封闭负压疗法治疗褥疮失败的相关因素研究

Study of factors relating to failure of vacuum assisted closure therapy in pressure ulcers

目的分析封闭负压疗法（VAc）治疗褥疮失败与相关因素的关系，指导临床适应证的选择。方法回顾2010年3月至2013年3月应用VAc治疗褥疮患者75例，分析12个预测变量与VAC失败的相关性，筛选有统计学意义的预测因素，计算其敏感性、特异性、阳性预测值、阴性预测值，再进一步行Logistic回归分析。结果75例褥疮病例有17例VAC治疗失败。影响褥疮愈合的12项危险因素中，血细菌培养阳性、骨质暴露、低蛋白血症和创面深度≥4cm与治疗失败呈相关性（P≤0．05），其失败率分别为70．0％、50．0％、38．5％、40．9％，Logistic回归分析未发现上述4因素是导致VAC治疗失败的独立因素。结论血细菌培养阳性、骨质暴露、低蛋白血症和创面深度≥4cm发生VAc治疗失败几率较高，是VAc治疗褥疮的相对适应证。

Objective To study the factors relating to failure of vacuum assisted closure （VAC） therapy for pressure ulcers control in order to guide the clinical indications. Methods A retrospective cohort study of 75 patients with pressure ulcers to undergo VAC therapy was conducted. Correlations between 12 risk factors and VAC therapy failure were analyzed. The statistical prognostic factors were screened and the sensitivity, specificity, positive predictive value and negative predictive value of them were analyzed. Risk factors for VAC failure were determined by using Logistic regression analysis. Results Among the 75 patients, 17 patients failed to respond to the VAC therapy. The failure rate of VAC therapy had correlations with positive blood cultures, bony exposure, hypoalbuminemia （alb %25 g/L） and wound depths≥ 4 em（ 70.0X, 50.0%, 38.50/00 and 40.9%, respectively）, but the Logistic regression analysis found that the 4 factors were not the independent risk factors for failure of VAC therapy. Conclusions Pressure ulcer patients with positive blood cultures, bony exposure, hypoalbuminaemia （alb %25 g/L）, and wound depthS4 cm tend to have a higher failure rate in VAC therapy, which are the relative indications for VAC therapy.