封闭式负压引流技术结合刃厚植皮治疗烧伤后残余创面的临床研究

Clinical study of vacuum sealing drainage and split skin graft for management of residual burn wounds

目的:观察封闭式负压引流技术(vacuum sealing drainage,VSD)结合刃厚皮片移植治疗烧伤后残余创面的效果。方法:在收治烧伤患者中选择38例需手术植皮修复的残余创面患者,随机分成试验组和对照组。在术前常规治疗的基础上,试验组(19例创面)根据创面形状剪切VSD敷料覆盖创面,实施VSD治疗;对照组(19例创面)常规外用碘伏清洗、油纱包扎,术前48 h用3%高渗盐水湿敷,1～2次/d。治疗6天后进行手术移植刃厚皮片。术后第7天、第14天及第21天分别观察创面愈合情况。对创面愈合率、创面愈合时间及两组治疗方法对细菌的清除率进行比较。结果:术后第7天、21天,试验组和对照组的创面愈合率比较,差异无统计学意义(P>0.05),但术后第14天试验组和对照组的创面愈合率有明显差异(P=0.002﹤0.05)。试验组创面愈合时间为(14±1)d,较对照组(16±2)d明显缩短(P=0.006﹤0.01)。试验组VSD治疗后细菌清除率(86.67%)较对照组(64.29%)明显增高(P=0.039<0.05)。结论:VSD治疗能提高烧伤残余创面植皮成功率,有效缩短了残余创面的愈合时间,为手术治疗烧伤残余创面提供了一条切实可行的途径。

Objective To investigate the curative effects of vacuum sealing drainage （VSD） and split skin graft on burn residual wounds. Method From April 2007 to April 2011,38 patients with residual burn wotmds which would be repaired with skin transplantation were randomly divided into the trial group （n = 19） and the control group （n = 19）. Before operation, VSD was applied onto the wounds of the trial group and 3% hypertonic saline absorbent gauze was compressed on the wounds once to twice a day in the control group. After 6 days,the split skin grafts were transplanted. The wound healing rate was recorded on the 7th, 14th and 21th post skin grafting days （PSGD）. And the wound healing time and the bacterial clearing rate were also observed. Results The healing rate of the trial group was significantly higher than the control group on the 14th PSGD（ P = 0. 002）, but there was no statistically significant difference on the 7th and 21 th PSGD （ P 〉 0. 05 ）. The wound healing time of the trial group was （ 14± 1 ） days, was significantly shorter than that of the control group [ （ 16 ± 2） days,P = 0. 006 ]. The pathogenic bacteria detection rate was significantly lower than the control group （ P = 0. 039 〈 0. 05 ）. Conclusion Success rate of skin transplantation is improved with VSD treatment, so it is effective in treating burn residual wounds.