负压封闭引流治疗小儿下肢大面积皮肤撕脱伤的围手术期护理

目的探讨采用负压封闭引流（VSD）治疗小儿下肢大面积皮肤撕脱伤的护理措施和体会。方法总结2010年12月-2012年10月收治的48例下肢大面积皮肤撕脱伤行VSD治疗患儿（VSD组）的围手术期的护理方法，并与2007年1月-2010年11月56例未接受VSD治疗的同类型患儿（传统组）进行比较。结果48例中患儿行VSD治疗1次者19例，治疗2次者23例，治疗3次者6例。留置期间5例堵管，予生理盐水冲洗后再通；3例漏气，其中2例重新连接后恢复正常，1例因VSD护创材料干结变硬，予更换敷料。行VSD至创面植皮时间（12．0±5．0）d，住院时间（19．2±5．6）dd。与传统组比较，VSD组患儿住院期间换药次数更少，创面或全身感染率更低，首次术后至创面植皮时间和住院时间更短，差异均有统计学意义（P〈0．05）；而两组住院费用差异并无统计学意义（P〉0．05）。结论加强伤后急救处理、心理护理，术后保持引流装置密闭有效，及时发现引流系统的异常情况，加强营养，能减轻患儿下肢大面积皮肤撕脱伤感染发生率，缩短疗程，预后效果好。

Perioperative Nursing for Children with Extensive Skin Avulsion Injury in Lower Limbs Treated by Vacuum Sealing Drainage

Objective To discuss nursing measures and experiences for children with extensive skin avulsion injury of lower limbs treated by vacuum sealing drainage （VSD）. Methods We reviewed the perioperative nursing data of 48 child patients with extensive skin avulsion injury in lower limbs who underwent VSD treatment between December 2010 to October 2012. And the data were compared with those for 56 children with the same disease and treatment between January 2007 and November 2010. Results In these 48 children, 19 received once, 23 received twice, and 6 received 3 times of vacuum sealing drainage. During the treatment, 5 drainage tubes were blocked and were solved with normal saline, and 3 drainage tubes had leakage and two of them were reconnected and the other one became normal after changing the dressing. For VSD, the time between being wounded and skin-grafting was 13.6 days, and the average hospitalization time was 24.3 days. Compared with the traditional method group, children in the VSD group had fewer drug changes during hospitalization, lower infection rate, and shorter hospitalization stay, and the differences were significant （P 〈 0.05）. Conclusion Keeping drainage tube airtight, normal and effective is as important as nutrition and mental nursing in the treatment of children＇s extensive skin avulsion injury in lower limbs, which can decrease infection rate, reduce average hospitalization time, and increase operative efficacy.