负压封闭引流技术应用于坏死性筋膜炎术后创面修复的疗效研究

目的探讨负压封闭引流(VSD)技术对坏死性筋膜炎术后创面修复的治疗效果。 方法选取哈尔滨医科大学附属第一医院普外科2013年1月至2018年1月收治的符合入组标准的坏死性筋膜炎患者50例，按随机数字表法分为治疗组和对照组，每组各25例，治疗组采用VSD技术治疗，对照组采用常规换药、清创、冲洗、引流。分别记录两组患者术后当日及术后5、10、15 d的创面愈合率、肉芽组织评分、视觉模拟评分(VAS)等各项指标以及患者总住院时间、住院期间更换敷料次数及平均间隔时间等。对数据行配对样本t检验、独立样本t检验。 结果两组患者术后当日创面肉芽组织评分、疼痛评分差异均无统计学意义(P值均大于0.05)。术后5、10、15 d，治疗组平均创面愈合率分别高于对照组，两组比较差异均有统计学意义(t＝10.184、10.498、11.523，P值均小于0.05)；治疗组平均肉芽组织评分分别优于对照组，差异均有统计学意义(t＝－4.925、－6.039、－6.647，P值均小于0.05)；治疗组VAS评分分别低于对照组，差异均有统计学意义(t＝－2.918、－3.540、－2.402，P值均小于0.05)。治疗组患者总住院时间为(19.4±17.1) d，对照组为(42.4±13.5) d，差异有统计学意义(t＝－5.275，P＝0.00048)。住院期间治疗组平均更换敷料(2.08±1.75)次，平均间隔(9.56±1.60) d；对照组平均更换敷料(20.16±6.63)次，平均间隔(2.11±0.06)d，差异均有统计学意义(t＝－13.179、23.322，P值均小于0.05)。 结论对比常规的换药方式，VSD技术具有创面愈合更快，肉芽组织更新鲜，疼痛更轻等特点，同时明显缩短患者住院时间，降低更换敷料次数及频率，提高了患者生活质量及医师工作效率，值得在坏死性筋膜炎术后的创面修复中进一步推广应用。

Effect of vacuum sealing drainage on the treatment of necrotizing fasciitis wound after surgery

ObjectiveTo investigate the effect of vacuum sealing drainage on the treatment of necrotizing fasciitis wound after surgery. MethodsAn analysis of patients in the Department of General Surgery of First Affiliated Hospital of Harbin Medical University from January 2013 to January 2018 was actualized. The elected patients were divided into two groups randomly accorcling to the random number table method. The treatment group (n=25) underwent vacuum sealing drainage, and the control group (n=25) underwent conventional dressing change, debridement, irrigation, drainage. Record the states of wound healing rate, granulation tissue score, and visual analogue score on the day of surgery and the 5th, 10th and 15th day after surgery, total hospital days, total dressing changing times and average interval days of dressing changing. Date were processed with paired sample t test and independent sample t test. ResultsThere was no significant difference between the two groups in diagnostic criteria of granulation and visual analogue scores on the day of surgery (with P values above 0.05). On the 5th, 10th and 15th day after surgery, there were statistically significant differences in wound healing rates (t=10.184, 10.498, 11.523; with P valuse below 0.05), diagnostic criteria of granulation (t=-4.925, -6.039, -6.647; with P values below 0.05) and visual analogue score (t=-2.918, -3.540, -2.402, with P values below 0.05) between the two groups, the results of the treatment group were better than the control group. The average total hospital days of the treatment group were (19.4±17.1) d, less than the (42.4±13.5 ) d of the control group (t=-5.275, P=0.00048) . The average total dressing changing times of the treatment group were(2.08±1.75) times, the average interval was (9.56±1.60 ) d. The average total dressing changing times of the control group were (20.16±6.63) times, the average interval was (2.11±0.06) d, the differences were statistically significant (t=-13.179, 23.322; with P values below 0.05). ConclusionsThe application of vacuum sealing drainage brings the patients higher wound healing rates, fresher granulation and less pain. Moreover, it reduces the dressing changing times remarkably and improves efficiency, and is worth to be popularized in the treatment of necrotizing fasciitis.