NPWT联合美皮贴于游离皮片移植中的应用

Technology of NPWT combined mepitel used in skin grafting

目的:将负压创面治疗技术(negative pressure wound therapy,NPWT)联合美皮贴治疗与传统打包治疗方法进行对比,探讨不同方式对于游离移植皮片成活率、并发症发生率的影响,总住院时间及揭除辅料时疼痛程度等指标,评价其优缺点及临床实用性。方法:将60例住院患者(多种原因致皮肤缺损需行游离皮片移植术者)随机分为NPWT联合美皮贴组(A组)与传统打包组(B组)。A组:30例,行游离皮片移植后采用NPWT联合美皮贴行创面封闭、负压创面治疗;B组:30例,采用传统打包加压包扎固定移植皮片。手术治疗后由同一观察者对移植皮片成活情况及疼痛程度进行评估。结果:A组移植皮片成活不良1例,并发症发生率3.3%,B组发生皮肤坏死4例,并发症发生率13.3%,两组患者并发症发生率比较,差异有显著性意义(χ2=11.8916,P<0.01),A组平均住院时间为(10.2±1.23)天,B组为(15.4±1.96)天,两组患者平均住院时间比较,差异有显著性意义(t=6.6589,P<0.01)。A组I^II度以上疼痛患者2例,B组I^II度以上疼痛患者8例,两组患者疼痛程度比较有显著性差异(χ2=17.7778,P<0.01)。结论:NPWT联合美皮贴治疗较传统打包操作简便,容易推广,可较明显地减轻患者病痛,降低并发症的发生率,降低移植皮片因黏附于敷料而在去除时造成破损的几率,缩短住院时间,具有更优的临床应用价值。

Objective To compare the clinical outcomes of negative pressure wound therapy combined Mepitel to conventional therapy （CT） in skin graft survival in all patients to determine whether NPWT combined Mepitel affects the outcome of the graft survival, in terms of total length of stay, duration of dressing, graft failure the level of pain, complications and so on. Methods A retrospective analysis of 60 cases from October 2012 to October 2013 were made. All patients were randomized to divided into two groups： Group 1-NPWT combined Mepitel （n=30） and group 2-conventional therapy （CT） （n =30）. After surgery, the result was evaluated by the same observer. Results There were significantly distinctions in group 1 compared to group 2： fewer complications in graft failure （seroma, hematoma and infection） [n=1（3.3%） versus n=4（13.3%）; P〈0.01], shorter total length of stay[（10.2±1.23）d versus （15.4±1.96） d; t=6.6589, P〈0.01] and lower pain level[n=2（6.7%） versus n=8（26.7%）;P〈 0.01]. Conclusion To sum up our experience,NPWT combined Mepitel is an excellent alternative for securing skin graft and is associated with improved graft survival as measured by a reduction in graft failure, complications, the level of pain,total length of stay and so on.