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

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...

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

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(24.34±2.69)%],the differences were statistically significant(t=2.65,2.71;P<0.05);the expression level of CD4⁺/CD8+in the experimental group was 1.84±0.31,which was not significantly different from that of the control group at(1.79±0.24)(t=0.70,P>0.05).There was no significant difference in SAS score and SDS score between the experimental group and the control group before treatment(P>0.05).After 14 days of treatment,the SAS score and SDS score of the experimental group were(36.63±2.38),(39.3±3.74)points respectively,compared with the control group[(45.27±2.25),(45.73±3.55)points],the differences were statistically significant(t=6.80,3.06;P<0.05).The average hospital stay of patients in the experimental group was(25.4±3.7)d,which was significantly different from the control group[(37.2±4.1)d],the difference was statistically significant(t=7.8,P<0.05);the number of operations in the experimental group was(2.1±0.2)times,compared with that in the control group[(4.2±0.3)times],the difference was statistically significant(t=10.20,P<0.05).The treatment cost of the experimental group was(8.6±1.8)million yuan,compared with the control group[(12.5±2.4)million yuan],the difference was statistically significant(t=6.40,P<0.05).The treatment acceptance rate of experimental group was 93.3%(14/15),which was higher than that of control group 66.7%(10/15),the difference between the two groups was statistically significant(χ2=4.25,P<0.05).Conclusion The treatment of necrotizing fasciitis of perineum by enteral and parenteral nutrition combined with vacuum sealing drainage can reduce the average length of stay,the number of operations and the cost of treatment,make the patients more easily accepted,reduce the occurrence of anxiety and depression,and have more advantages in the treatment of necrotizing fasciitis of perineum,which can be widely promoted in clinical work.