负压伤口治疗联合皮瓣移植治疗压力性溃疡的临床研究

Clinical study of NPWT combined with skin flap transplantation for repairing pressure ulcers

目的探讨应用负压伤口治疗技术(negative pressure wound therapy,NPWT)联合皮瓣移植治疗压力性溃疡的临床效果。方法选取2016年1月至2022年1月临沂市中医医院收治的90例Ⅲ~Ⅳ度压力性溃疡患者作为研究对象。采用随机数表法分为治疗组和对照组,每组45例。对照组给予清创、换药(外用生物敷料、银离子敷料、功能性敷料等)治疗,创面感染控制后行皮瓣移植术。治疗组一期行创面清创,清除坏死组织及窦道后行持续负压伤口治疗,待3~5天创面新鲜有生机,二期应用带蒂皮瓣移植修复创面。观察两组皮瓣坏死率、切口裂开率、切口感染率、创面引流量、住院时间和创面愈合时间。结果治疗组有43例创面一期愈合,1例患者皮瓣远端坏死,皮瓣坏死率2.2%,明显低于对照组的20%;治疗组1例患者发生切口裂开,切口裂开率为2.2%,明显低于对照组的24.4%;治疗组无切口感染,切口感染率明显低于对照组的13.3%,差异均有统计学意义(P<0.05)。治疗组创面引流量明显多于对照组,而在住院时间和创面愈合时间方面明显短于对照组,和对照组比较有显著的统计学差异(P<0.05)。结论应用负压伤口治疗技术联合皮瓣治疗压力性溃疡的疗效优于单纯皮瓣移植术。联合疗法一方面增加创面引流量,明显减少换药次数,缩短住院时间和创面愈合时间;另一方面降低皮瓣坏死率、切口裂开率和切口感染,安全可靠,值得推广应用。

Objective To explore the clinical effect of negative pressure wound treatment technique(negative pressure wound therapy,NPWT)combined with skin flap transplantation in the treatment of stress ulcer.Methods 90 patients withⅢ~Ⅳdegree stress ulcer treated in Linyi traditional Chinese medicine hospital from January 2016 to January 2022 were selected as the object of study.The patients were randomly divided into treatment group(n=45)and control group(n=45).The control group was treated with debridement and dressing change(external biological dressing,silver ion dressing,functional dressing,etc.).Skin flap transplantation was performed after wound infection was controlled.In the treatment group,debridement of the wound,removal of necrotic tissue and sinus were performed in the first stage,followed by continuous NPWT treatment.After 3~5 days,the wound was fresh and alive,and pedicled skin flap was used to repair the wound in the second stage.The flap necrosis rate,incision dehiscence rate,incision infection rate,wound drainage,hospital stay and wound healing time were observed in the two groups.Results There were 43 cases of primary wound healing in the treatment group,1 case of distal flap necrosis,and the flap necrosis rate was 2.2%,which was significantly lower than that of the control group(20%).As for the incision dehiscence rate:one patient in the treatment group had incision dehiscence,the incidence rate was 2.2%,which was significantly lower than that in the control group(24.4%).The incision infection rate in the treatment group was 0,significantly lower than that in the control group(13.3%),and the difference was statistically significant(P<0.05).The amount of wound drainage in the treatment group was significantly more than that in the control group,while the length of hospital stay and wound healing time in the treatment group were significantly shorter than those in the control group,and there was significant difference compared with the control group(P<0.05).Conclusion The efficacy of negative pressure wound treatment combined with skin flap in the treatment of stress ulcer is better than that of simple skin flap transplantation.On the one hand,increasing wound drainage,significantly reducing the number of dressing changes,shortening hospital stay and wound healing time;on the other hand,reducing skin flap necrosis rate,incision dehiscence rate and incision infection,safe and reliable,worthy of popularization and application.