负压封闭引流术联合临床护理路径在慢性骨髓炎治疗中的应用研究  

The clinical research of combing VSD with clinical nursing pathway in chronic osteomyelitis

作　　者：周雪来 沈斌 徐仲翔 张示示 张岚[1] 童培建[2] ZHOU Xue-lai;SHEN Bin;XU Zhong-xiang(Department of Orthopaedics, The TCM of Wenzhou Hospital, Wenzhou, Zhejiang 325000, Chin)

机构地区：[1]温州市中医院骨科,浙江温州325000 [2]浙江省骨伤科研究所浙江省中医院骨科,浙江杭州310006

出　　处：《中华全科医学》2018年第5期849-852,共4页Chinese Journal of General Practice

基　　金：浙江省科技计划项目(2014C03035)

摘　　要：目的观察临床护理路径在皮瓣植皮术结合负压封闭引流术(vaccum sealing drainage,VSD)治疗慢性骨髓炎的应用。方法收集温州市中医院骨科2013年5月—2015年5月收治100例慢性骨髓炎患者临床资料,按照随机数字表法均分为2组,2组均予皮瓣植皮结合VSD术,对照组予常规护理,研究组采取临床护理路径。观察2组住院时间、创面愈合时间、视觉模拟评分法(visual analogue score,VAS)、完全负重时间、换药次数、置管时间、住院费用、复发率、满意率、SAS、SDS、生活质量评分和疗效等。疗效评估标准参照WHO制定的慢性骨髓炎评估标准。结果研究组住院时间(5.29±1.31)周、创面愈合时间(4.36±1.25)周、VAS评分(2.53±0.46)分、完全负重时间(4.95±1.83)个月、换药次数(3.05±0.82)次、置管时间(9.65±1.82)d、住院费用(1.16±0.83)万元、SDS(32.19±5.48)分、SAS(37.24±5.06)分低于对照组、无一例复发;生活质量评分(77.89±8.25)分、满意率(94%)和疗效(94%)高于对照组,差异有统计学意义(P<0.05)。结论临床护理路径在皮瓣植皮术结合VSD治疗慢性骨髓炎可规范医护行为、有效控制感染、修复皮肤软组织缺损、促进创面愈合、缓解疼痛、缩短住院天数、提高生活质量、降低复发率,疗效较好。Objective To observe the application of CNP in combing flap transplantation with VSD in chronic osteomyeli- tis. Methods From May, 2013 to May, 2015,100 patients in TCM of Wenzhou hospital with chronic osteomyelitis were randomly divided into two groups and were given flap transplantation and VSD treatment. The control group was given routine nursing treatment, while the study group was treated by CNP. The hospitalization, wound healing time, VAS score, full weight-bearing time, dressing change times, catheterization time, hospitalization costs, recurrence rate, satis- faction rate, SAS, SDS, quality of life scores and curative effect were reviewed and compared in the two groups. The cri- teria for efficacy evaluation refer to the WHO＇ s chronic osteomyelitis standard. Results The hospitalization [ （5.29 ± 1.31 ） weeks], wound healing time [ （4.36 ± 1.25） weeks], VAS score [ （2.53 ±0.46） score], full weight-bearing time [ （4.95 ± 1.83） months], dressing change times （3.05 ±0.82）, catheterization time [ （9.65 ± 1.82） day], hos- pitalization costs [ （1.16 ±0.83） ten thousands yuan], SDS [ （32.19 ±5.48） score], SAS [ （37.24 ±5.06） score] in the research group were less than those in the control group without recurrence while the quality of life scores [ （77.89 ±8.25） score], satisfaction rate （94%） and curative effect （94%） in the research group were higher than those in the control group with statistical significance （P 〈 0.05 ）. Conclusion The application of CNP in combing flap transplantation with VSD in chronic osteomyelitis can regulate the behavior of doctors and nurses, effectively control infec- tion, repairing bone and skin soft tissue defect, promoting wound and fracture healing, relieving pain, shorten the hospi- tal stay, improving nursing quality and reducing recurrence rate. The curative effect was promising.

关 键 词：临床护理路径 皮瓣植皮术 负压封闭引流 慢性骨髓炎 

分 类 号：R473.6[医药卫生—护理学] R681.2[医药卫生—临床医学]