负压封闭引流技术在深度烧伤创面修复中的应用

目的探讨负压封闭引流技术（VSD）联合植皮术在深度烧伤创面修复中的临床应用价值。方法回顾性分析2010年2月至2012年12月榆林市第二医院收治的深Ⅱ度、Ⅲ度烧伤患者共50例,根据治疗方法不同分为两组：治疗组26例,植皮前后分别采用VSD治疗促进创面愈合;对照组24例,采用传统常规换药方法,肉芽组织新鲜后植皮,加压包扎植皮区。观察两组中并发症发生率、首次植皮存活率、创面感染率、住院时间、总医疗费用等差异。结果治疗组和对照组并发症发生率分别为3.85%和12.50%,两组比较差异有统计学意义（P〈0.05）,两组中细菌培养阳性率分别为7.69%和41.67%,两组比较差异有统计学意义（χ^2=7.898,P〈0.05）,首次植皮存活率分别为96.15%和70.83%,两组比较差异有统计学意义（χ^2=5.953,P〈0.05）;两组疼痛评分分别为（4.15±1.29）分和（6.24±2.01）分,差异有统计学意义（t=4.336,P〈0.05）;住院时间分别为（21.4±4.5）d和（30.8±6.7）d,两组比较差异有统计学意义（t=5.775,P〈0.05）;两组总医疗费用分别为（34960.4±8949.2）元和（29512.8±6749.7）元,差异无统计学意义（t=2.414,P〉0.05）。结论 VSD使用安全、简便,可有效促进烧伤创面的愈合,降低创面感染率,减轻患者痛苦,提高植皮存活率,缩短住院时间,值得临床推广应用。

Clinical application of the vacuum sealing drainage in treatment of depth burn

Objective To investigate the clinical therapeutic effect of the vacuum-sealing drainage（VSD） combining with skin graft in a deep burn wound. Methods From February 2010 to December2012,50 patients of deep burns were treated in the Second Hospital of Yulin City. They were divided into two groups according to treatment method. Twenty-six patients were assigned as the VSD treatment group,which was treated by VSD before and after skin transplantation. Twenty-four patients were assigned as the routine treatment group,which was treated by regular dressing change. Their wounds were transplanted by the split thickness skins binding up by packing when they were fitted. The results in terms of complications,the positive rate of bacterial culture of wound,the survival rate of first time skin grafting,pain score,the hospital length of stay and the cost of treatment were compared between the two groups. Results The incidence rate of complication in VSD group were obviously less than those of routine treatment group（3.85% vs. 12. 50%,P〈0. 05）. There were obvious differences between the two groups in following indices： the positive rate of bacterial culture（7. 69% vs. 41. 67%,P〈0. 05）,the survival rate of skin grafting（96. 15% vs. 70. 83%,P〈0. 05）,pain score（4. 15 ± 1. 29 vs. 6. 24 ± 2. 01,P〈0. 05）,the hospital length of stay（21. 4 ± 4. 5 d vs. 30. 8 ± 6. 7 d,P〈0. 05）. There was no significant difference between the two groups in the cost of treatment（34960. 4 ± 8949. 2 vs. 29512. 8 ± 6749. 7,P〉0. 05）.Conclusions The VSD provides a convenient and effective method for treating depth burn wound,which can reduce the positive rate of bacterial culture of wound,reduce the pain of patients,increase the survival rate of skin grafts,shorten the hospital length of stay. It is worth being widely applied in clinical practice.