负压封闭引流技术致骶尾部压疮创面异物残留1例报告

A Case Report of Sacrococcygeal Pressure Ulcer with Foreign Matter Residual Caused by the Application of Negative Pressure Wound Therapy

目的分析探讨负压封闭引流技术致骶尾部压疮创面异物残留的治疗体会。方法对2016年3月南苑医院烧伤创疡科收治的1例因使用负压封闭引流技术治疗长达1年余造成创面肉芽组织中嵌入大量海绵异物而致使创面迁延不愈的骶尾部压疮患者采用湿润烧伤膏联合分批次清创治疗,观察治疗效果。结果治疗期间,创面因海绵异物的存在反复感染,经十数次清创治疗后无海绵异物的创面可见新生上皮组织,创面明显缩小,但最终因患者身体机能较差,无法进行彻底清创,肉芽组织内仍夹杂较多海绵异物致使患者反复出现肺部感染,于治疗13周后家属放弃抢救治疗而死亡。结论临床应用负压封闭引流技术治疗压疮时,敷料的选择及应用时机均应仔细甄别,以避免出现海绵异物残留等问题;治疗压疮过程中应早期给予患者营养支持治疗,以提高患者的身体机能;湿润烧伤膏可为创面提供充足的营养物质,促进创面的愈合,且无不良反应发生,可作为压疮治疗的首选药物。

Objective To investigate the experience of treating non-healing sacroeoccygeal pressure ulcer caused by foreign matter residual following the application of negative pressure wound therapy (NPWT).Methods The subject was one patient who suffered from refractory sacrococcygeal pressure ulcer and was admitted into The Bums,Wounds and Ulcers Department of Nanyuan Hospital in March 2016.The pressure ulcer remained unhealed due to the embedding of a lot of sponge in granulation tissues after one year of applying the NPWT,for which MEBO combined with encroaching debridement were applied.The therapeutic effect was observed.Results During the treatment course,the wound developed repeated infection due to the existence of sponge.After dozens of times of encroaching debridement,newly-born epithelial tissues were visible on the wound surface without sponge residual and the wound area was significantly reduced.However,due to the poor physical condition of the patient,it was impossible to perform thorough debridement.There was still much sponge residual in granulation tissues,causing repeated pulmonary infections.After 13 weeks of treatment,the patient gave up treatment and died.Conclusion When applying the negative pressure wound therapy (NPWT)in pressure ulcer,what kind of dressing to use and when to use the dressing should be carefully decided to avoid the occurrence of problems including the residual of sponge.During the treatment course of pressure ulcer,nutritional support should be given at an early time to improve patients'physical function.MEBO can provide wounds with sufficient nutrients to promote wound healing and will not lead to adverse reactions,and thus should be used as the first choice for pressure ulcer treatment.