深部持续冲洗联合负压封闭引流治疗主干血管损伤术后创面多重耐药菌感染  

Continuous deep irrigation combined with vacuum sealing drainage for the treatment of postoperative multidrug‑resistant bacterial infections in wounds of patients with major artery injury

作　　者：刘世琼[1] 董娜[2] 熊明月[1] 梅晰凡 吴阳 刘振辉 鲁学良[1] Liu Shiqiong;Dong Na;Xiong Mingyue;Mei Xifan;Wu Yang;Liu Zhenhui;Lu Xueliang(Department of Orthopedics,First Affiliated Hospital of Henan University of Science and Technology,College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China;Department of Pathology,First Affiliated Hospital of Henan University of Science and Technology,College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China;Department of Orthopedics,Third Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China;Department of Sports Medicine,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Sports Medicine,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南科技大学临床医学院,河南科技大学第一附属医院骨科,洛阳471003 [2]河南科技大学临床医学院,河南科技大学第一附属医院病理科,洛阳471003 [3]锦州医科大学第三医院骨科,锦州121001 [4]复旦大学附属华山医院运动医学科,上海200040 [5]河南省人民医院运动医学科,郑州450003

出　　处：《中华创伤杂志》2023年第6期538-544,共7页Chinese Journal of Trauma

摘　　要：目的比较深部持续冲洗联合负压封闭引流(VSD)与日常规换药治疗主干血管损伤术后创面多重耐药菌感染的疗效。方法采用回顾性队列研究分析2015年3月至2021年12月河南科技大学第一附属医院收治的28例主干血管损伤术后创面多重耐药菌感染患者的临床资料,其中男15例,女13例;年龄15~65岁[(41.8±12.9)岁]。所有患者主干血管损伤后行血管移植手术,术后微生物培养提示创面发生耐碳青霉烯革兰阴性杆菌(CRO)或耐万古霉素肠球菌(VRE)感染,无敏感抗生素。所有患者每5 d给予手术清创,14例后续治疗采用常规换药(常规换药组),14例后续治疗采用深部持续冲洗联合VSD(冲洗联合VSD组)。清创术后第1天及之后每3 d行炎症指标[白细胞计数、中性粒细胞、C‑反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原]检测,若患者病情有变化,随时复测。每5 d留取患者标本行微生物培养。观察两组创面及感染控制情况。比较两组炎症指标降至正常时间、治疗后创面CRO或VRE培养转阴时间、换冲洗液(换药)前及换冲洗液(换药)后1,2,3 h视觉模拟评分(VAS)、创面植皮或皮瓣修复情况、吻合口瘘发生率。结果患者均获随访12~24个月[(14.3±2.4个月)]。两组创面均无红肿、破溃及脓性分泌物,感染未复发。冲洗联合VSD组白细胞计数降至正常时间为(9.4±2.4)d,中性粒细胞为(9.6±2.8)d,CRP为(9.8±3.1)d,ESR为(12.2±3.6)d,降钙素原为(7.6±1.9)d,短于常规换药组的(15.2±3.1)d、(13.6±3.4)d、(14.2±3.9)d、(19.9±3.3)d和(12.9±4.1)d(P均<0.01)。冲洗联合VSD组创面CRO或VRE培养转阴时间为(13.9±3.1)d,低于常规换药组的(19.2±6.9)d(P<0.05)。冲洗联合VSD组换冲洗液前及换冲洗液后1,2,3 h VAS为(4.2±0.7)分、(4.1±0.9)分、(4.2±0.9)分、(4.1±0.8)分,常规换药组分别为(4.3±0.6)分、(6.9±0.7)分、(5.4±0.9)分、(4.5±0.9)分。冲洗联合VSD组换冲洗液后1,2 h VAS低于常规换药Objective To compare the efficacy between deep continuous irrigation combined with vacuum sealing drainage(VSD)and routine dressing change in treating multidrug‑resistant bacterial infections at the surgical wound site in patients with major vascular injury.Methods A retrospective cohort study was conducted to analyze the clinical data of 28 patients with surgical wound infections by multidrug‑resistant bacteria after major vascular injury treated at the First Affiliated Hospital of Henan University of Science and Technology from March 2015 to December 2021.There were 15 males and 13 females,aged 15‑65 years[(41.8±12.9)years].All patients received vascular graft surgery after major vascular injury.Postoperative microbiological culture indicated that the wound infections were caused by Carbapenem‑resistant organisms(CRO)or vancomycin‑resistant Enterococci(VRE),with no available sensitive antibiotics for treatment.The patients received surgical debridement every five days after vascular graft surgery and were divided into two groups to receive the subsequent treatments including a routine dressing change(routine dressing group,14 patients)or a deep continuous irrigation combined with VSD(irrigation combined with VSD group,14 patients).On the first day post‑operation and then every 3 days,inflammatory indicators[white blood cell count,neutrophils,C‑reactive protein(CRP),erythrocyte sedimentation rate(ESR),and procalcitonin]were observed in the two groups(repeat tests when a patient′s condition changed).Microbiological cultures were applied with patient samples every 5 days to observe the wound and infection control.Comparisons were made between the two groups regarding the duration to normal levels of inflammatory indicators,duration to negative CRO or VRE cultures,visual analogue score(VAS)before and at 1,2 and 3 hours after changing the irrigation fluid(changing the dressing),conditions of wound skin grafting or flap repair,and incidences of anastomotic fistula.Results All patients were followed u

关 键 词：外科伤口感染 血管系统损伤 抗药性 细菌 

分 类 号：R654.3[医药卫生—外科学]