不同模式持续负压伤口疗法对下肢静脉性溃疡创面的临床疗效及其影响因素  

Clinical efficacy and influencing factors of different modes of continuous negative pressure wound therapy on venous ulcer wounds of lower limbs

作　　者：杨敏烈 周小金 朱宇刚 姜东林 丁羚涛 储国平 赵朋 程佳 吕国忠 李青峰[2] Yang Minlie;Zhou Xiaojin;Zhu Yugang;Jiang Donglin;Ding Lintao;Chu Guoping;Zhao Peng;Cheng Jia;Lyu Guozhong;Li Qingfeng(Department of Burns and Plastic Surgery,the Affiliated Hospital of Jiangnan University(Wuxi Third People′s Hospital),Wuxi 214041,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]江南大学附属医院(无锡市第三人民医院)烧伤整形科,214041 [2]上海交通大学医学院附属第九人民医院整复外科,200011

出　　处：《中华烧伤杂志》2020年第12期1149-1158,共10页Chinese Journal of Burns

基　　金：无锡市社会发展科技示范项目(N20192003);无锡市卫生健康委员会重点项目(Z201710)。

摘　　要：目的探讨不同模式持续负压伤口疗法(NPWT)对下肢静脉性溃疡创面的临床疗效并进行影响因素分析。方法2018年1月—2019年12月,江南大学附属医院收治53例符合入选标准的下肢静脉性溃疡患者,对其进行前瞻性随机对照研究。按随机数字表法将患者分为单一负压治疗组19例(男11例、女8例)、循环交替负压治疗组17例(男12例、女5例)和常规换药组17例(男10例、女7例),年龄分别为(47±11)、(49±10)、(47±10)岁。入院后,单一负压治疗组患者接受负压为-13.3 kPa单一负压模式持续NPWT,循环交替负压治疗组患者接受负压为-16.0^-10.7 kPa循环交替负压模式持续NPWT,常规换药组患者接受碘伏浸润的凡士林纱布换药治疗。治疗7、14 d,计算创面愈合率;治疗前及治疗7、14 d,采用经皮氧分压(TcPO2)测量仪检测创周TcPO2;治疗1、4、7、10、14 d,收集创面渗出液/引流液,采用pH计行pH值检测并记录渗出液/引流液量;治疗前及治疗7、14 d,采集静脉血,检测血清白细胞介素1β(IL-1β)、IL-6、肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)水平;治疗前及治疗7、14 d,采集创面分泌物行细菌培养,分别采用视觉模拟评分法和汉密尔顿焦虑量表评定患者创面疼痛和焦虑程度;统计患者住院时间及治疗总费用。对数据进行重复测量方差分析、单因素方差分析、LSD检验、Kruskal-Wallis H检验、Mann-Whitney U检验、χ2检验、Fisher确切概率法检验以及Bonferroni校正。根据治疗14 d创面愈合率,分创面愈合率≥70%的显著愈合和创面愈合率<70%的非显著愈合2个疗效评价等级,以此二分类的创面愈合率为因变量,以治疗前TcPO2、IL-1β、IL-6、TNF-α、TGF-β1、VEGF、bFGF水平与细菌检出情况、创面疼痛和焦虑程度及治疗1 d创面渗出液/引流液量和pH值为协变量,通过二分类多因素logistic回Objective To explore the clinical efficacy of different modes of continuous negative pressure wound therapy(NPWT)on venous ulcer wounds of lower limbs,and to analyze the influencing factors.Methods From January 2018 to December 2019,53 patients with venous ulcer of lower limbs who met the inclusion criteria and hospitalized in the Affiliated Hospital of Jiangnan University were recruited in this prospective randomized controlled study.According to the random number table,the patients were divided into single negative pressure therapy(SNPT)group(19 patients,11 males and 8 females),cyclic alternating negative pressure therapy(CANPT)group(17 patients,12 males and 5 females),and routine dressing change(RDC)group(17 patients,10 males and 7 females),aged(47±11),(49±10),and(47±10)years respectively.After admission,patients in SNPT group were given continuous NPWT with the single negative pressure setting at-13.3 kPa,patients in CANPT group were also given continuous NPWT but with the cyclic alternating negative pressure setting from-16.0 to-10.7 kPa,while patients in RDC group were given dressing change with vaseline gauze soaked with iodophor.The wound healing rate was calculated on treatment day 7 and 14.Transcutaneous oxygen pressure(TcPO2)around the wound was detected by TcPO2 meter before treatment and on treatment day 7 and 14.The wound exudate/drainage fluid was collected on treatment day 1,4,7,10,and 14,with the pH value measured using a pH meter,and the volume of exudate/drainage fluid recorded.Before treatment and on treatment day 7 and 14,venous blood was collected to detect the serum levels of interleukin 1β(IL-1β),IL-6,tumor necrosis factorα(TNF-α),transforming growth factor-β1(TGF-β1),vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF).Before treatment and on treatment day 7 and 14,wound exudates were collected for bacterial culture,and Visual Analogue Scale and Hamilton Anxiety Scale were used to evaluate the degree of wound pain and anxiety of patients respectively.T

关 键 词：负压伤口疗法 静脉曲张溃疡 伤口愈合 慢性创面 

分 类 号：R644[医药卫生—外科学] R63[医药卫生—临床医学]