负压封闭引流冲洗联合局部氧疗治疗深度烧伤创面的临床观察  

Clinical efficacy of vacuum sealing drainage joint liquid irrigation combined with topical oxygen therapy on deep burn wounds

作　　者：张美光[1] 阳纯兵[1] 肖勇[1] 李志清[2] Zhang Meiguang;Yang Chunbing;Xiao Yong;Li Zhiqing(Department of Burns and Plastic Surgery,Yue Bei People＇s Hospital,Shaoguan 512025,China;Department of Burns,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]粤北人民医院烧伤整形科,韶关512025 [2]南方医科大学南方医院烧伤科,广州510515

出　　处：《中华损伤与修复杂志（电子版）》2018年第5期336-341,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：广东省省级科技计划项目(2017A020215042);韶关市卫生计生科研计划项目(Y16022)

摘　　要：目的评估负压封闭引流(VSD)冲洗联合局部氧疗治疗深度烧伤创面的临床疗效。方法选取2015年1月至2017年6月粤北人民医院收治的30例符合标准的深度烧伤患者,按随机数字表法分为单纯VSD组(9例)、VSD冲洗组(10例)、VSD冲洗联合局部氧疗组(11例)。于治疗前、治疗7 d后,均行创面大体观察;治疗7 d后计算创面肉芽组织覆盖率;留取创面组织液,检测创面组织液氧分压;记录3组创面Ⅱ期手术方式及术后游离皮片或皮瓣成活率(%);比较术后平均换药次数,抗生素应用时间及住院时间。对数据进行单因素方差分析、LSD-t检验及Kruskal-Wallis H多组秩和检验。结果 (1)治疗7 d后,VSD冲洗联合局部氧疗组创面床新鲜程度明显优于VSD冲洗组和单纯VSD组,VSD冲洗组好于单纯VSD组。VSD冲洗联合局部氧疗组肉芽组织覆盖率[(95±4)%]均高于VSD冲洗组[(82±7)%]与单纯VSD组[(68±9)%],差异有统计学意义(t=13. 53、27. 63,P值均小于0. 01),VSD冲洗组与单纯VSD组比较差异有统计学意义(t=14. 09,P <0. 01);(2)治疗7 d后,VSD冲洗联合局部氧疗组氧分压为(118±12) mm Hg,均高于VSD冲洗组[(45±6) mm Hg]与单纯VSD组[(42±8) mm Hg](t=73. 91、76. 59,P值均小于0. 01),单纯VSD组与VSD冲洗组比较差异无统计学意义(t=2. 69,P> 0. 05);(3) 3组以游离皮片和带蒂皮瓣修复创面,VSD冲洗联合局部氧疗组皮片成活率[(97. 9±2. 0)%]与皮瓣成活率[(97. 5±0. 9)%]分别优于单纯VSD组,差异均有统计学意义(t=20. 4、15. 7,P值均小于0. 01),且分别优于VSD冲洗组,差异均有统计学意义(t=11. 9、11. 2,P值均小于0. 01),VSD冲洗组分别优于单纯VSD组,差异均有统计学意义(t=4. 43、8. 43,P值均小于0. 05)。(4) VSD冲洗联合局部氧疗组术后换药次数、抗生素应用时间及住院时间分别明显少于VSD冲洗组和单纯VSD组(t=3. 37、5. 95、7. 01,6. 25、10. 80、13. 26; P值均小于0. 01); VSD冲洗组少于单纯VSD组,差异有统计�Objective Evaluation of the therapeutic efficacy of vacuum sealing drainage （ VSD ） combined with topical oxygen therapy and liquid irrigation for deep burn wounds. Methods From January 2015 to June 2017, 30 patients with deep burn wounds required surgical treatment were divided into simple VSD group （n = 9） ; VSD joint irrigation group （n = 10） ; VSD combined with oxygen and liquid irrigation group （ n = 11 ） according to the random number table method after debridement. Post treatment of 7 days, overall situations of local wound and granulation tissue coverage rate were observed among three groups; the local tissue fluid partial pressure of oxygen was detected ; Furthermore, the postoperative survival of skin graft or flap were calculated; Moreover the frequency of dressing change, days of antibiotic used and hospital stay after operation were recorded. Date were processed with one-way analysis of variance and LSD-t test. Results （ 1 ） VSD combined with oxygen and liquid irrigation group wound bed was better than VSD joint irrigation group and simple VSI） group, VSI） joint irrigation group was better than the simple VSI） group after 7 days. Compared with that in simple VSD and VSI） joint irrigation group [ （ 68 ± 9 ） %, （ 82 ± 7 ） % ], granulation tissue coverage rate [ （95 ± 4） %] was higher in VSD combined with oxygen and liquid irrigation group （t = 13.53, 27.63; with P values below 0.01 ）, there was significant difference between VSI） joint irrigation group and simple VSD group （ t = 14.09, P 〈 0.01 ）. （2） Values of PiO2 in simple VSD group and VSD joint irrigation group [ （42±8）, （45 ±6） mmHg] were all lower than that in VSD combined with oxygen and liquid irrigation group [ （118 ± 12） mmHg] （t = 73.91,76.59; with P values below 0.01 ）, there was no significant difference between simple VSD group and VSD joint irrigation group （ t = 2.69, P 〉 0.05 ）. （ 3 ） The survival rate of skin graft and flap in VSD combined w

关 键 词：烧伤 负压伤口疗法 氧 皮肤移植 局部灌流 

分 类 号：R644[医药卫生—外科学]