难治性褥疮的综合治疗

COMBINED TREATMENT OF REFRACTORY DECUBITUS ULCERS

目的总结难治性褥疮的临床治疗经验。方法1998年5月~2005年3月,收治22例29处褥疮患者,年龄36~92岁。褥疮范围4cm×2cm^18cm×15cm。骶尾部18处,坐骨结节部6处,股骨大转子部5处。口服肠内营养素,创口采用五黄一号药纱布贴敷包扎8~15d后手术。其中3例合并糖尿病术前采用胰岛素控制血糖。根据患者年龄、褥疮部位、范围及深度等选择皮瓣类型。采用局部皮瓣修复3处,皮瓣范围6cm×4cm^12cm×10cm;筋膜皮瓣修复10处,皮瓣范围10cm×7cm^20cm×17cm;臀大肌皮瓣修复9处,皮瓣范围13cm×11m^17cm×14cm;股二头肌长头肌皮瓣修复6处,皮瓣范围11cm×6cm^14cm×7cm;直接缝合修复1处。术后睡气流悬浮床7~14d。结果22例29处褥疮,术前加强营养支持,创口用五黄一号换药,治疗8~15d,血红蛋白超过100g/L,白蛋白超过30g/L,褥疮部位坏死组织脱净,肉芽组织红润,创面分泌物减少,创周无红肿,全身营养状况明显改善。术后皮瓣均成活,切口期愈合。获随访6个月~5年,原手术部位无褥疮复发,皮瓣质地柔软,外形满意。结论应用综合方法治疗难治性褥疮效果显著,手术成功率高。

Objective To summarize the clinical experience in the treatment of refractory decubitus ulcers. Methods From May 1998 to March 2005, 22 patients with decubitus ulcers（29 decubitus ulcers） were admitted, whose age was 36-92 years. The lesion size was 4 cm × 2 cm to 18 cm × 15 cm. The locations of decubitus ulcers were the sacrococcygeal region（18 cases）, the tuber ischiadicum region （6 cases） and the trochanter major region（5 cases）. Enteral nutrient was given orally and the wound was treated with Wuhuangyihao 8-15 days. Three diabetic patients were injected with insulin. According to patient＇s age, ulcer position, ulcer extent and ulcer degree, the flap type was determined. Three wounds were repaired by local flaps, the flap size was 6 cm × 4 cm-12 cm × 10 cm; 10 by fasclocutaneous flaps, 10 cm×7 cm-20cm×17 cm; 9 by gluteus maximus myocutaneous flaps, 13 cm×11 cm-17 cm ×14 cm, and 6 by long-head of biceps femoris flaps, 11 cm× 6 cm-14 cm × 7 cm. One was sutured directly. After operation, the patients were placed on airflow suspended bed 7-14 days. Results General nutritional status was improved, hemoglobin was greater than 100 g/L, albumen was greater than 30 g/L. Necrosis tissue was removed, granulation tissue turned into fresh, secretion reduced and no redness and swelling occurred in wound. All flaps survived and the wounds healed by first intention. After a follow-up of 6 months to 5 years, no patient had a recurrence, the color and texture of the flaps were good, the appearance was satisfactory. Conclusion Applying the technique of combined treatment can accelerate the healing of refractory decubitus ulcers and improves the success of operation.