肠内外营养联合负压封闭引流治疗会阴部坏死性筋膜炎的疗效观察  

Clinical study on the treatment of necrotizing fasciitis of perineum with enteral and parenteral nutrition combined with vacuum sealing drainage

作　　者：井维斌 刘锐[1] 翟明翠[1] 刘振宝[1] 田枫[1] Jing Weibin;Liu Rui;Zhai Mingcui;Liu Zhenbao;Tian Feng(Department of Burns,Heilongjiang Provincial Hospital,Harbin 150036,China)

机构地区：[1]黑龙江省医院烧伤科,哈尔滨150036

出　　处：《中华损伤与修复杂志（电子版）》2021年第1期15-20,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：黑龙江省科技厅省院科技合作项目(YS20C02)。

摘　　要：目的探讨肠内外营养联合负压封闭引流治疗会阴部坏死性筋膜炎的疗效。方法选择2016年1月至2019年6月黑龙江省医院烧伤科收治的30例会阴部坏死性筋膜炎患者,按随机数字表法分为实验组(n=15)和对照组(n=15)。创面治疗方案均采取手术清创、持续负压封闭引流、创面基底床准备充分时植皮或皮瓣修复创面。实验组术后给予肠内外营养方案,对照组给予临时性结肠造瘘术。比较2组患者治疗前及治疗后14 d的营养学指标(血清前白蛋白、白蛋白、转铁蛋白水平),免疫学指标(血清CD4^(+)、CD8+和CD4^(+)/CD8+表达水平),焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分。记录患者平均住院时间、手术次数、治疗费用、治疗接受程度。数据比较采用t检验和χ2检验。结果治疗前,实验组与对照组患者血清前白蛋白、白蛋白、转铁蛋白水平和血清CD4^(+)、CD8+和CD4^(+)/CD8+表达水平比较差异均无统计学意义(P>0.05),治疗后14 d实验组血清前白蛋白、白蛋白、转铁蛋白水平分别为(259.6±34.0)mg/L、(37.1±2.2)g/L、(2.4±0.4)g/L,与对照组[(265.4±20.6)mg/L、(36.3±1.7)g/L、(2.5±0.4)g/L]比较,差异均无统计学意义(t=0.55、1.61、0.92,P>0.05);治疗后14 d实验组血清CD4^(+)、CD8+表达水平分别为(46.74±4.15)%、(25.99±2.90)%,与对照组[(43.15±4.95)%、(24.34±2.69)%]比较,差异均有统计学意义(t=2.65、2.71,P<0.05);治疗后14 d实验组CD4^(+)/CD8+表达水平为1.84±0.31,与对照组(1.79±0.24)比较差异无统计学意义(t=0.70,P>0.05)。实验组与对照组患者治疗前SAS评分及SDS评分比较差异均无统计学意义(P>0.05),治疗后14 d,实验组患者SAS评分及SDS评分分别为(36.63±2.38)、(39.30±3.74)分,与对照组[(45.27±2.25)、(45.73±3.55)分]比较,差异均有统计学意义(t=6.80、3.06,P<0.05)。实验组患者平均住院时间(25.4±3.7)d,与对照组[(37.2±4.1)d]比较差异有统计学意义(t=7.80,P<0.05);实验�Objective To explore the effect of enteral and parenteral nutrition combined with vacuum sealing drainage in the treatment of necrotizing fasciitis of perineum.Methods From January 2016 to June 2019,30 patients with necrotizing fasciitis of perineum admitted to Department of Burns,Heilongjiang Provincial Hospital were randomly divided into experimental group(n=15)and control group(n=15)according to the random number table method.All the patients were treated with surgical debridement,continuous negative pressure closure and drainage,and skin grafting or flap when the basal bed of the wound was fully prepared.The experimental group was given enteral and parenteral nutrition,while the control group was given temporary colostomy.The nutritional indexes(serum prealbumin,albumin,transferrin levels)of the two groups before treatment and 14 days after treatment were compared;immunological indexes(serum CD4^(+),CD8+,CD4^(+)/CD8+expression levels);self rating anxiety scale(SAS)score and self rating depression scale(SDS)score were compared and the average length of hospital stay,number of operations,cost of treatment and acceptance of treatment were recorded.Data were compared with t test andχ2 test.Results Before treatment,there was no significant difference between the experimental group and the control group in the levels of serum prealbumin,albumin and transferrin and expression levels of serum CD4^(+),CD8+,CD4^(+)/CD8+,the differences were not statistically significant(P>0.05).After 14 days of treatment,the levels of serum prealbumin,albumin and transferrin in the experimental group were(259.6±34.0)mg/L,(37.1±2.2)g/L,(2.4±0.4)g/L respectively,compared with those in the control group[(265.4±20.6)mg/L,(36.3±1.7)g/L and(2.5±0.4)g/L],the differences were not statistically significant(t=0.55,1.61,0.92;P>0.05);after 14 days of treatment,the expression levels of serum CD4^(+),and CD8+in the experimental group were(46.74±4.15)%and(25.99±2.90)%respectively,compared with those in the control group[(43.15±4.95)%and(24.

关 键 词：FOURNIER坏疽 负压伤口疗法 焦虑 抑郁 会阴部坏死性筋膜炎 肠内外营养 

分 类 号：R686.3[医药卫生—骨科学]