负压封闭引流技术在创伤序贯救治中的应用

Application of vacuum sealing drainage in sequential treatment of trauma

目的分析负压封闭引流技术在不同创面序贯救治中的应用情况,探讨负压封闭引流对血压、血液指标的影响,为规范化开展负压封闭引流技术提供临床应用依据。方法选取2009年5月—2015年11月成都医学院第一附属医院烧伤整形科收治的35例创伤所致皮肤软组织缺损、无法一期手术封闭的患者,采用"简单清创-负压封闭引流-二期手术"的序贯治疗方式,进行治疗。根据具体伤情变化制定负压封闭引流时间,每3~7 d更换敷料,观察创面改善进展;根据具体创伤情况制定二期皮肤或皮瓣移植手术方式,同时进行血压、血液学指标的监测。结果所有创面在简单清创并负压封闭引流后逐渐形成新鲜肉芽,无脓性渗出,创面面积逐渐缩小;29例患者经过1次皮肤或皮瓣移植手术后治愈,6例患者经过2次皮肤或皮瓣移植手术治愈;1例负压吸引面积达10%的患者在清创-负压封闭引流术后血红蛋白由117 g/L降至61 g/L,给予对症支持处理,保持负压封闭引流,随后患者血红蛋白逐渐上升,经负压封闭引流2周、植皮术后3周,创面愈合。结论 "简单清创-负压封闭引流-二期手术"的序贯救治方案为皮肤软组织缺损、无法一期手术封闭的创伤患者提供了一项简便可行、疗效确切的治疗方法,避免伤口感染,促进创面愈合;对于负压封闭引流面积达10%的患者,首次清创可能会影响血液学指标变化,但处于可控范围之内,负压吸引过程对血液指标以及血压的影响不大。

Objective To investigate the application of vacuum sealing drainage in sequential treatment of trauma, and discuss the influence of vacuum sealing drainage （VSD） on blood pressure, hematology indexes, provide the basis of the clinical application. Methods Total 35 cases of skin and soft tissue defect resulted by trauma that were unsuitable of one-stage surgical operation in our hospital between 2009 and 2015 underwent a sequential treatment with simple debride- merit-vacuum sealing drainage（VSD）-phase Ⅱ operation. The duration of VSD was adjusted according to the wound con- dition, and dressings were changed every 3 to 7 d in according with wound healing progress. And the phase Ⅱ operation, skin or the skin flap transplantation, were designed also according to the wound condition. At the same time, hematology indexes and blood pressure were monitored. Results After the treatment of VSD, all wounds gradually formed fresh gran- ulation tissue, without purulent exudate, and the wound area reduced apparently. All the patients were cured post-sequen- tial treatment. Among them,29 patients were cured after once operation, and 6 cases were cured after twice operation. He- moglobin of one patient with VSD area of 10% decreased from 117 g/L to 61 g/L after simple debridement and Vacuum Sealing Drainage, however, the levels of hemoglobin recovered and the wound was healed after the symptomatic treatment, VSD for 2 weeks and dermepenthesis. Conclusion Sequential treatment of simple debridement-Vaeuum Sealing Drain- age-phase Ⅱ operation could obviously promote wound granulation tissue growth, effectively control the wound infection, provide a good blood supply, improve the success rate of the skin or skin flap graft, was beneficial for the treatment of wounds unsuitable of one-stage surgical operation. Patients whose vacuum sealing drainage area arrived 10%, the first time debridement may affect hematology indexes, at a controllable scope.