皮下引流管持续冲洗及负压吸引预防腹部Ⅳ类切口感染的前瞻性研究  

Continuous irrigation and vacuum suction by subcutaneous drainage tube for prevention of abdominal IV incision infection： a prospective study

作　　者：李清汉[1] 甄作均[1] 吴志鹏[1] 陈焕伟[1] 李梅生[1] 陈应军[1] 计勇[1] 

机构地区：[1]佛山市第一人民医院肝脏胰腺外科,528000

出　　处：《中华消化外科杂志》2015年第10期839-843,共5页Chinese Journal of Digestive Surgery

基　　金：广东省科技计划项目（2014A020209003）

摘　　要：目的：探讨皮下引流管持续冲洗及负压吸引预防腹部Ⅳ类切口感染的应用价值。方法：选取2008年1月至2014年7月佛山市第一人民医院收治的123例腹部Ⅳ类切口患者进行前瞻性研究，采用随机、单盲对照法，通过随机数字表法将入组患者分为试验组和对照组。患者均行开腹手术，试验组患者术后采用皮下留置引流管，术后行持续冲洗及负压吸引的方法；对照组患者术后采用传统关腹方法，未留置皮下引流管。记录患者术前Hb，术前Alb，美国麻醉医师学会（ASA）分级，术后1、3、7 d Hb和Alb，观察术后患者切口感染及细菌培养情况。患者均于出院后定期门诊复诊，每2周复诊1次，复诊至切口拆线后 3个月。记录拆线后3个月内有无并发症发生。正态分布的计量资料采用±s表示，组间比较采用t检验；偏态分布的计量资料采用M（Qn）表示，组间比较采用秩和检验。重复测量的资料采用重复测量的方差分析，计数资料比较采用χ2检验。结果：123例患者纳入研究。65例试验组患者术后1、3、7 d Hb分别为（111±15）g/L、（107±18）g/L、（108±13）g/L；58例对照组患者分别为（112±13）g/L、（106±16）g/L、 （106±12）g/L，两组趋势比较，差异无统计学意义（F=0.124，P〉0.05）。试验组患者术后1、3、7 d Alb 分别为30 g/L（26 g/L，32 g/L）、31 g/L（28 g/L，33 g/L）、35 g/L（32 g/L，37 g/L）；对照组分别为30 g/L （25 g/L，32 g/L）、32 g/L（29 g/L，33 g/L）、37 g/L（32 g/L，38 g/L），两组趋势比较，差异无统计学意义（F=0.007，P〉0.05）。试验组术后4例患者发生切口感染；对照组12例患者发生切口感染，两组比较，差异有统计学意义（χ^2=2.723，P〈0.05）。患者感染均发生在术后4～6 d，感染均只限于皮下组织，未达肌肉层或以下组织，全部敞开引流后行清创缝合，均治愈。患者均未发生再�Objective：To investigate the application value of continuous irrigation and vacuum suction by subcutaneous drainage tube for prevention of abdominal type Ⅳ incision infection. Methods：A prospective, singleblind, randomized, controlled study was conducted based on the clinical data of 123 patients with abdominal type Ⅳ incision infection who were admitted to the First People′s Hospital of Foshan between January 2008 and July 2014. Patients were divided into the experimental group and the control group based on the random number table and received open surgery. Patients in the experimental group were placed subcutaneous drainage tube with postoperative continuous irrigation and vacuum suction, while patients in the control group adopted the method of traditional abdominal closure without subcutaneous drainage tube. The levels of preoperative hemoglobin （Hb） and albumin （Alb）, severity grading according to the American Society of Anesthetheologists （ASA）, levels of Hb and Alb at postoperative day 1, 3, 7 were recorded and postoperative incision infection and bacteria culture were observed. Patients received biweekly regular return visit by outpatient evamination after discharged up to 3 months after suture removal. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed by t test. Measurement data with skew distribution were presented as M （Qn） and comparison between groups were analyzed by rank sum test. Repeated measures data were analyzed by the repeated measures ANOVA. Count data were analyzed by the chisquare test. Results：One hundred and twentythree patients were screened for eligibility, and 65 were allocated into the experimental group and 58 into the control group. The levels of Hb and Alb at postoperative day 1, 3, 7 were （111±15）g/L, （107±18）g/L, （108±13）g/L and 30 g/L（26 g/L,32 g/L）, 31 g/L（28 g/L,33 g/L）, 35 g/L（32 g/L,37 g/L） in the experimental group and （112±13）g/L, （106±16）g/L, （106�

关 键 词：外科伤口感染 腹部Ⅳ类切口 引流 负压吸引 冲洗 

分 类 号：R473.6[医药卫生—护理学]