封闭负压引流技术在深度烧伤治疗中的应用

The clinical application of the vacuum sealing drainage combining with skin graft in a deep burn wound

目的探讨封闭负压引流（VSD）技术联合游离植皮术在深度烧伤治疗中的应用。方法根据治疗方法的不同对61例深度烧伤患者分组，VSD治疗组33例手术清创后采用VSD技术封闭创面，待创面肉芽组织新鲜后植皮，采用VSD技术加压植皮区；对照组28例采用传统换药方法，引流分泌物，去除坏死组织，促进肉芽组织生长，肉芽组织新鲜后植皮，加压包扎植皮区。结果在接受VSD技术治疗的33例中，无一例发生局部及全身过敏反应和异常出血情况。经过一次（7—10d）封闭负压治疗，除2例因创面组织缺损较大，血运欠佳等原因，需再一次清创后继续负压闭式引流外，其余31例病例创面肉芽组织鲜红，其后采用植皮术，效果良好。VSD治疗组与对照组治疗至植皮所用时间、疼痛评分、局部治疗费用分别为（8±0．9）d和（14±1．2）d、（5．7±1．6）分和（3．1±1．1）分、（1．5±0．4）万元和（0．6±0．2）万元；植皮成活率、创面细菌培养率分别为6．5％和28．6％、97．0％和75．0％，差异具有统计学意义（P〈0．05）。结论VSD技术方法简便，易于掌握，能促进烧伤创面肉芽组织生长，降低烧伤创面感染率，可尽快植皮，提高植皮成活，并可减轻患者痛苦。因此，值得在深度创面治疗上进行推广。

Objective To investigate the clinical therapeutic effect of the vacuum-sealing drainage （VSD） combining with skin graft in a deep bum wound. Methods Sixty one patients were divided into two groups according to treatment method. Thirty tree patients were assigned as the VSD treatment group, which was treated by VSD after debridement; their wounds were transplanted by the split thickness skins binding up by VSD when they were fitted. Twenty eight patients were assigned as the routine treatment group, which was treated by means of traditional regular dressing change to remove necrotic tissue and pro- mote granulation tissue; their wounds were transplanted by the split thickness skins binding up by packing when they were fitted. Results After treatment by VSD, there are no systemic hypersensitivity reactions and abnormal bleeding. Thirty three cases of VSD treatment group were treated by VSD for 7-10 days,the other 2 cases were treated by VSD for another 7 - 10 days because of granulation tissue badly. Until their granulation was fresh, skin grafting technique was used and the skin survived well. The treatment time before skin grafts, the pain score, and the cost of ablative therapy for wound were （ 8±0. 9 ） day, （ 5.7±1.6 ） point, and （ 1.5±0. 4） ten thousand yuan in VSD group vs. （ 14±1.2） day, （3.1±1.1 ） point, and （0. 6 ±0. 2）ten thousand yuan in control group. The survival rate and the wound germiculture positive rate were 97.0% and 6. 5% in the VSD group vs 75.0% and 28. 6% in the control group. The differences between groups were statistically significant （ P 〈 0.05 ） . Conclusions VSD is a simple method that is easy to grasp, and that can promote granulation tissue growth, reduces the wound germieulture positive rate, shortens the wound healing period, increases the survival rate of skin grafts, and relieves patients pain. It is worth popularizing and applying in the deep bum wound therapy.