暂时性腹腔关闭联合持续负压吸引在严重胰腺损伤中的应用分析  

Temporary abdominal closure combined with continuous negative pressure drainage in management of patients with severe pancreatic trauma

作　　者：易伟 李单[2] 朱宏亮 陈帆 李苑[1] 谢先强 Yi Wei;Li Dan;Zhu Hongliang;Chen Fan;Li Yuan;Xie Xianqiang(Department of General Surgery,the 908th Hospital of the Joint Logistics Support Force,PLA,Nanchang 330002,China;Nanchang 3rd Rest Home for Retired Cadres of Jiangxi Military Region,Nanchang 330000,China)

机构地区：[1]中国人民解放军联勤保障部队第九○八医院普外科,南昌330002 [2]江西省军区南昌第三离职干部休养所,南昌330000

出　　处：《中华肝胆外科杂志》2021年第9期672-675,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨暂时性腹腔关闭联合持续负压吸引在严重胰腺损伤中的应用效果。方法回顾性分析2014年6月至2020年6月中国人民解放军联勤保障部队第九○八医院收治的33例严重胰腺损伤患者临床资料,其中男性28例,女性5例,平均年龄43.1岁。16例手术后采用暂时性腹腔关闭联合持续负压吸引纳入联合组,17例采用直接关腹及传统引流纳入对照组。比较两组体温、心率、腹内压、住院时间以及术后并发症等。结果两组患者术前腹内压比较,差异无统计学意义(P>0.05)。联合组手术后3 d腹内压分别为(11.7±2.6)mmHg(1 mmHg=0.133 kPa)、(11.1±3.2)mmHg、(10.2±3.7)mmHg,均低于对照组(18.1±5.3)mmHg、(15.6±6.2)mmHg、(15.0±6.7)mmHg,差异均有统计学意义(均P<0.05)。联合组住院总时间(29.2±17.8)d、重症监护病房住院时间(7.1±3.2)d,均少于对照组(49.5±26.3)d、(11.8±7.6)d,差异均有统计学意义(均P<0.05)。联合组体温降低(-0.1±0.9)℃、心率降低(18.2±17.2)次/min,均高于对照组(-1.2±0.7)℃、(-5.9±17.2)次/min,差异均有统计学意义(均P<0.05)。联合组术后并发症发生率18.8%(3/16),低于对照组52.9%(9/17),差异有统计学意义(χ^(2)=4.164,P=0.041)。结论严重胰腺损伤患者手术后暂时性腹腔关闭联合持续负压吸引在控制腹腔压力、降低术后并发症、减少住院时间等方面有明显优势,值得在严重胰腺损伤中推广应用。Objective To study the use of temporary abdominal closure combined with continuous negative pressure drainage in management of patients with severe pancreatic trauma.Methods A retrospective analysis was conducted on the data of 33 patients with severe pancreatic trauma treated at the 908th Hospital of the Joint Logistics Support Force of PLA from June 2014 to June 2020.There were 28 males and 5 females,with an average age of 43.1 years.Sixteen patients were treated with temporary abdominal closure combined with continuous negative pressure drainage(the combined group),and 17 patients with direct abdominal closure and traditional drainage(the control group).The body temperature,heart rate,intra-abdominal pressure,length of hospital stay and postoperative complications were compared between groups.Results There was no significant difference in the preoperative intra-abdominal pressure between the two groups(P>0.05).The intra-abdominal pressure on the first,second and third postoperative days in the combined group were(11.7±2.6)mmHg(1 mmHg=0.133 kpa),(11.1±3.2)mmHg and(10.2±3.7)mmHg respectively,which were significantly lower than those in the control group of(18.1±5.3)mmHg,(15.6±6.2)mmHg,and(15.0±6.7)mmHg,respectively(all P<0.05).The total in-hospital and ICU stays in the combined group were(29.2±17.8)days and(7.1±3.2)days respectively,which were significantly less than those in the control group of(49.5±26.3)days and(11.8±7.6)days(both P<0.05).The decreases in body temperature and heart rate in the combined group were(-0.1±0.9)℃and(18.2±17.2)times/min respectively,which were significantly more than those in the control group of(-1.2±0.7)℃and(-5.9±17.2)times/min respectively(both P<0.05).The incidence of postoperative complication in the combined group was 18.8%(3/16),which was significantly lower than that in the control group of 52.9%(9/17)(χ^(2)=4.164,P=0.041).Conclusion Significant advantages were obtained by using temporary abdominal closure combined with continuous negative pressure drainag

关 键 词：腹部伤口闭合技术 伤口负压治疗 胰腺损伤 腹腔内高压 

分 类 号：R657.5[医药卫生—外科学]