动态调整负压封闭引流术负压值对软组织缺损创面愈合的影响  

Effect of dynamic regulation of negative pressure values in vacuum sealing drainage on healing of softtissue wounds

作　　者：刘鹏[1] 王专[1] 周际[1] 谭科[1] 彭宗银[2] 

机构地区：[1]四川省医学科学院·四川省人民医院城东病区骨外科,成都610110 [2]四川省医学科学院·四川省人民医院重症监护室,成都610110

出　　处：《中华创伤骨科杂志》2017年第5期404-408,共5页Chinese Journal of Orthopaedic Trauma

基　　金：四川省卫生厅基金课题（120081）

摘　　要：目的探讨动态调整负压封闭引流术（VSD）负压值对软组织缺损创面愈合的影响。方法回顾性分析2013年1月至2015年12月期间收治的115例开放性软组织损伤（Gustilo—Anderson分型为Ⅲ型）患者资料。男69例，女46例；年龄为17～76岁，平均44．7岁。根据负压值不同分为4组：A组29例，负压值为-40～-20kPa；B组29例，负压值为-80～-60kPa；C组29例，负压值丌始为-40～-20kPa，72h后改为-80～-60kPa；D组28例，负压值开始为-80～-60kPa，72h后改为-40～-20kPa。比较4组患者的引流量、创面变化、清洁时间、创面愈合时间及并发症发生情况等。结果B组和D组引流第7天时患者的平均引流量[（4．89±0．66）、（4．33±0．96）m1．／cm2J显著高于A组和C组【（2．90±0．67）、（2．99±0．56）mL／cm2]，引流第14天时患者的创面面积缩小【（14．16±1．77）、（13．84±1．65）cm2]显著优于A组和C组[（12．57±1．92）、（10．95±1．37）cm2】，差异均有统计学意义（P〈0．05）。A组患者的清洁时间显著长于其他3组患者，A组和C组患者的创皿愈合时间显著长于B组和D组患者，B组和c组患者的疼痛发生率显著高于A组和D组，A组患者感染和堵管发生率显著高于其他3组患者，差异均有统讣学意义（P〈0．05）。结论采用负压值开始为-80～-60kPa，引流72h后改为-40～-20kPa持续引流具有引流充分、创面变化明显、清洁时间快、创面愈合时间短及并发症少等优点。Objective To investigate the effect of dynamic regulation of negative pressure values in vacuum sealing drainage （VSD） on healing of soft tissue wounds. Methods From January 2013 to De- cember 2015, 115 patients were treated at our institute for open soft tissue defects of Gustilo-Anderson type ma- inc. They were 69 males and 46 females, aged from 17 to 76 years （average, 44.7 years） . They were di- vided into 4 groups to be subjected to different negative pressure values. Group A （ n = 29） was subjected to negative pressure values from - 40 to - 20 kPa, group B （ n = 29） to values from - 80 to - 60 kPa, group C （ n. = 29） to values from - 40 to - 20 kPa for the first 72 hours followed by values from - 80 to - 60 kPa, and group D （ n = 28） to values from - 60 to - 80 kPa for the first 72 hours followed by values from - 40 to - 20 kPa. The 4 groups were compared in terms of drainage volume, wound shrinking, cleaning time, healing time and complications. Results The drainage volumes on the 7th day in groups B and D （4.89 ± 0.66 mL/cm2 and 4.33 ± 0.96 mL/cm2） were significantly higher than those in groups A and C （2.90 ± 0.67 mL/cm2 and 2.99 ±0, 56 mL/cm2）; the wound shrinking areas on the 14th day in groups B and D （14. 16 ± 1.77 cin2 and 13.84 ± 1.65 cm2） were significantly larger than in groups A and C （12.57 ± 1.92 cm2 and 10.95 ± 1.37 cm2） （ P 〈 0.05） . The cleaning time in group A was significantly longer than in the other 3groups （ P 〈 O. 05）. The healing time in groups A and C was longer than in groups B and D （ P 〈 O. 05）. The incidences of pain in groups B and C were significantly higher than in groups A and D （ P 〈 0. 05） . The inci- dences of infection and blocking in group A were higher than in the other 3 groups （ P 〈 0. 05）. Conclusion Dynamic regulation of negative pressure values from - 80 to - 60 kPa for the first 72 hours followed by values from -40 to -20 kPa is an optimal choice for VSD management of soft tissue defect

关 键 词：创伤和损伤 组织缺损 引流术 

分 类 号：R687.3[医药卫生—骨科学]