点状皮片移植联合次氯酸冲洗治疗下肢静脉溃疡的临床研究  

Clinical study of punctate skin grafting combined with hypochlorous acid irrigation in treatment of venous leg ulcers

作　　者：何振华 陈深 孙世杰 孙晓芬 毛捷鸿 HE Zhenhua;CHEN Shen;SUN Shijie;SUN Xiaofen;MAO Jiehong(Shaoxing University Yuanpei College,Shaoxing 312000,Zhejiang,China;Chinese Medicine Nursing Center,Second Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang,China;Anorectal Surgery Department,Second Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang,China)

机构地区：[1]绍兴文理学院元培学院,浙江绍兴312000 [2]浙江中医药大学附属第二医院中医护理中心,浙江杭州310005 [3]浙江中医药大学附属第二医院肛肠外科,浙江杭州310005

出　　处：《中国现代医生》2023年第27期11-14,26,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020KY991);国家级大学生创新创业训练计划项目(202110349009);浙江省大学生科技创新活动计划(新苗人才计划)项目(2021R432031)。

摘　　要：目的探讨点状皮片移植联合次氯酸冲洗治疗下肢静脉溃疡的临床疗效。方法采用目的抽样法,选取2021年9月至2022年9月浙江中医药大学附属第二医院收治的下肢静脉溃疡患者96例,按照随机数字表法分为空白组、对照组和干预组,每组32例。空白组在标准化创面床准备后采用点状皮片移植治疗,术后给予常规换药;对照组在空白组的基础上,术前3d及术后3~5d采用恒温30℃生理盐水冲洗治疗;干预组将冲洗液改为次氯酸溶液。比较三组患者术后5d的皮片成活率、细菌阳性率、疼痛评分,创面愈合时间。结果术后5d,干预组的皮片成活率[(86.82±2.83)%]明显高于对照组[(75.37±4.56)%]和空白组[(66.84±9.68)%],差异有统计学意义(P<0.05)。干预组、对照组和空白组的细菌阳性率分别为10.00%、22.58%、46.43%,差异有统计学意义(P<0.05)。三组患者术后5d疼痛评分比较,干预组[(2.97±1.19)分]显著低于对照组[(4.26±0.10)分]和空白组[(5.42±1.14)分],差异有统计学意义(P<0.05)。与空白组[(33.91±3.78)d]和对照组[(27.02±3.13)d]的愈合时间比较,干预组[(16.00±2.35)d]的愈合时间较短,差异有统计学意义(P<0.05)。结论点状皮片移植联合次氯酸冲洗可有效控制下肢静脉溃疡皮片移植创面的局部感染,改善血氧供应,促进组织分化和表皮扩展,提高移植皮片的成活率,促进创面愈合进程,减轻患者疼痛感受,具有较好的临床应用和推广价值。Objective To investigate clinical effect of punctate skin graft combined with hypochlorous acid irrigation in treatment of venous leg ulcers.Methods Using the purpose sampling method,96 patients with venous leg ulcers admitted to Second Affiliated Hospital of Zhejiang Chinese Medical University from September 2021 to September 2022 were selected and divided into blank group,control group and intervention group according to the random number table method.32 cases in each group.The blank group was treated with punctiform skin grafts after standardized wound bed preparation,and routine dressing changes were given after the operation;The control group,on the basis of blank group,was treated with normal saline irrigation at a constant temperature of 30℃for 3 days before and 3-5 days after operation.The intervention group changed the irrigation fluid to hypochlorous acid solution.The skin survival rate,bacterial positive rate,pain score,wound healing time were compared in the 3 groups at 5 days postoperatively.Results On the 5th day after operation,the skin survival rate of intervention group[(86.82±2.83)%]was significantly higher than that of control group[(75.37±4.56)%]and blank group[(66.84±9.68)%],the difference was statistically significant(P<0.05).The positive rates of bacteria in intervention group,control group and blank group were 10.00%,22.58%,and 46.43%,respectively,and the difference was statistically significant(P<0.05).Comparing the pain scores of the three groups of patients on the 5th day after surgery,the intervention group[(2.97±1.19)points]was significantly lower than control group[(4.26±0.10)points]and blank group[(5.42±1.14)points],the difference was statistically significant(P<0.05).Compared with blank group[(33.91±3.78)d]and control group[(27.02±3.13)d]healing time,the healing time of intervention group[(16.00±2.35)d]was shorter,the difference was statistically significant(P<0.05).Conclusion Punctate skin grafting combined with hypochlorous acid irrigation can effectively control the l

关 键 词：点状皮片移植 次氯酸 下肢静脉溃疡 冲洗疗法 

分 类 号：R63[医药卫生—外科学]