封闭式负压引流持续吸引与间断吸引临床效果的对照研究

目的评价封闭式负压引流(VSD)持续吸引与间断吸引两种方法在促进肉芽生长及游离植皮覆盖的临床效果。方法选自2010年10月至2011年3月,来我院采用VSD治疗的患者作为研究对象。将患者随机分为持续吸引组及间断吸引组。手术室内对患者受伤局部进行清创,清创后将VSD填充创面,VSD的引流管与负压吸引瓶相连。持续负压组VSD持续吸引7天;间断吸引组VSD敷料吸引2小时,停吸2小时,以此类推吸引7天。7天后手术室内拆除VSD(记为第一次拆除VSD),对两组的创面进行评估,包括创面清洁度、肉芽生长情况等,同时进行细菌培养。清创完成后,对创面采用自体韧厚皮移植并再次采用VSD覆盖并予吸引。两组吸引方式同前。10天后两组均拆除VSD(记为第二次拆除VSD),观察皮肤存活情况及周围有无感染。在整个VSD吸引过程中,记录吸引管引流情况包括是否畅通,VSD有无堵塞等。结果共有84例患者参与本次研究。其中VSD持续吸引组为47例,VSD间断吸引组为37例。第一次拆除VSD时,肉眼看两组创面之间的肉芽生长无明显差异,两组创面内也没有感染灶,两组肉芽的厚度基本相同。两组的细菌培养均为阴性。第二次拆除VSD时,持续吸引组未有皮肤坏死病例,间断吸引组有2例出现皮肤部分坏死;两组均未有感染出现。持续吸引组发生吸引管堵塞次数为62次,其中第一次53次,第二次9次。间断吸引组发生吸引管堵塞次数为85次,其中第一次72次,第二次13次。两组之间总的堵塞次数存在明显差异(P=0.014),但无论是第一次还是第二次拆除VSD时的堵塞数,两组均没有明显差异(P=0.054,P=0.210)。结论持续负压吸引与间断负压吸引在促进肉芽生长及植皮方面无明显差异,但间断吸引组的堵塞数高于持续吸引组,说明间断负压吸引更需要全方位的护理。

Clinical Control Study of Continuous Suction and Intermittent Suction of Vacuum Sealing Drainage

Objective To evaluate the clinical effcet of continuous suction and intermittent suction of vacuum sealing drainage (VSD) on promoting the granulation growth and the coverage of free flap transplantation. Methods The patients treated with VSD in our hospital from October 2010 to March 2011 were selected as the researching objects and divided into continuous suction group and intermittent suction group. The injured position was debrided and filled with VSD in operation room and drainage tube of VIB were connected to the negative pressure suction bottle. The patients in continuous suction group received the continuous suction for 7 days, while the intermittent suction group received suction for 2 hours and stoped for 2 hours last for 7 days. The VSD was removed in operation room after 7 days (note for first removal), and the wound were evaluated including the cleaness, granulation growth and germiculture. Split-thickness skin autograft was taken and the wound was filled with VSD secondly. The suction ways were as above. The VSD was removed after 10 days (note for second removal), the skin survival and infection around the wound were observed. The drainage situation of suction tube including clear and blocking were recorded. Results 84 patients had involved in this study with 47 cases in continuous suction group and 37 cases in intermittent suction group. At the first removal of VSD, the granulation growth of wound in two groups had no significant difference; no infection was found in the wound and the thicknesses of granulation were the same in two groups; bacteria cultures were negative in both groups. At the second removal of VSD, the continuous suction group had no case of skin necrosis, while intermittent suction group had 2 cases of part skin necrosis; no infection was found in both groups. The frequency of suction tube jam in continuous suction group was 62 with 53 in first removal and9 in second removal; while the intermittent suction group was 85 with 72 in first removal and 13 in second removal; the difference of toal jam frequency in two groups had statistically significant (P =0.014); but the jam frequency in the first removal and in the second removal between two groups had no significant difference (P =0.054, P =0.210). Conclusions Continuous suction and intermittent suction has no significant difference in promoting the granulation growth, but intermittent suction has higher frequency of jam compared with continuous suction, which means that more comprehensive care should be taken in intermittent suction.