改良持续负压封闭引流法治疗老年难愈性创面的效果

目的探讨改良持续负压封闭引流法治疗老年患者难愈性创面上的效果。方法 65岁及以上难愈性创面患者57例随机分为改良持续负压封闭引流治疗组(改良组)28例和负压创面治疗(NPWT)组29例。对比两组创面治疗效果、愈合时间、手术次数、治疗费用。结果改良组与NPWT组难愈性创面治疗效果相同,但改良组伤口愈合时间明显缩短(P=0.042)、手术次数组及治疗费用显著降低(P0.001)。结论改良持续负压封闭引流技术可用于有效治疗老年患者难愈性创面。     

应用封闭式负压引流技术治疗肝胆胰系统肿瘤术后难愈性创面的效果观察

目的观察应用封闭式负压引流技术治疗肝胆胰系统肿瘤术后难愈性创面的效果。方法将30例肝胆胰系统肿瘤术后难愈性创面患者按住院号单双数分为观察组和对照组,各15例。观察组应用封闭式负压引流技术治疗,对照组应用常规换药方法治疗。结果经治疗观察组愈合率为93.3%,高于对照组的53.3%,差异有统计学意义(χ2=6.14,P<0.05);观察组愈合时间少于对照组,差异有统计学意义(t=4.92,P<0.01)。结论应用封闭式负压引流技术治疗肝胆胰系统肿瘤术后难愈性创面可有效缩短患者伤口愈合过程,提高愈合率。     

封闭负压引流技术对大面积创面愈合的影响

目的探讨封闭负压引流技术对大面积创面愈合的影响。方法选取60例大面积皮肤缺损患者,按照随机数字表法分为实验组和参照组各30例。参照组采取普通换药治疗,实验组予以封闭负压引流技术治疗,对比两组临床效果。结果实验组治疗后创面肉芽组织生长情况明显优于参照组(P0.05)。参照组并发症发生率明显高于实验组(P0.05)。结论对皮肤大面积缺损患者予以封闭负压引流技术治疗,可有效促进肉芽组织生长,并降低并发症发生率。     

持续负压引流治疗慢性骨髓炎23例疗效观察

目的探讨持续负压引流(VSD)对慢性骨髓炎的治疗效果。方法收治的慢性骨髓炎合并有慢性溃疡的患者共23例,均采用溃疡清创后,使用VSD治疗,待创面清洁、肉芽组织生长良好后,12例直接缝合,8例植皮封闭创面,3例经邻位皮瓣转移封闭创面。结果 VSD平均吸引15 d,平均更换VSD 2.5次。创面渗液均明显减少,且创面面积均有不同程度的缩小。经二期手术后治愈,随访6～29个月,无复发。结论 VSD治疗对慢性骨髓炎具有引流充分、缩小创面、促进肉芽组织生长、降低复发率等优点,疗效确切。     

老年难愈性创面的负压封闭治疗

老年难愈性创面在临床上较多,其中主要由长期卧床、营养不良、局部循环障碍、感染、放射性损伤等引起.由于老年患者组织再生能力差,创面愈合时间相对较长,给患者及家属带来较多不便及痛苦.目前针对老年难愈性创面应用负压封闭治疗不多,我科2006 年至今应用负压封闭技术(vacuum sealing technique,VS) 治疗老年难愈性大面积创面26例,效果良好.     

慢性难愈性创面的形成机制及治疗进展

慢性难愈性创面治愈难且常伴随功能的丧失,极大地降低了患者的生活质量,加重了患者的医疗负担,是创面修复领域亟待解决的难题。近年来,随着基础研究的不断深入以及新的治疗措施的应用和成熟,慢性难愈性创面的治疗水平逐步提高。该文就慢性难愈性创面的形成机制及治疗进展进行综述。     

负压引流配合碘伏持续冲洗用于糖尿病足感染创面治疗中的效果

目的 对糖尿病足感染创面患者采用负压引流配合碘伏持续冲洗治疗的效果进行探究.方法 选取该院在2019年8月—2021年5月收治的糖尿病足创面感染患者120例纳入到研究中,按照入院顺序进行分组,分为甲组和乙组,每组60例.甲组接受负压引流治疗,乙组则以此为基础接受碘伏持续冲洗治疗.对比两组的治疗效果、不良反应发生率、创面...     

负压封闭吸引对结核术后难愈性创面中相关因子表达及预后的研究

目的 探讨应用负压封闭引流(VSD)治疗结核术后出现难愈性创面的患者,研究其相关因子的表达及预后。方法 选取2016年1月-2022年5月我院胸外科结核术后出现伤口愈合不良的患者76例,按数字表格法分为观察组和对照组,每组38例,观察组接受VSD治疗,对照组接受外科换药治疗,在治疗前和治疗后第7天用ELISA法测定血清中TNF-α、IL-4、IL-8、IL-10的含量和伤口肉芽组织中TGF-β1、VEGF、HIF-1α的含量及伤口愈合拆线时间。结果 比较两组治疗前TNF-α、IL-4、IL-8、IL-10及TGF-β1、VEGF、HIF-1α水平,差异无统计学意义(P>0.05)。治疗后第7天检测,TNF-α、IL-8较治疗前均降低,其中观察组较对照组降低更明显(P<0.05);IL-4、IL-10较治疗前均升高,其中观察组较对照组升高更明显(P<0.05);TGF-β1、VEGF较治疗前均升高,其中观察组较对照组升高更明显(P<0.05);HIF-1α较治疗前均降低,其中观察组较对照组降低更明显(P<0.05)。观察组愈合拆线时间较对照组明显缩短,差异有...     

持续低负压吸引治疗难愈性气胸的护理体会

自发性气胸是呼吸系统的常见急症。临床上多数自发性气胸经休息、胸穿抽气或胸腔闭式引流等保守治疗可以治愈,但易复发。常发生在慢性阻塞性肺病、肺结核、肺大泡、哮喘等疾病基础上。我院2000年3月～2008年12月,对30例经胸腔置管闭式引流治疗自发性气胸效果欠佳者,予经胸腔置管后低负压持续吸引,效果良好。     

封闭负压引流联合超声清创术对糖尿病足难愈创面疗效及炎性因子的影响

目的 探讨临床对糖尿病足（DF）难愈创面患者采取封闭负压引流（VSD）联合超声清创术的疗效。方法选取2019年1月—2021年12月该院收治的DF难愈创面患者60例,经由随机数表法分为观察组（30例,VSD联合超声清创术）与对照组（30例,VSD技术）。对比两组临床治疗效果,疼痛评分及血清炎性因子[血清白细胞介素1β(IL-1β)、白细胞介素6(IL-6)及C反应蛋白（CRP）]水平的表达。结果 观察组治疗总有效率高于对照组,差异有统计学意义（P<0.05）。观察组治疗后创面血流灌注量、经皮氧分压均较对照组更高,细菌定量较对照组更低,差异有统计学意义（P<0.05）。观察组患者患肢溃疡治愈时间、住院时间记录值均短于对照组,换药次数少于对照组,差异有统计学意义（P<0.05）。观察组治疗后7、14 d的VAS评分较对照组更低,差异有统计学意义（P<0.05）。观察组治疗后IL-1β、IL-6及CRP各项水平值较对照组更低,差异有统计学意义（P<0.05）。结论 VSD联合超声清创术用于DF难愈创面治疗的临床效果良好,能减轻疼痛以及抑制炎性因子。     

两种伤口负压治疗模式对糖尿病足溃疡治疗作用的比较

目的比较两种伤口负压治疗模式对糖尿病足溃疡的治疗作用。方法选取2018年4至8月广西壮族自治区人民医院内分泌科收治的糖尿病足溃疡患者,经全身综合治疗和创面评估、清创后,对创面床适合伤口负压治疗的16例患者(男10例,女6例)按入组时间顺序进行随机分组,采用开放、平行、交叉方法,分为先负压辅助闭合(VAC)组(8例)和先负压封闭引流(VSD)组(8例),先VAC组第一周采用VAC治疗,第二周接受VSD治疗;先VSD组第一周采用VSD治疗,第二周接受VAC治疗。分别于治疗前、治疗1周末及治疗2周末对所有患者足部溃疡创面拍照,采用Image J软件分析溃疡面积及肉芽组织面积变化,同时采用丹麦雷度经皮氧分压测定仪测定2个部位的组织氧分压。运用两阶段交叉设计的方差分析方法,对治疗期间第1周和第2周两种治疗模式的溃疡面积及肉芽组织面积变化、经皮氧分压变化进行比较。结果(1)16例糖尿病足溃疡患者与治疗前比较,治疗后溃疡面积缩小[4.61(3.11)比9.51(6.55)cm^2,Z=3.517]、肉芽面积增加[4.08(2.49)比0.90(1.12)cm^2,Z=-3.516],2个部位的经皮氧分压值均升高[(54.19±6.91)比(32.16±10.16)mmHg(1 mmHg=0.133 kPa)、(56.75±12.95)比(30.56±11.93)mmHg,t=-11.814、-14.028],差异均有统计学意义(均P<0.05)。(2)VSD和VAC两种不同负压治疗模式对患者的溃疡面积、肉芽组织面积及2个部位的经皮氧分压变化有统计学意义(F=5.763~22.090,均P<0.05),且VAC治疗后的经皮氧分压增大值、溃疡面积缩小值及肉芽组织面积增加值要大于VSD治疗后(P<0.05)。(3)无论采用哪种负压治疗模式,治疗第1周后的2个部位的经皮氧分压增大值均大于治疗第2周后,差异有统计学意义(F=13.254、11.205,均P<0.05)。结论VAC在缩小糖尿病足溃疡面积,增加创面肉芽组织面积及提高溃疡周围组织氧分压方面要优于VSD,VAC治疗模式在治疗糖尿病足溃疡上更具有优势。     

创伤负压治疗技术治疗糖尿病足溃疡的研究进展

糖尿病足是导致我国糖尿病患者致残、致死的严重慢性并发症之一,不仅给患者带来沉重的心理负担,还造成沉重的家庭及社会负担。创伤负压治疗(negative pressure wound therapy,NPWT)技术是近年来用于治疗各类急、慢性创面的疗法,在糖尿病足溃疡的治疗方面取得了良好的效果。NPWT包括负压辅助闭合(vacuum assisted closure,VAC)和负压封闭引流(vacuum sealing drainage,VSD)两种模式。该文概述NPWT发展沿革、促进伤口愈合的作用机制,比较了VAC和VSD两种负压封闭技术的原理和作用差异。     

负压创面治疗技术在起搏器囊袋感染治疗中的临床应用

目的探讨负压创面治疗技术(NPWT)用于治疗心脏起搏器囊袋感染的有效性及安全性。方法 2013年1月至2016年5月收治心脏起搏器囊袋感染患者15例,根据NPWT原理,一期清创后囊袋内放置负压引流系统,封闭创面后持续负压(300~400mmHg)引流5~7d,二期将起搏器重置深埋于胸大肌后间隙并闭合创面,保留原心脏起搏器系统。结果术后随访5~37个月,平均随访时间18.2个月,其中14例起搏器囊袋感染治愈,伤口愈合良好,随访期内未发现感染复发。1例血培养阳性患者前后经过3个疗程的NPWT治疗,感染仍无法控制,最终移除感染侧整套起搏器装置,并在对侧植入新的起搏器系统后治愈。结论在严格选择适应证的前提下,NPWT是一种可行的治疗血培养阴性、非感染性心内膜炎的单纯心脏起搏器囊袋感染的新方法。     

Combination of negative pressure wound therapy and acoustic pressure wound therapy for treatment of infected surgical wounds: a case series

The optimal wound therapy for healing infected wounds post surgery or surgical debridement has not been established. Negative pressure wound therapy and acoustic pressure wound therapy are advanced wound-healing modalities that apply forms of mechanical pressure to wound tissue in an effort to promote healing by stimulating cellular proliferation. Using a combination of negative pressure wound therapy and acoustic pressure wound therapy was evaluated in a series of six patients with large, infected surgical wounds presenting with moderate to large amounts of serosanguineous drainage. After concurrent treatment with both modalities (range: 4 to 12 weeks), wound volume was reduced by 99% to 100% in all wounds except one wound for which depth at end of treatment was not measurable due to hypergranulation. Similarly, wound surface area was reduced by 82% to 100%, with the exception of the hypergranular wound, which decreased in size by 60%. Serosanguineous wound drainage was reduced in four wounds and remained unchanged in two wounds.     

猪尾巴导管加负压引流与传统胸腔闭式引流治疗液气胸的效果比较

目的探讨猪尾巴导管(一次性引流导管)加负压引流治疗液气胸效果与临床价值。方法将78例液气胸患者采用随机数字法分为两组,39例给予猪尾巴导管加负压引流(观察组),39例给予传统胸腔闭式引流(对照组),比较两组治疗效果及其他指标。结果猪尾巴导管加负压引流治疗液气胸在疼痛程度、手术时间、手术切口等方面的疗效优于传统胸腔闭式引流,差异具有统计学意义(P0.05)。结论猪尾巴导管加负压引流治疗液气胸疗效确切明显,具有手术时间短、患者痛苦程度轻、无明显并发症、无手术切口的优点,可改善患者生活质量。     

Dysregulation of wound healing mechanisms in diabetes and the importance of negative pressure wound therapy (NPWT)

Diabetes is a serious disease with severe side effects and comorbidities. Diabetic foot with its chronic nonhealing ulcers, or diabetic foot ulcers, as they are commonly called, can be devastating, even leading to amputation. Many therapies exist to assist and improve wound healing. One exciting discovery is the use of negative pressure wound therapy (NPWT) as an adjunct to standard treatment. Few studies have substantively explored the molecular mechanisms of NPWT and why we see improved wound healing, a concept that demands more research. The following commentary summarizes the current literature regarding NPWT as well as some of the vast body of work that focuses on the physiologic mechanisms of wound healing in diabetics in general.     

克拉霉素联合抗痨药治疗老年人复治肺结核临床观察

目的观察克拉霉素联合氧氟沙星、力克肺疾和利福喷丁治疗老年人复治肺结核的临床疗效。方法选择住院60例老年人复治肺结核病人为研究对象,随机分为治疗组和对照组。治疗组采用克拉霉素和氧氟沙星联合力克肺疾、利福喷丁四联抗痨;对照组采用力克肺疾、利福喷丁、氧氟沙星三联抗痨。疗程均为6个月(强化期2个月,维持期4个月,维持期均以力克肺疾和利福喷丁治疗),6个月后随访所有患者的症状、复查肝肾功能及胸片。结果治疗组在胸片病灶吸收方面,较对照组有明显改善(P<0.05);但在药物不良反应方面两种方案无显著差异(P>0.05)。结论克拉霉素联合氧氟沙星、力克肺疾及利福喷丁比氧氟沙星联合力克肺疾、利福喷丁治疗老年人复治肺结核疗效好。     

Impact of incisional negative pressure wound therapy on perineal wound healing after abdominoperineal rectum extirpation

Introduction

Perineal wound healing disorders are one of the major complications following abdominoperineal rectum extirpation.

Methods and results

We evaluated the impact of an “incisional negative pressure wound therapy” (iNPWT) system after abdominoperineal rectum extirpation in six patients. All patients had a neoadjuvant radiochemotherapy with 50.4 Gy and 5-FU. Five of the six patients (83%) experienced complication-free healing of the perineal wound after 5 to 12 days of iNPWT. One patient developed a wound healing disorder 8 days after abdominoperineal rectum extirpation during current iNPWT.

Discussion

Use of an iNPWT system can be of favor after abominoperineal rectum extirpation.

     

Individualizing the use of negative pressure wound therapy for optimal wound healing: a focused review of the literature

Currently available research suggests that negative pressure wound therapy (NPWT) creates a moist wound healing environment, drains exudate, reduces tissue edema, contracts the wound edges, mechanically stimulates the wound bed, and influences blood perfusion at the wound edge, which may lead to angiogenesis and the formation of granulation tissue. Although no clear evidence is available that NPWT accelerates wound healing compared to other interventions or that one form of NPWT is better than another, preclinical research suggests that the most commonly used dressings, level of negative pressure, and application mode (continuous, intermittent, or variable) may not be optimal for all patients. To summarize available literature related to these NPWT choices, pertinent literature published between 2005 and 2010 was reviewed. Preclinical study results suggest that the maximal biological effect of NPWT at the wound edge often can be achieved at -80 mm Hg and that foam dressings may be advantageous for large defect wounds, whereas gauze dressings may be more suitable for smaller wounds or when scar formation or pain is a concern. Preclinical research results also suggest that intermittent or variable pressure application has a better effect on granulation tissue formation than continuous application. The variable pressure mode maintains a negative pressure environment at lower pressure settings without dramatic fluctuations inherent to intermittent (on-and-off) pressure. Prospective, controlled clinical studies are needed to compare NPWT to other advanced wound care protocols of care and to ascertain the effect of various NPWT methods and regimens on outcomes of care.