） μmol/L], BUN [（6.92±2.61） mmol/L] and urine protein [（2.09±0.83） scores] in the observed group were better than those in the control group [WBC：（18.63±4.58）×10-9/L, serum K＋：（5.93±1.42） mmol/L, Scr：（334.56±109.82） μmol/L, BUN：（10.35±3.48） mmol/L,urine protein：（2.67±1.12） scores], the differences were statistically significant（P〈0.05）. The rates of complication AKF（42.9%）, SIRS（60.0%）, sepsis（48.6%）,MODS（11.4%） in observed group were lower than those in the control group（70.4%, 85.2%, 77.8%, 33.3%）, the differences were statistically significant（P〈0.05）. Wound closure time [（14.26 ±4.32） d], times of blood purification[（6.28±3.69） times] and hospital stays [（27.38±6.75） d] in the observed group were less

关 键 词：负压封闭引流 挤压伤 急性肾损伤 脓毒症 感染 

分 类 号：R641[医药卫生—外科学]